Chapter 11: Special Collections and Point-of-Care Testing

11. A transfusion of incompatible blood is often fatal because it can cause a. a major allergic reaction, releasing too much histamine. b. lysis, or rupturing, of RBCs within the vascular system. c. hemochromatosis in the patient's circulatory system. d. the patient's lungs to fill with nonfunctioning RBCs.

11. Answer: b WHY: A transfusion of donor blood that is not compatible with the patient's blood can be fatal because it causes agglutination (clumping) and lysis (rupturing) of the red blood cells within the patient's circulatory system. This massive destruction of red blood cells can overwhelm the patient's liver and kidneys causing death.

12. Before blood from a cell-salvaging procedure can be reinfused, it must be evaluated for a. chemical toxin. b. free hemoglobin. c. plasma glucose. d. white cell count.

12. Answer: b WHY: When patients request reinfusion of their own blood to replace blood lost during surgery, the blood must be salvaged and washed before being reinfused. Prior to reinfusion, it is recommended that the salvaged blood be tested for residual-free hemoglobin. A high free hemoglobin level indicates that too many red cells were destroyed during the salvage process, and renal dysfunction could result if the blood were reinfused. Free hemoglobin can be detected using point-of-care instruments such as the HemoCue Plasma/Low Hemoglobin Analyzer (Fig. 11-2).

13. When a donor unit of blood is collected, the blood collection bag a. employs a closed system connected to a 16- to 18-gauge needle. b. fills by weight that normally corresponds to around to 450 mL. c. is placed on a rotating device that mixes the unit as it is drawn. d. All of the above.

13. Answer: d WHY: When blood is collected from a donor, the collection unit is a sterile, closed system consisting of a blood bag connected by a length of tubing to a sterile 16- to 18-gauge needle. The collection bag containing an anticoagulant is placed on a mixing unit while the blood is being drawn to mix the anticoagulant with the blood to keep it from clotting. The unit is normally filled by weight but typically contains around 450 mL of blood when full.

14. Which of the following are coagulation tests that can be monitored using a POC instrument? a. BNP and Hct b. BUN and UA c. HCO3− and TnI d. INR and PT

14. Answer: d WHY: The prothrombin time (PT) and international normalized ratio (INR) are coagulation tests that are monitored through point-of-care testing by analyzers such as the CoaguChek® XS (Roche Diagnostics) (Fig. 11-3). The INR is a system established by international committees for reporting standardized results for all PT testing. Because the results are so critical to the therapy given, the standardization using the international sensitivity index for PT calculation permits a person on warfarin to obtain comparable results wherever he or she may be tested.

15. Pediatric blood cultures create challenges because a. antiseptic technique is different if you use a Chloroprep swab. b. collection requires two sets of cultures from a single venipuncture. c. media bottles are not made to accommodate such small veins. d. most ill children have already received broad-spectrum antibiotics.

15. Answer: d WHY: Besides the frequent difficulties in the collection of pediatric specimens, other challenges include the critical nature of pediatric pathogens such as Streptococcus pneumoniae and Neisseria meningitidis and the common encounter with children having previously received broad-spectrum antibiotics. Because of these considerations, special blood culture bottles (Fig. 11-4 Pediatric blood culture bottle.) must be used for pediatric populations. These bottles are different from adult blood culture bottles in both the formulation of the broth and the volume. The same methods for skin antisepsis for adults apply to pediatric patients unless the antiseptic is tincture of iodine. Two sets of cultures are not collected during a single venipuncture.

16. Blood gases can be monitored using the a. AVOXimeter. b. Cholestech. c. Stratus CS. d. Triage cardiac.

16. Answer: a WHY: The AVOXimeter 4000 (IL) (Fig. 11-5) is designed to provide quick blood gas results owing to POC availability. It offers comprehensive evaluation of blood gases in approximately 10 seconds, enabling the physician to make critical decisions concerning care and treatment without delay. The other choices are POCT instruments designed to test C-reactive protein, lipids, and troponin, respectively.

17. An autologous transfusion eliminates many risks associated with transfusions, such as a. blood incompatibility. b. disease transmission. c. transfusion reaction. d. All of the above.

17. Answer: d WHY: An autologous transfusion is a transfusion of blood that a person donated for his or her own use. Using one's own blood eliminates many risks associated with transfusions, such as disease transmission and blood incompatibilities that could result in a transfusion reaction.

18. Hyperkalemia means a. increased calcium in the blood. b. increased glucose in the blood. c. increased potassium in the blood. d. increased sodium in the blood.

18. Answer: c WHY: "Hyper" means excessive. Hyperkalemia means excessive or high potassium in the blood. The chemical symbol K for potassium comes from kalium, the Latin word for potash. Potassium was first isolated from potash (ashes of plants), which is where its English name comes from. Excessive calcium is called hypercalcemia. Excessive glucose is called hyperglycemia. Excessive sodium is called hypernatremia.

19. All POC glucose analyzers approved for hospital use have which of the following in common? a. The ability to use capillary, venous, or arterial blood samples b. Data can be downloaded to a data management program c. Requiring the use of an authorized operator ID number d. All of the above

19. Answer: d WHY: All glucose analyzers approved for use in healthcare facilities are made with the capability to download data to a data management system for the purposes of quality assurance, as shown in the photo of the i-STAT seated in the downloader/recharger. To use one of these glucose analyzers, a person must be an authorized operator with an ID number. All instruments can use whole blood, and that blood can come from the capillary, venous, or arterial system.

2. If only enough blood is collected from an adult to fill one blood culture bottle, it should be a. added to the aerobic bottle. b. added to the anaerobic bottle. c. put into a pediatric bottle. d. split between both bottles.

2. Answer: a WHY: According to CLSI, most bacteremia is caused by aerobic and facultative (able to live with or without oxygen) bacteria. In addition, pathogenic yeasts are recovered almost exclusively from aerobic bottles. Consequently, if less than the recommended volume of blood is collected, the blood should be added to the aerobic bottle first; any remaining blood should then be added to the anaerobic vial. It is not advised to use pediatric blood culture bottles for adults. The small volume of blood and broth may result in false-negative results.

20. ARD or FAN blood culture bottles a. detect problems in carbohydrate metabolism. b. eliminate vital interference from blood cells. c. remove any antibiotics that are in the blood. d. treat bloodborne pathogens in the circulation.

