CHAPTER 8, 9, 10

Blood smears made using EDTA specimens should be prepared within - 1 hour of collection -2 hours of collection -6 hours of collection -24 hours of collection

1 hour of specimen collection

According to CLSI, a heel puncture lancet should puncture no deeper than?

2.0 mm

When making a routine blood smear, the"pusher slide" is normally used at an angle of how many degrees?

30

what is the best angle to use for insertion during routine venipuncture?

30 degrees or less

what is the recommended angle of needle insertion when performing venipuncture on an arm vein and on a hand vein, respectively?

30° or less, 10 ° or less

drugs that interfere with blood tests should be stopped or avoided for

4 to 24 hours

according to CAP guidelines drugs that interfere with blood tests should be stopped

4 to 24 hours prior to the test

how long should the site be examined to determine if bleeding has stopped?

5-10 seconds

After cleaning the venipuncture site with alcohol, the phlebotomist should:

Allow the alcohol to dry completely

Which of the following is the least effective way to immobilize a pediatric patient before a blood draw?

Allowing a child to sir with one arm bracing the other

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

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

If collected during a single capillary puncture, which of the following test is collected first?

CBC

a patient has several short lengths of IV-type tubing protruding from his chest. This is most likely a

CVC

The concentration of this analyte is normally lower in capillary specimens than in venous specimens

Calcium

A plasma specimen for this type of test cannot be collected by capillary puncture

Coagulation studies

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

Come back after the clergy person has gone

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

Consult with the patients nurse to see if the specimen should be collected

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

Dialysis

Which of the following is a recommended site for finger puncture on adults

Distal segment of the middle finger

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

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

Which of the following PKU collection techniques is incorrect

Fill circles from both sides

Which of the following equipment is needed for a malaria test

Glass slide

Blood collection tubes are labeled

Immediately after specimen is collected

Which of the following is the least hazardous area of an infant`s foot for capillary puncture?

Lateral plantar heel surface

What's the proper procedure when dealing with elderly patients?

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

T8 NPO means...

Nothing by mouth

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

Notify the patient's nurse or physician

The blood specimen for this test is placed in circles on special filter out paper?

PKU

which test cannot be collected by capillary puncture and taken to the laboratory for processing and testing

PTT

W10 an inherited metabolic disorder detected through newborn screening

Phenylketonuria

Where is the tourniquet applied when drawing a hand vein ?

Proximal to the wrist bone

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

STAT glucose in the ER

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

Slightly thread it within the lumen of the vein

Criteria used to decide which needle gauge to used for venipuncture include

The size and condition of the vein

Specimen hemolysis can result from

Using a large volume tube with a 23 gauge needle

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

WBC count

Which of the following is a proper capillary puncture procedure?

Wipe away the very first drop of blood

pseudoanemia can be caused by

a change in position from standing to lying down

hoe can you tell that you are in a vein when you are using a syringe?

a flash of blood will appear in the hub of the syringe

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

a hemolyzed potassium specimen

the unique number assigned to a specimen request is called the

accession number

which type of therapy can increase bilirubin levels?

acetaminophen pills

Capillary collection is the preferred method of blood collection in infants because -An infant can be injured by the restraining method used -Removing larger quantities of blood can lead to anemia -Venipuncture may damage veins and surrounding tissue -all of the above

all

A hematoma may result from - inadequate site pressure applied after a venipuncture - needle penetration through the back wall of the vein - using a needle that is too large for the size of the vein - all of the above

all of the above

Adult capillary puncture may be performed when -there are no accessible veins -the patient has thrombotic tendencies -veins must be saved for chemotherapy -all of the above

all of the above

Capillary puncture is typically performed on adults when ? A. No accessible veins can be located B. Patients have thrombotic tendencies C. Veins are saved for chemotherapy D. All of the above

all of the above

Do not use providone-iodine to clean skin puncture sites because it interferes with

all of the above

The tourniquet should be released:

all of the above

Which activity can contaminate a blood specimen and affect the testing performed on it? -cleaning the site with alcohol before drawing an ETOH specimen -collecting blood cultures before the povidone-iodine is totally dry -using povidone-iodine to clean the site prior to a finger puncture -all of the above

all of the above

Which of the following conditions disqualifies a site for capillary puncture? A. Cyanotic B. Edematous C. Swollen D. All of the above

all of the above

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

all of the above

Wipe away the first drop of blood during capillary puncture to -Minimize tissue fluid contamination -Reduce the chance of hemolysis -Remove any alcohol residue

all of the above

capillary puncture blood contains - arterial blood -interstitial fluids - venous blood -all of the above

all of the above

interventions to ease pain in collecting blood specimens from infants include -EMLA -oral sucrose -pacifiers - all of the above

all of the above

which of the following is requires requisition information? - ordering physicians name - patients first and last names - type of test to be performed - all of the above

all of the above

which of the following is the best way to handle a need phobic patient?

all of the above

which situation can homolyze a specimen?

all of the above

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

an AV graft

skin changes in elderly patients can make it harder to

anchor veins

Capillary blood composition more closely resembles

arterial blood

when is the best time to release the tourniquet during venipuncture?

as soon as blood flows freely into the tube

when should additive tubes be mixed

as soon as they are removed from the holder

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

ask an experienced phlebotomist to perform the draw for you

you have made two unsuccessful attempts while trying to collect an ASAP specimen on an inpatient the specimen cannot be collected by skin puncture what should you do next?

