Phlebotomy: Chapter 13 Self Study

scalp draw

If an infant has no identifiable veins to collect blood and a sample is required for blood cultures, what are the phlebotomist options? a. Heel stick b. Finger stick c. Scalp draw d. None of the above

distracting the young child

In order to help with a venipuncture on a child, a parent can be asked to participate by: a. Distracting the young child b. Telling the child it will not hurt c. Threatening the child to have the procedure d. None of the above

If a parent or guardian is present and can restrain the child safely, the procedure can move forward. If the parents are unable to help, another healthcare worker that is familiar to the child can assist. If it is felt that the procedure cannot be done safely, a nurse or the physician should be notified. It may be possible to use alternative methods such as pharmacological intervention.

Under what conditions should a healthcare worker continue with a phlebotomy procedure on a combative child?

arterializes blood

Warming the heel does which of the following? a. Arterializes blood b. Dramatically decreases blood flow c. Prevents hemolysis d. Hastens hemostasis

Be sure the patient is sitting in the chair with arms

When collecting blood in a home care situation, it is important to _____________. a. Be sure the patient is sitting in the chair with arms b. Keep a supply of sharps in the home c. Place trash in a biohazard bag before placing in the home trash receptacle d. Avoid conducting identification procedures during every visit

maintain constant supervision

When working with children ages 3-5, be sure to __________. a. Maintain constant supervision b. Lower the bedside rails c. Leave supplies within the child's reach d. Avoid eye contact

Loss of taste, smell, and feeling

Which condition represents a challenge commonly seen in geriatric patients? a. Slurred speech b. Increased muscle tone c. Loss of taste, smell, and feeling d. High blood pressure

Prepare the access port with 70% alcohol, using sufficient friction and allowing the surface to dry

Which directive is a general rule for collecting blood from an IV line? a. Hold the infusion set with the two wings folded together b. Establish a sterile working place using latex bandages c. Apply tourniquet d. Prepare the access port with 70% alcohol, using sufficient friction and allowing the surface to dry

treatment room

Which is the best location for performing a phlebotomy on a hospitalized child? a. Bedside in a chair b. Playroom c. Treatment room d. In his or her bed

medial or lateral aspect

Which is the preferred site for a heel stick? a. Anteromedial aspect b. Medial or lateral aspect c. Posterior curve d. Previous puncture site

ring bell

Which method is appropriate for distracting a patient who is 0-6 months old during a procedure? a. Talk to parents b. Shout c. Ring bell d. Turn off the lights

fears separation from parent

Which of the following describes the behavior of a 6 to 12 month old infant undergoing a painful procedure? a. Fears separation from parent b. Is embarrassed to show fear c. Fears injury to body d. Wants privacy

Alzheimer's disease

Which of the following is a debilitating disease causing loss of intellectual abilities and mood disorders, particularly in the elderly individuals? a. Alzheimer's disease b. Parkinson's disease c. Arthritis d. Depression

EMLA application

Which of the following is an acceptable intervention to alleviate pain in pediatric blood collection? a. Xylocaine injection b. EMLA application c. Ice pack d. Lidocaine application

assess their past experience with blood drawing

Which of the following is an important step in preparing the child and parent for a phlebotomy? a. Assess their past experience with blood drawing b. Perform the phlebotomy slowly to avoid pain c. Ask the parent to leave the room d. Use lidocaine to decrease the pain of blood collection

thinner skin tissue

Which of the following may make the actual performance of the venipuncture difficult in a geriatric patient? a. Failing eyesight b. Memory loss c. Thinner skin tissue d. Hearing loss

true

True or False: The final step for collection for capillary blood gas testing it to immediately deliver the specimen to the laboratory. This is important because delays of more than 15 minutes at room temperature (or more than 60 minutes at 4 degrees C) will affect the results

False if a child is asking questions, they should be answered in age appropriate language

True or False: When a child asks a question regarding a phlebotomy procedure, the healthcare worker should avoid answering in case it frightens the child

fifteen

Blood gas samples must be delivered for testing within ________ minutes.

heparin

Blood gases collected by capillary stick require capillary tubes that are coated with ___________

False to determine the total blood volume of a premature infant, multiple the weight in kg times 115mL/kg. 115 x 3 = 345 mL

True or False: A premature infant who weighs 3 kg will have approximately a total blood volume of around 4000 mL.

