Deck 10: Venipuncture Complications and Preexamination Variables

Question 1

When a phlebotomist enters a room to draw blood, the patient states that blood was just collected 20 minutes ago. The phlebotomist should:

A) draw the patient and notify the nursing station.
B) check the patient's arm for bleeding.
C) draw the patient from the other arm.
D) check the order with the nursing station before drawing.

Answer 1

D

Question 2

The best way to prevent fainting in a patient during blood collection is to:

A) have the patient stand during the phlebotomy.
B) have the patient lie down during the phlebotomy.
C) have the patient pump the fist three times.
D) place a pillow under the patient's head.

Answer 2

B

Question 3

When encountering a patient who is sleeping, the phlebotomist should:

A) return at another time.
B) try to collect the specimen without waking the patient.
C) notify the nursing station.
D) awaken the patient before collecting the specimen.

Answer 3

D

Question 4

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 5

A phlebotomist with a request for a stat glucose does not find the patient in the room. The phlebotomist should:

A) return the requisition slip to the laboratory.
B) check back after completing rounds.
C) check the patient's location with the nursing station.
D) ask the hospital telephone operator to page the patient.

Question 6

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 7

Recent strenuous exercise may affect the results of tests for:

A) creatinine and creatine kinase.
B) bilirubin and alanine transaminase (ALT).
C) glucose and blood urea nitrogen (BUN).
D) amylase and uric acid.

Question 8

Areas that should be avoided for venipuncture include all of the following except:

A) hematomas.
B) deep cephalic veins.
C) sclerosed veins.
D) tattoos.

Question 9

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

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

Question 10

Patients taking diuretics frequently have blood drawn to monitor:

A) cholesterol.
B) blood urea nitrogen (BUN).
C) potassium.
D) glucose.

Question 11

The surgical fusion of a vein and artery frequently seen in dialysis patients is called:

A) an aneurysm.
B) hemoconcentration.
C) a fistula.
D) an angioplasty.

Question 12

A phlebotomist encountering a comatose patient with no identification band should:

A) notify the phlebotomy supervisor.
B) check the patient's identity with the patient's roommate.
C) leave the requisition at the nurse's station.
D) ask the nurse to band the patient.

Question 13

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

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

Question 14

The word meaning an abnormal accumulation of fluid in the tissues is:

A) phlebitis.
B) edema.
C) anemia.
D) plasma.

Question 15

When a request for collection of a blood sample is telephoned to the laboratory, the phlebotomist should:

A) request delivery of a requisition form.
B) pick up the requisition form at the collection area.
C) notify the phlebotomy supervisor.
D) suggest that the nurse collect the specimen.

Question 16

If a patient refuses to have blood drawn, the phlebotomist should:

A) send another phlebotomist to collect the specimen.
B) report the situation to the nursing station.
C) return the requisition form to the laboratory.
D) ask someone to hold the patient and collect the specimen.

Question 17

When encountering a patient with a fistula, the phlebotomist should:

A) apply the tourniquet below the fistula.
B) use the other arm.
C) collect the blood from the fistula.
D) attach a syringe to the T-tube connector.

Question 18

Specimens 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.

Question 19

Physician approval is required when collecting blood from:

A) patients with diabetes.
B) lower arm veins.
C) leg veins.
D) pediatric patients.

Question 20

A phlebotomist can interrupt a physician-patient visit:

A) when the physician is not examining the patient.
B) if the collection is a timed specimen.
C) if the patient has visitors present.
D) when the patient is scheduled for routine phlebotomy rounds.

Question 21

When collecting blood from a patient with a very edematous right arm and a large hematoma in the antecubital area of the left arm, the phlebotomist should collect the specimen from:

A) below the hematoma.
B) above the hematoma.
C) the antecubital area of the right arm.
D) the antecubital area of the left arm.

Question 22

Incorrect collection of blood from a patient who has had a mastectomy can result in all of the following except the:

A) patient developing lymphedema.
B) patient developing an infection.
C) samples being affected by lymphostasis.
D) samples being affected by chemotherapy.

Question 23

Collection of blood from an area that is edematous:

A) is acceptable for venipuncture.
B) may produce a hemoconcentrated specimen.
C) is acceptable for dermal puncture.
D) should be avoided.

Question 24

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 25

The maximum number of attempts that a phlebotomist should make to collect a specimen is:

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

Question 26

When collecting blood from a patient with an intravenous line, the phlebotomist should not:

A) collect from the intravenous line after it has been stopped for 5 minutes.
B) draw from the opposite arm.
C) draw from above the intravenous line.
D) draw from below the intravenous line.

