CHAPTER 8, 9, 10
Blood smears made using EDTA specimens should be prepared within - 1 hour of collection -2 hours of collection -6 hours of collection -24 hours of collection
1 hour of specimen collection
According to CLSI, a heel puncture lancet should puncture no deeper than?
2.0 mm
When making a routine blood smear, the"pusher slide" is normally used at an angle of how many degrees?
30
what is the best angle to use for insertion during routine venipuncture?
30 degrees or less
what is the recommended angle of needle insertion when performing venipuncture on an arm vein and on a hand vein, respectively?
30° or less, 10 ° or less
drugs that interfere with blood tests should be stopped or avoided for
4 to 24 hours
according to CAP guidelines drugs that interfere with blood tests should be stopped
4 to 24 hours prior to the test
how long should the site be examined to determine if bleeding has stopped?
5-10 seconds
After cleaning the venipuncture site with alcohol, the phlebotomist should:
Allow the alcohol to dry completely
Which of the following is the least effective way to immobilize a pediatric patient before a blood draw?
Allowing a child to sir with one arm bracing the other
You are asked to collect a blood specimen from an inpatient. The patient isn't wearing an ID band. What is the best thing to do?
Ask the patient's nurse to put an ID band on the patient before you draw the specimen
If collected during a single capillary puncture, which of the following test is collected first?
CBC
a patient has several short lengths of IV-type tubing protruding from his chest. This is most likely a
CVC
The concentration of this analyte is normally lower in capillary specimens than in venous specimens
Calcium
A plasma specimen for this type of test cannot be collected by capillary puncture
Coagulation studies
A member of the clergy is with the patient when you arrive to collect a routine specimen. What should you do?
Come back after the clergy person has gone
An inpatient is eating breakfast when you arrive to collect a fasting glucose. What is the best thing to do?
Consult with the patients nurse to see if the specimen should be collected
Which type of patient is most likely to have an arteriovenous fistula or graft ?
Dialysis
Which of the following is a recommended site for finger puncture on adults
Distal segment of the middle finger
What is the best approach to use on a 8 year old child who needs to have blood drawn ?
Explain the draw in simple terms and & ask for the child's cooperation
Which of the following PKU collection techniques is incorrect
Fill circles from both sides
Which of the following equipment is needed for a malaria test
Glass slide
Blood collection tubes are labeled
Immediately after specimen is collected
Which of the following is the least hazardous area of an infant`s foot for capillary puncture?
Lateral plantar heel surface
What's the proper procedure when dealing with elderly patients?
Make certain to hold adequate pressure after the draw until bleeding stops
T8 NPO means...
Nothing by mouth
If a patient adamantly refuses to have blood drawn, you should:
Notify the patient's nurse or physician
The blood specimen for this test is placed in circles on special filter out paper?
PKU
which test cannot be collected by capillary puncture and taken to the laboratory for processing and testing
PTT
W10 an inherited metabolic disorder detected through newborn screening
Phenylketonuria
Where is the tourniquet applied when drawing a hand vein ?
Proximal to the wrist bone
The following test orders for different patients have been received at the same time. Which test would you collect first?
STAT glucose in the ER
After inserting a butterfly needle the phlebotomist must "seat" it meaning
Slightly thread it within the lumen of the vein
Criteria used to decide which needle gauge to used for venipuncture include
The size and condition of the vein
Specimen hemolysis can result from
Using a large volume tube with a 23 gauge needle
which of the following tests is affected the most if collected from a crying infant?
WBC count
Which of the following is a proper capillary puncture procedure?
Wipe away the very first drop of blood
pseudoanemia can be caused by
a change in position from standing to lying down
hoe can you tell that you are in a vein when you are using a syringe?
a flash of blood will appear in the hub of the syringe
Which of the following specimens would most likely be rejected for testing?
a hemolyzed potassium specimen
the unique number assigned to a specimen request is called the
accession number
which type of therapy can increase bilirubin levels?
