Exam

Question 1

Explain Universal Precautions as it applies to phlebotomy

Answer 1

Blood and certain body fluids of all individuals are considered potentially infectious.

Question 2

Explain Standard Precautions as it applies to phlebotomy

Answer 2

Precautions to use in caring for all patients regardless of diagnosis or presumed infection status. Standard precautions apply to all body fluids. Wear proper PPE

Question 3

Explain Transmission based precautions as it applies to phlebotomy

Answer 3

Precautions to use for patients either suspected or known to be infected with certain pathogens transmitted by airborne, droplet, or contact routes

Question 4

What are 5 steps that can be taken to reduce the risk of exposure to bloodborne pathogens?

Answer 4

1) Wash hands when changing gloves and between patients.
2) Wear gloves during all blood collections.
3) Wear protective covering when clothing is likely to be soiled.
4) Wear mask or eye protection.
5) Properly dispose of needles / syringes / sharps.

Question 5

What are typical precautionary measures and actions that are taken in the event of an accidental needle puncture or body substance exposure?

Answer 5

Immediately cleanse exposed area.

Report incident to supervisor immediately.

Healthcare worker is tested for HIV, HBV and hepatitis C if consent is given.

If source patient is known, consent must be obtained and baseline HIV, HBV and hepatitis C tests are performed.

If source patient refuses testing, worker has a right to prophylaxis treatment.

Follow-up testing

Question 6

Describe Protective (Reverse) Isolation. When is it utilized? What is the phlebotomist’s responsibility to a patient in protective isolation?

Answer 6

Protective isolation is designed to protect the patient from the healthcare worker.

Patients who are immunosuppressed or transplant patients are often in protective isolation.

PPE must be worn before entering the patient’s room. All phlebotomy supplies need to remain outside of the patients room or cleaned before be brought in.

Question 7

List two instances when a syringe is more applicable than the evacuated® tube method for blood draw?

Answer 7

Drawing from a vein other than in the anticubital area.

Difficult-to-draw patient who have fragile, thin, or “rolling” veins.

Question 8

List the anticubital veins in order of choice for routine venipuncture:

Answer 8

a. Median cubital vein
b. Cephalic vein
c. Basilic vein

Question 9

What step should be done prior to beginning a specimen collection utilizing a syringe?

Answer 9

Pull back plunger to remove air lock.

Question 10

State the relationship between bore size and the gauge of the needle.

Answer 10

The larger the gauge the smaller the bore. A larger gauge needle would be used on a narrow vein.

Question 11

How does EDTA prevent coagulation?

Answer 11

Binds/chelates calcium

Question 12

How does Potassium Oxalate prevent coagulation?

Answer 12

Precipitates calcium

Question 13

How does Citrate prevent coagulation?

Answer 13

Binds/chelates calcium

Question 14

How does Fluoride prevent coagulation?

Answer 14

Inhibits glycolysis

Question 15

How does Heparin prevent coagulation?

Answer 15

Inhibits thrombin

Question 16

What anticoagulant is in the following?
Light blue
Gray
Green

Answer 16

Light blue - Sodium citrate 3.2%
Gray - Lithium iodoacetate and lithium heparin
Green - Sodium heparin or Lithium heparin

Question 17

What anticoagulant is in the following?
Lavender (purple)
Red
Red/black

Answer 17

Lavender - EDTA
Red - No anticoagulant
Red/black - gel/clot activator. Sodium heparin

Question 18

What is the purpose of adding a silicon coating to a collection tube?

Answer 18

Fills the microscopically rough surfaces of glass so that cells don’t adhere to the sides of the tube.
Reduces the chance for hemolysis.

Question 19

What is the purpose of adding silica particles to a collection tube?

Answer 19

Acts as a clot activator, initiates clotting process

Question 20

What is the purpose of adding thixotropic gel to a collection tube?

Answer 20

Inert gel that undergoes change in viscosity during centrifugation.
Acts as an interface between cells, serum or plasma

Question 21

In what order should blood tubes be drawn for evacuated tube?

Answer 21

Stop Light Red Stay Put, Green Light Go

Sterile (Blood culture), light blue, red, SST and PST(gold), green, lavender, grey

Question 22

What role does the tourniquet play in specimen collection? What effects are there if the tourniquet remains on to long?

Answer 22

Used to access and find a good vein

Leaving it on to long can cause hemoconcentration/hematoma.

Question 23

Describe different types of lancets used in capillary specimen collection based on area of collection and depth of puncture.

Answer 23

Neonatal to 12 months of age: heelsticks, < 2.0 mm
Shallow incision: for toddlers, children, = 1.8 mm
Normal incision: point of care tests. = 2.4 mm
Deeper incision: = 3.0 mm

Question 24

Explain social, clerical, and technical skills.

Answer 24

Social - skills involving the patient
Clerical - skills with data entry and record keeping
Technical - skills drawing the patient

Question 25

What are common causes of hemolysis in the syringe or evacuated tube techniques?

Answer 25

Traumatic draw. Alcohol still on the arm during the draw. A small needle on a syringe. Shaking the blood in a tube instead of gently inverting 5-8 times. Pulling or depressing plunger to hard.

