A client has been admitted with a fever and malaise. The health care provider has ordered a clean-catch midstream specimen for urinalysis on this client.
To collect the urine specimen, the nurse should instruct the client to do what?
Use sterile gloves to cleanse the meatus and collect the specimen in a sterile cup.
Cleanse the meatus, begin the stream, and then void into a sterile cup.
Return to bed to obtain the specimen using a straight catheter insertion.
Ask the client to void into a cup or urine collection container.
The Correct Answer is B
Choice A rationale
While the specimen cup used for a clean-catch midstream collection must be sterile, the nurse and client do not typically use sterile gloves for the procedure. The goal is to minimize contamination from the skin flora, which is achieved through proper cleansing of the urethral meatus with antiseptic wipes provided in the kit. Using sterile gloves is unnecessary and not part of the standard protocol for a client who is capable of performing the collection themselves in the bathroom.
Choice B rationale
The clean-catch midstream method is designed to flush out any resident microorganisms from the distal urethra before the specimen is collected. The client first cleanses the meatus to reduce surface bacteria. They then begin to void into the toilet to clear the initial portion of the urethra. The sterile cup is then moved into the stream to collect the middle portion of the urine, which most accurately reflects the status of the bladder and helps diagnose the fever.
Choice C rationale
Obtaining a specimen via a straight catheter involves inserting a tube through the urethra into the bladder. While this provides a very sterile sample, it is an invasive procedure that carries a risk of introducing bacteria and causing a urinary tract infection. It is generally reserved for clients who are unable to void on their own or when a non-contaminated specimen cannot be obtained by other means. It is not the first-line instruction for a client capable of voiding.
Choice D rationale
Simply asking the client to void into a cup without specific instructions for cleansing or midstream collection results in a routine voided specimen. This type of sample is frequently contaminated with skin cells and bacteria from the external genitalia, which can lead to false-positive results in a urinalysis or culture. Given that the client has a fever and malaise, an accurate, uncontaminated clean-catch specimen is necessary to determine if a urinary tract infection is the cause.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
This sequence correctly follows the foundational hierarchy where physiological needs like oxygen, water, and food are prioritized first. Once physical survival is ensured, safety and security become the next focus. Subsequent levels involve social love and belonging, followed by self-esteem through achievement. The pinnacle is self-actualization, representing the fulfillment of one potential. This structured progression ensures that basic human survival requirements are addressed before higher-level psychological or self-fulfillment needs are pursued by the individual.
Choice B rationale
Starting with safety is scientifically incorrect because physiological needs are the most basic requirements for human survival. Without addressing oxygenation, nutrition, and elimination, an individual cannot survive long enough to worry about physical or environmental safety. The body requires homeostatic balance, typically measured by vital signs like a heart rate of 60 to 100 beats per minute, before higher-order security needs can be prioritized. Therefore, placing safety before physiological needs violates the fundamental biological order of the hierarchy.
Choice C rationale
This choice incorrectly reverses the hierarchy, placing self-actualization at the bottom. In clinical practice and psychology, self-actualization is the ultimate goal achieved only after all subordinate needs are met. Reversing this order suggests that a person would seek personal growth while lacking basic oxygen or safety, which is biologically impossible. Effective nursing care must prioritize life-sustaining interventions first. Reversing the pyramid fails to recognize that lower-level needs act as the essential foundation for any higher-level development.
Choice D rationale
Placing love and belonging before safety is incorrect because a person must feel secure in their environment before they can focus on social relationships. Safety needs include protection from harm and stability, which are more immediate than the need for friendship or intimacy. In a medical setting, ensuring a client is safe from falls or injury takes precedence over facilitating social interactions. This sequence disrupts the logical progression from physical security to psychological connection, which is necessary for healthy development.
Correct Answer is D
Explanation
Choice A rationale
The back of the hand is a common site for peripheral intravenous catheters but is not an appropriate location for a central venous access device. Central lines must terminate in a large vessel, typically the superior vena cava, to handle highly concentrated or vesicant medications. Peripheral veins in the hand are too small and are located too far from the central circulation to serve as an insertion point for a standard non-peripherally inserted central catheter.
Choice B rationale
The fourth intercostal space is an anatomical landmark often used for positioning ECG leads or identifying heart sounds, but it is not a primary site for central venous access. While the tip of a central line often resides near the level of the fourth intercostal space within the superior vena cava, the actual insertion of the needle and catheter occurs higher up in the neck or chest area to access the internal jugular or subclavian veins.
Choice C rationale
The area below the sternum is generally associated with the epigastric region of the abdomen. There are no major veins in this specific superficial location suitable for the insertion of a central venous access device. Central access requires reaching deep, large-diameter veins that lead directly to the heart. Attempting access below the sternum would involve risking injury to abdominal organs and would not provide the necessary direct route to the central venous system.
Choice D rationale
The subclavian vein, located just beneath the clavicle, is one of the most common and preferred sites for the insertion of a central venous access device. It provides a direct and relatively straight route to the superior vena cava. Assessing this area involves checking for anatomical landmarks, skin integrity, and any contraindications such as previous surgeries or pacemakers. This site is favored for its lower risk of infection compared to the femoral or jugular sites.
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