Phlebotomy practice 7
100. It is important to fill anticoagulant tubes to the proper level to ensure that a. the specimen yields enough serum for the required tests. b. there is a proper ratio of blood to anticoagulant additive. c. there is an adequate amount of blood to perform the test. d. tissue fluid contamination of the specimen is minimized.
100. Answer: b WHY: It is important to fill additive tubes to the proper fill level to ensure a proper ratio of additive to blood. The proper fill level is attained by allowing the tube to fill until the normal vacuum is exhausted and blood ceases to flow into the tube. Tubes will not fill completely because there is always dead space at the top. Serum comes from clotted blood. Blood in an anticoagulant tube does not clot. A partially filled anticoagulant tube might yield enough specimen to perform the test; however, the results would be inaccurate. Tissue thromboplastin is a problem for some tests, however that is not why the tubes must be filled to the proper level.
101. It is important to mix anticoagulant tubes immediately after filling them to a. avoid microclot formation. b. encourage coagulation. c. inhibit hemoconcentration. d. minimize hemolysis.
101. Answer: a WHY: Lack of or inadequate mixing immediately after filling anticoagulant tubes can lead to microclot formation. Adequate mixing requires complete inversions of the tube, as shown in Figure 8-10 Illustration showing one complete tube inversion. Anticoagulant tubes are not supposed to clot, so coagulation would not be encouraged. Hemoconcentration is related to dehydration of the patient, fist pumping, and prolonged tourniquet application, not mixing of the tube. Hemolysis can be caused by mixing tubes too vigorously.
11. Going without food or drink except water for 8 to 12 hours before a blood test is defined as a. fasting. b. NPO. c. routine. d. TDM.
11. Answer: a WHY: Some tests are affected by the patient's diet. To eliminate the effects of diet, these tests are typically ordered fasting. This means that the patient must go without food or drink except water for 8 to 12 hours before the specimen is to be collected. NPO (nil per os) means that the patient is not allowed to have anything by mouth, including water. Patients are NPO before surgical procedures, not blood tests (Table 8-1 Common Test Status Designations). Fasting is not routine, and it is not normally a part of therapeutic drug monitoring (TDM).
12. The reason a test is ordered "timed" is to a. assess a patient's condition after surgery. b. determine patient suitability for surgery. c. draw it at the best time for accurate results. d. establish a clinical diagnosis or prognosis.
12. Answer: c WHY: A "timed" test means that the test is collected at a specific time because the results will be the most accurate at that specific moment (see Table 8-1 Common Test Status Designations).
13. Examples of timed tests include a. basic metabolic panel, potassium, and glucose. b. blood cultures, cardiac enzymes, and cortisol. c. calcium, ferritin, and complete blood count. d. creatinine, lactic acid, and reticulocyte count.
13. Answer: b WHY: Blood cultures, cardiac enzymes, and cortisol levels are timed tests (see Table 8-1 Common Test Status Designations). It is critical to collect timed tests as close as possible to the requested time because that is when the information gained from results is most useful to the physician.
14. A test is ordered "fasting" to a. assess a patient after outpatient surgery. b. eliminate the effects of diet on test results. c. determine patient eligibility for surgery. d. standardize test results on critical patients.
14. Answer: b WHY: Fasting means "to go without food or drink except water for 8 to 12 hours." Fasting eliminates the effects food or drink may have on the test results (see Table 8-1 Common Test Status Designations).
15. Bending the arm up to apply pressure to the site after venipuncture has been shown to do all the following EXCEPT a. disrupt the platelet plug when the arm is eventually lowered. b. enable the site to quickly stop bleeding after needle removal. c. increase the possibility of bruising and hematoma formation. d. keep the wound open, especially if it is at the side of the arm.
14. Answer: b WHY: Fasting means "to go without food or drink except water for 8 to 12 hours." Fasting eliminates the effects food or drink may have on the test results (see Table 8-1 Common Test Status Designations).
16. The unique number assigned to a specimen request is called the a. accession number. b. health facility number. c. patient date of birth. d. patient ID number.
16. Answer: a WHY: The term accession means "the process of recording in the order received." To accession a specimen means "to take steps to unmistakably connect the specimen and the accompanying paperwork with a specific individual." To do this, each specimen request is given a unique number called the "accession number," which is different from the patient ID number, date of birth, or the health facility's number assigned to that patient at admission.
17. Failure of the patient to follow required diet restrictions before specimen collection could lead to a. compromised patient care and treatment. b. erroneous and meaningless test results. c. misinterpreted test results by the physician. d. All of the above.
17. Answer: d WHY: If required diet restrictions for a test are not met before the specimen is collected, the results can be erroneous and meaningless. The test results can also be misinterpreted by the physician, which leads to compromised patient care and treatment. The phlebotomist should always verify the patient's diet status before collecting the specimen.
18. Which of the following individuals has legal authority to authorize patient testing? a. Laboratory director b. Patient's physician c. Phlebotomist d. All the above
18. Answer: b WHY: Typically, a physician or other qualified healthcare professional requests laboratory testing. Exceptions are certain rapid tests that can be purchased and performed at home by consumers or blood specimens requested by law enforcement officials and used as evidence. A few states have legalized direct access testing (DAT), in which patients can request certain blood tests themselves. So far, DAT is not widespread and the number of tests that can be requested is limited.
19. Test requisition information must include the a. ordering physician. b. patient's diagnosis. c. patient's location. d. prior draw times.
19. Answer: a WHY: The name of the ordering physician is required requisition information. The patient's location is generally given on inpatient requisitions only. There is no need for the patient's diagnosis, if known, to be on the request for blood work. According to the Health Insurance Portability and Accountability Act (HIPAA), release of such information is limited to those with a valid need to know. Prior draw times are also not normal requisition information.
2. Actions that help a phlebotomist display competence, gain the patient's trust, and help put the patient at ease include all the following EXCEPT a. acting confident and assured in bedside manner. b. being professional in dress and personal appearance. c. collecting a specimen before the requested time. d. showing the tubes to the patient to verify the labeling.
2. Answer: c WHY: The way you present yourself and interact with the patient sets the stage for whether you will gain the patient's trust. A phlebotomist with a professional bedside manner and appearance will more easily gain a patient's trust. Acting confident and assured helps convey that confidence to patients and help them feel at ease. Showing the labeled tubes to the patient displays competence and helps gain the patient's trust in your abilities. Collecting a specimen earlier than the assigned time of collection could affect the results of the test and undermine the patient's confidence and trust in your knowledge and abilities.
