CALRegional Phlebotomy Midterm Review

Standard aid to control external bleeding

Applying direct pressure

Which process should be followed for the HBV Vaccine

A dose of vaccine, another one month later, and a final dose 6 months later

What is the purpose of protective isolation?

To protect susceptible patients from outside contamination

What is another name for the OSHA hazard communication standard (HCS)?

Right to know law

What is the first thing to do in the event of an accidental needlestick?

Decontaminate the site and report the incident to your immediate supervisor

Which is an example of a nosocomial infection?

A catheter site of a patient in the ICU becomes infected (nosocomial infections \= infections acquired while admitted to the hospital)

What is the proper order for putting on PPE?

Gown, mask, gloves (GMG)

When should the HBV vaccine be made available to employees with occupational exposure risk?

Within 10 days of initial working assignment

Which is an an example of transmission that differs from parenteral transmission?

Drinking water from a contaminated glass (parenteral transmission is a form of transmission that bypasses the GI tract)

In what instance might a patient be placed in protective isolation?

They have severe burns

Which is an example of a work practice control that reduces risk of exposure to BBP (blood born pathogens)?

Hand decontamination

What type of contact transmission involves transfer of microbes to mucous membranes of another person through a cough or sneeze?

Droplet

When can occupational exposure to BBP (blood born pathogens) occur while the healthcare worker is performing work duties?

Blood comes into contact with a cut

True or False: Employees can put on chapstick in the lab if they have chapped lips

False

The function of the left ventricle is to

deliver oxygenated blood to the aorta

The receiving chambers of the heart are the

atria

The relaxing phase of the cardiac cycle is called

Diastole (if you relax to much you die[astole])

Which of the following is the proper direction of blood flow?

Arterioles to capillaries to venules (in alphabetical order)

A blood clot circulating in the bloodstream is called a(n)

Embolus (becomes an embolism when it stops moving and blocks something)

Which blood cell has the ability to pass through the blood vessel walls?

Leukocytes (white blood cells)

How can you visually tell serum from plasma?

You cannot visually tell them apart

Hemostasis refers to

Stoppage of bleeding

Which of the following veins is not an antecubital vein?

Femoral (median, cephalic, and basilic are the antecubital veins, listed in preference to draw from)

Which test must be performed on whole blood?

CBC (complete blood count)

A major difference between arteries and veins is that most veins

Have one way valves

Which of the following is best to collect an ethanol sample?

Sodium Fluouride

Which needle gauge has the largest lumen?

18 (smaller number \= larger lumen and vice versa)

Specimens for these tests are usually collected in light blue top tubes

Coagulation

A tube with a green stopper usually contains

Heparin (an anticoagulant)

The purpose of an antiglycolytic agent is to

Preserve glucose (antiglycolytic agents are the additives in gray top tubes)

The solution normally used to clean the site before a routine venipuncture is

70% isopropanol

When a tourniquet becomes soiled with blood it is best to

Throw it away

What is the most important factor to consider when choosing which gauge needle to use for a venipuncture is

The size and condition of the vein (smaller needle/ larger gauge like 22 or 23 used for smaller more fragile veins)

Which additive is present in tubes with a lavender stopper?

EDTA

Glass particles in SSTs (serum separator tubes)

Enhance clotting (ensure more complete clotting but do not actually speed up clotting process)

The slanted top of the needle that enters the vein is called the

Bevel

According to CLSI standards, which tube is filled last when using a syringe?

EDTA (lavender top)

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

True

True or False: The 21 gauge multisample needle is considered the standard needle for routine venipuncture

True

True or False: In routine venipuncture using an ETS the red tube should be drawn before the green tube

True

There is a request to draw a specimen from an inpatient by the name of John Doe. Which of the following is an acceptable way to confirm the patient's identity?

Match the ID band and requisition form to the patient's statement of ID

The following tests have been ordered at the same time on different patients, which do you collect first?

STAT electrolytes in the ER (always collect STAT orders first)

Doing this during the vein selection process is bad for the specimen.

Allowing the patient to pump their fist

Communicating with a child this way is poor technique

Telling the child it won't hurt

The patient just finished a big breakfast before arriving for a fasting specimen draw. What should you do?

Check with the nurse to see if the specimen can still be collected (write nonfasting, okay to draw per nurse so and so on the requisition)

What happens if you mix a specimen too vigorously?

Hemolysis

Never leave a tourniquet on for more than

1 minute

How can you tell you are in the vein when using a needle and syringe?

You will normally see blood appear in the hub of the syringe

What is the most critical error a phlebotomist can make?

Misidentifying a patient specimen

What is the best way for a newly trained phlebotomist to handle a venipuncture on a patient with needle phobia?

