PHELBOTOMY

adhesive tape

(Regular tapes )tape used to secure bandages and dressings; available in rolls and in a variety of widths

Polycythemia

(an abnormal proliferation of blood cells) is a hereditary condition.

The physician has ordered a prothrombin time (PT) and complete blood count (CBC) for an adult patient with a diagnosis of thrombophlebitis. The medical assistant should collect the evacuated tubes in which of the following orders?

- blue - lavender

When performing a fingerstick on a patient, the phlebotomist must pay close attention to the extremity that has been compromised by

- circulation - swelling - infection.

A phlebotomist is staffing the outpatient clinic at a remote site. There is a centrifuge at the site, but it is not functional. The courier will be arriving to pick-up all samples collected at 1300, and will deliver to the testing laboratory at 1500. A patient arrives at 1200 with orders for Complete Blood Count, Prothrombin Time, and Basic Metabolic Panel. Which tubes should the phlebotomist use for blood collection?

1- Lavender 2- Blue 3- Green 4-Gray

The patient was sent to the lab to have CBC (lavender), PT/PTT (light blue), CMP (green), and glucose (grey). Place the evacuated tubes in the correct order of draw.

1- light blue 2- green 3- lavender 4- gray

Blood thinners

1. Anticoagulants: work on chemical reactions in your body to lengthen the time it takes to form a blood clot 2. Antiplatelet therapy: prevent blood cells called platelets from clumping together to form a clot

The medical assistant has an order to collect a CBC with diff, PT, a basic metabolic panel (BMP), and blood cultures. Place the collection tubes in the correct order of draw.

1. blood culture bottles 2. light blue 3. red 4. lavender

Place the following steps in the correct sequence when preparing to perform a venipuncture

1. identify the patient and explain the procedure 2. wash hands and put on gloves 3. apply a tourniquet, palpate the antecubital space of the arm 4.locate an acceptable vein

The appropriate needle gauge to use for most venipuncture collections is

21. (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)

After selecting the appropriate location to collect a blood sample, how many inches above that location should the phlebotomist fasten the tourniquet?

3 to 4 inches

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?

8-12 hours (To ensure accuracy of the blood test results, the patient must remain NPO for 8-12 hours prior to the test.)

Which patient description is correctly matched with the appropriate site selection?

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)

enzyme

A type of protein that speeds up a chemical reaction in a living thing. (catalyst)

Which of the following actions should the medical assistant take to make a vein more prominent when attempting to select a venipuncture site?

Apply a warm compress to the area for 5 minutes. (should apply a warm compress to the area for 5 minutes. Warm moist heat promotes circulation and vasodilation and will help make the vein more visible.)

An infant is brought to the clinic for a CBC. After performing a heelstick, not enough blood is collected to perform the test. Which of the following actions should the medical assistant take?

Apply a warm compress. (heat from a warm compress will encourage capillary vasodilation resulting in increased blood flow. Warming helps make blood collection easier and faster.)

Which of the following is the proper way to identify a patient prior to performing a venipuncture?

Ask the patient to state his/her full name and DOB and compare to the chart.

Which of the following actions by the medical assistant demonstrates safe use of a centrifuge?

Balance the tube load to prevent breakage. (It is important to properly balance a centrifuge, equally distributing the samples)

What is the laboratory abbreviation for calcium?

Ca

vascular access devices

Catheters, cannulas, or infusion ports designed for long-term, repeated access to the vascular system.

Prior to any type of inpatient specimen collection, a phlebotomist must correctly verify their patient's identity by using which two-step procedure?

Check ID bracelet, and ask patient to verbally confirm their identity.

The phlebotomist needs to draw routine labs. The skin preparation for this procedure would be.

Cleanse the site by using a circular motion from center to periphery (Phlebotomists cleanse the selected venipuncture site before routine lab draws.)

CLSI

Clinical Laboratory Standards Institute; an organization that sets standards for laboratories

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?

Do not bandage the site. (if the child has shown evidence of wanting to touch everything in sight, you 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)

Patient has a DVT in left arm and the patient is also on blood thinners, where would be the best site for drawing blood?

Draw right arm and hold for 5 minutes

Identify the CLSI recommended micro-collection order of draw for a BMP, CBC & Bilirubin.

EDTA, Heparin, Serum Separator

When performing a CBC on a six year old, the parent insists upon using an anesthetic at the venipuncture site. Which would be correct?