20. A type of care for patients who are terminally ill is a. elder care. b. home care. c. hospice care. d. long-term care.
20. Answer: c WHY: Hospice is a type of care designed for patients who are dying or terminally ill. Most hospice patients have incurable forms of cancer. Hospice care allows terminally ill patients to spend their last days in a peaceful, supportive atmosphere that emphasizes pain management to help keep them comfortable.
21. Using information from the computer requisition (Fig. 8-1), identify which of the following numbers points to the type of tube to be drawn. a. 1 b. 2 c. 3 d. 4
21. Answer: d WHY: On the sample requisition in Figure 8-1, the type of tube to be collected appears as a mnemonic code with the volume of tube requested preceding the type of tube requested. In the example, the type of tube requested is a 10-mL Corvac (type of serum separator tube). A 5.0-mL lavender-top tube is also requested.
22. Using information from the computer requisition (see Fig. 8-1), identify which of the following numbers points to the patient's age. a. 1 b. 6 c. 7 d. 9
22. Answer: c WHY: On the sample requisition in Figure 8-1, the patient's age is signified by the number "55" followed by the letter "M," which means that the patient is a 55-year-old male.
23. Using information from the computer requisition (Fig. 8-1), identify which of the following numbers points to the accession number. a. 1 b. 3 c. 6 d. 7
23. Answer: b WHY: A computer requisition has an accession number given to the patient's sample during the data-entry phase. On the sample requisition in Figure 8-1, arrow 3 points to the accession number.
32. When a test is ordered ASAP, it means that a. the patient is in critical condition and results are needed now. b. the patient requires a test that has critical timing of collection. c. results are needed soon to respond to a situation that is serious. d. test results are needed to calculate a patient's medication dosage.
32. Answer: c WHY: ASAP means "as soon as possible." If a test is ordered ASAP, it means that test results are needed soon to respond appropriately to a serious situation but the patient is not in critical condition or in immediate danger of dying (see Table 8-1 Common Test Status Designations).
33. A preop patient a. has been admitted to the hospital. b. is an ambulatory outpatient. c. is being assessed after surgery. d. will soon be going to surgery.
33. Answer: d WHY: "Preop" means before an operation and indicates that the patient will soon be going to surgery (see Table 8-1 Common Test Status Designations).
37. An example of a test that is commonly ordered fasting is a. BUN. b. cortisol. c. glucose. d. PTT.
37. Answer: c WHY: Glucose levels normally rise with the intake of food and return to normal fasting levels within 2 hours if no more food is eaten. Glucose levels are ordered fasting (see Table 8-1 Common Test Status Designations) to see if glucose is being metabolized properly. If glucose is not being metabolized properly, fasting levels will not be normal.
45. Which one of the following tests is used to identify protein disorders that lead to nerve damage in geriatric patients? a. ANA b. ESR c. PTT d. SPEP
45. Answer: d WHY: One of the tests used to identify protein or immune globulin disorders that lead to nerve damage is serum protein electrophoresis (SPEP). See Table 8-2 for more tests commonly ordered for geriatric patients and the indications for ordering.
52. Misidentification of a specimen for which test is most likely to have fatal consequences? a. Blood culture b. Cold agglutinin c. Platelet count d. Type and screen
52. Answer: d WHY: Misidentification of a type and screen could lead to a patient getting the wrong type of blood and a possible fatal transfusion reaction.
46. Your inpatient is asleep when you arrive to draw blood. What do you do? a. Call out the patient's name softly, and shake the bed gently. b. Cancel the test and ask the nurse to resubmit the requisition. c. Check back every 15 minutes until the patient has awakened. d. Proceed to draw the patient quickly before he or she awakens.
46. Answer: a WHY: It is normally acceptable to wake an inpatient for a blood draw. If the patient is asleep, call out his or her name softly and shake the bed gently. Do not shake the patient because you may startle him or her, which can affect test results. Never attempt to collect a blood specimen from a sleeping patient. Besides not having consent for the draw, such an attempt can also startle the patient, and you or the patient may be injured.
55. The medical record number on the ID band matches the number on your requisition, but the patient's name is spelled differently than the one on your requisition. What should you do? a. Collect the specimen and report the error to the patient's nurse. b. Do not collect the specimen until the difference is resolved. c. Draw the specimen because the medical record number matches. d. Make the correction on the requisition and draw the specimen.
55. Answer: b WHY: Any discrepancy in the patient's name, date of birth, or medical record number between the requisition and the patient's ID band should be addressed and resolved before a specimen is collected.
56. An unconscious inpatient does not have an ID band. The name and information on an ID band taped to the patient's IV pole matches with the requisition. What should you do? a. Ask the nurse to identify the patient and draw the blood for you. b. Collect the required specimens and then file an incident report. c. Do not start any procedure until the nurse attaches an ID band. d. Make a computer entry to alert other phlebotomists of the issue.
56. Answer: c WHY: Patient identification should never be based on information that is not attached to the patient. If the patient is not wearing an ID band, ask the patient's nurse to make positive identification and attach an ID band before you draw the specimen.
57. What would be the system of choice to identify laboratory specimens from an unconscious woman in the ER? a. Assign a name to the patient such as Jane Doe. b. Assign a number to the patient until she is admitted. c. Use a three-part identification band with special tube labels. d. Wait to process the specimens until the patient can be identified.
57. Answer: c WHY: It is not uncommon for an emergency room to receive an unconscious patient with no identification. Specimens should not be collected without some way to positively connect the specimen with the patient. In many institutions, a special three-part ID band will be attached to the unidentified patient's wrist. The special ID band has a unique number. The same number is on labels that are placed on specimens collected from that patient.
58. Which type of inpatient is most likely to have more than one ID band? a. Adult b. Child c. Newborn d. Outpatient
58. Answer: c WHY: A newborn may have more than one ID band: one with the infant's information and one with the mother's.
63. A cheerful, pleasant bedside manner and exchange of small talk can do all the following EXCEPT a. divert attention from any discomfort associated with the draw. b. increase the patient's confidence in the phlebotomist's abilities. c. keep the patient from fainting during the venipuncture procedure. d. redirect the patient's thoughts away from what is going to happen.
63. Answer: c WHY: A cheerful, pleasant bedside manner and exchange of small talk puts both you and the patient at ease, helps you gain the patient's trust and confidence, and helps divert attention from any discomfort associated with the blood draw. What it may not affect is the tendency for a patient to faint—a vasovagal response that can be triggered, for example, by seeing blood or from pain when the needle is inserted.
