Written exam Pt III
What are the appropriate sights to obtain a TB skin test at? What should you assess the site for?
-the inner forearm or upper back -be sure site is free of lesions and hair
How much PPD should be administered?
0.1 ml only
In what order should you test each eye for the vision test?
1. FAR VISION: right, left, then both 2. NEAR VISION: right, left, then both
Before conducting a nasopharyngeal swab, what must you do to prepare the patient and be sure for optimal testing?
1. instruct patient to blow their nose 2. check their nasal passages with a pen light 3. instruct pt to occlude 1 nostril then the other when they exhale 4. listen for the most patent nostril to insert the swab into
The ORAquick test results are invalid if these 3 things occur:
1. no reddish, purple line next to triangle "C" 2. red background in the result window 3. no reddish, purple line in "C" or "T" triangles
How will you insert the TB needle?
1. pull the pt skin taut 2. insert needle at a 5 to 15 degree angle almost parallel to pt skin with bevel up 3. insert about 1/8 of the needle, it will be visible under the skin
Once you have prepared the patient for an NP swab, how will you insert this swab?
1. tilt their head back 70 degrees 2. pass the swab through nostril 3-4 inch while keeping it near the septum and floor of the nose 3. when you meet resistance, rotate swab 2-3 times and hold in place for 5 sec to ensure absorbency
If an individual who appears to have a healthy immune system gets a positive result from a PPD test, what would be the size of the induration?
10 mm or greater
What is the 1st set of a vision test and the 2nd set?
1st set: far vison (5/mountain) 2nd set: near vision (8/book)
What vision is the legal definition of blindness?
20/200 or worse
20/20 is considered ___ visual efficiency whereas 20/40 is considered ___ visual efficiency.
20/20= 100% visual efficiency 20/40= 85% visual efficiency
What needle is used to do a venipuncture?
22G or a butterfly
How much blood should be transferred from an Insti test? Where is it transferred to first?
50 microliters = pipette stem transfer to the sample reagent bottle # 1 and mix then pour it into the membrane unit
How long does the Insti HIV test take?
60 seconds
If the patient wears contact lenses and is corrected for mono vision, you must test ___
BOTH eyes together only by using the center column for the binocular view
What should you be sure of before conducting the Oraquick rapid test?
Be sure the patient hasn't eaten, drink, or chewed gum in the last 15 minutes. If they have, wait 30 minutes before testing
If you get negative test results obtained from a RIDT and the patient has signs and symptoms of influenza, what does that mean?
Even though the test didn't detect influenza viral agents, this could be a false negative and you should do more test such as the RT-PCR and start empiric antiviral treatment
How can you tell that the ORAquick HIV test was non-reactive?
If a reddish, purple line is seen in the "C" triangle but not the "T" triangle
Which line should you instruct the patient to read first for an eye exam using the machine? How do you indicate which line should be read next?
Instruct pt to read line 5. If they missed 1 or no letters then instruct them to read the line below. Continue to read each line until all lines are read or they've missed 2 or more letters on a line.
What does a non-reactive reading mean? What does a reactive reading mean?
NON-react: HIV 1 & 2 antibodies weren't detected and the test results are negative REACT: HIV 1 & 2 antibodies were detected and the test results are preliminary positive
What's the difference between RT-PCR and RIDTs?
RT-PCR is for a sensitive and more accurate test to detect the flu whereas RIDTs are rapid influenza diagnostic test
What are the two rapid HIV test called?
Surcheck and Insti
What is recommended if your patient cannot read or recognize letters for a vision test?
Use the "E" chart and ask the patient to point in the directions that the E is facing
How do you know that the tip of the SURcheck device is completely in the buffer vial cover?