20. Answer: c WHY: It is not unusual for patients to be on antimicrobial (antibiotic) therapy at the time blood culture specimens are collected. The presence of the antimicrobial agent in the patient's blood can inhibit any growth of microorganisms in the blood culture bottle. Antimicrobial removal device (ARD) or fastidious antimicrobial neutralization (FAN) blood culture bottles (Fig. 11-6 Left to right: FAN and ARD blood culture bottles.) contain, respectively, resins or activated charcoal that will neutralize antibiotics.

21. Septicemia is a. a positive test for transmissible disease. b. bacteria measurement in whole blood. c. fever in which the cause is not known. d. presence of microorganisms in the blood.

21. Answer: d WHY: Septicemia is defined as microorganisms or their toxins in the blood. Bacteremia is a type of septicemia, but it is more specific to bacteria in the bloodstream. Fever of unknown origin (FUO) can be a symptom, not the definition of septicemia. Septicemia is not a test.

22. Which test is used as a marker of the severity of sepsis? a. Bilirubin b. Lactate c. Protime d. Troponin

22. Answer: b WHY: The accumulation of lactic acid (lactic acidosis) in blood has been identified as a cause of acid-base disorder (metabolic acidosis). Lactic acidosis is associated with major metabolic issues and is due to hyperlactatemia (increased lactate in the blood). Hyperlactatemia is usually present in patients with severe sepsis or septic shock. A lactate level can be used as a marker of the severity of the condition and the patient's stress response.

23. Persons wishing to donate blood in most states must be at least a. 16 years old and weigh at least 105 lb. b. 17 years old and weigh at least 110 lb. c. 18 years old and weigh at least 120 lb. d. 21 years old and weigh at least 125 lb.

23. Answer: b WHY: Eligibility rules for donating blood help protect the health and safety of the donor and the recipient. According to the American Red Cross, persons wishing to donate blood must feel well and be in good general health. They must be at least 17 years old in most states and weigh at least 110 lb.

24. Which condition requires a unit of blood to be withdrawn from a patient as a treatment? a. ABO incompatibility b. Autologous donation c. Hemochromatosis d. Hemolytic anemia

24. Answer: c WHY: Hemochromatosis is a disease characterized by excess iron deposits in the tissues. Periodic removal of single units of blood gradually depletes excess iron stores because the body then uses the stored iron to make new red blood cells to replace those removed.

25. Which test requires especially strict identification and specimen labeling procedures? a. Aldosterone b. Cross-match c. Plasminogen d. Valproic acid

25. Answer: b WHY: Specimens for cross-match testing require especially strict identification and labeling procedures. Misidentification of a specimen for a cross-match can cause a patient to receive an incompatible unit of blood and have a serious and possibly fatal transfusion reaction. Special blood bank specimen identification systems intended to reduce errors are available. Figure 11-7 shows a phlebotomist comparing information on a blood bank tube containing a label peeled from a special blood bank ID bracelet with the carbon copy of the label on the bracelet attached to the patient's arm.

26. Drugs of abuse include all of the following EXCEPT a. amphetamines. b. cannabinoids. c. "crack" and "ice." d. phenobarbital.

26. Answer: d WHY: Amphetamines ("ice") and cocaine ("crack") are classified as drugs of abuse as are cannabinoids (marijuana compounds). Phenobarbital is a drug that is prescribed for epilepsy, seizure prevention, and mood stabilization; it typically requires therapeutic monitoring.

27. Donor units of blood are typically collected using needles that are a. 16- to 18-gauge. b. 18- to 28-gauge. c. 20- to 22-gauge. d. 23- to 25-gauge.

27. Answer: a WHY: Large-bore (16- to 18-gauge) needles are used to collect donor units. The large bore helps keep the blood flowing freely and minimizes the hemolysis of red blood cells during collection.

28. A typical unit of donated blood contains approximately a. 250 mL. b. 450 mL. c. 750 mL. d. 1 L.

28. Answer: b WHY: A donor unit is filled by weight but typically contains around 450 mL of blood.

29. Which of the following tests is collected from patients with FUO to rule out septicemia? a. Blood cultures times two b. Nasopharyngeal culture c. Urine culture and sensitivity d. Wound and skin culture

29. Answer: a WHY: The body's response to septicemia is to raise body temperature to kill the microorganisms. When a patient experiences fever with no known cause (referred to as fever of unknown origin, or FUO), a physician may suspect septicemia and order blood cultures. Figure 11-8 shows the equipment necessary for collecting a blood culture. Blood cultures are typically ordered immediately before or after anticipated fever spikes when bacteria are most likely to be present. Recent studies have shown that the best chance of detecting bacteremia exists between 30 minutes and 2½ hours prior to the fever peak before the body can eliminate some of the microorganisms. Therefore timely collection is essential.

3. Which test requires four special tubes collected using a special order of draw? a. Ethanol b. OGTT c. PT/INR d. TB-Gold

3. Answer: d WHY: TB-Gold is a type of blood test that detects tuberculosis infection by measuring an individual's immune response to Mycobacterium tuberculosis (M. tuberculosis or M-TB ). The test requires collection of four special tubes (Fig. 11-1 Four special TB-Gold test tubes. From left to right, gray-top Nil or negative control tube, green-top TB1 antigen tube, yellow-top TB2 antigen tube and purple-top positive control tube.), a gray-top Nil or negative control tube that does not contain an additive; green-top TB1 antigen tube, a yellow-top TB2 antigen tube; and a purple-top positive control tube that contains mitogen, a nonspecific T-cell stimulator.

30. All of the following tubes can be used for collecting blood bank specimens EXCEPT a. large gel-barrier tubes. b. lavender-top tubes. c. nonadditive red-top tubes. d. pink-stopper EDTA tubes.

30. Answer: a WHY: A type and screen can be performed on a specimen collected in a nonadditive red-top, a lavender-top EDTA, or a special pink-top EDTA tube, depending on laboratory preference. Blood bank specimens are not collected in gel-barrier tubes because the gel and clot activator could affect antigen and antibody testing and cause erroneous results.

31. Which of the following tests is collected using special skin decontamination procedures? a. Blood urea nitrogen b. Complete blood count c. Set of blood cultures d. Type and cross-match

31. Answer: c WHY: Skin antisepsis is a critical part of blood culture collection. A special skin decontamination procedure must be used when collecting blood cultures because the culture can become contaminated by normal microbial flora on the skin if they are not removed. Contamination causes a major difficulty in interpreting the results.

32. Genetic fingerprinting can be used to determine a. grandparent-to-child relationships. b. parent-to-child relationships. c. sibling-to-sibling relationships. d. All of the above.