64. Your patient is cranky and rude to you. What should you do? a. Ask the patient's nurse to draw the specimen as you stand by to assist. b. Be as professional as you can, and collect the specimen in a normal way. c. Do not speak to the patient; just get the necessary blood work and leave. d. Refuse to draw the patient, and leave the request for another phlebotomist.
64. Answer: b WHY: Most patients understand that blood tests are often needed as part of their treatment. However, illness can be quite stressful and occasionally a patient who is tired of being "poked" will be cranky and rude. It is important to remain polite and professional and draw the specimen in your normal way. You may discover that the patient will actually apologize to you by the time you have finished.
65. Which of the following is part of informed consent for specimen collection? a. Advising the patient of his or her prognosis b. Explaining what disorders the test can detect c. Informing the patient that you are a student d. Notifying the patient of future venipunctures
65. Answer: c WHY: Advising a patient of his or her prognosis, explaining what disorders the test can detect, or notifying the patient of future venipunctures is a physician's responsibility. It is not a phlebotomist's duty and is not necessary to informed consent. Informing a patient that you are a student is important to informed consent. A patient has a right to refuse to have blood drawn by a student.
72. You must collect a specimen on a 6-year-old. The child is a little fearful. What do you do? a. Calmly explain the procedure to the child using simple terms. b. Restrain the child, and draw the specimen without explanation. c. Tell the child that you will give him a treat if he does not cry. d. Tell the child to relax and not to worry because it will not hurt.
72. Answer: a WHY: Do everything you can to establish a rapport with the child and his or her parents. Even young children can sense when you are not being honest with them. Explain what you are going to do in simple terms, and explain the importance of staying still. Tell the child that the procedure may hurt a little bit but will be over quickly. Never tell a child it will not hurt. Offering a child a treat is a temporary distraction but does nothing to instill trust in the phlebotomist and the procedure. In addition, any treat, sticker, or toy should be a reward just for going through the procedure, not for being brave enough to not cry. Some crying is to be anticipated, and it is important to let the child know that it is alright to cry.
73. If the patient asks whether the procedure will hurt, you should say that it a. could hurt if you watch, so look the other way. b. is painless and will be over before you know it. c. might hurt just a little, but only for a short time. d. hurts only if the phlebotomist is inexperienced.
73. Answer: c WHY: You should never tell a patient that a venipuncture will not hurt, nor should you suggest that it will hurt a great deal. Some patients are more sensitive to pain than others. Tell the patient that it may hurt a little, but only for a short time. You should warn patients just before you slip the needle into the vein to help them prepare for it. You can suggest to a fearful patient that he or she look away as the needle goes in, but do not imply that looking away will keep it from hurting.
74. What is the proper arm position for routine venipuncture? a. Downward in a straight line from shoulder to wrist, palm up b. Extended straight forward at about waist height and palm up c. Held out at an angle, bent at the elbow, and the palm up d. Straight down to the elbow, parallel elbow to wrist, palm up
74. Answer: a WHY: Proper arm position is important for successful venipuncture. An arm in proper position for routine venipuncture is supported firmly and extended downward in a straight line from shoulder to wrist (see Fig. 8-3 Proper placement of thumb and fingers in anchoring a vein.) with the palm up. It should not be bent at the elbow. Be aware of the angle of the arm when you are collecting your samples. If the arm is straight forward, the tubes will not fill from the bottom up. The hand may be turned palm down when you are accessing the cephalic vein or hand veins.
67. An inpatient vehemently refuses to allow you to collect a blood specimen. What should you do? a. Badger the patient until he or she agrees to the draw out of frustration. b. Have the nurse physically restrain the patient, and draw the specimen. c. Notify the patient's nurse, and then document the patient's refusal. d. Return to the lab, cancel the test request, and inform the physician.
67. Answer: c WHY: When it has been determined that a patient truly refuses to cooperate, you should write on the requisition or otherwise document according to facility policy that the patient has refused to have blood drawn. You should also notify the patient's nurse and the phlebotomy supervisor that the specimen was not obtained because of patient refusal. Some institutions have a special form on which you state that you were unable to collect the specimen and the reason why. The original form is left at the nurses' station and a copy goes to the lab.
68. You arrive to draw a fasting specimen. The patient is just finishing breakfast. What do you do? a. Check with the patient's nurse to see if the specimen should be collected or not. b. Collect the specimen and write "nonfasting" on the lab slip and the specimen. c. Do not draw the blood, fill out an incident slip, and leave a copy for the nurse. d. Proceed to collect the specimen since the patient had not quite finished eating.
68. Answer: a WHY: If you determine that the patient has not been fasting for a test that requires it, notify the patient's nurse so that a determination can be made regarding whether to proceed with the test. If you are told to proceed with collection, write "nonfasting" on the requisition and specimen label so that testing personnel know the status of the patient.
69. If you assemble equipment after selecting and cleaning the blood collection site, you will a. be more apt to allow sufficient time for the alcohol to dry. b. have a better idea of what equipment you will need to use. c. waste less equipment by knowing exactly what is needed. d. All of the above.
69. Answer: d WHY: If you wait to assemble equipment after selecting the collection site, you will have a better idea of what equipment to use and will ultimately waste less equipment. For example, if you have a multisample needle and holder ready before you select the site, it will have to be thrown away if you later decide to use a butterfly instead. However, if you had waited until after selecting the site to select equipment, you would know to select the butterfly equipment. There is plenty of time to get equipment ready while you are waiting for the alcohol to dry after cleaning the site, and you will be more apt to allow sufficient time for the alcohol to dry.
75. Outpatients who have previously fainted during a blood draw should be a. allowed to sit up so they can carefully watch the draw. b. asked to lie down or sit in a reclining drawing chair. c. drawn in a separate room that has first-aid equipment. d. permitted to sit in a chair if someone stands near them.
75. Answer: b WHY: Patients rarely faint when they are lying down. An outpatient who has previously fainted during a blood draw should be asked to lie down, or the drawing chair should be reclined if possible. Sitting upright poses the danger of injury should the patient faint and fall, so no exceptions should be made.
27. Steps taken to unmistakably connect a specimen and the accompanying paperwork to a specific individual are called a. accessioning the specimen. b. barcoding specimen labels. c. collection verification. d. patient identification.