acetaminophen pills
Capillary collection is the preferred method of blood collection in infants because -An infant can be injured by the restraining method used -Removing larger quantities of blood can lead to anemia -Venipuncture may damage veins and surrounding tissue -all of the above
all
A hematoma may result from - inadequate site pressure applied after a venipuncture - needle penetration through the back wall of the vein - using a needle that is too large for the size of the vein - all of the above
all of the above
Adult capillary puncture may be performed when -there are no accessible veins -the patient has thrombotic tendencies -veins must be saved for chemotherapy -all of the above
all of the above
Capillary puncture is typically performed on adults when ? A. No accessible veins can be located B. Patients have thrombotic tendencies C. Veins are saved for chemotherapy D. All of the above
all of the above
Do not use providone-iodine to clean skin puncture sites because it interferes with
all of the above
The tourniquet should be released:
all of the above
Which activity can contaminate a blood specimen and affect the testing performed on it? -cleaning the site with alcohol before drawing an ETOH specimen -collecting blood cultures before the povidone-iodine is totally dry -using povidone-iodine to clean the site prior to a finger puncture -all of the above
all of the above
Which of the following conditions disqualifies a site for capillary puncture? A. Cyanotic B. Edematous C. Swollen D. All of the above
all of the above
Which of the following is a clue that you have accidentally punctured an artery instead of a vein?
all of the above
Wipe away the first drop of blood during capillary puncture to -Minimize tissue fluid contamination -Reduce the chance of hemolysis -Remove any alcohol residue
all of the above
capillary puncture blood contains - arterial blood -interstitial fluids - venous blood -all of the above
all of the above
interventions to ease pain in collecting blood specimens from infants include -EMLA -oral sucrose -pacifiers - all of the above
all of the above
which of the following is requires requisition information? - ordering physicians name - patients first and last names - type of test to be performed - all of the above
all of the above
which of the following is the best way to handle a need phobic patient?
all of the above
which situation can homolyze a specimen?
all of the above
A patient's arm is in anatomical position. There appears to be a loop under the skin between the wrist and the elbow. You feel a buzzing sensation when you touch it. What you are most likely feeling is
an AV graft
skin changes in elderly patients can make it harder to
anchor veins
Capillary blood composition more closely resembles
arterial blood
when is the best time to release the tourniquet during venipuncture?
as soon as blood flows freely into the tube
when should additive tubes be mixed
as soon as they are removed from the holder
you are a phlebotomy student on rotation at an outpatient site. a patient who seems extremely apprehensive about having her blood drawn tells you that she is afraid of needles. what should you do?
ask an experienced phlebotomist to perform the draw for you
you have made two unsuccessful attempts while trying to collect an ASAP specimen on an inpatient the specimen cannot be collected by skin puncture what should you do next?
ask another phlebotomist to perform the draw for you
which type of test requisition has been shown to decrease laboratory errors?
barcoded
A patient has had a mastectomy on the left side and has an IV midway down the right arm. Where is the best place to perform a venipuncture?
below the IV on the right arm
in an infants heel the primary blood supply is located
between .36 and 1.6 mm deep
phototherapy is used to reduce levels of which substance
bilirubin
examples of timed tests include...
blood cultures, cardiac enzymes, and cortisol
Which of the following can result in a blood smear that is too long
blood drop is to large or to thin
capillary action is a term used to describe how
blood fills a microhemotocrit tube
T10 which of the following tests requires an arterialized specimen?
blood gases
how can you tell that you are in a vein when drawing blood with a butterfly?
blood usually appears in the tubing
It is necessary to control the depth of lancet insertion during heel puncture to avoid
bone injury
strong repetitive pressure such as squeezing or milking a site during capillary specimen collection
can hemolyze and contaminate specimens
Which activity is least likely to lead to failure to draw blood
choosing a vein that has patency
Which of the following specimen conditions wold lead you to suspect that the patient was not fasting when it was collected?
cloudy white serum
T9 Peak levels of which analyte typically occur around 08:00 hours?
cortisol
the time is 07:50 hours. you have received the following test requests on different patients. which test specimen should you collect first? - CBC ordered ASAP - cortisol ordered for 0800 - fasting glucose - postop hemoglopin
cortisol ordered for 08:00
Results of this test have a direct correlation with the patient's age
creatinine clearance
an AV fistula is most commonly used for
dialysis access
a patient complains of extreme pain when you insert the needle during a venipuncture attempt. the pain does not subside, but the patient does not feel any numbness or burning sensation. you know the needle is in the vein, what should you do
discontinue the draw and attempt collection at another site
A phlebotomist needs to collect a plasma specimen for a coagulation test. The patient has an IV in the left arm near the wrist an a hematoma in the antecubital area of the right arm. Which of the following is the best place to collect the specimen?
