Phlebotomy

The medical assistant is educating the patient on fasting diet requirements prior to a glucose tolerance test. Which of the following is the minimum time frame the patient must remain NPO before the start of the test? A. 12-24 hours B. 8-12 hours C. 1-2 hours D. 2-4 hours

8-12 hours --------------- To ensure accuracy of the blood test results, the patient must remain NPO for 8-12 hours prior to the test. Gum chewing, eating mints, and/or smoking are not allowed. Sips of water may be permitted depending on the provider NPO policy.

The appropriate needle gauge to use for most venipuncture collections is A. 15. B. 18. C. 21. D. 24.

21. ------------------ The 21 gauge needle is long enough and thin enough to access most veins and the internal diameter (bore size) is wide enough to permit blood collection with little concern about mechanical hemolysis when using evacuated tubes. Butterfly collection sets (wing sets) typically use needles of a higher gauge, and blood donation centers typically use needles of a lower gauge. Remember, the higher the gauge, the smaller the bore (opening).

After selecting the appropriate location to collect a blood sample, how many inches above that location should the phlebotomist fasten the tourniquet? A. 1 to 2 inches B. 3 to 4 inches C. 5 to 6 inches D. more than 6 inches

3 to 4 inches ----------------- Tourniquets are used to make it easier to locate veins by causing them to become distended and easier to palpate. This occurs because the tourniquet impedes venous blood flow right (i.e., below the application site) but does not impede arterial blood flow. Most phlebotomy experts recommend a tourniquet be applied approximately 3 to 4 inches above the site of blood collection for optimum palpation in venipuncture. Placing a tourniquet too far away will not impede blood flow sufficiently to help with palpation, but too close may cause hemoconcentration, possibly affecting the ratio of cellular components to plasma and laboratory test results.

Which patient description is correctly matched with the appropriate site selection? A. A 53-year old female that has had a double mastectomy has a specimen collected on the palmar side of the wrist. B. A two-day old male has a specimen collected from central section of the plantar surface of the heel. C. A two-year old female has a specimen collected from the palmar surface of the distal phalanx of the fifth finger. D. A 53-year old male with a central line has a specimen collected from the dorsal side of the hand.

A 53-year old male with a central line has a specimen collected from the dorsal side of the hand. --------------- Patients with central lines would be candidates for specimen collection from dorsal side of the hand. Venous samples are not collected from the palmar side of the wrist; veins are accessible from the dorsal side. Fingersticks are not performed on newborns as the blade depth could injure nerves in the fingertips and blood would be difficult to extract. Heel sticks may be performed on newborns, but not in the central section of the plantar surface. Nerve and/or tissue damage could result.

CRP (C-reactive protein)

A substance produced by the liver that increases in the presence of inflammation in the body.

Which of the following is the proper way to identify a patient prior to performing a venipuncture? A. Ask the patient if he/she is a certain patient (i.e. "Are you Steven Smith?"). B. Verify the patient's order against the name on the chart. C. Ask the nurse what the patient's name is. D. Ask the patient to state his/her full name and DOB and compare to the chart.

Ask the patient to state his/her full name and DOB and compare to the chart. -------------- Before a venipuncture, the medical assistant should ask the patient to state his/her full name and DOB (comparing what is stated to what is written in the chart or on a wrist band patient identifier). This minimizes the risk for mis-identification errors because it cross-checks what the patient says against written documentation. This provides a verified identity so that all tubes collected will be associated with the correct patient (provided the medical assistant labels them properly).

What artery is in the arm?

BRACHIAL artery

Which of the following actions by the medical assistant demonstrates safe use of a centrifuge? A. Ensure all specimen tubes are uncapped. B. Open at timed intervals to monitor proper function. C. Open the centrifuge during operation to ensure the separation of blood cells from serum. D. Balance the tube load to prevent breakage.

Balance the tube load to prevent breakage. ---------------- It is important to properly balance a centrifuge, equally distributing the samples. An imbalance of weight could cause the centrifuge core to break while spinning, and/or cause damage to the rotors, brushes, or other components. The shaking of an imbalanced centrifuge could also lead to tube breakage. Tubes within a centrifuge should be capped at all times (to contain all samples and aerosols). It is not necessary to stop the centrifuge to make sure samples are separating or to monitor function.

Most common hematology test is?

CBC (collected in LAVENDER tube)

What is the laboratory abbreviation for calcium? A. CA B. cal C. Ca D. CAL

Ca ---------------- Ca is the scientific abbreviation for calcium. The laboratory uses scientific abbreviations from the Periodic Table of Elements. CA = cancer, carcinoma. Calorie = cal. CAL can indicate many things, but is not the general abbreviation for calcium.

Prior to any type of inpatient specimen collection, a phlebotomist must correctly verify their patient's identity by using which two-step procedure? A. Check ID bracelet and IV bag. B. Check ID bracelet, and ask patient to verbally confirm their identity. C. Check ID bracelet and foot bed chart. D. Check foot bed chart, and ask patient to verbally confirm their identity.

Check ID bracelet, and ask patient to verbally confirm their identity. ------------- The correct answer is to check the ID bracelet and ask the patient to verbally confirm his/her identity. Patients may not have foot bed charts or IV bags, and the goal is to select the BEST answer of all choices. If a patient has both an ID bracelet and can verify his/her own identity, it is ideal.

The phlebotomist needs to draw routine labs. The skin preparation for this procedure would be. A. Sterilize the site by using a circular motion from the center to the periphery. B. Disinfect the site by using a circular motion from periphery to center C. Cleanse the site by using a circular motion from center to periphery D. Sterilize the site by using a circular motion from periphery to center

Cleanse the site by using a circular motion from center to periphery ---------------- Phlebotomists cleanse the selected venipuncture site before routine lab draws. Cleansing is accomplished by moving the alcohol pad in a circular motion from the center to the periphery of the puncture site. The alcohol pad is sterile at first touch to the patient's skin and thereafter will contain surface bacteria from the skin. If a blood culture is ordered, disinfection is required before the collection; disinfection devices can vary among institutions, but often include an isopropyl pad and providone iodine swab and possibly the PREP method (70% isopropyl/10% acetone scrub and povidone iodine dispenser). Total sterilization of the skin is not possible.