32. Answer: d WHY: Parental testing uses DNA profiling (also called genetic fingerprinting) to determine the probability that two specific individuals have a genetic parent-child relationship. Although it is most commonly used to determine if an alleged man is the biologic father of a specific child, it can also be used to determine the probability of other genetic relationships such as grandparent-to-grandchild, and sibling-to-sibling relationships.

33. Why would blood cultures be collected with an antimicrobial-adsorbing resin? a. The patient has had fever spikes for more than a week. b. The patient is taking a broad-spectrum antibiotic. c. It will eliminate contaminating normal skin flora. d. It will absorb and remove bacteria-caused contamination.

33. Answer: b WHY: It is not unusual for patients to be on an antimicrobial (antibiotic) when a blood culture specimen is collected. An antibiotic present in the specimen can inhibit the growth of any microorganisms in it and lead to a false-negative result. The special resin removes any antibiotics from the blood specimen. The blood is then cultured by conventional techniques.

34. Which specimen tubes must contain a 9-to-1 ratio of blood to anticoagulant to be accepted for testing? a. Blood bank b. Chemistry c. Coagulation d. Hematology

34. Answer: c WHY: Coagulation specimens must have a 9-to-1 ratio of blood to anticoagulant, or test results on the specimen will not be accurate. If a coagulation tube is not filled completely, this ratio is altered and the laboratory will not accept the specimen for testing.

35. Which type of additive is best for collecting an ethanol specimen? a. CPD + adenine b. Potassium EDTA c. Sodium citrate d. Sodium fluoride

35. Answer: d WHY: The recommended additive for collecting blood alcohol (ETOH) specimens is the antiglycolytic agent sodium fluoride. This agent prevents the breakdown of ETOH and stops the growth of bacteria, consequently inhibiting possible bacterial fermentation that could increase the ETOH.

36. Which blood culture bottle is inoculated first when the specimen has been collected by needle and syringe? a. Aerobic media b. Anaerobic vial c. ARD container d. It does not matter

36. Answer: b WHY: If both aerobic and anaerobic cultures are collected at one time, the anaerobic bottle is inoculated first when filled from a syringe. The anaerobic bottle is filled first and the aerobic bottle is filled last because any air in the top of the syringe could be drawn into the last bottle filled. If a butterfly with tubing is used and blood is collected directly into the bottles, the aerobic bottle is filled first because air from the tubing will be drawn into the bottle ahead of the blood. The antimicrobial removal device (ARD) is a resin that can be found in bottles of both aerobic and anaerobic media.

37. Which of the following is the most critical aspect of blood culture collection? a. Media inoculation b. Needle gauge c. Skin antisepsis d. Specimen handling

37. Answer: c WHY: Cleaning the skin (Fig. 11-9 Performing a friction scrub.) to achieve skin antisepsis or asepsis, the destruction of microorganisms on the skin, is a critical part of the blood culture collection procedure. Failure to follow proper antiseptic technique when cleaning the skin can result in contamination of the blood culture by skin-surface bacteria or other microorganisms and interfere with the interpretation of results. The laboratory must report all microorganisms detected, so it is up to the patient's physician to determine whether the organism is clinically significant or merely a contaminant.

38. A site for blood culture collection can typically be cleaned with which of the following? a. Chlorhexidine gluconate b. Hydrogen peroxide c. Sodium hypochlorite d. All of the above

38. Answer: a WHY: Antiseptic or sterile technique for blood culture collection varies slightly from one laboratory to another. Tincture of iodine, chlorhexidine gluconate, and a povidone/70% ethyl alcohol combination have all been shown to be effective in cleaning the collection site. Hydrogen peroxide and sodium hypochlorite are not used to clean blood collection sites.

39. Which of the following additives is sometimes used to collect blood culture specimens? a. ACD b. CPD c. EDTA d. SPS

39. Answer: d WHY: Blood is sometimes collected in an intermediate collection tube rather than blood culture bottles. A yellow-top sodium polyanethol sulfonate (SPS) tube is acceptable for this purpose. Other anticoagulants are toxic to bacteria and are not recommended.

4. Which of the following blood culture collection steps are in the correct order? a. Cleanse bottle tops, select equipment, perform friction scrub, and perform venipuncture. b. Perform friction scrub, select equipment, perform venipuncture, and cleanse bottle tops. c. Select equipment, cleanse bottle tops, perform friction scrub, and perform venipuncture. d. Select equipment, perform friction scrub, cleanse bottle tops, and perform venipuncture.

4. Answer: d WHY: Blood culture procedure steps in correct order are as follows: aseptically select and assemble the equipment, perform the friction scrub for 30 to 60 seconds, and allow the site to dry because antisepsis does not occur instantly. Next, cleanse the culture bottle stopper while the site is drying and then perform the venipuncture without touching or repalpating the site.

40. Which type of specimen may require collection of a discard tube before the test specimen is collected? a. Blood culture b. Coagulation c. Drug testing d. Paternity

40. Answer: b WHY: If a coagulation specimen in a light blue-top tube is the first or only tube collected with a winged blood collection needle (butterfly), a discard tube must be collected first to prime the tubing. Otherwise, air in the tubing will take the place of blood in the specimen tube and the critical 9-to-1 ratio of blood to anticoagulant will be adversely affected.

41. The oral glucose challenge test a. detects high peak glucose levels. b. is a 1-hour glucose screening test. c. screens for gestational diabetes. d. All of the above.

41. Answer: d WHY: Some pregnant women develop high blood glucose levels during pregnancy, a condition called gestational diabetes. A modified version of the glucose tolerance test (GTT or OGTT) called the oral glucose challenge test (OGCT) screens for gestational diabetes. Like the GTT, it detects high peak blood glucose levels. It is also called a 1-hour glucose screening test or gestational glucose screening test.

42. Which test is used as a screening test for glucose metabolism problems? a. 2-hour PP b. GTT c. Lactose d. WBC

42. Answer: a WHY: "Postprandial" (PP) means after a meal. Glucose levels in blood specimens obtained 2 hours after a meal are rarely elevated in normal individuals but may be significantly increased in diabetic patients. Therefore, a glucose test on a specimen collected 2 hours after a meal (2-hour PP) is an excellent screening test for diabetes and other metabolic problems.

44. When does the timing of specimen collection begin during a GTT? a. After the fasting blood specimen has been collected. b. As soon as the patient begins to drink the beverage. c. Before the fasting blood specimen is to be collected. d. When the patient has finished the glucose beverage.