You will hear 3 snaps: 1.) through the foil 2.) into the buffer cap 3.) seat and seal
What type of syringe is needed for a TB test?
a tuberculin syringe with a 1/4 to 1/2" 27 gauge needle
What is used to collect the blood specimen from a venipuncture?
a vacutainer vial; different colors have different additives
Once bottle 1 has been absorbed in the membrane, whats the next step? What occurs when you do this?
add bottle 2 the color developer; the membrane will have a blue control spot and a 2nd spot if HIV is present
Once bottle 2 has been absorbed in the membrane, whats the next step? What occurs when you do this?
add bottle 3 the clarifying solution; the membrane will reduce the background color and give more contrast to the spots
What is a nasopharyngeal swab for?
an NP swab is the optimal upper respiratory tract specimen collection for influenza testing
What do you need prior to performing a TB test?
an order and informed consent
What should be considered for adults with glasses getting a vision screening?
assess the glasses to see if they're scratched, yellow, or old; ask pt when was their last eye exam
For an Insti HIV test, where should the patient's hand be positioned?
at waist level or lower
What should you do to the NP swab before inserting it?
bend the swab at the curve when it's still in the package, then take it out without contaminating it
Before performing a deep nasal swab or NP swab, what should you instruct the patient to do?
blow their nose to clear nasal passages
When doing a vision test with a machine, should the patients eyes be opened or closed?
both eyes need to be open
When obtaining a throat specimen, what areas should you avoid swabbing?
cheeks, teeth, tongue
What is mono vision?
distance in one eye (far vision) and near vision in the other
What is the snellen chart used for?
distant visual acuity; how far a person is able to see 20 feet away
If patient wear glasses/contacts, how should they be tested on the Snellen chart?
do it with their corrective lenses and without and record both results
What PPE's are needed for swabs?
face shield or mask, goggles, and gloves
When is a butterfly needle suggested for a venipuncture?
for pediatric patients or pts with an aversion to needles bc of how small and less painful a butterfly is
If there is a positive reaction to a TB skin test, then what should be done?
get a confirmatory diagnosis: sputum sample to test for bacilli and a chest x-ray
How do you obtain a sample for the SURcheck HIV test?
get a venous or fingertip blood sample by pricking; wipe the first drop of blood away and get the sample from the second drop
While giving a PPD injection, what should you observe for?
give the injection slowly to observe the site for blanching and the appearance of the wheal
How can you tell that the ORAquick HIV test was reactive?
if a reddish, purple line is seen in the "C" and "T" triangles
How can you indicate that a TB injection was given incorrectly?
if bleeding or no wheal is seen (however sometimes there is a drop of blood but the wheal formation is adequate)
Describe the letter of someone who sees in 20/40 versus 20/20 vision
in 20/40 the letters are twice the size of the 20/20 letters
Who may you not collect an NP swab from? How else can they get tested?
infants and many OAs may combine nasal and throat swab specimen or aspirate specimen
After obtaining a swab from the Oraquick test, how do you begin conducting the testing? How long does the test take to read?
insert the flat pad into the developer solution vial all the way to the bottom. Wait 20 minutes but no more than 40 minutes to read the results in the result window.
How should a venous blood sample be obtained for a SURcheck HIV test?
invert the surcheck device and pipette 2.5 microliters of specimen to the sampler tip
When performing a deep nasal swab, how far should you insert the swab?
less than 1 inch into the nostril until you feel resistance of turbinate. Rotate several times against nasal wall and repeat with the same swab in the other nostril
If an individual is immunocompromised and gets a positive result from a PPD test, what would be the size of the induration?
less than 5 mm
What helps to bring blood to the skin surface?
massaging the area (it should turn pink)
What should be documented after doing a venipuncture?
method of sample collection patient's tolerance any pertinent physical findings
Most sensitive and accurate tests for influenza virus detection are ___ test
molecular or nucleic acid amplification test (RT-PCR)
If patient is unable to read line 5, then what should you do?
move up 1 line at a time until they are able to read a line missing 1 or less; stop at the line that they're able to read.
