Deck 11: Special Blood Collection

Question 1

A patient who is not allowed to have food or water for a specified time is classified as:

A) fasting.
B) NPO.
C) preprandial.
D) basal.

Answer 1

B

Question 2

A phlebotomist who cannot locate the patient on whom a cortisol level is scheduled for collection at 1000 should:

A) return the requisition to the nursing station for rescheduling.
B) request the nursing station to call the laboratory when the patient is available.
C) collect the specimen 2 hours after the patient finishes lunch.
D) reschedule the test for 1600.

Answer 2

A

Question 3

A trough level is drawn:

A) 30 minutes after drug administration.
B) while the patient is fasting.
C) prior to administering medication.
D) immediately after administering medication.

Answer 3

C

Question 4

The test order with the highest priority is classified as:

A) fasting.
B) ASAP.
C) STAT.
D) postprandial.

Question 5

Blood cultures are performed to detect the presence of:

A) septicemia.
B) spiking fevers.
C) fever of unknown origin (FUO).
D) antibiotics.

Question 6

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 7

The number of specimens collected from a patient receiving a 2-hour postprandial glucose test is:

A) one.
B) two.
C) three.
D) four.

Question 8

The timing for a glucose tolerance test (GTT) begins:

A) after collection of the fasting sample.
B) when the patient begins drinking the glucose.
C) when the patient finishes drinking the glucose.
D) 30 minutes after the glucose is finished.

Question 9

The specimens collected during the glucose tolerance test (GTT) after the patient drinks the glucose will be analyzed at the end of the test. The specimens should be collected in:

A) gray stopper tubes.
B) serum separator tubes (SSTs).
C) plasma separator tubes (PSTs).
D) red stopper tubes.

Question 10

Collection of a cardiac risk profile from an outpatient at 1600 may result in:

A) increased triglycerides.
B) decreased aspartate aminotransferase (AST).
C) increased blood urea nitrogen (BUN).
D) decreased cholesterol.

Question 11

Plasma cortisol levels are scheduled to be drawn between 0800 and 1000 because:

A) patients must be in a basal state.
B) patients must not be fasting.
C) cortisol exhibits diurnal variation.
D) cortisol is only produced during the morning.

Question 12

Major phlebotomy rounds are scheduled early in the morning because

A) physicians make their rounds before 0800.
B) most medications must be administered before 0700.
C) patients will be in a basal state.
D) visitors are usually not present.

Question 13

A postprandial blood specimen should be collected:

A) after the patient has eaten.
B) in the delivery room.
C) after the patient has been fasting for 12 hours.
D) while the patient is in a basal state.

Question 14

Peak and trough levels are collected to monitor:

A) illegal drug use.
B) diurnal variation.
C) therapeutic drug levels.
D) basal metabolism.

Question 15

The term diurnal variation is associated with:

A) blood cultures.
B) fasting specimens.
C) forensic specimens.
D) timed collections.

Question 16

If a supervisor tells the phlebotomist to collect a fasting specimen from a nonfasting patient, the phlebotomist should:

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

Question 17

A glucose tolerance test is performed to diagnose or evaluate:

A) hypoglycemia.
B) diabetes insipidus.
C) diabetes mellitus.
D) both A and C

Question 18

To monitor changes in a patient's hemoglobin level, a phlebotomist may be requested to collect:

A) a fasting specimen.
B) specimens from both arms.
C) specimens at specific times.
D) a specimen as soon as possible.

Question 19

A phlebotomist who enters a patient's room to collect a fasting specimen and finds the patient eating breakfast should:

A) draw the specimen immediately.
B) reschedule the test in 12 hours.
C) return when the patient has finished breakfast.
D) notify the nursing station.

Question 20

All of the following should be included on a peak or trough level requisition form except:

A) time the medication was given.
B) method of medication administration.
C) time the specimen was drawn.
D) name of the person giving the medication.

Question 21

Specimens for all of the following should be protected from light except:

A) beta-carotene.
B) vitamin A.
C) gastrin.
D) bilirubin.

