PRE, POST analytical

Regarding specimens for legal testing, which one of the following is false?

Use an alcohol prep pad when cleaning the phlebotomy site prior to collecting a blood alcohol specimen.

Which one of the following statements about fingersticks is correct?

Use the middle or fourth finger.

Blood samples for complete blood counts are collected on morning rounds and stored in a rack in the phlebotomist's basket. When the phlebotomist delivers the samples to your work station, the cells and plasma in the samples have separated. One of the samples has lipemic plasma. Which of the following parameters may be affected by the lipemia?

MCHC

What is the approximate time that should be allowed for samples to completely clot before centrifugation for serum samples?

20 minutes

Which area(s) are acceptable to puncture on the foot of a newborn for collection of a capillary blood specimen?

Choice B - Either side of the heel

All of the following veins are used for routine phlebotomy collection procedures, EXCEPT?

Femoral vein

For routine phlebotomy procedures, the antecubital area of the forearm is the preferred site for blood collection procedures. All of the following veins are located in the antecubital area, EXCEPT?

Femoral vein

Which of the following will cause an acidic urine pH?

Meat-filled diet

All of the following are acceptable patient identifiers to use prior to performing a venipuncture procedure, EXCEPT:

Patient's room number

The phase of testing where most errors occur is:

Pre-analytical phase

Which of the listed fingers should be used for dermal puncture to obtain capillary blood specimens?

#4 Ring finger or #3 Middle finger

What minimum level of specific resistance (megohms@25o C) is required for a Type I water system:

10.0

Which of the following analytes would be increased due to delay in centrifugation?

ALT

Which of the following analytes would be increased due to delay in centrifugation?

AST

A laboratory information system (LIS) generated number used for identifying a laboratory specimen for tracking and reporting purposes is called:

Accession number

What is the CORRECT blood-to-anticoagulant ratio in blue top (sodium citrate) tubes used for coagulation tests?

9:1

EDTA and Sodium citrate combine with _________ to inhibit coagulation in blood samples.

Calcium

What is the inside portion of the needle tube called?

Lumen

Which of the following collection method is the MOST appropriate for obtaining a routine blood sample?

Venipuncture

Which one of the following statements about heelstick is incorrect?

You may collect blood from any part of the heel.

It is important for laboratory employees to complete and properly file all forms used to add tests, cancel tests, and other compliance policy forms because of all of the following reasons, EXCEPT:

Your supervisor wants to keep you busy at all times and needs to find more work for you.

Which of the following is the MOST commonly used anticoagulant in the routine hematology laboratory?

Ethylenediaminetetraacetic acid (EDTA

Hemolysis may be caused by all of the following EXCEPT:

Failing to invert the blood tube after collecting to mix it with anticoagulant.

All of the following tests are affected by the pneumatic tube system transport, EXCEPT?

Albumin

All of the following tests are affected by the pneumatic tube system transport, EXCEPT?

Alkaline phosphatase

All of the following sites would be considered primary sites for obtaining an arterial blood gas sample, EXCEPT?

Carotid artery

In the clinical laboratory, after correctly matching the blood collection tube(s) with the appropriate test requisition and patient identification labels, the laboratorian will ascertain if the sample is acceptable for further processing. What is NOT part of this criteria?

Checking for hemolysis.

Which of the following would ensure positive patient identification prior to specimen collection?

Patient's full name and hospital or medical record number.

Which analyte shows no difference between capillary and venous values?

Phosphorus

Which of the following tests would be most affected by microclots in an EDTA tube drawn for a CBC?

Platelet count

Which of the following blood additives is most useful for serum collection?

Polymer barrier

Blood serum contains each of the following substances except:

Coagulation proteins

Which of the following analytes would be increased due to delay in centrifugation?

Creatinine

To properly use a volumetric pipette calibrated "to deliver" (TD), one should:

Drain the contents in the vertical position but do not blow out.

Which of the following analytes would be decreased due to delay in centrifugation?

Folate

Specimens for blood gas determination should be drawn into a syringe containing:

Heparin

Which of the following analytes would be increased due to delay in centrifugation?

Potassium

A phlebotomist enters a blood draw room to perform a routine venipuncture procedure. The phlebotomist notices a vein that appears to be a good choice for venipuncture and inserts a needle. There is no blood return; therefore, the phlebotomist has to perform a second venipuncture in the opposite arm. All of the following information would have been obtained by the phlebotomist from palpation of the vein EXCEPT

Observation of hematoma formation.

Which statement is associated with random error?

Occurs solely by chance

Other than signing an informed consent form, a patient may give consent for a venipuncture procedure through all of the following actions EXCEPT:

Nodding in agreement with the information shared by the health care provider.