27. Answer: a WHY: The steps taken to unmistakably connect a specimen and the accompanying paperwork to a specific individual is called accessioning the specimen. The accession number is automatically assigned when the request is entered into the computer.
28. Which priority does a timed test typically have? a. First b. Second c. Third d. Fourth
28. Answer: b WHY: A timed test typically has second priority. It must be collected as close to the required time as possible, but a STAT test would have priority over it (see Table 8-1 Common Test Status Designations).
47. Laboratory test results can be negatively affected if the phlebotomist a. awakens a sleeping patient and raises the head of the patient's bed. b. collects a specimen in dim lighting conditions in the patient's room. c. draws a specimen from an unconscious patient without assistance. d. while preparing to collect a specimen, startles a patient who is asleep.
47. Answer: d WHY: A startle reflex can affect test results and should be avoided. Raising the head of the bed after the sleeping patient was awakened should not affect test results. Collecting the specimen in dim lighting or collecting a specimen from an unconscious patient should not affect test results provided that the specimen is collected properly.
48. In collecting a blood specimen from an unconscious patient, all the following steps are necessary EXCEPT a. having someone assist you just in case the patient moves. b. identifying yourself and informing the patient of your intent. c. moving the patient to a special phlebotomy collection area. d. talking to the patient as you would to a patient who is alert.
48. Answer: c WHY: Some patients can hear what is going on around them despite being considered unconscious. Identify yourself and inform the patient of your intent, talking to him or her as you would an alert the patient. In addition, an unconscious patient may be able to feel pain and may move during a blood draw, so it is important to have someone assist you by holding the patient's arm still. The patient's blood may be drawn in the bed where he or she is. No special collection area is necessary.
49. What do you do if a physician is with the patient and the specimen is ordered STAT? a. Ask the patient's nurse to collect the STAT specimen immediately. b. Come back later when you know the physician is no longer there. c. Introduce yourself and ask for permission to draw the specimen. d. Say "excuse me" to both, and proceed to collect the specimen.
49. Answer: c WHY: If a physician is with the patient and the test is ordered STAT, it is generally acceptable procedure to politely introduce yourself, explain why you are there, and ask permission to collect the specimen. The physician may or may not give you permission. If permission is not given, the STAT will have to wait until the physician leaves.
5. Symptoms of needle phobia can include a. arrhythmia. b. fainting. c. light-headedness. d. All of the above.
5. Answer: d WHY: Symptoms of needle phobia include pallor (paleness), profuse sweating, light-headedness, nausea, and fainting. In severe cases, patients have been known to suffer arrhythmia and even cardiac arrest.
50. What is the best thing to do if family or visitors are with a patient? a. Ask them to wait outside of the room until you are finished. b. Come back later to collect the specimen when they have left. c. Have the patient's nurse tell everyone that they should leave. d. Tell them to quietly watch from the opposite side of the bed.
50. Answer: a WHY: It is acceptable and in the best interest of all to ask family or visitors to step out of the room temporarily while you collect a blood specimen. Most will be more than willing to do so.
51. Your patient is not in the room when you arrive to collect a timed specimen. The patient's nurse states that the patient will be unavailable for several hours. What should you do? a. Ask the nurse to have the patient brought to the lab when the patient is available. b. Fill out a delay slip stating you were unable to collect the specimen. c. Report the situation to a supervisor, and tell him or her to cancel the request. d. Return to the lab, and put the request in the stack for the next sweep.
51. Answer: b WHY: All specimens and test requests must be accounted for. Generally, if a patient is unavailable for testing, a delay slip is filled out stating why you were unable to collect the specimen. The original is left at the nurses' station, and a copy goes back to the laboratory. It is then up to the patient's nurse to notify the lab when the patient is available for testing and the phlebotomist can return.
76. Which of the following acts can lead to liability issues? a. Asking visitors to leave the room while you draw a specimen. b. Drawing a patient who is lying in bed talking on a cell phone. c. Lowering a bed rail to make access to the patient's arm easier. d. Pulling the curtain between the beds while drawing a specimen.
76. Answer: c WHY: It is acceptable to lower a bed rail to make blood collection easier; however, you can be held liable if you forget to raise it again after you are finished and the patient falls out of bed and is injured.
79. If the tourniquet is too tight, a. arterial flow below it may be stopped. b. blood below it may hemoconcentrate. c. the pressure can cause the arm to ache. d. All of the above.
79. Answer: d WHY: A tourniquet that is too tight may prevent arterial blood flow into the area, resulting in failure to obtain blood. A tourniquet that is too tight increases the effects of hemoconcentration and contributes to erroneous results on the sample. A tourniquet that is too tight can also pinch and hurt the patient, cause the arm to ache, and cause it to turn red or purple.
8. To examine by touch or feel is to a. ambulate. b. anchor. c. palpate. d. pronate.
8. Answer: c WHY: To examine by touch or feel is the definition of palpate. Some veins are easily visible; others must be located by feel, which is called palpating. Palpating involves pushing down on the skin with the tip of the index finger (Fig. 8-5). Palpating also helps determine the vein's patency, the size and depth, and the direction or the path that it follows.
80. All of the following actions are acceptable during the vein selection process EXCEPT a. having a patient pump his or her fist. b. lowering the arm alongside the chair. c. palpating the antecubital area firmly. d. using warmth to increase blood flow.
80. Answer: a WHY: To enhance vein selection, you are encouraged to palpate the antecubital area, lower the arm, or use a warm towel to increase blood flow. It is not a good idea to have a patient pump (repeatedly open and close) his or her fist because this may cause erroneous results for some tests, most notably potassium levels.
85. You must collect a light blue-top tube for a special coagulation test from a patient who has an IV in the left wrist area and dermatitis all over the right arm and hand. The veins on the right arm and hand are not readily visible. What is the best way to proceed? a. Apply a tourniquet on the right arm over a towel and do the draw. b. Ask the patient's nurse to collect the specimen from the IV line. c. Collect from the left antecubital area without using a tourniquet. d. Collect the specimen by capillary puncture from the left hand.
85. Answer: a WHY: When a person has dermatitis and there is no other site available, it is acceptable to apply the tourniquet over a towel or washcloth placed over the patient's arm. A coagulation test should not be collected from an IV, and a coagulation tube cannot be collected by fingerstick. The area above an IV must not be used regardless of whether you use a tourniquet.
96. How can you tell when the needle is in the vein as you insert it into the patient's arm? a. Blood will enter the ETS tube. b. The needle will start to vibrate. c. You will feel a slight "give." d. You will hear a hissing sound.
