53 & 54 Hematology & Blood Draw

Question 1

Plasma could be retrieved from

Answer 1

Thixotropic gel can be found in some tubes, including Becton-Dickinson’s SST tube with the red-gray marbled top and PST tube with the green-gray marbled top. The density of this synthetic gel is between that of red cells and plasma or serum, and it settles between the two during centrifugation, forming a barrier. This barrier facilitates retrieval of the liquid portion without cellular contamination.

Question 2

The needle size most commonly used in infants and older adults is _____ gauge

Answer 2

The smallest gauge needles (23-gauge) are used to collect blood from small or fragile veins, such as those of older or very young patients.

Question 3

The color of the tube top for the collection of a coagulation test is

Answer 3

Light blue tops contain sodium citrate, which prevents blood from clotting.

Question 4

Leaving a tourniquet tied on a patient’s arm for longer than the recommended time results in

Answer 4

Hemoconcentration can occur, which is an increased concentration of blood cells in proportion to plasma.

Question 5

No anticoagulants are found in which of the following tubes?

Answer 5

Red-topped tubes have no additives and are used for serology and chemistry studies.

Question 6

Which is the most correct method for performing a capillary puncture?

Answer 6

Squeezing the finger causes an increase in tissue fluids, the lateral surface of the finger should be used, alcohol should be allowed to dry before the sample is collected, and the first drop of blood is wiped away because it contains tissue fluid.

Question 7

The needle size most commonly used for adult venipuncture is ___ gauge.

Answer 7

Routine adult venipuncture requires a 20- to 21-gauge needle.

Question 8

Which vein(s) can be used for routine venipuncture?

Answer 8

The medial veins generally run parallel or at a slight angle to the fold in the antecubital area, whereas the cephalic veins run lateral or to the outside of the antecubital area. These veins are the veins of choice.

Question 9

The slant at the open end of a needle used for venipuncture is called the:

Answer 9

The bevel is the slanted edge at the tip of the needle.

Question 10

During a routine venipuncture, when should the phlebotomist request that the patient make a fist?

Answer 10

After the tourniquet is in place, the patient should be asked to make a fist; the medical assistant then palpates for an acceptable vein with the ungloved index finger.

Question 11

The device used for dermal puncture is a(n):

Answer 11

A lancet is used to perform a dermal puncture; it delivers a quick puncture to a predetermined depth.

Question 12

A needlestick is more likely to occur if:

Answer 12

The medical assistant should never attempt to recap a contaminated needle.

Question 13

Which type of tube should be used to collect blood specimens during a glucose tolerance test?

Answer 13

The fluoride in gray-topped tubes prevents glycolysis.

Question 14

The clear part of whole blood that contains clotting agents is

Answer 14

Plasma is the liquid part of whole blood that provides the medium for blood cells and dissolved particles to be carried through the bloodstream.

Question 15

A hematoma can be caused by

Answer 15

The most common causes of hematoma formation during blood draws are excessive probing with the needle to locate a vein, failure to insert the needle far enough into the vein, and penetration of the needle through the vein. *All of the above

Question 16

You are performing a capillary puncture on a patient and are having difficulty collecting an adequate sample. Which of the following is an accepted method to encourage blood flow from the site

Answer 16

Gentle massage of the finger encourages blood flow without risking the quality of the sample.

Question 17

The most common phlebotomy site in adults is (are) the

Answer 17

The medial and cephalic veins in the antecubital space are the veins of choice for phlebotomy in an adult patient.

Question 18

_________ is an anticoagulant that prevents platelets from clumping and preserves the appearance of blood cells for microscopic preparation

Answer 18

Ethylenediamine tetraacetic acid (EDTA), which is present in the lavender-topped tube, prevents platelet clumping and preserves the appearance of blood cells for microscopic examination

Question 19

Which is the proper technique for performing a venipuncture?

Answer 19

The needle bevel should always be face up so that the sharpest part of the needle is inserted first; the needle is inserted at a small angle so that it does not pass through the vein.

Question 20

When is the correct time to remove the tourniquet during a routine venipuncture?

Answer 20

As the end of the draw nears and the last tube to be collected fills, the tourniquet should be carefully released.

