Deck 12: Dermal Puncture

Question 1

Collection of excess blood from a premature infant could cause:

A) hemorrhage.
B) venous thrombosis.
C) anemia.
D) gangrene.

Answer 1

C

Question 2

Collection of a complete blood count (CBC) by dermal puncture is most likely to be requested for a patient:

A) receiving chemotherapy.
B) with poor circulation.
C) with coronary artery disease.
D) receiving allergy injections.

Answer 2

A

Question 3

Blood collected by dermal puncture most closely resembles:

A) venous blood.
B) anticoagulated blood.
C) arterial blood.
D) clotted blood.

Answer 3

C

Question 4

All of the following are reasons why hemolysis is seen more frequently in specimens collected by dermal puncture than venipuncture except:

A) lancets make a wider incision.
B) newborns have high red blood cell counts.
C) excessive squeezing may have been used.
D) red blood cells of newborns are more fragile.

Question 5

A sharps container is not needed when performing dermal punctures using:

A) a laser lancet.
B) a permanent retractable blade.
C) fully automated puncture devices.
D) platform devices.

Question 6

The maximum safe length of lancets used for heel puncture is:

A) 1.5 mm.
B) 2.0 mm.
C) 2.75 mm.
D) 3.4 mm.

Question 7

Plastic beads are present in some microcollection tubes to facilitate:

A) clotting.
B) mixing.
C) serum and cell separation.
D) plasma and cell separation.

Question 8

The depth of a dermal puncture must be controlled to:

A) prevent hemolysis.
B) ensure adequate blood flow.
C) prevent contact with bone.
D) obtain a representative sample.

Question 9

The microspecimen collection container that would hold the largest volume of blood is a:

A) microhematocrit tube.
B) Natelson pipette.
C) microcollection tube.
D) Unopette.

Question 10

Dermal puncture is preferred over venipuncture in infants because:

A) superficial veins may not be large enough.
B) collection from deep veins is dangerous.
C) restraining the child can cause injury.
D) all of the above

Question 11

Using a lancet that produces a puncture deeper than recommended may cause:

A) septicemia.
B) hemolysis.
C) osteomyelitis.
D) specimen contamination.

Question 12

All of the following are acceptable skin puncture devices except:

A) Autolets.
B) surgical blades.
C) laser lancets.
D) Tenderfoots.

Question 13

Which of these complications is not associated with deep vein puncture in infants?

A) Danger to nearby organs
B) Collapsing of superficial veins
C) Reflex arteriospasm
D) Cardiac arrest

Question 14

Collection of a sufficient amount of blood by dermal puncture is most difficult from:

A) obese patients.
B) geriatric patients.
C) severely dehydrated patients.
D) patients performing home glucose monitoring.

Question 15

Which of the following is not used in microcollection?

A) Lancet
B) Autolet
C) Tourniquet
D) Microtainer

Question 16

Warming the site of a dermal puncture will:

A) increase the flow of venous blood to the site.
B) increase the flow of arterial blood to the site.
C) increase the possibility of hemolysis.
D) produce excess tissue fluid contamination.

Question 17

The major vascular area of the skin is located in the:

A) dermal layer.
B) cutaneous layer.
C) soft tissue.
D) dermal-subcutaneous juncture.

Question 18

A Unopette could be used to collect which of the following tests?

A) Glucose
B) Potassium
C) Hemoglobin
D) Sedimentation rate

Question 19

Natelson pipettes and microhematocrit tubes differ with respect to:

A) color coding.
B) ability to produce plasma.
C) size.
D) ability to produce serum.

Question 20

Alternating between venipuncture and dermal puncture collection techniques is not recommended when comparing test results for:

A) bilirubin.
B) hemoglobin.
C) reticulocytes.
D) glucose.

Question 21

Which of the following statements is wrong?

A) Phlebotomists perform extensive handwashing in the nursery.
B) Only necessary equipment is carried to a nursery patient.
C) Infants are identified by the bassinet label.
D) Isolation procedures are followed in the nursery.

Question 22

The calcaneus is located at the:

A) posterior of the heel.
B) arch of the foot.
C) plantar surface of the heel.
D) lateral curvature of the heel.

