chpt 7-14

phlebotomy

D

Which is the best tube for collecting an ethanol specimen?
A) Ethylenediaminetetraacetate (EDTA)
B) Siliceous earth
C) Sodium citrate
D) Sodium fluoride

A

Which needle gauge has the largest lumen?
A) 18
B) 20
C) 21
D) 22

C

The tests performed in the following department are collected in a tube with a light blue stopper:
A) Chemistry
B) Hematology
C) Coagulation
D) Microbiology

B

A tube with a green stopper normally contains
A) EDTA
B) Heparin
C) Sodium citrate
D) Thrombin

C

What is the purpose of an antiglycolytic agent?
A) To enhance clotting
B) To inhibit electrolyte breakdown
C) To preserve glucose
D) To prevent clotting

B

The solution normally used to clean the site before routine venipuncture is
A) 5.25% sodium hypochlorite
B) 70% isopropyl alcohol
C) 70% methanol
D) Povidone-iodine

B

When disposable latex tourniquets become soiled with blood, it is best to
A) Autoclave them before reuse
B) Throw them away
C) Wash them in bleach
D) Wipe them with alcohol

C

What is the most important factor in choosing which gauge needle to use for venipuncture?
A) Age of the patient
B) Number of tubes to be collected
C) Size and condition of the patient's vein
D) Type of test being performed

C

Which additive is usually present in a tube with a lavender stopper?
A) Acid citrate dextrose
B) Citrate
C) EDTA
D) Heparin

A

Glass particles present in serum separator tubes
A) Accelerate coagulation
B) Deter clotting
C) Inhibit glycolysis
D) Prevent hemolysis

C

Heparin prevents blood from clotting by
A) Activating calcium
B) Binding calcium
C) Inhibiting thrombin
D) It does not prevent clotting

D

Which one of the following is not an antiseptic?
A) Benzalkonium chloride
B) Isopropanol
C) Povidone-iodine
D) Sodium hypochlorite

A

The slanted tip of the needle that enters the vein is called the
A) Bevel
B) Gauge
C) Hub
D) Lumen

B

Which government agency regulates the quality of gloves worn when performing phlebotomy procedures?
A) CDC/HICPAC
B) FDA
C) JCAHO
D) OSHA

True

True or False? EDTA is the most common source of carryover problems.
True
False

False

True or False? Citrate prevents clotting by inhibiting thrombin.
True
False

True

True or False? The 21-gauge multisample needle is considered the standard needle for routine venipuncture.
True
False

False

True or False? In a routine ETS venipuncture, the lavender tube should be drawn before the red tube.
True
False

True

True or False? In a routine ETS venipuncture, the red tube should be drawn before the green tube.
True
False

B

You have a request to draw a specimen on an inpatient by the name of John Doe. How do you proceed to identify (ID) your patient once you have identified yourself?
A) Ask the patient, "Are you Mr. John Doe?"
B) Look at his ID band and ask the patient to please state his name
C) Check the patient's ID band and say, "I see that you are John Doe"
D) If the ID band and requisition match, draw the specimen

C

The following tests have all been ordered at the same time on different inpatients. There is only one phlebotomist on duty. Which test would the phlebotomist collect first?
A) ASAP CBC in oncology
B) Routine Hgb in long-term care
C) STAT electrolytes in the ER
D) Timed blood culture in ICU

A

Which of the following should not be used to enhance the vein selection process?
A) Having the patient vigorously pump his or her fist
B) Lowering the arm
C) Palpating the antecubital area
D) Using a warm towel to increase blood flow

C

Before obtaining a blood specimen from a child, you must do all of the following except
A) Establish rapport with the child and parent
B) Greet the parent and child
C) Tell the child it won't hurt
D) Tell the child what to expect

A

You arrive to draw a "fasting specimen." The patient is just finishing a big breakfast. What do you do?
A) Check with the patient's nurse first; if the specimen is collected, write "nonfasting" on the laboratory slip
B) Collect the specimen anyway since breakfast was just eaten and not absorbed
C) Collect the specimen but write "nonfasting" on the laboratory slip
D) Refuse to collect the specimen and fill out an incident report slip

B

What may happen if you mix tubes too vigorously?
A) Hemoconcentration
B) Hemolysis
C) Lipemia
D) Vigorous mixing has no effect

C

Never leave a tourniquet on for more than
A) 30 seconds
B) 45 seconds
C) 1 minute
D) 3 minutes