Question 22

Chain of custody refers to the:

A) method of infection control.
B) patient identification procedures.
C) documentation of specimen handling for legal specimens.
D) collection of specimens for employment physicals.

Question 23

A phlebotomist on the evening shift draws a specimen for cold agglutinins and places it in the refrigerator for the morning shift. Test results of this specimen will:

A) be falsely decreased.
B) be falsely increased.
C) be unaffected.
D) represent the patient's true condition.

Question 24

When blood is inoculated into blood culture bottles using a butterfly apparatus, the:

A) anaerobic bottle is inoculated first.
B) safety device is activated first.
C) aerobic bottle is inoculated first.
D) volume of blood inoculated is increased.

Question 25

A phlebotomist required to testify in a legal proceeding may be asked questions regarding all of the following except:

A) specimen collection method.
B) patient identification procedure.
C) time of collection.
D) method of chemical analysis.

Question 26

The purpose of sodium polyanetholsulfonate in a blood culture bottle is to:

A) inhibit bacterial growth.
B) prevent clotting.
C) prevent contamination.
D) identify bacterial growth.

Question 27

Specimens that require chilling immediately after collection are placed in a:

A) container of ice cubes.
B) container of ice and water.
C) bag of dry ice.
D) flask of cold water.

Question 28

Three blood cultures from a patient requiring ASAP administration of antibiotics are collected:

A) every 30 minutes.
B) before, during, and after the antibiotic is administered.
C) immediately from three different sites.
D) before, during, and after the fever spikes.

Question 29

Which of the following tests must be placed on ice immediately after collection?

A) Cold agglutinins
B) Lactic acid
C) Cholesterol
D) Antibody identification

Question 30

Specimens for cold agglutinins must be:

A) transported on ice.
B) drawn in a green stopper tube.
C) processed in a refrigerated centrifuge.
D) kept warm.

Question 31

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

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

Question 32

A falsely decreased blood alcohol level may be obtained if:

A) blood is collected in a gray stopper tube.
B) the site is cleansed with Zephiran chloride.
C) the tube is only partially filled.
D) the tube is overfilled.

Question 33

Some blood culture collection systems contain a resin to:

A) prevent clotting.
B) inactivate antibiotics.
C) concentrate the microorganism.
D) remove skin contaminates.

Question 34

The most important consideration when collecting a blood culture is:

A) aseptic technique.
B) the puncture site.
C) minimizing the number of sticks.
D) the amount of blood collected.

Question 35

A blood specimen for DNA analysis to determine paternity is considered a:

A) routine specimen.
B) timed specimen.
C) forensic specimen.
D) postprandial specimen.

Question 36

When locating a venipuncture site in a geriatric patient, all of the following techniques are acceptable except:

A) applying heat.
B) using a blood pressure cuff.
C) swabbing the area with alcohol or iodine.
D) tapping the antecubital area.

Question 37

After collection, blood cultures are delivered to:

A) blood bank.
B) hematology.
C) serology.
D) microbiology.

Question 38

The order in which cleansing solutions are applied to the patient's arm before and after the collection of a blood culture is:

A) soap, alcohol, and iodine.
B) alcohol, iodine, and alcohol.
C) iodine, alcohol, and soap.
D) alcohol, alcohol, and iodine.

Question 39

To inoculate blood culture media with blood drawn in a syringe, the phlebotomist:

A) vents an anaerobic container.
B) inoculates aerobic media first.
C) mixes syringe before inoculation.
D) inoculates anaerobic media first.

Question 40

The ideal time for collecting a blood culture is:

A) just before the patient's temperature spikes.
B) after antibiotics have been given.
C) when the patient's white blood cell (WBC) count is the highest.
D) when the patient's temperature is the highest.

Question 41

A postprandial glucose test requires the patient to fast for 3 hours.

Question 42

Select the response that lists the major steps of the 2-hour oral glucose tolerance test (OGTT) in the proper order.