EMLA (is the topical anesthetic of choice for pediatric venipuncture.)

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?

ESR (Erythrocyte Sedimentation Rate ) - 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 special precautions are needed for patients with Vascular Access Devices, which of the following devices are contraindicated for any type of blood draws?

Fistula (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.)

Which of the following actions should the medical assistant take to prevent hemolysis of a blood specimen in an EDTA tube?

Gently invert the tube after collecting the specimen.

Which of the following tests is drawn in an EDTA tube for the hematology department of the laboratory?

HGB (Hemoglobin, typically measured as part of a Complete Blood Count and collected in an evacuated tube containing Ethylenediaminetetraacetic acid (EDTA)

A patient's past history indicates episodes of syncope. Which of the following would be the best course of action the phlebotomist would perform to prevent complications of syncope?

Have the patient lie down on a hospital bed or exam table.

Which of the following characteristics applies to veins

Have valves to prevent backflow of blood (Veins have valves which maintain the unidirectional flow of blood, even against gravity.)

The physician orders a hemoglobin level to be checked on a 2-month-old patient. Which of the following sites should the medical assistant use to obtain the specimen?

Heel of the Foot (The heel of the foot is the recommended site to obtain a capillary sample on infants less than one year.)

While performing a venipuncture, the medical assistant removes the filled tubes, but forgets to remove the tourniquet prior to needle withdrawal. Which of the following is the most likely result?

Hematoma (is a large painful bruise at the puncture site, caused or created by blood seeping into the surrounding tissues, one of the causes is the delay in tourniquet release and pulling the vacuum tube out.)

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?

Hemoconcentration (loss of plasma in relation to number of red blood cells. Prolonged tourniquet use impedes circulation and will cause this to happen)

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?

Hold direct pressure until bleeding stops, apply a bandage, and notify nurse.

During a venipuncture the patient has excessive bleeding and then states she forgot to mention her anticoagulant (Coumadin) therapy. Which of the following should the medical assistant do?

Hold pressure on the site for a minimum of 5 full minutes until bleeding stops.

Which of the following Vacutainer tubes is routinely used for hematology testing?

Lavender-topped (most common hematology test is a complete blood count (a.k.a. CBC- collected in a lavender topped tube)

A physician asked you to draw a INR on Mr. Jones which tube and additive would you choose

Light Blue, Sodium Citrate

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?

Light blue, red, lavender

Antecubital veins (Median vein)

Major superficial veins in antecubital fossa

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?

Marbled red and grey (they contain silica particles enhance the clot formation of whole blood)

Which of the following tests is required in all 50 states to screen newborns for metabolic disease?

PKU (Phenylketonuria)

Which of the following tests monitor anticoagulation therapy?

PT and PTT

Name the two most used patient identifiers.

Patient's name/date of birth

PKU

Phenylketonuria (is collected on a Guthrie blot card and is only for newborn screening)

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?

Relax the needle's angle slightly, and insert new tube

When performing a venipuncture, sudden swelling is observed at the insertion site. Which of the following actions should the medical assistant take?

Release the tourniquet, remove the needle, and immediately apply pressure at the site.

During a blood draw, a patient begins complaining of discomfort and tingling, at which time the phlebotomist notices bruising and discoloration at the site. How should the phlebotomist proceed?

Release the tourniquet, withdraw the needle, and apply pressure.

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?

Remove the tourniquet, wash hands, change to non-latex gloves and use a new tourniquet.

Using the guidelines for any method of venipuncture, which of the following actions should the medical assistant perform directly after confirming patient identity?

Review the requirements for collecting and handling the blood specimen as ordered by the physician

Which of the listed tubes can contain ethylenediamine tetraacetic acid?

Royal blue (blood Collection tubes may be purchased with EDTA, sodium heparin, or no additive at all.)

The phlebotomist is drawing plain red, lavender, and blue top tubes. Upon completion of the blood draw, the phlebotomist noticed that an order that requires a SST has been missed. What would be the next action?

Share the plain red top specimen for the SST test.

The medical assistant is collecting four tubes of blood on a patient who begins wheezing. She asks the patient if he is okay, he states that he has asthma. The medical assistant is in the process of switching to the fourth tube when the patient faints in the phlebotomy chair. Which of the following steps should the medical assistant take?

Stop the collection, apply pressure to site, call for help, and assist the patient.

A medical assistant has active symptoms of the common cold. Under which of the following conditions may he perform venipuncture?