D

How can you tell that you are in a vein when using a needle and a syringe?
A) The blood will pump into the syringe if you are in a vein
B) There is no way to tell
C) You cannot tell until you pull back on the plunger and see the blood
D) You should see blood appear in the hub of the needle

D

What is the most critical error a phlebotomist can make?
A) Collecting a timed specimen late
B) Failing to obtain a specimen from a patient
C) Giving a patient a hematoma
D) Misidentifying a patient specimen

C

The best way to collect specimens from a dorsal hand vein is
A) To use a butterfly and full-sized ETS tubes
B) To use a regular ETS system
C) To use a butterfly and small, pediatric ETS tubes
D) All of the options are correct

C

What would be the system of choice to identify laboratory specimens from an unconscious, unidentified woman in the emergency room?
A) Assign a name to the patient such as Jane Doe
B) Assign a number to the patient until admitted
C) Use a three-part identification band and labels
D) Wait to process specimens until the patient can be identified

B

The priority designation for a test request is based on all of the following classifications except
A) Diet restrictions to be followed
B) Location of the patient
C) Priority of collection according to patient condition
D) Specific timing of test collection

A

You arrive to draw a specimen from an inpatient. The patient's door is closed. What do you do?
A) Knock softly and open the door slowly, checking to see if it is all right to enter
B) Knock softly and wait for someone to come to the door
C) Leave to draw another patient and come back later
D) Open the door and proceed into the room

D

The patient asks if the specimen you are about to draw is for a diabetes test. How do you answer?
A) If the test is for glucose, say, "Yes, it is"
B) Say, "No," even if the test is for diabetes
C) Say that you don't know
D) Tell the patient that it's best to discuss the test with his or her physician

B

An unconscious patient does not have an ID band. The name and room number on the door agree with the requisition. What should you do?
A) Call your supervisor and ask what to do
B) Do not draw the blood until the nurse has applied an ID bracelet
C) Draw the blood and fill out an incident report form
D) Draw the blood and then ask the nurse to identify the patient

B

Which of the following is the job of a student phlebotomist?
A) Explaining why a test was ordered
B) Letting the patient know that you are a student phlebotomist
C) Telling a patient what can happen if he or she refuses to be drawn
D) Telling the patient what disease or condition he or she might have

D

What is the purpose of waiting 30 seconds for the alcohol to dry before needle insertion?
A) To allow the evaporation process to help destroy microbes
B) To avoid a stinging sensation
C) To prevent hemolysis of the specimen
D) All of the options are correct

False

True or False? You must draw blood from a 4-year-old child. You should restrain him immediately, tell him to be quiet, and say that the procedure will not hurt.
True
False

False

True or False? Once the tourniquet has been applied it should be removed within 2 minutes to avoid changes in blood chemistry.
True
False

True

True or False? Geriatric patients may need special consideration because they have mental and physical problems.
True
False

True

True or False? The regular ETS system is used most commonly because it is direct, efficient, and safe.
True
False

False

True or False? It is important to mix anticoagulant tubes immediately so that they will clot.
True
False

C

Which instance most closely resembles basal state? A patient who has
A) Been lying down for an hour
B) Just arrived for a fasting blood test
C) Just awakened at 0600 after fasting all night
D) Worked all night but did not eat at work

B

You must draw a protime specimen from a patient with IVs in both arms. Which of the following is the best thing to do? Draw the specimen
A) Above an IV
B) Below an IV
C) From an ankle vein
D) From an IV

D

It is not a good idea to collect a CBC specimen from a screaming infant because the
A) Platelets are more likely to clump
B) Specimen will be hemoconcentrated
C) Specimen will be more likely to hemolyze
D) White blood count may be falsely elevated

A

You have no choice but to draw a specimen from a site with a hematoma. Where should you obtain the specimen?
A) Distal to the hematoma
B) In the area of the hematoma
C) Proximal to the hematoma
D) None of the options is correct

A

Prolonged tourniquet application may cause a change in blood composition primarily because of
A) Hemoconcentration
B) Hemoglobin
C) Hemolysis
D) Homeostasis

B

Which of the following vascular access devices is inserted in the peripheral venous system for the purpose of blood collection and administration of medication?
A) Fistula
B) Heparin lock
C) Implanted port
D) PICC

B

A phlebotomist has attempted twice to draw a partial thromboplastin time (PTT) specimen from a patient with difficult veins. Both times the phlebotomist has been able to draw only a partial tube. What should the phlebotomist do?
A) Collect the specimen by skin puncture
B) Have another phlebotomist attempt to draw the specimen
C) Pour the two tubes together and mix well
D) Send the tube with the most blood to the laboratory with a note that it was a difficult draw