The medical assistant is collecting a sample on a 2 year old outpatient by finger stick. Following the collection, the medical assistant holds firm pressure on the site until bleeding has stopped. How should the medical assistant proceed? A. Put a cartoon character bandage on the site. B. Bandage with a pressure wrap. C. Bandage with gauze and tape. D. Do not bandage the site.

Do not bandage the site. ---------------- If the child has shown evidence of wanting to touch everything in sight, the phlebotomist should not add a bandage to the list of things within his reach as a 2 year old could easily decide to put it in his mouth. Putting a smiley face on the bandage might make it even more enticing. A pressure dressing is unwarranted if firm pressure was held on the site until bleeding stopped. Bandages are not biohazards prior to being used, but only become so when in contact with blood.

Patient has a DVT in left arm and the patient is also on blood thinners, where would be the best site for drawing blood? A. Draw right arm and hold for 5 minutes B. Draw left arm and hold for 5 minutes C. Draw right foot and hold for 3 minutes D. Draw left foot and hold for 3 minutes

Draw right arm and hold for 5 minutes --------------- A patient with a deep vein thrombosis (DVT) in the left arm requires special precautions during a phlebotomy procedure. Blood thinners are a common treatment for DVT. The best site for collecting a blood sample would be the right arm, opposite the DVT. Once the draw is complete, pressure should be applied for 5 minutes since the patient is on blood thinners. A foot draw would not be recommended in this case.

The physician orders a sedimentation rate for a patient recovering from an infection. This is indicated on the lab requisition as which of the following? A. EBV B. ESR C. CRP D. INR

ESR ------------------ The Erythrocyte Sedimentation Rate (ESR) is a common test to detect inflammation by measuring the rate at which red blood cells settle to the bottom of a tall, thin tube. Since inflammation can cause cells to clump, these clumps are heavier than single cells and settle more quickly. The test measures the distance settled in one hour. This test is most useful in combination with other more specific laboratory tests. EBV = Epstein Barr Virus (causes a number of diseases, including infectious mononucleosis) CRP = C-Reactive Protein ( appears with inflammation in the body) INR = International Normalized Ratio (a measure of coagulation)

What artery is in the thigh?

FEMORAL artery

Since special precautions are needed for patients with Vascular Access Devices, which of the following devices are contraindicated for any type of blood draws? A. Arterial line catheter B. Central venous catheter C. PICC Line catheter D. Fistula

Fistula --------------- The AV fistula requires the surgical connection of a vein and artery, typically in the forearm. It is predominately used for patients in renal failure who may need long term dialysis. To avoid any complications, blood draws are contraindicated. Central venous access devices/catheters are small, flexible tubes placed in large veins for people who require frequent access to the bloodstream. They are more easily created than the arteriovenous fistula, and there are more available locations for placement.

Which of the following characteristics applies to veins A. Transports blood from peripheral tissues directly to the lungs B. Carry blood that is normally blue in color C. Have thicker walls than arteries D. Have valves to prevent backflow of blood

Have valves to prevent backflow of blood -------------- Veins have valves which maintain the unidirectional flow of blood, even against gravity. Veins are also the blood vessels which carry the blood from peripheral tissues towards heart. They carry the deoxygenated blood, which is bluish in color and for the same reason veins appear blue.

After a phlebotomy draw, the phlebotomist realizes the tourniquet was on the patient's arm for an extensive length of time. Which of these is the most common complication? A. Hemolysis B. Hemoconcentration C. Hematoma D. Hematocrit

Hemoconcentration ----------------- Hemoconcentration is decrease in the volume of plasma in relation to the number of red blood cells. Prolonged tourniquet use impedes circulation and will cause this to happen, but will likely not cause hemolysis or a hematoma. Hematocrit is a measure of the volume of red blood cells in a whole blood sample, and is not a physiological complication at all.

green tube contains what additive

Heparin. green tops used for collecting heparinized plasma/whole blood for special tests. **electrolytes can be collected in red tube

The medical assistant completes a venipuncture in the antecubital area without complications. Pressure is placed on the site following the collection. The patient is still bleeding after five minutes of continuous pressure by the medical assistant and there is bruising at the site. The medical assistant asks the patient if she is on anticoagulants. The patient indicates that she is, and states that this is normal for her. How should the medical assistant proceed? A. Apply a pressure bandage and let the patient leave. B. Bend the arm up, apply a pressure bandage, wait 2 minutes, and notify nurse. C. Hold direct pressure for 2 minutes, apply a bandage, and let the patient leave. D. Hold direct pressure until bleeding stops, apply a bandage, and notify nurse.

Hold direct pressure until bleeding stops, apply a bandage, and notify nurse. ---------------- It is the responsibility of the phlebotomist to ensure bleeding has stopped before leaving the patient. In addition, since bruising had occurred at the site, nursing staff will want to know the source for documentation and follow up purposes.

Which of the following Vacutainer tubes is routinely used for hematology testing? A. Red-topped B. Green-topped C. Yellow-topped D. Lavender-topped

Lavender-topped ------------------ Hematology is a general term or branch of medicine that studies blood, the organs that form blood, and blood disorders and diseases. The most common hematology test is a complete blood count (a.k.a. CBC- collected in a lavender topped tube), often ordered with a cell differential. The other tube options listed in this example are generally collected for chemistry testing, serology testing, and blood cultures.