Question 21

A tourniquet should remain tied on a patient’s arm no longer than:

Answer 21

1 minute. Leaving a tourniquet on for longer than 1 minute greatly increases the possibility of hemoconcentration and altered test results.

Question 22

Without a clot activator, whole blood typically clots in ________ minutes.

Answer 22

30 to 60. Clot activators promote clotting of blood. Without a clot activator, blood clots in 30 to 60 minutes, after which it must be centrifuged.

Question 23

You are required to collect a venous sample for a typical hematology test, the complete blood count. You collect:

Answer 23

The EDTA in the lavender-topped tube prevents platelet clumping and preserves the appearance of blood cells for microscopic examination.

Question 24

Why should a tourniquet not be tied too tightly?

Answer 24

The tourniquet should not be tied so tightly as to impede arterial blood flow; this restricts venous blood return, resulting in poor venous distention.
*All of the above

Question 25

In a routine venipuncture, the angle at which the needle enters the arm should be _______ degrees.

Answer 25

15 Degrees. The needle should enter the arm at a 15-degree angle, parallel to the vein, to puncture the vein without passing through it.

Question 26

Thixotropic gel, found in the SST red-gray marbled-topped Vacutainer tube is:

Answer 26

less dense than red blood cells but more dense than serum. Thixotropic gel can be found in some tubes, including Becton-Dickinson’s SST tube with the red-gray marbled top and PST tube with the green-gray marbled top. The density of this synthetic gel is between that of red cells and plasma or serum, and it settles between the two during centrifugation, forming a barrier.

Question 27

Before a routine venipuncture or capillary puncture, the site typically is cleaned with:

Answer 27

The most commonly used antiseptic is 70% isopropyl alcohol.

Question 28

During a routine venipuncture, when should the phlebotomist request that the patient release the fist?

Answer 28

When blood enters the first tube or barrel, the patient should be asked to unclench her or his fist.

Question 29

A syringe is preferred over a Vacutainer collection device when:

Answer 29

Syringes are used when there is concern that the strong vacuum in a stoppered tube may collapse the vein.

Question 30

The ____________ is the part of the venipuncture needle that fits into the syringe or Vacutainer adapter.

Answer 30

The hub attaches the needle to the adapter or syringe.

Question 31

A winged infusion set is also known as a:

Answer 31

Butterfly needles are designed for use on small veins, such as those in the hand or in pediatric patients.

Question 32

Blood obtained via capillary puncture can be collected:

Answer 32

``` in Microtainer tubes. in capillary tubes. in microhematocrit tubes. onto filter paper. by *all of the above. ```

Question 33

Capillary blood samples may be collected at all of the following sites except the:

Answer 33

The antecubital space is used to collect venous samples.

Question 34

The needle size most commonly used by the blood bank for donations is ___ gauge.

Answer 34

16; Blood bank donation requires a larger gauge needle; using a 16-gauge needle to collect blood reduces the chance of hemolysis.

Question 35

A tourniquet is used during the phlebotomy procedure to:

Answer 35

A tourniquet prevents venous flow out of the site, causing the veins to bulge. *Both B and C

Question 36

The proper procedure for collecting a serum specimen is to:

Answer 36

A serum specimen must clot, and red-topped and marble-topped tubes aid this process. *Both B and D

Question 37

The laboratory requisition indicates that you are to collect a venous blood specimen for hematology testing, serum chemistry testing, and coagulation studies. What is the proper order of collection for these tubes?

Answer 37

The order of tube filling is light blue, red, and lavender to secure the blood samples.

Question 38

Which of the following Vacutainer tubes is routinely used for hematology testing?

Answer 38

Lavender-topped tubes contain EDTA to prevent clotting; therefore, samples for hematology testing are collected in these tubes.

Question 39

Which of the following tests is used to determine renal function?

Answer 39

Creatinine levels increase if the kidneys are damaged and cannot excrete waste adequately.

Question 40

Which component of the complete blood count is not necessary to calculate the red cell indices?

Answer 40

The differential analyzes the numbers of WBCs in the blood sample.

Question 41

Platelets

Answer 41

Thrombocytes are not true cells but rather cytoplasmic fragments of a large cell in the bone marrow, the megakaryocyte. The coagulation of the blood is initiated by blood platelets. Thrombocytopenia is a decrease in normal platelets. *none of the presented answers

Question 42

Which of the following is not detected in a liver panel test?

Answer 42

CBC. A liver panel is ordered to detect possible damage in hepatocytes. If damaged, these cells release certain enzymes, including gamma-glutamyltransferase (GGT), ALT, and alkaline phosphatase (ALP). A CBC count provides information about all blood cells but not about blood enzymes.

Question 43

Granular leukocytes:

Answer 43

act as phagocytes. The granular leukocytes, called polymorphonuclear leukocytes, include the neutrophils, eosinophils, and basophils. They are characterized by their heavily granulated cytoplasm and segmented nuclei. Granular leukocytes are phagocytic and engulf invading bacteria and viruses. Unlike erythrocytes, leukocytes function in the tissues.

Question 44

Which department of the laboratory performs H&H tests?

Answer 44

The hematology section deals with the counting of RBCs, WBCs, and platelets, differentiating WBCs on stained blood smears, measuring the percentage of RBCs in blood (hematocrit), and determining the oxygen-carrying capacity of the blood (hemoglobin).

Question 45

Hormones detected in a thyroid panel include:

Answer 45

All three hormone levels are assessed in a thyroid panel. The pituitary gland produces TSH to stimulate the thyroid to produce T3 and T4. *All of the above

Question 46

When performing a microhematocrit:

Answer 46

Capillary tubes should be filled two-thirds to three-quarters full and sealed with clay before they are placed in the centrifuge.

Question 47

The ESR test results:

Answer 47

vary greatly between genders and as people age. The ESR test result is not specific for a particular disease, but is used as a general indicator of inflammation. Normal values vary slightly with age and gender. Various tests can be done, and some are CLIA-waived. The results are reported in millimeters per hour (mm/hr).

Question 48

When is the administration of Rho(D) immune globulin absolutely necessary?

Answer 48

If an Rh-negative mother gives birth to an Rh-positive stillborn. Rho(D) immune globulin is a protein solution containing large amounts of Rh(D) antibodies. It is given to the Rh-negative mother by injection after a miscarriage or abortion or after the delivery of an Rh-positive baby. In most cases, it now is also given during pregnancy. The immune globulin prevents the infant’s Rh-positive cells from stimulating the mother’s immune system.

Question 49

Hemoglobin A1c is measured to monitor:

Answer 49

Diabetes. The hemoglobin A1c (HbA1c) test provides information about the average blood sugar level during the previous 2 or 3 months. In the blood, glucose binds irreversibly to hemoglobin molecules in RBCs. The amount of glucose bound to hemoglobin is directly tied to the concentration of glucose in the blood.

Question 50

Which of the following is a normal adult WBC count?

Answer 50

10,000 cells/mm3 The normal WBC count varies with age. It is higher in newborns and declines throughout life. The average adult range is 4,000 to 11,000 cells/mm3.

Question 51

The copper sulfate method of determining the hemoglobin level is:

Answer 51

The copper sulfate method is a CLIA-waived, manual method of determining the hemoglobin level. It is often used to screen blood donors. The test is based on the principle of specific gravity. When a drop of blood from a patient with a normal hemoglobin value is dropped into a copper sulfate solution, it falls rapidly to the bottom. If the drop falls slowly or not at all, the hemoglobin level is below reference range. *All of the above

Question 52

A properly prepared wedge smear:

Answer 52

A good wedge smear should cover one half to three fourths of the slide. It should show a gradual transition from a thick to a thin end, with a feathered edge. It should have a smooth appearance with no ridges, holes, lines, streaks, or clumps. The cells should be distributed evenly on microscopic examination.

Question 53

While Mr. Chakrabarti’s hematocrit sample is spinning in the centrifuge, you perform an automated hemoglobin test on a sample of his blood and record the value as 15 g/dL. You do a quick mental calculation and expect that the hematocrit value will be approximately:

Answer 53

45%. Hemoglobin and hematocrit are often performed together and are referred to as an “H&H.” A quick mental calculation should always be done before reporting out H&H results; the hemoglobin value, ´3 ±3, should equal the hematocrit value.