96. Answer: c WHY: When the needle enters the vein, you will feel a slight "give," or decrease in resistance. Some phlebotomists describe this as a "pop." If the needle hisses, the vacuum of the tube is drawing in air, which means that the needle bevel is partially or totally out of the vein and not completely under the skin. If you can feel the needle vibrate, the needle bevel is against the vein wall or a valve, causing flapping of tissue against the needle opening. When you are using the ETS, blood does not flow until the tube is fully engaged after the needle is in the vein.
94. What is the best angle to use for needle insertion during routine antecubital venipuncture? a. Less than 15 degrees b. 30 degrees or less c. 35 to 45 degrees d. 45 to 60 degrees
94. Answer: b WHY: Under normal circumstances the best angle for routine antecubital venipunctures depends on the depth of the vein but should be less than 30 degrees (see Fig. 8-6 Refer to #9.). When you are using a butterfly on a hand vein, the angle will normally be less than 10 degrees, as seen in Figure 8-9 An illustration of needle insertion at a 10-degree angle.
95. In performing venipuncture, the needle is inserted a. as you prefer. b. bevel facing up. c. bevel side down. d. bevel sideways.
95. Answer: b WHY: A venipuncture needle is always inserted with the bevel up.
60. Which of the following would be a good position for a home draw patient for a blood draw? a. Leaning back in a reclining chair b. Lying down on a comfortable sofa c. Sitting in a sturdy chair with arms d. All the above
60. Answer: d WHY: It is acceptable to collect a specimen from a home draw patient while he or she is in a reclining chair, lying on a sofa, or sitting in a chair with arms.
1. When properly anchoring a vein, the a. index and middle fingers are pulling the skin parallel to the arm just below the site. b. index finger is pulling the skin above the site, and the thumb is pulling toward the wrist. c. thumb is 1 to 2 in below the intended site and is pulling the skin toward the wrist. d. thumb is next to the intended vein and pressing heavily downward into the tissue.
1. Answer: c WHY: To anchor or pull the vein taut (Fig. 8-3), place the thumb a minimum of 1 to 2 in below and slightly to the side of the intended venipuncture site, and pull the skin toward the wrist in line with the vein.
10. To "seat" the needle in the vein means to a. anchor the vein while inserting the needle. b. increase the angle needed to enter the vein. c. redirect the needle to gain entry to the vein. d. thread part of the needle within the lumen.
10. Answer: d WHY: A needle is seated in a vein by carefully threading it within the lumen or the central area of the vein. This may mean lowering the angle of the needle slightly to accommodate the vein's path.
24. Information represented by a patient ID barcode typically includes the patient's a. credit information and employer. b. health status and lab test results. c. medical record number and name. d. All of the above.
24. Answer: c WHY: visual depiction of data in a code that can be read electronically. Barcodes can be linear one-dimensional (1D) codes, or two-dimensional (2D or matrix) barcodes. Information in a barcode can include patient name and medical record number.
25. If a patient is known to be combative and you are asked to collect a blood specimen from him or her, what should you do? a. Enlist another person's assistance if necessary. b. Make certain there is an unobstructed exit route. c. Place your equipment out of the patient's reach. d. All of the above.
25. Answer: d WHY: If a patient exhibits unpredictable behaviors it is essential for an additional person or employee to be enlisted to assist if necessary. In addition, make certain you have an unobstructed exit route in case it is needed. Also, be mindful of where you place equipment and keep it out of the reach of the patient. As with any patient, always have a gauze pad ready and be prepared to release the tourniquet quickly in case the patient pulls the needle out or suddenly jerks, causing the needle to either come out or go deep into the arm.
26. When received by the laboratory, inpatient requisitions are typically sorted according to a. alphabetical order by name and then by test requested. b. collection priority, date and time, and patient location. c. difficulty of draw and type of equipment needed. d. proximity of the patient's room to the laboratory.
26. Answer: b WHY: After the laboratory receives them, requisitions are sorted according to priority of collection, date and time of collection, and location of the patient.
29. A test that is ordered STAT should be collected a. as soon as it is possible to do so. b. immediately, without any hesitation. c. on the next closest scheduled sweep. d. within 1 hour of the test request.
29. Answer: b WHY: STAT comes from the Latin word statim, which means "immediately." A test that is ordered STAT should be collected immediately, without hesitation (see Table 8-1 Common Test Status Designations ).
30. Which of the following tests is commonly ordered STAT? a. Creat b. Diff c. Lytes d. RAST
30. Answer: c WHY: Abnormal levels of electrolytes (lytes) can lead to death; consequently, electrolytes (e.g., sodium and potassium) are often ordered STAT (see Table 8-1).
31. If a test is ordered STAT, it may mean that the patient is in a. critical condition. b. fragile condition. c. rehabilitation. d. transition status.
31. Answer: a WHY: When a test is ordered STAT, it means that the results on a patient in critical condition are urgently needed (see Table 8-1 Common Test Status Designations). A patient who is in critical condition is in a life-or-death situation.
34. Tests are classified as routine if they are ordered a. for collection at a specific time and place. b. in the process of establishing a diagnosis. c. to assess a patient's condition after surgery. d. to specifically eliminate the effects of diet.
34. Answer: b WHY: Routine tests are those that are typically ordered in the process of establishing a diagnosis or in monitoring a patient's care (see Table 8-1 Common Test Status Designations).
35. Which term means the same as STAT? a. Fasting b. Med emerg c. Postop d. Timed
35. Answer: b WHY: Medical emergency (med emerg) means the same as STAT (see Table 8-1 Common Test Status Designations). It has replaced STAT in some institutions to identify specimens whose results are needed immediately to respond to critical situations.
36. A patient who is NPO a. cannot have any food or drink. b. cannot have anything but water. c. is in critical but stable condition. d. is recovering from minor surgery.
36. Answer: a WHY: NPO (see Table 8-1) comes from Latin (nil per os) and means nothing by mouth. Patients who are NPO cannot have food or drink, not even water. Patients are typically NPO before surgery, not after.
38. Which liquid is acceptable to drink when one is fasting? a. Black coffee b. Diet soda c. Plain water d. Sugarless tea
38. Answer: c WHY: The only liquid that it is acceptable to drink when fasting is plain water (see Table 8-1 Common Test Status Designations).