How many times can a venipuncture be attempted?
no more than twice
Does a negative HIV test mean that there is no infection of HIV at all?
no, it doesn't exclude possible infection
How do you know if the SURcheck test is non-reactive or reactive?
non react: purple, pink line in the control area but not the test area react: purple pink line in the control area and test area
How do you know if results are non-reactive or reactive for the insti HIV test? Invalid?
non-reactive=one spot reactive= 2 spots invalid= no spots
What is important to instruct the patient to do when doing the Snellen vision test?
not to squint or lean forward to see the chart more clearly
How do you check visual acuity?
one eye is recorded at a time and the evaluation of each eye is recorded separately, as well as both eyes together
What are the two types of HIV test?
oraquick rapid test and rapid HIV test
What do you occlude the eye with during the Snellen test?
paddle or opaque device
What is used to obtain a specimen from the Oraquick test? What is the only part of the mouth that should be touched?
place the flat pad above pt teeth, against the outer gums and gently swab completely around the upper and lower outer gums on both sides of the pad
How can you confirm that the vision machine is working?
place your head in the screening machine
How do you record the results for a vision screening with the machine?
record the results that correspond with the last line they were able to read
How should a Snellen eye chart result be recorded?
record the visual acuity score for the smallest line they read correctly
What should you not swab during an Oraquick test?
roof of the mouth, inside the cheek, or tongue
The larger the needle gauge the __ the opening of the needle is
smaller
Who may get a positive result from a Mantoux test but may not have active TB?
someone who has been treated and exposed of TB in the past OR if they have gotten a BCG vaccination
What should you make the patient aware of before performing any type of specimen swab?
that they may gag a little
In a Snellen visual acuity chart, what does the fraction 20/20 mean?
the first number represents the distance of the test (20 feet) and the second number represents the distance that the average eye can see the letters on a certain line of the chart
If you get a reactive Insti HIV test result, what must be done next?
the results need to be confirmed from a second testing system
Which eye should be tested first for visual acuity on the machine?
the right eye, occlude the left by pushing the proper button
What is the visual acuity line on the evaluation chart?
the smallest line that can be read
If patient is unable to read the Snellen chart, what is another alternative?
the tumbling E; they will state or indicate which direction the E is facing
What does "uncorrected vision" mean?
the visual acuity when no glasses or contacts are used to visualize the evaluation chart
Why are smaller needles sometimes inappropriate for some types of phlebotomy?
they can lyse blood cells
Describe the vision of an individual with 20/40 vision.
this is vision in atleast one eye and is required to pass a driving test
What should you be sure of when getting a blood sample from the SURcheck HIV test?
touch the tip of the device on the drop of blood ONLY until the tip is filled with blood
How should the pt be positioned when obtaining a venipuncture blood specimen?
up right with arm extended to form a straight line from shoulder to wrist
Before you begin collecting a throat swab specimen, what should be done?
use a tongue blade to depress the tongue and illuminate throat checking for inflamed areas; if pt gags, remove the blade and instruct pt to breathe deeply, then reinsert the blade but not as deep as before
How should you obtain the bubble of blood from a lancet for an INSTI test?
use the pipette to completely fill the stem by slowly releasing the pressure from the bulb
What is the blood transfer device called for a venipuncture?
vacutainer cylinder called a vanish point
How long do the results take for a SURcheck HIV test?
wait 15-20 minutes to read but NOT after 20 minutes
Which line should the patient begin with on a Snellen eye chart? How do you proceed?
whichever line they can see most comfortably; if they read it correctly or miss 1 then tell them to read the next smaller line and repeat this until the pt misses 2 or more letters
When obtaining a throat specimen, what areas should be swabbed?
wipe the swab side to side in the tonsillar areas, including inflamed or purulent sites, and the mucosa behind the uvula and between the tonsils
If patient wears glasses/contact, how should you test their vision?
with their contacts/glasses on
When is the best time to collect an NP swab for the best results?
within 4 days of illness onset, this is the highest influenza virus yield
When should the pt return for a reading of the PPD test?
within 48-72 hours
What's an advantage of using an evacuated collection tube system (vancutainer)?
you can fill multiple tubes from a single puncture
