NHA phlebotomy pocket prep

How should you greet a patient?

"Hello, my name is Bob. Today we are going to collect a test for Dr. Jones." The right approach for success is a professional friendly introduction. Avoid using medical terms and try to give easy to understand instructions

When does gestational diabetes occur?

during pregnancy Gestational diabets is a type of diabetes that occurs during pregnancy in women who do not already have diabetes. Phlebotomists must take care when working with pregnant patients and carefully explain why the ordered tests are being performed.

A centrifuge that is shaking excessively and is louder than usual when turned on most likely

Needs to be properly rebalanced An unbalanced centrifuge may shake, vibrate excessively or sound noisier than usual when it is turned on. Some centrifuges however will automatically slow down or shut off it the load is unbalanced. To correct this problem, turn of the centrifuge immediately and rebalance the specimens. Then, verify the timer and speed are correctly set before turning it on again.

When are blood samples drawn above an IV site acceptable

Never blood samples may be drawn from an IV site, but never above one if IV medication or fluids are being administered. The appropriate thing for the phlebotomist to do is to draw blood from the opposite arm.

What is syncope

fainting The medical term for fainting is syncope. it is preceded by any combination of the following symptoms Patient turning pale, perspiration, shallow breathing, rapid pulse. Fainting is not entirely uncommon during the venipuncture procedure. THe phlebotomist can ensure patient safety by making sure the patient is sitting in a chair when performing the procedure

A critically ill geriatic patient receives orders for his daily labs to monitor whether he is responding to treatment. At least four tubes are required for the daily labs and each need five to ten milliliters(mL) of blood. The patient has Venous Access Device(VAD) that will be used for collection, and facility policy requires that five to ten milliters of blood should be wasted before drawing from the site If daily labs must be drawn for 7 days, what is the minimum total blood volume in liters that will be drawn from this patient for daily labs?

0.175 L 25 mL of blood will be drawn per day(4 tubes of 5 ml blood eachi + 5 ml of blood to be discarded) 25 ml x 7 days = 175 mL 1000 ml =1 L so 175 mL= 0.175 L

To calculate the blood volume of an adult, which equation should you use?

1 kilogram of body weight = 70 milliliters of blood volume Calculating total blood volume may be necessary for certain patients at risk of iatrogenic anemia. Actual blood volume is based on weight and is calculated using the equation of 1 kilogram of body weight = 70 milliliters of blood volume

which of the following blood products does not increase after a patient has been excercising?

Oxygen(O2) as exercise increases, oxygen supply to the muscles decreases, forcing the muscles to use anaerobic metabolism. Creatine kinase and bilirubin increase due to exercise and stress. A major product of anaerobic metabolism is lactate. The other products that decrease as a result of exercise are glucose and hemoglobin.

Removing more than what percentage of an infants blood volume at one time can lead to cardiac arrest

10% Removing more than 10% of an infants blood volume at once can cause cardiac damage or shock Most facilities do not allow more than 35 of blood volume to be withdrawn at one time of 10% in one month

What platelet count should be achieved before a bleeding test can be administered

100,000 platelets per mm^3 Before measuring bleeding time, a physician should order a platelet count in order to ensure the bleeding time test is going to yield accurate results. A normal platelet count will be above 100,000 per mm^3. If less, the test will not help physicians understand platelet activity in patients.

What is the normal blood glucose range

100-126 mg/dL Phlebotomist sometimes may perform a blood glucose test on patients when working with the nursing staff to undrestand the patient's normal and fasting blood glucose levels 100-126 mg/dl is normal, under 100 mg/dl is hypoglycemic and over 126 mg/dl is hyperglycemic

How many milliliters are in one liter

1000

A phlebotomy technician is working in a critical care unit using an i-STAT portable testing machine for a B -type Natriuretic Peptide(BNP) result. Which of the following is most critical to report immediately

1000 pg/ml B type natriuretic peptide(BNP) is a cardiac hormone produced by the heart in response to overload. BNP levels can help physicians determine if shortness of breath is related to a lung problem or heart problem The reference range for BNP is 0-100 pg/ml, so a level of 1000 pg/ml indicates a patient could be experiencing a heart failure episode.

The most effective thing that healthcare workers can do to prevent disease transmission is

Observe good hand hygiene Hand hygiene is the most important way to preven the spread of microbes among workers, patients and in the community

What is the maximum time allowed from collection to analysis of fertility semen samples

30 minutes Due to the rapid cellular deterioration and loss of mobility of sperm, it is important that fertility semen samples are taken to the lab to be analyzed within 30 minutes

What is the minimum amount of time any antiseptic should be in contact with the skin to keep it clean

30 seconds For any cleansing product used to clean skin for venipuncture, the minimum amount of time that the product must be in contact with the skin is 30 seconds. Various cleaners are used for various procedures; however, all of them are required to be in contact with the skin for at least 30 seconds

How much time is allowable between inflation of the blood pressure cuff incision during a bleeding time test

30 seconds once the blood pressure cuff is inflated to 40 mm Hg during the bleeding time test, 30 seconds must be allowed to pass before making the incision. the incision is made in the antecubital region(inside the elbow) 5 cm below the antecubital crease

To prepare a routine blood smear, what angle should the pusher or spreader slid hold at

30 to 45 degrees For a routine blood smear, it is recommended to hold the second slide moving the blood drop at 30 to 45 degrees The angle in which the spreader or pusher slide is held during preparation will vary the results of blood smear. An angle greater than 45 degrees makes the smear thicker. An angle less than 45 degrees makes the smear thinner

What is the most common complication with venipuncture

Pain Pain can be reduced in most patient populations by decreasing the patient's anxiety through a thorough patient introduction and by choosing a site for the venipuncture that is away from nerves and underlying structures

how long should an iodine cleaning solution be allowed to dry on the skin before performing venipuncture?

30-60 seconds Iodine needs 30-50 seconds to dry before the venipuncture can begin. If more than two minutes has elapsed, the site may no longer be clean

To collect blood samples for inborn errors of metabolism such as phenylketonuria or galactosemia, it is important that the filter paper does not touch the skin for all the following reasons except;

Paper discoloration may occur To collect blood for newborn screening tests, the filter paper is brought close to the heel and a large drop of free flowing blood is applied to the center of the first circle on the printed side of the paper. The flowing blood must be kept in contact with the paper, but the paper must not be allowed to touch the surface of the heel as this can result in smearing, blotting, stoppage of blood flow or incomplete penetration of the blood through the paper. Also ,if the paper touches the skin surface, the test paper may be contaminated by the microbes on the skin.

All of the following are methods for collecting blood cultures except:

Urine collection tube Blood cultures cannot be collected with anything other than devices that are meant to contain blood. Preferably no syringe will be used when collecting blood cultures in order to prevent false positive test results.

What temperature is considered appropriate for warm samples?

37 degrees celcius Normal body temperature is about 37 degrees celcius and that is the temperature that samples must be warmed to ensure correct test results. Correct methods for warming samples include using a heel warmer or holding the sample in hand. Warmed samples are very rare and will have instructions from the lab on how to handle. Tests that must be warmed are: Cold agglutinins, cryoglobulin

What pressure must be maintained with the blood pressure cuff when performing a bleeding time test?

40 mmHg A Surgicutt device is a spring loaded blade taht makes a standardized cut 5 mmlong and 1 mm deep into the patient's skin, retracting into the device after use. Next, testing paper is applied to the wound once every 30 seconds until the process is complete. pressure is created with a blood pressure cuff inflated to precisely 40 mmHg. the phlebotomist should be careful to not create an incision on top of any superficial veins as this will create more bleeding than is necessary.

When collectin an arterial blood gas sample, at what angle should the needle be inserted in the skin

45 degrees Arteries have thicker walls and higher interior pressure than veins; therefore, it is necessary to use a steeper angle than when performing venous collections to ensure the needle does not reflect off the arterial wall

All of the following are types of diabetes except

Post diabetes The three types of diabetes the phlebotomist needs to be aware of are pre-diabetes, diabetes mellitus type 1 and type 2

Which of the following is not part of the coagulation cascade?

Potassium There are six steps to the coagulation cascade, of which clots, platelet activation, and the conversion of prothrombin to thrombin are essential Potassium is not part of the cascade directly; the chief electrolyte is calcium

Why must fertility semen be analyzed within 30 minutes of collection

Rapid sperm deterioration and loss of mobility After 30 minutes of leaving the patient, sperm begin to deteriorate and lose mobility. As these are two major consideration in fertility testing. It is important to get the sample to the lab within 30 minutes

Which of the following is not considered part of properly greeting the patient?

Reading the patient's chart When greeting a patient, introduce yourself with your name and role, make eye contact to ensure the patient is attentive and describe the venipuncture procedure While the patient's chart is important, it does not contain the information a phlebotomist needs to greet the patient and develop trust. Reading the patient's chart should not be performed at this time

After performing a dermal puncture for the collection of a capillary blood specimen, the phlebotomist knows that the correct order of draw is

Slides, platelet counts or hematology specimens, anticoagulant microtubes, serum tubes Slides, platelet counts, and other hematology specimens should be collected first to avoid the effects of platelet aggregation(clumping) and clotting. Next, anticoagulant microtubes should be collected. Serum tubes are collected last

Reviewing laboratory requisition forms is an important step in the venipuncture procedure. A thorough review helps identify

Test status and collection priority In reviewing laboratory requisitions forms, the phlebotomist can prioritize the requests and sort them to ensure that specimens are collected at the right time under proper conditions and that the required supplies are available Information that is not found on a lab form and that cannot be obtained from a review of the laboratory requisition forms, include: 1. other tests a provider might order 2. what time will lunch be 3. previous reactions patients have had

In addition to patient name and a unique identifying number, what other information is required to be on the sample label

Test to be performed The test to be performed is crucial information and must be on all labels to ensure accurate results and proper billing Patient middle name, phlebotomist name and tube additives are not required information on the sample label although they are sometimes included particularly with computer printed labels

What is the average time it takes a laboratory to process a STAT sample

45-60 minutes Although STAT samples require immediate attention from the phlebotomist, the lab tests on those samples can take a long time. Certain cardiac and thyroid tests can take 45 minutes to over an hour on average to process

How long does a urine sample remain stable in a gray top urine collection tube?4

48 hours Remember that urine in a standard sterile urine collection cup stays stable for only two hours and slightly longer than that if refrigerated. The gray top tube can keep urine stable for 48 hours allowing for long transport tubes

what time frame is required for a purified protein derivative(PPD) test to be read?

48- 72 hours The PPD test takes 48-72 hours to develop into a finalized induration; this is the standard time frame. Any test read before 48 hours or after 72 hours could yield inaccurate results

What is the ideal temperature needed to preserve a urine sample?

5 degrees celcius(41 F) A urine sample should never be frozen. 5 degrees celcius is above freezing but stilled chilled. Freezing would destroy metabolites in the urine for which it is being tested.

how many times should a tube be inverted to be mixed appropriately

5-8 times. The only appropriate way to mix a sample is by inversion which is accomplished by putting the blood tube in hand and turning it upside down 5 to 8 times, ensuring proper mixing with additives. Any other method especially shaking can lead to damaged sample or even the tube. Light blue and lavender tubes are anticoagulant tubes and therefore the most sensitive to mixing

What is hyperinsulinemia?

Overproduction of insulin by the body Hyperinsulinemia is a condition in which the body overproduces insulin, which can cause dangerously low level of blood glucose(hypoglycemia). Phlebotomist will often see blood glucose levels below 70 mg/dl

Newborn/neonatal screening (NBS) tests are important because some health conditions present at birth may not show signs right away but can be life threatening All of the following may contaminate the NBS results except

Oxygen NBS test forms are printed on filter paper with outlined collection circles. For accurate results , the only blood specimens should touch the circles. Substances known to alter NBS specimens include alcohol, formula, lotion, powder and urine. After collection, specimens should be allowed to air-dry

Why are fertility semen samples collected

To determine sperm count and activity The two main reasons semen is collected and tested is to check for the presence of sperm after a vasectomy and to perform a fertility test, which observes sperm count and activity

Why are post-vasectomy semen samples collected?

To determine sperm presence The two main reasons semen is collected and tested is to check the presence of sperm after a vasectomy and to perform a fertility test which observes sperm count and activity.

What is the purpose of additives in a blood culture bottle

To encourage micoorganism growth The purpose of collecting blood cultures is to test for microorganism; therefore the blood culture tubes are designed to encourage microorganism growth and replication so they can be easier to identify

The purified protein derivative(PPD) test is used to determine what communicable disease

Tuberculosis The purified protein derivative(PPD) test is an injection of 0.1 mL 5-TU(toxin unit) PPD directly under the skin to produce a wheal which is a white raised bump. This test is only for tuberculosis and is often a skill required of phlebotomists

Which of the following is the phlebotomist not required to report to their supervisor

A patient compliment Patient or employee injuries or potential injuries must be reported as incident or occurrence reports

Which of the following is an appropriate form of patient identification

A patient identification bracelet attached to the patient's body with the patient's correctly spelled first and last name, full date of birth and hospital numbers A patient identification bracelet is attached to the patient and contains the patient's correctly spelled first and last name, correct date of birth(month, day and year) hospital account and identifcation numbers and sometimes the physician name. The most important information is the patients full name and date of birth Appropriate patient identification does not include country of origin or gender

Which of the following patients is most at risk for a low pH error?

A patient with a tourniquet on for more than one minute- A tourniquet that is on for too long will create a hemoconcentration at the location the tourniquet is being placed, forcing electrolytes to attempt to maintain homeostasis by moving in and out of the cells and into the blood. This causes pH to lower.

What additives does the yellow top blood collection tube contain?

ACD or SPS The yellow top blood colelction tube contains ACD(acid-citrate-dextrose) or SPS(sodium polyanethnol sulfonate) and is used for paternity testing and DNA studies

At what point in the venipuncture process should the phlebotomist remove their gloves

After disposing of used materials Gloves should be discarded and hands sanitized after the procedure is complete but before the phlebotomist leaves the drawing area The phlebotomist should still have gloved hands when they raise the bed rail to prevent pick up microbes on their hands from the patient's bed. The phlebotomist should not leave the room with dirty or used gloves on.

When should samples be labeled?

After collecting the sample and before leaving the patient Labeling samples after collecting the sample and before leaving the patient allows the phlebotomist to ensure that a misidentification has not been made. Sample collection tubes are generic and do not come labeled with any patient or order information. however, tubes are color-coded based on the tests to be completed. the phlebotomist may utilize the patient's nurse or laboratory staff if he/she has any questions about which tubes to use.

What is hemoglobin?

An oxygen carrying molecule Hemaglobin is a molecule that carries oxygen around the body to the tissues and organs where it is used for metabolism. Anything that affects hemoglobin such as an anemic disease, also affects the body's ability to deliver oxygen to the tissues

Where is edema most commonly observed in patients?

Arms and legs edema is most commonly observed in the arms and legs because the hands and feet are the furthest away from the heart, which means less pressure is available to pump fluid back into the central circulation causing it to leak into the tissue

Which of the following is within the certified phlebotomy technician's scope of practice?

Arterial blood gas sampling Arterial blood gas sampling is a procedure taht can be performed by a certified phlebotomist who has received specialized training. it is likely the most complex procedure that the phlebotomist will learn More extensive procedures involving bone marrow, cytology sampling, or involving autopsies require advanced training, and they are usually performed by a laboratory pathologist. A pathologist is a physician who has completed medical school and three to four years of additional study in the laboratory

Which of the following Arterial Blood Gas(ABG) results received at Point of Care Testing(POCT) indicates a critical result and should be reported immediately?

Arterial s02 of 79 ABG's measured at POCT inside pH which normally ranges from 7.35 to 7.45 and oxygen saturation(sO2) which normally ranges from 90 to 98

Which vessels carry blood away from the heart

Arteries carry blood away from the heart. Arterial blood is oxygenated except that flowing through the pulmonary artery, which carries deoxygenated blood to the lungs. The phlebotomist must be aware of the difference between arteries and veins

When attempting to palpate a vein, a phlebotomist feels a pulse. What structure is the phlebotomist feeling?

Artery Arteries are surrounded by smooth muscle that assist the heart in pushing oxygenated blood to the tissues. If the phlebotomist thinks a vein has been found but can detect a pulse, this vessel is an artery rather than avein. Ligaments and tendons do not have pulses and are easily differentiated in most patients.

How does posture affect blood pressure and blood volume

As the patient stands from sitting or laying, blood pressure goes down and blood volume goes up As blood volume goes up and blood pressure drops, the permeability of the cell walls changes, which can alter the blood products in a blood sample. Normally patients are sitting or laying down when blood is being drawn. however, it is important to remember that posture can affect test results

What should the phlebotomist do with an order for blood samples from a patient who has a intravenous(IV) line running on each arm?

Ask the nurse to stop the infusion and draw from a site below the intravenous(IV) insertion site A phlebotomist is not qualified to make IV adjustments like turning off the IV pump. IT is preferred that blood specimens not be drawn from an am with an IV because the sample can be contaminated or diluted by the IV fluid givving erroneous test results If there are IVs in both arms, blood can be collected below the IV site by the phlebotomist

What is the best way to verify a conscious patient's identification

Ask the patient While a seemingly obvious answer, asking the patient is the first and often the best method for verifying any information the phlebotomist might need. Remember, ,most errors in the healthcare setting are administrative/ clerical, the area under which patient identification and verification fall

After a successful venipuncture using a buttefly needle or winged infusion collection set, all of the following are correct actions except:

Ask the patient to close their hand when the patient closes their hand, this increases venous pressure which could cause increased blood flow to the puncture site. Instead the patient should relax and allow the site to clot so bleeding stops The phlebotomist should activate the butterfly needle safety shield and then disconnect it from the syringe to discard it in a labeled biohazard container. Then the phlebotomist should remove the gloves and wash their handsd

How does aspirin affect bleeding time?

Aspirin prolongs bleeding time Aspirin is a drug which decreases platelet function by preventing them from sticking to each other, which makes forming clots more difficult. This is very important for patients who are at risk of forming clots in their vasculature but can mean increased bleeding times if they are injured or undergo procedures.

What are two components of a syringe?

Barrel and plunger- a syringe is compromised of a barrel and a plunger. The barrel is a hollow tube which is used for storing and measuring various liquids. The plunger creates the physical means to either draw or push a liquid into the barrel. A phlebotomist must be very careful to control the amount of force he or she exerts on the plunger so as to not damage to blood cells.

Point-of care testing (POCT) require Quality Control(QC) checks to monitor the quality of waived tests that are performed. the college of american pathologists(CAP) requires external liquid control testing

Be done before using a new batch of test strips or kits The college of american pathologists does not set a frequency of testing but rather advises facilities to conduct external quality control checks when new supplies are used, new personnel are using the device and as recommended by the manufacturer

Why might samples be collected from a patient in timed intervals

Because drug levels differ in the patient as time goes on Samples may be collected from a patient in timed intervals to allow the physician to see how the patient's body is responding to a medication that has been administered. The levels of the drug in the system will decrease as it is metabolized. The phlebotomist must be aware of trough level samples(also known as predose) and peak level samples and when they must be taken

Why are standard procedures often ignored in routine urine collection?

Because the patient is the one collecting the sample- Patients are often the ones collecting the urine samples without a phlebotomist or staff member nearby to hellp. Because of this, the standard procedures of collecting urine are not always followed.

Why should a phlebotomist avoid using his or her thumb to palpate a patient's vein

Because the thumb has a pulse and is not as sensitive A phlebotomist should use their first and middle fingers to palpate for a patient's vein because they are more sensitive to touch than the thumb. Furthermore, the thumb has an artery large enough to feel if pressure is applied, which can give a false sensation to the phlebotomist

Current American heart Association(AHA) guideline for infant or child cardiopulmonary resusciation(CPR) include:

Compression depth of four centimeters for infants For infant of Child CPR: CPR begisn with 30 compressions(single rescuer) or 15 compressions(2 person CPR). Recommended compression depth is 4 cm for infants and 5 cm for children up to the onset of puberty An infant or child compression rate of 100 to 120 per minute is the same as current guidelines for adult CPR. one or two healthcare professionals can perform CPR on a victim

STAT and panic(critical) value test results should be

Confirmed for accuracy by read back When phoning test results, it is important to make certain the person receiving the results is authorized to receive the information writes it down and then reads it back to you for accuracy. This practice is known as read back STAT and panic(critical) value tests results are reported to the physician right away, not to the patient. Results are reported first before a decision is made about repeating the test if indicated.

A phlebotomist palpates a venipuncture site just after cleaning it with an alcohol based solution provided by the healthcare facility. What is the next step the phlebotomist should take?

Clean the site again Once the venipuncture site has been cleaned, nothing can touch it except for the sterile materials including the needle being used to puncture the patient's skin. if the phlebotomist is forced to palpate the site again, he or she must clean the site again using appropriate technique

When performing phlebotomy for blood donation, the phlebotomist should

Clean the site in the same way as a blood culture collection Principles of donor unit collection include: Clean the venipuncture site in a manner similar to blood culture collection Choose the site in a manner similar to routine venipuncture; the antecubital veins are preferred Use a 16 or 18 gauge needles Position the bag lower than the patient's arm so it will be filled with gravity

The best resource for a phlebotomy technician to find established guidelines and laboratory procedures i

Clinical Laboratory Standards Institute(CLSI) Procedures by the Clinical Laboratory Standards Institute(CLSI) publications are a constant source of reference. The CLSI establishes laboratory guidelines and procedures and maintains uniformity of lab procedures on a national basis

What additive does the red-mottled or tiger top blood collection tube contain?

Clot activator the red mottled or tiger top tube is a serum separating tube(SST) with clot activator and is used for blood type screening and chemistries

Which of the following tests require warming after collection

Cold agglutins

Lab coats worn for specimen collection should:

Come in reusable or disposable styles Lab coats are worn to protect the skin and the healthcare worker's clothing during patient care in which splashes or sprays of blood are possible. Lab coats used for specimen collection and handling are generally made of fluid-resistant cotton or synthetic material, have long sleeves with knit cuffs and come in both reusable and disposable styles. Lab coats worn as Personal Protective Equipment(PPE) must be removed before entering nonpatient care areas

In addition to ejaculation, what else should the phlebotomist ensure the male patient has not done three days prior to providing a fertility semen sample

Consumed alcohol Alcohol has a variety of toxic effect on the body, one of which is on sperm. Sperm count and activity can be diminished by the consumption of alcohol; therefore, the avoidance of alcohol is a standard instruction for most clinics performing male fertility tests

A patient with diarrhea with a likely infectious cause might be on

Contact precautions Contact precautions are used when a patient is known or suspected to have an infection with microbes that are spread by direct contact with the patient or indirect contact with surfaces

What kinds of swabs are used for nasopharyngeal cultures

Dacron/cotton tipped swabs- there are many different types of swabs for collecting specimens. Swabs that are for collecting throat cultures are not appropriate for nasopharyngeal cultures because of the material used and the additives on the tip. The phlebotomist must check with their employer regarding what swab is used for each test.

What is meant by diurnal?

Daily variation of blood levels at a particular time of day. Diurnal refers to daily variations in blood levels at a particular time of day. By definition circadian refers to cyclical changes throughout the day, such as with sleep, body chemistry, and energy levels. Circannual refers to seasonal changes of the same things over the course of a year.

Blood in the urine may indicate what condition?

Damage to renal organs Blood in the urine is usually easily detected. The phlebotomist will see orange or red urine in the sample cup. if this is the case, notify the nurse and physician immediately. Without other symptomsthis may not be an emergency or the condition may be known

Which of the following tubes contain heparin?

Dark green top The dark green top blood collection tube inactivates thrombin and thromboplastin to prevent the blood from clotting in the tube. its uses include ammonia, lactate and HLA typing

Jane is in the laboratory preparing a peripheral blood smear for a Complete Blood Count (CBC) differential. After the slide dries, she observes ridges in the blood film and is disappointed that the smear is not smooth. She decides to remake the slide. Which of the following should Jane do this time to improve the quality of her blood smear?

Decrease pressure on the spreader slide One common problem observed with blood smear slides is the presence of ridges or uneven thickness in the smear. This occurs when too much pressure is applied to the spreader slide. It takes considerable practice to make good slides consistently. Any pressure exerted on the spreader slide should be directed across the slide in the direction that the film is made, rather than down on the stationary slide

Delaying the analysis of urine samples can cause all of the following except:

Decreased red blood cell counts Delaying the analysis of urine samples can cause multiplication of bacteria, increased or decreased nutrient levels and deterioration of chemical and cellular elements. Delaying the analysis of urine samples would not typically affect red blood cell count as red blood cells should not be in urine. Their unusual presence may indicate damage to internal renal organs

Which of the following is not an agency which regulates the transportation of clinical specimens?

Department of Revenue the healthcare industry is heavily regulated by various state and federal agencies which extend to the shipping of clinical specimens. These specimens can contain dangerous pathogens or infectious agents, and they must be closely watched. This being said, it is not the function of the department of revenue to regulate the shipping of clinical specimens.

What is the advantage of pneumatictube system

Faster sample delivery Pneumatic tube systems ensure faster sample delivery to labs in hospitals. However, they are more traumatic to the samples and do not function as secondary containers. Furthermore they can be prone to errors such as sending the sample to the wrong tube station

What is a typical length of time a patient is asked to fast before a blood test

Fasting samples are generally taken 8 to 12 hours after a patient last ate or drank and are often obtained early in the morning. Both black coffee and smoking affect metabolism and therefore affect fasting samples

What is nausea?