The laboratory requisition indicates that you are to collect a venous blood specimen for hematology CBC testing, serum chemistry testing, and coagulation studies. What is the proper order of collection for these tubes? A. Red, light blue, lavender B. Yellow, red, light blue C. Light blue, red, lavender D. Red, lavender, yellow

Light blue, red, lavender ---------------- Light blue (coagulation studies), red (serum chemistry), then lavender (hematology CBC) tubes follows CLSI established order of draw.

Which of the following tube tops contain silica particles to enhance clotting and a thixotropic gel to assist in the separation of serum and blood cells? A. Marbled red and grey B. Lavender C. Green D. Blue

Marbled red and grey -------------- Marbled red and gray top tubes contain silica particles enhance the clot formation of whole blood. When the sample is centrifuged, the gel will form a barrier between the serum and blood cells, with the serum portion on top. Lavender, green, and blue topped tubes all have anticoagulants that inhibit the clotting process.

Name the two most used patient identifiers. A. Bed number/Physicians name B. Medical record number/date of birth C. Patient's name/date of birth D. Patient's name/Physicians name

Patient's name/date of birth ------------- Name and DOB are most often used as positive patient identifiers as they are easily documented and work for inpatients or outpatients. Bed numbers should never be used as identifiers for inpatients or outpatients, nor should physician name associations. Medical record numbers are valuable for inpatients, with name and DOB being used most often.

Which of the following tests is required in all 50 states to screen newborns for metabolic disease? A. HIV B. RSV C. PKU D. Rh Factor

PKU ----------------- The government has mandated newborn screening for the purpose of early diagnosis and treatment of Phenylketonuria (PKU). It is an inherited disease that may lead to mental retardation if not detected. The specimen for the test is usually collected in the newborn nursery via heel stick between 48-72 hours of life.

What artery is located behind the knee?

POPLITERAL artery

Which of the following tests monitor anticoagulation therapy? A. PT and PTT B. T3 and T4 C. Hgb and Hct D. ABO and Rh

PT and PTT ---------------- PT and PTT are coagulation tests (collected in blue top tubes). They are routinely collected to monitor a patient's anticoagulant drug therapy (to make sure that the dose the patient is taking provides the proper effect, but does not dangerously over-anticoagulate and introduce a critical risk of bleeding). In short, these tests monitor a patient's blood clotting time. T3 and T4 are thyroid tests. Hgb and Hct reflect the amount of hemoglobin in the red blood cells and the number of red blood cells per volume of whole blood (hematocrit). ABO and Rh are blood typing tests that determine a patient's blood group.

A phlebotomist inserts a needle into a patient's vein and notices there is no blood flow into the tube. The needle is positioned against the wall of the vein. How should the phlebotomist proceed? A. Retract the needle slightly, remove the tube, and insert needle deeper B. Relax the needle's angle slightly, and insert new tube C. Withdraw the needle completely, and begin procedure again from the beginning D. Insert the needle deeper in the opposite direction, and insert new tube

Relax the needle's angle slightly, and insert new tube ----------------- If the needle is believed to be positioned against the vein wall, sometimes relaxing the needle's angle slightly will bring blood into the blood collection tube. In case the tube's vacuum was compromised, using a new tube should provide blood flow. Retracting the needle might pull it out of the vein entirely. Starting over subjects the patient to the discomfort of another needle stick, and inserting the needle deeper may cause the needle to move through the vein entirely.

After the phlebotomist puts on latex gloves and ties a non-latex tourniquet on the patient's arm, the patient indicates that he is highly allergic to latex. Which of the following is the phlebotomist's best course of action? A. Remove the tourniquet, change to non-latex gloves and proceed with the same tourniquet. B. Change to non-latex gloves and use a new tourniquet. C. Wash hands, change to non-latex gloves, and proceed with the same tourniquet. D. Remove the tourniquet, wash hands, change to non-latex gloves and use a new tourniquet.

Remove the tourniquet, wash hands, change to non-latex gloves and use a new tourniquet. ----------------- The key here is not to expose the patient to latex. The phlebotomist should remove the tourniquet that is on the patient (taking care not to touch the patient with anything latex). Washing the hands removes any residual latex that may be on the skin. Non-latex gloves should then be put on, and a new non-latex tourniquet should be used.

Using the guidelines for any method of venipuncture, which of the following actions should the medical assistant perform directly after confirming patient identity? A. Assemble the appropriate equipment and select the proper evacuated tubes for test to be performed B. Review the requirements for collecting and handling the blood specimen as ordered by the physician C. Apply the tourniquet and thoroughly palpate the selected vein D. Position the patient's arm and cleanse the site with an antiseptic wipe

Review the requirements for collecting and handling the blood specimen as ordered by the physician ------------- To ensure accuracy and quality, it is important to anticipate your needs before beginning the actual venipuncture (i.e. tube color/size, minimum acceptable blood volume, whether or not the specimen needs to be placed on ice). Therefore, the medical assistant would identify the patient, then review the requirements for collecting and handling the blood specimen as ordered by the physician. Next, assemble the appropriate equipment and select the proper evacuated tubes for test to be performed. Then, apply the tourniquet and thoroughly palpate the selected vein. Finally, position the patient's arm and cleanse the site with an antiseptic wipe, then proceed with the venipuncture protocol.

A medical assistant has active symptoms of the common cold. Under which of the following conditions may he perform venipuncture? A. The medical assistant may not perform venipuncture with an active cold. B. The medical assistant may perform venipuncture provided the patient is wearing a mask. C. The medical assistant may perform venipuncture provided he is wearing a mask and afebrile. D. The medical assistant may perform routine venipuncture as usual

The medical assistant may perform venipuncture provided he is wearing a mask and afebrile. ------------------ It is not uncommon for people to be able to work with the common cold. However, it is important for medical personnel to use good judgment and not transmit diseases to their patients. Medical personnel should take precautions and handle patient contact in a responsible manner. They should not have patient contact if they are febrile, since that is when colds are highly contagious. In this instance, the medical assistant may perform venipuncture provided he/she is wearing a mask and afebrile. The medical assistant should wear the mask to keep from transmitting the cold via coughing or sneezing on a patient.