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. BUT, it is important for medical personnel to use good judgment and not transmit diseases to their patients)

When performing a skin puncture on an infant what is the preferred site?

The plantar surface of the heel

After centrifuging a blood specimen, the medical assistant notes the serum has a reddish appearance. Which of the following has occurred?

The specimen is hemolyzed. (Normal serum should be amber-colored. If it's reddish in appearance, the specimen is hemolyzed)

Which of the following statements best describes the reason antecubital veins are most desirable to use when performing venipuncture?

The tissue surrounding these veins is less sensitive, making the procedure less painful.

When a complete metabolic profile (CMP) and complete blood count (CBC) are ordered at the same time, why should the CMP be drawn first?

Tubes without additives should be drawn before tubes with additives. (blood specimen will naturally clot (yielding a serum component) when collected in a tube without an additive to anticoagulate it and keep it whole blood (which has a plasma component).

A phlebotomist is asked to collect a CBC, PT and Chem 7 on a patient that requires a hand stick with a butterfly needle into evacuated tubes. The correct order of draw for this collection would be

Two Light Blue Top Tubes, Green Top Tube, Lavender Top Tube

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?

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.)

After a patient's skin is punctured to obtain a blood glucose level, what should be the phlebotomist's next step?

Use a sterile gauze pad to remove the first drop.

syringe

a medical instrument used to inject or withdraw fluids

Filling evacuated tubes to the indicated level results in the correct ratio of

additive to blood

When performing a venipuncture on an infant, the amount of blood taken from the infant should be monitored to avoid

anemia (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)

Which of the following types of additives is present in an EDTA tube?

anticoagulant (EDTA tube contains the anticoagulant sodium ethylenediamine tetra-acetic acid, which prevents clotting.)

EDTA is an

anticoagulant.

To help prevent a hematoma at the site after drawing blood, which of the following actions does the medical assistant take?

apply direct pressure with cotton gauze

PT/PTT

are coagulation tests (collected in blue top tubes)

Capillary blood specimens are typically collected on patients that

are extremely obese.

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

ask a nurse to collect the specimen. (PICC line draws are outside an entry level MA's scope of practice)

At what time should a test tube be labeled with the patient's identification?

before leaving the patient's room, after drawing the blood

Which of the following specimens is most susceptible to cross contamination and should always be drawn first?

blood culture

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?

blood pressure cuff

While performing a venipuncture in the antecubital space, the patient verbalizes an extreme amount of pain and the blood in the collection tube is noted to be bright red. Which of the following sites is most likely to have been inadvertently punctured?

brachial artery (brachial artery is most likely punctured, because it is a large artery and the bright red bleeding and fast, pulsating movement indicates arterial blood flow and not venous.)

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?

capillary using heel puncture lancet (PKU is a neonatal screening test collected on a blot card.)

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?

chain-of-custody (formed used to maintain a legal record of individuals who have had physical possession of the specimen. It prevents the possiblity of tampering)

During processing, the centrifuge rotor lid should be kept

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)

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)?

coagulation (is a term that describes how blood clots (changes from a liquid to a clump or solid)

While performing a venipuncture using an evacuated tube, a small amount of blood enters the tube and then stops. Which of the following conditions is likely to lead to this?

collapsing vein (When blood ceases to flow during the venipuncture process, the likely culprit is a collapsing vein. The walls of the vein lose tension, stopping blood flow)

A medical assistant needs to draw a bilirubin on a jaundiced infant. The medical assistant should

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). - specimen forbilirubin testing are collected in an amber tube which will protect it from light (a regular tube wrapped in aluminum foil could also be acceptable)

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?

confirm hemostasis and apply paper tape

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

create a hematoma (can cause bruise)

When collecting specimens for alanine aminotransferase (ALT) or aspartate aminotransferase (AST), avoid gray-topped sodium fluoride tubes because the anticoagulant

destroys many enzymes.

Venipuncture on the foot is performed in which of the following locations?

dorsal pedis

Which of the following arteries provides direct blood flow to the foot?

dorsalis pedis (dorsalis pedis artery is located on the upper surface (dorsal region) of the foot, and provides direct blood flow to the foot.)

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?

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.)

Syncope

fainting

DVT (deep vein thrombosis)

formation of a blood clot in a deep vein of the body, occuring most commonly in the legs or thighs

Which of the following additives protects serum from interacting with red blood cells after a specimen has been centrifuged?

gel separators (Gel separators create a barrier between the serum and formed elements of the blood.)