Feeling sick- nausea is a common sign in patients and can be the result of a myriad of conditions. if a patient tells the phlebotomist that they are feeling nauseated, the phlebotomist should be aware that the patient may vomit and should have a container ready for the patient.

Which type of patient is most likely to have a contaminated urine sample

Female Females have more surface are in which bacteria can accumulate, placing them at higher risk for foreign microorganisms contaminating the urine sample. Proper cleaning is essential for female patients

Which of the following is not an appropriate venipuncture site?

Femoral vein The femoral vein is not an appropriate site for venipuncture because it is deep inside the patient's hip and runs very close to the femoral artery. The femoral vein is used when central lines are placed by physicians but should not be considered for routine venipuncture The most appropriate site for venipuncture is the antecubital fossa(the region of the arm in front of the elbow) followed by the back of the hand and wrist. Caution must be used when attempting venipuncture on the hand or writst because these can be very panful and difficult to accomplish. The ankle or foot may be used, however, these sites tend to be them most painful. The ankle and foot are also the most unclean areas which will require the phlebotomist to take extra preparation and caution

To verify a patient's identity, you must ask them to state

Full name, date of birth and spelling of their name According to the Clinical Laboratory Standards(CLSI) standards, the phlebotomist must ask the patient to state his or her full name, date of birth, and spell their firsts and last names. Their response must match the information on the test requisition and/ or all specimen labels

What color tube is used for platelet function

Light blue When assessing coagulation tests in patients, platelet function is often observed. This is done with the light blue which must be filled 100%

Which of the following is the first site a phlebotomist should look for a suitable vein for venipuncture

Upper arm The upper arm(antecubital region) is the most appropriate site to assess vein quality on a patient and therefore the first place a phlebotomist should look. These veins are easy to palpate, visualize and puncture with a needle ,so the chance of error is greatly diminished

Sputum samples are collected by coughing up phlegm and mucus from the

Upper respiratory tract To properly and safely collect a sputum sample, the patient is asked to rinse their mouth with warm water to reduce bacteria and food particles that might mix with the sample. Then, the patient is instructed to breathe deeply several times, and cough up sputum into a sterile container. The patient should seal the container tightly and hand it to the phlebotomist

Which of the following is untrue regarding the handling requirements of urine specimens

Urinalysis and urine culture specimens can be held at room temperature for two hours if protected from light If immediate processing of Urinalysis(UA) and Culture and Sensitivity(C&S) samples are not possible, the specimen must be refrigerated immediately. It should not be held at room temperature. An alternative to refrigeration would be to transfer the urine to a preservative tube. When filling urine specimen tubes, it is important to fill exactly at the indicated level for the correct urine to additive ratio. Overfilling would dilute the preservative concentration

A high bacterial count in a urine sample may indicate what condition

Urinary tract infection Urinary tract infection(UTIS) are a common form of disease and present with fever, painful urination, the urgency to urinate, and bacteria in the urine. Obtaining a clean catch urine sample is critical in diagnosing a UTI.

What type of sample is most often collected for chain of custody scenarios

Urine Most chain of custody samples are urine for drug testing. The phlebotomist should follow all normal procedures for collection and labeling and be sure to include the chain of custody paperwork

What is the most common specimen a patient will be asked to collect themselves

Urine Patients will often be asked to collect samples themselves. the most common of these is urine. It is imperative that the phlebotomist is experienced in giving instructions to patients so that samples are not contaminated

What is the function of the gray top urine collection tube

Urine Cultures Urine collection tubes look much like blood tubes; however, they are only to be used for urine. Although they are somewhat uncommon in the inpatient setting, a phletbotomist may need to use one of these tubes in the event the urine needs to be stored for a period of time without degrading.

What device is used by the phlebotomist to collect urine from a pediatric patient who cannot yet control urination

Urine collection bag Pediatric patients often do not have full control of their ability to urinate on demand. Therefore, after thoroughly cleaning the genitalia and the surrounding area, a phlebotomist may apply a bag that covers the genitalia and adheres in place. The patient may then urinate and the contents will be used for testing.

What is the first test most physicians order in the diagnosis of diabetes?

fasting glucose The first step to diagnosing diabetes is a fasting glucose. With this test, physicians can get an idea of what further tests needed to be ordered to complete the patient diagnosis

When should a catheter be used to collect a urine sample from a patient

When a patient cannot voluntarily give a urine sample Catheters are an effective way to retrieve urine samples from patient who cannot voluntarily give a urine sample. Do not confuse this with a patient who refuses to give a urine sample; a patient must always give consent. Unconscious patients are good candidates for catheters. placing a catheter should be avoided whenever as possible as catherization can introduce bacteria resulting in infection

Correct labeling must be placed on specimens and it should include

date of draw, time of drawing, identification of the person collecting the sample The correct label must be placed on the correct specimen and the date, time of drawing and identification of the person collecting the sample should be noted

What is the definition of thrombocytopenia?

decrease in platelet count The phlebotomist must be aware of different conditions that may affect how the patient forms clots as the phlebotomist is performing an invasive procedure that requires clotting.

Blood volume for adults is generally reported in

Liters Blood volume is reported in liters rather than milliliters for adults. one thousand milliliters equal one liter of volume

All of the following are common tests for blood smears except:

Liver panels Blood smears are not very common tests; however, a phlebotomist should be familiar with what they are. the smalls drops of blood approximately the size of a dime place on a glass slide to be evaluated in a lab. Blood smear test for malaria, are use in hematology and for complete blood counts

What is hypoglycemia

Low blood sugar Hypoglycemia is the medical term for low blood sugar and is found in patients who have been fasting and who have diabetes. The phlebotomist should be aware of this as the condition can be dangerous although easily treated if caught in time

anchoring the vein below the venipuncture site

is meant to prevent rolling veins Anchoring the vein below the venipuncture site helps to prevent the vein from moving or rolling after the needle is inserted

Which of the following is the best practice regarding the labeling of a "discard" tube?

Mark any discard tube with an x or the word discard It is helpful to mark the discard tube with an x or the word discard so that it is not inadvertently sent to the lab for testing

Which of the following is an acceptable temperature for the laboratory freezer

-5 degrees celsius. Five below zero degrees Celsius is equal to 23 degrees fahrenheit. To convert celsius to fahrenheit multiply the degrees Celsisu by 2 and then add 30 to get the estimated temperature in degrees fahrenheit.

What is the size of the blood drop needed for a good blood smear

1 to 2 millimeters- to make a good blood smear, a drop of blood that is one to two millimeters in size should be placed in the center of the slide approximately 1/2 to one inch away from the edge of the slide. If the drop is large than this size, the smear may be too thick or too long. If the drop is smaller than this size, it will make a blood smear that is too short or too thin

The speed and time of centrifugation are important specifications for each lab. Which setting would likely result in the best separation of serum from cells

1,200 g for 10 minutes The force applied to the substance being centrifuged is called gravity(g) or relative centrifugal force(RCF). This force is a function of the rotation speed of the centrifuge and the rotation radius and thus varies according to the centrifuge size. Generally centrifuging blood specimens in a setting that creates a force of 1,000 g for 10 minutes will result in a good separation of plasma from the cells Gel tubes may require a force of 1,000 to 1,300 for 10 minutes. If a force less than 1,000 g is used the gel may not function properly and the barrier it provides will be incomplete.

How much blood is required for pediatric blood cultures

1-5ml per bottle Recall iatrogenic anemia is a type of anemia that occurs when too much blood is drawn from pediatric patients. This is very dangerous and must be kept in mind when drawing blood for pediatric draws. Draw no more than 5 mL per bottle in pediatric patients. In neonates, refer to the nurse and physician for exact draw amounts

When obtaining a nasopharyngeal specimen, how much of the specimen swab shaft should be inserted through the nare

1/3 to 1/2 To obtain a nasopharyngeal specimen, gently insert the swab into one nostril, stopping when the swab contacts the mid-inferior portion of the inferior turbinate. This is typically 1/3 to 1/2 way up the shaft

Which of the following is not an approved antiseptic agent for cleaning a site prior to skin puncture

10 % bleach solution A 10 % bleach solution is approved for cleaning hard surfaces such as countertops but is not approved for cleaning skin. Zephrin chloride and benzalkonium chloride are alternative skin cleansers used for certain procedures and hydrogen peroxide may be used if patient is allergic to alcohol.

A children's hospital uses 5% as the maximum total blood volume that can be drawn from a preterm infant during a 30 day period. What is the maximum blood volume that can be drawn from an infant weighing 4.4 pounds (lbs) in that time period?

10 mL A preterm infant that weighs 4.4 lbs weights approximately 2 kg(4.4 divided by 2.2 because 2.2 lbs = 1kg) if the infant weights 2 kg and the blood volume is 100 ml per 1 kg per weight then the baby's total blood volume is 200mL if the maximum blood volume that can be drawn during a 30 day period is 5% then the maximum volume that can be drawn for this patient is 10mL( 200 x 0.05 = %5 of 200 ml)

The phlebotomist calculated the total blood volume of a 33.4 kg pediatric pateint to be 2672 ml. If the toal amount of blood drawn during hospitalization(up to 30 days) should not exceed 5% of total blood volume, what is the maximum amount of blood that can be collected from the patient.

133.6 mL 5% of the pediatric patient's total blood volume of 2672 mL is 133.6 ml(2672 x0.05=133.6)

If the phlebotomist can easily visualize and palpate a patient's vein, which angle would be optimal for needle insertion?

15 degree angle- the angle at which the needle is inserted into the skin of the patient depends on the depth of the vein. The phlebotomist has selected. shallow veins require more of shallow angle, whereas deeper veins require a steeper angle. The phlebotomist should remember that too shallow of an angle will create more pain for the patient, while too steep of an angle will not provide adequate blood flow and may damage underlying structures

For patients on anticoagulant drugs, what length of time should the patient be asked to stay in the lab or clinic to ensure bleeding has not continued after venipuncture?

15 minutes For patients on anticoagulant medications, bleeding is a major concern, even with small needles used in blood sample collection. Therefore, the patient should remain in the clinic or lab for 15 minutes to make sure the bleeding stops. If the bleeding does not stop, the nurse or physician should be notified

When properly washing one's hands, what minimum amount of time must one scrub with soap?

15 to 20 seconds the minimum amount of time that a healthcare worker should scrub their hands with soap when their hands are soiled is 15 to 20 seconds. Often healthcare facilities have their own specific protocols for handwashing. Remember, alcohol based cleaners are not appropriate when the hands are visibly soiled.

To obtain maximum blood flow, between which angles should the needs be inserted into the patient's skin

15 to 30 The angle at which the needle is inserted into the skin of the patient depends on the depth of the vein the phlebotomist has selected. Shallow veins require more shallow angle whereas the deeper veins require a steeper angle. The phlebotomist should remember that too shallow of an angle will create a great deal of pain for the patient, while too steep of an angle may not provide adequate blood flow and may damage underlying structures

Which of the following needles has the largest diameter

16 gauge The seemingly counter intuitive way of measuring needles must be understood by the phlebotomist. The smaller the gauge the larger the diameter of the needle. Blood cannot be drawn from anything smaller than a 23 gauge needle as blood would be destroyed by being forced through such a small diamter. A typical gauge for drawing blood is 20. Gauges 18 and 16 are used for IV infusions and blood donor

If the average blood volume for a geriatric client is 70 milliters(mL) per kilogram(kg) of body weight, what is 2.5% of the total blood volume in a patient that weighs 212 pounds

168.28 mL 212 pounds(lbs) =96.16 kg(1 l1b = 0.454 kg) 96.16 kg x70 ml=6731.2 mL of total blood volume 2.5% of 6731.2 =168.28 ml(6731 mLx0.025)

What is the smallest gauge needle that can be used for blood donor unit collection

18 gauge A sterile 16 to 18 gauge needle is required for donor unit collection because this sizes minimizes shearing forces that can irreversibly damage blood cells as they flow through the lumen. The blood collection unit is a sterile closed system consisting of a bag to contain the blood, connected by a length of tubing and needle When it comes to gauging, a higher number means a thinner needle. Therefore, the 18 gauge is the smaller needle.

What is the minimum number of verifiers a phlebotomist may use to verify a patient's identity

2 Using two patient identifiers to correctly verify a patient is standard across the medical community. The most common two identifiers are the spelled the full name correctly and correct date of birth. The third is an identifcation number. If the phlebotomist believes there might be an error, of cannot attain at least two identifiers from the patient, then they can refer to the patient's nurse, physician or even the clinic's registration staff.

How many bottles are typically filled when a blood culture test is ordered

2 bottles When a blood culture test is ordered, two bottles are filled. One anaerobic(without air) and one aerobic(with air). The aerobic bottle is always filled first to prevent air coming in contact with the anaerobic bottle

For microcollection through capillary puncture on infants, what is the optimal puncture depth of the heel for a full term infant

2 millimeters From birth to about six months, the heel is the proper area of capillary puncture, after six months, the heels starts to become too thick, and a finger stick or large toe stick may be appropriate. The puncture must be done with a depth controlled lancet. The optima ldepth of puncture of the heel of a full term infant is 2 millimeters

Which of the following needles is inappropriate for blood collection?

25 gauge needle A 25 gauge needle cannot be used for venipuncture because the red blood cells would be destroyed when the blood is pulled through the bore of the needle. 25 gauge needles are used for intramuscular injection. insulin shots are given through much smaller needles sometimes as small as 30 gauge

Where should a tourniquet be placed?

3-4 inches above the puncture site The tourniquet should be placed 3-4 inches above the puncture site to allow for enough space for the vein to be easily palpated and enough space for the needle to puncture the vein If the tourniquet is too close to the puncture site, it could constrict the vein enough to not allow for sample collection. If the tourniquet is too high on the patient's arm, a suitable vein may be too deep within the arm for the phlebotomist to palpate

Avoiding hair and veins, the site of injection for a purified protein derivative(PPD) test is .

3-4 inches down from the antecubital fossa The PPD test must be allowed to develop over 48-72 hours and must be in a comfortable yet safe location that can easily be read by technicians but not exposed to common event such as bumping into doorways or direct exposure to sunlight

If the phlebotomist suspects the patient's veins lie deep inside the arm, he or she should insert the needle at which angle

30 The angle at which the needle is inserted into the skin of the patient depends on the depth of the vein the phlebotomist has selected. Shallow veins require a more shallow angle(15 degrees) wherease deeper veins require a steeper angle(30 degrees). the phlebotomist should remember too shallow of an angle will create more pain for the patient while too deep of an angle will not provide adequate blood flow and may damage underlying structures.

What strength of purified protein derivative (PPD) is injected under the skin to test for tuberculosis?

5-TU(toxin units) When a tubercuosis skin test is administered and injected underneath the skin, the strength of the purified protein derivative used is 5-TU(toxin units). This is the standard amount and is not live tuberculosis. nonetheless, gloves should be worn at all times.

A patient in critical care with a sepsis diagnosis has a STAT lactate level obtained. Which of the following is the most concerning?

5.1 mmol/L Lactic acidosis is associated with major metabolic problems due to hyperlactatemia(Increase lactate in teh blood). A normal reference range for lactate level is 0-1.0 mmol/L A pattient with a lactate level of more than 5 mmol/L has a very poor prognosis.

Centers for Disease Control and Prevention (CDC) studies have shown that phlebotomy procedures were involved in appoximately what percentage of the HIV exposures that occured in healthcare settings

50% Approximately half or 50% of HIV exposures reported in healthcare settings involve phlebotomy

To calculate total blood volume in an elderly patient at risk of iatrogenic anemia, which is the most appropriate conversion factor

70 milliliters of blood per 1 kilogram of body weight The average adult blood volume is 70 ml/kg of body weight 100 ml/kg is the average blood volume for newborn babies who do not have the bones or muscle tissue that adults do

When cleansing a finger for capillary puncture, what percentage of isopropyl alcohol is appropriate?

70% A 70% isopropyl alcohol solution is the most appropriate for cleaning a finger for capillary puncture. Be sure the site is dry before performing the puncture as the solution could cause a stinging sensation for the patient.

What is a normal fasting blood glucose range

70-100 mg/dl Phlebotomists sometimes may perform a blood glucose test on patients when working with the nursing staff to understand the patient's normal and fasting blood glucose levels. 100-126 is normal, under 100 mg/ dl is hypoglycemic and over 126 mg/ dl is hyperglycemic

How long does a urine sample remain stable in a red-yellow(tiger) top urine collection tube?

72 hours The red-yellow(tiger) top urine collection tube can keep a urine sample stable for 72 hours; however cultures, drugs test, and other specialized tests cannot be run on it, only urinalysis

At least how full must all anticoagulated blood tubes be filled?

75% Anticoagulated tubes generally do not need to be filled to 100% and can include air if necessary. the anticoagulation additives often alter the sample to the point where the other tests cannot be run on the sample, so the minimum required amount is 75% of the tube

What is the minimum level to which most blood tubes should be filled?

75% Most blood collection tubes are required to be at least 75% filled with blood to ensure a correct lab result. The light blue and other coagulation tubes must be filled to 1oo% if a phlebotomist can only get a limited amount of blood, the patient's nurse should be notified and the samples sent to the lab

According to the Clinical Laboratory Standards Institutes(CLSI), the blood volume for infants and children is

75-100 ml/kg Actual blood volume is based on weight. Blood volume can be calcualted for any size patient if the weight is known. To calculate total blood volume in a pediatric patient. The clinical laboratory standards institue(CLSI) gives the following Premature infants: 115 ml/kg New borns- 80-100 ml/kg Infants and children 75-100 ml/kg

For a pediatric patient weighing 39 kilograms, collection of which blood culture bottle is recommended

8 milliters of blood in a blue capped aerobic culture bottle For a child weighing 39 kilograms(86 pounds) it is safe and preferred to collect 5-10 ml of blood in a routine anaerobic blood culture bottle Laboratory and facility protocols for pediatric blood cultures will detene the recommended amount of blood the phlebotomist will obtain. Blood volume for pediatric patients is usually age or weight dependent. In infants and young children, a pediatric(pink capped) bottle may be used. this typically requires only 1-5 milliliters of blood specimen, although requirements may vary according to the manufacturer

What is the amount of blood needed to accurately conduct a blood culture

8-10 mL per bottle Much like blood tubes, the additives in blood culture bottles require a very specific amount of blood to produce the results needed. In 10 mL of blood, it is very possible that only one or two microorganisms are present so the full amount 8-10 mL is needed

At least how full must all coagulated blood tubes be filled?

90% the additives in coagulated blood tubes are measured very carefully and require a specific amount of blood to provide accurate results. The only tube that requires 100% is the light blue top blood collection tube; the other coagulant tubes require at least 90%

What is a blood smear

A blood sample placed on a glass slide for analysis Blood smears are not very common tests; however, a phlebotomist should be famliar with what they are. they are small drops of blood approximately the size of a dime placed on a glass slide to be evaluated in a lab. if a phlebotomist is expected to prepare a slide, he or she will be trained by their employer

What is septicemia?

A condition in which microorganisms are circulating and multiplying in the patient's blood Septicemia is a basic term that must be understood as almost all types of tests performed on patient could be looking for microorganisms. Septicemia arises from a countless number of microorganisms, many of which can be communicable, so proper safety precautions must always be observed when septicemia is suspected.

Which of the following patients are most at risk for an error in white blood cell count?

A crying baby The WBC count of a blood test can be significantly altered if a baby has been crying forcefully without being consoled. It is common for infants to cry when a blood sample is taken; therefore it is important to use proper technique when dealing with pediatric patients

What is a meconium?

A dark tarry material passed from a neonate's rectum in the first days after birth Meconium is a very useful body fluid as it is readily available from neonates after birth and provides a longer history of metabolic processes than urine does. Phlebotomist can only collect meconium with special permission from an employer

The genetic disorder, phenylketonuria(PKU) is characterized by deficiency of an enzyme that breaks down the amino acid phenylalanine. treatment for PKU involves

A diet low in phenylalanine Phenylketonuria(PKU) cannot be cured but normally it can be treated with a diet low in phenylalanine. If not treated, PKU can lead to brain damage, seizures, and severe mental retardation.

If you experience occupational exposure, your employer is required to provide

A free confidential physician evaluation A free confidential medical evaluation following an exposure incident is required by OSHA regulations If post-exposure treatment is recommended, it should be started as soon as possible

What is induration?

A hard red bump that is the result of lymphocytes migrating to the injection site induration is what is created and observed during a tuberculosis test. redness occurs as a result of lymphocytes migrating to the site

The leakage of blood out of the vein during or after venipuncture that causes a bruise is called

A hematoma Hematomas are a common occurrence. Most of the time, they are small bruises that resolve quickly; however for patients on blood thinners, they can be very large and uncomfortable. To prevent a hematoma, the phlebotomist should apply pressure with gauze for one minute after the procedure is completed.

What is a total quality management plan

A plan that ensures expectations are met Two parts of quality assurance in healthcare are to ensure that minimum expectations are met which is the responsibility of a total management plan and to strive to exceed expectations which is the goal of continuous quality improvement(CQI)

All requests for laboratory testing must have

A requisition or computer label For a laboratory to perform any testing of a collected sample, it must first have a patient requisition in the form of a paper order or a computer label. As the healthcare industry integrates technology into patient care, paper requisition forms have become less common yet they can be thought of as having the same information as a computer label. Both will contain information on what tests are to be performed on the samples, patient identifying information and physician identifying information.

What is a fasting sample?

A sample taken after a patient has not had anything to eat or drink Fasting samples are generally taken 8 to 12 hours after a patient last ate or drank and often are obtained early in the morning. Both black coffee and smoking affect metabolism and therefore affect fasting samples.

What is hyperglycemia

A sign a patient might have diabetes mellitus Hyperglycemia is defined as a high blood glucose content and is a routine finding in patients with pre-diabetes and diabetes. if a patient has been fasting and their blood glucose is greater than 126 mg/ dl, they may have diabetes

By law, a patient consenting to venipuncture for the purpose of participating in a clinical research trial must give which type of consent?

A signed informed consent document Informed consent implies voluntary and competent permission for medical test, procedure, or medication By law, research purposes requires a signed consent document

What is needed in order for laboratories to release patient results to the patients themselves

A signed release form Patients are not released their own test results automatically for several reasons, the most important being the possibility that those results are mistakenly displayed to unintended viewers.A release form, therefore, is required to release the laboratory of patient confidentiality responsibilties

If a phlebotomist is transporting samples in a car, what is used to protect samples from extreme temperatures

A standard cooler Often a phlebotomist will use a standard work vehicle to transport samples to the lab. When this is the case a standard cooler is acceptable to protect samples from extreme temperatures. The cooler only functions as a secondary container if only one patient's specimens are in it otherwise all the samples need to be separate secondary bags.

What type of container can a patient use to provide an accurate urine sample

A sterile urine container Patients will sometimes be asked to give urine samples at home and they will provide urine in various kinds of containers. The only acceptable container is one that is sterile and designed for urine testing.

What are convulsions

A sudden violent irregular movement of a limb or of the body A patient who goes into convulsions can be a danger to themselves and must be carefully cared for. A nurse and/or physician should be notified immediately, and any object which the patient could come in contact with should be moved. The patient should never be restrained when in convulsions.

In addition to the Surgitcutt device, what other medical device is needed to perform a bleeding time test

A surgicutt device is a spring loaded blade that makes a standarized cut 5mm long and 1 mm deep into the patient's skin, retracting into the device after use. Next, testing paper is applied to the wound once every 30 seconds until the process is complete. Pressure is created with a blood pressure cuff inflated to precisely 40 mmHg. The phlebotomist should be careful to not create an incision on top of any superficial veins, as this will create more bleeding than necessary.

What is the hemoglobin A1c test?

A test to gauge blood glucose over time- hemoglobin is protein in red blood cells that are responsible for carrying oxygen around the body. An additional feature of hemoglobin is that is has a mechanism taht "remembers" blood glucose levels for about 2-3 months. The A1c test isolates red blood cells and is tested in a lavender top tube.

What does the peak level post dose refer to

A time at which drug levels in the blood are highest When determining therapeutic range, peak levels(also known as postdose) are taken to understand how long the patient needs to metabolize the medications given. This helps determine the timing and size of doses

What does the "trough level" (predose) refer to?

A time at which the drug levels in the blood are the lowest- when determining therapeutic range, trough levels( also known as predose) are taken to understand how long patient needs to metabolize the medications given. This helps to determine the timing and sizes of doses.

A tourniquet should be on the patient's arm for a maximum of

A tourniquet should be on the patient for no longer than one minute to prevent stagnation of blood which deprives tissue of oxygen. The phlebotomist can place the tourniquet, look for a vein release the tourniquet for one minute, then re-tie the tourniquet if necessary

What is a papoose

A type of pediatric restraint in the form of a blanket wrapped around the patient's body A papoose can come in the form of a board with Velcro straps or a blanket. In both cases, the child's body is wrapped so that they are unable to move. One of the patient's arms remains outside of the blanket and is used for the venipuncture procedure. While effective , a pappose can be very traumatic for the patient and should be used as a last resort

What generates a vacuum in an evacuated system?

A vacuum exists within the blood collection tube The evacuated system is the most common blood collection system in phlebotomy. The vacuum that is needed to draw blood from a patient's vein exists inside the blood collection tube from the manufacturer. Sometimes the vacuum may be lost from the tube. IF the phlebotomist thinks this is the case, they should try another tube

Blood donation centers follow guidelines for donor collection and patient safety that are set by

AABB The AABB, formerly known as the American Association of Blood Banks, and now only known by the initals is an international organization that develops standards and provides educational accreditation programs focusing on enhancing patient and donor care and safety

What is edema?

