Phlebotomy Chapter 8 & 9

How long do you need to let the site air dry before continuing

30sec - 1min.

According to CAP guidelines, drugs that interfere with blood tests should be stopped:

4 to 24 hours prior to the test.

What is the first tube drawn for coagulation tubes using an ETS setup

A "clear" tube.

How do you determine that you've established blood flow with a butterfly device

A "flash" in the hub.

If an infant cries, and the WBC count is too high in the specimen, what might happen

A Blood Culture might be ordered.

Which type of patient is most likely to have an arteriovenous fistula or graft

A dialysis patient.

Which of the following specimens would most likely be rejected for testing

A hemolyzed potassium specimen.

Catheter with a stopcock or cap for delivering medication or drawing blood

A patient in the dialysis unit has what appears to be a loop under the skin on the inside of his forearm in which the large needles connected to the dialysis tubing have been inserted. What is this? Arteriovenous (AV) Shunt/Fistula/Graft.

Pre-op or post-op time designations mean the same as what

ASAP.

A patient's arm is in the anatomical position. There appears to be a loop under the skin between the wrist and the elbow. You feel a buzzing sensation when you touch it. What you are most likely feeling is a

AV graft.

Basal state is influenced by what

Age, gender, and condition of the body.

What does a 3-Part ID have on it

All 3 sections have the patient's name and temporary number on it. The first part becomes the patient's ID band, the second part is attached to the specimen, the third part is issued if the patient needs a transfusion, and it is attached to the unit of blood.

After cleaning the venipuncture site with alcohol, the phlebotomist should

Allow the alcohol to dry completely.

Who do you notify if you've accidentally poked an artery

An RN.

Skin changes in elderly patients can make it harder to

Anchor veins.

What do you clean the venipuncture site with

Antiseptic, 70 percent isopropyl alcohol.

When should additive tubes be mixed

As soon as they are removed from the holder.

You are a phlebotomy student on rotation at an outpatient site. A patient who seems extremely apprehensive about having her blood drawn tells you that she is afraid of needles. What should you do

Ask an experienced phlebotomist to perform the draw for you.

You have made two unsuccessful attempts while trying to collect an ASAP specimen on an inpatient. The specimen cannot be collected by skin puncture. What should you do next

Ask another phlebotomist to collect it.

You are asked to collect a blood specimen from an inpatient. The patient is not wearing an ID band. What is the best thing to do

Ask the patient's nurse to put an ID band on the patient before you draw the specimen.

Where is an AV Shunt or Fistula located

Back of the arm, above the wrist.

Which type of test requisition has been shown to decrease laboratory errors

Bar Coded.

A patient has had a mastectomy on the left side and has an IV midway down the right arm. Where is the best place to perform a venipuncture

Below the IV on the right arm.

How can you tell that you are in a vein when drawing blood with a butterfly

Blood usually appears in the tubing.

A patient has several short lengths of IV-type tubing protruding from his chest. This is most like a/an

CVC.

Laboratory personnel will assume that blood in a microtube is what type of blood

Capillary.

Pregnancy has what effect on a specimen

Change in RBC count (by dilution).

Diurnal variation has what effects on a specimen

Changes in TSH, Cortisol, and Fe.

Stress has what effects on a specimen

Changes in WBC count, Fe, ACTH, Catecholamine, and Cortisol.

Drug therapy has what effects on a specimen

Changes in enzymes and hormones. You need to wait 4-24 hours after drug therapy has stopped for a serum specimen, and 48 -72 hours for urine specimen.

What is the third step in a 3-way ID

Checking the label of the specimen with the patient's ID band before leaving the room.

Which activity is least likely to lead to failure to draw blood

Choosing a vein that has patency.

How large of an area needs to be cleaned for venipuncture

Circle around 2-3in in diameter.

What will happen if you fail to mix a plasma tube immediately after collection

Clots will form and compromise test results.

Which of the following specimen conditions would lead you to suspect that the patient was not fasting when it was collected

Cloudy white yellow serum

You are performing a venipuncture on a difficult vein using a butterfly. You have an SST and a light blue-topped tube to collect. How do you proceed

Collect and mix the light-blue top tube before filling and mixing the SST.