A

Why do pregnant patients have lower reference ranges for red blood cell counts?
A) Blood fluid increases in pregnancy, having a diluting effect on red blood cells
B) Constant nausea leads to hemoconcentration of red blood cells
C) Poor appetite leads to transient anemia
D) The growing fetus uses up the mother's iron reserves

D

Which of the following tests is most often a timed test?
A) Blood urea nitrogen
B) Complete blood count
C) Rapid plasma reagin
D) Therapeutic drug monitoring

C

Which instance may lead you to suspect that you have accidentally punctured an artery?
A) A hematoma starts to form instantly
B) The blood obtained is dark red
C) The blood pulses into the tube
D) There is no way to tell

B

If blood is drawn too quickly from a small vein, the vein will have a tendency to
A) Bruise
B) Collapse
C) Disintegrate
D) Roll

B

How long before obtaining blood for testing should drugs known to interfere with blood tests be discontinued?
A) 1 to 4 hours
B) 4 to 24 hours
C) 24 to 36 hours
D) 48 to 72 hours

B

A fistula is a(n):
A) Implanted port attached to an indwelling line
B) Permanent fusion of an artery and a vein
C) Special winged infusion set left in a patient's arm
D) Temporary fusion of an artery and a vein

D

When a test requires a fasting specimen, but the serum is \__________, it is a clue that the patient was not fasting.
A) Hemoconcentrated
B) Hemolyzed
C) Jaundiced
D) Lipemic

D

Tests influenced by diurnal variation are often ordered as \__________ tests, and it is important to collect them as close as possible to the time ordered.
A) Fasting
B) Postprandial
C) STAT
D) Timed

False

True or False? Peak levels of cortisol occur late in the afternoon.
True
False

True

True or False? A person who lives at Pike's Peak is more likely to have a higher RBC count than a person who lives in Florida.
True
False

True

True or False? A drug known to interfere with a urine test should be discontinued 48 to 72 hours prior to urine collection.
True
False

True

True or False? If the blood is filling the tube very slowly and a hematoma is beginning to form, the needle may not be deep enough.
True
False

False

If a patient is complaining of sharp radiating pain from the needle insertion site, the phlebotomist should hurry and finish the draw.
True
False

B

A blood smear made from an EDTA specimen should be made
A) Anytime after collection
B) Within 1 hour of collection
C) Within 4 hours of collection
D) Within 12 hours of collection

D

Why are capillary blood gases less desirable than arterial blood gases (ABGs)?
A) Skin puncture blood contains tissue fluid
B) Skin puncture blood is only partly arterial in composition
C) The blood is exposed to air during collection
D) All of the options are correct

C

What is the Clinical and Laboratory Standards Institute (CLSI) recommended maximum depth of heel puncture?
A) 1.0 mm
B) 1.4 mm
C) 2.0 mm
D) 2.4 mm

B

Why are EDTA specimens obtained before other specimens when collected by skin puncture?
A) Collection order does not matter
B) To minimize effects of platelet clumping
C) To minimize tissue fluid contamination
D) To reduce effects of hemolysis

A

Why should a laboratory report form indicate the fact that a specimen has been collected by skin puncture?
A) Because test results may vary depending on the method of collection
B) For liability insurance and billing purposes
C) So that subsequent specimens will be collected by skin puncture also
D) So that the patient's nurse can check the site for signs of infection

C

Which of the following is the safest area for infant heel puncture?
A) The area of the arch
B) The central area
C) The lateral plantar surface
D) The posterior curvature

C

A skin puncture should be done rather than a venipuncture in all of the following situations except
A) A child younger than 1 year of age
B) A patient with difficult veins
C) When a light blue stopper tube is needed
D) When a small volume of blood is adequate

B

The purpose of wiping away the first drop of blood during skin puncture is
A) To avoid bacterial contamination
B) To eliminate tissue fluid contamination
C) To minimize effects of hemolysis
D) To minimize effects of platelet aggregation

A

Skin puncture blood most closely resembles
A) Arterial blood
B) Intracellular fluid
C) Tissue fluid
D) Venous blood

C

What does the term "calcaneus" mean?
A) Bone infection
B) Calcium containing
C) Heel bone
D) Osteomyelitis

B

Skin puncture blood reference values (normals) are higher for
A) Calcium
B) Glucose
C) Phosphorus
D) Total protein