Question 27

When using a blood pressure cuff as a tourniquet, the cuff is inflated:

A) below the systolic and above the patient's diastolic pressure.
B) to 40 mm Hg.
C) and deflated three times.
D) above the systolic and below the patient's diastolic pressure.

Question 28

The puncture site may require additional pressure to stop bleeding when the patient:

A) has low blood pressure.
B) is taking anticoagulants.
C) frequently takes aspirin.
D) both B and C

Question 29

Collection of specimens from leg veins is not recommended in all of the following except:

A) patients with multiple fractures.
B) diabetic patients.
C) patients with coagulation disorders.
D) cardiac patients.

Question 30

A patient's identification band may contain special stickers to be applied to specimens for:

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

Question 31

Collecting blood from an area containing a tattoo may result in:

A) hemolysis.
B) an infection.
C) elevated test results.
D) syncope.

Question 32

Fistulas are seen in patients who:

A) are receiving dialysis.
B) have very fragile veins.
C) must be rapidly transfused.
D) are receiving frequent medications.

Question 33

If a suitable vein is not located in the left arm, the phlebotomist should:

A) check the right arm.
B) apply a blood pressure cuff.
C) apply the tourniquet above the hand.
D) puncture in the area of the median cubital vein.

Question 34

A tourniquet is not applied when collecting a specimen for:

A) lactic acid.
B) cortisol.
C) ammonia.
D) glucose.

Question 35

Attempting to draw blood from a vein that is occluded may result in:

A) patient syncope.
B) formation of a hematoma.
C) failure to obtain sufficient blood.
D) excessive bleeding.

Question 36

If a patient requests a drink of water, the phlebotomist should:

A) report the request to the nursing station.
B) fill the patient's water pitcher.
C) tell the patient they are to have nothing by mouth (NPO).
D) explain that water will affect the patient's condition.

Question 37

If a patient begins to faint during the venipuncture, the phlebotomist 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 38

Difficult-to-locate veins can be made more prominent by all of the following except:

A) massaging the arm.
B) applying cold compresses.
C) applying hot compresses.
D) having the patient clench the fist.

Question 39

Prolonged tourniquet application will cause:

A) edema.
B) hemolysis.
C) hemoconcentration.
D) both B and C

Question 40

A phlebotomist may be required to obtain information from a second wrist band when collecting specimens for:

A) blood bank.
B) chemistry.
C) coagulation.
D) HIV.

Question 41

Hematomas can be caused by all of the following except:

A) having the patient bend the elbow.
B) inserting the needle partially into the vein.
C) drawing below an intravenous line.
D) removing the tourniquet after removing the needle.

Question 42

Failure to remove the tourniquet before removing the needle:

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

Question 43

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

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

Question 44

The plastic wings on a butterfly:

A) help hold the needle in place after insertion.
B) allow the angle of insertion to be lowered.
C) allow the angle of insertion to be raised.
D) both A and B

Question 45

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 46

Which of the following patient conditions will prolong the time it takes to stop the bleeding from a venipuncture site?

A) Low blood pressure
B) Low blood sugar
C) Patient taking Coumadin
D) Patient taking vitamin K

Question 47

When blood is collected from an intravenous line:

A) this should be noted on the requisition form.
B) the physician should be notified.
C) the intravenous fluid should not be restarted.
D) a butterfly apparatus should be used.

Question 48

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

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

Question 49

When collecting a blood culture, complete blood count (CBC), and prothrombin time (PT) from a central venous device (CVAD), how many syringes must be used?

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

Question 50

All of the following specimens would be rejected except a(n):

A) unlabeled specimen.
B) half-full red stopper tube.
C) half-full light-blue stopper tube.
D) specimen without a requisition form.

Question 51

After filling the first tube of a three-tube collection, blood does not flow into the second tube. The phlebotomist should: 1. move the needle slightly.
2) remove the tube and try the third tube.
3) try a new second tube.
4) immediately discontinue the phlebotomy and stick the other arm.

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

Question 52

While performing a venipuncture, the phlebotomist notices bright red blood spurting into the tube. The phlebotomist should:

A) immediately withdraw the needle.
B) immediately remove the tourniquet.
C) lower the patient's head.
D) apply pressure for 10 minutes after withdrawing the needle.