44. Answer: d WHY: The timing of specimen collection during a GTT begins as soon as the patient finishes the glucose beverage. For example, if a patient finishes the glucose beverage at 0805 hours, the half-hour specimen is collected at 0835 hours, the 1-hour specimen is collected at 0905 hours, and so on. Timing of specimen collection is critical for computation of the GTT curve and correct interpretation of results.

45. A phlebotomist arrives to collect a 2-hour postprandial glucose specimen on an inpatient and discovers that 2 hours have not elapsed since the patient's last meal. What should the phlebotomist do? a. Ask the patient's nurse to verify the correct collection time. b. Come back later at the time the patient tells you is correct. c. Draw the specimen, and write the time collected on the label. d. Fill out an incident report form, and return it to the laboratory.

45. Answer: a WHY: If there is a discrepancy concerning the timing of a 2-hour postprandial specimen, the patient's nurse should be consulted to establish the correct time to draw the specimen. It is not a good idea to ask the patient because he or she may not know the correct time or understand the importance of exact timing. The specimen should not be collected early because glucose levels may still be elevated, leading to the misinterpretation of results. Filling out an incident report and returning to the laboratory may cause the correct collection time to be missed.

46. A patient undergoing a GTT vomits within 30 minutes of drinking the glucose beverage. Which action should the phlebotomist take? a. Continue the test, and note on the laboratory slip that the patient vomited and at what time. b. Discontinue the test, and write on the requisition that the patient vomited the drink. c. Give the patient another dose of the glucose beverage, and continue with the test. d. Notify the nurse or physician immediately to see if the test should be rescheduled.

46. Answer: d WHY: If a patient undergoing a GTT vomits within 30 minutes of drinking the glucose beverage, his or her nurse or physician should be notified immediately to determine if the test should be continued or rescheduled.

47. Increased blood glucose is called a. hyperglycemia. b. hyperinsulinism. c. hyperkalemia. d. hypernatremia.

47. Answer: a WHY: Increased blood glucose (sugar) is called hyperglycemia. Hyperinsulinism is excessive blood insulin levels, hyperkalemia is excessive blood potassium levels, and hypernatremia is excess sodium in the blood.

1. When does a blood glucose level in normal individuals typically peak after glucose ingestion? a. In 15 to 20 minutes b. In 30 to 60 minutes c. In 1 to 1½ hours d. In roughly 2 hours

48. Answer: b WHY: Blood glucose levels in normal individuals typically peak within 30 minutes to 1 hour of glucose ingestion and return to normal fasting levels within 2 hours. GTT specimen results are plotted on a graph to create what is referred to as a GTT curve. Figure 11-10 shows a graph with examples of normal and abnormal GTT curves.

49. Which of the following must remain consistent throughout an oral glucose test? a. Arm used for the draw b. Blood specimen source c. Position of the patient d. Size of ETS tubes used

49. Answer: b WHY: Oral glucose tolerance test (OGTT) is another name for a glucose tolerance test. Blood glucose levels vary according to the source of the specimen. It is important that the specimen source be consistent for the duration of the test for proper interpretation of results. Consequently, GTT blood specimens can be collected by capillary puncture or venipuncture but not by a combination of the two methods.

5. A lactose tolerance test is used to determine if a patient lacks the a. ability to metabolize glucose and convert it into milk sugar. b. enzyme needed to convert milk sugar into glucose and galactose. c. hormone that is required in the metabolism of glucose and lactose. d. protein responsible for the synthesis of lactose and galactose.

5. Answer: b WHY: A lactose tolerance test determines if a patient lacks the enzyme (mucosal lactase) that is necessary to convert lactose, or milk sugar, into glucose and galactose. A person lacking the enzyme suffers from gastrointestinal distress and diarrhea following the ingestion of milk and other lactose-containing foods. Symptoms are relieved by eliminating milk from the diet.

50. Patient preparation before a GTT involves a. eating meals with a measured amount of carbohydrate 3 days prior. b. exercising for 3 hours a day for a week before having the test. c. fasting for at least 2 hours before having the fasting specimen drawn. d. no chewing gum before or during the test unless it is sugarless.

50. Answer: a WHY: Proper patient preparation before a GTT involves eating balanced meals containing 150 g of carbohydrate for 3 days prior to the test, fasting for at least 12 hours before the test, and avoiding smoking or chewing gum before or during the test. There is no exercise requirement.

51. Which of the following can be used to clean a site before a blood alcohol specimen is collected? a. Diluted methanol b. Isopropyl alcohol c. Tincture of iodine d. Zephiran chloride

51. Answer: d WHY: Zephiran chloride (also called benzalkonium chloride) and povidone-iodine are the preferred antiseptics for blood alcohol collection. Isopropyl alcohol (isopropanol) and methanol are types of alcohol. Alcohol solutions or alcohol-based antiseptics can affect test results and must not be used to clean a site prior to the collection of a specimen for blood alcohol testing. Tincture of iodine cannot be used because tinctures contain alcohol.

52. Which of the following specimens may require chain-of-custody documentation when it is collected? a. Blood culture b. Cross-match c. Drug screen d. Trace elements

52. Answer: c WHY: Chain-of-custody documentation is required for legal or forensic specimens. Whether it is performed for legal reasons or not, drug screening has legal implications that require the use of a chain-of-custody protocol.

53. The purpose of TDM is to a. determine and maintain a beneficial drug dosage. b. maintain peak levels of drug in a patient's system. c. prevent trough levels of drug in a patient's system. d. screen for illegal drug use using multiple samples.

53. Answer: a WHY: Therapeutic drug monitoring (TDM) is performed to determine and maintain a beneficial drug dosage for a patient. Peak drug levels represent the highest serum concentrations of a drug and are collected during TDM to screen for drug toxicity. Trough drug levels are monitored during TDM to ensure that drug levels stay within the therapeutic or effective range. TDM has nothing to do with screening for illegal drug use.

54. Which of the following tests would not be subject to therapeutic drug monitoring? a. Digitoxin b. Gentamicin c. Phenylalanine d. Theophylline

54. Answer: c WHY: Digitoxin, gentamicin, and theophylline are drugs. Phenylalanine is an amino acid, not a drug.

55. A peak drug level has been ordered for 0900 hours. You draw the specimen 10 minutes late because of unavoidable circumstances. What additional action does this necessitate? a. Drawing two tubes for duplicate drug screening b. Establishing the next dosage time from the chart c. Filling out a delay slip and leaving at the desk d. Recording the actual time of specimen collection

55. Answer: d WHY: Timing of TDM specimens is extremely important. A pharmacist calculates drug dosages based on blood levels of the drug at specific times. If a specimen is collected late, it is important that the actual time of collection be recorded so that the pharmacist will be aware of the time change and can calculate values accordingly. It is not the phlebotomist's responsibility to establish dosage times. Not collecting the specimen and leaving a notification with the desk clerk or at the nursing station could cause an unnecessary and expensive delay.