The vertical technique has the parent holding the child in the parent's lap. The parent hugs the child, restraining the body and the arm not being used for the procedure. The healthcare worker then secures the arm being used. The horizontal technique has the child lying face up (supine) with the parent. The phlebotomist is on the side of the bed nearest the child. The parent leans over the child restraining the near arm and body so the healthcare worker can secure the arm being used for the procedure.

Describe the preferred methods for restraining a child in order to obtain blood.

true

True or False: Arterial blood is the specimen of choice for blood gas testing; however, capillary (skin puncture) blood is most often collected from infants and small children because it is a safer procedure than arterial blood collection

true

True or False: Bandages should not be used on infants or toddlers as they may cause a reaction, or worse, if they come loose, they can get into the child's mouth and be eaten or cause an obstruction

true

True or False: Distraction helps a child refocus on a more pleasant experience than that of performing a blood collection procedure

true

True or False: If a 6 year old child is exhibiting behaviors more like a 3 year old, the healthcare worker should treat the child like a 3 year old

true

True or False: If a patient is combative and it is unclear if the procedure can be performed safely, it should be discontinued and a nurse or physician notified

False allowing a child to hold a comforting item can aid in reducing anxiety and make the procedure go more smoothly

True or False: It is not a good idea to allow children to hold dolls, stuffed animals, or blankets during a phlebotomy procedure as they may get contaminated

23-gauge

A ________ safety winged infusion set (butterfly needle) is used for scalp vein venipunctures a. 25-gauge b. 23-gauge c. 18-gauge d. 28-gauge

False calcified nodules will usually resolve by 18-20 months

True or False: Multiple heel sticks can result in calcified nodules that are permanent indents of the heel

false

True or False: Newborn/neonatal screening refers to special testing of newborns that are performed once mental handicaps or other serious abnormalities have been detected

a year

A fingerstick is usually preferred for children older than age ______. a. 6 months b. 18 months c. 9 months d. 1 year

lower arm / 48 hours

A heparin or saline lock is often placed in a vein in the _________ and can be kept in place for up to ____________. a. Lower arm / 48 hours b. Lower arm / 72 hours c. Upper arm / 48 hours d. Upper arm / 72 hours

true

True or False: PPE must be worn when collecting blood from premature infants and put in place before entering the room and removed after leaving to protect the infant

False at the recommendation of the physician 25% sucrose put on a pacifier can help calm the infant due to suckling effect

True or False: Sucrose can be sued as a skin anesthetic for infants having a phlebotomy procedures performed

3-5 years old

A reaction that is aggressive when performing a venipuncture on a child, usually happens in which of the following age groups? a. 1-2 years old b. 3-5 years old c. 6-12 years old d. 13-17 years old

1-3 years

At what age do children first become self-centered, fear injury, and fear separation from parents? a. 1-3 years b. 3-5 years c. 5-10 years d. 11-17 years

true

True or False: Swaddling is an acceptable way to retrain and bring comfort to an infant who must have a phlebotomy procedure

-Mailing the filter paper before it is completely dry -Circles on the filter paper not being completely filled -Filter paper is contaminated by substances such as hand creams, soaps, alcohol -Blood was applied to the wrong side or both sides of the filter paper -Too much blood was applied -Heel stick was squeezed and too much tissue fluid contaminated the sample

Identify complications or interfering situations that can occur in collecting blood for neonatal screening tests.

parent

If a child needs to be restrained for a phlebotomy procedure, it is recommended that a _____________ help in the restraint.