Question 54

Which statement is true about HDL?

Answer 54

It transports cholesterol. HDL cholesterol is known as the good cholesterol because a high level of HDL cholesterol seems to protect against heart attacks. Medical experts think that HDL carries cholesterol away from the arteries and back to the liver, where it is passed from the body.

Question 55

The protime is:

Answer 55

The protime, or prothrombin time (PT), test uses whole blood collected in a tube that prevents the blood from clotting. This test, which measures how well the blood clots, is used to monitor patients taking warfarin. *All of the above

Question 56

A hematocrit reading of 37 indicates what?

Answer 56

RBCs account for 37% of the total blood volume. The hematocrit is a measurement of the percentage of packed RBCs in a blood sample.

Question 57

A decreased hematocrit value could be the result of:

Answer 57

A low microhematocrit value can indicate anemia or the presence of bleeding; a high value may be caused by dehydration or a condition such as polycythemia vera. *both B and C

Question 58

Dr. Lim orders a creatine phosphokinase (CPK) draw on Mr. Roberts. What do elevated CPK levels indicate?

Answer 58

Possible myocardial infarction (MI). CPK levels are elevated if tissue damage has occurred; myocardial damage causes an increase in CPK.

Question 59

The buffy coat:

Answer 59

Is white. After centrifugation, RBCs are at the bottom of the tube, the white buffy coat, which includes WBCs and platelets, is in the center, and the plasma is on top.

Question 60

Which statement is true about leukocytes?

Answer 60

Leukocytes are the largest circulating blood cells. Granulocytes have segmented nuclei. Neutrophils are the most numerous WBCs in circulation. Bacterial infections stimulate increased production of neutrophils. *All of the above. Leukocytes are the largest of the normal circulating blood cells. Each of the five types has a characteristic appearance. The granulocytes include neutrophils, eosinophils, and basophils. Granulocytes contain distinctive granules in their cytoplasm and may have segmented nuclei. The agranulocytes include lymphocytes and monocytes. They have few, if any, granules and nonsegmented nuclei. The nuclei of the leukocytes should appear purple, and their cytoplasm may vary from pink to blue or blue-gray. Neutrophils are known by a variety of names, including polymorphonuclear neutrophils and segmented neutrophils (“polys” and “segs”). They are the most numerous WBCs in circulation in adults. They are produced in bone marrow, released into the circulation, and eventually enter tissues to fight off invading microorganisms by phagocytosis. Many types of bacterial infections stimulate increased production of neutrophils.

Question 61

A blood test that analyzes the ability of the kidneys to perform their function is the:

Answer 61

BUN. The blood urea nitrogen (BUN) test evaluates the kidneys’ ability to filter out and excrete wastes.

Question 62

Which of the following is a normal H&H for a woman?

Answer 62

36% and 14 g/dL. The normal range for the hematocrit in women is 36% to 45%; the normal range for the hemoglobin is 12 to 16 g/dL.

Question 63

Thyroid-stimulating hormone (TSH) levels are assessed to determine the function of which organ(s)?

Answer 63

The pituitary gland produces TSH to stimulate the thyroid to produce triiodothyronine (T3) and thyroxine (T4).

Question 64

Which of the following is an abnormal value for a differential?

Answer 64

50% to 70% basophils Basophils are associated with an immediate immune response to external antigens, such as occurs with asthma, hay fever, and anaphylaxis.

Question 65

A person with type O blood has:

Answer 65

anti-A and anti-B antibodies in circulation. Type O negative blood is referred to as the universal donor because it has no circulating antibodies to the ABO antigen, nor does it have Rh antigens that might sensitize an Rh-negative recipient.

Question 66

Erythrocytes have a typical ________ shape because of _________.

Answer 66

convex; adequate hemoglobin concentration The immature form of the RBC has a nucleus that disintegrates as the cell matures. Loss of the nucleus results in the familiar shape of the RBC, the biconcave disk that is thicker at the rim than in the middle.

Question 67

Increases in the RBC count are found in which of the following disorders?

Answer 67

Dehydration. The RBC count often is decreased in anemia. Increases are found in individuals with dehydration, polycythemia vera, or severe burns and in people who live at high altitudes as an adaptation to the lower oxygen content of the air.

Question 68

You need to collect a venous blood specimen from a patient to run an FBS. Which of the following would be an inappropriate statement to make to the patient during this procedure?

Answer 68

“This procedure will not hurt.”

Question 69

Which of the following antecubital veins is considered the best vein to use for a venipuncture?

Answer 69

Median cubital vein

Question 70

Which of the following represents an ERROR in technique when obtaining a capillary blood specimen?

Answer 70

Using the first drop of blood for the test

Question 71

If you suspect a vein selected for venipuncture might collapse, you should:

Answer 71

Use the butterfly method to perform the venipuncture

Question 72

Which of the following is a disadvantage of using the syringe method of venipuncture?

Answer 72

The amount of blood specimen that can be collected is limited by the size of the syringe

Question 73

Which of the following gauge needles should be used to perform a venipuncture?

Answer 73

21 G

Question 74

An evacuated glass tube with a red stopper contains:

Answer 74

Nothing

Question 75

What may occur if an outdated evacuated tube is used to collect the blood specimen?

Answer 75

The tube may no longer have a vacuum Correct

Question 76

During the venipuncture procedure, a sudden swelling occurs in the area around the puncture site. You should:

Answer 76

Immediately remove the tourniquet and then the needle

Question 77

When performing a capillary puncture, the finger should NOT be squeezed to avoid:

Answer 77

Diluting the blood sample with tissue fluid Correct

Question 78

Which of the following sites can be used to make a skin puncture on an adult?

Answer 78

Lateral part of the third fingertip

Question 79

Which of the following should NOT be used as a venipuncture site?

Answer 79