56. A trough drug level is collected a. 30 minutes after administration of the drug intravenously. b. immediately before the next scheduled drug dose is given. c. immediately after administration of the drug by the nurse. d. when the highest serum concentration of drug is expected.

56. Answer: b WHY: A trough, or minimum drug level, is collected when the lowest serum concentration of the drug is expected. A trough drug level is easiest to obtain because it is collected immediately before administration of the next scheduled drug dose.

57. Which test requires the collection of multiple specimens? a. ACT b. GTT c. Hct d. PTT

57. Answer: b WHY: A GTT involves the collection of multiple blood specimens. Blood specimens are serially collected at specific times throughout the duration of the test.

58. Timing of collection is most critical for drugs with short half-lives, such as a. digitoxin. b. gentamicin. c. methotrexate. d. phenobarbital.

58. Answer: b WHY: A half-life is the time required for the body to metabolize half the amount of the drug. Timing of collection is most critical for aminoglycoside drugs with short half-lives, such as gentamicin, amikacin, and tobramycin. Timing is less critical for drugs such as phenobarbital, methotrexate, and digitoxin, which have longer half-lives.

59. Molecular tests can be used to a. classify the genetic makeup of an individual. b. determine increased risk of a certain disease. c. identify genetic changes that cause a disease. d. All of the above.

59. Answer: d WHY: Clinical molecular genetic testing provides for detection of genetic variations that can (1) identify whether an individual has a certain genetic disease, (2) determine whether an individual has an increased risk for a certain disease, (3) classify an individual's genetic makeup to determine whether a drug and dosage is suitable for a that patient, and (4) examine the whole genome to discover genetic alterations that may cause disease.

6. The preferred sample for parentage testing is a. amniotic fluid. b. blood sample. c. buccal swab. d. chorionic villi.

6. Answer: b WHY: Blood is the preferred sample for parentage testing; however, the use of buccal samples is increasing. Obtaining amniotic fluid or a sample of chorionic villus tissue can only be done before the child is born.

60. The most common reason for glucose monitoring through POCT is to a. check for sporadic glucose in the urine. b. diagnose glucose metabolism problems. c. monitor glucose levels for diabetic care. d. control medication-induced mood swings.

60. Answer: c WHY: Glucose monitoring in patients with diabetes mellitus is the most common reason for performing glucose testing through point-of-care testing (POCT) for glucose. An example of a POCT glucose analyzer is seen in Figure 11-11, Accu-Chek Inform II System kit.

61. Which one of the following tests could be collected using a tube other than a trace element-free tube? a. Copper b. Lead c. Sodium d. Zinc

61. Answer: c WHY: Traces of elements or minerals such as copper, lead, and zinc can be contaminants in glass and other materials used to make blood collection tubes and stoppers and can leach from the tube into the specimen. Trace element-free tubes have the lowest possible contaminating amounts of these elements. Iron, lead, and zinc are all elements or minerals measured in such small quantities that it is best if they are collected in trace element-free tubes. Sodium is not considered a trace element.

62. The definition of toxicology is a. a protocol for drug trafficking. b. the scientific study of poisons. c. the study of drug therapy levels. d. the tracking of illicit drug trade.

62. Answer: b WHY: Toxicology is defined as the scientific study of poisons or toxins. There are two types: clinical toxicology and forensic toxicology. Clinical toxicology comprises the detection of toxins and treatment of their effects. Forensic toxicology is concerned with the legal consequences of both intentional and accidental exposure to toxins.

63. Which test typically has the shortest TAT if performed by POCT? a. BUN b. DNA c. GTT d. PSA

63. Answer: a WHY: Turnaround time (TAT) in laboratory testing is the amount of time that elapses between when a test is ordered and when the results are returned. BUN results are part of a panel that can be performed on small, portable handheld instruments, such as the i-STAT. Once the instrument's cartridge is injected with blood, the BUN test results are available within minutes. A GTT is a timed test involving the collection of serial specimens over a period of 1 to 6 hours, depending on how the test is ordered by the physician. A DNA profile can be performed on buccal samples, which are collected by rubbing a swab against the inside of the cheek to collect loose cells. DNA results are not immediate; TAT may be several days. PSA is not a POC test and must be collected by venipuncture, processed in the laboratory, and delivered for testing, which makes for a TAT of several hours at least.

64. Which of the following is not a POCT analyzer? a. ABL80 b. BacT/ALERT c. GEM 5000 d. i-STAT

64. Answer: b WHY: ABL80, CoaguChek, and GEM Premier 5000 are all POCT analyzers. BacT/ALERT (Fig. 11-12) is a blood culture media bottle with collection adapter.

65. To prevent introducing a contaminating substance into a trace-element collection tube, it is suggested that you a. collect the royal-blue tube last in the order of draw. b. draw it by itself using a syringe or evacuated tube system. c. use a syringe and transfer blood into the royal-blue tube last. d. use only a royal-blue, short-draw tube with heparin or EDTA.

65. Answer: b WHY: In collecting trace elements, it is important to prevent introducing even the smallest amount of the contaminating substance into the tube since the amounts being tested are in the range of micro- or nanograms. Contaminants in the stoppers accumulate in the needle each time a different tube is pierced in a multiple-tube collection. That accumulation can then carry over to the royal blue-stoppered tube, thus changing the results. When a trace-element test is ordered, it is best to draw it by itself if you are using a needle/tube assembly or to use a syringe. For best results when using a syringe, change the syringe transfer device before filling the royal blue-top tube.

66. Which of the following is one of the most common bedside or POCT tests? a. Bilirubin b. Cholesterol c. Glucose d. Troponin

66. Answer: c WHY: Whole-blood glucose or bedside glucose monitoring is one of the most common point-of-care tests. Bilirubin, troponin, and cholesterol can be performed as point-of-care tests but are not performed nearly as often.