39. Which is a common postop test? a. CBC b. ESR c. H&H d. PTT
39. Answer: c WHY: "Postop" means after an operation (see Table 8-1 Common Test Status Designations). Both hemoglobin and hematocrit are indications of the RBC count. H&H levels are a common postop test to monitor blood levels after surgery.
4. Needle phobia is defined as a(n) a. anxiety about admission to the hospital. b. inability to watch while others are drawn. c. intense fear of needles and being stuck. d. personal preference for smaller needles.
4. Answer: c WHY: Needle phobia is defined as intense fear of needles. The signs by the patient that suggest this phobia, such as extreme fear or apprehension in advance of venipuncture, should not be taken lightly. Although a patient may be anxious about being admitted to the hospital, have a problem watching others being drawn, or have a needle preference for the venipuncture procedure, these do not constitute needle phobia.
40. You arrive to draw a specimen on an inpatient. The patient's door is closed. What do you do? a. Knock lightly, open the door slowly, and ask whether it is alright to enter. b. Knock softly and wait for someone in the room to come to the door. c. Leave to draw another patient in the same area and come back later. d. Open the door, announce yourself, and quickly proceed into the room.
40. Answer: a WHY: If the door to the room is closed, you should knock lightly and proceed with caution. Even if the door is open, it is a good idea to knock lightly to make occupants aware that you are about to enter and to get their attention so that you can ask if it is alright to enter.
41. There is a sign above the patient's bed that reads, "No blood pressure or venipuncture, right arm" (Fig. 8-2). The patient has an intravenous (IV) line in the left forearm. You have a request to collect a complete blood count (CBC) on the patient. How should you proceed? a. Ask the patient's nurse to collect the specimen from the IV. b. Ask the patient's nurse what to do when the sign is posted. c. Collect a CBC from the right arm without using a tourniquet. d. Collect the specimen from the left hand by finger puncture.
41. Answer: d WHY: Because the specimen is a complete blood count (CBC), it can easily be collected by fingerstick from the left hand. The right arm should not be used. Collecting the CBC from the IV is not worth the risk when it can easily be collected by capillary puncture. A competent phlebotomist should be able to decide what to do in this situation without having to ask the nurse.
42. A code is a way to a. convey important information without alarming the public. b. transmit messages over the facility's public address system. c. use numbers or words to represent important information. d. All of the above.
42. Answer: d WHY: Codes are one of the ways healthcare institutions convey important information over a public address system to those who need to know without alarming the general public. Codes use numbers or words to convey information. For example, code blue typically means that someone has stopped breathing.
43. DNR means a. do not alert a nurse. b. do not call 911. c. do not call relatives. d. do not resuscitate.
43. Answer: d WHY: "DNR" means do not resuscitate. It means that no code should be called or heroic measures taken if the patient stops breathing. It is sometimes used when patients are terminally ill.
44. You greet your patient in the following manner: "Hello, my name is Jean, and I am here to collect a blood specimen. Is that alright with you?" The patient responds by saying, "OK, but I would rather not." How do you proceed? a. Ask another phlebotomist to draw the specimen. b. Come back the next shift to collect the specimen. c. Do not proceed until you are sure you have consent. d. Go ahead and draw the specimen without comment.
44. Answer: c WHY: When you ask if it is alright to draw a patient's blood and the patient replies, "Yes, but I would rather not," or something similar, he or she has given permission and taken it back. You must not draw blood from the patient until you are certain that you have permission.
53. You arrive to collect a specimen on a patient named John Doe in 302B. What is the first thing you should do to verify that the patient in 302B is indeed the John Doe you are looking for? a. Ask him, "Are you John Doe?" If he says "yes," he must be John Doe. b. Ask him to state his name and DOB, and spell his first and last names. c. Check the patient's ID band to see if the name that is on it is John Doe. d. Have the nurse verify the patient's name after you check his ID band.
53. Answer: b WHY: Proper patient identification involves asking the patient to state his or her full name and date of birth (DOB) and spell the first and last name. This information and the information on the ID band are compared with the information on the requisition to verify that it matches. Verbal statement of identity is important. An ill or hard-of-hearing patient may answer "yes" to almost anything. It is not unheard of for a patient to be wearing an ID band with incorrect information.
54. Which requisition information must match information on the patient's ID band? a. Medical record number b. Name of the physician c. Room and bed number d. Test collection priority
54. Answer: a WHY: It is important that certain information on the ID band match the information on the requisition exactly. The medical record number is mandatory information and should match exactly. The room number may change during a patient's stay in the hospital and should not be relied on as proper identification. In addition, the physician may change, or the patient may have more than one physician ordering tests. Test status and collection priority may change with each order and is not information that is found on the ID band.
59. What is the most critical error a phlebotomist can make? a. Drawing a timed specimen an hour late b. Failing to obtain a requested specimen c. Misidentifying the patient's specimen d. Unknowingly giving a patient a bruise
59. Answer: c WHY: The most critical error a phlebotomist can make is misidentifying a patient specimen. A misidentified specimen can have serious or even fatal consequences for the patient, especially if the specimen is for a type and screen for a blood transfusion. Misidentification of a patient's specimen can be grounds for dismissal of the person responsible and can even lead to a malpractice lawsuit against that person.
6. A basic step that can be taken with needle-phobic patients to minimize any trauma associated with a venipuncture is to a. allow the patient to sit in the waiting room for half an hour before collection. b. choose the most skilled phlebotomist available to perform the venipuncture. c. have the patient wear an eye mask or close his or her eyes during the procedure. d. thoroughly explain every detail of the draw before doing the venipuncture.
6. Answer: b WHY: Basic steps that can be taken with needle-phobic patients to minimize any trauma associated with the venipuncture include: (1) having the patient lie down; (2) applying an ice pack to the site for 10 to 15 minutes before the venipuncture; and (3) having the most experienced and skilled phlebotomist perform the venipuncture. Explaining every detail of the procedure, having patients close or cover their eyes, or having them wait outside the blood drawing room to calm down could increase the trauma of the experience.
61. Which of the following types of patients is least likely to need his or her identity confirmed by the patient's nurse or a relative? a. A grouchy geriatric patient b. A crying 3-year-old child c. A mentally incompetent patient d. A non-English-speaking patient
61. Answer: a WHY: The patient's nurse or other caregiver, or a relative, may be needed to confirm the identity of a patient who is a young child or someone who is mentally incompetent or cannot speak English. The term geriatric means "relating to old age"; it does not mean senile or fragile. One would expect that this type of patient could identify him or herself correctly.