A test tube with which of the following colored stoppers has a glycolytic inhibitor?

gray top (blood collection tube contains powdered sodium fluoride and/or potassium oxalate, which will inhibit glycolysis. Glycolysis involves the breakdown of sugar to produce energy.)

Which of the following evacuated tubes should the medical assistant select for collection of electrolytes?

green-top (green top tube contains heparin. Green tops are used for collection of heparinized plasma or whole blood for special tests.)

Coumadin (Anticoagulation)

have thin blood - hold 5 min until bleeding stops

The medical assistant is instructed to perform a capillary stick for newborn screening. Which of the following collection devices should the medical assistant use?

heel stick lancet (heel stick lancet (e.g., Tenderfoot) is required for infants.)

Forceful shaking of blood in an evacuated collection tube will cause which of the following complications?

hemolysis (is the breakdown/damage of blood cells and could end in an unusable specimen and costly re-draw for the patient)

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

hold pressure on the draw site until bleeding has stopped.

non-adhering bandage

ideal for open wounds that have light to moderate exudate.

Which of the following should be avoided as a form of patient identification?

insurance number

Von Willebrand disease

is an inherited condition that can cause extended or excessive bleeding

Sulfosalicylic acid

is used in urine testing to precipitate proteins.

Which of the following tubes should the medical assistant select in collecting a blood sample for a Complete Blood Count (CBC)

lavender top, ethylenediaminetetraacetic acid additive

The physician orders a prothrombin time. Which of the following tubes should be used to collect the specimen?

light blue (light blue top tube contains sodium citrate to prevent blood from clotting.)

A patient is at the lab for their weekly PT/INR. Which of the following tubes should the medical assistant collect for this test?

light blue top

Which of the following evacuated tubes should the medical assistant draw first?

light blue top (blood culture)

Neonatal jaundice (hyperbilirubinemia)

liver condition that causes yellowing of a newborn baby's skin and eyes.

Centrifuge

machine that separates substances by whirling them

The phlebotomist should send a specimen collected in a yellow stopper tube with SPS additive to which of the following laboratory departments?

microbiology (Blood Culture has SPS)

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?

microtainer tube

Which of the following items is more commonly found on a phlebotomy tray?

multi-sample needle (the choices provided, only the multi-sample needle would be commonly found on a phlebotomy tray)

For which of the following patients is the use of an adhesive bandage contraindicated?

newborn with hyperbilirubinemia

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?

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)

Which of the following steps is completed first in performing venipuncture?

patient

Capillary blood specimen collections are contraindicated in patients with

peripheral edema. (Patients with peripheral edema have a great deal of fluid in their tissue/swelling)

PICC

peripherally inserted central catheter - is a long, thin tube that's inserted through a vein in your arm and passed through to the larger veins near your heart.

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?

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.)

Which of the following sites should the medical assistant use for newborn screening blood collection?

plantar surface of the heel (heel stick should be performed on the lateral or medial portions of the plantar surface of the heel-skin surface (left and right)

venipuncture

puncture of the vein with a needle

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?

put on gown

While performing a venipuncture, immediately before removing the needle, the medical assistant should

release the tourniquet.

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?

remove the tourniquet

When performing venipuncture on a patient with a left mastectomy, which site should the medical assistant use?

right antecubital fossa

A centrifuge functions in which of the following ways?

rotates to separate components of a patient's blood

Which of the following is a likely complication from repeated phlebotomy procedures in the same area?

sclerosed veins (Repeated punctures in a vein would cause hardening of the vessel tissue, known as sclerosis.)

Which of the following is the additive in the light blue top tube?

sodium citrate

hematology

study of blood

mastectomy

surgical removal of a breast

A syringe is preferred over a vacuum collection device when

the patient's veins are fragile. (A needle and syringe would be chosen over a vacuum collection device when a patient has fragile veins)

Blood cultures are always drawn first because?

to avoid contamination of the cultures.

Which of the following actions is appropriate for the medical assistant to take if an evacuated tube does not even begin to fill during a specimen draw?

try another evacuated tube prior to withdrawing from the vein

When inserting a needle during venipuncture, the bevel should be in which of the following positions in relation to the vein?

up

saphenous vein

vein that carries blood from the leg to the groin

In which of the following time frames should a tourniquet be routinely released on a patient while performing a blood draw?

within one minute (standard time limit for having a tourniquet on a patient is one minute.)