Question 1

Phil is preparing to collect a blood specimen. During his examination of the patients arm for a potential site, Phil observes the presence of petechiae scattered across both of the patients' arms. Phil understands what this indicates. He proceeds with the venipuncture, allowing extra time to make sure the site has completely stopped bleeding before leaving the patient. Why did Phil do this?

Accepted Answer

Phil knows that the presence of petechiae indicates there may be possible excessive bleeding problems after the venipuncture procedure.
It is the responsibility of the phlebotomist to be aware of all possible complications and special precautions necessary. A phlebotomist should not leave a patient until bleeding from the venipuncture site has completely stopped. If excessive bleeding occurs, the phlebotomist should apply pressure over the site, and elevate the arm above the level of the heart for five to ten minutes or until the bleeding has stopped. Notify nursing personnel before leaving the floor.

Question 2

Which of the following is not a special consideration phlebotomists should consider when working with older adults?

Accepted Answer

Providing a protective environment is a special consideration when working with newborns. When working with older adults, special considerations include mobility issues, issues with vision and hearing, cognitive or memory issues, and issues related to a suitable venipuncture site. As people age, veins begin to roll more easily because of the loss of fat and collagen. Medication or disease may cause thin fragile veins.

Question 3

Which of the following is not a special consideration when working with newborns?

Accepted Answer

An infant does not require protective restraints to safely draw a blood specimen. A phlebotomist or patient care technician should be aware of the special considerations of this population, especially monitoring the total amount of withdrawn blood, as an infant's total blood volume is much less than an older child or adult.

Question 4

Kendra is gathering equipment for an arterial puncture. She has gathered the following equipment: heparin solution of 1,000 IU per ml, sterile gauze, betadine wipes, sterile needle, and syringe. What has Pheona forgotten?

Accepted Answer

Kendra has forgotten to gather a container for ice water. An arterial blood sample is placed in a container of ice water to keep blood gasses from escaping. The sample should be transported to the lab in the container of ice water and analyzed within ten minutes of being collected. A tourniquet is not required for arterial punctures, because of arterial pressure. Tincture of iodine is used to cleanse the puncture site.
Note that arterial blood samples should be obtained in strict anaerobic conditions and should be placed on ice and held at 0° C until analysis occurs. If any air bubbles introduced during the sampling procedure it will lead to overestimation of arterial oxygen tension (PaO2), and underestimation of arterial carbon dioxide tension (PaCO2).

Question 5

What is the difference between fainting and hypovolemic shock?

Accepted Answer

Hypovolemic shock is a medical emergency that requires immediate care. Fainting, while frightening, is generally not a medical emergency. Shock is caused by excessive loss of body fluids, while fainting can be caused by several conditions, including emotional reactions. Fainting is the temporary loss of consciousness, with rapid return of consciousness.
Symptoms of shock include pale, cool, and clammy skin; shallow and rapid breathing; rapid pulse rate; and low blood pressure. Symptoms of fainting may include pale skin, low blood pressure, and complaints of feeling light headed.

Question 6

Phil has just successfully performed his first venipuncture using a syringe! He was careful not to pull up too quickly on the plunger when collecting the specimen or push it down too forcefully when transferring the blood from the syringe to the specimen container. What purpose do the special precautions used when performing a syringe serve?

Accepted Answer

Taking care not to pull up on the plunger too quickly or pushing down on it too forcefully will help prevent hemolysis of the specimen. Using a syringe instead of vacutainers system is sometimes necessary. The special precautions necessary with this kind of procedure will prevent possible lab rejection and retesting.

Question 7

Kendra is about to perform venipuncture on a patient who had a mastectomy on the right side. What special precautions should Kendra observe for this patient?

Accepted Answer

Lymph nodes are usually removed along with the breast during a mastectomy. The lack of lymph nodes on the surgical side increases the potential for infection and lymphedema. Drawing blood from an arm on the same side as a mastectomy may result in infection for the patient and invalid or inaccurate test results.

Question 8

What are the symptoms of a latex allergy?

Accepted Answer

Latex allergy signs and symptoms range in severity from hives and skin redness to anaphylactic reaction. Generally, the signs and symptoms coincide with the amount of times previously exposed to the allergen, with the mildest reaction usually being after the first exposure. Phlebotomists should question patients about all known allergies and be watchful for possible reactions.

Question 9

Phil's patient just returned from a radiology test that included an IV injection of dye. Phil collects the blood specimen and notes the radiographic test and time it was performed on the requisition form. Why did Phil do this?

Accepted Answer

Phil noted on the requisition form the name and time of the radiographic procedure because the IV dye may interfere with the blood test. The clinical laboratory relies on the phlebotomist to provide information that may affect the results of a test. The lab techs would not know this without the aid of the phlebotomist.

Question 10

Which term refers to the process through which the human body attempts to maintain internal stability in response to stimuli disturbing its normal condition?