62. The laboratory receptionist finishes checking in a patient and hands you the test request. The request is for a patient named Mary Smith. You call the name, and a woman who was just checked in responds. She is also the only patient in the waiting room. How do you verify that she is the correct patient? a. Ask the woman to state her full name and date of birth and spell her first and last names. b. Assume that you do not have to verify her identity because the receptionist already did. c. Conclude that she must be the right one because she is the only one in the waiting room. d. Decide that she must be right one because she answered you when you called the name.
62. Answer: a WHY: Never make assumptions about a person's identity and do not rely on others to identify patients for you. Always verify patient identification yourself by asking the patient to state his or her full name and date of birth and spell the first and last names.
71. Which of the following is the best thing to do if your hands are visibly contaminated? a. Clean them with a hand sanitizer. b. Cover them up with clean gloves. c. Wash them with soap and water. d. Wipe them with an alcohol pad.
71. Answer: c WHY: According to CDC guidelines, hands that are visibly dirty or contaminated with blood or other body fluids must be washed with soap and water. If hand-washing facilities are not available, the hands should be cleaned with detergent-containing wipes followed by an alcohol-based hand cleaner.
66. The patient asks if the test you are about to draw is for diabetes. How do you answer? a. Explain that it is best to discuss the test with the physician. b. If the test is for glucose say, "Yes, it is," but do not elaborate. c. Say, "HIPAA confidentiality rules won't let me tell you." d. Tell the patient that it is not for a glucose test even if it is.
66. Answer: a WHY: There are many reasons why a physician will order certain tests. Any attempt to explain why a test was ordered may mislead the patient. For example, a glucose test may be ordered because the patient is taking medication that can affect glucose levels, not because diabetes is suspected. Usually such inquiries are handled by explaining that the doctor has ordered the tests as part of the patient's care and that he or she will be happy to explain the tests if asked. The Health Insurance Portability and Accountability Act (HIPAA) clearly states that patient confidentiality must be protected. However, it does not apply to inquiries by patients about their own tests. Lying to the patient would be unprofessional and unnecessary.
7. Proper use of a hand sanitizer includes a. allowing the alcohol to evaporate completely. b. rubbing it in between and around the fingers. c. using a generous amount of the sanitizer. d. All of the above.
7. Answer: d WHY: When using hand sanitizers, it is important to use a generous amount and allow the alcohol to evaporate to achieve proper antisepsis. As shown in Figure 8-4, the sanitizer must be rubbed between and on the back of the fingers as well as the palms.
70. When performing a venipuncture, hand sanitization is required a. after drawing your last patient. b. before and after each patient. c. only after drawing the patient. d. only before putting on gloves.
70. Answer: b WHY: In performing a routine blood draw, the hands must be sanitized before glove application at the beginning of the procedure and at the end after glove removal, before proceeding to the next patient.
77. Never leave a tourniquet on for more than a. 30 seconds. b. 1 minute. c. 2 minutes. d. 3 minutes.
77. Answer: b WHY: Blockage of blood flow (stasis) by the tourniquet causes hemoconcentration, which affects specimen composition and leads to erroneous test results. To minimize these effects, the tourniquet should never be left in place longer than 1 minute.
78. Where is the best place to apply the tourniquet? a. 3 to 4 in above the venipuncture site b. Distal to the venipuncture site on the forearm c. Distal to the wrist bone if drawing a hand vein d. Immediately above the venipuncture site
78. Answer: a WHY: The best place to apply the tourniquet is 3 to 4 in above the intended venipuncture site (Fig. 8-7 A properly tied tourniquet with ends pointing toward the shoulder.). If it is too close to the collection site, the vein may collapse as blood is withdrawn; if it is too far away, it may be ineffective. Applying a tourniquet distal to or below a venipuncture site would prevent blood flow into the area and result in vein collapse and unsuccessful venipuncture. In drawing blood from a hand vein, the tourniquet is applied proximal to the wrist bone, not distal.
81. In selecting a venipuncture site, how can you tell a vein from an artery? a. A vein has a lot less resilience. b. A vein pulses and feels larger. c. An artery has a distinct pulse. d. An artery is more superficial.
81. Answer: c WHY: You can easily tell an artery from a vein because an artery has a pulse; a vein does not. Veins used for venipuncture are normally more superficial than arteries which are typically located deeper in the arm. A patent vein has lots of resilience. Arteries also have resilience, but it is harder to feel since they pulse.
82. What does a sclerosed vein feel like? a. Bouncy and resilient b. Hard and cord-like c. Pulsating and firm d. Soft and pliable
82. Answer: b WHY: A normal vein feels bouncy and resilient; a sclerosed vein feels hard and cordlike and lacks resiliency. A sclerosed vein is difficult to penetrate, rolls easily, and should not be used for venipuncture.
83. It is acceptable to use an ankle vein if a. coagulation tests are requested. b. the patient is partially paralyzed. c. the physician gives permission. d. there are no other suitable sites.
83. Answer: c WHY: Ankle veins are sometimes used as a last resort, but only after obtaining permission from the patient's physician.
84. Which of the following will help you avoid inadvertently puncturing an artery during venipuncture? a. Avoid drawing the basilic vein in the antecubital area. b. Do not select a site that is near where you feel a pulse. c. Do not select a vein that overlies or is close to an artery. d. All of the above.
84. Answer: d WHY: To avoid inadvertently puncturing an artery, never select a vein that overlies or is close to an artery or near where you feel a pulse. Avoid drawing from the basilic vein because it is in the area of the brachial artery.
9. In most cases, needle insertion should be performed a. at a 45-degree angle to the surface of the arm. b. using a smooth, steady motion forward. c. with a deliberate and rapid forward jab. d. with the bevel of the needle face down.
9. Answer: b WHY: For antecubital-site venipunctures, insert the needle into the skin at an angle of 30 degrees or less (Fig. 8-6) depending on the depth of the vein. Use one smooth, steady, forward motion to penetrate first the skin and then the vein. Advancing the needle too slowly prolongs any discomfort. A rapid jab can result in missing the vein or going all the way through it. The needle bevel should be face up, not down.
86. What is the best thing to do if the vein can be felt but not seen, even with the tourniquet on? a. Insert the needle where you think it is, and probe until you find it. b. Keep the tourniquet on while cleaning the site and during the draw. c. Look for visual clues on the skin to remind you where the vein is. d. Mark the spot using a felt-tipped pen, and clean it off when finished.
