Question 1

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

Accepted Answer

Using a pipette may scratch the filter paper during the transfer of blood, potentially compromising the integrity of the sample and affecting the accuracy of the newborn screening results.

Question 2

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

Accepted Answer

Arteries do not naturally lie near the surface of the sites used for dermal puncture. Dermal puncture is typically performed on capillary-rich tissues such as the fingertips, heel, or earlobe, which have a rich network of capillaries beneath the skin surface. While the other options listed are valid reasons why blood collected by dermal puncture closely resembles arterial blood, the incorrect option is the one that does not accurately describe the anatomy or physiology of blood collection by dermal puncture.

Question 3

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

Accepted Answer

The correct order of draw for these tests by dermal puncture is to first collect for the blood smear, as it requires the freshest blood with minimal platelet clumping. Next, the CBC is collected, followed by the bilirubin test, which is sensitive to light and may require protection from light immediately after collection. This order helps prevent cross-contamination and ensures the accuracy of test results.

Question 4

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:

Accepted Answer

The fleshy areas of the third and fourth fingers are actually more vascular, which is why they are preferred for finger puncture, to ensure adequate blood flow for sampling.

Question 5

Newborns who appear jaundiced:

Accepted Answer

Newborns who appear jaundiced have increased levels of bilirubin in their blood, which can sometimes cause a yellowing of the skin and eyes. It doesn't necessarily mean they have increased red blood cells, are always premature, or will develop liver disease. Bilirubin is processed by the liver, so high levels could indicate a problem with liver function, but it doesn't always lead to liver disease.

Question 6

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

Accepted Answer

Puncturing the plantar surface of the heel is the recommended site for neonatal bilirubin collection, so it would not affect the quality of the results. However, hemolysis, exposure to light, and collection at the wrong time can all affect the quality of neonatal bilirubin results. Hemolysis can cause an increase in bilirubin levels due to the release of additional bilirubin from the hemoglobin breakdown, exposure to light can break down bilirubin and falsely lower results, and collection at the wrong time can result in inaccurate readings as bilirubin levels fluctuate throughout the day.

Question 7

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

Accepted Answer

Complications associated with skin puncture can include hemolysis due to alcohol not being fully dried before the puncture, osteomyelitis especially in deep punctures or in patients with compromised immune systems, and tissue fluid contamination which can dilute the sample and affect test results. Hematoma is also a potential complication, but it is not listed under the correct options based on the provided choices.

Question 8

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

Accepted Answer

Bilirubin levels can be artificially reduced when collecting the specimen under the bili light. Therefore, a normal result in a jaundiced infant may indicate that the specimen was collected under the bili light, leading to a false normal result.

Question 9

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

Accepted Answer

Exposing the specimen to light, especially bili lights used in the treatment of jaundice, can break down bilirubin in the sample, leading to falsely low results.

Question 10

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

Accepted Answer

The acceptable amount of blood used to fill a filter paper circle for newborn screening tests is one drop, which is approximately 50 microliters. Using more blood than necessary may result in inaccurate test results and can also increase the risk of bleeding and infection for the newborn.

Question 11

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

Accepted Answer

The correct order of collection for these tests by dermal puncture is to first collect for the blood smear, then the hematocrit, and finally the glucose. This order helps to prevent contamination of the samples and ensures the accuracy of the test results. The blood smear requires the freshest blood with minimal tissue fluid contamination, followed by the hematocrit, and then tests such as glucose, which can tolerate a slight delay.

Question 12

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

Accepted Answer

While jaundice or elevated bilirubin is routinely monitored in newborns, it is not necessarily a disease that is directly tested for using a heel stick specimen. Rather, it is typically detected through physical observation and/or blood tests. The other options listed (galactosemia, congenital hypothyroidism, and PKU) are all diseases that are routinely screened for using a heel stick specimen.

Question 13

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

Accepted Answer

The major concern when determining the order of draw for a dermal puncture is the adherence of platelets to the puncture site. If a sample is collected first that could cause platelet activation, it could affect the accuracy of subsequent sample collections. Therefore, it is important to follow the correct order of draw to minimize the risk of platelet activation and to ensure accurate test results.

Question 14

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

Accepted Answer

The answer of The high red blood cell counts normally...

Question 15

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:

Accepted Answer

Wearing gloves is a standard safety precaution and not a special hazard.

Question 16

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

Accepted Answer

The use of small plastic beads in the collection tube helps in the proper mixing of anticoagulated specimens collected by dermal puncture. These beads facilitate thorough mixing of the anticoagulant with the blood sample, ensuring that the blood does not clot before analysis.

Question 17

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:

Accepted Answer

Not allowing the alcohol to dry can cause hemolysis because the alcohol can hemolyze red blood cells if it enters the puncture site.

Question 18

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

Accepted Answer

Amber-colored Microtainer tubes are used to collect specimens for the measurement of bilirubin levels. Bilirubin is a breakdown product of hemoglobin and is primarily processed by the liver. Elevated levels of bilirubin can indicate liver disease or other conditions affecting liver function.

Question 19

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.

Accepted Answer

The answer of Select the response that describes how the...

Question 20

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

Accepted Answer

Excessive squeezing of a dermal puncture site can cause tissue fluid contamination, hemolysis, and bruising of the area, but it does not cause an increase in glucose levels. In fact, excessive squeezing can cause falsely elevated glucose readings due to the dilution of blood with tissue fluid.

Quiz 12: Dermal Puncture