Child Life

Many hospitals employ a _______________ specialist to help children cope with the stress of medical care.

providing the samples of blood collection equipment to be used

Methods of distracting a child to alleviate anxiety include: a. Showing the child where the venipuncture will occur b. Providing the samples of blood collection equipment to be used c. Music d. Pinching an alternative site

Treat this elderly patient with the utmost respect and dignity. It is important to establish eye contact. Be sensitive to the patient's needs and smile. Probably speak with a louder voice since he most likely has an inability to hear as well as younger individuals

Mr. Frank McGuire is a 90-year-old former industrial worker who has lost 30 pounds over the past 4 years, resulting in a frail body. He has been diagnosed as having Parkinson's disease as well as congestive heart failure. Mr. McGuire is having is blood collected in the nursing home where he now resides; his physician has ordered a potassium level, a hemoglobin level, and a PT/INR test because he is on Coumadin. How should the patient be approached for the blood collection?

The elderly person is most likely to have fragile veins and this it is best to collect the blood by venipuncture using a butterfly needle and small vacuum tubes to decrease the impact of the vacuum pressure on his fragile veins

Mr. Frank McGuire is a 90-year-old former industrial worker who has lost 30 pounds over the past 4 years, resulting in a frail body. He has been diagnosed as having Parkinson's disease as well as congestive heart failure. Mr. McGuire is having is blood collected in the nursing home where he now resides; his physician has ordered a potassium level, a hemoglobin level, and a PT/INR test because he is on Coumadin. What is the most appropriate blood collection equipment to use?

The coagulation tube (light-blue evacuated tube) needs to be collected first for the PT/INR. A "dummy" red topped tube should be collected prior to the light-blue topped tube since the butterfly needle with the tubing will be the needle of choice for the venipuncture. The serum tube should be collected next for potassium. The EDTA tube for the hemoglobin test is collected as the last tube

Mr. Frank McGuire is a 90-year-old former industrial worker who has lost 30 pounds over the past 4 years, resulting in a frail body. He has been diagnosed as having Parkinson's disease as well as congestive heart failure. Mr. McGuire is having is blood collected in the nursing home where he now resides; his physician has ordered a potassium level, a hemoglobin level, and a PT/INR test because he is on Coumadin. What is the proper "order of draw" for the collection of blood for these assays?

diabetes

Neonatal screening can be used to identify metabolic or genetic defects. Which of the following is not included in a metabolic or genetic screening? a. Phenylketonuria b. Galactosemia c. Sickle cell disease d. Diabetes

the child is less emotionally mature than adults

Performing a blood collection on a child is challenging because: a. The child is less emotionally mature than adults b. A child's veins roll more often than adult veins c. Smaller equipment must be used d. A child's blood clots more quickly

6-12 years old

Sam is a new patient and his parents say that he is becoming less dependent on them. He is also easily embarrassed and seems to be comforted by his teddy bear. According to what you have learned today, how old do you think Sam is? a. 6-12 years old b. 12-16 years old c. 3-5 years old d. None of the above

metabolic

Tandem mass spectrophotometry is the technique used for screening for over 50 ____________ disorders.

capillary

The collection of __________ samples for blood gases is not preferred since the sample contains a mixture of arterial and venous blood and is more difficult to control the contamination with room air.

vertical with child sitting in parents lap

The preferred technique for restraining a child is: a. Vertical with child sitting in parent's lap b. Total sedation c. Mechanical restraint d. Vertical with parent leaning child against the wall

EMLA

To reduce the pain a child experiences during a venipuncture _________ can be administered about an hour in advance.

false

True or False: A microcapillary skin puncture is performed with the intent of performing laboratory analysis by using the largest amount of blood volume possible

As people age, changes occur that can make collecting a blood sample more challenging. This would include loss of hearing, sight, and memory which may all change how the patient reacts to the healthcare worker. In addition, changes in the integrity of the skin and connective tissue may make the actual collection more difficult as scarring and sclerosis cause tougher veins, and fragile skim allowing more rolling of the vessels.