Abnormal accumulation of fluid in the tissues, resulting in swelling Edema is swelling as a result of fluid accumulation in the body tissues. Edema is very common and has causes that can be simple, such as IV fluids leaking from a non-patent IV attempt or incredibly complex such as edema secondary to heart, kidney or lung failure. The phlebotomist will encounter patients with edema and must be able to recognzie the challenges associated with edema. for patients with peripheral edema, the swelling of the tissues may force theveins deeper into the tissue making finding a vein very difficult. Additionally tourniquets may not be effective and might even cause tissue damage. these patients require more attention and often a more experienced phlebotomist.

Approximately where should the phlebotomist insert the needle into the patient's skin in relation to the chosen venipuncture site

About 0.5 cm below the site when a phlebotomist palpates a vein and finds a suitable venipuncture site, it must be kept in mind that this is where the bevel of the needles needs to be when it punctures the vein, not the skin. To correct for this, the phlebotomist must first find an appropriate site and then palpate above and below that site to get an idea of how the vein travels up the arm. If the vein is deeper in the arm, the phlebotomist should go furher down the vein to compensate for more tissue

What is the most prevalent hazard for phlebotomist

Accidental needlestick While all of the answers(irate patients, fines imposed by the Joint commission, legal actions following errors in care) can be possible hazards for phlebotomists, the used of needles is far the most common action performed by phlebotomist which makes the likelihood of an accidental needle stick more likely. The phlebotomsit should have good understanding of their facility's procedure for accidental needle sticks.

If a transfer device is not available, what is the phlebotomist's primary concern when using a standard needle to transfer blood into an evacuated tube?

Accidental needlestick In the unlikely event the phlebotomist is without a transfer device and must use a standard needle to push the blood into a collectiontube, the primary risk is accidental needle sticks. Even blunt tipped needles can easily penetrate the skin. The phlebotomist should make use of a test tube rack to hold the tube in place while pushing the needle with the attached syringe down onto the tube.

When working in a large facility, phlebotomist may be called on to assist other providers to obtain specimens. All of the following can negatively impact effective communication between phlebotomists and other healthcare workers except:

Active listening Active listening does not negatively impact effective communication. Rather, it promotes effective comunication in a positive way Kinesics(body language), past experiences and levels of education can all confuse communication and can be barriers if t hey are not considered in challenging interactions

Which of the following is not a common role of the phlebotomist

Administering pain medications Phlebotomist do not administer medications. In the event the phlebotomist feels the patient needs medication or other medical treatment, they should immediately contact the patient's nurse or the physician

When must the phlebotomist wash his or her hands?

After each patient contact or blood and body fluid exposure handwashing is the single most important way to prevent the spread of infection. Hands must be washed after each patient contact or blood and body fluid exposure, even when gloves are used. hands must be washed under running water with soap and vigorous rubbing. When rinsing the soap off, the water should flow from the wrists to the fingertips

During a nasopharyngeal culture collection, what should the phlebotomist do after insertingthe swab and collecting the specimen

After inserting the swab, the phlebotomist should gently rotate the swab tip several times to loosen and collect the material. Then they should gently withdraw the swab and place it in the collection tube with transport media. The tube should either be refrigerated or sent to the lab at that time.

After the phlebotomist has successfully obtained the ordered specimens, which next step is appropriate?

After obtaining the ordered specimens, the appropriate step is to apply pressure for three to five minutes at the puncture site. Failure to apply pressure or applying inadequate pressure can result in blood leakage from the puncture site and hematoma formation. **needles must be discarded in an appropriately labeled biohazard container after venipuncture. The Occupational Safety Hazard Administration(OSHA) prohibits recapping needles due to the risk of needlestick injury. The appropriate time to ask about the medications is before the procedure, not at the end.

Performing external liquid Quality Control (QC) checks on waived tests should be done at which of the following time points?

After questionable test results Quality Control(QC) checks should be performed according to facility policy and manufacturer's instructions. Most facilities require external QC testing if the results are questionable upon receipt of new kits with each new testing personnel QC checks before every test are unnecessary, and can waste control solution. Internal QC checks identify problems without using an external solution, and therefore it would also be wasteful to perform an external solution test when the device detects the problem with the specimen

At what point should the phlebotomist remove the needle from the patient's arm

After removing the tourniquet the needle should be removed after removing the tourniquet from the patient's arm because otherwise, the pressure created by the tourniquet would cause blood to gush out of the hole left by the needle as well as into the tissue causing a hematoma

When should the blood pressure cuff be released during a bleeding time test?

After the bleeding stops The blood pressure cuff creates pressure within the veins to encourage bleeding from the incision made for a bleeding time test. 40 mm Hg is not a dangerous amount of pressure, so removing the cuff once bleeding stops is acceptable.

A patient with active herpes zoster(shingles) infection and vesicular skin eruptions would most likely be on

Airborne precautions With active shingles infection, airborne plus contact precautions are recommended to prevent transmission. this means the patient should be in a special airborne isolation room and healthcare workers should keep the door closed. Hand hygiene is encouraged and an N-95 mask is recommended

Which form of cleaner is acceptable in place of handwashing

Alcohol based Alcohol based hand cleaners are acceptable in place of handwashing. Hand cleaners have become widely accepted because even when running water is available, people are more likely to use hand cleaner because of the convenience alcohol based hand cleaners offer

If soap and water are not available, what should the phlebotomist use for hand hygiene?

Alcohol based hand sanitizer Hand hygiene must be performed after aeach patient contact, even when gloves are used. Alcohol based hand cleaners may be used in place of handwashing unless the hands are soiled.

when using the syringe technique to collect blood cultures, what critical step must be taken to ensure a clean transfer to a blood culture tube

Alcohol prep pad placed on rubber top of bottle The only way to ensure that the transfer of blood from a syringe to a blood culture tube is clean is to place an alcohol prep pad on the rubber top of the bottle while drawing the blood. The hard plastic top is not a sterile seal. Never use non safety needles to force blood into a bottle as it may damage the blood sample.

To avoid causing iatrogenic anemia, a facility limits the amount of blood that can be drawn in a single draw to 2.5% of the patient's total blood volume. A phlebotomist has orders to obtain the following tests on a 2.2 lbs preterm infant: -Complete Blood Count (CBC) test requiring 0.5 mL volume in one lavender microtainer tube -Comprehensive Metabolic Panel (CMP) test requiring 0.8 mL in a light green, red, or gold Microtainer tube - needs 2 Microtainer tubes -C-Reactive Protein (CRP) test requiring 0.4 mL in one light green, red, or gold Microtainer tube Assuming preterm infant blood volume of 100 mL / 1 kg of body weight, which of the following is true regarding this patient?

All of these tests can be safely drawn. the ordered tests meet the maximum volume allowed in one draw. A preterm infant weighing 2.2 lbs weighs 1 kg so the total blood volume is 100 mL if the limit for each blood draw is 2.5% of the total blood volume, the limit for this patient would be 2.5 mL per blood draw The order test require 0.5 mL(CBC) + 0.8 mL(CMP) + 0.8mL(CMP) + 0.4 ml(CRP) = 2.5 mL

Which of the following is not recommended for positioning a pediatric patient to maximize comfort and safety while optimizing specimen collection

Allowing younger children to sit by themselves in the blood drawing chair, and have mom or dad hold the child's feet Older children may be able to sit by themselves in the blood-drawing chair, but a parent or another phlebotomist should help steady the child's arm. Younger children should sit on Mom or dad's lap to let them hold the child's arms and legs securely for safety during the blood draw

What type of sample is most appropriate for drug testing

Although hair may be used for drug testing, urine is the preferred medium. This is because hair cannot be easily tested nor can it be tested quickly. Additionally, urine provide a glimpse of patient condition at the time of collection

A phlebotomist should call the physician to clarify which of the following

An adult male with a requisition form for a serum Human Chorionic Gonadotropin(HCG) test A serum HCG test should not be performed on a man because HCG is a hormone produced in the body during pregnancy. Since men cannot get pregnant, it is likely than an order test on a man was an error. A phlebotomist would want to check the order with a provider before drawing the specimen Glucose tolerance test and fasting lab results are commonly ordered in obstetrics. a complete blood count is normally checked before an operation. These are not a cause for concern and do not need to be clarified with a provider

What is EDTA

An anticoagulant that binds calcium, preventing clot formation EDTA is the most preferred anticoagulant of the family of anticoagulants that bind calcium and prevents clot formation. EDTA does not distort the size and shape of the cells allowing for accurate recognition by lab staff. The phlebotomist should be familiar with how EDTA differs from other anticoagulants

What is heparin

An anticoagulant that prevents the conversion of prothrombin to thrombin Heparin is a naturally occurring molecule that acts on the clotting cascade by preventing the conversion of prothrombin to thrombin. Thrombin is a molecule that is required to form a clot. heparin is not only found as an additive in blood collection tubes ; it can be administered as a drug as well.

Avoid venipuncture in an arm that has

An arteriovenous shunt A shunt is a dialysis patient's lifeline. never perform venipuncture or apply a blood pressure cuff or tourniquet on an arm with any type of shunt in it.

A patient in the emergency room is being admitted to operating room for emergency surgery. The nurse who drew the blood specimen for cross match labeled the tube incorrectly which of the following is true

An error in specimen collection labeling requires recollection of the specimen Specimens that have labeling errors of any kind or are unlabeled will not be accepted for testing. This pertain to specimens drawn in the emergency room and operating rooms as well. An error in specimen identification or labeling requires recollection of the specimen and causes a delay in patient treatment

What is a prexamination erro

An error that occurs before the sample is analyzed A pre-examination error is any error that occurs prioer to the sample being tested. This includes temperature, fasting, equipment, order of draw and syringe collection errors and others.

What is local infection

An infection affecting only one area of the body

What is a systemic infeciton

An infection which affects the entire body An infection which affects the entire body is known as systemic infection. A local infection which only affects one part of the body can spread to the entire body. The phlebotomist must be aware of the common signs and symptoms of a systemic infection including increased temperature, increased heart rate, low blood pressure and increased breathing rate

Which of the following statements is true regarding the equipment used for blood culture tests?

Anaerobic and aerobic bottles are required There are many different types of microorganism. however all of them either require air for metabolism or they do not. Therefore to get testing started only anaerobic(without air) and aerobic(with air) bottles are required

If a needle and syringe are used when a blood culture test is ordered, which blood collection tube must be filled first?

Anaerobic bottle There are many different types of microorganisms. however, all of them either require air for metabolism or do not If a needle and syringe is used the anaerobic bottle should be filled first to prevent any air at the top of the syringe from being introduced to the second bottle If a butterfly needle and a needle safety connector device is used then the aerobic bottle should be filled first as there will likely be air in the tubing

What is iatrogenic anemia?

Anemia caused by drawing too much blood from a patient Iatrogenic anemia is caused by drawing too much blood from a patient and is of great concern in newborns. The phlebotomist must take care when taking blood samples from newborns and be sure to used pediatric sized blood collection tubes

Which of the following is the last site a phlebotomist should look for a suiteable vein for venipuncture

Ankle or foot The ankle or foot are the last places a phlebotomist should look for a suitable vein for venipuncture. This is mainly due to the risk of causing a clot that can form and go back to the heart. Furthermore, the ankle and foot are more painful to the paitent and require more cleaning to prevent infection

What does the term "additive" refer to

Any material placed in a tube that maintains or facilitates the integrity and function of the sample Additives are introduced to the tubes as part of a manufacturing process to improve the quality of the sample. The additives are not anticoagulants or preservatives but are used to improve sample quality or to accelerate sample processing.

In addition to the name of the patient and the phlebotomist collecting the sample, who else is named on the chain of custody paperwork

Anyone who has handled the specimen- to ensure that tampering does not occur to samples sent for legal reasons, chain of custody paperwork must be sent with the samples. Chain of custody paperwork displays patient identification information, the names of everyone that has contact with the samples and the phlebotomist who performed the blood draw.

All of the following are acceptable methods to prevent formation of hematoma except

Applying heat the venipuncture site In the most serious of cases, hematomas arising from venipuncture can cause permanent injury. To comply with best practices, heat should never be used to prevent hematomas as heat would make a hematoma worse following venipuncture Should: remove the tourniquet before the needle, avoid superficial veins, and applying pressure with gauze after removing needles

How long does the centers for disease control and prevention(CDC) recommend washing your hands in the healthcare setting

At least 20 seconds According to the Centers for Disease control and Prevention(CDC), routine handwashing should take at least 20 seconds which is the time it takes to hum the "happy birthday" song or ABCs twice

How long does a urine sample remain stable in a standard sterile urine cup at room temperature

At room temperature and with additives , urine in a standard sterile urine cup will be stable for two hours. After that, the urine starts to break down. Refrigeration, not freezing adding additives or putting the urine in a urine collecting tube will ensure longetivity

Phlebotomists should visually inspect the needle after removing the cover or cap because although rare, manufacturer's defects include all of the following except

Beveled tip A smooth sharp pointed bevel is not a manufacturer's defect. Rather a needle should appear to have a smooth surface and a sharp beveled tip manufacturer defects that are rare and problematic include rough surfaces, lumen obstructions, or metal barbs. if these defects are discovered, the needle should be discarded in a biohazard container and a different needle should be used.

of the following tests which is most sensitive to light exposures

Bilirubin Protecting a tube from light is important in severaltypes of tests including, and most especailly bilirubin. An amber tinted tube is designed for this purpose. if an amber tube is not available, tin foil may be wrapped around the tube

When shipping samples long distances, what must be placed on the outside of the shipping container?

Biohazard label When shipping samples long distances, any container that the samples are in must have a biohazard label on the outside. This is important because the samples may be shipped with other non-medical packages and the samples themselves may be in several other containers. Any patient identifying information that is exposed to persons non involved in the care of the patient is a HIPAA violation

Of the following which is not considered an acceptable solution for cleaning a patient's skin

Bleach is suitable only for hard surface cleaning and should never be used to clean skin The phlebotomist should use one of the other methods cleaning in a circular motion, starting with small circles over the selected site and moving outward to prevent bacteria from being pushed towards the site

What is the first tube to be collected in a series?

Blood culture tubes When using a transfer device or a standard needle to deliver blood to a collection tube, the additives within that tube contaminate the needle. if those additives are added to the blood for another tube, the results from that tube could be wrong. An order of draw has been established to prevent this and is set up in such a way that the additives from the first tube do not interfere with the additves of the following tube. The order is: Blood Cultures-Coagulants(light blue)- serum tubees- heparin tubes- EDTA tubes

What is the correct order of draw for blood collection tubes?

Blood cultures- Coagulants(Light blue)- serum tubers- heparin tubes- EDTA tubes The reasoning for the order of draw is that blood culture tubes are filled first to prevent bacterial contamination of the blood culture sample. The coagulation tube is collected next to avoid any additives such as clot activators or anticoagulants from getting into the tube. The heparin tube is collected before the EDTA tube because the EDTA would alter the chemistry tests run on the heparin tube

Which of the following does not affect bleeding time?

Blood glucose levels Bleeding time is not affected by blood glucose levels. Because a standard incision is made on each patient at the same site, anything that affects the body's ability to generate clots will affect bleeding time(clotting diseases, vessel constriction, anticoagulant drugs(blood thinners))

What does the Hemoccult card test for

Blood in the stool hemoccult cards are cardboard testing cards designed to test for blood in feces. if the phlebotomists employers allows, the phlebotomist may be asked to perform this test, which consists of adding a fecal sample and developer to the card.

What is a preferred alternative to a traditional tourniquet in a bariatric patient

Blood pressure cuff When working with bariatric patients, the phlebotomist must take into account that these patient's veins are located underneath multiple layers of fatty tissue, often making venipuncture difficult. A normal tourniquet may need to be so tight that it cuts into the patient's arm. If this is the case, a blood pressure cuff may provide the necessary force for palpation without causing the patient distress or injury

To calculate the blood volume of an adult what information is required

Body weight To calcuate blood volume, the patient's weight is required. Blood volume can be calculated for any size person from infant to adult as long as the person's weight is known

How can a phlebotomist prevent patient injury before performing venipuncture?

By ensuring the patient is sitting in a chair A phlebotomist can greatly minimize the risk of injury to patients by ensuring they are sitting in a chair with a back and armrests. Patients should never be standing during venipuncture due to the risk of syncope

How can a phlebotomist significantly reduce the risk of damage to bones, arteries and nerves when performing capillary puncture in pediatric patients?

By using a spring-loaded puncture device that is preset to a specific length Spring loaded puncture devices contain blades that automatically puncture the skin to a preset depth. Benefits to using such device include phlebotomist safety and patient satisfaction; however the most important benefit for pediatric patients is the protection of the underlying structures such as bones, nerves, and arteries.

When performing a throat swab on a pateint with a suspected airway infeciton, how can the phlebotomist protect himself from becoming infected

By wearing gloves and a mask A mask and gloves are appropriate when performing a throat swab in a patient with a suspected infection. A completely sterile environment will not protect the phlebotomist, and a gown is unnecessary

How can a phlebotomist protect themselves from acquiring a urinary tract infection from a patient

By wearing gloves and if necessary a gown Urinary tract in infections are caused by common forms of bacteria and cannot be transmitted through the air. Because of this, gloves and gowns are perfectly acceptable although face masks can also be used

cardiopulmonary resuscitation (CPR) certification is good for how many years before it must be renewed

CPR certification must be renewed with a refresher course every two years Most healthcare institutions require their personnel to be certified in CPR so most phlebotomy programs require it as a prerequisite

Anne is a phlebotomist who is employed by a visiting physician that makes house calls. Part of her job requires her to obtain blood samples at patient homes using lab in a box kits. After preparing the specimens, what is the best way Anne can coordinate processing.

Call a lab courier with special training in specimen transport to pick up the lab box The best way to coordinate processing for specimens taht must travel many miles to a laboratory is to use special couriers who have been trained in how to handle blood bourne pathogens and have special containers to transport samples to the lab. There are severe fines for shipping etiologic agents without proper identification.

A phlebotomist processing a laboratory specimen obtains a panic(critical) potassium result of 6.5. What should the phlebotomist do next?

Call or page the ordering physician immediately Panic values are signficantly abnormal test results that could indicate a life threatening situation that requires immediate attention by the physician. that is why it is important to phone or page the physician immediately for follow-up The phlebotomist should not wait or call the patient directly. A phlebotomist should not enter an order unless specified by the doctor

One way to minimize the effects of postural changes on some analytes in the outpatient or clinic setting is to:

Call the patient into the drawing area and have them site while you prepare Body position before and during blood collection can influence specimen composition. Going from lying to standing or standing to sitting causes body fluids to filter into the tissues thereby decreasing plasma volume Calling patients into the drawing area and having them sit in the drawing chair while paperwork is completed can help minimize the effects of postural changes on some analytes

When testing for malaria, what type of blood is preferred?

Capillary Malaria is a disease that can be seen in the blood. given the size of malaria, it ends to congregate in the capillaries due to their small diameter. Because of this, phlebotomists should get blood samples from capillary blood samples from capillary blood for analysis.

Which of the following is true regarding order of draw when performing capillary collection

Capillary Blood Gases(CBGS) are collected first to minimize air exposure The order of draw for collecting multiple specimens by capillary puncture is not the same for venipuncture. When the skin is punctured, thromboplastin is released, which activates coagulation in the blood. Specimens must be collected quickly to minimize the effects of platelet clumping and microclot formation According to the Clinical Laboratory Standards Institute(CLSI) the recommended order of draw is Capillary Blood Gases(CBGS) are collected first

in addition to the sample and requistion, what else must accompany samples that are collected or legal reasons

Chain- of custody paperwork-to ensure taht tampering does not occur to samples sent for legal reasons, chain of custody paperwork must be sent with the samples. chain of custody paperwork displays patient identification information, the names of everyone that has had contact with the samples and the phlebotomist who performed the blood draw.

What can be used for site cleansing instead of iodine when collecting blood cultures?

Cholorohexidine swabs- the single most important step following properly identifying the patient when drawing blood cultures is the proper cleansing of the venipuncture site. This can be done with an iodine tincture and 70% isopropyl alcohol or cholorohexidine. If the patient's skin is visibly soiled, use soap and water. Alcohol prep pads are not sufficient to clean the skin for blood cultures but are appropriate for cleaning the bottle tops.

The phlebotomist may use a facility's laboratory information system(LIS) to enter or retrieve specimen data. To prevent a system breach, users should:

Choose a password that has eight characters or more Passwords must be kept strictly confidential. This means it should not be shared with coworkers or managers and should not be something that they can guess

Which of the following is typically used in collecting units of blood for transfusion purposes to stabilize pH and provide energy to the cells for viability

Citrase phosphate dextrose(CPD) The anticoagulant and preservative citrate phosphate dextrose(CPD) or CPDA1(CPD plus adenine) is typically use in collecting units of blood for transfusion because The citrate prevents clotting by chelating calcium The phosphate compound stabilizes pH Dextrose gives energy to the cells to keep them viable

A phlebotomist asks about a patient's current medications prior to performing venipuncture. Of these four medications, which one is least likely to cause excessive bleeding from the puncture site?

Contraceptives Contraceptives are not blood thinners and they have been linked to blood clots Aspirin works as a blood thinner to decrease blood clotting. Anticoagulants such as Coumadin and clopidogrel are also known to prevent blood from clotting. Following venipuncture, the patient who is taking aspirin or anticoagulants may take longer to stop bleeding

Quality Control(QC) measures in the laboratory, such as using checklists are implemented for the main purpose of

Correcting errors in specific practices Although Quality Control(QC) and Quality Assurance(QA) are mistakenly used interchangeably, they are different. QC refers to activities or techniques in the lab that are reactionary and meant to find and eliminate sources of error. Correcting an error in a specific practice, such as labeling a specimen tube in correct direction is an example of QC On the other hand, QA refers to a proactive process of reviewing past and present performance to standardize processes and improve overall care. Developing standards for care, creating new processes, and evaluating past performances are all examples of QA activities

What is the most common type of diurnal tests

Cortisol, cortisol is the natural hormone of thebody and exhibits diurnal effects. it is the most common target for diurnal testing. Digoxin also exhibits diurnal effects, however it is tested for far less commonly than cortisol.

A patient who is unconscious or semiconscious

Could be in shock An individual who is in shock may be unconscious or semiconscious, so they will likely need first aid. Do not move them in case there are injuries unless they are in danger. Do not give fluids because of risk of aspiration

Which of the following tests require warming after collection

Cryoglobulins Normal body temperature is about 37 degrees Celsius and that is the temperature that samples must be warmed to ensure correct test results. Correct methods for warming samples include using a heel warmer or hold the sample in hand. Warmed samples are very rare and will have instructions from the lab on how to handle. Tests that must be warmed are Cold agglutins Cryoglobulin

What is the definition of the term circadian?

Cyclical changes throughout the day such as with sleep, body chemistry and energy levels Circannual refers to seasonal changes of the same things over the course of a year. Diurnal refers to daily variation in blood levels at a particular time of day

What is the preferred size of blood droplet for blood smears?

Dime (1-2mL) Blood smears are not very common tests however a phlebotomist should be familiar with what they are. They are small drops of blood approximately the size of a dime placed on a glass slide to be evaluated in a lab. if a phlebotomist is expected to prepare a slide, he or she will be trained by their employer

What additive does the tan top blood collection tube contain

Dipotassium EDTA The tan top blood collection tube uses another form of EDTA to inactivate thrombin and thromboplastin. This is an uncommon tube and is used primarily for serum lead determination

When drawing blood or collecting specimens from two patients that are in the same room, which of the following is the correct sequence of events after Patient One's blood is collected

Discard gloves. Wash hands. Don gloves, draw from patient two, discard gloves, wash hands Hand hygiene must be performed after contact with each patient even when gloves are used. Even though there are two patients, hands should be washed and gloves changed between the patient's care.

For venipuncture using the Evacuated Tube System(ETS) method, the phlebotomist should break the needle seal and then thread the needle into the holder. If the needle seal is already broken, the phlebotomist shoul

Discard it in a biohazard container because it may not be sterile The phlebotomist should check supplies before use for sterility expiration dates, and any manufacturer defects. if a needle seal is broken, that indicates the cap has been displaced and the needle may no longer be sterile. The best action is to discard it in a label biohazard container because it should not be used. Do not put it in the trash receptacle because it is sharp and can cause a needlestick injury A broken needle seal does not indicate the size of the needle. pushing a needle beyond the guide mark of the holder could release the vacuum pressure and cause the Evacuated Tube System(ETS) to fail or not work properly.

Judy is a phlebotomist working in a blood donation center. She is assisting one of the nurses who is having trouble. her patient's bag is only 1/4 to 1/2 of the way full but the blood flow has stopped. Neither judy nor the nurse was able to achieve blood flow again despite repositioning the patient's arm, tubing and collection unit. What should be done next?

Discontinue the venipuncture site and apply firm pressure. Then, identify a vein on the other side to repeat the collection procedure The unite is normally filled by weight but typically conatins around 450 ml of blood when full. Only one needle puncture can be used to fill a unit. if the unit only partially fills, then the procedure must be repeated and an entirely new unit must be used.