A) Patient drinks a 75-g glucose solution within 5 minutes, a fasting glucose specimen is collected, and patient returns for an additional glucose test in 2 hours.
B) Patient drinks a 75-g glucose solution within 5 minutes, patient returns for an additional glucose test in 1 hour, and patient returns for an additional glucose test in 2 hours.
C) A fasting glucose specimen is collected, patient returns for an additional glucose test in 2 hours, and patient drinks a 75-g glucose solution within 5 minutes.
D) A fasting glucose specimen is collected, patient drinks a 75-g glucose solution within 5 minutes, and patient returns for an additional glucose test in 2 hours.

Question 43

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

Question 44

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

A) complete blood count (CBC), 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 45

It is best to address geriatric patients using their first names.

Question 46

All of the following statements regarding cold agglutinins testing are true except:

A) the specimen must be kept warm until it is processed because cold agglutinins act at cold temperatures.
B) cold agglutinins are autoantibodies produced by persons infected with Mycoplasma pneumoniae.
C) the specimen must be kept cold until it is processed because cold agglutinins act at cold temperatures.
D) cold agglutinins are autoantibodies produced by persons with an autoimmune hemolytic anemia.

Question 47

In what order should the phlebotomist collect these specimens?

Question 48

Blood cultures may be ordered on a stat basis because:

A) this makes collection of the samples more convenient for the phlebotomist.
B) the concentration of microorganisms fluctuates and is often highest at specific times of the day.
C) the stat sample will act as a control for the cultures drawn at scheduled times.
D) the concentration of microorganisms fluctuates and is often highest just before the patient's temperature spikes.

Question 49

Blood cultures should be mixed after collection.

Question 50

Methods to reassure pediatric patients may include all of the following except:

A) applying a local anesthetic.
B) encouraging them to ask questions.
C) showing them the needle.
D) having their parents present.

Question 51

Peak therapeutic drug monitoring (TDM) levels are collected 30 minutes after the medication is administered.

Question 52

Performing venipunctures on pediatric patients may require all of the following except:

A) assistance from a parent to hold the arm.
B) telling the child it will not hurt.
C) using toys to demonstrate the procedure.
D) obtaining identification from the parents.

Question 53

Parents should not be allowed to hold a child in their lap while venipuncture is being performed.
Short Answer
At 0900 a phlebotomist receives requisitions for a peak theophylline level at 1000, a stat complete blood count (CBC) in L & D, and a cortisol level.

Question 54

Iodine should be wiped off the tops of blood culture bottles using isopropyl alcohol.

Question 55

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 56

When performing a glucose tolerance test (GTT), the fasting blood specimen is tested before the patient drinks the glucose.

Question 57

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 butterfly with a syringe.
B) 23-gauge needle and a butterfly and evacuated tubes.
C) 21-gauge needle and a small syringe.
D) 25-gauge needle and an evacuated tube.

Question 58

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

Question 59

To ensure patient safety and medication effectiveness, the blood levels of many therapeutic drugs are monitored. The specimens that are typically drawn to do this are:

A) a trough level drawn before the next scheduled dose is given, and a peak level drawn after the dose is given.
B) a trough level drawn as a fasting specimen at 6:00 AM and a peak level drawn 2 hours later.
C) a peak level drawn before the next scheduled dose is given, and a trough level drawn after the dose is given.
D) a peak level drawn as a fasting specimen at 6:00 AM and a trough level drawn 2 hours later.

Question 60

When transferring blood from a syringe to a blood culture bottle, a new needle should be used.

Question 61

If a known skin contaminant grows in both aerobic bottles, what error in technique is indicated?

Question 62

Which specimen should be delivered immediately to the laboratory?

Question 63

Why is this collection schedule requested?
A phlebotomist is requested to collect two sets of blood cultures from a patient on a stat basis.

Question 64

If the cortisol level was not collected until 0100, how would the results be affected?

Question 65

If the phlebotomist collects both sets using a butterfly, and an anaerobic organism grows in one set and not the other, what error could have caused this?

Question 66

Where should the phlebotomist collect these specimens?