Which of the following statements best describes the reason antecubital veins are most desirable to use when performing venipuncture? A. These veins are more flexible and allow for large bore needles. B. These veins have thin walls, making it easier to penetrate with the needle. C. The tissue surrounding these veins is less sensitive, making the procedure less painful. D. The veins are the most superficial and are therefore easier to see.

The tissue surrounding these veins is less sensitive, making the procedure less painful. --------------- Of the three veins in the antecubital area acceptable for venipuncture, the median cubital vein (in the middle) is the vein of choice for four reasons: 1) it's more stationary; 2) puncturing it is less painful to the patient; 3) it's usually closer to the surface of the skin; and 4) it isn't nestled among nerves or arteries.

After several minutes of searching the medical assistant can only palpate a small vein. The patient is prepared and the venipuncture is performed. The blood is filling the tube, but slows and then stops even though the patient and medical assistant remained still. Which of the following actions should the medical assistant take? A. Advance the needle slightly because the needle is no longer in the vein. B. Pull back slightly because the needle has gone through the vein. C. Use a smaller tube because the vein has collapsed. D. Slightly turn the needle because the bevel is partly through the vein.

Use a smaller tube because the vein has collapsed. -------------- Since blood was once filling the tube, the needle was once in the vein. Since the phlebotomist knew this was a small vein at palpation, the fragility of the vein may have caused the vein to collapse if the vacuum of a regular size collection tube was too strong. Putting a smaller tube on the multi-sample needle would decrease the force of the vacuum pulling blood from the vein. If blood flowed easily again, problem is solved! Presuming the phlebotomist had a steady hand during the draw, the other causes could be ruled out. Since blood filled the tube normally for a time and slowed to a stop, there is no reason to believe the needle had been moved. And if the bevel was still in the vein at all, blood would still be able to trickle into the tube.

After a patient's skin is punctured to obtain a blood glucose level, what should be the phlebotomist's next step? A. Use the first drop of visible blood, and place it onto the test strip. B. Use an alcohol pad to wipe away the first drop. C. Use a sterile gauze pad to remove the first drop. D. Squeeze the fingertip, and place the large blood drop onto the test strip.

Use a sterile gauze pad to remove the first drop. ----------------- It's important to wipe off the first drop of blood in any capillary collection, as this drop may include sufficient tissue fluid to influence test results. Using a sterile gauze pad helps to prevent infection without inhibiting blood flow. Using an alcohol pad might affect test results and is likely to cause discomfort. Squeezing the fingertip might increase the dilution of the sample with tissue fluid.

INR (international normalized ratio)

a measure of coagulation

Normal serum is ______ colored.

amber

When performing a venipuncture on an infant, the amount of blood taken from the infant should be monitored to avoid A. septicemia B. polycythemia C. venous thrombosis D. anemia

anemia ---------------- The removal of just 10 mL of blood from an infant can result in a 10% loss of total blood volume and lead to iatrogenic anemia caused by blood collection. This is most serious in the first week of life. For this reason, the amount of collected blood must be carefully logged over time. Septicemia is not related to the amount of blood, but to the introduction of microorganisms into the bloodstream. Polycythemia (an abnormal proliferation of blood cells) is a hereditary condition. Venous thrombosis refers to blood clots in the veins, which may occur with indwelling catheterization but are typically not connected to venipuncture.

lavender, green, and blue topped tubes all have?

anticoagulants (inhibits clotting processes)

To help prevent a hematoma at the site after drawing blood, which of the following actions does the medical assistant take? A. ask the patient to make a fist B. clean the site with an alcohol prep C. apply direct pressure with cotton gauze D. have the patient bend the elbow to hold cotton gauze on the site

apply direct pressure with cotton gauze -------------- To promote clotting and help prevent the leakage of blood outside of the vein (hematoma or bruise), the medical assistant should apply direct pressure with cotton gauze. Asking the patient to make a fist, cleaning the site with an alcohol prep, or having the patient bend the elbow will not prevent a hematoma from forming.

Capillary blood specimens are typically collected on patients that A. are extremely obese. B. are dehydrated. C. have poor peripheral circulation. D. have peripheral edema.

are extremely obese. ----------------- Capillary blood samples are advisable on patients when veins are not palpable, which includes patients who are morbidly obese, among others. A phlebotomist should never just "hope for the best" if a vein cannot be located

An entry level medical assistant goes to collect blood from a 70-year-old woman with diabetes who had a mastectomy of the left breast. The medical assistant notices a PICC line in the patient's right arm. For this specimen collection, the medical assistant should A. draw the specimen from the left arm. B. draw the specimen from the PICC line. C. draw the specimen from one of the ankles. D. ask a nurse to collect the specimen.

ask a nurse to collect the specimen. --------------- This scenario is a scope of practice example. The medical assistant should ask a nurse to draw the sample. PICC line draws are outside an entry level MA's scope of practice. It should be noted that a facility may offer special training for PICC line draws, but specific training must be completed and competency assessed before any personnel collect such specimens. Performing a venipuncture in the left arm is not an option because the patient's left breast has been removed (it is not advisable to draw blood from an arm on the same side of a mastectomy). It is easier on the patient to have a nurse collect the specimen from the PICC line instead of enduring a venipuncture in an ankle.