All of the following are considered standard precautions except:

Disinfecting hard surfaces such as countertops While working to keep the workplace free of infectious diseases is important, it is not considered to be part of standardized precautions. Standardized precautions are designed to protect the healthcare worker from possible disease processes of the patient e.g. Washing hands when changing loves and in between patients, wearing gloves when likely to touch bodily fluids, wearing a mask and eye protection when likely to be splashed with body substances.

What are advance directives?

Documents written before incapacitating illness that give instructions about patients' health care Advance directives are instructions for healthcare workers in the event a patient has a medical condition that renders them unable to relay their wishes. These directives are usually interpeted at a high level usaully with a physician. However, the phlebotomist can be affected by what the advance directives may say

Blood collection for donation is usually performed at which site

Donor units are normally collected from a large antecubital vein. Venipuncture sites on hand and writst are more painful and slower to draw from, so they are not preferred for blood collection with larger gauge needles. Arteries are used for ABG testing but not blood donation

Which of the following is the reason two partially filled light blue tubes cannot be combined

Doubles the amount of additive resulting in error Light blue tubes require 100% filling. If the phlebotomist can only partially fill a light blue tube, it is not acceptable to combine it with the contents of another tube because this will double the amount of additive causing erroneous results

Which of the following is not an indication for nasopharyngeal swab

Down syndrome Down syndrome is a genetic disorder that can be detected by chromosome studies of amniotic fluid. IT cannot be identified by a nasopharyngeal swab test. Nasopharyngeal(NP) secretions can be cultured to detect the presence of microorganisms that cause disease such as diptheria, influenza, meningitis, pertussis, and pneumonia

Hand hygiene guidelines for infection control recommend rinsing the hands with fingertips pointing

Downward towards the sink drain Washing and rinsing the hands with fingertips pointing downward towards the drain allows contaminants to be flushed from the hands and fingers into the sink rather than flowing back up the arm and wrist

When transporting chilled samples long distances, what substance is used to chill samples

Dry ice Dry ice is the substance used when transporting chilled samples long distances. This is because no water is left behind when it melts

What additive does the lavender top blood collection tube contain?

EDTA The lavender top blood collection tube uses the anticoagulant EDTA which forms calcium salts with the blood, effectively removing calcium from the blood in stopping the clotting process. This is one of the most common blood tubes used by the phlebotomist and is used for hematology and blood bank draws

what time of day are electrolytes at their lowest concentration in the urine?

Early morning as human sleeps ,metabolism continues. The diurnal observations of electrolytes show they are lowest concentration in the early morning. Other metabolites such as catecholamines are at their highest concentration around noon

Failure to calibrate equipment for waived tests can lead to all of the following except

Employee awards Failure to calibrate equipment can lead to inaccurate test results, poor patient care, and delayed treatment

A urine specimen cup with 100 mL of patient urine spills on the laboratory counter. The best way to clean up the spill would be

Environmental Protection Agency(EPA) approved chemical solution and/or kit Special EPA approved chemical solutions and kits are available for the cleanup of body fluids and for disinfecting surfaces. cleanup procedures should concentrate on absorbing thefluid without spreading it over a wider area than the original spill Disposable cleanup materials should be discarded in a biohazard waste container. Reusable cleanup materials should be properly disinfected after use

What is a key factor for gaining trust with the pediatric patient

Establishing rapport with both the child and parent Performing venipuncture on a pediatric patient can be one of the most difficult skills a phlebotomist will perform. A child has vivid imagination and may misinterpret the intent of the phlebotomist's explanations. Gaining rapport with the parent is the most direct way to gain the trust of the child. This can be attained in the same way that trust is attained with an adult patient with direct eye contact, positive words, and confident body language Lying to a peditric patient is never considered a good idea and can damage the relationship between not only the child and the phlebotomist but the parent and the phlebotomist as well

How often should testing paper be placed on the incision during a bleeding time test

Every 30 seconds until bleeding stops Once the incision is made, a testing paper is bplaced on the incision every 30 seconds until bleeding stops. After each stop, the phlebotomist should rotate the paper enough so that new paper will touch the incision each time

Creatine Kinase(CK), Aspartate aminotransferase(AST), and Lactate dehydrogenase(LDH) are most likely be affected by

Exercise and stress Exercise and stress increase a patient's metabolism and therefore alter the amount of products of metabolism. A phlebotomist should not necessarily worry if a patient is athletic or not but rather understand taht certain patient conditions including a patient who is under stress for any reason can affect common test results.

What does the term malpractice refer to?

Failure of a professional person to offer a standard of care resulting in harm to a patient To prove malpractice, one must first prove that a standard of care was not met. Next, it must be shown that harm was caused to a patient by a standard of care not being met. Phlebotomists can prevent malpractice claims by adhering to all regulations and by observing best practices for all collections.

To obtain the most accurate results on a newborn screening (NBS) test the phlebotomist should

Fill the filter paper circles with one drop of blood on one side of the card Unfilled or incompletely filled circles can result in inability to perform all required tests. circles must be filled from one side of the paper only and by one large drop that spreads through the circle Application of mulitple drops or filling the circles from both sides of the filter paper causes layering of blood and possible misinterpretationi of results

Which are Clinical Laboratory Improvement Amendment(CLIA) waived tests

Finger stick blood glucose with a Point of Care machine Three categories of testing are recognized according to the level of complexity of the test. Point of care (POC) glucometer checks are considered a waived test as waived tests are the most simple Moderate tests include microscopy (newborn screennings and other POC TESTS and high complexity tests (arterial blood gases) must have written protocols for lab handling

What specimen is ideal for urinalysis because it has high specific gravity

First voided A first voided specimen is usually collected immediately upon waking in the morning after approximately 8 hours of sleep. This type of specimen normally has a high specific gravity, which means it is more concentrated than a random specimen. This makes it ideal to identify substances or formed elements such as cells and casts that would not be detected in a more diluted or lower specific gravity specimen. Other terms for this type of test are : first morning, eight hour, overnight, early morning specimen

Pleural fluid is.

Fluid from the lungs- it is important that the phlebotomist understands that infectious diseases can be found in the pleural fluid. A disease found in the pleural fluid can be spread by coughing, sneezing, crying, and even talking. if the phlebotomist believes that a patient may have a respiratory infection, a mask should be worn by the patient and by the phlebotomist to reduce the spread of illness.

During a routine blood draw, Mary's patient suddently jerks, dislodging the needle from her antecubital vein. Blood squired into mary's mouth. In the event of an occupational exposure like this, Mary should

Flush her mouth with water for ten minutes In the event of mucous membrane exposure, which in includes the eyes, nose or mouth, the employee should flush the site with water or sterile saline for ten minutes

After applying an antiseptic agent to the blood collection site, how long should the cleaned area be allowed to dry

For 30 seconds to one minute The evaporation and drying process helps destroy microbes and helps to avoid a burning or stinging sensation when the needle is inserted. This is why it is best practice to allow the blood collection to air dry for 30 seconds to 1 minute. Less than 30 seconds may not be enough time for the antiseptic to dry naturally and more than one minute is unnecessary

The purpose of properly greeting the patient is to..

Gain the patient's trust and decreases the patient's anxiety- Gaining the patient's trust is the most important part of developing a good relationship with the patient and is a responsiblity shared by the whole patient care team. Often, the phlebotomist will be one of the first clinical staff the patient meets and therefore has one of the best opportunities to make a good first impression. Establishing eye contact, providing a clear introduction, and maintaining confident body language are key in starting a good patient relationship and decreasing the patient's anxiety.

An inherited disorder in which a newborn lacks the enzyme needed to convert milk sugar into glucose for energy is called

Galactosemia Galactosemia is an inborn metabolic disorder in which the body lacks an enzyme needed to convert the milk sugar known as galactose into glucose Cystic fibrosis is a disorder in a gene that directs a protein responsible for the transport of chloride across the cell membrane Phenylketonurina is a genetic disorder characterized by a defect in an enzume involved in converting phenylalanine into tyrosine Hypothyroidism is a condition caused by insufficient levels of thyroid hormones

How can the phlebotomist prevent injury in a patient who is convulsing b0 G

Gently lay the patient down and move objects out of the way A patient who goes into convulsions can be a danger to themselves and must be carefully cared for. A nurse and or physician should be notified immediately, and any object which the patient could come in contact with should be moved. The patient should never be restrained when in convulsions

All of the following are reasons a healthcare worker should wear gloves except:

Gloves make handwashing unnecessary.- there are very few instances in which the phlebotomist will be performing patient care without wearing glvoes. Any time, the phlebotomist has a physical interaction with a patient, gloves must be worn and then immediately discarded once the procedure is finished. Second only to handwashing, gloves are the easiest and the most important form of PPE. Gloves do prevent healthcare worker from transmitting microflora to the patient., prevent transmission of microorganisms from one patient to another and help prevent the phlebotomist from being infected with what is infecting the patient

The correct order in which to doff Personal Protective equipment is

Gloves, goggles, gown, mask The correct order to remove personal protective clothing is 1. Glovs(to avoid contaminating anything with your hands) 2.Eye protection next 3. Gown is removed next and rolled up 4. lastly mask is removed.

What type of blood sample has higher levels of glucose

Glucose molecules are large, so they congregate in capillaries due to the small diameters of capillaries. This is also why finger sticks are appopriate for glucose levels.

What color blood sample tube is used for glucose testing

Gray The additives in the gray tube stop the cellular breakdown of glucose which is known as glycolysis. if a lab is readily available, then a gray top may not be needed.; however, for glucose samples that need to be transported, a gray top tube is essential

Following an oral glucose tolerance test, what blood glucose level indicates diabetes

Greater than 200 mg/dl The oral glucose tolerance test(GTT) is a test in which patients take oral doses of glucose based on their eight to see how well their body can process glucose. Phlebotomists will draw the patient's blood two hours after the test. Levels higher than 200 mg/ dl indicates diabetes.

What size induration of a purified protein derivative(PPD) test signifies a positive tuberculosis test

Greater than or equal to 10 mm A purified protein derivative test for tuberculosis creates a wheal underneath the skn taht then turns into an induration. The induration will most likely be red; however, the size of the induration is what is observed. if the induration is less than 5 mm, the test is negative, if it is between 5-10 mm, the test is doubtful. if the induration is greater than 10mm, the test is positive and more testing must be conducted

According to World health organization(WHO) guidelines, hand hygiene includes

Handwashing before and after touching a patient WHO Guidelines say that healthcare workers should not wear artificial nails because they harbor more pathogenic microbes than natural nails. Gloves are not a replacement for handwashing but should be used in conjunction to hand hygiene for infection control. According to the WHO hand hygiene guidelines, a palmful of cleanser should be used and the procedure should take 20 to 30 seconds

What quality of the induration caused by a purified protein derivative (PPD) test for tuberculosis is observed to determine a positive result

Hardness A purified protein derivative test for tuberculosis creates a wheal underneath the skin that then turns into an induration if positive. The induration will most likely be red; however the hardness of the induration is what is observed. If the induration is less than 5 mm, the test is negative; if it is between 5-10 mm. the test is doubtful. If the induration hardness is greater than 10 mm, the test is positive and more testing must be conducted

According to the Clinical Laboratory Standards Institute(CLSI) standards, a phlebotomist who must identify an unconsious patient can

Have a woman who claims to be the patient's girlfriend provide the name and date of birth According to the Clinical laboratory standards, if the patient is unconscious or unable to orally verify their identity, the phlebotomist should take the following steps: 1. Ask a caregiver or relative to identify the patient. Ask for full name, the spelling of last name, the identification number and or birth date 2. Compare this information to the identification bracelet and the requisiton form 3. Report any discrepancy to the area supervisor Canceling the order, labeling a specimen with UC and asking for a temporary patient number are not appropriate responses.

Which of the following is the only correct method for mixing anticoagulant tubes

Inversion

According to the Clinical Laboratory Standards Institute(CLSI), what is the preferred method of blood specimen collection for Newborn Screening tests

Heel puncture Capillary blood collection is the preferred method of blood specimen collection for newborns and infants. The Clinical Laboratory Standards Institute(CLSI) recommends capillary blood collection via heel stick for infants less than one year of age.

Which of the following is an immediate concern a phlebotomist should have if a tourniquet is left on the patient's are for too long?

Hemoconcentration The most immediate concern the phlebotomist should have if the tourniquet is left on the patient's arm for too long is hemoconcentration because this returns erroneous test results Bruising is a concern as are numbness and tingling. However, this can easily be prevented and do not occur before hemoconcentration

What color tube is used for the hemoglobin A1c test

Hemoglobin is proteins in red blood cells that are responsible for carrying oxygen around the body. An additional feature of hemoglobin is that is has a mechanism that "remembers" blood glucose levels for about two to three months. The A1c test isolates red blood cells and is tested in a lavender top tube

If the alcohol used to clean the skin is not allowed to fully dry before venipuncture, which of the following is possible?

Hemolysis Precautions must be observed to produce the most accurate sample. Hemolysis means there is free hemoglobin the serum or plasma o f the blood and it may not be readily apparent until the lab results are received One cause of hemolysis is alcohol introduced into the specimen by venipuncture when the skin is not allowed to dry fully before the skin puncture

Which of the following prevents the conversion of thrombin to prothrombin

Heparin

Which of the following anticoagulants does not bind calcium in the blood

Heparin Heparin is a naturally occurring molecule that acts on the clotting cascade by preventing the conversion of prothrombin to thrombin. Thrombin is a molecule that is required to form a clot. Heparin is not only found as an additive in blood collection tubes; it can be adminstered as a drug as well.

To collect a capillary blood specimen, what is the correct way to fill a microtube

Hold it upright just below the blood drop, not touching the skin Holding a microbtube upright allows gravity to draw the blood into the tube. Touching the collector's device edge to only the blood drop will let the blood flow freely down the inside wall The scoop should only be allow to touch the blood drop and never the skin. Scraping the skin activates platelets and can cause clumping, hemolysis or contamination of the specimen

laboratory results are distributed to ordering providers in all of the following ways except

Hospital intercom system a hospital intercom system is not appropriate for transmitting results because it would not protect patient privacy. Instead results from laboratory tests are distributed in a variety of ways, including fax, phone, and software systems that generate reports automatically and are secured to protect patient medical records

What is a possible complication with fasting

Hypoglycemia Hypoglycemia is the state of low blood sugar in the patient's body. Sugar is a source of energy for the body, and when fasting , a patient may not have enough sugar to maintain homeostasis. The signs and symptoms of hypoglycemia are very similar to syncope and include pale skin, fast heart rate, and shallow breathing. However, one very clear difference is the rapid onset of confusion. Good patient rapport will allow the phlebotomistto notice a change in mental status in most patients.

Weakness, shaking and confusion are signs of what possible complications

Hypoglycemia The signs of syncope mimic those of hypoglycemia very closely with the one major difference of confusion. patients who have a low blood sugar become confused. Sometimes to the point that they appear intoxicated or as though they may be suffering from a stroke. The phlebotomist must be aware of this distinction.

A patient who has been fasting before a blood test presents confused and weak. What complication should the phlebotomist suspect?

Hypoglycemia The signs of syncope mimics the signs of hypoglycemia very closely with the one major difference of confusion. Patients who have a low blood sugar become confused, sometimes to the point they appear intoxicated or as though they may be suffering from a stroke. It is vital for the phlebotomist to be aware of this distinction.

A phlebotomy technician is called from the laboratory to assist another healthcare provider on a post-surgical unit. The nurse needs a blood sample on a patient who is refusing to allow venipuncture. The elderly is "a hard stick" On arrival, the upset patient has four different puncture sites and bandaids on his left hand and arm. Which of the following is the best statement for the phlebotomist to make

I understand your frustration, I will do my best to make this easy for you Effective communication is important in difficult situations or when patients are upset."I( understand" and "Ill try my best" are good responses because they validate the patient's feelings and convey that you are trying to help them.. Responses such as "calm down" "its not my fault" or telling a patient what they should have done differently can be perceived as confrontational and are not the best response to an upset patient

Other than antibiotic removal devices, what else can be used to disable antibiotic drugs in blood samples testing for microorganisms

IF an ARD is not available, Pencilillinase can be used instead. A phlebotomist will not be performing the procedure; however, a phlebotomist will find this information very useful in the event they do not have an ARD in their kit

Removing blood on a regular basis in large quantities for testing can lead to:

Iatrogenic anemia Iatrogenic is an adjective used to describe an adverse condition brought on by the effects of treatment. Blood loss through blood draws for testing is called iatrogenic blood loss. Removing blood on a regular basis or in large quantities can lead to iatrogenic anemia in some high risk patients

How should a blood sample testing for ammonia be handled immediately after collection?

Ice and water bath The chilling of sample is sometimes required to allow for proper testing results. To properly chill a sample, the only correct method is by using an ice and water bath. There will be instructions from the lab on which samples to chill but generally they include Ammonia Lactic Acid pH/ blood gases Acid phosphatase catecholamines

To access documents and medical records in the Laboratory information system(LIS) most software programs require users to click on which of the following

Icons Access to many Laboratory Information System (LIS) programs is initiated by clicking on icons that open or launch files The cursor or mouse is what users will position over the icon on the screen. Orders and matrices are generated by the LIS programs but are not usually the way to navigate around or access records

The most important step in any routine sample collection is

Identifying the patient- in any medical procedure, the most important step is to identify the patient. The phlebotomist must make sure they are performing the correct skill on the correct patient so as to avoid disastrous consequences.

The bloodborne pathogens(BPP) standard is mandated by federal law and enforced by OSHA to reduced occupatoinal exposure. The standard requires healthcare employers to:

Implement medical surveillance for all at risk employees The bloodborne pathogens (BPP) standard requires the following for all at risk employees 1. medical surveillance 2. availability of hepatitis b vaccine(HBV) vaccine 3. availability and use of PPE 4. mandatory reporting for exposure incidents

If a patient is unconscious with no advance directives and the physicians believes that venipuncture is the best interest of the patient's health, what kind of consent is applied?

Implied consent- consent can at times seem like a complex subject. However all questions, regarding consent can be answered by refferring to the patient's rights. Implied consent stems from a situation where the patient cannot give consent such as when the patient is unconscious. in this case, if it is reasonable to assume that the patient would give consent to the treatment if they were conscious, implied consent is assumed **informed consent stems from the patient's right to be informed of their treatment and the patient's right to consent or to refuse treatment. By informing the patient of the venipuncture procedure, and the patient consenting to that procedure, the phlebotomist has received informed consent.

Computer labels allow the phlebotomist to

Improve accuracy by scanning barcodes to retrieve orders and patient information - Computer labels normally contain correctly printed patient information and can improve accuracy. However, errors still occur and the phlebotomist must check the information in the computer record. Typically each label will specify a tube that is to be drawn and should be matched to that order. The phlebotomist must write the date and time of collection along with their initials when using a computer generated label.

How should a venipunctures site be cleaned?

In a circular motion from the center moving outward The phlebotomist selects a venipuncture site and then, using the appropriate cleaning solution, cleans the patient's skin using small circles starting at the venipuncture site and moving outward. This motions prevents microorganism from being pushed back onto the venipuncture site

How samples from different patients be transported

In separate secondary containers Often a phlebotomist will need to draw blood from multiple patients back to back and will not be able to send the samples to the lab in between. Therefore, after each sample collection, the phlebotomist should put each patient's sample in a single secondary container and not mix patient samples in containers.

When is a fasting sample to be taken from a patient

In the morning before the patient has had anything to eat Fasting samples are taken in the morning before the patient has had anything to eat and before any activities. If a fasting sample is needed in the inpatient setting, the patient will be placed on an NPO order

Explaining the sample collection procedure accomplishes all of the following except:

Increasing the chance that nothing is wrong with the patient Explaining a sample collection procedure to a patient is an expected behavior of a healthcare professional regardless of their scope of care. A physician will explain a surgical process, a nurse will explain the benefits and side effects of a drug, and a phlebotomist will explain the method and purpose of their procedure. Explaining the procedure accomplishes the goals of improving the patient provider relationship and reducing error through double checking the preparations the provider has made.

Eiligibility rules for blood donation includ

Individuals over 76 require written physician approval Indviduals who are 75 years of age or younger do not require physician approval. however, individuals under 16 years of age require written parental approval.

What type of hypersensitivity reaction is observed when using a purified protein derivative(PPD) test to test for tuberculosis

Induration Recall that induration is a hard red bump that indicates lymphocytes have rushed to the PPD injection site. Induration is a positive result; however, it does not mean that there is an active infection. More testing is required following a positive PPD test

What is the Material Safety Data Sheets?

Informational sheets that indicate hazards of the chemicals used in each section of the laboratory In 1987, the Hazard communication ACT established Material Data Safety sheets as the standard method to inform employees of the risks and hazards associated with the chemicals found in their workplace. Material Data Safety Sheets are required to be available to employes in the form of physical sheets or electronic files

When the phlebotomist explains the collection procedure to the patient and the patient agrees to the test, what kind of consent was collected

Informed consent Consent can at times seem like a complex subject. However all questions regarding consent can be answered by referring to the tpatient's rights Informed consent stems from the patient's right to be informed of their treatment and the patient's right to consent to or refuse treatment. By informing the patient of the venipuncture procedure and the patient consenting to that procedure, the phlebotomist has received informed consent. implied consent stems from a situation where a patient cannot give consent such as when the patient is unconscious. In this case, if it is reasonable to assume that the patient would give consent to the treatment as if they were conscious, implied consent is assumed.

Which of the following is the correct sequence for routine Evacuated tube system venipuncture

Inspect the needle, ask the patient to make a fist, anchor the vein insert the needle The needle should be visually inspected before use, so that should be done before proceeding to the next steps. The patient should make a fist next to stimulate blood flow to chosen site before venipuncture. However, making a fist after the needlestick could cause a hematoma. The vein should also be anchored before needle insertion to firmly secure it and prevent any movement when trying to pierce the vein

how should all anticoagulant tubes be mixed

Inversion The only appropriate way to mix a sample is by inversion. Inversion is done by putting the blood tube in hand and turning it upside down five to eight times ensuring proper mixing with additives. Any other method especially shaking, can lead to a damaged sample or tube. Light blue and lavender tubes are anticoagulant tubes and are therefore the most sensitive to mixing

What is irritant contact dermatitis?

Irritant and redness of the skin caused by direct contact with a chemical irritant Irritant contact dermatitis is a condition of the skin following contact with an irritant. for the phlebotomist, this condition is most commonly seen in those with latex allergies. Although many facilities are moving away from the use of latex products, the phlebotomist must be aware that many products contain latex such as gloves, tourniquets, blood pressure cuffs, and bandages.

If you are a student or you are in training/ orientation, you should let the paitent know when you introduce yourself because

It is a part of informed consent and patient rights The patient has the right to refuse to have blood drawn by a student or anyone else

Jane is called on to assist another healthcare provider following a failed venipuncture. Which of the following is true?

Jane should perform a capillary specimen if she is unable to obtain a specimen by sticking the patient twice When assisting another provider following a failed venipuncture, the phlebotomist should perform a capillary collection if she is unable to obtain a specimen within two sticks. Phlebotomist should use a vein in the opposite arm or a puncture a site below the first site. Probing a site is discourage because it is painful and may cause a hematoma, to stimulate blood flow, the arm should be position lower than the patient, not elevated.

Penalties for violation of the Health Insurance Portability and Accountability ACT(HIPAA) include all except

Job promotion Patient confidentiality is protected under the health insurance portability and accoutability act(HIPAA). HIPAA vioations can lead to penalties including criminal and civil charges in the form of lawsuits, fines and jail sentencing

John is a phlebotomist working in an outpatient laboratory. Today the label printer is broken and the lab cannot generate the barcoded labels for each tube. Which of the following should john do?

John should write his name or initials on blank labels for specimens he collected. When printer-generated barcoded labels are unavailable, or a manual requisition is used, specimen tubes and containers must be hand-labeled. They should be labeld in the presence of patient for accuracy. The minimum information needed includes. The patient first and last name, an identification number such as date of birth the collection date, the time the sample was collected, the initials or name of the person collecting the sample. The name of test order is generally not written on the label.

When is the alcohol prep pad removed from the septum of the blood culture tube?

Just before transferring blood to the bottle By placing an alcohol prep pad on the septum of the blood culture bottle, a phlebotomist can ensure that the surface is clean and not contaminated. No dry time is necessary as the prep pad will not come into contact with teh sample

Which of the following lab results can increase by over 100% or more as a result of the patient pumping their fist?

Lactate When the patient clenches their fist, they are using muscles to do so. Clenching the fist for too long and or too hard will create a by product of muscle metabolism called lactate. Falsely elevated lactate levels can completely change a patient's treatment plan, so the phlebotomist must watch for this

What allergy could potentially affect venipuncture specimen collection?

Latex Because many gloves and medical supplies are made with latex, it is important for the phlebotomist to identify a latex allergy in pre-examination

According to the Clinical Laboratory Standards Institute(CLSI), the established procedure for capillary collection, the order of draw recommends drawing which tube first?

Lavender top The Clinical Laboratory Standards Institute(CLSI) recommends that EDTA tubes(lavender top) be drawn first to ensure good quality specimens. hematology specimens would be followed by other additive tubes(green top for heparin or light blue for sodium citrate additives) and finally serum specimens tubes( red top)

Which of the following tubes contains EDTA

Lavender top The lavender top blood collection tube uses the anticoagulant EDTA which forms calcium salts with the blood, effectively removing the calcium from the blood in stopping the clotting process. This is one of the most common blood tubes used by the phlebotomist and is used for hematology and blood bank draws

Blood collection for donation requires a sterile closed system consisting of a collection bag, tubing, and a needle. The bag is filled by gravity so therefore the bag must be placed

Lower than the patient's arm The bag fills by gravity and must be placed lower than the patients arm Placing the bag higher than or next to the patient's arm would cause blood to flow slowly and make the process take longer. There is no guideline for how far away the collection unit should be and may vary depending on the tubing length and the collection set.