Question 23

Upon completion of a heel puncture on a 4-month-old infant, all of the following are acceptable except:

A) raising the heel and applying pressure.
B) placing capillary pipettes in a large tube for transport.
C) applying a bandage to the site.
D) thanking the parents for their cooperation.

Question 24

All of the following are acceptable dermal puncture sites except the:

A) big toe on a 6-month-old infant.
B) arch of the foot.
C) heel of an infant.
D) index finger of an adult.

Question 25

Which of the following pairings is incorrect?

A) Thumb and calluses
B) Index finger and increased nerve endings
C) Third finger and increased possibility of bone puncture
D) Fifth finger and decreased tissue mass

Question 26

When warming a dermal puncture site, the temperature should not exceed:

A) 32°C.
B) 42°C.
C) 52°C.
D) 62°C.

Question 27

Falsely elevated dermal puncture bilirubin results may be caused by:

A) contamination with tissue fluid.
B) collection under an ultraviolet light.
C) collection from an agitated patient.
D) cleansing the site with iodine.

Question 28

The heel of an infant with ecchymoses will appear:

A) jaundiced.
B) bruised.
C) edematous.
D) cyanotic.

Question 29

To produce a rounded drop of blood, finger punctures should be made:

A) on the index finger.
B) on the fingerprint.
C) before the alcohol is dry.
D) across the fingerprint.

Question 30

What is the most acceptable puncture site for a 6-month-old infant?

A) Heel
B) Antecubital vein
C) Middle finger
D) All of the above

Question 31

The presence of air bubbles will most seriously affect a:

A) bilirubin collected in a Caraway pipette.
B) complete blood count (CBC) collected in a microcollection tube.
C) hematocrit collected in a microtube.
D) platelet count collected in a Unopette.

Question 32

Failure to puncture across the fingerprint during a finger puncture will cause:

A) blood to run down the finger.
B) hemolysis.
C) contamination of the specimen.
D) additional patient discomfort.

Question 33

Vigorous massaging of the area during dermal puncture will result in:

A) decreased blood flow to the site.
B) a hematoma.
C) specimen contamination by tissue fluid.
D) increased glucose results.

Question 34

During dermal puncture, the first drop of blood is wiped away because it may be:

A) diluted with tissue fluid.
B) already clotted.
C) too concentrated because blood has not been flowing.
D) contaminated with skin bacteria.

Question 35

Following a dermal puncture, the phlebotomist should first:

A) prepare the blood smear.
B) massage the site.
C) wipe away the first drop of blood.
D) fill the lavender stopper Microtainer.

Question 36

Capillary punctures on newborns are performed on the:

A) index finger.
B) plantar area of the heel.
C) back of the heel.
D) earlobe.

Question 37

Selection of an improper heel puncture site can result in:

A) puncture of the calcaneous.
B) specimen hemolysis.
C) the need for vigorous massaging.
D) increased blood flow.

Question 38

How many attempts should a phlebotomist make to obtain an adequate amount of blood by dermal puncture before requesting assistance from another phlebotomist?

A) One
B) Two
C) Three
D) Four

Question 39

To obtain the best flow of blood from a dermal puncture, the phlebotomist should:

A) alternately apply and release pressure to the site.
B) tightly squeeze the area above the site.
C) frequently wipe the site with alcohol.
D) firmly massage the area around the puncture site.

Question 40

The possibility of infection is increased when:

A) the thumb is punctured.
B) alcohol is used to cleanse the site.
C) a puncture is made through a previous site.
D) the palmar side of the finger is punctured.

Question 41

Collection of blood for newborn screening in a capillary pipette and transferring it to the filter paper circle is not recommended because:

A) the blood is heparinized.
B) the circle cannot be filled on both sides.
C) two pipettes must be used.
D) the pipette may scratch the filter paper.

Question 42

Blood collected by dermal puncture closely resembles the composition of arterial blood for all of the following reasons except:

A) warming the site increases blood flow in the area.
B) capillary samples come from the capillaries, arterioles, and venules.
C) arteries naturally lie near the surface of the collection sites used for dermal puncture.
D) because of the action of arterial pressure.

Question 43

The order of draw for a bilirubin, blood smear, and complete blood count (CBC) by dermal puncture is:

A) CBC, blood smear, and bilirubin.
B) blood smear, CBC, and bilirubin.
C) bilirubin, blood smear, and CBC.
D) blood smear, bilirubin, and CBC.