67. Which of the following tests is used to monitor heparin therapy? a. ACT b. BNP c. BT d. PT

67. Answer: a WHY: The activated clotting time (ACT) test is used to monitor heparin therapy. The GEM Premier 5000 (Fig. 11-13) analyzer is an example of a POCT instrument used to perform ACT tests. B-type natriuretic peptide (BNP) is a cardiac hormone produced by the heart; it helps physicians differentiate chronic obstructive pulmonary disease (COPD) from congestive heart failure (CHF). Sodium (Na+) is an electrolyte and part of an electrolyte panel that is used in evaluating a wide variety of illnesses. The prothrombin time (PT) is used to monitor warfarin (Coumadin) therapy.

68. Tan-top tubes containing K2ETDA can be used to collect specimens for which test? a. Blood alcohol b. Glucose screen c. Lead analysis d. Protime/INR

68. Answer: c WHY: Lead is a trace element that can be collected in a royal blue, trace element-free tube that contains K2ETDA, or a special tan-top tube that contains K2ETDA.

69. The CAP requires QC for many waived tests to be performed a. before each patient test performed. b. daily and when a new kit is opened. c. on a weekly basis as a minimum. d. when test manufacturer specifies.

69. Answer: d WHY: At one time, all POCTs required external quality control (QC) to be performed daily if any patient testing was to be done that day. Today, the College of American Pathologists (CAP) requires that external liquid control be performed only as specified by the manufacturer's instructions on many of the waived tests.

7. Those allowed to order paternity testing include all the following EXCEPT a a. child support agent. b. child who is a minor. c. defense attorney. d. family physician.

7. Answer: b WHY: Paternity testing is performed to determine the probability that a specific individual fathered a certain child. Unlike routine clinical tests, which require an order from a physician, paternity testing can be requested by lawyers, child support enforcement bureaus, physicians, and individuals. It cannot be requested by minor children.

70. A noninvasive transcutaneous method can be used to measure a. C-reactive protein. b. glycosylated Hgb. c. infant lead levels. d. neonatal bilirubin.

70. Answer: d WHY: The new Bilichek meter (Philips Healthcare) allows for a noninvasive, transcutaneous bilirubin measurement system for newborns. The meter directs light into the skin on the baby's head or sternum and measures the intensity of the specific wavelengths that are reflected back to determine the bilirubin concentration. The test can be performed wherever the newborn is, even in the mother's room.

71. The accumulation of which substance in the blood can cause metabolic acidosis? a. Copper b. Lactate c. Mercury d. Troponin

71. Answer: b WHY: A type of metabolic acidosis called lactic acidosis is due to hyperlactatemia (increased lactate in the blood). Hyperlactatemia is usually present in patients with severe sepsis or septic shock.

72. POCT analyzer QC must be repeated if the analyzer a. is dropped. b. battery is replaced. c. function is questioned. d. All of the above.

72. Answer: d WHY: QC must be repeated if the POCT analyzer is dropped, the battery is replaced, or patient results or analyzer functioning are questioned.

73. Ionized calcium plays a critical role in all of the following EXCEPT a. blood clotting. b. cardiac function. c. glycation of Hb. d. nerve impulses.

73. Answer: c WHY: Ionized calcium makes up approximately 45% of the calcium in the blood. The rest is bound to protein and other substances. Only ionized calcium can be used for critical functions such as blood clotting, cardiac function, and nerve impulses. Glycation of hemoglobin (Hb) is the forming of a chemical bond between glucose and hemoglobin. Ionized calcium does not play a critical role in this process.

74. Below-normal blood pH is referred to as a. blood acidosis. b. blood alkalosis. c. hypokalemia. d. hyponatremia.

74. Answer: a WHY: Normal arterial blood pH is 7.35 to 7.45. Below-normal blood pH is called acidosis. Above-normal pH is called alkalosis. Hypokalemia is reduced potassium in the blood. Hyponatremia is reduced sodium in the blood.

76. B-type natriuretic peptide is a cardiac a. antibody. b. enzyme. c. hormone. d. protein.

76. Answer: c WHY: B-type natriuretic peptide (BNP) is a cardiac hormone produced by the heart in response to ventricular volume expansion and pressure overload. It is the first objective measurement for congestive heart failure (CHF). This test allows the physician to differentiate between CHF and chronic obstructive pulmonary disease (COPD).

77. Which test is used to evaluate long-term effectiveness of diabetes therapy? a. 2-hour postprandial b. Glucose tolerance c. Hemoglobin A1c d. Random glucose

77. Answer: c WHY: Hemoglobin A1c is a type of hemoglobin formed by glycation (the chemical binding of glucose with hemoglobin). Figure 11-14 shows a POCT analyzer used for hemoglobin A1c measurement. Glycated Hgb levels reflect the average blood glucose level during the preceding 4 to 6 weeks and therefore can be used to evaluate the long-term effectiveness of diabetes therapy.

78. Which test is also referred to as packed cell volume? a. ESR b. HCT c. Hgb d. HMT

78. Answer: b WHY: The hematocrit (Hct) test is a measure of the volume of RBCs in a patient's blood. It is also called packed cell volume (PCV) because it can be calculated by centrifuging a specific volume of anticoagulated blood to separate the cells from the plasma, thus determining the proportion of red blood cells to plasma. The StatSpin CritSpin (Fig. 11-15) is a microhematocrit centrifuge that is small and portable enough to be used in a "point-of-care" setting.

79. Which is a type of TB blood test? a. TDM b. TnT c. T-Spot d. All of the above

79. Answer: c WHY: The T-Spot tuberculosis (TB) blood test is a type of test called an interferon-gamma release assay (IGRA) that detects TB infection by measuring an individual's immune response to Mycobacterium tuberculosis (M. tuberculosis, or M-TB). An IGRA test is performed by mixing the patient's white blood cells with M-TB antigens. When they are mixed with the TB antigens, the white blood cells of most individuals who have been infected with M-TB will release a substance called interferon-gamma (INF-g) that can be measured. TDM stands for therapeutic drug monitoring. Cardiac troponin T (TnT) is a protein specific to heart muscle.

8. Which is the recommended disinfectant for blood culture sites in infants two months and older? a. Isopropyl alcohol swab b. Chlorhexidine gluconate c. Benzalkonium chloride d. Povidone-iodine swab

8. Answer: b WHY: According to CLSI, chlorhexidine gluconate is the recommended disinfectant for blood culture sites in infants 2 months of age and older.

80. You are in the process of collecting a protime from a patient who is a difficult draw. The tube loses vacuum when it is only partially full. You try another tube, and blood flow stops when it is also only partially full. You discontinue the draw. What do you do with the partial tubes? a. Call the lab, and ask them which of the tubes you should keep. b. Deliver the one that is fullest to the lab, noting it was a difficult draw. c. Discard them both and try again to draw the specimen at a new site. d. Pour the two tubes together to create one full tube, and send it to the lab.