When considering timed samples, what is a major concern for documentation aside from properly identifying the patient

Making sure the draw time on the tube and in the computer match exactly While patient information and billing information are important, they are not major considerations when speaking specifically about timed samples. Ensuring the draw time and the time in the computer(or on the patient's charts) match is critical. Computers that print labels for the blood tubes generally take care of this; however, not always will a phlebotomist have this system available and must chart on paper

A thick blood smear can be used in the detection of which illness

Malaria Malaria is caused by an organism that multiples in the red blood cells. They are found in high concentrates in peripheral capillary blood. A thick blood smear made from a drop of capillary blood can help identify infection. Multiple sclerosis and muscular dystrophy are neurological disorders that are not commonly diagnosed by blood smear. Mycobacterium is an infection related to tuberculosis that affects the lungs and is not detected by blood smear

Capillary blood is preferred for making a blood smear of a patient with which condition.

Malaria- for a malaria diagnosis, it is preferred to take a smear of capillary blood. The cells of the malarial organism concentrate in the capillaries during a malarial crisis and therefore are in a larger concentration in the capillaries. Making the smear from a capillary puncutre will increase the changes the slide will show malaries. COMPLETE BLOOD COUNT(CBC) can identify abnormalities with blood cellls and is made with venous blood. Red blood cells are affected by anemia and jaundice. White blood cells are affected by leukemia.

A phlebotomist in the hospital setting may be observed on the job or asked questions by which regulatory entity

Many hospitals are accredited by either the Joint Commision(TJC) or the American Osteopathic Association(AOA). The Joint Commission formerly known as the Joint Comission on Accreditation of Healthcare Organizations is the preferred independent not for profit organization that conducts on site visits to inspect hospitals for regulatory compliance. Phlebotomist working in the inpatient laboratory setting may be observed or asked questions by TJC surveyors The clinical laboratory act(CLIA) and the American Medial Assocation(AMA) are not regulatory entities. Health Maintenance Organizations(HMOs) do not regulate laboratory compliance.

After locating an acceptable vein, what is the best way for the phlebotomist to find the site again after cleansing the skin with antiseptic

Mapping the location After locating an acceptable vein, the phlebotomist should mentally map the location with landmarks such as freckles or wrinkles Marking on the skin is unacceptable practice. After the site is cleaned, nothing should touch the skin except the sterile needle point

Of the following sample types which is not appropriate for drug testing

Metabolites of drugs are found in the hair, urine and saliva. urine is the most common medium for drug testing. Blood analysis may be appropriate in situations when it is suspected that the person is actively under the influence of drugs or alcohol. Since drugs are rapidly metabolized and eliminated from teh body, blood analysis offers a very brief detection window. Drugs in the blood are typically detectable within minutes to hours, depending on the drug and the dose, versus one to several days in the urine

A throat culture could be processed in which laboratory department

Microbiology Throat swab specimens are most often collected to aid in the diagnosis of strep throat infections. The swabs can be cultured in the microbiology department or used with a rapid strep screening test Microbiology is the department devoted to culturing, examining, and identifying microorganisms such as bacteria

What is commonly being tested for when performing a throat swab

Microorganisms Throat swabs can provide various information about a patient; however, most commonly the test is used when the patient has an upper airway disease and the physician is suspicious of a microorganism such as streptococcal bacteria

Wearing rings or watches increases the phlebotomist's risk of exposure to which of the following?

Microorganisms-watches, rings, necklaces, bracelets and other forms of jewelry have the potential to harbor microorganisms which can be spread to the healthcare worker or other patients. The phlebotomist should remove these forms of jewelry to ensure appropriate aseptic technique. Blood borne pathogens and dangerous chemicals should never come into contact with the skin of the phlebotomist if he or she is wearing appropriate PPE. Handwashing is always necessary for those performing care.

Which of the following is not a risk of collecting a timed sample at the incorrect time

Misidentifying the patient By the time the sample has been taken, the patient has been identified correctly There are many risks to collecting a timed sample at the wrong time. if a phlebotomist has any questions they should ask the patients nurse or physician Risks: Flawed treatment plan, incorrect medication dosage, miscalculated lab results

Exsanguination is blood loss to a point in which life cannot be sustained. Life may be threated if what amount of blood is removed at one time or over a short period of time

More than 10% More than 10% blood loss in a short period of time may lead to cardiac arrest or death Coordination with the healthcare team to minimize the number of draws per patient and following specimen collection requirements to reduce the number of redraws are ways that phlebotomist can help prevent blood loss complications

Most healthcare facilities require employees to maintain certification in Cardiopulmonary Resuscitation (CPR). Phlebotomists are encouraged to take the Basic Life Support(BLS) for healthcare providers course. Appropriate actions for a patient in the hospital who is wearing a Do Not Resuscitate(DNR) wristband would include all of the following except

Mouth to mouth breathing and chest compressions in the case of respiratory arrest A Do NOT resuscitate wristband alerts healthcare providers of the physician's order to withhold Cardiopulmonary Resuscitation. Do not resuscitate means that the patient does not wish to be resuscitated, but other life saving treatments should not be withheld Infusions, treatment for uncontrolled breathing(hemorrhage), and treatment for choking are all appropriate for a client who has a DNR order in place

which of the following patients is at most risk of an error in white blood cell (WBC) count

Much like a crying baby, a patient who is experiencing a high amount of stress can also have an elevated WBC count. Stress increases a generalized immuno-response by the body, which in turns increases the production of white blood cells.

What is sputum

Mucus/phlegm coughed out from respiratory tract At times, it may be pertinent to collect mucus that is coughed up by the patient. Cultures run on sputum indicate lower airway diseases. If an infection is suspected , the phlebotomist should take standard precautions.

What is one advantage the butterfly system has over the needle and syringe technique when performing venipuncture?

Multiple syringes can be collected A buttefly system also known as a winged set has a small needle with a tube attached. This tube will have a simple device for preventing blood from pouring out the open end allowing a phlebotomist to remove the original syringe and attach another. With a simple needle and syringe technique, collecting more than one syringe is far more difficult and should be avoided

Cardiac Point of Care testing (POCT) analyzers are valuable tools for diagnosis. a critical troponin I(TNI) result may indicate

Myocardial damage from a heart attack Troponin I(TnI) is a valuable tool in diagnosis of Acute Myocardial Infarction(AMI) or heart attack. It cannot detect congenital anomalities or valve complications A different test called C- Reactive Prtoein(CRP) shows proteins in the blood that are evidence of tissue injury but not in the heart, rather in the liver. CRP tests indicate infection or inflammation.

For the protection of healthcare workers, the Occupational Safety and Health Administration(OSHA) prohibits which of the following

Nail biting in the workplace The Occupational Safety and Health Administration(OSHA) regulations prohibit putting pens, pencils or fingers in the mouth. This prevents potentially infectious material from being introduced in the mouth. Protective clothing, gloves, alcohol based cleansers and waste incineration are all approved safety measures.

All of the following are special considerations a phlebotomist should consider when working with geriatric patients except

Never leave these patients unattended Concerns regarding unattended patients apply specifically to newborns and infants. this is because this age group is at risk for quickly rolling off the table and injuring themselves. The geriatric patient has special considerations regarding their care and sample collection; however, generally, these patients can be left unattended as they are capable of taking care of themselves Considerations of geriatric patients Assistance in holding the patient's arm or hand when attempting venipuncture may be needed, veins that roll easily are common in this population, the patient's ability to see and hear clearly may be impaired

Is a 25-gauge needle appropriate for drawing blood samples from a patient? Why or why not?

No, a 25 gauge needles is too small and would destroy the blood cells when blood is pulled through the bore of the needle A 25 gauge needle cannot be used for venipuncture because the red blood cells would be destroyed when the needle is pulled through the bore of the needle

What additive does the red top blood collection tube contain

None, the blood is allowed to clot Red top tubes contain no additives and are used for chemistries , immunology and serology and blood bank tests

At what time of day are catecholamines at their highest concentration in the urine

Noon Catecholamines are hormones made by your adrenal glands. they are relased when you have physical or emotional stress.These hormones include epinephrine, norepinephrine, and dopamine. they send nerve impulses in ur brain, narrow blood vessels, and raise your heart rate Circadian rhythms in the body have certain levels of different bodily metabolites fluctuating throughout the day. Catecholamines are highest in the noon. other substances such as electrolytes are lowest in the early morning.

An infection that develops in a patient 48 hours or more after admission to a hospital or health facility is known as

Nosocomial infection Also known as healthcare-associated or hospital acquired infection, a nosocomial infection is an infection that a patient acquires while at a healthcare facility. Noscomial infections are a major problem in the healthcare industry and the focus of many regulatory bodies. Everyone on the patient care team including the phlebotomist is responsible for reducing healthcare associated infections.

How long after a tube's expiration date may the tube be used for sampling

Nothing may be used after its expiration date Expiration dates are calculated based on the material the device is made out of, the additives inside of the device and the effects of temperature and light that will surround the device. Because of this, expiration dates are very firm and do not allow for leeway.

If a patient does not have a patient identification braceleet, what should the phlebotomist immediately do

Notify the patient's nurse. If the phlebotomist notices that the patient does not have a patient idenficiation bracelet on he or she must immediately notify the patient's nurse. The phlebotomist should not continue with sample collection defer the issue to someone else or ignore the patient. Remember, proper patient identification is the most important part of ensuring no erroneous results occur.

If an aware patient refuses venipuncture you should:

Notify the physician-an aware patient that is not forced by a judge or court has the right to refuse any treatment,even if that treatment is considered urgent by the healthcare team. A proper introduction and attempt at gaining trust with the patient is the easiest way to diffuse this situation, however, if the patient still resists the phlebotomist should notify the physician so they can attempt to convince the patient to undergo the procedure. *restraining the patient is an absolute last resort and onlhy occurs in emergency situations, phlebotomist will never be responsible for making this decision. An aware pateint refusing venipuncture is not an indication to call 911

What is the most common sign of nerve damage following venipuncture?

Numbness and tingling When a nerve is touched or damaged by a needle the patient may feel pain but will almost always report numbness and tingling distal to the location where the needle touched the nerve. The phlebotomist should immediately remove the tourniquet and needle from the patient's arm and ensure patient comfort

Most experienced phlebotomists can perform advanced procedures such as injections, tuberculin skin tests, and arterial punctures. What is usually required for these advanced phlebotomy procedures.

Observed comptency check off- a phlebotomist can performed advanced procedures when they have receieved thorough training to perform the task and have been evaluated with a competency check off. *a health physical, CPR certification, and infection control training may be required by an employer, but are not specific to performing advanced procedures.

A safety manual contains policies and procedures related to chemical, electrical, fire ,and radiation safety. Which organization requires every business to have a workplace safety manual?

Occupational Safety and Health Administration(OSHA) THe occupatonal safety and health administraton(OSHA) requires every business to have a safety manual available for employee use and they issue hefty fines for noncompliance

The phlebotomist working in a doctor's office is paged by one of the new nurses who has a question. The nurse says that the doctor has ordered a urine specimen for culture on a child that is approximately 12 months old, and she would assistance to catheterize the child. What should the phlebotomist do to assist the new nurse?

Offer assistance with collecting a bagged urine sample instead A urine bag with an adhesive seal is used to collect urine from children who do not yet have the control to urinate in a container. A bagged urine collection is used to perform urinalysis or urine culture on this type of patient. The procedure for a bagged urine sample in children involves the following; Clean the front of the body with an antiseptic wipe where the bag will attach Allow the skin surface to dry completely Attach the bag to the front of the child with the adhesive Put a diaper over the bag and wait for infant to void Carefully remove the bag with urine in it and put it in the appropriate container to send to the lab

Where are phlebotomists most likely to find patients in reverse isolation

On a burn unit Reverse isolation also known as protective isolation is used for patients who are highly susceptible to infections such as those with suppressed or compromised immune systems. This includes burn victims, organ transplant patients, AIDS patients, or those on chemotherapy The post partum unit is where women recover from childbirth, so it is not a good place to find patients on protective isolation precautions. Isolation procedures are meant to separate the patients in the hospital and therefore, doctors' offices are unlikely places to find isolated patients.

To prevent contamination, where is the best place for a hospital phlebotomist to put the phlebotomy tray while obtaining blood samples

On a clean towel laid over the bedside table. -The phlebotomy tray is taken from one patient's room to another. Phlebotomists should never place the tray directly on an area that the patient will tuch because that can transfer contaminants to the patient. Laying a clean cloth down as a mat protects the tray from patient's surface and also protect's the patient's table surface from the phlebotomist's tray. At departure, the phlebotomist should move the towel to dirty linens.

Where is the bleeding time test conduced on a patient

On the inside of the arm, 5 cm below the antecubital crease, once the blood pressure cuff is inflated to 40 mmHg during the bleeding time test, 30 seconds must be allowed to pass before making the incision. The incision is made in the antecubitial region(inside of the elbow) 5 cm below the antecubital crease.

Where are capillary punctures performed on children under one year of age?

On the medial or lateral surface of the infant's heel-when performing capillary punctures on children under one year of age- the site should be on the plantar surface, medial to a line drawn from the middle of the big toe to the heel or lateral to a line drawn from the fourth or fifth toes to the heel. Do not perform capillary puncture in the central arch area of the foot as puncture performed here may result in damage to nerves, tendons, and cartilage.

Where are the labels for urine samples required to be placed?

On the side of the container The only appropriate site for a urine sample label is on the side of the container. Often phlebotomists place the label on the lid which is inappropriate. Urine sample lables sometimes come with temperature sensitive detectors in the even drugs are being tested for to ensure the sample has not been tampered with

When using a sterile urine collection cup, in what time fame must the sample be collected to ensure them most accurate results

One hour Sterile urine collection cups can keep a urine sample stable for about two hours; however in the presence of microorganisms, the sample can degrade quickly. Because of this , it is recommended that the sample is subjected to culture tests within one hour

What is the maximum allowable time between application of the tourniquet and removal of the tourniquet from the patient's arm

One minute Once the tourniquet has been applied to the patient's arm, the phlebotomist has one minute to perform the venipuncture and remove the tourniquet. Proper setup and practice makes this easier

What is STAT sample

One which requires the immediate attention of the phlebotomist STAT refers to something that is needed immediately. STAT samples are usually taken in the inpatient setting, so phlebotomist are near the nurses and physicians that need them

What is the relationship between oral medications and IV medications

Oral medications take longer to reach peak levels than IV medications The phlebotomist should be aware of this fact when assisting in therapeutic drug monitoring so as to not collect samples from a patient too soon or too late

Which of the following tubes contains thrombin

Orange top Thrombin is a factor in the clotting cascade and is used in a blood collection tube to quickly clot blood samples. This gives a "snapshot" of the chemistries at teh time of blood collection

When making the incision with a Surgicutt device, what orientation should the device be placed in relation to the antecubital fossa crease?

Parallel The incision made for a bleeding test is 5 cm below the antecubital crease and is oriented parallel to the crease. Additionally the incision should not be on top of any noticeable veins as this could lead to much more bleeding than the test requires for results

What is an aliquot

Part of the whole sample that has been taken off for use or storage The phlebotomist at times will have blood samples in syringes and will divide the blood into sample collection tubes or give it to the nurse to use for bedside testing. Each of these divisions is called an aliquot.

What is the first thing that is needed when collecting a sample for drug testing

Patient consent- Whenever anything is done to a patient, their consent is needed, even in legal cases. In the event that the patient does not give a urine sample, and they are in the custody of a law enforcement agent, there are other ramifications for the patient that is not the concern of a phlebotomist.

All of the following variables influence the effectiveness of a drug except:

Patient height the height of the patient, in and of itself has no effect on how well a drug works. Variables that influence the effectiveness of a drug include concentration of administration weight of patient Age of patient Patient's metabolism Disease state Kidney function and liver function Interacting drug therapy

To which of the following does "airbourne" precautions refer

Patients known or suspected to have an illness transmitted through small particle airborne particles which may remain suspended in the air Patients infected with airborne diseases such as measles, varicella, and tuberculosis can post a significant risk to the healthcare worker. if an airborne infection is suspected, the healthcare worker should take full precatuions as per the healthcare facilities protocols. The phlebotomist should also remember that airborne infections may also be suspended in dust particles in the air

To which of the following does "droplet precautions" refer?

Patients known or suspected to have illness transmitted through larger droplets containing microorganisms Droplet precautions refer to patients known or supsected to have illness transmitted through larger droplets(larger than 5 micrometers in size) containing microorganisms. These droplets travel only short distances of 1m(3 feet) or less

The term "geriatric" refers to

Patients over the age of 65 A geriatric patient is considered to be over the age of 65. These patients present may unique challenges to the phlebotomist. often, a healthcare worker will need to speak more deliberately and may have to provide physical stability for sample collection

Phlebotomists working in clinics or outpatient settings may be involved in the collection of various types of cultures. All of the following are important steps to remember except.

Patients should be fasting for culture tests Under normal circumstances, patients are not required to fast prior to specimen collection for a culture tests Important steps Sites should be swabbed with enough force to remove organisms adhering to membranes, specimen collection containers are sterile, and hands should be washed before and after collection

the term pediatric refers to

Patients that belong to the toddler(one to three years) preschool(three to six years) and school age 6 to 12 years age groups Pediatric patients present some of the most challenging situations to any healthcare worker. For the phlebotomist, pediatric patients can be physically difficult to collect samples from can be unwilling to provide samples or a combo of both Great care must be taken when working with pediatric patients as they are still developing an understanding of their world and the necessity of being healthy. Always considering using parents, grandparents siblings or counselors when available to make sample collection easier.

You have entered the room to perform a venipuncture. Your patient's identification bracelet has incorrect information. You should

Perform a venipuncture after a corrected identification bracelet is attached Any healthcare setting has the potential to be very hectic and patients can move without staff members being consulted first, such as when a pateint goes to imaging or the restroom. Whenever a patient sample is collected, the phlebotomist must make sure that the patient is wearing a patient identification bracelet and that the informationon the patient information bracelet is correct

Record-keeping requirements of a laboratory's exposure control plan include all except.

Phlebotomy certification- training records, sharps logs, and employee medical records should all be maintained to show compliance with the plan to reduce risk of employee exposure

In paternal testing cases how does a phlebotomist prove the samples were collected from the correct individuals?

Photos are taken of all individuals and sent with the sample Paternal testing cases can be very difficult for the patients and the medical staff. Because of this, witnesses and regular identifying information are not sufficient to prove whom the the samples were taken. additionally, obtaining signed affidavits is not a job of the clinical staff, therefore, pictures are taken and sent with samples

Jane is a newly certified phlebotomist applying for a job at a Women's hospital. During her interview, she is asked how familiar she is with phytotherapy. What is Jane's best response?

Phytopherapy is a treatment for newborns with hyperbilirubinemia Phytotherapy lamps or blankets emit blue spectrum light which helps break down bilirubin in newborns whose levels get too high. Dangerously high levels are toxic to the brain and can cause damage. A blood transfusion may be needed if levels increase higher than 18 mg/ dl of blood Although the phlebotomist may not be the one responsible for providing phytotherapy, it is important to be knowledgeable about conditions and procedures in the healthcare setting to be able to assist other healthcare professionals on the team

What blood test should be performed on a patient before measuring bleeding time

Platelet count Before measuring bleeding time, a physician should order a platelet count to ensure the bleeding time test is going to yield accurate results. A normal platelet count will be above 100,000 per mm^3. if less the test will not help physicians understand platelet activity in patients

What is the correct way to instruct the patient for a throat culture specimen collection?

Please tilt your head back and open your mouth wide Instructing the patient to tilt their head back and open their mouth wide allows adequate evaluation of collection site and ease in specimen collection. using a penlight, the phlebotomist can visualize the back of the throat to see where to direct the swab and can avoid contaminating the swab by touching the tongue and lips **the phlebotomist should not instruct the patient to cough because that could expel pathogens into the air. Tilting the head down would make it harder to collect the specimen

Which of the following is an example of ethical phlebotomy practice

Politely declining an invitation to dinner from a patient that frequents your office Ethics is a moral philosophy that requires an individual to act responsibly towards patients and employers. Declining a dinner invitation maintains the professional boundary with the patient. Actions such as taking items for your workplace, or spending time on the clock with activities that are not work related are unethical

Why are arterial sites more prone to extended bleeding than venous sites

Pressure is higher inside arteries than in veins At times phlebotomists will perform arterial blood gas sample collections. The phlebotomist should be very aware that arteries are surrounded by smooth muscle and tend to have thick walls than veins, which causes an increase in pressure inside arteries. This can greatly extend bleeding time.

Which containerr must be labeled before sending to the laboratory

Primary The primary container is the container that holds the sample itself and must be labeled with patient identification, hospital identification, test to be run, and expiration date before it can be sent to the lab Secondary and tertiary containers are often not labeled as they are used for temperature regulation, transportation over long distances and protection from light.

When transporting a sample out of a facility, what additional step must be taken?

Primary container placed in a secondary container- primary container placed in a secondary container- often a phlebotomist will need to send samples to an external laboratory. THis is particulary the case when blood samples are drawn at skilled nursing facilities. When this is the case, the primary sample containers must be placed in a secondary container at a minimum has a biohazard sticker on it to indicate there are biological samples in the container.

What risk do microorganisms on the skin pose to blood culture collection and testing?

Produce a false-positive result Blood is supposed to be sterile; however, the skin is not. Because of this, proper cleansing of the venipuncture site is crucial to prevent microorganisms on the surface of the skin from getting into the blood culture set.

According to Clinical Laboratory Standards Institute(CLSI) standards, all of the following are acceptable positions for a patient undergoing a capillary blood collection procedure except:

Prone position for newborns Prone means lying face down. It would be inappropriate to position a newborn face down to obtain a capillary blood specimen. Infants should be placed on their backs instead. Sitting and reclining are other acceptable ways to position a client

What is the most critical step in collecting blood cultures?

Proper cleansing of the venipuncture site The single most important step following properly identifying the patient when drawing blood cultures is the proper cleansing of the venipuncture site. this can be done with an iodine tinture, alcohol prep pad, or chlorhexidine. if the patient's skin is visibly soiled, use soap and water

When testing for vitamins such as vitamins C, E, and K, what considerations must be made for the sample following collection?

Protection from light- protecting a tube from light is important in several types of tests including and most especially bilirubin. Tests for vitamins such as vitamin C, E, and K are also susceptible to light exposure. An amber tinted tube is designed for this purpose. If an amber tube is not available, tin foil may be wrapped around the tube.

Electronic Medical Record(EMR) documentation is used by all of the following except

Public schools Insurance companies, large medical facilities, and federal and state governments use EMR patient records because they are involved in reimbursement and regulation of patient care Schools are eduacational institutions and therefore do not routinely use healthcare information for routine operation

Which of the following could cause a vein to collapse during sample collection

Pulling back to hard or too fast on the syringe plunger The purpose of pulling the syringe plunger back when collecting the blood sample is to create a vacuum in the syringe barrel which inevitably fills the syringe with blood. If the vacuum is created too fast, the vein could collapse, yielding no blood return. To rectify this, the phlebotomist pulls back on the plunger slowly.

Emma is obtaining a microcollection blood sample from a newborn via capillary puncture. She should be careful to avoid the central arch area of the baby's foot because:

Puncture here may result in nerve damage Puncture in the central arch area of the foot may result in damage to nerves, tendons and cartilage. Additionally it offers no advantage over a heel puncture, so it is not recommended

Which of the following is an acceptable yet unsafe method to transfer blood to an evacuated tube

Pushing the blood through a standard needle While the use of a standard needle is an acceptable way to transport blood from a syringe to an evacuatedtube, a phlebotomist should not make it common practice for several reasons; the first is safety. Using any needle increases the risk of exposure to bloodbourne pathogens. Second, the delay could allow the blood to clot. All of the of the distracting answers are patently unacceptable methods for blood collection

Joe was recently hired as a phlebotomy technician in an outpatient laboratory known as Patient Service Center(PSC). During his orientation, his preceptor told him that one of his responsibilities would be to perform Quality Control(QC) checks on the centrifuges. Joe correctly suspects that this will involve

Recording the date and time of routine maintenance tasks on designated logs Quality Control(QC) checks refer to tasks aimed at identifying errors and preventing problems. Routine maintenance of the centrifuges and recording logs are commonly performed as QC checks in the lab. Transporting equipment, calling repair technicians, and programming new equipment are not duties that phlebotomist routinely perform to prevent errors or problems in the lab.

All of the following drugs are monitored for diurnal effect except:

Recreational drugs Recreational drugs do not exhibit diurnal effects and therefore are not tested in a diurnal fashion Diurnal effects: digoxin, coagulation drugs, aminoglycosides

What cells in the blood is hemoglobin attached to

Red blood cells Hemoglobin is proteins in red blood cells that are responsible for carrying oxygen around the body. An additional feature of hemoglobin is that they have a mechanism that remembers blood glucose levels for about two to three months. The A1c test isolates red blood cells and is tested in a lavender top tube

Which of the following devices can only be used for urinalysis

Red yellow(tiger) top urine collection tube While the other devices mentioned can be used for urinalysis, only the red yellow tiger top urine collection tube can be used for only the purpose of urinalysis. Keep this in mind as this can be a limiting factor Tubes used for urinanalysis and other urine tests : Gray top urine collection tube Red top urine collection tube Sterile urine collection cup

The Joint Commission(TJC) National Patient Safety Goals(NPSGs) program promotes patient safety. Which one of the following is not a recent NPSG?

