Deck 34: Phlebotomy and Blood Specimens

Question 1

The nurse will not label an evacuated tube before entering the patient's room because

A) The nurse could accidently use the labeled tube for the wrong patient.
B) Tubes should be labeled after they have all been filled and the nurse has left the patient's room, just before being sent to the laboratory.
C) Doing so would be less time efficient, although it would reduce the likelihood of an error.
D) Labeling the tube later ensures that the writing on the label is more legible.

Answer 1

The nurse could accidently use the labeled tube for the wrong patient.

Question 2

The nurse recognizes that locating or accessing a vein is made more difficult by all of the following conditions except

A) Obesity.
B) Low blood pressure.
C) Dehydration.
D) Rolling or collapsing veins.

Answer 2

Low blood pressure.

Question 3

The following patients have had blood draws ordered. The nurse will not perform venipuncture on

A) The hand of an infant who does not have adequate hand veins.
B) The right arm of a mastectomy patient who has had a mastectomy on the right side.
C) The feet of patients with poor circulation in the extremities.
D) The arm of an elderly patient with edema.

Answer 3

The right arm of a mastectomy patient who has had a mastectomy on the right side.

Question 4

As the nurse attempts venipuncture in the patient's right hand, the vein rolls. To stabilize the vein, the nurse will

A) Carefully apply enough pressure with the index and middle fingers to trap the rolling vein.
B) Use the index finger and thumb of the nondominant hand to anchor the vein above and below the intended venipuncture site.
C) Use a winged-infusion set with a syringe rather than a Vacutainer.
D) Apply heat for several minutes to enhance the visibility of the vein.

Question 5

A nurse has successfully inserted the Vacutainer needle into the patient's right median cubital vein. Next, the nurse will correctly

A) Draw the appropriate amount of blood.
B) Release the tourniquet to reduce pressure on the vein.
C) Transfer the collected blood into the appropriate evacuated tube.
D) Gently push the Vacutainer tube onto the sheathed end of the needle.

Question 6

If the nurse fails to obtain blood on the first attempt at venipuncture, she should avoid

A) Palpating the vein proximal to the needle and redirecting the needle.
B) Pulling back on or rotating the needle.
C) Removing and then reapplying the tourniquet.
D) Removing the needle and then reinserting it in the other arm.

Question 7

The nurse correctly labels the tube containing a blood-draw specimen

A) Before entering the patient's room.
B) In the patient's room but before obtaining the specimen.
C) Immediately after obtaining the specimen.
D) After leaving the patient's room.

Question 8

The nurse will properly avoid performing venipuncture on all of the following sites except

A) The scalp veins of an infant.
B) Skin with incisions or sutures.
C) Veins that feel hard or ropey.
D) Skin with new tattoos.

Question 9

When having difficulty drawing blood from a patient, the nurse knows that it is necessary to avoid leaving the tourniquet on longer than 1 minute because

A) In patients with hypertension, doing so can cause an increase in blood pressure.
B) Doing so can cause discomfort if the patient's skin is fragile.
C) Doing so can cause edema.
D) Doing so can alter laboratory results.

Question 10

To prevent rupturing an elderly patient's vessel when performing venipuncture, the nurse will

A) Use the Vacutainer collection method.
B) Use a blood pressure cuff to occlude venous return.
C) Collect the patient's blood with an 18-gauge needle.
D) Apply warm compresses to the arm for 20 minutes before venipuncture.

Question 11

An 86-year-old female patient has orders for a complete blood cell count this morning. As part of gathering the necessary equipment to collect the patient's blood, the nurse will correctly gather

A) A winged-infusion set.
B) A Vacutainer holder.
C) A 50-mL syringe.
D) An 18-gauge Vacutainer needle.

Question 12

A patient has several blood tests ordered. The nurse determines that the best vein to use for the blood draw is superficial and will correctly initiate the stick at a

A) 45-degree angle.
B) 30-degree angle.
C) 15-degree angle.
D) 5-degree angle.

Question 13

To minimize the risk for complications from phlebotomy, the nurse should

A) Remove the tourniquet after removing the needle from the vein.
B) Have the patient bend the elbow to keep up pressure on the site after removing the needle.
C) Keep the patient lying supine or sitting in the high Fowler position.
D) Allow the patient to stand during venipuncture if the patient is more comfortable that way.

Question 14

To prevent hemolysis after drawing blood, the nurse correctly

A) Massages the puncture site to produce sufficient blood flow.
B) Pulls back quickly on the plunger of the syringe when drawing blood.
C) Selects a 23-gauge needle or larger.
D) Selects a 24-gauge needle or smaller.

Question 15

After drawing the patient's blood, the nurse will correctly

A) Have the patient bend his or her elbow to help stop the bleeding.
B) Apply pressure for at least 1 full minute.
C) Leave the tourniquet on until the patient has stopped bleeding.
D) Apply deep pressure for approximately 3 to 5 minutes.