Question 53

To transfer blood from a syringe to an evacuated tube:

A) do not puncture the evacuated tube stopper.
B) make sure all of the blood in the syringe enters the evacuated tube.
C) do not hold the tube in your hand while puncturing the rubber stopper.
D) attach a butterfly apparatus to the syringe.

Question 54

When drawing blood from a central venous access device (CVAD):

A) a syringe larger than 20 mL must be used.
B) heparin is first injected into the catheter.
C) the first 5 mL of blood is always discarded.
D) a double or triple lumen catheter must be present.

Question 55

When collecting blood using a butterfly all of the following are acceptable except:

A) lowering the angle of insertion.
B) drawing blood into the syringe.
C) using a 15-mL evacuated tube.
D) threading the needle into the vein.

Question 56

When a central venous access device (CVAD) is present:

A) blood is drawn from the line using a 30-mL syringe.
B) laboratory specimens should not be collected from the catheter.
C) blood is drawn and discarded before the specimen is collected.
D) an evacuated tube is attached to the line for specimen collection.

Question 57

When a patient is receiving an intravenous line, blood should be collected from:

A) the other arm.
B) an area above the intravenous line.
C) an area below the intravenous line.
D) both A and C

Question 58

When using a syringe:

A) the plunger should be pulled back slowly.
B) the needle should be inserted bevel down.
C) a tourniquet should not be used.
D) blood should be rapidly withdrawn.

Question 59

Specimens are rejected by the laboratory for all of the following reasons except:

A) clots in a lavender stopper tube.
B) collection in the wrong tube.
C) incompletely filled light-blue stopper tubes.
D) clots in a red stopper tube.

Question 60

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

A) use of a 23-gauge needle.
B) collapsing of the vein.
C) the bevel of the needle resting on the vein wall.
D) an occluded vein.

Question 61

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. All of the following are true statements about these changes, except:

A) patients should generally be lying down or sitting for 5 minutes prior to having blood samples collected.
B) the effects are about the same for all laboratory tests.
C) the effects are greatest in patients with congestive heart failure and liver disease.
D) the effects are most noticeable for lipid profiles

Question 62

Central venous access devices (CVADs) are threaded into the superior vena cava.

Question 63

When using a syringe to fill blood collection tubes:

A) fill all the evacuated tubes with the same needle used for collection.
B) allow the evacuated tubes to fill according to the vacuum in the tube; do not force the plunger.
C) activate the needle safety device after filling all the evacuated tubes with the blood transfer device.
D) use the blood transfer device only for potentially combative patients.

Question 64

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

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

Question 65

Isopropyl alcohol is a stronger antiseptic than povidone-iodine.

Question 66

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 67

Commercial identification bands with built-in matching stickers that may be placed on the patient's blood sample tubes are particularly useful for which of the following types of samples:

A) outpatient services.
B) coagulation tests.
C) transfusion service (blood bank).
D) chemistry tests.

Question 68

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 69

Serum appearing red suggests that:

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

Question 70

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 requires several hours of normal physical activity by the patient.
B) patients should have consumed a meal no less than three 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 71

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

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

Question 72

A patient has the right to refuse to have blood drawn.

Question 73

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

Question 74

Prolonged application of a tourniquet (for greater than 1 minute) during routine blood collection procedures results in which of the following events:

A) no effect on patient results will occur except for tests for lactic acid.
B) causes hemoconcentration because cells and large molecules are forced into the bloodstream.
C) no significant effects on patient results will occur.
D) causes hemoconcentration as the plasma portion of the blood is forced into the tissues.

Question 75

To collect 5 mL of blood a 10-mL syringe should be used.

Question 76

Evacuated tubes containing anticoagulant do not need to be mixed immediately.

Question 77

Applying a tourniquet to or drawing blood from an arm located on the same side of the body as a recent mastectomy can be harmful to the patient and may produce erroneous test results. The application of a tourniquet as part of such blood collections is discouraged for all of the following reasons except:

A) may cause a release of harmful cells from the surgical site into the circulation.
B) interferes with the flow of lymph fluid in the area.
C) causes increases in the blood level of lymphocytes and waste products in the area.
D) increases the danger of developing lymphedema in the affected area.

Question 78

Bandages should not be applied to children younger than 2 years of age.

Question 79

Before leaving a patient's room, a phlebotomist should ask the patient if he or she would like a glass of water.

Question 80

All of the following can cause hemolyzed specimens except:

A) use of 25-gauge needles.
B) shaking a tube forcefully.
C) difficult venipunctures where blood enters the tube slowly.
D) gentle inversion of tubes containing blood.