Ask a more experienced phlebotomist to do the draw

What would be the system of choice to do specimen collection on an unidentified, unconscious patient?

A three part identification band and labels

A phlebotomist arrives to draw a specimen while the patient door is closed. They should

Knock softly, open it slowly, and ask for permission to enter

The patient asks if the draw you're doing is for diabetes. How should you answer?

Say it's best to talk about that with their doctor

Which of the following is the job a student phlebotomist?

Letting the patient know that you are a student phlebotomist

What is the purpose of waiting 30 seconds for the alcohol to dry before needle insertion?

All of the above (to avoid stinging sensation, prevent hemolysis, and to let evaporation destroy the microbes)

True or False: When drawing a four year old immediately restrain them, tell them to be quiet, and tell them it won't hurt

False

Which patient most closely resembles basal state?

A patient who has just awakened at 6 am after fasting all night (basal state \= rested state + fasting)

You must draw from a patient with an IV in both arms. Where should you draw from?

Below the IV

It is not a good idea to collect a CBC specimen from a screaming infant because

The white blood cell count may be falsely elevated

You need to draw from a site with a hematoma. Where should you draw?

Distal to the hematoma

Prolonged tourniquet application may cause a change in blood composition primarily because of

Hemoconcentration

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?

Have another phlebotomist attempt the draw

Level of this analyte can differ by 50% or more between the morning and late afternoon

Cortisol

Which instance may lead you to suspect that you have accidentally punctured an artery?

The blood pulses into the tube

If blood is drawn too quickly from a small vein, the vein will have a tendency to

Collapse

A fistula is

A permanent fusion of an artery and a vein

When a test required is a fasting specimen but the serum is \______, it is a clue that the patient was not fasting

Lipemic

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.

Timed

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

False (they peak in the morning around 8 am)

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 (insert a little bit further to try and fix, if hematoma continues to form terminate the draw)

True or False: If a patient is complaining of a sharp radiating pain, the phlebotomist should hurry and finish the draw

False (they should terminate the draw as they have likely irritated a nerve)

Why are capillary blood gasses less desirable than arterial blood gasses?

All of the above (tissue fluid contamination from skin prick, capillary draw blood is exposed to air, and the blood gas from capillaries is only partially arterial)

What is the CLSI recommended maximum depth of heel puncture?

2 mm

Why are EDTA specimens obtained before other specimens when collected by skin puncture?

To minimize the effects of platelet clumping

Why should a lab report form indicate the fact that a specimen has been collected by capillary puncture?

Because test results can very depending on the collection method

Which of the following is the safest area for infant heel puncture?

Lateral Plantar Surface

A capillary puncture should be performed rather than a venipuncture in all the following scenarios except when

A light blue top tube is needed (coagulation / light blue top tests cannot be done by skin puncture)

The purpose of wiping away the first drop of blood during skin puncture is to

Avoid tissue fluid contamination

Capillary puncture blood most closely resembles

Arterial blood

What does the term calcaneus mean?

Heel bone

Which microcollection container would be used to collect a specimen for a CBC?

Purple top (lavender)

It is necessary to control the depth of lancet insertion during capillary puncture to avoid

Injuring the heel bone

What is the purpose of warming the site before skin puncture?

To increase blood flow up to seven times

True or False: A phlebotomist should puncture the finer perpendicular to the fingerprint whorls

True

True or False: A magnet is used to mix capillary blood gas specimens

True

True or False: If a baby has a huge fleshy big toe it is okay to collect a bilirubin specimen from it

False

Which of the following tests is most likely to lead to fatal complications if the patient is misidentified?

Type and crossmatch

Which test requires strict skin antisepsis procedures before specimen collection?

Blood culture

Which additive is recommended for collecting an ethanol test specimen?

Sodium fluoride (gray top tube)

When performing a GTT (glucose tolerance test) the timing should begin

As soon as the patient finishes the drink

When collecting blood cultures directly from a butterfly setup, which should be filled first

Aerobic

Which of the following tests may require a special chain of custody documentation when it is collected?

Drug screen

Identify the condition in which a unit of blood is withdrawn from a patient as a treatment

Hemochromatosis

Which tube can be used to collect blood for a type and crossmatch?

Pink top EDTA tube

An autologous blood transfusion is a transfusion of blood

Donated by the patient for the patient

The most critical aspect of blood culture collection is

Skin antisepsis

This test requires a specimen with a 9:1 ratio of blood to anticoagulant

Prothrombin time (PT)

The hormone detected in a positive urine pregnancy test is

HCG

A 2 hour post prandial specimen should be drawn

2 hours after the patient finishes eating a meal

True or False: Paternity testing is used to determine the probability that a specific individual fathered a specific child

True