80. Answer: c WHY: A protime tube must be filled to its normal volume to maintain the critical 9:1 ratio of blood to anticoagulant. Neither tube satisfies this requirement. A phlebotomist should know without asking that specimen processing will reject either specimen and that the specimen must be collected from a new site. Never pour two partial tubes together as it creates excess anticoagulant that does not result in a 9:1 ratio.

81. POCT lipid testing includes a. BNP. b. HDL. c. RNA. d. TcB.

81. Answer: b WHY: POCT lipid testing includes total cholesterol (TC), triglycerides, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and non-HDL and TC/HDL ratio. B-type natriuretic peptide (BNP) is a cardiac hormone produced in response to ventricular volume expansion and pressure overload. RNA stands for ribonucleic acid. TcB stands for transcutaneous bilirubin measurement.

82. Which point-of-care blood analyzer uses a microcuvette instead of a test strip or cartridge? a. CoaguChek XS Plus b. HemoCue HB201+ c. I-STAT system d. StatStrip Lactate

82. Answer: b WHY: HemoCue HB 201+ blood analyzer (Fig. 11-16) uses a microcuvette instead of a test strip. The CoaguChek XS Plus and the StatStrip lactate use a reagent strip for testing. The i-STAT uses a special cartridge for testing.

83. An uncorrected imbalance of which analyte in a patient can quickly lead to death? a. Hemoglobin b. Potassium c. Prothrombin d. Troponin T

83. Answer: b WHY: Potassium is an electrolyte. The body maintains electrolytes in specific proportions within narrow ranges, and any uncorrected imbalance can lead to death. Potassium plays a major role in nerve conduction, muscle function, acid-base balance, and osmotic pressure. It influences cardiac output by helping to control the rate and force of heart contraction.

84. The POC instrument VerifyNow does platelet testing to a. continuously check the glycemic index. b. determine response to aspirin therapy. c. evaluate warfarin or heparin therapy. d. measure abnormal increase in thrombocytes.

84. Answer: b WHY: Platelet function testing allows the clinician to determine a patient's response to medication before open heart surgery or cardiac catheterization. This can help prevent excessive bleeding or blood clots. The testing can be done with an automated analyzer and single-use, disposable assays using the VerifyNow System (Fig. 11-17). This system uses whole-blood samples and gives measurements that correlate with laboratory testing. The VerifyNow System Aspirin Assay, which is CLIA-waived, provides a measurement to determine if a patient is responding to aspirin therapy.

85. The Lookback program occurs a. at the time the unit of blood is collected at the donor center. b. before the unit has been matched to a recipient's blood sample. c. if a transfusion reaction occurs because of incompatible blood. d. when the blood service is made aware of a transfusion infection.

85. Answer: d WHY: Lookback is the tracing and testing of blood donors and recipients when a blood product has been determined to be potentially contaminated with a bloodborne pathogen. Lookback can only occur when the blood service is made aware of the possibility of a transfusion-related infection. At that time, notification to all blood recipients is required and verification for all blood components previously collected and currently in inventory has been retrieved.

86. A hemoglobin A1c test is performed to monitor the effectiveness of therapy in which of the following conditions? a. Acidosis b. Diabetes c. Inflammation d. Renal disease

86. Answer: b WHY: Glycohemoglobin (also called glycated hemoglobin) is glucose which is chemically bound to hemoglobin A, the primary form of hemoglobin in adults. The combination of hemoglobin A and glucose is more commonly called hemoglobin A1c (HbA1c). The rate of formation of HbA1c is directly proportional to plasma glucose levels. Glucose stays attached to the hemoglobin for the life of the red blood cell, which is around 120 days. Consequently, HbA1c levels reflect the average blood glucose level over the previous 2 to 3 months and can be used to evaluate the long-term effectiveness of diabetes therapy.

87. Which of the following is an example of an immunosuppressant drug? a. Cyclosporine b. Digoxin c. Lithium d. Theophylline

87. Answer: a WHY: An immunosuppressant lowers the body's immune response. Cyclosporine is an immunosuppressant used to prevent organ transplant rejection. Digoxin is a cardiac drug used to treat problems such as congestive heart failure (CHF), angina, and arrhythmia. Lithium is a psychiatric drug used to disorders such as manic depression. Theophylline is a bronchodilator used to treat asthma and other pulmonary diseases.

88. Which test is important in the management of patients with anemia? a. CRP b. Hb c. PT d. TcB

88. Answer: b WHY: Hemoglobin (Hb or Hgb) is the oxygen-carrying component of red blood cells. Anemia is a disorder in which the number of red blood cells in the blood is abnormally low or the amount of hemoglobin in the red blood cells is abnormally low. Hemoglobin levels are monitored to tell if and how well the anemia treatment is working. C-reactive protein (CRP) is a marker of inflammation. A protime (PT) test is a coagulation test. Transcutaneous bilirubin (TcB) is a type of noninvasive bilirubin measurement for newborns.

89. The international normalized ratio (INR) was created to solve the problem of a. differences in results on the same patient using PT tests from different companies. b. lack of standardization of quality control specimens sold by different companies. c. patients not taking their warfarin or taking more than the required dose of warfarin. d. All of the above.

89. Answer: a WHY: There are several manufacturers of PT tests, and the tests are slightly different. Consequently, there can be a difference in the results obtained on the same patient if tested using PT tests from different companies. The international normalized ratio (INR) was created to solve this problem.

9. All the following statements about autologous donations are true EXCEPT a. blood cannot be collected within 72 hours of surgery. b. patients must have a written order from their physicians. c. unused autologous units may be used by other patients. d. using the patient's own blood eliminates many risks.

9. Answer: c WHY: An autologous donation is the process by which a person donates blood for his or her own use. If autologous units of blood are not used by the person who donated them, they must be discarded because rules for autologous donation are less strict and the blood does not meet safety standards required for blood that is used for other patients. An autologous donation can be made for an elective surgery when it is anticipated that a transfusion may be needed, because using one's own blood eliminates many risks associated with transfusions. To be eligible to make an autologous donation, a person must have a written order from a physician, and the minimum time between donation and surgery must be more than 72 hours.