Which of the following blood tests needs to be placed on ice immediately after collection?

Ammonia

Which of the following analytes would be decreased due to delay in centrifugation?

Glucose

Which of the following analytes would be decreased due to delay in centrifugation?

Ionized Calcium

A phlebotomist must perform a skin puncture to obtain capillary specimens for a complete blood count (CBC), a plasma-based chemistry test, and a serum-based immunology test. The microcollection containers that will be used are lavender top containing EDTA anticoagulant, green top containing heparin anticoagulant, and gold top containing no anticoagulant. Which microcollection container should be collected first?

Lavender top

Unsatisfactory specimens may be caused by all of the following, EXCEPT:

Leaving a tourniquet on for one minute or less

To prevent an infection at the puncture site, the skin should be cleansed at the start of a venipuncture. What answer below best describes this procedure?

Using an alcohol wipe, clean the site using back-and-forth friction. Allow the site to air dry.

Heparin interacts with _____________, which subsequently inhibits thrombin.

Antithrombin III

What is the phase of the testing process that occurs prior to the actual analysis of the specimen known as?

The pre-analytical phase

Which of the following techniques is likely to an adverse effect on a capillary specimen?

Beginning collection immediately following puncture

A phlebotomist who is performing venipuncture on a small delicate hand vein should choose a needle with a gauge number of:

23

Leading causes for laboratory rejection of a specimen include the following reasons EXCEPT:

A printed label is placed on the tube or container after specimen collection

Each day, laboratorians must evaluate the quality of samples submitted to the laboratory for analysis, specifically to help prevent pre-analytical errors. Based on the photograph to the right, match the tubes with letters to their correct corresponding descriptions below.

A-lipemic B-hemolyzed C-normal D-icteric

When should a pipette be wiped off?

Before lowering the meniscus to the calibration mark

How can a phlebotomist help to reduce pre-analytical variability associated with sample collection?

All of these techniques help to minimize the pre-analytical variability related to sample collection.

All of the following statements about using bar-coded labels on specimens are true, EXCEPT?

All possibility of errors is eliminated

You have access to the results of your friend's laboratory test results. She asks you to look up the results for her.

Ask the friend to contact her doctor to obtain the results.

Which one of the following methods is the best way to confirm your patient's identity?

Ask the patient to state his/her name, and check the patient's armband, comparing the full name and medical record number to that shown on your preprinted collection list.

Which of the following represents the correct order of draw for blood tubes in a peripheral blood collection?

Blue, red, green, purple

What are key things to remember when collecting a light-blue top tube for coagulation testing?

If a winged device is used for collection of a light-blue top tube for coagulation testing, always draw a waste tube first.

Which image below illustrates the correct site and angle for a finger puncture that was performed to collect capillary blood specimens?

Image A

A blood specimen has been collected from an inpatient. When should the specimen be labeled?

Immediately after collection in the presence of the patient.

All of the following are patient safety indicators, EXCEPT?

Inappropriate cost per test

Which occurrence is a medical error?

Incompatible blood is transfused into a patient during surgery

Which occurrence is a medical error?

Incompatible blood is transfused into a patient during surgery.

Which of the following errors could most likely occur in the preanalytical phase?

Incorrectly collected sample

What order of draw should be used to collect the following tubes if plastic evacuated tubes with a regular blood collection needle (not a winged blood collection device)? Lavender top Light-blue top Serum

Light blue first, then serum tube, finally lavender tube

Which of the following can cause hemolysis and perhaps result in recollection of the specimen?

Pushing the plunger of a syringe when transferring blood into vacuum tubes.

Which type of error is associated with the precision of the method?

Random error

Which one of the following statements about blood collection tubes is incorrect?

Red-topped tubes are used for electrolytes and contain anticoagulant.

Which one of the following answer choices is correct when collecting capillary blood specimens for routine laboratory tests?

The first drop of blood at the puncture site should be wiped away

If a plasma glucose specimen is not centrifuged, how will the test results be affected?

The glucose test result may be decreased.

Which integral member of the laboratory team plays a vital role in minimizing pre-analytical variability associated with the clinical laboratory testing process?

The phlebotomist

Which of the following conditions should be suspected if a healthy patient presents with an elevated potassium level while all other chemistry results are normal?

The sample is hemolyzed.

An MCV is reported by the instrument as 82 fL. The MCV is flagged with a delta check alert as the previous MCV reported on this patient 12 hours earlier was 97 fL. What is a possible cause for this discrepancy?

The specimens are not from the same patient

A laboratory test flags as a critical result. The technologist repeats the test and it again flags as a critical result. Which of these scenarios correctly describes all the actions that need to be taken after this occurs?