What are some changes that may affect the ability to collect a blood sample from an elderly person?

The depth of the puncture must be less than 2.0mm hence correct puncture devices must be used. The end of the heel should not be used as it increased the risk of puncturing the heel bone. The fleshy parts to each side of the heel are preferred sites. The first drop should be wiped off after puncture. Do not touch the puncture site with any of the collection equipment during the procedure. The site should be held with sterile gauze after the procedure. No bandages should be placed on the site.

What are some things to be aware of when collecting blood by a heel puncture?

heel

What site should be sued on a child less than one year old when performing a capillary puncture? a. Earlobe b. Index finger c. Third finger d. Heel

butterfly set

When collecting blood from an elderly patient with fragile skin, using a _______________ can help to reduce risk for injury or excessive bleeding.

Perform the procedure in a room other than the patient's room

When collecting blood from an inpatient pediatric patient, which of the following is recommended? a. Turn off any TV's or videos to avoid distractions b. Put goggles on before entering the room c. Perform the procedure in a room other than the patient's room d. Bring all the equipment into the room with you in cause you need something

Involve them in the procedure by explaining each step and each piece of equipment

While working with teenage patients, which of the following things can you do to make them feel more comfortable? a. Avoid giving them privacy b. Involve them in the procedure by explaining each step and each piece of equipment c. Have their parent hold their hand d. All of the above

13-17 years old

With which age group is it most important to respect privacy during the phlebotomy procedure? a. 1-2 years old b. 2-5 years old c. 6-12 years old d. 13-17 years old

A two year old is likely to be fearful and since they are in the ER, they will be feeling poorly. The phlebotomist should introduce themselves to the child and family/caregiver and describe the procedure in simple terms. When talking to the child, the phlebotomist should give simple commands the child can follow. They should work slowly and calmly. They should suggest the parent or guardian hold the child and offer comforting items such as a pacifier, blanket, or toy. They should make sure the child is kept warm, and keep the parent present and a part of the process if possible

Working on the evening shift, the phlebotomist was called to the emergency department to collect blood from a 2 year old. The orders included CBC, blood culture, electrolytes, glucose, and BUN. How should the phlebotomist approach the patient and family?

The phlebotomist could employ the help of other healthcare workers to hold the child for the procedure. If absolutely necessary, the child can be swaddled or restrained through other methods. If time is allowed, EMLA could be used to minimize the pain

Working on the evening shift, the phlebotomist was called to the emergency department to collect blood from a 2 year old. The orders included CBC, blood culture, electrolytes, glucose, and BUN. The child in this case is very sick and agitated. The parents are distraught and appear unable to provide calm support to the child. What could be recommended to the phlebotomist?

Using a winged infusion set with a smaller needle is recommended. The phlebotomist will need to collect either sterile yellow tubes or tubes with culture media first depending on the hospital's policies. The CBC will be collected in an EDTA (lavender) tube and the chemistry (electrolytes, glucose, and BUN) will be collected in a heparin (green) tube. Pediatric size tubes can be used for the hematology and chemistry tests to decrease the blood volume removed from the child. Using a syringe is also a possibility.

Working on the evening shift, the phlebotomist was called to the emergency department to collect blood from a 2 year old. The orders included CBC, blood culture, electrolytes, glucose, and BUN. What equipment should be used for the procedure?

Since a blood culture is ordered, then a venipuncture is required and a capillary puncture is not acceptable

Working on the evening shift, the phlebotomist was called to the emergency department to collect blood from a 2 year old. The orders included CBC, blood culture, electrolytes, glucose, and BUN. What kind of phlebotomy procedure should the phlebotomist perform?

Parkinson's

_____________ disease can be a debilitating condition resulting in tremors in the elderly.

skin puncture

__________________ samples are not adequate for blood cultures, coagulation, and erythrocyte sedimentation rate (ESR) tests.