A nurse is preparing to collect a sputum specimen from a client. Which of the following actions should the nurse take?
Wear sterile gloves to collect the specimen from the client.
Obtain the specimen immediately upon the client waking up.
Wait 1 day to collect the specimen if the client cannot provide sputum.
Ask the client to provide 15 to 20 mL of sputum into the container.
The Correct Answer is B
A. Clean gloves (not sterile) are sufficient for collecting a sputum sample.
B. The best time to collect a sputum specimen is immediately upon waking because secretions accumulate overnight, making it easier to obtain a sample.
C. Waiting a day delays diagnosis and treatment; other techniques can help induce sputum production.
D. Typically, 5 to 10 mL of sputum is sufficient for diagnostic testing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","D","E","F"]
Explanation
A. Instruct the client on the use of an incentive spirometer. Although this intervention can improve lung expansion, it is not a priority in this situation, given the possibility of an airborne infectious disease and the need to address systemic and diagnostic concerns first.
B. Request a glucocorticoid prescription from the provider. While glucocorticoids may reduce inflammation, there is no immediate indication they are necessary based on the client's presentation. The priority is diagnosing and managing the underlying infection.
C. Obtain blood cultures. Blood cultures are critical to identify any systemic infection that may be contributing to the client's fever, tachycardia, and worsening symptoms. This helps guide the initiation of appropriate antimicrobial therapy.
D. Obtain a sputum culture. The client’s productive cough with blood, fever, and weight loss raise suspicion for serious respiratory infections, such as tuberculosis (TB) or other pathogens. A sputum culture is necessary to identify the causative organism for targeted treatment.
E. Recommend ABGs be drawn. The client’s oxygen saturation has dropped to 92% on room air, and there is an increase in respiratory rate, indicating possible hypoxemia or impaired gas exchange. Arterial blood gases (ABGs) provide critical information about oxygenation, ventilation, and acid-base status, guiding further interventions.
F. Place the client in a negative-pressure room. The symptoms, including a cough producing blood-tinged sputum, fever, and weight loss, are consistent with a potential diagnosis of TB or another airborne infectious disease. A negative-pressure room prevents the spread of airborne pathogens to others.
G. Administer small, frequent meals. Although the client reports a lack of appetite and weight loss, this intervention is not urgent. Addressing the client’s infection and respiratory status takes precedence.
Correct Answer is D
Explanation
A. Keeping a newborn on NPO (nothing by mouth) status may be required in specific situations but not generally for routine care.
B. Laxatives are not routinely administered to newborns unless medically indicated for constipation.
C. Applying heat to the abdomen is not appropriate unless ordered by a healthcare provider, especially if the infant's temperature regulation is compromised.
D. Placing the head of the bed flat can help with positioning the newborn to prevent any breathing difficulties or aspiration.
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