A member of the clergy is with the patient when you arrive to collect a routine specimen. What should you do

Come back after the clergy person has gone.

An inpatient is eating breakfast when you arrive to collect a fasting glucose. What is the best thing to do

Consult with the patient's nurse to see if the specimen should be collected.

List four ways to minimize iatrogenic blood loss

Coordinate with physicians to minimize draws on the patient, follow quality assurance procedures to minimize re-draws, collect minimum required specimen volumes, especially on infants, keep a log of draws.

The time is 0750 hours. You have received the following requests on different patients. Which test specimen should you collect first

Cortisol ordered for 0800.

Peak levels of this analyte typically occur around 0800 hours

Cortisol.

Decreases with age

Creatinine Clearance.

When a permanent number is issued for a patient that was given a 3-Part ID, you must do what

Cross-reference it with the temporary ID number.

Icteric Serum has what appearance

Dark yellow, yellow/brown color.

When drawing on an arm with an IV site, where do you place the tourniquet, and where do you draw

Distal to the IV site.

If you have to draw from the same arm as a hematoma, where do you draw

Distal to the hematoma, only as a last resort.

A phlebotomist needs to collect a plasma specimen for a coagulation test. The patient has an IV in the left arm near the wrist, and a hematoma in the antecubital area of the right arm. Which of the following is the best place to collect the specimen?

Distal to the hematoma.

You are in the process of identifying an inpatient. The patient's verbal confirmation of name and date of birth matches the requisition, but the medical record number is different. What should you do

Do not collect the specimen until the problem has been addressed and resolved.

There are two patients in a room. One of them has a latex allergy. You have a request to collect a blood specimen on the other one. How should you proceed

Do not take anything that contains latex into the room.

Interventions used to ease pain in collecting blood specimens from infants include.

EMLA, oral sucrose, pacifiers.

When the arm of the patient is swollen with excess fluid, the condition is called

Edema.

Which of the following is most likely to affect test results

Edema.

You have a request to collect a stat specimen. A doctor is with the patient when you arrive. What should you do

Excuse yourself and politely ask the doctor for permission to do the draw.

What is the best approach to use on an 8-year-old child who needs to have blood drawn

Explain the draw in simple terms and ask for the child's cooperation.

Blood loss to a point where life cannot be sustained is called

Exsanguination.

Which of the following statements describes proper venipuncture technique

Fill additive tubes until the vacuum is exhausted.

Which of the following would be most likely to allow reflux to occur during venipuncture

Filling the tube stopper end first.

Which of these tests are most affected if the patient is not fasting

Glucose and triglycerides.

Underfilling this tube will most likely result in a hemolyzed specimen

Grey Top.

A vein that has patency

Has a bounce or resilience to it.

Relating to the action of a particular nerve on blood vessels

Heparin/Saline Lock

Blood collection tubes are labeled when

Immediately after specimen collection.

Why do we ask patient's to spit out gum or other objects in their mouths

In case of fainting, items must be removed from the mouth to avoid choking.

What is a 3-Part ID

It is used in blood banks & emergency departments to collect a specimen before the facility has had time to attach an ID bracelet to a patient, or if the patient is unconscious and has no ID on them.

Why do we need to let the site air dry

It prevents stinging and hemolysis.

What is a basal state specimen used for

It's ideal for establishing reference ranges on inpatients, because the effects of diet, exercise, etc are minimized.

A microclot in what color tubes makes the tubes useless

Lavender or Light Blue.

Which of the following situations can result in hemoconcentration

Leaving the tourniquet on over 1 minute.

Mild hemolysis of a Serum sample has what appearance

Light pink.

The best way to keep a vein from rolling is to

Make certain to anchor it well.

Which of the following is proper procedure when dealing with an elderly patient

Make certain to hold adequate pressure after the draw until bleeding stops.

Lipemic Serum has what appearance

Milky yellow.

What is the most critical error a phlebotomist can make

Misidentifying a patient specimen.

ID bands found on the wall, IV pole, table or bed can be used when

Never.

Is it ok to draw from a vein that already has an IV in it

No, pick a different vein.

If you try a venipuncture and a capillary specimen collection, and neither work, can you continue to try somewhere else

No, two strikes and you're out.

NPO means what

Nothing by mouth.