At what time should a test tube be labeled with the patient's identification? A. before entering the patient's room B. after leaving the patient's room C. before leaving the patient's room, before drawing the blood D. before leaving the patient's room, after drawing the blood

before leaving the patient's room, after drawing the blood --------------- Three crucial identification steps in phlebotomy must be performed in this sequence without interruption—(1) positively identifying the patient, (2) collecting the patient's blood into tubes, and (3) labeling the tubes immediately afterward. Any change in this sequence or any significant interruption between steps has been linked to significantly increased chances for error.

hemostasis

bleeding is stopped

Which of the following is an appropriate alternative to using a rubber tourniquet when attempting a venipuncture on a known patient who is difficult to obtain a sample from? A. blood pressure cuff B. non-adherent gauze C. hypoallergenic tape D. elastic bandage

blood pressure cuff ---------------- The only acceptable choice among the listed options is the blood pressure cuff. Occlusion pressure may be adjusted as needed as an alternative to ensure circulation. In compliance with CLSI (Clinical and Laboratory Standards Institute) standards, the blood pressure cuff can provide uniform constriction, as long as the phlebotomist doesn't inflate the cuff beyond 40 mm of mercury.

hemolysis

breakdown/damage of blood cells

A 2 week old infant has been brought to the lab for a repeat PKU/neonatal screening. Which of the following collection procedures is appropriate to collect the specimens? A. venipuncture using evacuated tube system B. venipuncture using winged infusion set C. capillary using dermal puncture lancet D. capillary using heel puncture lancet

capillary using heel puncture lancet ---------------- PKU is a neonatal screening test collected on a blot card. The recommended method of blood collection on infants less than a year old is via capillary (thus eliminating the venipuncture choices). A capillary collection using heel puncture lancet would be the correct choice in this situation. The heel puncture lancet would go the proper depth on an infant (there are even different sizes of lancets available for premature vs. term infants).

EBV (Epstein-Barr Virus)

causes a number of diseases (e.g. infectious mononucleosis)

Which of the following forms is the medical assistant responsible for having the patient sign when a specimen is being collected for substance abuse screening for employment? A. advance directive B. chain-of-custody C. informed consent D. release of medical Information

chain-of-custody ------------------ A Chain-of-custody form is used to maintain a legal record of individuals who have had physical possession of the specimen. It prevents the possiblity of tampering. An Advance Directive is a legal document that allow someone to spell out medical decisions about end-of-life care ahead of time. Informed Constent recognizes the need of a patient to know about a procedure, surgery, or treatment, before deciding whether to have it. No medical information may be released without proper authorization (Medical Release form) from the patient or legal guardian, currently dated and signed.

When performing a fingerstick on a patient, the phlebotomist must pay close attention to the extremity that has been compromised by A. dry skin, bug bites, and coldness. B. circulation, swelling, and infection. C. swelling, infection, and dry skin. D. circulation, dry skin, and infection.

circulation, swelling, and infection. --------------- When performing fingersticks, dry skin and bug bites would not cause problems in collection or recovery from collection. Thus, the only reasonable answer is circulation, swelling, and infection. If there is little circulation, blood flow may be greatly diminished. If the finger is swollen or appears infected, the phlebotomist risks further damage and pain to the patient.

During processing, the centrifuge rotor lid should be kept A. closed to maintain an airtight seal. B. unlocked to promote safe access to contents. C. open to allow optimum visibility. D. partially vented to release pressure.

closed to maintain an airtight seal. ----------------- To ensure safety, the lid of a centrifuge should remain closed, locked and sealed until the rotor reaches a complete stop. A centrifuge is not a pressure device, therefore venting is not appropriate. The lid should be closed, locked and sealed while in operation to contain all contents should a tube break and disperse sample and/or glass (or other parts) around the inside of the centrifuge.

thrombosis

clotting of blood w/in a blood vessel (NOT a test tube)

The medical assistant collects blood for a test that requires a blood smear. What is the terminology that would indicate that the sample clumped (therefore requiring a redraw)? A. coagulation B. thrombocytosis C. hemolysis D. thrombosis

coagulation ------------------ Coagulation is a term that describes how blood clots (changes from a liquid to a clump or solid). Sometimes if the person performing a phlebotomy procedure fails to adequately mix the blood within a tube, the anticoagulant does not fully work and the sample will have clumps/clots. Thrombocytosis describes a disorder that occurs when the body produces too many thrombocytes (a.k.a. platelets). Hemolysis is a term used to indicate destruction of red blood cells. Thrombosis indicates the clotting of blood within a blood vessel (not a test tube).

A medical assistant needs to draw a bilirubin on a jaundiced infant. The medical assistant should A. collect the specimen in an amber tube to protect from light. B. wrap the specimen in a heel warmer to keep at body temperature. C. chill the specimen to slow metabolism and stabilize the analyte. D. run the specimen STAT.

collect the specimen in an amber tube to protect from light. ----------------- Bilirubin is a photo-sensitive analyte (can degrade by as much as 50% with an hour of light exposure). A specimen submitted for bilirubin testing should be collected in an amber tube which will protect it from light (a regular tube wrapped in aluminum foil could also be acceptable). It is not necessary to keep the specimen warm with a heel warmer, nor is it necessary to chill the specimen to slow metabolism and stabilize the specimen. As long as the specimen is properly collected, protected from light, and handled according to normal serum protocol, it can be run as routine, thus Stat analysis is not necessary.

ESR (erythrocyte sedimentation rate)

common test to detect inflammation by measuring the rate at which RBCs settle to the bottom of a tall, thin tube

After a phlebotomist has successfully followed all the steps for blood collection, the patient informs the phlebotomist that he tends to bleed longer than the average person. What would be the next course of action for the phlebotomist? A. confirm hemostasis and apply paper tape B. apply extra gauze with non-adhering tape and wait for hemostasis C. confirm hemostasis and apply gauze and non-adhering tape D. apply gauze and tape and tell patient not to bend his arm for 20 minutes

confirm hemostasis and apply paper tape --------------- A proper phlebotomy procedure includes confirmation of hemostasis, regardless of whether or not a patient bleeds longer than normal. This definitely applies to this case when a patient admits a tendency to bleed longer than the average person.

