Deck 4: Preexamination Variables and Venipuncture Complications

Question 1

When an evacuated tube is pushed onto the needle,blood begins to flow and then stops.This could be caused by which of the following?

A) An occluded vein
B) Collapsing of the vein
C) The bevel of the needle resting on the vein wall
D) All of the above

Answer 1

D

Question 2

Samples are rejected by the laboratory for which of the following reasons?

A) Clots in a lavender stopper tube
B) Collection in the wrong tube
C) Incompletely filled light-blue stopper tubes
D) All of the above

Answer 2

D

Question 3

Samples for test substances that exhibit diurnal variation must be collected:

A) at specific times.
B) from fasting patients.
C) when patients are lying down.
D) when patients are in a basal state.

Answer 3

A

Question 4

A patient who presents with petechiae prior to tourniquet application may require:

A) additional reassurance.
B) use of a blood pressure cuff.
C) blood to be drawn from a hand vein.
D) additional pressure following needle removal.

Question 5

A sample collected from a patient who has recently eaten may appear:

A) hemolyzed.
B) watery.
C) lipemic.
D) icteric.

Question 6

Using a 20-gauge needle and a 10-mL evacuated tube on a small vein may cause:

A) sample hemolysis.
B) a hematoma.
C) a collapsed vein.
D) loss of tube vacuum.

Question 7

Recent strenuous exercise may affect the results of tests for:

A) lactate dehydrogenase and creatine kinase.
B) bilirubin and alanine transaminase.
C) glucose and blood urea nitrogen.
D) amylase and uric acid.

Question 8

Hematomas can be caused by which of the following?

A) Having the patient bend the elbow
B) Inserting the needle partially into the vein
C) Removing the tourniquet after removing the needle
D) All of the above

Question 9

Which of the following samples would be rejected?

A) Unlabeled sample
B) Sample without a requisition form
C) Half-full light-blue stopper tube
D) All of the above

Question 10

If the plunger of a syringe is pulled back too fast:

A) the patient feels a stinging sensation.
B) the sample may be hemolyzed.
C) the patient will develop a hematoma.
D) Both A and B

Question 11

Blood tests that are affected by the patient's posture are those that measure:

A) electrolytes.
B) large molecules.
C) glucose.
D) small molecules.

Question 12

Failure to remove the tourniquet before removing the needle:

A) may cause hemolysis.
B) is uncomfortable for the patient.
C) may produce a hematoma.
D) affects sample coagulation.

Question 13

Older patients are more prone to hematoma formation because:

A) they have smaller veins.
B) tourniquets must be tied tighter.
C) their veins have decreased elasticity.
D) they have difficulty making a fist.

Question 14

A patient who appears pale and has cold,damp skin may develop:

A) coagulation problems.
B) septicemia.
C) sclerosis.
D) syncope.

Question 15

Allowing blood to leak from a vein into the surrounding tissue will cause:

A) hematomas.
B) hemolysis.
C) nerve damage.
D) syncope.

Question 16

Using a small-gauge needle with a large evacuated tube can cause:

A) a hematoma.
B) petechiae.
C) hemolysis.
D) patient discomfort.

Question 17

A tourniquet is placed on the patient's arm,the vein is located,and the needle is inserted into the arm.No blood flows into the tube,but a dark bulge begins to appear at the puncture site.This describes:

A) hemolysis.
B) hemodialysis.
C) hemoconcentration.
D) hematoma.

Question 18

Patients are most likely to be in a basal state at:

A) 6 a.m.
B) 10 a.m.
C) 2 p.m.
D) 6 p.m.

Question 19

Collection of blood from a vigorously crying child may cause a falsely:

A) decreased white blood cell count.
B) increased glucose level.
C) increased white blood cell count.
D) decreased glucose level.

Question 20

If a patient begins to faint during the venipuncture,the blood collector should immediately:

A) lower the patient's head.
B) remove the tourniquet and needle.
C) summon a supervisor or nurse.
D) provide the patient with a sweet drink.

Question 21

Lipemic serum appears:

A) clear and pale yellow.
B) dark-yellow due to the presence of bilirubin.
C) clear and red.
D) cloudy due to the presence of fat.

Question 22

Forcing blood from a syringe into an evacuated tube may:

A) increase potassium values.
B) decrease glucose values.
C) produce lipemic serum.
D) contaminate a blood culture.

Question 23

Which of the following can cause sample contamination?

A) Blood collected from edematous areas
B) Blood collected through hematomas
C) Incorrect order of draw
D) All of the above

Question 24

If a supervisor tells the blood collector to collect a fasting sample from a nonfasting patient,the blood collector should:

A) record "nonfasting" on the requisition slip.
B) ask to speak to the physician.
C) tell the supervisor to collect the sample.
D) inform the patient that the results may be inaccurate.

Question 25

Hemolysis can be present in a sample even though the plasma does not appear pink.

Question 26

Methods to reassure pediatric patients may include which of the following?

A) Applying a local anesthetic
B) Encouraging them to ask questions
C) Having their parents present
D) All of the above

Question 27

Which of the following factors are associated with possible nerve injury when collecting a blood sample?

A) Inserting the needle greater than at a 30-degree angle
B) Laterally redirecting the needle when collecting blood from the basilic vein
C) Blind probing
D) All of the above

Question 28

What is the condition caused by blood accumulating in the tissues of the muscles causing muscle and nerve injury?

A) Compartment syndrome
B) Syncope
C) Hemolysis
D) Hematoma

Question 29

The best choice of equipment for venipuncture from a geriatric or pediatric patient with small fragile veins is a:

A) 23-gauge needle and a winged blood collection set with a syringe.
B) 23-gauge needle,a winged blood collection set,and evacuated tubes.
C) 21-gauge needle and a small syringe.
D) 25-gauge needle and an evacuated tube.