Reduce healthcare costs Reduction of costs is not a primary safety goal In 2018 the National Patient Safety goals(NPSGs) were identifying patients correctly Improve communication Prevent infection

What does the phrase "breathing the syringe" refer to

Releasing the plunger which may be stuck to the barrel A syringe system is manufactured by machine in a sterile environment. When the syringe is put together for the first time, the machine does not push the plunger completely into the barrel so as to prevent the plunger from completely adhering itself to the end of the barrel. To the phlebotomist, this may present as a plunger that is gently stuck to the inside of the barrel. Simply pull the plunger back halfway of the barrel then push the plunger all the way in.

Which of the following is an aseptic technique to prevent infection of the venipuncture site?

Remind the patient to keep the bandage in place for at least 15 minutes following the procedure Keeping the bandage in place for 15 minutes allows the site to close and therefore prevents a portal of entry for bacteria transmission.

When performing first aid to a hemorrhaging wound;

Removal of the original compress can disrupt the clotting process When providing first aid to a hemorrhaging wound, the original compress should not be removed when adding additional ones because removal can disrupt the clotting process Elevating the affected extremity and compression of arterial pressure points are not recommended and have not been found to be effective interventions. using a tourniquet to control bleeding is harmful and should not be attempted

What should a phlebotomist not do immediately following obtaining a blood sample

Remove the tube holder from the needle Per OSHA regulation: The practice of removing the needle from a used blood-drawing/ phlebotomy device is rarely if ever required by a medical procedure. Because such devices involve the use of a double ended needle such removal clearly clearly exposes employees to additional risk. Devices with needles must be used and immediately discarded after use, uncapped into accessible sharps container Should: recheck the identification bracelet with the labels or requisitions place an alcohol swab immediately above the needle insertion point activate the safety shield over the needle

What is the firs step in removing isolation attire

Removing gloves The first step when removing isolation attire is to remove the gloves and then wash hands. This allows for clean hands to remove the mask and prevents biohazards from coming in contact with your face hair and neck. The face mask is then removed, followed by the gown and another round of hand washing.

Which of the following is not an appropriate action for a victim in shock.

Removing the clothing to cool the patient The primary objective of first aid for shock is to improve blood circulation so that an adequate supply of oxygen is delivered to all parts of the body. When performing first aid to a victim of shock it is important to do the following: 1. maintain an open airway for the victim 2. call for emergency assistance 3. keep the victim lying down 4. elevate the legs approximately 12 inches so the head is lower than the rest of the body unless a broken back , leg or hip bone is suspected 5. keep the victim warm until help arrives It would not be appropriate to remove clothing to cool the patient if you are trying to keep the victim warm

When referring to fire safety what does the acronym RACE stand for

Rescue, Alarm Contain Extinguish/Evacuate The National Fire Protection Associations' acronym for action in case of fire is RACE. R-rescue anyone in danger A-Sound the alarm C-Contain the fire by closing doors and/or windows E-Extinguish the fire if possible,; evacuate if the fire is too large

Before sputum collection, what should the phlebotomist instruct the patient to do before the collection

Rinse mouth Before collecting a sputum sample, the patient needs to rinse their mouth to remove any food particles and or microorganisms from the mouth. The purpose of this is to ensure any sputum is from the lower airway and not from the mouth

What is the best temperature needed to maintain a sputum sample

Room temperature Sputum comes from the lungs which is generally inhale air at room temperature, so it is acceptable to store sputum at room temperature. Standard precautions must be maintained however

What is the most serious problem that may occur if a sample is exposed to extreme temperatures?

Rupture of red blood cells. Extreme temperatures can cause the rupturing of red blood cells which then spill their contents into the surrounding fluid drastically altering the testing accuracy.

Rank these common test statuses in order of priority, from greatest or first priority to last or least priority: routine, STAT, preop timed

STAT, timed, preop, routine- STAT labs are always first priority, "STAT" is latin for immediately. Timed labs are second priority and should be collected as close to the ordered time as possible. Preop labs would come next and routine labs are last priority.

Biohazardous waste disposal is regulated by all of the following except

Safety Data Sheets(SDS) Safety Data Sheets(SDS) formerly known as Material Safety Data Sheets(MSDS) communicate important information about hazardous chemicals Regulated by OSHA, EPA(environmental protection agency), and States department of health

What is the main disadvantage to using a T-spot blood test over a purified protein derivative(PPD) test when testing for tuberculosis?

Samples have a limited amount of time to be tested by a lab. T-Spot blood tests' main disadvantage is that they need to be tested within a certain amount of time. if a tuberculosis test is drawn at a location that does not have immediate access to a lab, the transport time may invalidate the sample

What is the definition of the term circannual

Seasonal changes over the course of a year

What is a generally accepted form of a secondary container

Self- sealing bag The most basic form of a secondary container is a self-sealing(ziplock) bag with a biohazard symbol on it. Locked safes are not common as secondary containers. patients may often put samples they collect at home in their pockets; however, phlebotomists should not. Pneumatic tubes are not forms of secondary containers

The patient has left and the phlebotomist has noted the blood tubes are not filled to the appropriate level. After notifying the patient's nurse, what should the phlebotomist do?

Send the results to the lab- sometimes the blood tubes cannot be filled completely. laboratories have procedures for tubes not filled appropriately and sometimes they can circumvent filling requirements with applied chemistry. Always make sure to notify the nurse and make a note in the chart

Which of the following is not information gained by palpation of a vein

Sensitivity Veins do not have nerves and therefore do not generate pain when punctured. Sometimes nerves may run alongside veins. however, palpation will not determine the sensitivity of that nerve. A patient who has had blood taken before is a good source to determine sensitivtiy Size direction and depth(gained by palpation of vein)

What additives does the gold top blood collection tube contain

Separating gel and clot activator The gold top blood collection tube is a serum separator tube(SST) that separates the blood from serum on coagulation. its uses include serology, endocrine, immunology, including HIV

Which of the following tests does not exhibit a diurnal effect

Serum alcohol Remember that diurnal refers to regularly changing throughout the day. Serum alcohol is based on when the patient ingests alcohol and has nothing to do with natural biological rhythms Tests that exhibit diurnal effect Cortisol, corticosteroids, and serum iron

What types of samples are less affected by exposure to extreme temperatures

Serum and plasma Serum and plasma blood samples are less affected by extreme temperatures because the red blood cells have already been removed, preventing any alteration in test results. Urine samples often are tested for red blood cells which cannot be detected if exposed to extreme temperatures

How long can analysis for drugs in the urine wait from a yellow top urine collection tube

Seven days Drugs screening using yellow top collection tubes can wait as long as seven days to test. This is not true for the other tests that can be run on the yellow tube

Following a venipuncture procedure , patient care should include all of the following except

Shake the patient's hand before removing gloves You should avoid shaking the patient's hand with your gloves on following venipuncture because they could have blood on them. Before touching anything, the phlebotomist should remove gloves and sanitize hands After collecting a venipuncture sample, the phlebotomist should thank the patient for cooperating and observe that the patient is not having any complications such as feelings of nauseas or hyperventilation. Syncope(fainting) is a common reaction to having blood drawn and rapid breathing or pallor can be signs of impeding complications. Before dismissing a patient from the care area, the phlebotomist should ask if the patient feels well

A 16 year old female arrives at the physician's office for treatment. She is alone and has not told her parents that she was going to the doctor. Which of the following is true?

She cannot give consent for treatment because she is not at the age of the majority The definition of minor confuses some. State law determines the age when a child ceases to be a minor and reaches the age of majority tobe recognized as adult legally. That age varies by state, but it is over 16 in all states. As a general rule a minor cannot give consent for the administration of medical treatment. Parental or guardian consent is required. healthcare personnel who violate this rule are liable for assault and battery

When palpating a vein, a vessel that pulsates

Should not be punctured If the "vein" you feel pulsates, it is an artery and should not be punctured

The xylose tolerance test is an indication of the absorption function of which organ

Small intestine The xylose tolerance test is a test in which patient are administered oral xylose, which is a type of sugar, then tested for blood levels of xylose. If the levels are high, absorption of the small intestine is adequate, if the levels are low, there may be a problem that needs to be further diagnosed

What additive does the dark blue top blood collection tube contain

Sodiujm heparin or Na(2) EDTA The dark blue top blood collection tube is designed to contain no contaminating metals because its purpose is for toxicology and trace element testing including zinc, copper, lead and mercury. The dark blue top blood collection tube can also be used for drug level testing

What additive does the black top blood tube contain?

Sodium citrate The black top blood collection tube contains sodium citrate which forms calcium salts to remove calcium from the blood. This tube is used for the westergren sedimentation rate

What additive does the light blue top blood collection tube contain?

Sodium citrate The light blue tops contain the anticoagulant sodium citrate which binds calcium from the blood, effectively stopping the clotting process. This tube is used for coagulation tests. A discerning student will notice that both the lavender and light blue top tubes bind calcium from the blood which stops the clotting process. It is the mechanism by which both EDT and sodium citrate complete the separation of calcium that makes them different

Of the following, what additive(s) does the light green top blood collection tube contain?

Sodium heparin The light green top blood collection tube contains sodium heparin or lithium heparing and a gel separator used for the collection of heparinized plasma for routine chemistry tests.

The T-Spot blood test for tuberculosis requires what type of blood tube additve

Sodium heparin the t-spot blood test is a test for tuberculosis via the blood,, instead of the intradermal injection. the green tube containing sodium heparin not lithium is used to keep the blood in the necessary testing state

What additive does the dark green-top blood collection tube contain?

Sodium heparin or lithium heparin The dark green-top blood collection tube inactivates thrombin and thromboplastin to prevent the blood from clotting in the tube. its use includes ammonia, lactate and HLA typing

How should a normal, healthy vein feel to palpation

Soft and bouncy A vein will feel somewhat firm until pressure is applied at which point the structure collapses slightly. There are very few structures that mimic veins. Tendons are hard and do not move when pushed. Arteries have a pulse which is generally very obvious

All of the following should be discarded in labeled sharp and biohazard containers except

Soiled gloves Soiled gloves can go in the regular waste receptacle. IT is important to avoid overfilling a sharp container with bulky trash such as glove because that practice increases the risk of exposure to biohazard materials or injury

Peter is a phlebotomist in a pediatric office. his first appointment of the morning is a new mother who has brought in her baby for a follow up galactosemia test. The mother makes a statement to Peter that she is sure nothing is wrong with her baby. "She is already 5 days old and she looks fine. I'm sure everything is going to be alright" Peter knows which of the following is true

Some forms of galactosemia do not require treatment Galactosemia is an inherited disorder characterized by the lack of enzyme needed to convert milk sugar into energy for the body's cells. Within one week of birth, infants with galactosemia may fail to thrive due to anorexia, diarrhea, and vomiting unless galactose and lactose are removed from the diet. The incidence of galactosemia is in 1 in 60,000 to 80,000 births. Some forms of disorder are less sever and do not require treatment, only further monitoring and testing

Which of the following does not require the patient to have a private room

Standard precautions Standard precautions maintain that personal protective equipment and barrier controls must be worn for contact with all body fluids, whether or not blood is visible. The goal of standard precautions is to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection Only transmission based isolation precautions such as airborne, droplet, and contact precautions require the patient to be separated from others in a private room

Phlebotomist documentation should

State facts, not feelings Documentation should be objective and recall only the facts not feelings. it should not place blame Documentation should be completed daily before the shift ends. Abbreviations are allowed if they are approved by the facility

Where are the blood samples for legal alcohol testing sent?

State or local police laboratories-when legal alcohol testing is required of a patient's blood, the samples are sent to a police laboratory and tested there. It is possible that the police may have a specialty trained nurse or phlebotomist at a hospital; however, for liability reasons, hospitals generally do not perform these tests. Any alcohol tests done in a hospital are protected by HIPAA and not immediately available to the police.

of the following what is a prohibited function of a phlebotomist

Taking vital signs The phlebotomist can have a wide array of functions in the healthcare setting even entering billing information on samples they have collected and are sending to a lab. Performing nursing functions such as vital signs, drug administration and reviewing patient's charts for diagnosis information is not a function of the phlebotomist

Only nurses and other specially trained personnel are permitted to draw blood specimens from Vascular Access Devices (VADs). However, the phlebotomist typically assists by:

Supplying the appropriate tubes, a syringe if one is needed, and transferring the blood to the tubes using a syringe transfer device Vascular Access Devices(VADs) are tubing and other devices that are specifically designed to allow entry to veins or arteries. The most common VADs that the phlebotomist might encounter are intravenous(IV) lines. IV catheter locks, arterial lines(A-lines) Arteriovenous(AV) shunts or grafts, and Central Venous Access Devices(CVADS). When a phlebotomist encounters these, they should find the nurse for assistance. Only the nurse and other specially trained personnel are permitted to draw blood specimens from Vascular Access Devices(VADs). However, the phlebotomist typically assists by supplying the appropriate tubes, a syringe if one is needed, and transferring blood to the tubes using a syringe transfer device

What device is used to measure bleeding time?

Surgitcutt- a surgicutt device is a spring-loaded blad that makes a standardized cut 5 mm long and 1 mm deep into the patient's skin, retracting into the deviced after use. Next, testing paper is applied to the wound every 30 seconds until the process is complete. Pressure is create with a blood pressure cuff inflated to precisely 40 mmHg. The phlebotomist should be careful to not create an incision on top of any superficial veins, as this will create more bleeding than is necessary.

With which complication does hypoglycemia share similar signs and symptoms?

Syncope

Shallow breathing, pale skin, rapid pulse and perspiring are all symptoms of what complications of venipuncture that a phlebotomist may encounter?

Syncope The medical term for fainting is syncope. it is preceded by any combination of the following symptoms: Patient turning pale, perspiration, shallow breathing, rapid pulse Fainting is not entirely uncommon during the venipuncture procedure. The phlebotomist can ensure patient safety by making sure the patient is sitting in a chair when performing the procedure.

Sarah is a phlebotomist working in a physician's office laboratory. this morning, a healthy-appearing young adult male arrived at the lab with a request form for a complete blood count(CBC) and a Comprehensive Metabolic Panel(CMP). Sarah verified the order and the patient's identity before the patient began sweating and his face turned pale. Sarah should suspect a possible patient complication What should she suspect and what is the best action

Syncope, ask if he has ever had a problem with venipuncture Syncope is the medical term for fainting and is a possible complication for any patient. Signs to watch for indicate pallor(pale skin) perspiration(sweating), and hyperventilation(rapid breathing). If a patient complains of feeling like they might faint or exhibits these symptoms, the phlebotomist should determine if they have ever experienced syncope with venipuncture before Any patient who has fainted before must lie down for the procedure, no matter how long ago the event occurred. Ammonia inhalants should be avoided because they may cause respiratory distress in patient with a history of asthma. Pain is unlikely in this scenario and would not be considered first in a pale patient.

When using a butterfly collection system, a flash of blood indicates what?

That the needle is in the vein. The butterfly collection system has a feature built in that flashes blood into a small chamber at the base of the butterfly needle itself or into the connected tubing. This indicates that the needle is drawing blood. if the blood stops moving, it may be necessary to pull the needle back slightly to regain flow.

What is the primary law that goveerns patient privacy in the United States

The Health Insurance Portability and Accountability Act(HIPAA) The Health Insurance Portability and Accountability Act(HIPAA) is the premier peice of legislation guarding privacy information in the healthcare industry. the phlebotomist will not always have patient information due to HIPAA but will be required to keep all patient interactions within the healthcare team private

What is phlebotomy

The act of bloodletting as a means of therapy or diagnosis PHlebotomy is the act of collecting blood from a patient via a variety of methods. Acts such as venipuncture, capillary puncture and clean catch refer to the specific techniques used to gain samples from patient

John is perfomring single site blood cultures x2 on a patient with a Fever of Unknown Origin(FUO) which collection device should he fill first?

The aerobic vial According to the clinical laboratory standards institute(CLSI), most bacteremia is caused by aerobic and facultative(able to live with or without oxygen) bacteria. Anaerobes on the other hand cannot grow in the presence of oxygen. Therefore blood should be added to the aerobic bottle first. if the recommended amount of blood cannot be obtained to fill both blood culture bottles or vials, the aerobic one should get sufficient blood volume for the most accurate test and waht is left over should be added to the anaerobic one

What is the bevel of a needle

The angle of the needle at the tip The bevel of the needle is the angle of the needle at the tip. The sharper the bevel the less pain the the needle produces. the length of the bevel must remain small enough to fit within the lumen of the vein

What additives are in antibiotic removal devices(ARD)

The antibiotic removal device(ARD) is used to diable antibiotic drugs in a blood sample. This is very important in the event antibiotics were started before cultures were were collected. Phlebotomists should be aware to not mix these tubes

Which arm should be used in patients who have had a masectomy

The arm on the opposite side A patient who has had a masectomy is at risk for developing lymph-stasis in the arm that is on the same side as the masectomy. Lympy statis refers to the backing up of lymph fluid. A careful introduction to the patient along with a thorough reveiw of the order will help ensure that the phlebotomist does not make an error

A phlebotomist working in a pediatrician's office frequently performs throat culture swabs for detection of streptococcal strep throat infections. Which of the following is false regarding the throat culture specimen collection procedure?

The back of the tongue should be swabbed along with the tonsils The tongue should not touch the specimen swab because it will contaminate the swab The throat specimen swab is meant to collect microbes that are present in the throat and tonsils should not come in contact with the lips , tongue or uvula Should use a tongue depressor to depress the tongue while the patients says ah to raise the uvula out of the way, should wash their hands prior to procedure and wear gloves and mask, and any areas of ulceration, exudation or inflammation of throat should be swabbed

Where is the antecubital fossa located?

The bend of the elbow, front of the arm By definition, the antecubital fossa is located at the bend of the elbow on the front surface of the arm. The antecubital fossa contains three veins often used for venipuncture Median cubital vein Cephalic vein Basilic vein

A phlebotomist should be aware of common problems associated with routine blood smear preparation. Streaks or tails on the feathered edge of a blood smear is most likely to result because

The blood drop started to dry out during preparation If the blood drop starts to dry out during preparation, streaks or tails in the feathered edge may form Specimens from patients with anemia or low hemaglobin would likely yield a smear that was too thin or too long. Specimens from patients with lipemia or fat globules in the blood would likely show holes in the smear. When the spreader slide is lifted early then the smear may not have a feathered edge

Why must the phlebotomist be cautious when attempting venipuncture on the basilic vein?

The brachial artery and nerve are close by and may be damaged by the needle The basilic vein is close to the brachial artery and major nerves that run down the arm. If the phlebotomist touches either the artery and or the nerve with the needle, difficult to control bleeding and or extreme pain may result

Mark is a phlebotomist in the Neonatal Intensive Care Unit(NCU). As he approaches his next patient, he is greeted by a student nurse who introduces herself. She asks if she can observes mark's techniques. mark agrees and explains that today he will be collecting a capillary sample and applies the lancet device to the premature infant's heel, the nursing student ask why Mark does not puncture the back of the heel where the skin is read and should have good blood flow. what is the best response to this question?

The calcaneus is very close to the skin surface there and we don't want to risk bone damage Studies have shown that the calcaneus or heel bone of small or premature infants may be as little as 2.4 millimeters below the skin surface on the plantar(sole or bottom) of the heel surface and only half the distance at the posterior curvature( back of the heel). Deep punctures here can cause bone damage, osteomyelitis, inflammation of the bone marrow, or osteochondritis due to infection. It is important to perform heel sticks where there is little risk of puncturing the bone.

Who is a key figure in developing trust with a patient with a psychiatric disorder?

The caregiver that works with the patient on an ongoing basis The phlebotomist will likely encounter a patient with a psychiatric illness at some point in their career. These patients often do not understand why they are in a healthcare setting and may become defensive. When developing trust with a psychiatric patient, the best resouce is the patient's usual caregiver. The caregiver will likely understand how to communicate with the patient and make the venipuncture easier.

All of the following require chilling except

The chillin of samples is sometimes required to allow for proper testing results. to properly chill a sample, the only correct method is by using an ice and water bath. There will be instructions from lab on which samples to chill but generally they will include Ammonia, lactic acid,pH/ blood gases, acid phosphatase, and catecholamines

Which metho is used to chill specimens after collection?

The chilling of samples is sometimes required to allow for proper testing results. To properly chill a sample, the only correct method is by using an ice and water bath. There will be instructions from the lab on which samples to chill but generally They include Ammonia, lactic acid, pH/blood gases, acid phosphatase, catecholamines

Therapeutic range refers to what concept?

The dosing range of a drug that gives the desired effects without being too toxic to the patient Therapeutic range is a major part of getting the dosing of certain drugs correct and the phlebotomist plays an important role in the process. once a dose is administered, the patient is observed closely for the effects and samples are collected at timed intervals to give the physicians an idea of what dose is correct for the patients

When collecting a 24 hour urine sample, what is the last sample the patient should be instructed to collect

The first void of the second morning The final collection of a 24 hour urine collection collection is the first void of the second day. The first collection saved when beginning a 24 hour collection is the second void of the first day.

What major concern should a phlebotomist have when attempting to perform venipuncture on the patient's leg or foot veins

The formation of clots The veins of the feet are an alternative when the arms are not available. A physician's permission is needed before drawing blood from the veins of the leg or feet. The physician may not want the patient's leg or foot veins punctured because the act of drawing blood may cause clots to form. These clots could dislodge and cause a blockage elsewhere in the body.

A hemoglobin or hematocrit check is performed prior to blood donation. In order to donate blood which is true

The hemoglobin must be greater than 12.5 g/dl and hematocrit must be more than 38% Prior to donating blood, hemoglobin or hematocrit levels are check to show that the patient can safety donate blood without any adverse effects. This test is done each time the person donates., regardless of how many times they have donated previously. The minimum hemoglobin to donate is 12.5/dL and the minimum hematocrit is 38%

Which part of the needle attaches to a syringe or evacuated tube holder?

The hub The hub of the needle is the part that connects to the blood draw system. The hub generally has the blood collection system screw over the top, however, in some systems, such as the butterfly system, the hub may screw over the top of a blood collection tube.

If a phlebotomist were to document the wrong time on a specimen because they are unsure of when the specimen actually collected all of the following could happen except;

The laboratory could be protected from prosecution If the specimen was used to calculate drug dosing, incorrect documentation of time, could lead to patient receiving a toxic next dose of drug. The patient could suffer harm or even death. legal action could be taken against the doctor laboratory and phlebotomist. There may also be grounds for punitive damages against the phlebotomist for knowingly committing an intentional act or falsifying the time in complete disregard for the patient's safety.

What is the relationship between syringe size and vacuum force created?

The larger the syringe, the greater amount of vacuum obtained This is a basic concept of phlebotomy. when using larger syringes, the phlebotomist must be cognizant of how much additional vacuum is created. The large amount of vacuum created by a larger syringe does not only exert unnecessary force on the blood cells themselves, but this also may collapse the patient's veins due to excess vacuum. The syringe and needle technique is generally only used on patient's with difficult to find veins such as geriatric and pediatric patients

What is the shaft of a needle?

The long, hollow portion of the needle between the tip and the hilt The shaft of the needle is also referred to as the length of the needle. Generally, needles are 1 to 1.5 inches in length. For pediatrics and geriatric patients, the shaft may be shorter; likewise for bariatric patients, the shaft may be longer

What is the unit of measurement used in blood collection tubes and syringes

The mililliter is a standard of unit of measurement used when collecting blood. Milli refers to one thousands of a liter. This is a very small amount of blood. When the phlebotomist is explaining the procedure to the patient he or she can point out that the amount of b lood needed is tiny; this may help to ease the patient's fears

What is the definition of the term vasoconstriction

The narrowing of the vessels that carry blood Vasoconstriction refers to the constriction of the vessels that carry blood which limits blood flow. Patients are not generally on medications that cause vasocontriction ; however, the phlebotomist might encoutner vasoconstriction as a result of fear or anxiety in a patient

What does the term nasopharyngeal refer to

The nasal cavity and pharynx The term nasopharngeal means nose pharynx in the most basic terms. The phlebotomist should know this term as it is a common area of the body from which to collect specimens for cultures particularly to test for the flu

During venipuncture a phlebotomist feels a "pop" immediately after inserting the needle into the patient's skin. What does the pop most likely indicate

The needle entering the vein The needle will generally enter the patient's skin with ease not creating a noticebable pop or generating much resistance. The phlebotomist will feel some resistance followed by a quick release that feels like a "pop" as the needle enters the vein A tendon or other hard structure will not create a pop and will most likely cause increased pain for the patient

What must happen to samples in syringes before they are sent to the lab

The needle must be removed In the event that a collection tube is unavailable or inappropriate for use, such as when there is an emergency, getting the blood is difficult, or when the physician wants to order additional tests, the syringe collection technique may be used. If this is the case, the needle must be removed to ensure safety for all those handling the sample.