``` Scarred skin Bruised skin An area that is painful to the patient Burned skin *All of the above ```

Question 80

The primary function of a neutrophil is to:

Answer 80

Engulf pathogens through phagocytosis Correct

Question 81

Which is the largest of the white blood cells?

Answer 81

Monocyte

Question 82

Leukocytes do their work in the:

Answer 82

Tissues

Question 83

An increase in eosinophils often occurs:

Answer 83

During an allergic reaction Correct

Question 84

Mrs. Nelson has a white blood cell count of 14,500. This is considered:

Answer 84

Above normal range Correct

Question 85

Which type of the following white blood cells has granules in the cytoplasm that stain a bright reddish orange?

Answer 85

Eosinophil

Question 86

Mr. Johnson has a hematocrit reading of 60. This is considered:

Answer 86

Increased

Question 87

The nucleus of a neutrophil generally contains:

Answer 87

Three to five lobes

Question 88

Mr. Peterson has a hemoglobin reading of 16. This is considered:

Answer 88

Within normal range Correct

Question 89

Pus consists of all of the following EXCEPT:

Answer 89

Erythrocytes

Question 90

Hemolysis of a blood specimen results in:

Answer 90

Inaccurate test results Correct

Question 91

On standing, a blood specimen to which an anticoagulant has been added separates into:

Answer 91

Plasma, buffy coat, and blood cells Correct

Question 92

When performing a venipuncture, which of the following techniques represents a violation of the OSHA standard?

Answer 92

Placing the contaminated needle in a biohazard bag

Question 93

Which of the following represents an ERROR in technique when selecting a vein for venipuncture?

Answer 93

Using the thumb to palpate the vein

Question 94

Which of the following indicates the correct order of draw for the vacuum tube method of venipuncture?

Answer 94

Red, green, lavender, gray

Question 95

You are performing a venipuncture, and the patient becomes dizzy and is about to faint. Your first priority in this situation should be to:

Answer 95

Protect the patient from injury

Question 96

Which of the following may result in hemolysis of the blood specimen?

Answer 96

Using a needle with a small lumen to collect the specimen

Question 97

Why should the veins of the hands be used as a venipuncture site only as a last resort?

Answer 97

They have a tendency to roll They are more difficult to stick The procedure is more uncomfortable for the patient The hand veins are more susceptible to collapsing *All of the above

Question 98

An evacuated glass tube with a lavender stopper contains:

Answer 98

EDTA

Question 99

When collecting a blood specimen using the vacuum tube method of venipuncture, venous reflux is prevented by:

Answer 99

Keeping the patient’s arm in a downward position Correct