distal to the hematoma
you are in a process of identifying an inpatient the patients verbal confirmation of name and date of birth matches the requisition. but the medical record number is different. what should you do?
do not collect the specimen until the problem has been addressed and resolved
the following precautionary information was given to an outpatient after venipuncture. No other tests were scheduled. all the information was necessary EXCEPT
do not eat or drink for two hours after collection
there are two patients in a room. one of them has a latex allergy. you have a request to collect a blood specimen on the other one. how should you proceed?
do not take anything that contains latex into the room
you are performing a venipuncture on a difficult vein using a butterfly. you have an SST and a light blue top tube to collect. how do you proceed?
draw a clear tube. fill and mix the light blue top then fill and mix the SST
Which of the following is the most likely to affect test results?
edema
when the arm of the patient is swollen with excess fluids, the condition is called
edema
bending the arm up to apply pressure to the site after venipuncture has been shown to do all the following except...
enable the site to quickly stop bleeding after needle removal
you have a request to collect a stat specimen. a doctor is with the patient when you arrive. What should you do?
excuse yourself and politely ask the doctor if you can do the draw
Blood loss to a point where life cannot be sustained is called
exsanguination
which of the following statements describes proper venipuncture technique?
fill additive tubes until vacuum is exhausted
which of the following would be most likely to allow reflux to occur during venipuncture
filling the tube stopper end first
The concentration of this substance is higher in capillary blood than in venous blood?
glucose
which of these tests are most affected if the patient is not fasting?
glucose and tryglicerides
Underfilling this tube will most likely result in a hemolyzed specimen
gray top
an arm that is paralyzed
has no muscle function
most test result reference ranges are values for
healthy individuals
fluid in spaces between the cells is called
interstitial fluid
creatinine clearance is a measure of
kidney function
which of the following situations can result in hemoconcentration
leaving the tourniquet on over 1 minute
The best way to keep a vein from rolling is to
make certain to anchor it well
which of the following fingers is the best choice for capillary puncture
middle
what is the most critical error a phlebotomist can make?
misidentifying a patient specimen
if a venipuncture fails to draw blood and the phlebotomist senses a slight vibration of the needle
needle is against a valve
neonatal screening is the testing of
newborns for certain disorders
Medial plantar surface of the heel is located
on the big toe side of the bottom of the heel
a bariatric phlebotomy chair is designed for individuals who are
overweight
which type of disease is most likely to cause tremors?
parkinsons
The serum or plasma of a hemolyzed specimen would most likely look
pinkish to red
the best way to judge patency of a vein is to
press and release it several times to determine resilience
an infant bilirubin specimen is collected in an amber microtubule to
protect the specimen from light
capillary puncture supplies include all of the following except...
providone- iodine pad
If using a capillary puncture to collect the following microtubles from a patient, what would be collected first (color)
purple (hematology)
While you are in the middle of drawing a blood specimen, your patient starts to faint. The first thing you should do is
quickly release the tourniquet and remove the needle
which of the following venipuncture steps are in the following order?
remove needle, place gauze, activate safety device
the proper way to transfer blood from a syringe into an ETS tube is to
safely remove the needle and attach a transfer device to fill the tube
tiny red spots that appear on the patient's arm when the tourniquet is applied are a sign that the
site may bleed excesively
w9 the medical term for fainting is
sycope
which needle can be removed from the blood collection unit before disposal? -butterfly needle - ETS needle - syringe needle - none of the above
syringe needle
doing what before obtaining a blood specimen from a child is a bad idea?
telling the child it will not hurt
veins that feel hard and cord-like when palpated may be:
thrombosed
The primary purpose of warming a capillary puncture site is
to increase blood flow
Which of the following represents proper capillary specimen collection technique
touch the scoop to the blood drop, not the skin surface
You insert the needle in a patient's arm and properly engage the tube. No blood flows into the tube. You make subtle needle adjustments and there is still no blood flow. Which of the following is the best thing to do next?
try a new tube in case it is a vacuum problem
you are in the process of collecting a specimen by venipuncture. you hear a hissing sound, there is a spurt of blood into the tube, and the flow stops. what happened
tube vacuum escaped
correct newborn screening test collection or handling includes
using a large drop to entirely fill a collection circle
w8 which of the following venipuncture steps are in the correct order?
withdraw need, place gauze, activate safety device
a student asks the patient for permission to draw a blood specimen. which of the following answers implies that the student does not really have permission?
yes but i would rather not
