Ch. 18 - Specimen Collection

The nurse is reviewing a urinalysis laboratory report of a client. The nurse notes there are nitrates and white blood cells present in the urine. Based on these results, what intervention(s) would be necessary? Select all that apply.

1. Notify the healthcare provider. 2. Prepare to do another urine collection via catheterization. 3. Prepare to obtain a urine culture. Rationale: White blood cells and nitrates may indicate infection, so the nurse should notify the provider. The provider may order a urine culture. The nurse should prepare for another specimen collection via catheterization because another voided sample or mid-stream sample would not be sterile.

The nurse is preparing to obtain a stool specimen for ova and parasites culture. Which actions are correct? Select all that apply.

1. Obtain 15-30 mL of liquid stool sample or 1 inch of formed stool. 2. Obtain the sample directly after the pt has a bowel movement. 3. Include any blood or mucus seen in stool in the sample. 4. Use a specimen container with preservatives. Rationale: Do not refrigerate stool sample if it's being tested for ova and parasites because the cold may affect the organisms. Avoid any barium or enema seen in the stool.

The nurse is explaining the procedure for collecting a midstream urine specimen to a female client capable of performing the procedure without assistance. How should the nurse instruct the client to cleanse the perineal area prior to collecting the sample?

Clean each side of the labia, then down the middle of the urinary meatus, all front to back. Rationale: Three wipes should be used - one for each side, then one down the middle.

The nurse has placed a urine collection bag on an infant. How often should the nurse check the bag to see if the infant has voided?

Every 15 minutes. Rationale: Infants void whenever their bladder is full, so in order to avoid the bag overfilling and detaching, checking the bag ever 15 minutes is ideal.

The nurse needs to collect a stool specimen for culture from a client with a colostomy. What is the proper procedure for the nurse?

Remove current bag, obtain stool sample, replace with new bag. Rationale: Old bag should not be replaced. Stool samples should be obtained from colostomy bag. Proper ostomy care should be completed when necessary.

The nurse is teaching a client how to collect a midstream urine sample. After the client has cleaned the perineal area or penis, what instruction would the nurse give to the client?

Void a small amount into the toilet, bedpan or commode, then void sample into the cup. Rationale: If pt voids first amount of urine into cup, it may contain old, contaminated urine that was caught in the urethra. By voiding a small amount first, it ensures that the urine in the cup is all fresh urine.

The nurse needs to collect a stool specimen for culture from a client. The client has been having watery stools for several days and asks if a sample can still be tested since stool is not formed. What is the best response by the nurse?

"As long as it's an adequate amount, even liquid stool can be tested." Rationale: 1 inch of formed stool or 10-20 mL liquid stool can be used for testing. The provider doesn't need to be notified since he/she is the one who ordered the culture.

The nurse is instructing a client in proper technique for collecting a midstream urine sample. The client reports having voided only a short while ago and is concerned there may not be a sufficient volume of urine. Which amount of urine would the nurse instruct the client is necessary for testing to be performed?

Approximately 1.5 T or 10-20 mL is necessary for testing purposes. Rationale: The nurse should instruct the pt to void approximately 2 T (30 mL), stop, and then collect approximately 1.5 (10-20 mL) into the cup. More than that amount would be fine too.

The nurse needs to collect a stool specimen for culture from a client. The client passed stool into the toilet instead of using the collection container. What is the next step for the nurse?

Instruct the pt to use the specimen collection hat for the next bowel movement rather than the toilet. Rationale: The stool is contaminated after it enters into the toilet, so it can't be used for testing. If no order or indication, the test should not be canceled and the pt should not be given a laxative.

A nurse is giving instructions to a client on the proper method for providing a stool sample. Which should the nurse tell the client?

Void into the toilet/bedpan/commode first, and then provide stool sample in the collection container. Rationale: Toilet paper should not be included with stool sample. Urine should not be included with stool sample. Both can contaminate the sample. Have the pt inform the nurse right away after the BM so they can prepare the sample, as fresh stool is better for testing.