After performing a venipuncture on a patient the medical assistant notices the patient is bending his elbow to hold the gauze in place. This action is contraindicated because bending the elbow is likely to A. create a hematoma. B. cause hemostasis. C. cause bacterial infection. D. result in hemorrhage.

create a hematoma. --------------- If adequate pressure is not applied following a venipuncture, a hematoma can form via the transfer of blood from the vein into the surrounding tissue. Proper procedure would be to keep the arm straight and apply direct pressure until bleeding stops.

thrombocytosis

disorder that occurs when the body produces too many thrombocytes (aka platelets)

Venipuncture on the foot is performed in which of the following locations? A. medial plantar surface B. posterior curvature C. dorsal pedis D. anterior curvature

dorsal pedis

Which of the following arteries provides direct blood flow to the foot? A. dorsalis pedis B. popliteal C. brachial D. femoral

dorsalis pedis --------------- The dorsalis pedis artery is located on the upper surface (dorsal region) of the foot, and provides direct blood flow to the foot. The popliteal artery is located behind the knee, the brachial artery is in the arm, and the femoral artery is in the thigh.

The medical assistant is asked to draw blood from a patient with an I.V. whose opposite, left arm is inaccessible. Drawing blood from which of the following sites would be appropriate without a physician's approval? A. Draw from the ankle B. Draw from the I.V. line C. draw from the right arm proximal to the I.V. site D. draw from the right arm distal to the I.V. site

draw from the right arm distal to the I.V. site --------------- Collecting blood distal to the I.V. site prevents contamination of the sample by the intravenous solution. Medical assistants are not permitted to collect samples from an I.V. line and may not draw from an ankle vein without physician's approval.

Which of the following additives protects serum from interacting with red blood cells after a specimen has been centrifuged? A. sulfosalicylic acid B. gel separators C. clot activators D. anticoagulants

gel separators ----------------- Gel separators create a barrier between the serum and formed elements of the blood. Prolonged contact of serum with formed elements can lead to pre-analytical variations in certain tests (such as serum glucose levels). Tubes with clot activators, such as thrombin, actually expedite the clotting process. Anticoagulant tubes keep the blood from clotting, yielding plasma instead of serum. Sulfosalicylic acid is used in urine testing to precipitate proteins.

Which of the following evacuated tubes should the medical assistant select for collection of electrolytes? A. blue-top B. green-top C. grey-top D. lavender-top

green-top --------------- A green top tube contains heparin. Green tops are used for collection of heparinized plasma or whole blood for special tests. Note: After the tube has been filled with blood, the tube is inverted several times to prevent coagulation. Note: Green top tubes can contain ammonium, lithium, and sodium in addition to the heparin. In this instance, lithium heparin would be the green-top of choice (and sodium heparin would NOT be used for an electrolyte test). Electrolytes can also be collected in a red-top tube.

The medical assistant is instructed to perform a capillary stick for newborn screening. Which of the following collection devices should the medical assistant use? A. heel stick lancet B. needle and syringe C. evacuated tube D. finger stick lancet

heel stick lancet ------------------ The heel stick lancet (e.g., Tenderfoot) is required for infants. If a heelstick in an infant is being performed, the phlebotomist should apply a warming device for approximately 3-5 minutes to the heel to increase blood flow to the area, which will facilitate the collection of the capillary specimen. The bones of the distal phalanx (located in the thickest part of the finger) may be injured or damaged by a traditional finger stick lancet puncture.

Forceful shaking of blood in an evacuated collection tube will cause which of the following complications? A. hemostasis B. hemoconcentration C. hemolysis D. contamination

hemolysis ---------------- Hemolysis is the breakdown/damage of blood cells and could end in an unusable specimen and costly re-draw for the patient. Hemostasis is when bleeding is stopped, hemoconcentration is the loss of plasma, and contamination is when something dirty causes the material to be unusable.

febrile

highly contagious

A phlebotomist has received a requisition for a PT/aPTT to evaluate the patient for Von Willebrand's disease. Because of the patient's potential diagnosis, the phlebotomist should be sure to A. hold pressure on the draw site until bleeding has stopped. B. call the doctor to confirm collection site. C. collect the specimen from the hand to avoid edema. D. use a blood pressure cuff to apply consistent pressure.

hold pressure on the draw site until bleeding has stopped. ---------------- Von Willebrand disease is an inherited condition that can cause extended or excessive bleeding. Those affected have deficient amounts or impaired von Willebrand factor, a protein important to the clotting process. Thus, the phlebotomist must hold steady pressure on the venipuncture site until all bleeding has stopped. The collection site does not need confirmation from anyone, as the disease would not affect site selection. Edema is not a problem, and use of a blood pressure cuff could force more bleeding if applied after the draw.

Which of the following steps is completed first in performing venipuncture? A. apply the tourniquet B. cleanse site with an alcohol wipe C. identify the patient D. arrange tubes in order of draw

identify the patient ---------------- To prevent error and maintain a culture of safety, at least 2 identifiers (ex. full name and date of birth) must be verified prior to performing a procedure.

Place the following steps in the correct sequence when preparing to perform a venipuncture. -apply tourniquet -palpate the antecubital space of the arm -identify the pt and explain the procedure -wash hands and put on gloves -locate an acceptable vein

identify the patient and explain the procedure, wash hands and put on gloves, apply tourniquet, palpate the antecubital space of the arm, locate an acceptable vein ------------------ The standard order of preparation calls for identification of the patient before continuing with the phlebotomy. Then explain the procedure and prepare yourself. Apply the tourniquet, palpate, and decide on an acceptable vein.

