charge nurse overhears a newly licensed nurse providing instructions to a female client on the proper steps to collect a midstream urine specimen. Which of the following statements made by the newly licensed nurse requires the charge nurse to intervene?

"Use the provided towelette to cleanse the area by moving in a back-and-forth motion."

"It will be easier to use your nondominant hand to spread the labia."

"Start the flow of urine before passing the container under the stream to collect the specimen."

"Remove the specimen container before stopping the stream of urine"

Answer and Explanation

The Correct Answer is A

Choice A Rationale: The correct method for cleansing the area before collecting a midstream urine specimen is to wipe from front to back, not back-and-forth. This is to avoid contamination of the specimen with bacteria from the anal area. The towelette should be used in a single stroke and then discarded to ensure cleanliness.

Choice B Rationale: Using the nondominant hand to spread the labia is a standard practice that allows the dominant hand to manipulate the collection container. This technique helps to prevent contamination of the specimen by keeping the container away from the body and ensuring a clean catch.

Choice C Rationale: It is important to start the flow of urine before collecting the specimen to ensure that the 'midstream' urine is captured. This helps to flush out any bacteria that may be present at the opening of the urethra, reducing the risk of contaminating the sample.

Choice D Rationale: The specimen container should be removed from the stream before stopping the flow of urine to avoid contamination. The initial and final parts of the urine stream can carry bacteria from the urethra and skin, so only the midstream should be collected in the container.

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Correct Answer is C

Explanation

a. Hypoglycemia: Hypokalemia is not typically associated with hypoglycemia.

b. Hyperreflexia: Hypokalemia can lead to decreased reflexes, not hyperreflexia.

c. Cardiac dysrhythmias: Hypokalemia can cause disturbances in cardiac conduction, potentially leading to dysrhythmias.

d. Increased appetite: Increased appetite is not a common manifestation of hypokalemia.

A. Decreased calcium level B. Decreased potassium level C. Elevated magnesium level D. Elevated sodium level

Correct Answer is B

Explanation

a. Decreased calcium level: NG tube drainage is more likely to result in hypokalemia (decreased potassium) than hypocalcemia (decreased calcium).

b. Decreased potassium level: NG tube drainage, which contains stomach contents, can lead to loss of potassium. Monitoring for hypokalemia is crucial as it can result in cardiac dysrhythmias.

c. Elevated magnesium level: NG tube drainage is not typically associated with an increase in magnesium levels.

d. Elevated sodium level: NG tube drainage may contribute to sodium loss, leading to hyponatremia, rather than hypernatremia.

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charge nurse overhears a newly licensed nurse providing instructions to a female client on the proper steps to collect a midstream urine specimen. Which of the following statements made by the newly licensed nurse requires the charge nurse to intervene?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing the laboratory results of a client who is taking a loop diuretic and notes the client’s potassium level is 3.0 mEq/L. Which of the following physiological responses should the nurse expect related to the client’s hypokalemia?

Correct Answer is C

Explanation

A nurse is caring for a client who is postoperative and has an NG tube that has drained 2,500 mL in the past 6 hr. The nurse should monitor the client for which of the following electrolyteimbalances?

Correct Answer is B

Explanation

A nurse is collecting data from a client who is having an acute asthma exacerbation. When auscultating the client's chest, the nurse should expect to hear which of the following sounds?

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A nurse is collecting data from a client whose arterial blood gas values reveal a pH of 7.24, PaCO2 of 53, and an HCO3 of 24. The nurse should prepare to treat the client for which of the following acid-base imbalances?

A nurse is caring for a client who has a seizure disorder and reports experiencing an aura. The nurse should recognize the client is experiencing which of the following conditions?

A nurse is collecting data from a client prior to the administration of digoxin. Which of the following findings should the nurse report to the provider?

A nurse is reinforcing teaching about breast self-examination (BSE) with a client who has a regular menstrual cycle. The nurse should instruct the client to perform BSE at which of the following times?

A nurse is assisting with the care of a client who has cirrhosis of the liver with ascites. Which of the following actions should the nurse take?

A nurse is preparing to collect a specimen from a client for a guaiac test. The client asks what the test will detect in his stool. Which of the following responses should the nurse make?