Which of the following tubes are most likely to provide erronous results if not inverted properly

The only appropriate way to mix a sample is by inversion which is accomplished by putting the blood tube in hand and turning it upside down five to eight times, ensuring proper mixing with additives. Any other method especially shaking can lead to a damage sample or even the tube. light blue and lavender tubes are anticoagulant tubes and are therefore the most sensitive to mixing

When should venipuncture be performed on a patient receiving IV therapy

The opposite arm The opposite arm is the most appropriate location for venipuncture with a patient who is receiving IV theraphy. By the time the blood reaches the opposite arm, it has already circulated through the body and organs, resulting in a more accurate sample. Venipuncture should never be attempted on the same arm that IV fluids are running proximal(above ) the IV site because this will result in a flawed sample. If an appropriate venipuncture site cannot be found on the opposite arm, then the most appropriate response is to consult with the patient's nurse.

A phlebotomist working in an oncology clinic, receives an order for a urine test. in which situation should the phlebotomist page a nurse for assistance

The order is for a urine Culture and Sensitivity and the patient has a suprapubic catheter A nurse or physician should collect specimens from a suprapubic catheter. Typically, inpatient urine specimen collection is handled by nursing personnel while outpatient specimens are handled by phlebotomists. But, in some cases, it may be appropriate to contact the physician or nurse for assistance. In this case, of a suprapubic catheter, the specimen should be aspirated using a sterile technique with a sterile syringe to mitigate the risk of infection or contamination

When obtaining a blood sample from a baby, the preferred site for a heel puncture is

The outside of the heel on the lateral side The outside of the heel on the lateral side(little toe) side is the preferred site to avoid possible damage to: the posterior tibial artery that runs on the medial side of the heel bones near the skin surface on the back of the heel nerves in the center of the foot

What is the main advantage of using a T Spot blood test over a purified protein derivative (PPD) test when testing for tuberculosis?

The patient does not need to return to have the results read The purified protein derivative (PPD) test requires patients to return within 48-72 hours to have the test read, which can be difficult for some. the T-spot test is not safer, cheaper or necessarily faster than the PPD, although it can be if the laboratory is on site and can perform the test. Not all labs can perform this test.

What does a sign reading NPO on a patient's door mean?

The patient is not to have anything to eat or drink NPO stands for "nothing per oral" and is used when a test or procedure needs to be completed when the patient has been fasting or if the patient is going to be prepped for surgery.

Who can receive patient lab results

The person who ordered the test Phlebotomist will often be asked what the results of tests were or if the phlebotomist can have results sent to an outside physician. this is not acceptable unless a waiver is signed by the patient. Both the clinical laboratory improvement act(CLIA) and HIPAA state only authorized providers can view patient results. Without additional waivers, only the primary person who ordered the tests can view the results

Which of the following is an example of ethical standards applicable to the practice of phlebotomy

The phlebotomist must be considerate of patient privacy It is important to remember to be discreet in approaching the patient. Often the phlebotomist may be in the room at the time another procedure is performed, the patient is completing personal hygiene or the physician is examining the patient. Under all these different circumstances, it is necessary to approach the patient and the situation in a mature fashion

how should the phlebotomist explain the venipuncture procedure to be performed on a patient with psychiatric disorders

The phlebotomist should ask the patient's nurse and relative if avaiable to accompany and assist them When the phlebotomist is drawing from pateints in a psychiatric health care area, the nurse needs to be informed. The nurse often accompanies the phlebotomist to the patient's room to help explain the procedure to the patient or to help hold the patient for optimal care. The patient's caregiver or relative may be the only person a patient with psychiatric disorder trusts. The phlebotomist may need to enlist help to explain what is going on.

Which of the following is true about post procedure patient care for the infant?

The phlebotomist should not apply a bandage on an infant A bandage could become loose and end up as a choking hazard. Or, the bandage could irritate the skin when it is removed. Instead, the phlebotomist should apply pressure to stop the bleeding and leave the puncture site open to the air. ** the phlebotomist should then thank the parents for cooperation, remove the gloves, and watch for bleeding. If the patient bleeds longer than 5 minutes, a physician should be notified.

When explaining the venipuncture procedure to the patient

The phlebotomist should speak to a non-responsive patient as if they were alert even if the patient is non-responsive it is best to continue to explain the procedure as if the patient were alert comotose patient often hear but they are unable to respond. explaining what is being done prevents the patient from moving when blood is drawn. it also conveys respect and compassion to the patient.

Who submits the order for venipuncture?

The physician or mid-level provider In a healthcare setting, the physician or a mid level provider such as a nurse practitioner or physician assistant submits an order for venipuncture. This order will include which tests will be submitted to the laboratory. multiple tests can be run on a single tube, so it is vital for the phlebotomist to ensure that they get enough sample and in the correct sample containers

What is the preferred site for performing capillary punctures on adult patients?

The preferred site for collection of a capillary puncture in an adult is the ring finger or middle finger. This is due to the adequacy of the blood flow in those two fingers. In extreme cases, such as when the patient is severely burned, the phlebotomist may use the ear lobe.

Which of the following is true regarding urinalysis reagent strips

The procedure to collect urine specimens for reagent strip testing is the same as the collection for a microscopic examination- the collection method for any urinalysis(UA) test is the same. However UA by dipstick or reagnet strip involves dipping the strip of absorbent square pads into the urine and reading the color changes of the swatches. Each test has an optimal time to read the reaction, so they are not all read at once. In addition to to judging the color change visually, UA reagent strips can also be read by inserting them into a reflectance photometer machine. To ensure the integrity of the strips, they should be kept sealed in their original containers, so that they are not affected by light , moisture or chemical contamination.

Restraining a pediatric patient for venipuncture is necessary for which of the following reasons

The safety of the patient Restraining the pediatric patient for venipuncture is a stressful procedure for not only the patient but often for the parents and the phlebotomist too. The most important goal of restraining a pediatric patient for venipuncture is to ensure safety of the patient by providing a more stable venipuncture location. Appropriate methods for restraining a patient include other staff, parents who have been properly instructed and a papoose

When collecting a 24 hour urine sample, what is the first sample the patient should be instructed to collect

The second void of the day The first void of the day is always very concentrated from metabolic processes over night. Because of this, the second void of the day is appropriate. The final collection of a 24 hour urine collection is the first void of the next day.

Why are blood cultures drawn first in the order of draw

The sterility of the site is optimal on the first draw blood cultures detect microorganisms in the blood. Therefore, special site -cleaning measures are required to prevent contamination of the specimen by microorganisms found on the skin. Blood culture tubes or bottles are collected first in the order of the draw when sterility of the site is optimal This also helps prevent microbial contamination of the needle from any unsterile tops of tubes used for other tests.

What is bleeding time?

The time it takes for a standardized incision to stop bleeding Bleeding time is measured in patients who are suspected to having clotting issues or who are on blood thinners to gauge the effectiveness of their treatments. Of particular importance is that the incision made when measuring bleeding time is a standard size which ensures comparable results to other tests

To prevent complications from excessive blood draws, the hospital's policy limits the amount of blood that can be drawn to 5% of a patient's total blood volume in a 30 day period. A 100 year old female patient in the Intensive Care Unit (ICU) recently suffered a stroke. The medical record indicates that this patients weighs 99.3 pounds. Which of the following is true about volume requirements for this high risk patient

The total volume of blood that is drawn over 30 days should not exceed 157 mL Convert the weight from lbs to kg 99.3 lbs = 45.04 kg Calculate the total blood volume 45.04 kg x 70 ml = 3152.80 Ml 3152.80 mL x 0.05 to calculate 5% of blood volume= 157.64 mL The total blood volume that can be drawn from this patient during a 30 day hospitalization is 157.64 mL. the gender and diagnosis do not affect blood volume requirements.

Which of the following is a reason to immediately remove a tourniquet

The tourniquet has cut off arterial blood flow A tourniquet simply applies pressure to a vein to cause a vein to fill with blood, making the vein easier to see and palpate, and therefore puncture for a sample. Sometimes, it may be prudent to attempt to tie the tourniquet tighter to achieve better results; however at no time should the tourniquet cut off arterial bloodflow.. Tourniquet are not to be left on any longer than one minute and often cause mild discomfort in patients. Gloves should be put on after the tourniquet

Why should a blood tube holder never be separated from a needle following a venipuncture?

The tube holder serves as protection from the double sided needle-Per osha regulation: the practice of removing the needle from a used blood-drawing/ phlebotomy device is rarely, if ever, required by medical procedure. Because such devices involve the use of a double sided needle, such removal clearly exposes employees to additional risk. Devices with needles must be used and immediately discarded after use, uncapped, into accessible sharps containers.

Which of the following would be a reason a blood tube is rejected by a laboratory

The tube is past its expiration date Tubes have an expiration date to indicate when they should no longer be used. the tubes are good until the end of the month stamped on them. After the expiration date, the vacuum will possibly not fill the tube completely, and additives are not guaranteed to perform per design.

When filling a coagulation tube such as the light-blue top tube, what is a requirement in order to ensure accurate test results?

The tube must be completely filled- The coagulation tubes are the most sensitive to how much blood is added as the results depend specifically on sample volume. The phlebotomist must be aware of this fact especially when using a butterfly setup. The butterfly setup has air in the tubing that, if not correctly drawn into a discard tube, will not provide the necessary amount of blood to the sample tube.

When disposing of a butterfly device, what additional pieces go into the sharps container

The tubing and attached holder The best way to dispose of the butterfly device is to treat it as a snake, whereby the needle is the head of the snake and the holder is its end. The buttefly needle, tubing and holder all go into the sharps container

When performing a blood draw, why are the veins of the antecubital fossa preferred over those located on the back of the hand or wrist

The veins in the antecubital fossa are larger and do not cause as much patient discomfort The veins of the upper arm and antecubital fossa tend to be larger and further away from nerves, bones, and tendons. While a major nerve does run down the medial aspect of the antecubital fossa, there are several other appropriate veins a phlebotomist may use to avoid causing patient pain. Furthermore, because of their larger diameter, drawing blood is much easier. When performing venipuncture in the hand or writs, a phlebotomist must be very cognizant of the increased risk of causing tissue damage and / or severe pain to the patient

Phlebotomist must be vigilant in handwashing to prevent the transmission of microorganisms. Which of the following is true regarding medical asepsis handwashing?

The water temperature should be lukewarm The medical asepsis handwashing procedure begins with removing all rings, watches and so on, to prevent jewelry from harboring microorganisms. The water should be turned on to a lukewarm temperature. The phlebotomist should then place both hands under running water and apply soap. A scrubbing action and the soap lather will remove any dead skin and direct. A nailstick and brush are recommnded for the first handwashing of the day. Using the aseptic technique, the hands are washed for 15 to 20 seconds. This is different from surgical or sterile technique in which hands are scrubbed for at least two minutes

What does the term vasodilation refer to

The widening of the veins and arteries Vasodilation refers to the widening of the vessels that carry blood. Vaso refers to vasculature(arteries and veins) and dilation means to widen. The phlebotomist must understand this concept as many patients may be on drugs taht cause vasodilation

Point of Care testing (POCT) instruments such as HemoCue Plasma or Low hemoglobin analyzer can detect free hemoglobin levels prior to autologous donation. A high free hemoglobin level indicates

There is a possibility of renal dysfunction is blood is transfused Elevated free hemoglobin indicates that too many red blood cells have been destroyed in the blood. Reinfusing the blood in an autologous donation may result in renal dysfunction. It is unsafe to reinfuse blood that is tested and found to have a high free hemoglobin level

Why are patients never to be seated on a stool or standing when undergoing venipuncture

There is always a possibility the patient could faint and be injured one of the most common risks associated with venipuncture is a patient becoming light-headed or fainting. This happens because of a vagal response triggered by the fear of the procedure. to help eliminate this danger, it is most appropriate to have a patient lying down or reclining.

The Emergency Room(ER) has requested assistance with an aggressive patient that was brought in after a suspected drunk driving accident. The doctor order a Blood Alcohol Concentration(BAC) test and the nurse was unable to draw the specimen. Which of the following is true regarding this tests

There is no requirement for chain of custody in this situation In the case of a blood alcohol concentration (BAC) test order for medical treatment, there is no chain of custody requirement. however, the results could become evidence in court. Therefore, it is important to follow facility protocols carefully. Glass tubes are preferred because they are less porous. Alcohol(ethanol) is volatile and evaporates quickly. Tubes should be filled up completely to prevent aeration of the blood

Why do the veins of the hand and wrist tend to roll more than arm veins

They are not supported by as much connective tissue The veins of the arm have more connective tissue have more connective tissue holding them in place than the veins of the hand and wrist. Veins that are close to the surface of the skin tend to roll more

what is the advantage of using the direct draw collection bottle or the butterfly collection system for blood cultures

They eliminate the hazard of inoculating bottles with a syringe The traditional syringe method of blood culture collection requires the phlebotomist to draw blood into the barrel of a syringe and then innoculate the culture bottles There is some risk of puncturing oneself with this method Using a direct draw method or butterfly collection system allows the phlebotomist to draw the blood directly into the bottles instead.

Of the following which gauge of needles is the smallest?

This seemingly counter-intuitive way of measuring needles must be understood by the phlebotomist. the smaller the gauge, the larger the diamter of the needle. Blood cannot be drawn from anything smaller than a 23 gauge needle as blood would be destroyed by being forced through such a small diamter

How many antiseptic wipes are preferred when collecting a clean catch specimen sample from a female patient

Three Three antiseptic wipes are preferred for cleaning the labia and vagina to ensure a clean sample catch. One is used for each fold of the labia and the third is for the urethra opening.

How long must sexual abstinence be observed to accurately obtain an accurate semen sample

Three days A phlebotomist will need to ensure that three days have passed with no sexual activity if an accurate semen sample is to be collected. THis is about as long as it takes for new sperm to grow

To collect blood samples for inborn errors of metabolism such as phenylketonuria(PKU) or galactosemia, it may be helpful to prepare a baby's foot by applying a heel warmer. How long should the heel warmer be applied before the capillary puncture?

Three to five minutes Warming makes blood collection easier and faster by increasing capillary blood flow. Warming also reduces the tendency to squeeze the site which may affect specimen results. Generally, the heel should be warmed for three to five minutes by wrapping it in a comfortably warm wet washcloth, towel, diaper, or commercial heel warming device

What additives does the orange top blood collection tube contain

Thrombin

Which of the following speeds up the formation of clot in a blood sample

Thrombin Thrombin is a naturally occurring molecule in the human body that is responsible for the formation of clots. Opposite of anticoagulants, thrombin will provide medical staff with a snapshot of the blood as it is when the phlebotomist takes the sample. Thrombin comes in an orange top tube and should never be mistaken for other tubes.

The most crucial step in collection of blood cultures is cleansing of the venipuncture site. Failure to rid the skin surface of microorganisms could produce a false positive result. Which of the following is true about preparing the venipuncture site for blood culture collection

Tinture of iodine should be used after alcohol or chlorohexidine/alcohol To prepare for blood culture collection, the phlebotomist should remove the tourniquet because it will take more than one minute to clean the site Tinture of iodine takes appoximately 30 seconds to dry and povidone iodine takes 60-90 seconds. Each solution must dry before moving on to the next step. Do not fan or blow dry on the stie. Air dyring allows time for the antiseptic to eliminate skin microbes Aggressing scrubbing on adult skin helps remove oils and bacteria from the skin. But in neonates , it is important to take a more gentle approach because their skin is fragile and scrubbing could cause skin tears

When introducing yourself to a patient, you should provide your name and which of the following

Title Greeting the patient in a cheerful and friendly manner may help put the patient at ease. Phlebotomist should identify themselves to the patient by name and title. Personal information such as Date of Birth, venipuncture success rate, and years of experience should not be shared. it is important for the patient to perceive you as a professional

What is the purpose of wrapping a sample container in an absorbent material

To absorb specimens in case of tube breakage These days, most sample collection tubes are plastic to prevent breakage. Secondary and tertiary containers also protect the samples from breaking. Nevertheless, an absorbant material is used to absorb specimens in case of breakage

Why is an alcohol prep pad placed on the septum of a blood culture collection bottle

To clean the transfer site and prevent other organisms from coming in contact with the bottle By placing an alcohol prep pad on the septum of the blood culture bottle, a phlebotomist can ensure that the surface is clean and not contaminated. No dry time is necessary as the prep pad will not come into contact with the sample

What is the purpose of an oral glucose tolerance test(GTT)

To detect borderline diabetes The oral glucose tolerance test(GTT) is a test in which patients take oral doses of glucose based on their weight to see how well their body can process glucose. Phlebotomist will draw the patient's blood 2 hours after the test. Levels of higher than 200 mg/ dl indicate diabetes

What is a stool sample useful for

To detect gastrointestinal disorders Stool samples can give a wide array of data about a patient from the presence of microorganisms to gastrointestinal trauma to even the use of recreational drugs. Many of these tests are more easily attained in other ways as asking for stool samples can sometimes be embarassing for patients.

What is the purpose of a blood culture test

To detect the presence of and identify microorganisms Blood is sterile naturally, which is to say it does not have any microorganisms from the outside world flowing in it. microorganisms in the blood can be very dangerous, even deadly, so detecting them and selecting the appropriate antibiotic is key in a patient's care plan

When using a butterfly collection setup, why must the phlebotomist draw a discard tube before drawing a coagulation(light blue) topped tube?

To ensure the tube is filled completely with sample blood The coagulation tubes are the most sensitive to how much blood is added as the results depend specifically on the sample volume. The phlebotomist must be aware of this fact especially when using a butterfly setup. The butterfly setup has air in the tubing that if not correctly drawn into a discard tube, will not provide the necessary amount of blood to the sample tube.

What is the purpose of an exposure control plan

To identify exposure hazards and minimize exposure risk to employees OSHA guidelines require healthcare facilities to have exposure control plans in place to identify exposure risks,the employees who are at risk, and detailed plans to minimize those risks, whenever possible. it is the phlebotomist's responsiblity to put those plans in action

Which of the following is not a goal of the Patient's bill of rights of 1973 and the Patient Care Partnership of 2003

To increase the effectiveness of CPR in unresponsive patients The Patient's bill of rights of 1973 and the Patient Care partnership of 2003 outline the rights of a patient and the expectations a patient may have during the course of his/ her treatment. As an integral part of the patient care team, an effective phlebotomist understands these rights and their role in providing safe, effective and ethical patient care. Cardiopulmonary Resuscitation(CPR) is a skill the phlebotomist might be expected to perform but is not considered a patient right Goals: To show support of ethical treatment patients and an understand of a patient's rights and responsiblities To ensure greater satisfaction of the patient, the physician and the healthcare facility To contribute to more effective care

Why should the phlebotomist prevent the patient from pumping their hand once a tourniquet is in place

To prevent alteration of some test results The phlebotomist should take care in how the patient presents his or her arm for venipuncture. it is appropriate for the patient to close their hand and leave it closed as this flexes the muscles in the lower arm and makes palpation easier. Pumping the hand is not acceptable as this releases potassium into the bloodstream and alters certain blood tests

Why are blood culture tubes collected first?

To prevent contamination of the blood culture sample The reasoning for the order of draw is that blood culture tubes are filled first to prevent bacterial contamination of the blood culture sample. The coagulatin tube is collected next to avoid any additive such as clot activators or anticoagulants from other tubes getting into the tube.The heparin tube is collected before the EDTA tube because EDTA would alter the chemistry tests run on the heparin tube.

Why is compliance with healthcare regulations essential to the healthcare process?

To prevent overcharging Adhering to compliance laws prevents overcharging of services to patients. the phlebotomist should be aware of the laws governing compliance and how they affect their job.

Why is there an order of draw for blood collection tubes

To prevent the additives in one tube from interfering with the blood in another tube When using a transfer device or standard needle to deliver blood to a collection tube, the additives within that tube contamninate the needle. if those additives are added to the blood for another tube, the results from that tube could be wrong. An order of draw has been established to prevent this and is arranged in such a way that the additives from the first tube do not interfere with additives of the following tube

What is the goal of the Occupational Safety and Health Administration (OSHA)?

To promote safety for healthcare workers and their environment OSHA is a regulating organization that ensures safety in the workplace. many dangerous situations arise in the healthcare especially for those working directly with patients and certain regulations must be met by employers to keep employees safe

What is the goal of the phlebotomist

To provide acceptable samples for testing Phlebotomist collect blood, urine, stool, sputum, and other bodily fluids and send them to a laboratory for testing. In addition, phlebotomists ensure accurate patient identification and provide a professional image to their patients and their families

What is the goal of therapeutic drug monitoring(TDM)

To provide information that will allow the dose given to the patient to be effective but not toxic Recall that a therapeutic index of a drug is a dosing range that provides the desired effect and does not cause harm. Therapeutic drug monitoring is the process of getting timed blood samples to determine what that range should be

What is the goal of standard precaution

To reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection Standard precautions create the first tier of precautions for all patients regardless of their diagnosis or infectious status. Standard precautions were derived from universal precautions and body substance isolation precautions. Standard precautions are to be used in all patient interactions

Why is the first drop of blood drawn in capillary puncture wiped away

To remove surface contaminants and interstitial fluids It is general practice to wipe aaway the first drop of blood when performing a capillary puncture to ensure the removal of surface contaminants and because the first dropo contains intersitital fluid that may alter test results

Which of the following is not a function of the sharps container?

To safely transport blood samples Sharps containers are used to store sharp objects including used needles and broken glass in order to protect the healthcare worker., patient and patient's family members from accidental sticks. Sharps containers are never used to transport collected samples *to reduce or eliminate potential transfer of infectious disease, provide safe location for sharp objects, protect healthcare worker from accidental sticks.

What is the goal of Continuous Quality Management(CQI)

To seek to improve any chosen practice or procedure beyond minimum expecations Two parts of quality assurance in health care are to ensure that minimum expectations are met- which is the responsibility of a total quality management plan- and to strive to exceed expectations- which is the goal of continuous quality improvement(CQI)

What is the function of the Joint Commission?

To set standards of care and reliability of health care The Joint commission is an accrediting body that reviews hospitals and healthcare facilities to ensure that certain standards are met. The Joint commission does not spell out day to day functions for employees nor is it responsible for workplace safety. however ,the requiements of joint commission are related to those ends

What is the purpose of chilling samples in an ice and water bath

To slow down metabolic processes and preserve sample integrity the chilling of samples is sometimes required to allow for proper testing results. As temperature decreases so does the metabolic rate of blood products and microorganisms. Freezing samples damages them beyond repair, so this should be avoided.

What is the purpose of a sputum collection

To test for abnormal cell counts and/or microorganisms Testing for microorganisms is a major function of any specimen collection; however, sputum collection given its origin in the middle and lower airways; it is also tested for abnormal cell counts such as the presence of blood or evidence of breakdown of the air sacs in the lungs

Why are re-collection of samples most often done?

To track patient results over time Re-collection of samples is something that happens very often, usually to track the progress of a patient over time. Re-collection may also occur due to error or a sample collected outside of lab acceptance criteria. the phlebotomist should check with his or her lab for their acceptance criteria

To what part of the body does the lateral aspect refer to

Toward the side of the body In the anatomical position. The body is viewed from the front with the palms facing forward. if one were to imagine a line down the middle of the body, the portion of the body close to that line is considered medial, while the portion of the body further from that line is considered lateral.. For example, in the anatomical position, the thumb is more lateral than the pinky finger. Similarly, the inside of the thigh is the medial aspect, while the outside of the thigh is the lateral aspect. The understanding of the medial and lateral becomes particularly useful for the phlebotomist when describing capillary puncture sites

Which of the following definitions correctly identifies the medical aspect of the body?

Towards the midline, or middle of the body.- in the anatomical position, the body is viewed from the front with the palms facing forward. If one were to imagine a line down the middle of the body, portions of the body close to that lline are considered medial, while portions of the body further from that line are considered lateral. For example, in anatomical position, the thumbe is more lateral than the pinky finger. Similarly, the inside of the thigh is considred the medial aspect while the outside of the thigh is considered the lateral aspect. The understanding of medial and lateral becomes particularly useful for the phlebotomist when describing capillary puncture sites.

Which device provides the phlebotomist with a safe method for transferring blood from a syringe to an evacuated tube

Transfer device While the answer may seem obvious, the phlebotomist must know how to transfer blood from patient to the blood tube A transfer device is far safer than a straight needle and provides a regulated flow that will not destroy blood cells. butterfly devices are used to obtain blood from the patient. A transfer device may be attached to the buttefly set if blood flow is adequate.

What is the major disadvantage of pneumatic tube systems?

Traumatic to samples Pneumatic tube systems ensure faster sample delivery to hospitals however they are more traumatic to the samples and do not function as secondary containers. furthermore they can be prone to errors such as sending the sample to the wrong tube station

When performing a nasopharyngeal swab, what technique ensures maximum specimen collection

Twisting swab as it is removed When performing a nasopharyngeal swab, the phlebotomist should insert the swab once until it passes through the nose and into the nasopharynx and gently remove it while twisting at the same time. never push and pull the swab as this causes extreme discomfort for the patient

How many antiseptic wipes are preffered when collecting a clean catch specimen from a male patient?

Two antiseptic wipes are preferred for cleaning the penis to ensure a clean urine sample. The first is used to clean the opening of the ureter and the second is for the shaft

To prepare a blood smear, the phlebotomist should choose;

Two glass slides free of chipped edges when preparing a blood smear, the phlebotomist should choose two clean glass slides free of chipped edges To prepare a blood smear, blood is carefully spread on a glass slide to produce a wedge or thin smear/ A drop is placed on one clean glass slide while the other slide called the spreader slide, is used to evenly spread blood out to a feathered edge. **plastic slides would not be appropriate

How long after administering an oral glucose tolerance test must a patient's blood be drawn to determine glucose levels

Two hours The oral glucose tolerance test(GTT) is a test in which patient takes oral doses of glucose based on their weight to see how well their body can process glucose. Phlebotomist will draw the patient's blood two hours after the test. Levels higher than 200 mg/dl indicates diabetes

Postvasectomy samples semen should be delivered to the laboratory within

Two hours- because postvasectomy samples are only checking to see if sperm is present, it is not important that they are moving. Therefore two hours is acceptable.