Question 44

Reasons for the selection of the fleshy areas located near the center of the third and fourth fingers on the palmar side of the nondominant hand as the preferred sites for finger puncture include all the following except:

A) these parts of the third and fourth finger are less vascular than other parts of the fingers.
B) calluses may be present on the thumb.
C) the index finger naturally contains increased nerve endings.
D) there is decreased tissue in the fifth finger.

Question 45

Newborns who appear jaundiced:

A) have increased red blood cells.
B) are always premature.
C) have increased bilirubin levels.
D) will develop liver disease.

Question 46

All of the following can affect the quality of neonatal bilirubin results except:

A) hemolysis.
B) exposure to light.
C) collection at the wrong time.
D) puncturing the plantar surface of the heel.

Question 47

Complications associated with skin puncture include: 1. hemolysis due to alcohol
2) osteomyelitis
3) tissue fluid contamination
4) hematoma

A) 1 and 3
B) 1, 2, and 3
C) 1 only
D) 4 only

Question 48

A bilirubin collected from a jaundiced infant has a normal result. This result:

A) should be expected because the infant is jaundiced.
B) may indicate the specimen was collected under the bili light.
C) can be accepted if a control has been run.
D) should be called immediately to the nursing station.

Question 49

A physician questions the low bilirubin result on a jaundiced baby. This discrepancy may be due to:

A) puncturing too deeply into the heel.
B) exposing the specimen to the bili light.
C) collecting in an amber container.
D) collecting too much blood.

Question 50

The acceptable amount of blood used to fill a filter paper circle for newborn screening tests is:

A) one drop.
B) three drops.
C) 0.5 mL.
D) 1.0 mL.

Question 51

Order of collection for a hematocrit, blood smear, and glucose by dermal puncture is:

A) hematocrit, glucose, and blood smear.
B) blood smear, hematocrit, and glucose.
C) glucose, hematocrit, and blood smear.
D) glucose, blood smear, and hematocrit.

Question 52

Laws in all states of the United States require testing for all of the following diseases in newborns using a heel stick specimen except:

A) galactosemia.
B) congenital hypothyroidism.
C) jaundice or elevated bilirubin.
D) phenylketonuria (PKU).

Question 53

The major concern when determining the order of draw for a dermal puncture is the:

A) speed of specimen collection.
B) amount of blood needed.
C) ability to adequately mix the specimen.
D) adherence of platelets to the puncture site.

Question 54

The high red blood cell counts normally seen in newborns may cause:

A) decreased bilirubin levels.
B) decreased glucose levels.
C) decreased potassium levels.
D) both A and B

Question 55

Preparing smears of the patient's blood sample on glass microscope slides can present special hazards to the phlebotomist. All of the following responses are example of these special hazards except:

A) the blood must be forced from the needle onto the slide.
B) gloves must be worn when handling the slides.
C) the needle cannot be disposed of until the smear has been made.
D) the blood smears are considered infectious until they have been fixed with alcohol.

Question 56

The proper mixing of anticoagulated specimens collected by dermal puncture is enhanced by:

A) sealing the end of the collection tube with clay or a small plastic plug.
B) centrifugation in specifically designed centrifuges.
C) the use of plain glass microcollection tubes.
D) the use of small plastic beads in the collection tube.

Question 57

A phlebotomist is recollecting a dermal puncture specimen because of hemolysis. The patient complains about a stinging sensation from the first puncture. The most probable cause of the hemolysis in the first specimen is:

A) not allowing alcohol to dry.
B) excessive massaging.
C) vigorous mixing of the microcollection tube.
D) use of a small lancet.

Question 58

Amber-colored Microtainer tubes are used to collect specimens for:

A) glucose.
B) thyroid tests.
C) platelet counts.
D) bilirubin.

Question 59

Select the response that describes how the collection of a dermal puncture sample for capillary blood gasses from a newborn or a young child differs from other capillary collections.

A) Plugs or clay sealants are used to seal the capillary tube.
B) A commercial heel warmer or warm, moist washcloth is used to arterialize the sample.
C) The sample is collected from the plantar area of the heel or big toe or the palmar area of the fingers.
D) A magnetic stir bar is inserted into the sample tube.