If a patient adamantly refuses to have blood drawn, you should

Notify the patient's nurse or physician.

Which type of disease is most likely to cause tremors

Parkinson's.

The serum or plasma of a hemolyzed specimen would most likely look

Pinkish to red.

The best way to judge patency of a vein is to

Press and release it several times to determine resilience.

While you are in the middle of drawing a blood specimen, your patient starts to faint. The first thing you should do is

Quickly release the tourniquet and remove the needle.

Increases with altitude

RBC Count. Venous Stasis.

What effects do altitude have on a specimen

RBC is higher when altitude is higher.

Gross Hemolysis of a Serum sample has what appearance

Red.

What is basal state

Resting state of body early in the morning after fasting 12 hours.

The following test orders for different patients have been received at the same time. Which test would you collect first

STAT glucose in the ER.

The proper way to transfer blood from a syringe into an ETS tube is to

Safely remove the needle and attach a transfer device to fill the tube.

Tiny red spots that appear on a patient's arm when the tourniquet is applied are a sign that the..

Site may bleed excessively.

After inserting a butterfly needle, the phlebotomist must seat it, meaning

Slightly thread it within the lumen of the vein.

Name the test time designations in order

Stat, timed, ASAP, fasting. (STAF).

Med Emerg time designations mean the same as what

Stat.

The medical term for fainting is

Syncope.

Which needle can be removed from the blood collection unit before disposal

Syringe needle.

What can cause a tube to lose its vacuum pressure

The bevel is partially out of the skin during venipuncture, or the tube is damaged.

Which of the following is a clue that you have accidentally punctured an artery instead of a vein

The blood spurts into the tube.

What is the problem with partially filled tubes

The blood-to-additive ratio may be incorrect.

You must verify diet and latex sensitivity on who

The patient, and their roommate if they have one.

What can cause a vein to collapse

The vacuum of the tube or the plunger pressure is too strong for the vein, the tourniquet is too tight or too close to the site, the tourniquet is removed during the draw.

Veins that feel hard and cord-like when palpated may be...

Thrombosed.

You insert a needle in a patient's arm and properly engage the tube. No blood flows into the tube. You make subtle needle adjustments and there is still no blood flow. Which of the following is the best thing to do next

Try a new tube in case it is a vacuum problem.

You are in the process of collecting a specimen by venipuncture. You hear a hissing sound, there is a spurt of blood into the tube, and blood flow stops. What most likely has happened

Tube vacuum escaped.

What must you avoid doing after cleaning the venipuncture site

Use unsterile gauze to dry it, fan the site, or blow on it.

Stagnation or stoppage or the normal blood flow

Vasovagal.

If you are drawing a fasting lab, you must do what

Verify that the patient has been fasting. If they have not, check with the RN or Dr. to see if you should proceed with the test. Be sure to label the specimen "fasting" or "non-fasting".

Which of the following tests is affected the most if collected from a crying infant

WBC count.

A student asks the patient for permission to draw a blood specimen. Which of the following answers implies that the student does not really have permission

Yes, but I would rather not.

A patient complains of extreme pain when you insert the needle during a venipuncture attempt. The pain does not subside, but the patient does not feel any numbness or burning sensation. you know the needle is in the vein because the blood is flowing into the tube.

You have only two tubes to fill, and the last one is almost full. What should you do? Discontinue the draw and attempt collection at another site.

Which statement is true of syringe venipuncture

a. A syringe is sometimes used for veins that collapse easily.

The tourniquet should be released

a. As soon as blood flow is established. b. Before needle removal from the arm. c. Within 1 minute of its application.

Which activity can contaminate a blood specimen and affect the testing performed on it

a. Cleaning the site with alcohol before drawing an ETOH specimen. b. Collecting blood cultures before the povidine-iodine is totally dry. c. Using povidine-iodine to clean the site prior to a finger puncture. d. All of the above activities can affect testing done on the specimen.

A hematoma may result from

a. Inadequate site pressure applied after a venipuncture b. Needle penetration through the back wall of the vein. c. Using a needle that is too large for the size of the vein. d. All of the above can result in hematoma formation.

Which of the following is required requisition information

a. Ordering physician's name. b. Patient's first and last names. c. Type of test to be performed.