PKU (phenylketonuria)

inherited disease that may lead to MENTAL RETARDATION if not detected

Which of the following should be avoided as a form of patient identification? A. insurance number B. social security number C. date of birth D. full name

insurance number -------------- An insurance number is not a common means of positive patient identification (entire families can share the same insurance policy number). Patients must be positively identified for medical services, whether they have insurance or not. Insurance information is necessary for billing purposes. The only true unique identifier listed among these choices is the social security number. Patient name and date of birth are also commonly used to confirm identification.

advance directive

legal document that allow someone to spell out medical decisions about end-of-life care ahead of time

hemoconcentration

loss of plasma

hematocrit

measure of the volume of RBCs in a whole blood sample

The phlebotomist should send a specimen collected in a yellow stopper tube with SPS additive to which of the following laboratory departments? A. microbiology B. immunohematology C. chemistry D. hematology

microbiology ----------------- Blood cultures are collected in yellow-top tubes with SPS (sodium polyanethole sulfonate), a constituent in blood culture media used to grow bacteria from patients suspected of bacteremia, i.e. bacteria in the blood. SPS prevents the patient's blood from killing any bacteria in the sample through the blood's own immune response to infection, allowing the bacteria to multiply so they can be identified. Additional antimicrobial susceptibility testing can help the physician in prescribing antibiotics.

A patient with an order for a blood draw presents with burns covering both arms. Which of the following is the medical assistant's best option for collecting the largest amount of blood for this patient? A. microtainer tube B. capillary tube C. PKU (Guthrie) card D. evacuated tube

microtainer tube ---------------- A microtainer tube would be the best choice in this case. If a patient has burns covering both arms, a routine venipuncture from a brachial vein is not an option. The person collecting the blood will have the best chance at getting the highest volume of blood from a smaller vein using a microtainer tube (has less vacuum pressure than a regular sized tube). There are many ways to collect blood, and using a evacuated tube is generally the best method. But in case of a burn, the best procedure would be to do a capillary finger stick and then use a microtainer tube which works on the same principle. A PKU is collected on a Guthrie blot card and is only for newborn screening.

Which of the following items is more commonly found on a phlebotomy tray? A. multi-sample needle B. normal Saline C. 5/8 inch needle D. sterile water

multi-sample needle ---------------- Of the choices provided, only the multi-sample needle would be commonly found on a phlebotomy tray. The typical length of such a needle varies from 1 to 1.5 inches, much longer than the 5/8 inch needle commonly used for injections. Neither sterile water nor saline are used in typical phlebotomy procedures, but do have other uses. Sterile water may be used in rehydrating a medication for injection. Normal saline (0.90% solution of Sodium Chloride or NaCl) may be used intravenously (IV).

For which of the following patients is the use of an adhesive bandage contraindicated? A. adult with hemophilia B. immunocompromised child C. adolescent with sickle cell anemia D. newborn with hyperbilirubinemia

newborn with hyperbilirubinemia ---------------- The person collecting a blood sample from a newborn with hyperbilirubinemia would not use an adhesive bandage post-stick. Bleeding would be stopped by direct pressure and no bandage would be utilized. It is not recommended to use a bandage on children under two years of age because it could introduce a choking hazard if the child works the bandage loose. Bandaging a newborn's foot is a controversial issue because of skin sensitivity and potential bandage aspiration. Sensitivity is of particular concern in newborns with hyperbilirubinemia as they must endure multiple sample collections. Still, the incision should be monitored for bleeding and inflammation. It would be acceptable to use an adhesive bandage on the other patients in this example unless there was an indication specified, such as a latex allergy. After drawing an adult with hemophilia, the phlebotomist should monitor the venipuncture site to ensure a platelet plug has formed to stop bleeding before bandaging the patient. There are no additional requirements for using a sterile adhesive bandage on an immunocompromised child or an adolescent with sickle cell anemia.

The phlebotomist is drawing blood from a patient that is taking blood thinners. Which of the following is a necessary piece of additional equipment to have at the drawing station? A. paper tape B. elastic gauze C. non-adhering bandage D. adhesive tape

non-adhering bandage ----------------- Non-adhering bandage material would be helpful for patients on anticoagulant therapy who may bleed more extensively than typical patients after venipuncture. It is necessary to contain the bleed with a bandage, but adhesive might bruise once removed from a patient who has anticoagulated blood.

afebrile

not highly contagious

Capillary blood specimen collections are contraindicated in patients with A. peripheral edema. B. severe burns. C. extreme obesity. D. very difficult veins.

peripheral edema. -------------- Patients with peripheral edema have a great deal of fluid in their tissue. Collection of capillary blood would provide a sample that is likely to be highly diluted with tissue fluid, affecting laboratory test results. Capillary testing would be a choice for the other patient conditions.

A phlebotomist has received a requisition to collect a blood culture. Using a butterfly, three milliliters of blood is collected. Into which of the following bottles is the proper dispensation of the specimen? A. place all three mLs in the aerobic bottle B. place all three mLs in the anaerobic bottle C. place 1.5 mLs in the aerobic bottle followed by 1.5 mLs in the anaerobic bottle D. recollect the specimen

place all three mLs in the aerobic bottle ---------------- Since the phlebotomist was only able to obtain three milliliters of blood, place all three mLs in the aerobic bottle. The aerobic bottle would be the first bottle to innoculate if there is limited sample. It is not advisable to split the innoculation of 3 total mLs into both bottles since it would not adequately innoculate either bottle. The fact that a butterfly was used in this instance indicates that the patient was probably a hard stick, thus attempting a recollection is not the first course of action here. The first course of action is to best utilize the sample that was collected by dispensing all of it into the aerobic bottle.

