final lecture

Question 1

serum

Answer 1

the liquid portion of blood after clotting has occured

Question 2

plasma

Answer 2

the liquid portion of blood without the cells when blood is spun down in a tube with anticoagulant

Question 3

what is the primary function of the anticoagulant sodium fluoride?

Answer 3

antiglycolytic agent

inhibits glycolysis

Question 4

choice of anticoagulant for hematology

Answer 4

EDTA

Question 5

choice of anticoagulant for coagulation

Answer 5

sodium citrate

Question 6

choice of anticoagulant for chemistry

Answer 6

heparin

Question 7

why is freezing whole blood not normally recommended to preserve a specimen

Answer 7

the red cells will lyse causing hemolysis

Question 8

what are the two primary reasons patients are placed in isolation rooms?

Answer 8

to protect healthcare staff and visitors from infections

to protect an immunocompromised patient

Question 9

how does EDTA prevent clotting?

Answer 9

by binding/chelating calcium in the form of potassium or sodium salt

Question 10

how does heparin prevent clotting?

Answer 10

inhibits conversion of prothrombin to thrombin

Question 11

what are the capillary puncture sites on an adult?

Answer 11

the index, middle, or ring finger.

Question 12

where would you not want to perform capillary puncture on adult?

Answer 12

the middle of the finger

Question 13

what is the preferred area on a finger for puncture?

Answer 13

perpendicular to the fingerprints on the outside of the finger

Question 14

what is a hematoma and what causes it?

Answer 14

• collection of blood under the skin - indicative of poor technique
• going through a vein
• partially inserting needle into vein
• grazing side of the vein

Question 15

state the consequences of pushing a tube onto the needle before entering the patient’s vein.

Answer 15

loss of vaccum = no suction in tube

could contaminate tube

Question 16

explain the purpose of removing the tube from the needle prior to withdrawing from the patient’s vein.

Answer 16

to release the vaccum in the tube

Question 17

what are clot activators and some examples

Answer 17

substance that inhibits or enhances coagulation

ex. glass/silica/siliceous earth/ thrombin

Question 18

explain the order of draw

Answer 18

the order of draw is the list of when to draw specific tubes in a specific order

Question 19

why does the order of draw exist?

Answer 19

this exists to prevent the cross contamination of additives between tubes

Question 20

what does a sclerosed vein feel like when palpated?

Answer 20

hard/cord like

Question 21

should a sclerosed vein ever be used for veinipuncture?

Answer 21

no

Question 22

what is edema?

Answer 22

swelling

Question 23

what is fistula?

Answer 23

abnormal connection between artery and vein

Question 24

why are fistulas important to consider when deciding on site selection for venipuncture?

Answer 24

they are used for dialysis patients, so cannot be used

Question 25

explain what a bevel is & what abnormalities to look for

Answer 25

bevel is the slanted tip on hollow venipuncture needle ex. bent/curved/shaved/burns/spurs

Question 26

why are therapeutic drug monitoring tests often timed collection tests?

Answer 26

to measure the peak and trough levels because people metabolize drugs at different rates and to monitor the amount of drugs at certain times to maximize effectiveness and prevent toxicity

Question 27

what is the name of the heel bone?

Answer 27

calcaneus

Question 28

what does skin puncture blood most closely resemble?

Answer 28

arterial blood

Question 29

explain why routine or strict isolation is used.

Answer 29

patient is isolated to prevent the spread of a communicable disease

Question 30

what is the PPE used in routine and strict isolation?

Answer 30

gown, masks, gloves

Question 31

explain protective or reverse isolation.

Answer 31

patient is isolated to protect from infection (severely immunocompromised patients)

Question 32

what PPE is used in protective or reverse isolation?

Answer 32

gown, masks, gloves, hair net, booties

Question 33

what does an abnormal retraction of a blood vessel wall during venipuncture cause?

Answer 33

vein collapse

Question 34

what is the most important thing you should do before performing any type of specimen collection on a patient

Answer 34

wash hands and ID patient

Question 35

what should you do if a patient refuses to let you collect a specimen on them?

Answer 35

let the doctor know

Question 36

why should you allow the alcohol on the skin to dry properly before inserting the needle?

Answer 36

painful to patients and will lyse red cells

Question 37

specimens should always be labeled where and when?

Answer 37

immediately after draw while still with patient

Question 38

in regards to placement of the needle's bevel in the vein, where would it fall that it would NOT allow collection of a blood specimen?

Answer 38

anywhere except facing up needle penetrates through entire vein went alongside vein

Question 39

what are some possible techniques for transferring blood from a syringe into the proper collection tubes?