Question 60

Excessive squeezing of a dermal puncture site can cause all of the following except:

A) increased glucose levels.
B) tissue fluid contamination.
C) hemolysis.
D) bruising of the area.

Question 61

Specimens collected by venipuncture that require preparation of a blood smear are collected in:

A) blue stopper tubes.
B) lavender stopper tubes.
C) green stopper tubes.
D) gray stopper tubes.

Question 62

Which is the right way to handle specimens for filter paper neonatal screening tests?

A) Stack specimens after drying
B) Dry specimens in sunlight
C) Suspend specimens horizontally to air-dry
D) Stack specimens while they are drying

Question 63

Most states require testing of newborns for:

A) Down syndrome.
B) cystic fibrosis.
C) sickle cell anemia.
D) phenylketonuria.

Question 64

All of the following will affect the quality of a blood smear except:

A) pushing the spreader slide the complete length of the smear.
B) increased pressure on the spreader slide.
C) pushing the spreader slide too slowly.
D) using a dirty spreader slide.

Question 65

The purpose of a thick malaria smear is to:

A) increase parasite multiplication.
B) detect the presence of Plasmodium species.
C) identify the Plasmodium species.
D) produce better staining reactions.

Question 66

Detection and identification of parasites in red blood cells requires:

A) preparation of thick and thin blood smears.
B) a blood smear with two feathered edges.
C) culturing of hemolyzed blood.
D) blood collection by venipuncture.

Question 67

Specimens for newborn filter paper tests are collected from the:

A) plantar area of the heel.
B) volar surface of the arm.
C) back of the heel.
D) arch of the foot.

Question 68

Failure to wipe away the first drop of blood when collecting a neonatal filter paper screening test could:

A) cause a false-negative result.
B) enhance the bacterial growth.
C) destroy the filter paper.
D) cause a false-positive result.

Question 69

Failure to completely fill the filter paper circle for a newborn screening test:

A) is only important for phenylketonuria (PKU) tests.
B) can cause a false-positive result.
C) can cause a false-negative result.
D) occurs when the circle has been contaminated.

Question 70

Blood smears are important for evaluating:

A) the coagulation system.
B) blood cell morphology.
C) neonatal bilirubin concentration.
D) autoimmune disorders.

Question 71

Blood smears are labeled by:

A) numbering with a wax pencil.
B) hematology personnel only.
C) placing a label on the thick end.
D) placing a label on the thin end.

Question 72

The filter paper screening test for phenylketonuria (PKU) uses:

A) microscopic examination.
B) chemical analysis.
C) bacterial growth.
D) immunochemical analysis.

Question 73

Blood smears are prepared for all of the following tests except:

A) differential counts.
B) special stains.
C) reticulocyte counts.
D) red blood cell counts.

Question 74

Multiplication of parasites within red blood cells occurs in:

A) anemia.
B) septicemia.
C) malaria.
D) leukemia.

Question 75

When preparing a blood smear, raising the angle of the spreader slide will:

A) cause streaks in the feathered edge.
B) increase the length and thickness of the smear.
C) produce a thin smear.
D) decrease the length of the smear.

Question 76

Preparation of a blood smear using a slide that is not clean will result in:

A) streaks in the feathered edge.
B) holes in the smear.
C) a smear that is too thick.
D) ridges in the smear.

Question 77

When preparing a blood smear, the correct angle of the spreader slide is:

A) 10 to 20 degrees.
B) 20 to 30 degrees.
C) 30 to 40 degrees.
D) 40 to 50 degrees.

Question 78

When preparing a blood smear, the spreader is placed:

A) in the frosted area of the slide.
B) behind the drop of blood.
C) at the edge of the frosted area.
D) in front of the drop of blood.

Question 79

All of the following statements about neonatal filter paper screening tests are true except:

A) one large drop of blood is used to fill a circle.
B) both sides of the filter paper circle must be filled.
C) specimens are dried in a suspended, horizontal position.
D) stacking of specimens will cause cross-contamination.

Question 80

A suitable blood smear should:

A) cover the entire slide.
B) have two thick ends.
C) dry within 5 minutes.
D) have a feathered edge.