Question 26

What is informed consent?

Answer 26

A decision made by or for a patient after being informed about the proposed procedures. Implied consent is patient laying out their arm.

Question 27

What is the order of draw from microcollection tubes?

Answer 27

Blood gases, EDTA, other additives, serum specimen.

Question 28

Proper area for capillary specimen collection of finger and heel.

Answer 28

Finger - 3rd and 4th fingers of the non-dominant hand. Perform the stick off to side of the center of the finger. Heel - Most medial or lateral portions of the plantar surface of the heel.

Question 29

Criteria for the following specimens: Fasting Timed

Answer 29

Fasting - Patient can't eat for 12 hours. Helps with a more accurate glucose level Timed - Should be drawn within 15 minutes of being ordered.

Question 30

Criteria for the following specimens: Therapeutic Drug Monitoring Stat ASAP

Answer 30

Therapeutic Drug Monitoring - measurement of medication concentrations in blood Stat - 10 minutes or less ASAP - one hour or less

Question 31

Reasons to reject a sample.

Answer 31

Incomplete or not clearly labeled specimen Unlabeled or mislabeled specimen Specimen hemolyzed Specimen too old

Question 32

Describe the modified allen test procedure and purpose.

Answer 32

Purpose: A modified Allen test measures arterial competency, and should be performed before taking an arterial sample. Procedure: Apply pressure to wrist both radial and ulnar artery. Have patient open and close hand slowly, it will turn white. Release pressure from artery by pinky (ulnar). If hand turns pink you can collect sample.

Question 33

Define Arteriospasm

Answer 33

Spasm of the artery

Question 34

Describe the cleansing process utilized in the collection of blood cultures.

Answer 34

Clean the tops of collection bottles with iodine. Place a clean alcohol pad on top of each bottle until they are inoculated. Immediately before inoculation, wipe the top with the pad to prevent iodine contamination of the sample.

Question 35

What anticoagulant is used in arterial blood draws?

Answer 35

Heparin

Question 36

What is the angle of the needle when performing an arterial puncture?

Answer 36

45 degrees

Question 37

Causes of hematoma

Answer 37

Push needle in to far.

Question 38

What tube should be drawn for coagulation tests? (PT and APTT)

Answer 38

Light blue, plasma used

Question 39

What tube should be drawn for a CBC?

Answer 39

Purple top, whole blood used

Question 40

What tube should be drawn for Troponin or electrolyte tests?

Answer 40

Green top (without sodium), plasma or whole blood used

Question 41

What tube should be drawn for a transfusion work up?

Answer 41

Purple top (EDTA tube), plasma and RBCs

Question 42

What is a yellow/Gold top SPS tube used for?

Answer 42

Blood cultures

Question 43

What are Dark blue top EDTA tubes used for?

Answer 43

trace elements testing

Question 44

What are red top tubes used for?

Answer 44

Serum used - chemistry analytes

Question 45

What are grey cap tubes used for?

Answer 45

blood sugars, legal or medical blood draws, lactic acid/lactate

Question 46

Special circumstances for a hematoma

Answer 46

May need to draw elsewhere. | Hold pressure for longer periods of time

Question 47

What to do when a patient faints?

Answer 47

Stop procedure and apply pressure. If they are sitting put their head between knees. Call for help,

Question 48

How to draw from obese patients?

Answer 48

May need to do capillary (fingerstick) draw

Question 49

Importance of a phlebotomist on a healthcare team.

Answer 49

1. Represent the laboratory 2. A properly collected sample is a very important part of the process of obtaining an accurate lab result test 3. "humanistic care"

Question 50

Correct patient and specimen identification protocol

Answer 50

Use two forms of identification

Question 51

Serum vs plasma

Answer 51

Serum is the liquid that remains after the blood has clotted. Plasma is the liquid that remains when clotting is prevented with the addition of an anticoagulant

Question 52

Drawing from a psychiatric patient

Answer 52

May have to have nurse draw the sample. Only bring supplies you need, they might take items.

Question 53

Drawing from the saline lock

Answer 53

Check with nurse. Use other arm is possible. Must stick below I.V site.

Question 54

Drawing from a patient with a mastectomy

Answer 54

Can't draw on same side as mastectomy.

Question 55

Drawing from a catheter.

Answer 55

Requires nurse.

Question 56

Drawing from fistula/cannula patient

Answer 56

Requires nurse. Draws from dialysis machine.

Question 57

What is the effect of a short collection in the following tubes: Blue Lavender

Answer 57

Blue: will decrease the blood to anticoagulant ratio. Lavender: RBC shrinkage.

Question 58

What can cause hemolysis that may occur during the capillary specimen collection process?

Answer 58

Milking the finger or heel

Question 59

Order of the draw for syringe

Answer 59

Sterile (blood culture), light blue, lavender and PPT, green and PST, grey, red, SST

Question 60

Drawing patients with edema

Answer 60

Should be avoided. Edema can contaminate or dilute the results.

Question 61

Interfering substances.

Answer 61

Alcohol, betadine.