Answer 39

transfer device

Question 40

describe the proper puncture site on an infants' heel for skin puncture

Answer 40

medial or lateral on plantar surface

Question 41

once a red stopper tube is spun down, what type of specimen does it yield

Answer 41

serum and clotted red cells

Question 42

how much a collection site be prepared for collecting blood cultures?

Answer 42

cleaned with beta-dyne in non-overlapping circular motion

Question 43

why is it important to take the extra steps for blood cultures?

Answer 43

to ensure sterility

Question 44

in regards to therapeutic drug monitoring, the highest concentration of the drug during a dosing interval is called the ____

Answer 44

peak

Question 45

explain the procedure for collecting specimens for a glucose tolerance test

Answer 45

- specimen drawn after pt. has fasted overnight - pt. drinks glucose solution - mark time - specimens drawn at 1 hr. intervals until complete (up to 5 hours)

Question 46

does the order of draw change depending on the collection equipment you use ?

Answer 46

no

Question 47

why should the site be warmed before performing skin puncture?

Answer 47

increases blood flow

Question 48

why is controlling the depth of your lancet important during skin puncture?

Answer 48

if depth is not controlled could puncture bone or cause excessive bleeding

Question 49

what step must you take, when doing a skin puncture, to eliminate tissue fluid contamination?

Answer 49

wipe away first drop of blood

Question 50

what is a possible consequence of mixing a tube to vigorously?

Answer 50

hemolysis

Question 51

when drawing a blood on a child, what are some extra steps you should take prior to venipuncture because of the age of your patient?

Answer 51

- gain child's confidence - -acknowledge child and parent - ask for help to restrain child

Question 52

what should you not do when performing specimen collection on a child?

Answer 52

- rush in - do not ignore the child - do not try to draw without a restrain on hand

Question 53

why should a patient not pump their fist prior to venipuncture?

Answer 53

hemoconcentration

Question 54

what is the most critical error a phlebotomist can make?

Answer 54

ID error

Question 55

what indicator lets you know you are in the vein when performing a syringe draw?

Answer 55

flash of blood

Question 56

what is the longest amount of time a tourniquet should be tied on a patient's arm prior to venipuncture?

Answer 56

less then one minute

Question 57

the alcohol prep pad used for cleaning a puncture site is what concentration?

Answer 57

70% isopropyl alcohol

Question 58

give a couple examples of coagulation test

Answer 58

PT PTT fibrinogen D-Dimer

Question 59

what color tube is coagulation tests collected in?

Answer 59

blue

Question 60

what is the anticoagulant used in the blue tubes?

Answer 60

sodium citrate

Question 61

what should you do if your patient does not have an ID band on but is not conscious or able to ID themselves?

Answer 61

have a nurse put an ID band on

Question 62

how should you handle questions from a patient about what tests you're drawing and what they mean?

Answer 62

be as brief as possible and refer them to their doctor

Question 63

do you ever draw a specimen from above an IV? why?

Answer 63

no because of the dilution that will occur in the sample

Question 64

what should you do if you cannot draw on a patient's arms because of multiple IV's?

Answer 64

ask nurse to stop the IV wait 10 minutes then draw

Question 65

why is it so important to mix anticoagulant tubes thoroughly after filling them?

Answer 65

mix equally with additives because micro-clots may occur

Question 66

what is the smallest bore on a needle?

Answer 66

25

Question 67

what is the largest bore on a needle?

Answer 67

18

Question 68

small veins on a patient may collapse when what occurs?

Answer 68

blood drawn to quickly

Question 69

what indication might alert you to the possibility that you have entered an artery during venipuncture?

Answer 69

bright red blood pulsing into the tube

Question 70

what is the number one cause of hemoconcentration during venipuncture/

Answer 70

long tourniquet application

Question 71

is water considered an acceptable thing to drink before a fasting sample is drawn?

Answer 71

yes

Question 72

is coffee acceptable to drink before drawing of fasting sample?

Answer 72

no

Question 73

is smoking acceptable before fasting sample?

Answer 73

no

Question 74

normal serum appearance

Answer 74

clear straw color

Question 75

normal plasma appearance

Answer 75

slightly opaque straw color

Question 76

hemolyzed serum appearance

Answer 76

clear red

Question 77

icteric serum appearance

Answer 77

brownish-yellow

Question 78

lipemic serum appearance

Answer 78

milky-white

Question 79

color tube of heparin

Answer 79

green

Question 80

color tube of no additive

Answer 80

red

Question 81

color tube of EDTA

Answer 81

lavender

Question 82

color tube of sodium citrate

Answer 82

blue

Question 83

color of tube of silicon serum separation material

Answer 83

red/gray/gold

Question 84

color of tube sodium fluoride

Answer 84

gray

Question 85

color of tube SPS

Answer 85

yellow