90. Which point-of-care test helps a physician detect low-grade inflammation even in asymptomatic individuals? a. ALT b. BNP c. hsCRP d. T-spot

90. Answer: c WHY: C-reactive protein (CRP) is a nonspecific marker of systemic inflammation. Traditional CRP tests detect concentrations of 3 to 5 mg/L. High-sensitivity CRP (hsCRP) can detect CRP concentrations as low as 0.3 mg/L. The higher sensitivity allows it to detect low-grade inflammation even in asymptomatic individuals. Alanine transferase (ALT) is a liver enzyme that is monitored when a patient is on lipid-lowering medication. B-type natriuretic peptide (BNP) is a cardiac hormone and a measurement for congestive heart failure (CHF). T-Spot is a blood test for tuberculosis.

91. A chain of custody is a. a special protocol used when collecting forensic specimens. b. necessary to patient management for therapeutic phlebotomy. c. required for the POC quality assurance program for nursing. d. part of the type and cross-match procedure for blood bank.

91. Answer: a WHY: The term "chain of custody" refers to the paper trail associated with detailed documentation of forensic specimen collection from the time of collection to the reporting of results. The specimen must be accounted for at all times. This special protocol must be strictly followed so that any legal action is not compromised.

92. Glucose levels are regulated by insulin produced by the a. liver. b. gallbladder. c. pancreas. d. spleen.

92. Answer: c WHY: The pancreas produces insulin, which is primarily responsible for regulating blood glucose levels.

93. The time required for the body to metabolize half the amount of a drug is called the a. dose response. b. drug half-life. c. peak level. d. trough level.

93. Answer: b WHY: A drug's half-life is the time required for the body to metabolize half the amount of a drug. A dose-response curve is plotted based on doses of a drug given each half-life. A peak level is the highest serum concentration of a drug. The trough level is the lowest serum concentration of a drug.

94. Which test is used to identify individuals at future risk of heart disease? a. HbA1c b. hsCRP c. OGCT d. pCO2

94. Answer: b WHY: C-reactive protein (CRP) is a nonspecific marker of inflammation. High-sensitivity CRP (hsCRP) can detect very low CRP concentrations and is used a marker to identify individuals at risk for future heart disease. Hemoglobin A1c (HbA1c) is glucose that is chemically bound to hemoglobin and is measured to evaluate the long-term effectiveness of diabetes therapy. An oral glucose challenge test (OGCT) screens for gestational diabetes. The pCO2 is an indicator of how well air is being exchanged between the blood and the lungs.

95. What is the order of draw if drawing a protime and CBC with a blood culture specimen? a. Blood culture, protime, CBC b. Blood culture, CBC, protime c. Protime, blood culture, CBC d. Protime, CBC, blood culture

95. Answer: a WHY: Blood cultures are always collected first in the order of draw. The protime would be collected second, and the CBC would be collected last.

96. Rapid syphilis tests detect a. Clostridium difficile. b. Neisseria meningitidis. c. Streptococcus pneumoniae. d. Treponema pallidum.

96. Answer: d WHY: Rapid syphilis tests detect Treponema pallidum, the organism that causes syphilis.

97. Initial specimen diversion is a technique used in the collection of a. blood cultures. b. drug screens. c. paternity tests. d. All of the above.

97. Answer: a WHY: Initial specimen diversion (ISD) is a technique used to reduce blood culture contamination rates. A special sterile device (Fig. 11-18 SteriPath® initial specimen diversion (ISD) device.) is used to divert the first few milliliters of blood flow before the blood culture bottles are filled.

43. Which of the following activities can negatively affect a glucose tolerance test (GTT)? a. Chewing sugarless gum b. Drinking tea without sugar c. Smoking low-tar cigarettes d. All of the above

43. Answer: d WHY: Chewing sugarless gum, drinking sugarless tea, and smoking cigarettes all stimulate the digestive process and therefore can negatively affect GTT results.

1. Forensic toxicology is concerned with a. deliberate, not accidental, toxin contact. b. legal consequences of toxin exposure. c. toxins only found in water resources. d. treating the effects of toxin exposure.

1. Answer: b WHY: Toxicology is the scientific study of toxins (poisons). Forensic toxicology, which involves the use of scientific methods in crime investigation, is concerned with the legal consequences of toxin exposure, both intentional and accidental. Clinical toxicology is concerned with the detection of toxins and treatment for the effects they produce. Toxicology tests examine blood, hair, urine, and other body substances for the presence of toxins, often present in very small amounts.

10. The phosphate additive in a donor unit of blood a. keeps the blood from clotting. b. prevents the growth of bacteria. c. provides nutrition for the cells. d. stabilizes the pH of the plasma.

10. Answer: d WHY: Citrate phosphate dextrose (CPD) is an anticoagulant and preservative that is typically used in collecting units of blood for transfusion purposes. The citrate prevents clotting by removing calcium. A phosphate compound stabilizes the pH, and dextrose provides energy to the cells and helps keep them alive. There is nothing in CPD that prevents the growth of bacteria.

100. In performing a glucose tolerance test, the fasting specimen is collected at 0600. The patient is given the glucose beverage at 0610 and finishes it at 0615. When should the 1-hour specimen collected? a. 0700 b. 0710 c. 0715 d. 0720

100. Answer: c WHY: The timing for a glucose tolerance test (GTT) begins when the patient finishes drinking the glucose beverage. Since the patient in this example finished the glucose beverage at 0615, the 1-hour specimen should be collected at 0715.

75. Which of the following is a protein that is specific to heart muscle? a. ALT b. BNP c. LDL d. TnT

75. Answer: d WHY: Cardiac troponin T (TnT) is a protein that is specific to heart muscle. It is measured in the diagnosis of acute myocardial infarction (AMI), or heart attack.

98. A blood specimen was collected in a royal blue-top tube with a lavender stripe on the label. What type of specimen could it have been, and what type of additive did the tube contain? a. Blood bank, SPS b. Coagulation, citrate c. Serology, no additive d. Trace element, EDTA

98. Answer: d WHY: A royal blue-top is needed to collect trace-element specimens. A royal blue-top can contain EDTA, heparin, or no additive. The additive in the tube is often indicated by a color band or stripe corresponding to the color associated with the stopper color for that additive. Consequently, a royal blue-top tube with a lavender band indicates the presence of the anticoagulant EDTA.

99. Which of the following is a type of "good" cholesterol? a. HDL b. LDL c. Non-HDL d. TC/HDL

99. Answer: a WHY: HDL is considered "good" cholesterol because it is believed to carry "bad" cholesterol (LDL) away from the arteries. To remember that HDL is thought of as "good" cholesterol, think of the "H" as standing for "healthy."