What is a unique feature of secondary sample bags

Two separate pockets Secondary sample bags have two pockets, one for the order(requisition) and one for the samples themselves. This is particularly useful when the phlebotomist needs to transport the samples to an external laboratory Sample bags are generally not opaque, do not protect from spilling and do not allow for ventilation.

What is the most common type of diabetes

Type 2 95% OF PATIENTS in the united states with diabetes have type 2 diabets which is commonly known as the body's inability to use available insulin correctly. Phlebotomists will frequently encounter patients with diabetes. Knowing which type of diabetes is important for administering an oral glucose tolerance test.

All of the following are reasons why masks are valuable as a form of Personal Protective Equipment(PPE) except:

Typical masks can be worn indefinitely and with multiple patients Common masks worn by healthcare workers are a valuable form of Personal Protective Equipment(PPE). However, like other forms of PPE, masks must be change between patients and come with the risk of no longer being effective such as when they become saturated by the healthcare worker's breath or other fluids, even water Other forms of highly specialized masks are used in very specific situations, however, the typical mask found in healthcare must be changed between patient visits and not worn for extended periods

All of the following tests can be run on a yellow top collection tube except

Urine cultures Yellow top urine collection tubes are the most versatile of the urine collection tubes and can be used for drug testing. the only urine test that cannot be run on a yellow top urine collection tube is urine cultures

What test result can be altered if there are bacteria in the urine

Urine glucose levels When bacteria are present in the urine, there may or may not be an infection of internal organs so other urine levels may b e normal; Urine glucose, however, will be low because bacteria use glucose for their metabolic processes

Which technique would be most hellpful to anchor a vein on the back of a patient's hand

Use the non-dominant thumb to pull the skin over the knuckles The dominant thumb should not be used to anchor because it must be free to maneuver the needle device. Anchoring the vein must be done below the needle insertion site, never above. Squeezing the patient's wrist would not help anchor the vein. An L hold should not be used on the back of the hand because it is a technique that can be used on the forearm

All of the following can cause hemolysis except:

Using a 20-gauge safety needle Hemolysis can occur in a variety of ways and almost always results from improper venipuncture technique. Using needles that are too small, pulling back on the plunger too forcibly and exposing blood to extreme temperatures are some examples of how hemolysis occurs. A 20 gauge needle is an appropriate size and will not cause hemolysis to occur

Older fecal occult blood tests, also called guaiac stool tests require what kind of diet for three days prior to specimen colelction

Vegetarian diet Some of the card test systems require a meat free diet for at least 3 days before the test(e.g. hemoccult test by smith and kline diagnostics) some newer tests do not have diet restrictions but may require multiple cards to be collected over different days.

What is possible outcome if a phlebotomist pulls back on the syringe plunger too hard or too fast

Vein collapse- the purpose of pulling the syringe plunger back when collecting a blood sample is to create a vaccuum in the syringe barrel which inevitably fills the syringe with blood. If the vaccum is created to fast, the vein could collapse, yielding no blood return. To rectify, this the phlebotomist pulls back on the plunger slowly.

For which type of veins is the butterfly system not appropriate

Veins that are easily palpated on a healthy adult patient The butterfly system is used for veins that cannot be easily punctured by other systems, the veins of pediatric patients and the veins of some geriatric patients and veins shallow

After entering an order into the Laboratory Information System(LIS), the phlebotomist can do all of the following in the system except.

Venipuncture Venipuncture is not an action performed in the Laboratory Information System(LIS) The other choices, including modifying, approving, and canceling, are all actions that can be completed in the lab's computer system

Which of the following is an example of how phlebotomists can maintain the integrity of the patient's medical record?

Verify the patient's identity with two identifiers when collecting or anyalyzing a specimen THe patient's medical record is used for decisions about care, interdisciplinary communication, provider performance evaluation, and is a legal document. It must be chronological, factual, and objective account. Verification of the correct patient is the first step to preventing errors in the medical record Specimen collection times should be exact times rather than rounding minutes. phlebtomists should not enter information that is untrue or not verifiable as in the case of "guessing". Confidentiality laws prohibit healthcare professionals from discussing the contents of a patient's medical record with those who are not directly involved in their care.

What is the most important variable in detecting the causative agent of septicemia in blood cultures?

Volume of blood drawn It has been shown that the identification of pathogens increases in direct proportion to the volume of blood cultured. Phlebotomist should follow laboratory protocol and the American Society of microbiology(ASM) recommendations to determine the required blood volume for testing.

What complication follows nausea?

Vomiting Nausea is a very common sign in patients and can be the result of a myriad of conditions. If a patient tells the phlebotomist that they are feeling nauseated, the phlebotomist should be aware the patient may vomit and should have a container ready for the patient

Eric is discarding soiled gloves in a waste receptacle when he feels a prick on the side of his hand. He takes a closer look to discover that there was an uncapped needle and syringe in the trash, and he is bleeding from the site where he felt pain. He is unsure where the needle came from or it it was contaminated. Following this accidental exposure, Eric should:

Wash the site with soap and water for a minimum of 30 seconds Occupational exposure to potential pathogens when skin is pierced by a contaminated object requires immediate attention. The employee should remove the sharp object and wash the wound with soap and water for a minimum of 30 seconds. Then, the employee should report the incident to their supervisor and seek an evaluation by a licensed healthcare provider

What is the most effective way of reducing disease transmission between patients and healthcare providers

Washing your hands Numerous studies have shown that washing one's hands is the single most effective method of reducing the spread of disease. it is vital that healthcare providers change gloves and wash their hands in between visiting patients.

In some cases, the phlebotomist may be called to assist other healthcare professionals with specimen collection. In a case where venous access is poor, the phlebotomist can collect a capillary specimen except for

Westgren Erythrocyte Sedimentation Rate Although many tests can be performed on a small amount of blood, some tests cannot be performed on skin puncture specimens. These include most Erythrocyte Sedimenation Rate(ESR) tests, coagulation studies that require plasma specimens blood cultures due to the risk of contamination, and test that requires large volumes of blood

Which of the following changes most when a patients stands for after lying down or sitting for a period of time

When a person stands after sitting or lying for some time, the volume of the vasculature increases making a certain amount of blood fit in a bigger space. This can lead to a drop of blood pressure, which can affect many different test. This is also the reason why we get dizzy when we stand to fast.

What type of sample is used for laboratory alcohol testing

When alcohol levels need to be attained, blood is the preferred medium for the testing. Alcohol breath tests are often used for other testing; however they are less accurate than blood tests. Alcohol is not in urine or stool

When is the ideal time to perform newborn screening(NBS) testing for inborn errors of metabolism

When an infant is between 24 and 72 hours old- most newborn screening tests are ideally performed when an infant is between 24 and 72 hours old. It is not unusual though, for tests to be performed within the first 24 hours of life because of early hospital discharge for uncomplicated deliveries.

When are alcohol based cleansers are unacceptable option for hand cleansing

When hands are visibily soiled- when the healthcare worker has anything visible on their hands such as blood or any bodily fluids, dirt, chemicals food or when the healthcare worker just used the restroom ,the only acceptable form of handwashing is with soap and water. Alcohol based cleaners will kill microorganisms but will not remove sediment.

In antecubital vein venipuncture by buttefly(winged infusion set) collection system using evacuated tubes, the phlebotomist should remove the venipuncture device

When the final tube is removed from the needle holder Removing the needle before the last tube is removed could cause blood to leak from the needle and it exposes the phlebotomist to bloodbourne pathogens and makes a mess A needle should also be removed at the first sign of a hematoma not when it has progressed to a quarter size Phlebotomist should not probe for veins because it is painful for the patient and cause a hematoma to form

A rapid strep test uses how many swabs

While swabbing the back of a patient's throat can be uncomfortable for the patient, a rapid strep test requries two swabs. this is because the rapid test uses one swab while the second swab is reserved for the throat culture

Occupational Safety and Health Administration (OSHA) inspectors in the hospital setting

Will observe healthcare workers performing procedures An Occupatonal Health and Safety Administration investigation will consist of record reviews, observation of employees, and interviewing management. Where deficiencies are found, OSHA may fine the hospital up to $7000 per individual infraction. Safety inspections are serious and may last from weeks to months.

To prepare a blood smear, what should the phlebotomist do after performing a capillary puncture

Wipe away the first drop The next step after the capillary puncture is to wipe away the first drop. wiping away the first drop removes excessive tissue fluid and alcohol residue that could distort cell morphology in hematology testing

A blood smear should be labeled

With a pencil on the end of the slide near the thick part of the smear Patient information should be written on the slide using a pencil on the slide at the thick end of the smear. if a frosted end slide is used, the information should be written on the frosted area. The ink from ballpoint pens will wash off or dissolve when the slide is processed

How is bleeding controlled in the typical patient following venipuncture?

With gauze or cotton balls Most of ten, bleeding following venipuncture can be controlled with gauze or cotton balls and should stop after about two minutes. Applying pressure is another valuable tool and can prevent a hematoma from forming

When using the needle and syringe technique to collect a blood sample, how should a phlebotomist hold the syringe?

With their dominant hand When using the needle and syringe technique, the phlebotomist should hold the syringe with their dominant hand and use the other hand to pull back the plunger. The reasoning her is so that the phlebotomist can maintain correct positioning of the needle in the vein to ensure adequate blood flow and reduce risk of hematoma

Potential scarring and keloids can be prevented by using which medical device?

Wound closure strip Wound closure strips are useful for closing clean incisions because they pull the two sides of the wound together, instead of simply covering them such as with band-aids and gauze pads. phlebotomists are not certfied to use glue to close wounds

Which procedure is not within the phlebotomist's scope of practice?

Wound debridement Wound debridement is not taught in phlebotomy certification programs and is outside the phlebotomist's scope of practice. Wound debridement is an invasive procedure that requires specialized training by a physician or a nurse Within scope of practice blood culture collection, newborn metabolic screening, bagged urine collection

Grace is an elderly patient who has been hospitalized due to a fall-related injury. The phlebotomist arrives at her room with orders for tests requiring a lavender top and a blue top tube. The phlebotomist greets Grace and tells her that he will be drawing her blood this morning. When assessing Grace's forearms for a good site, he observes her veins appear thin and they feel moveable Which of the following actions is appropriate for performing the venipunctures

Wrap the non-dominant hand around Grace's forearm from behind to pull the skin taut about two inches below the site Elderly patients may have fragile veins with a tendency to roll so it is important to anchor them firmly and enter quickly to increase the chance of a successful venipuncture. If the skin is loose and veins are not well- supported by subcutaneous tissue, it may be helpful to gently pull the skin taut from behind on both sides rather than using the thumb Veins should always be anchored with the nondominant hand because the dominant hand must be free to position and maneuver the needle

During a quality control (QC) check in the laboratory, a technician observes the thermometer inside the refrigerator that reads 7 degrees Celsius. What is the most appropriate action

Write the date, time, temperature and initals on the refrigerator log The laboratory refrigerator for serum and plasma tubes should be maintained at greater than two but less than eight degrees celsius. The refrigerator thermometer reads 7 degrees; the best action is to record the QC CHECK ON THE LOG.

What urine collection tube is used in drug screening

Yellow top Yellow top urine collection tubes are the most versatile collection tubes and can be used for drug testing. The only urine test that cannot be run on a yellow top urine collection tube is urine cultures

Can coffee and smoking affect test results?

Yes, they affect metabolism; therefore, they affect test results. Fasting samples are generally taken 8 to 12 hours after a patient last ate or drank and are often obtained early in the morning. Both black coffee and smoking affect metabolism and therefore affect fasting samples.

The blood draw should be discontinued and the needle withdrawn from the site when

You can see a hematoma starting to form At the first sign of hematoma formation, the phlebotomist should remove the needle and apply pressure to the site for three to five minutes Avoid withdrawing the needle when a tube is still connected through the evacuated tube system becasue the needle may drip blood and cause contamination A tourniquet should never be left on for more than one minutes If blood is flowing freely and smoothly, there is no reason to withdraw the needle until you have obtained all of the needed sample

A capillary collection should be attempted when

Your patient has severe burns The capillary puncture method is the method of choice for children under one year of age and for adults whose veins and capillaries are inaccessible. Capillary punctures in adults are used in several situations: patients who are severely burned patients with cancers whose veins are reserved for therapeutic purposes patients who are obese and veins too deep to locate geriatric patients or other patients whose veins are fragile A phlebotomist should not stick three times but rather call another phlebotomist if they are unsuccessful with two attempts

To prepare a blood collection set for venipuncture, it is important to check package integrity and verify sterility. WHICH OF THE FOLLOWNG PACKAGES SHOULD THE PHLEBOTOMIST USE?

a package that is sealed and intact Packaging should be sealed and intact on inspection. Any package that has been opened or has holes cannot be considered sterile and should not be used for venipuncture

What is an evacuated tube

a tube that comes from the manufacturer with a vacuum already inside as evacuated tube is a key ingredient for the phlebotomist and provides all the necessary vacuum force needed to draw a specific amount of blood each time. The phlebotomist must pay attention however as some tubes have lost their vacuum and do not draw blood, this may be mistaken as a missed stick.

After the last tube is drawn from the venipuncture side the phlebotomist should

activate the needles' safety feature after withdrawing from the site After obtaining blood for collection tubes, the phlebotomist should withdraw the needle and activate the needle's safety feature. Failure to promptly engage the safety mechanism exposes you or the patient to a needlestick injury. After the needle device is discarded, then the phlebotomist can attend to the patient and the puncture site The tourniquet should be removed when blood flow is established and certainly before removing the needle. Phlebotomist should avoid applying pressure while the needles is still under the skin because it can cause pain and bruising. Studies have shown that folding the arm back at the elbow also causes brusing by disrupting the platelet plug when the arm is lowered.

When drawing a blood alcohol sample, all of the following are appropriate for cleaning venipuncture sites except

alcohol based solutions When drawing blood for an alcohol tests it is inappropriate to use alcohol based solution to clean the venipuncture site. Doing so can produce an artificially high test result

Which of the following is true regarding a patient who faints following venipuncture?

all specimen collection related incidents such as fainting must be documented All specimen collection related incidents, including fainting, should be documented and reported to the supervisor according to facility policy. Any patient has the potential to faint before, during or after venipuncture procedure. And, just because a patient has fainted before doesn't mean it will happen again. Hypoglycemia and dehydration are just two factors that can cause fainting. other contributing factors include anemia, emotional problems, fatigue, hyperventilation, medication, and needle phobia

Which color tube protects the blood sample from light

amber protecting a tube from light is important in several types of tests including and most especially bilirubin. An amber tinted tube is designed for this purpose. If an amber tube is not available, tin foil may be wrapped around the tube.

Why may venipuncture be more difficult to perform on obese patients?

an obese patient's veins are difficult to feel through multiple layers of tissue The phlebotomist is likely to encounter obese patients often in his/her career. increased competency with these patients comes with experience and the phlebotomist will learn which techniques work best for them. Often, the tourniquet will need to be tighter to ensure the median cubital vein is more easily palpated. The phlebotomist also needs to learn to differntiate between localized tissue globules that mimics vessels and actual veins

What is a tourniquet

any constrictor used to facilitate vein prominence Tourniquets are very common devices used by phlebotomists to make venipuncture site selction easier. The phlebotomist must be aware that as blood accumulates near the tourniquet, the concentration of metabolites in the blood increases and may give an altered sample. A tourniquet should not be left on the patient any longer than 1 minute

What should the phlebotomist attempt to scrub when collecting the specimen for throat cultures.

any red or white spots in the back of the pharynx if the phlebotomist notices any red or white spots in the back of the throat, they should attempt to scrub on those spots with enough force to remove some tissue to optimize microorganism collection

How can a phlebotomist prevent a patient from vomiting if the patient reports nausea

apply cold compresses to the patient's forehead and place the patient in a position of comfort. Vomiting does not always follow nausea, and some things can be done to prevent a patient from vomiting. These includes placing cold packs on the patient's forehead and laying the patient down or in a position of comfort. A phlebotomist can also consult a nurse for nausea medication.

To prevent contamination after cleaning the blood collection site, the phlebotomsit should

avoid touching the site after cleaning it after cleaning the intended blood collection site, it is important to avoid touching the area to avoid compromising the aseptic technique. A gauze pad could have microbes on it that would be transferred to the site on contact. Blowing or fanning the site should be avoided because airborne microbes could be transported onto the cleaned area through the air

Why should a phlebotomist avoid larger syringes when performing the syringe and needle technique?

because the greater amount of vacuum obtained may collapse the patient's veins- if a phlebotomist is using the needle and syringe technique, he or she should use the smallest syringe possible to avoid damage to the patient's veins. if larger amounts of blood are needed(greater than 10 mL), the phlebotomist should consider using the butterfly technique to draw the blood.

Difficult draws are best performed with

butterfly system The butterfly system is the most appropriate method for difficult sticks because the phlebotomist has the most control over the butterfly needle and the needle itsefl is very small allowing puncture in small veins

how can hematoma be prevented from forming in a typical patient

by applying pressure to the venipuncture site after removing the needle. By applying gentle pressure with either gauze or cotton, the phlebotomist can prevent hematoms(bruises) from forming. Preventing brusising is a sign of a professional phlebotomist and greately increases patient satisfaction

All of the following are examples of pre-examination errors: except

collecting the coagulation tubes first.- preexamination errors are errors that occur before the sample is analyzed. Following the correct order of draw, the coagulation tubes are always collected first, so as to not allow the anticoagulant additives to mix with other tubes. each of the distracting answers alter blood sample integrity and therefore accuracy. *examples of preexamination errors: exposing the blood tu bes to extreme temperatures having patient pump their fist not cleaning the venipuncture site

Which sample of urine is the most concentrated

first void of the day the first void of the day is the most concentrated and can be beneficial in a number of ways such as the detection of bacteria or other foreign substances such as recreational drugs. Sometimes however, the first void is not ideal for testing due to circadian and diurnal rhythms.

What negative outcome is most likely to occur if a phlebotomist removes a needle from a patient's arm before releasing a tourniquet

hematoma if the phlebotomist removes the needle before the tourniquet, the blood pooled at the venipuncture will spill out onto the patient's skin and into the surround tissues causing a large bruise

What is the only common analyte that decreases due to exercise and stress

hemoglobin is an oxygen carrying molecule. In times of high stress or exercise, hemoglobin is in high demand by the body to carry oxygen to the tissues. In patients who exercise frequently or are highly stressed, hemoglobin will be lower than normal.

All of the following affect the film quality on a blood smear except

how long the slide is allowed to dry Blood smear slides should be allowed to air-dry naturally. The length of time the slide takes to dry should not affect the slide's quality The quality of blood smear is however affected by the speed, angle, pressure and the drop size used to prepare the blood smear slide

What is the fist thing a healthcare worker should do if they have been exposed to a biohazard

immediately wash the exposed area with soap and water Following an accidental exposure to a biohazard, the healthcare worker should immediately wash the affected area with soap and water Soap found in healthcare facilities will be far more effective in cleaning the area than hand sanitizer and can possible reduce the level of infection

When are fasting samples generally taken?

in the morning Fasting samples are generally taken in the morning after the patient has had nothing to eat or drink for at least 8 to 12 hours. This is not a hard rule, however, because a patient may be fasting during the day. If a fasting test is order on a blood sample, it is the responsiblity of the phlebotomist to ensure the fasting requirements have been met by the patient

Why does a tourniquet help during

it increases blood pressure in the vein, causing it to bulge Tourniquets increase intravascular blood pressure causing the vein to bulge, making it easier to puncture. A tourniquet should be on for no longer than one minute

The federal program that requires tracing and testing of blood donors and recipients when a blood product is potentially contaminated with a bloodborne pathogen is called

lookback The lookback program is a federally required program that mandates that blood services be able to trace blood back to the donor. in the event that a blood product is discovered to be potentially contaminated, the blood service must notify all recipients of donor products

What is the vein most preferred for venipuncture?

median cubital vein-is the easiest vein to paplate and see in most patients. The cephalic vein is the second vein of choice for venipuncture and the basilic vein is the third. The phlebotomist must take care when choosing the basilic vin as an artery and major nerve run close by this vessel.

How should a blood sample testing for pH/ blood gases be handled immediately after collection

placed in ice and water Ice and water bath- the chilling of samples is sometimes required to allow for proper testing results. to properly chill a sample, the only correct method is by using an ice and water bath. There will be instructions from the lab on which samples to chill but generally, they include: Ammonia, lactic acid, pH/blood gases, acid phosphatase, catecholamines.

Which of the following is not a step in the blood collection technique?

receive verbal order from nurse Often a phlebotomist will work in a busy facility and in close working quarters with nurses, doctors and other phlebotomists; however a verbal order is never appropriate to take for venipuncture. a phlebotomist must be able to identify the patient that an order is for, and the order must be written in either digital form or on paper Steps: Remove tourniquet, identify the patient, label sample collection tubes

An event in which death or serious physical or psychological injury occurs is called a/an

sentinenl event- an unexpected occurrence involving death or serious psychological injury or risk thereof. Serious injury specifically includes loss of limb or function. The phlebotomist must be aware of the risks involved with the phlebotomy procedure inlcudes. Infection, Damage to tissue, loss of limb function, unnecessary psychological stress to the patient.

How should the bevel of the needle be positioned when the phlebotomist inserts the needle into the patient's vein

straight up- it is universal practice across the medical field that the bevel of the needle face straight up when the phlebotomist inserts the needle into the patient's vein. The purpose of this is to ensure maximum b lood flow and decrease the amount of pain the patient feels

What is meant by the term "best practices"

the most efficient and effective way of accomplishing a task, process, or activity based on repeatable procedures that have proven themselves over time for large numbers of people Best practices is a global term that encompasses all practices that are considered the safest and most effective way of completing a task. Each answer by itself is an example of best practices; however only the correct answer defines the term appropriately

What is hemolysis?

the rupture or destruction of red blood cells. Hemolysis can occur in a variety of ways and almost always results from improper venipuncture technique. Using needles taht are too small, pulling on the plunger too forcibly, and exposing blood to extreme temperatures are some examples of how hemolysis occurs.

Emma is a phlebotomist for a pediatrician's office. She always approaches her patients in a warm and friendly but confident manner. Today she must draw a blood specimen on a five year old child who had a recent traumatic experience. When explaining the phlebotomy procedure she will be performing, what is the best statement for emma to make?

this may hurt a little, but it will be over quickly When explaining wha t you are going to do to a child, do so in terms the child can understand and be honest. never tell a child it won't hurt. do not put conditions on receiving a reward. it is important to let the child know it is alright to cry.

To prepare a blood smear, how much of the slide should be covered?

three- fourths An acceptable blood smear will cover approximately one half to three fourths of the surface of the slide. it should have no holes, lines or jagged edges and should show a smooth transition from thick to thin when held up to the light.

When using the syringe and needle technique to draw blood from a patient, why does the phlebotomist pull back on the plunger

to create a vacuum in the syringe which pulls blood in from the patient's vein With few exceptions , vacuum force is what is used to draw blood from a patient. the vacuum can be created in two ways: by pulling back on a plunger connected to a needle, or by using the evacuated system in which the vacuum exists in the blood tubes themselves. The syringe and needle technique is generally not a preferred way to collect blood in the modern healthcare setting.

A phenylketouria(PKU) should be performed.

to fulfill federal newborn screening requirements. Screening for phenylketonuria(PKU) is required by law in all 50 states. The test is typically collected shortly after birth and repeated 10 to 15 days later.. PKU is a disorder of amino acid metabolism, not a hemoglobinapathy. heel puncture blood from a capillary sample is preferred over a venous sample according to the Clinicial Laboratory Standards Institue(CLSI)

Why are blood samples for alcohol testing in legal cases sent to state laboratory instead to a private lab

to protect the hospital from legal repercussions In legal cases, hospitals often do not want to be exposed to the liability of testing patient's for illegal substances and alcohol, although they may be drawn at a clinic or hospital and sent to a police laboratory. The identity of a patient is protected by HIPAA.

When labeling tubes for handling and transport, the phlebotomist should NOT:

turn their back to the patient- the phlebotomist should face the patient while labeling tubes or finishing the paperwork to observe the patient for any post-procedural complication such as fainting or excessive bleeding. The phlebotomist should use hand printed labels if necesary, label the tubes while still with the patient to verify the label details with the patient and put their initals on the tubes that they drew.

Which vessels carry blood toward the heart

veins- veins carry blood towards the heart. This blood is deoxygenated except in the case of the pulmonary vein, as this blood is oxygenated after leaving the lungs.

Matthew is a phlebotomist in a cardiaac unit. Today he is assisting the Registered Nurses(RNS) by performing bedside Point of Care Testing(POCT) to obtain fingerstick Internatonal Normalized Ratio (INR) results Matthew knows that the INR test is used to monitor the levels of which medidation

warfarin The International Normalized Ratio(INR) test standardizes the differences found between the reagents in various manufacterer's tests for Prothrombin Time(PT), the PT test also called protime is used to monitor warfarin(Coumandin) therapy. It provides an indicater how long it take for patient's blood to cut Warfarin is an anticoagulant a mediation that reduces the body's ability to clot