Question 16

The nurse is satisfied that a tourniquet is placed correctly on the patient's arm when

A) The patient's arm is cool to the touch.
B) The patient is not complaining of discomfort.
C) The arterial pulse distal to the tourniquet is palpable.
D) There is increased visibility of the veins.

Question 17

The nurse has inserted the Vacutainer needle into the patient's left median cubital vein, but when the tube is activated, it does not fill with blood. The nurse correctly suspects that

A) There is no suction in the evacuator tube.
B) The bevel of the needle is damaged in some way.
C) The evacuated tube is too small.
D) The tourniquet is apparently too tight to allow blood to enter the tube.

Question 18

A patient who was admitted with possible septicemia has orders to draw blood cultures. The nurse has correctly drawn blood cultures when

A) Blood is collected in two separate bottles, one aerobic and the other anaerobic, while the patient's temperature is spiked.
B) Blood cultures are drawn on admission to the unit and again when febrile.
C) Two lavender collection tubes of blood have been collected while the patient's temperature is elevated above 101°F.
D) The patient's blood cultures have been collected using either two anaerobic bottles or two aerobic culture bottles.

Question 19

The nurse is having difficulty finding a vein for venipuncture. An appropriate course of action is to

A) Have the patient drink fluids.
B) Apply cold packs to the venipuncture site.
C) Remove the blood pressure cuff from the arm to let the blood flow freely.
D) Let one of the patient's arms hang below the heart for several minutes.

Question 20

Before drawing the patient's blood, the nurse carefully lines up evacuated tubes in the order in which they will be filled. The nurse collects blood in the correct order because

A) Laboratory draws are time-consuming and collecting blood in the correct order will be a more efficient use of time.
B) The medical technologist in charge of the laboratory has designated the order based on the facility's protocol.
C) Some tubes have additives that have the potential to contaminate each of the remaining tubes to be filled.
D) The collection tube that is filled first has an anticoagulant, which prevents blood from clotting in the remaining tubes to be collected.

Question 21

A nursing instructor is preparing a lecture about the difference between veins and arteries. Which of the following statements could the instructor correctly include?

A) Veins carry oxygenated blood, whereas arteries carry deoxygenated blood.
B) Blood pressure is higher in veins than in arteries; veins thus have thicker walls than arteries.
C) Veins and arteries have many junctions (or anastomoses) where veins and arteries join each other.
D) Veins have valves, whereas arteries do not.

Question 22

The nurse correctly understands that he should use a skin puncture for diagnostic tests in which of the following circumstances?

A) When the patient is younger than 2 years.
B) When the veins are inaccessible.
C) When a patient's fingers are calloused.
D) When a simpler way to obtain blood is desirable.
E) If the test requires a large volume of blood.

Question 23

In planning patient care, the nurse will take into account the fact that the most appropriate time to draw a blood culture specimen is

A) When the patient's temperature is normal.
B) During a temperature spike.
C) After the patient is given antibiotics.
D) When the patient is sleeping.

Question 24

A nurse knows that a blood culture specimen must be drawn if it is suspected that the patient has

A) Hemoconcentration.
B) Lymphostasis.
C) Septicemia.
D) Tortuous veins.

Question 25

The nurse correctly understands that when collecting blood for diagnostic tests, risk factors for the patient include which of the following?

A) The formation of a hematoma
B) Fainting or syncopal episodes
C) Infection as a result of a skin puncture
D) The formation of anastomoses
E) Pinpoint areas of hemorrhage, known as petechiae

Question 26

A nurse expects that a blood culture sample will be ordered if the presence of which of the following is suspected?

A) Organic toxins
B) Aerobic organisms
C) Anaerobic organisms
D) Anastomoses
E) Hemolysis

Question 27

Before performing a phlebotomy, a nurse correctly

A) Washes his hands and then puts on nonsterile gloves.
B) Washes his hands and then puts on sterile gloves.
C) Puts on nonsterile gloves (hand washing is not needed because the gloves prevent contact with the patient).
D) Puts on sterile gloves (hand washing is not needed because the gloves prevent contact with the patient).

Question 28

The nurse explains the blood-drawing process to the patient before performing it

A) To reduce liability because an uninformed patient may sue for malpractice.
B) To reduce patient anxiety and gain cooperation.
C) To give patients the opportunity to refuse treatment if they so choose.
D) To educate the patient so he can perform the procedure at home.

Question 29

A patient who was just admitted has orders for several blood tests. The nurse will draw the patient's blood and fill the following collection tubes. Indicate the order in which the tubes should be filled (1-5).(Enter the number of each step in the proper sequence, do not use commas).
1. Red tiger-striped
2. Green
3. Light blue
4. Lavender
5. Yellow