86. Answer: c WHY: If the vein can be felt but not seen, try to mentally visualize its location. It often helps to note the position of the vein in reference to a mole, hair, or skin crease. Never insert the needle blindly or probe to find a vein because damage to nerves and tissue may result. Never leave the tourniquet on for more than 1 minute because hemoconcentration of the specimen may result. Marking the site with a felt-tipped pen could contaminate the specimen or transfer disease from patient to patient.
87. Release the tourniquet as soon as blood flow is established to a. allow arterial blood flow to return to normal. b. decrease hemoconcentration of the specimen. c. increase the venous flow to the vein selected. d. All of the above.
87. Answer: b WHY: The CLSI guidelines recommend that the tourniquet be released as soon as blood flow is established. This avoids hemoconcentration of the specimen and helps ensure accurate test results. Arterial flow should not be affected by the tourniquet if the pressure is correct. Venous flow should return to normal, not increase, when the tourniquet is released.
88. According to CLSI standards, a venipuncture site should be cleansed a. employing a scrubbing motion from outside to center. b. thoroughly with disinfectant using concentric circles. c. using a circular motion from the center to the periphery. d. with friction using a 70% isopropyl alcohol prep pad.
88. Answer: d WHY: Studies have shown that back-and-forth friction is superior to cleaning using concentric circles. Consequently, CLSI standards now recommend cleaning the site with 70% isopropyl solution or prep pads (Fig. 8-8) using friction. Although previous CLSI standards recommended using a circular motion, starting at the point of expected needle entry, and moving outward in ever-widening concentric circles, this is no longer considered necessary. Disinfectants are not safe to use on human skin and are not used to clean venipuncture sites (Fig. 8-8 Cleaning a venipuncture site.).
89. All of the following are important reasons to wait 30 seconds for the alcohol to dry before needle insertion EXCEPT a. It allows the process of evaporation to help destroy any microbes. b. It avoids a stinging sensation when the needle penetrates the skin. c. It gives the phlebotomist time to prepare equipment and supplies. d. It prevents hemolysis of the specimen from alcohol in the needle.
89. Answer: c WHY: Alcohol takes around 30 seconds to evaporate completely. The evaporation process helps destroy microbes. Allowing the alcohol to dry before venipuncture also prevents hemolysis of the specimen and a stinging sensation when the needle is inserted. This is a desirable time to prepare equipment, but it is not a reason why you wait for the alcohol to dry.
90. What happens if you advance the tube past the guideline on the holder before needle insertion? a. The ETS tube will fail to fill with blood because of loss of tube vacuum. b. Nothing; the line is actually a fill guideline for all evacuated tubes. c. The needle sleeve stops penetration of the tube until fully advanced. d. There will be transfer of the tube additive to the needle at that point.
90. Answer: a WHY: When the tube is advanced past the guideline on the holder, the stopper is penetrated. If the needle is not under the skin, the tube will lose its vacuum. A tube that has lost its vacuum will fail to fill with blood, which means that you will have to replace it with a new tube.
91. Visual inspection of the needle tip before inserting it in a patient's vein can detect all of the following EXCEPT a. the presence of external contamination. b. flaws that could damage a vein. c. proper positioning of the bevel. d. that the needle is out of date.
91. Answer: d WHY: Visually inspecting the needle tip before insertion not only ensures that you are entering with the bevel up but also prevents damage and unnecessary pain during the procedure should the point or beveled edges have imperfections. Needles are supposed to be sterile when first opened and should not have any external contamination. However, they should be checked nonetheless because contaminants have been observed on rare occasions. You cannot tell that a needle is outdated by inspecting the tip. The expiration date is typically printed on the label that covers the twist-apart shields or on the packaging, as in the case of butterfly and other blood collection set needles. Outdated needles must be discarded during regular inventory of the stock.
92. Which of the following steps are in the correct sequence within the venipuncture procedure? a. Clean the site, prepare equipment, sanitize the hands, and apply tourniquet. b. Sanitize the hands, put on gloves, position the patient, and apply the tourniquet. c. Select the site, apply the tourniquet, prepare equipment, and clean the site. d. Select the vein, clean the site, position the patient, and put on the gloves.
92. Answer: b WHY: The venipuncture steps that are in the correct sequence within the venipuncture procedure are: sanitize the hands, put on gloves, position the patient, and apply the tourniquet. Gloves are required by OSHA to protect the phlebotomist from potential exposure to bloodborne pathogens. Due to infection control issues, most healthcare facilities require phlebotomists to put on gloves immediately after hand sanitization, before touching the patient.
93. You are about to draw blood from a patient. You touch the needle to the skin but change your mind and pull the needle away. What do you do next? a. Clean the site and try again using the same needle. b. Stop and obtain a new needle before trying again. c. Try it again immediately using that same needle. d. Wipe the needle across an alcohol pad and retry.
93. Answer: b WHY: If the needle touches the skin and then is withdrawn before piercing the tissue, the needle is considered contaminated and a new needle should be used for the draw to avoid the possibility of giving the patient an infection.
99. All of the following are proper specimen collection techniques EXCEPT a. collecting sterile specimens before all other specimens. b. drawing a "clear" tube before special coagulation tests. c. filling each tube until the normal vacuum is exhausted. d. positioning the arm so tubes fill from stopper end first.
99. Answer: d WHY: The arm should be in a downward position during venipuncture so that tubes fill from the bottom up and not from the stopper end first. This keeps blood in the tube from being in contact with the needle, preventing reflux of tube contents into the patient's vein and minimizing the chance of additive carryover between tubes. Collecting sterile specimens before filling tubes for other specimens, clearing for special coagulation tests, and......
97. When is the best time to release the tourniquet during venipuncture? a. After the last tube is filled completely b. After the needle has been withdrawn c. As soon as blood flow is established d. As soon as the needle enters the skin
97. Answer: c WHY: According to CLSI guidelines, the best time to release the tourniquet is as soon as blood flow is established in the first tube. Releasing the tourniquet as well as having the patient release the fist minimizes the effects of stasis and hemoconcentration on the specimen. A tourniquet should not remain in place longer than 1 minute.
98. Which of the following analytes is least affected by prolonged tourniquet application? a. Potassium b. Prothrombin c. Red cell count d. Total protein
98. Answer: b WHY: Prolonged tourniquet application or vigorous fist pumping leads to hemoconcentration of the specimen, notably affecting potassium, protein levels, and cell counts.