Accepted Answer

If the body's normal state is disturbed, the attempt to maintain or regain internal stability is known as homeostasis. The blood's ability to clot is one example of homeostasis.

Question 11

Phil is selecting a vein for venipuncture. After applying a tourniquet, and palpating the vein, he is sure he has found a suitable vein. The chosen vein feels very big and cord-like. Has Phil made a good choice?

Accepted Answer

No, Phil has not made a good choice. Veins that feel cord-like are thrombosed. Along with feeling cord-like, thrombosed veins will easily roll away when palpated. They are not a good choice for collecting blood.

Question 12

For which of the following test(s) should alcohol wipes NOT be used when drawing samples?

Accepted Answer

Alcohol wipes should not be used when drawing samples for an ETOH level and blood cultures. An ETOH level is ordered to measure the blood alcohol level of a person. Using an alcohol wipe may increase the ETOH level when the needle pierces alcohol-moistened skin and contaminates the sample. Betadine is used to cleanse the skin when drawing a sample for blood cultures.

Question 13

Which of the following is the "proper order of draws"?

Accepted Answer

Yellow top (or yellow and black), light blue top, red top, and lastly additive tubes, is the proper order of draws. Following the proper order is crucial when drawing for multiple tests. Not adhering to the proper order of draws may result in additive cross-contamination and ultimately, incorrect lab results.

Question 14

Phil is collecting blood from a finger-stick. Phil is concerned he may not have collected enough blood drops; he is worried he may have to re-stick his patient. Phil is able to squeeze out a few more drops of blood by squeezing and milking the fingertip. What (if anything) did Phil do wrong, and why?

Accepted Answer

Excessive squeezing and milking of a fingertip may cause fluid in the fingertip tissue to leak into the blood, possibly resulting in inaccurate test results. Avoiding callused areas, selecting the third or fourth finger of the non-dominant hand, massaging towards the intended puncture site prior to sticking, and applying gentle pressure while collecting the blood drops, are methods to avoid Phils mistake.

Question 15

What does ARD stand for, and what is its purpose?

Accepted Answer

ARD stands for antibiotic removal device, and it is used for patients who have received antibiotic therapy before a blood culture. ARD collection bottles contain a resin that inactivates antibiotics, allowing bacteria to grow.

Question 16

Phil is drawing for multiple tests: a CBC, PT & PTT, blood glucose level and thyroid panel. Phil recalls from class that collection tubes are drawn in order. Phil arranges the collection tubes in this order: lavender top, light blue top, gray top and SST/ tiger top. What (if anything) has Phil done wrong?

Accepted Answer

Phil may remember to arrange collection tubes in order, but he does not remember the purpose or the correct order of draws. Understanding what the color top system represents, as well as the different kinds of additives used, will aid in understanding the purpose of the order of draws. When drawing for multiple tests, collection tubes must be drawn in a specific order (determined by the colored top) to avoid cross-contamination of specimens by the additives. Additive cross-contamination may alter test results and/or result in the sample being rejected by the laboratory.

Question 17

Which is first in the order of draws, a SST or PST?

Accepted Answer

If a multi-test draw required using both, a SST collection tube and PST collection tube, the order would require drawing the SST first. SST/tiger tops contain a clot activator and gel separator, used to separate serum from blood products. Along with the gel separator, PST collection tubes also contain an anticoagulant additive, used to separate plasma from blood. To avoid contamination of the SST sample by the anticoagulant in the PST collection tube, the SST specimen should be collected first.

Question 18

Which colored top indicates a tube containing the additive EDTA?

Accepted Answer

Lavender or purple-topped collection tubes indicate presence of the additive EDTA. Lavender tops will contain either EDTA, EDTA K2 or EDTA K3. Generally, EDTA is used for studies on whole blood, EDTA K2 tubes are used for molecular studies of whole blood.

Question 19

Phil has entered his patients' room. Phil knows the first step in the phlebotomy procedure is to identify his patient. He greets and identifies his patient by saying "Hi, I'm Phil; I'm here to draw a little blood. Are you Mrs. Jane Doe?" What (if anything) has Phil done wrong?

Accepted Answer

To verify the identity of his patient, Phil should allow the patient to say her name. Saying the patient name, before the patient does, risks misidentification. The patient may nod in agreement, to Phil's' question, not because she is Mrs. Jane Doe, but because she is hearing-impaired. On the other hand, she may answer that she is indeed Mrs. Jane Doe, but this may not be reliable, if she is not oriented to her name. Allowing the patient to say their full name and birth date, while comparing the answer to the hospital ID band, is the correct identification process and will help avoid identification mistakes.

Question 20

Is it necessary to follow an order of draws when using micro-containers?

Accepted Answer

Some micro-containers contain anticoagulant additives. When using micro-containers, drawing samples in the following order will prevent additive cross-contamination: hematology, chemistry studies, and blood bank. Micro-containers (also known as capillary tubes) are the preferred method of specimen collection when only a small amount of blood is needed.

Quiz 5: Phlebotomy