A nurse is collecting a sputum specimen from a client who has tuberculosis.
Which of the following actions should the nurse take?
Obtain the specimen immediately upon the client waking up.
Ask the client to provide 15 to 20 mL of sputum into the container.
Wear sterile gloves to collect the specimen from the client.
Wait 1 day to collect the specimen if the client cannot provide sputum.
The Correct Answer is A
The correct answer is Choice a.
Choice a rationale: The nurse should obtain the specimen immediately upon the client waking up, as sputum from deep in the lungs is usually more easily collected at this time. Sputum collected upon waking up is more likely to contain secretions from the lower respiratory tract, providing a better sample for tuberculosis diagnosis. This timing maximizes the chance of detecting the bacteria.
Choice b rationale: Choice b is incorrect because the typical volume of sputum needed for testing is about 1 teaspoon (5 mL), not 15 to 20 mL. Collecting such a large volume could be challenging for the client and unnecessary for diagnostic purposes.
Choice c rationale: Choice c is incorrect because while gloves should be worn, they do not need to be sterile, just clean. The use of clean gloves is sufficient to prevent contamination during specimen collection, and sterile gloves are not required for this procedure.
Choice d rationale: Choice d is incorrect because it’s important to try to collect the specimen as soon as possible, not wait a full day. Delaying collection for a day could result in a missed opportunity to diagnose tuberculosis and initiate appropriate treatment promptly. Collecting the specimen promptly maximizes the accuracy of diagnostic testing and facilitates timely intervention for the client's health.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","E"]
Explanation
Choice A rationale:
Depression commonly coexists with eating disorders. Patients with eating disorders often experience profound sadness, hopelessness, and a distorted body image, leading to depressive symptoms. Addressing both conditions simultaneously is crucial for effective treatment.
Choice B rationale:
Obsessive-compulsive disorder (OCD) frequently accompanies eating disorders. Obsessive thoughts about body weight, shape, and food intake are common in individuals with eating disorders. These obsessions can lead to compulsive behaviors, such as strict dietary rules or excessive exercise, reinforcing the connection between eating disorders and OCD.
Choice C rationale:
Schizophrenia is not typically considered a comorbidity of eating disorders. Schizophrenia involves distorted thinking, hallucinations, and impaired emotional responses, which are distinct from the symptoms of eating disorders. While it's essential to assess patients comprehensively, schizophrenia is not a common comorbidity of eating disorders.
Choice D rationale:
Breathing-related sleep disorder is not a direct comorbidity of eating disorders. However, individuals with severe eating disorders, especially anorexia nervosa, may experience complications like sleep apnea due to extreme weight loss. While this is a potential issue, it is not a direct comorbidity of eating disorders for all patients.
Choice E rationale:
Anxiety often coexists with eating disorders. Anxiety about body weight, shape, and food intake is a significant concern for individuals with eating disorders. This anxiety can further perpetuate disordered eating behaviors, creating a cycle that is challenging to break without addressing the underlying anxiety.
Correct Answer is D
Explanation
The correct answer is D. The nurse should measure the client's vital signs first to assess for any injuries or complications from the fall, such as bleeding, shock, or head trauma. The nurse should then notify the provider and document the fall in the client's medical record. Completing an incident report is also important, but it is not the first action that the nurse should take.
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