The technologist phones the patient's caregiver, reports the result and asks the caregiver to read back the information; documents his placement of the call, who was notified, time and date of notification.

A phlebotomy student is asked to collect a CBC from a patient. He quickly performs the venipuncture and collects the specimen in a heparinized tube (green top). While labeling the specimen, he realizes he collected the specimen in the incorrect tube and proceeds to pouring the blood from the green top tube into a EDTA (lavender top) tube. All of the following are the possible consequences of the student's actions, EXCEPT?

The test results will not be affected by mixing the two anticolagulants.

An investigation into a pre-analytical cause for an unanticipated laboratory finding should START with which of the following actions?

Verification of the sample identity, which includes at least two unique identifiers, such as the pateint name, medical record number, and date of birth.

The majority of laboratory errors occur during the preanalytic phase of testing. Which of the following would be a preanalytic error related to laboratory testing?

Wrong test ordered.

During which phase of testing are MOST laboratory errors known to occur?

During the pre-analytical phase of testing.

The accuracy of an immunoassay is its ability to discriminate between results that are true positives and results that are true negatives. Two parameters of test accuracy are specificity and sensitivity. Which of these statements apply to an immunoassay with high specificity, but low sensitivity?

Accurately identifies the absence of disease and has few false-positives

Which of the following analytes would be decreased due to delay in centrifugation?

Bicarbonate

If a commercial lyophilized reagent is diluted using slightly more distilled water than indicated, what type of error will occur?

Systematic error

What is the correct procedure when using a winged collection device (butterfly) to draw a light-blue top tube intended for a coagulation test if this is the first tube that will be collected in the draw?

Draw and discard a waste light-blue top tube before the tube that will be used for coagulation studies.

Which of these procedures should be followed when collecting blood specimens for laboratory testing?

Ensure that blood collection tubes containing anticoagulants are adequately filled.

Which of the following processes can lead to the formation of microclots in a patient specimen that is collected in a tube containing EDTA anticoagulant?

Failing to invert the tube after specimen collection

Critical values not reported or not reported in a timely manner is an example of a laboratory error made during which phase of laboratory testing?

Postanalytic

A phlebotomist arrives in the blood draw area where a mother and her 3-year-old toddler have been seated. Prior to performing the capillary blood collection on the child, the phlebotomist asks the mother "Is this Amanda? " The mother says yes. The phlebotomist then proceeds to cleanse the child's middle finger with alcohol and allows the site to air dry before performing the finger puncture. The phlebotomist punctures the side of the fleshy pad of the finger, wipes away the first drop, fills a lavender top microcollection container, caps it, inverts it several times and lays it on the table. She makes sure that the child's finger has stopped bleeding and then tells the mother that they can go. She then labels the specimen. Using the scenario above, answer the following question. Which of the following steps in the venipuncture process did the phlebotomist perform correctly?

Puncture site preparation

What is the anticoagulant most commonly used for routine coagulation testing?

Sodium citrate

To prevent or inhibit coagulation of blood in collected samples, the use of the following anticoagulants and/or additives are recommended EXCEPT:

Sodium polyanethol sulfonate

A mother and young child arrive at the outpatient laboratory with a physician's order for a lead test on the child. The phlebotomist decides to perform a dermal puncture (fingerstick). What procedure is important to implement when a test for lead is collected by finger puncture that would NOT be necessary prior to an antecubital venipuncture?

Thoroughly washing patient's hands with soap and water.

All of the following statements about blood cultures are correct, EXCEPT:

Since latex gloves are sterile, you may use your gloved finger without further preparation to feel the vein on a prepped arm before making the stick.

Among the most common causes of specimen rejection, which of the following is considered to be the most preventable with precautions taken during sample collection and handling?

Hemolysis

The site most frequently used to collect bone marrow samples from adults is

Posterior iliac crest

The majority of all laboratory errors occur during which phase of laboratory testing?

Preanalytic

Which is the incorrect statement about sample labeling requirements?

Prelabeled tubes should be used.

A blue-top tube containing 3.2% sodium citrate needs to be collected for coagulation studies. The physician also ordered other tests to be collected in a green-top containing lithium heparin, a serum separator tube containing a clot activator, and a lavender-top containing EDTA are collected at the same time. At what point should the blue-top tube be collected?

Should be the first tube collected

Which type of error is represented in this image?

Systematicis defined as the loss of accuracy consistently to a reproducible value different from the mean.

If a sodium citrate sample drawn for coagulation is noted to be filled an inch below the fill line (black line), then the specimen is considered:

Unacceptable for coagulation studies

A blood sample is left on a phlebotomy tray for four hours before it is delivered to the laboratory. Which group of tests could still be performed?

Uric acid, BUN, creatinine