Question 30

A blood collector asks an outpatient whether she has had breakfast before obtaining blood for a fasting glucose.The patient responds "yes." What should the blood collector do?

A) Draw the sample immediately.
B) Reschedule the test in 12 hours.
C) Ask the patient to return 2 hours later.
D) Ask the health-care provider if the blood should be drawn.

Question 31

Extra care may have to be taken when positioning the arm of patients with:

A) Alzheimer disease.
B) arthritis.
C) paralysis.
D) Both B and C

Question 32

Performing venipunctures on pediatric patients may require which of the following?

A) Obtaining assistance from a parent to hold the arm
B) Obtaining identification from the parents
C) Using toys to demonstrate the procedure
D) All of the above

Question 33

Which of the following can cause hemolyzed samples?

A) Use of 25-gauge needles
B) Shaking a tube forcefully
C) Difficult venipunctures where blood enters the tube slowly
D) All of the above

Question 34

The best reason why the majority of patient samples are drawn in the early morning hours is because:

A) the patient will not be in the basal state early in the morning because this state requires several hours of normal physical activity by the patient.
B) patients should have consumed a meal no less than 3 hours prior to the time of collection.
C) the patient will be in the basal state,having restrained from strenuous exercise and having fasted for approximately 12 hours.
D) patients are generally more agreeable with collection times scheduled early in the morning.

Question 35

Serum appearing red suggests that:

A) the patient was not fasting.
B) the sample was exposed to light.
C) potassium values will be falsely elevated.
D) the patient is jaundiced.

Question 36

Geriatric patients are more prone to infection at the venipuncture site because their:

A) epidermal cells are replaced more slowly.
B) veins are closer to the surface.
C) immune systems are weakened.
D) Both A and C

Question 37

When performing a venipuncture,if blood does not immediately enter the tube,the needle should be withdrawn.

Question 38

The effects of a posture change in the patient,from a supine position to standing,can have a significant effect on some laboratory test results.Which of the following statements about these changes are true?

A) Patients should generally be lying down or sitting for 5 minutes prior to having blood samples collected.
B) The effects are most noticeable for lipid profiles.
C) The effects are greatest in patients with congestive heart failure and liver disease.
D) All of the above

Question 39

Tests that are most critically affected when a patient is not fasting at the time of collection include:

A) complete blood count,calcium,and magnesium.
B) glucose,cholesterol,triglycerides,or lipid profiles.
C) prothrombin time (PT) and partial thromboplastin time (PTT).
D) electrolytes and ionized magnesium.

Question 40

When locating a venipuncture site in a geriatric patient,which of the following techniques are acceptable?

A) Applying heat
B) Using a blood pressure cuff
C) Swabbing the area with alcohol
D) All of the above

Question 41

It is not necessary to allow the alcohol to dry before blood collection.

Question 42

Parents should not be allowed to hold a child in their laps while venipuncture is being performed.

Question 43

Ammonia inhalants are helpful for a patient who faints.

Question 44

Matching
Match the following variables with the possible effect on test results.
A.
Decreased glucose
B.
Decreased white blood cell (WBCs) and platelets
C.
Increased cholesterol and triglycerides
D.
Increased hemoglobin
E.
Increased PO₂ and white blood cells (WBCs)
F.
Increased prothrombin time (PT) and activated partial thromboplastin time (APTT)
Chemotherapy

Question 45

Matching
Match the following variables with the possible effect on test results.
A.
Decreased glucose
B.
Decreased white blood cell (WBCs) and platelets
C.
Increased cholesterol and triglycerides
D.
Increased hemoglobin
E.
Increased PO₂ and white blood cells (WBCs)
F.
Increased prothrombin time (PT) and activated partial thromboplastin time (APTT)
Stress

Question 46

Good listening skills are particularly necessary when collecting samples from geriatric patients.

Question 47

Matching
Match the following variables with the possible effect on test results.
A.
Decreased glucose
B.
Decreased white blood cell (WBCs) and platelets
C.
Increased cholesterol and triglycerides
D.
Increased hemoglobin
E.
Increased PO₂ and white blood cells (WBCs)
F.
Increased prothrombin time (PT) and activated partial thromboplastin time (APTT)
Prolonged fasting

Question 48

When working in pediatrics,a blood collector must gain the confidence of the patient and the parents.

Question 49

Matching
Match the following variables with the possible effect on test results.
A.
Decreased glucose
B.
Decreased white blood cell (WBCs) and platelets
C.
Increased cholesterol and triglycerides
D.
Increased hemoglobin
E.
Increased PO₂ and white blood cells (WBCs)
F.
Increased prothrombin time (PT) and activated partial thromboplastin time (APTT)
Herbal supplements

Question 50

Matching
Match the following variables with the possible effect on test results.
A.
Decreased glucose
B.
Decreased white blood cell (WBCs) and platelets
C.
Increased cholesterol and triglycerides
D.
Increased hemoglobin
E.
Increased PO₂ and white blood cells (WBCs)
F.
Increased prothrombin time (PT) and activated partial thromboplastin time (APTT)
Posture change from supine to erect

Question 51

Matching
Match the following variables with the possible effect on test results.
A.
Decreased glucose
B.
Decreased white blood cell (WBCs) and platelets
C.
Increased cholesterol and triglycerides
D.
Increased hemoglobin
E.
Increased PO₂ and white blood cells (WBCs)
F.
Increased prothrombin time (PT) and activated partial thromboplastin time (APTT)
Smoking