Which of the following sites should the medical assistant use for newborn screening blood collection? A. plantar surface of the heel B. antecubital fossa C. superficial scalp vein D. lateral surface of the great toe

plantar surface of the heel ---------------- A heel stick should be performed on the lateral or medial portions of the plantar surface of the heel-skin surface (left and right). Never stick the center area of heel, the arch, or the back of the heel. Avoid puncturing the bone by targeting the plantar surface. Draw an imaginary line starting in the middle of the big toe to the back of the heel. Then draw another imaginary line between the small toes to the back of the heel. The proper collection sites will be the fleshy portions outside those lines and below where the arch meets the heel. The anteromedial aspect, lateral surfaces and plantar curvature do not provide good flesh for a proper collection.

SPS prevents?

pt's blood from killing any bacteria in the sample through the blood's own immune response to infection --> bacteria multiplying to allow identification

A phlebotomist has received a requisition to collect a blood specimen on patient in isolation. When entering the patient's room, which should the phlebotomist do first? A. put on the gloves B. put on the mask C. put on the gown D. put on gloves, a mask, and a gown. The order is not important.

put on the gown ---------------- The phlebotomist should put on the gown, followed by the mask and gloves. To reduce the risk of contaminating oneself with infectious agents, the order of removal of personal protective equipment is important. As a rule, remove items in the following order: gloves, mask, then gown.

informed consent

recognizes the need of a pt to know about procedure/surgery/tx before deciding whether to have it

If it's ___ in appearance, the specimen is hemolyzed.

reddish

While performing a venipuncture, immediately before removing the needle, the medical assistant should A. activate the needle safety mechanism. B. release the tourniquet. C. gently invert the evacuated tubes. D. apply a gauze pressure dressing.

release the tourniquet. ----------------- Right before the medical assistant removes the needle, he/she should release the tourniquet. If the tourniquet is left on for too long, blood flow to the extremity could be impaired. Activating the needle safety mechanism, inverting the evacuated tubes, and applying a gauze dressing are all actions that need to be taken after the tourniquet is released and the needle is removed.

The patient reports feeling faint, and slumps forward during a venipuncture. After calling for assistance, which of the following actions should the medical assistant take next? A. remove the needle B. remove the tourniquet C. continue obtaining the specimen D. activate the needle safety mechanism

remove the tourniquet ---------------- The procedure should be discontinued immediately, with the initial step of releasing the tourniquet. The needle would also need to be removed, but the tourniquet should be removed first because it is causing pressure to the vein. Since the needle is being removed, activating the needle safety mechanism before removing the tourniquet would not be appropriate. The medical assistant should not continue obtaining the specimen, because the patient is clearly not tolerating the procedure.

A centrifuge functions in which of the following ways? A. slowly warms a refrigerated blood specimen to room temp B. magnifies cellular blood components C. measures the amount of glucose in a patient's blood D. rotates to separate components of a patient's blood

rotates to separate components of a patient's blood ---------------- A centrifuge rotates to separate components of a patient's blood. Depending on specimen requirements for a particular test, certain samples must be processed by centrifugation to maintain the integrity for testing. A centrifuge does not serve as a specimen warmer, nor does it magnify sample components (microscopes are used for magnification). Glucose measurements are obtained by analyzing the sample on a glucose meter or designated laboratory instrument, not the centrifuge.

the higher the gauge, the ____ the bore (opening).

smaller

A syringe is preferred over a vacuum collection device when A. the patient's veins are fragile. B. the sample must be drawn from a large antecubital vein. C. many tests have been ordered and multiple tubes must be drawn. D. collecting a sample for newborn PKU screening.

the patient's veins are fragile. ----------------- A needle and syringe would be chosen over a vacuum collection device when a patient has fragile veins. The vacuum pressure of evacuated tubes can collapse small or fragile veins such as those on the back of the hand. When many tests requiring multiple tubes are collected, vacuum devices are preferred. A capillary puncture would be indicated for a newborn screening PKU test since it is collected on filter paper.

After centrifuging a blood specimen, the medical assistant notes the serum has a reddish appearance. Which of the following has occurred? A. The finding is normal. B. The specimen is contaminated with neutrophils. C. A buffy coat has formed and discolored the serum. D. The specimen is hemolyzed.

the specimen is hemolyzed. ----------------- Normal serum should be amber-colored. If it's reddish in appearance, the specimen is hemolyzed. The reddish color is caused by broken red blood cells, not neutrophils (which are white blood cells). The buffy coat is the layer of white blood cells and platelets that forms in whole blood between the plasma and the red blood cells. This question refers to serum, which is the liquid layer of clotted blood (the white blood cells/platelets would be contained within the clot).

When inserting a needle during venipuncture, the bevel should be in which of the following positions in relation to the vein? A. up B. down C. left D. right

up ---------------- Positioning the needle bevel (slanted opening at the end of needle) up helps to maintain the integrity and position of the vein. If the bevel was down or to the left or right, it would not be as easy to hit the vein, and could cause damage to the tissue.

red tube

used for chemistry testing. encourages clotting

light blue tube

used for coagulation studies

lavender tube

used for hematology CBC

chain-of-custody form

used to maintain a legal record of individuals who have had physical possession of the specimen; prevents tampering possiblity

contamination

when something dirty causes the material to be unusable

In which of the following time frames should a tourniquet be routinely released on a patient while performing a blood draw? A. within 30 seconds B. within one minute C. within three minutes D. within five minutes

within one minute --------------- The standard time limit for having a tourniquet on a patient is one minute. Inaccurate laboratory test results may occur if a tourniquet is not removed within one minute. When a tourniquet is applied, the local blood flow is stopped. This leads to concentration of the blood and blood entering the surrounding tissue. This may result in falsely high values for all protein-based analytes, increased packed cell volume, and changes in other cellular elements. The most current edition of the CLSI Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture, H3-A6, states that the tourniquet application for preliminary vein selection should not exceed one minute. For most patients, it is easy to release the tourniquet within the one-minute period. Most veins are easily located and the venipuncture procedure can be completed quickly.