ask another phlebotomist to perform the draw for you

which type of test requisition has been shown to decrease laboratory errors?

barcoded

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

below the IV on the right arm

in an infants heel the primary blood supply is located

between .36 and 1.6 mm deep

phototherapy is used to reduce levels of which substance

bilirubin

examples of timed tests include...

blood cultures, cardiac enzymes, and cortisol

Which of the following can result in a blood smear that is too long

blood drop is to large or to thin

capillary action is a term used to describe how

blood fills a microhemotocrit tube

T10 which of the following tests requires an arterialized specimen?

blood gases

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

blood usually appears in the tubing

It is necessary to control the depth of lancet insertion during heel puncture to avoid

bone injury

strong repetitive pressure such as squeezing or milking a site during capillary specimen collection

can hemolyze and contaminate specimens

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

choosing a vein that has patency

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

cloudy white serum

T9 Peak levels of which analyte typically occur around 08:00 hours?

cortisol

the time is 07:50 hours. you have received the following test requests on different patients. which test specimen should you collect first? - CBC ordered ASAP - cortisol ordered for 0800 - fasting glucose - postop hemoglopin

cortisol ordered for 08:00

Results of this test have a direct correlation with the patient's age

creatinine clearance

an AV fistula is most commonly used for

dialysis access

a patient complains of extreme pain when you insert the needle during a venipuncture attempt. the pain does not subside, but the patient does not feel any numbness or burning sensation. you know the needle is in the vein, what should you do

discontinue the draw and attempt collection at another site

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

distal to the hematoma

you are in a process of identifying an inpatient the patients verbal confirmation of name and date of birth matches the requisition. but the medical record number is different. what should you do?

do not collect the specimen until the problem has been addressed and resolved

the following precautionary information was given to an outpatient after venipuncture. No other tests were scheduled. all the information was necessary EXCEPT

do not eat or drink for two hours after collection

there are two patients in a room. one of them has a latex allergy. you have a request to collect a blood specimen on the other one. how should you proceed?

do not take anything that contains latex into the room

you are performing a venipuncture on a difficult vein using a butterfly. you have an SST and a light blue top tube to collect. how do you proceed?

draw a clear tube. fill and mix the light blue top then fill and mix the SST

Which of the following is the most likely to affect test results?

edema

when the arm of the patient is swollen with excess fluids, the condition is called

edema

bending the arm up to apply pressure to the site after venipuncture has been shown to do all the following except...

enable the site to quickly stop bleeding after needle removal

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

excuse yourself and politely ask the doctor if you can do the draw

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

exsanguination

which of the following statements describes proper venipuncture technique?

fill additive tubes until vacuum is exhausted

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

filling the tube stopper end first

The concentration of this substance is higher in capillary blood than in venous blood?

glucose

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

glucose and tryglicerides

Underfilling this tube will most likely result in a hemolyzed specimen

gray top

an arm that is paralyzed

has no muscle function

most test result reference ranges are values for

healthy individuals

fluid in spaces between the cells is called

interstitial fluid

creatinine clearance is a measure of

kidney function

which of the following situations can result in hemoconcentration

leaving the tourniquet on over 1 minute

The best way to keep a vein from rolling is to

make certain to anchor it well

which of the following fingers is the best choice for capillary puncture

middle

what is the most critical error a phlebotomist can make?

misidentifying a patient specimen

if a venipuncture fails to draw blood and the phlebotomist senses a slight vibration of the needle

needle is against a valve

neonatal screening is the testing of

newborns for certain disorders

Medial plantar surface of the heel is located

on the big toe side of the bottom of the heel

a bariatric phlebotomy chair is designed for individuals who are

overweight

which type of disease is most likely to cause tremors?

parkinsons

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

pinkish to red

the best way to judge patency of a vein is to

press and release it several times to determine resilience

an infant bilirubin specimen is collected in an amber microtubule to

protect the specimen from light

capillary puncture supplies include all of the following except...

providone- iodine pad

If using a capillary puncture to collect the following microtubles from a patient, what would be collected first (color)

purple (hematology)

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

quickly release the tourniquet and remove the needle

which of the following venipuncture steps are in the following order?

remove needle, place gauze, activate safety device

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

safely remove the needle and attach a transfer device to fill the tube

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

site may bleed excesively

w9 the medical term for fainting is

sycope

which needle can be removed from the blood collection unit before disposal? -butterfly needle - ETS needle - syringe needle - none of the above

syringe needle

doing what before obtaining a blood specimen from a child is a bad idea?

telling the child it will not hurt

veins that feel hard and cord-like when palpated may be:

thrombosed

The primary purpose of warming a capillary puncture site is

to increase blood flow

Which of the following represents proper capillary specimen collection technique

touch the scoop to the blood drop, not the skin surface

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

try a new tube in case it is a vacuum problem

you are in the process of collecting a specimen by venipuncture. you hear a hissing sound, there is a spurt of blood into the tube, and the flow stops. what happened

tube vacuum escaped

correct newborn screening test collection or handling includes

using a large drop to entirely fill a collection circle

w8 which of the following venipuncture steps are in the correct order?

withdraw need, place gauze, activate safety device

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

yes but i would rather not