C

Which microcollection container would be used to collect a specimen for a CBC?
A) Gray
B) Green
C) Lavender
D) Red

B

What is PKU?
A) A contagious condition caused by lack of phenylalanine
B) A hereditary inability to metabolize phenylalanine
C) An acquired condition caused by lack of phenylalanine
D) An inherited condition caused by lack of thyroid hormone

B

It is necessary to control depth of lancet insertion during skin puncture to avoid
A) Bacterial contamination
B) Bone injury
C) Excessive bleeding
D) Puncturing an artery

B

What is the purpose of warming the site before skin puncture?
A) It comforts the patient
B) It increases blood flow up to seven times
C) It makes the veins more visible
D) It prevents hemolysis of the sample

False

True or False? A microhematocrit tube is primarily used for manual potassium determinations.
True
False

False

True or False? If a patient has cold hands, you should puncture the pinky (or little 5th finger).
True
False

True

True or False? A phlebotomist should puncture a finger perpendicular to the fingerprint whorls.
True
False

True

True or False? A magnet and "flea" are used to mix a CBG.
True
False

False

True or False? A baby has a huge, fleshy big toe. You should collect a bilirubin specimen from it.
True
False

D

Of the following tests, which is most likely to result in fatal consequences for the patient if the specimen is misidentified?
A) Blood cultures
B) Drug screen
C) Postprandial glucose
D) Type and crossmatch

A

Which test requires strict skin antisepsis procedures before specimen collection?
A) Blood culture
B) Blood urea nitrogen
C) Complete blood count
D) Type and crossmatch

D

A bleeding time (BT) test assesses the functioning of
A) Erythrocytes
B) Leukocytes
C) Neutrophils
D) Thrombocytes

D

What type of additive is recommended for collecting an ethanol test specimen?
A) EDTA
B) No additive
C) Sodium citrate
D) Sodium fluoride

C

When performing a GTT, the timing should begin
A) When the patient arrives
B) When the fasting specimen is drawn
C) When the patient finishes the glucose drink
D) One-half hour after the drink is finished

A

Which test is used to monitor heparin therapy?
A) ACT
B) BT
C) PT
D) TnT

C

At what intervals is the blood blotted during a bleeding time test?
A) 15 seconds
B) 20 seconds
C) 30 seconds
D) 45 seconds

A

Which of the following test specimens is collected from patients with fever of unknown origin (FUO) to rule out septicemia?
A) Blood culture
B) Nasopharyngeal cultures
C) Urine culture and sensitivity (C & S)
D) Wound culture

D

Which of the following should be avoided during a glucose tolerance test (GTT)?
A) Chewing sugarless gum
B) Drinking sugar-free tea
C) Smoking low-tar cigarettes
D) All of the answers are correct

B

When collecting a blood culture specimen directly from a butterfly into blood culture bottles, which should be filled first?
A) Either, it does not matter
B) Aerobic
C) Anaerobic
D) A discard tube should be drawn first

C

Which of the following tests may require special "chain of custody" documentation when collected?
A) Blood culture
B) Crossmatch
C) Drug screen
D) TDM

C

Identify the condition in which a unit of blood is withdrawn from a patient as treatment.
A) ABO Rh incompatibility
B) Autologous donation
C) Hemochromatosis
D) Leukemia

B

Which of the following tubes can be used to collect blood for a type and crossmatch?
A) Gray top
B) Nonadditive red top
C) Royal blue top
D) Serum separator tube

B

An autologous blood transfusion is a transfusion of blood
A) Directly from the donor to the patient
B) Donated by a patient for his or her own use
C) Donated by a relative
D) From an anonymous donor

B

The most critical aspect of blood culture collection is
A) Needle gauge
B) Skin antisepsis
C) Specimen handling
D) Volume of blood collected

C

This test requires a specimen with a 9:1 ratio of blood to anticoagulant.
A) Ethanol
B) Glycohemoglobin
C) Prothrombin time
D) Zinc

C

The hormone detected in positive urine pregnancy tests is
A) ACTH
B) GH
C) HCG
D) TSH

D

Tests that can be performed using special POCT instruments or test kits include
A) Arterial blood gases
B) Glucose
C) Occult blood
D) All of the answers are correct

A

TDM is used by physicians to
A) Determine a beneficial drug dosage for a patient
B) Maintain "peak" levels of a drug in a patient's system
C) Maintain "trough" levels of a drug in a patient's system
D) Screen for illegal drug use