Sample Management: Patient Preparation, Specimen Collection, Labeling, Handling and Processing

Question 1

Points to consider before releasing laboratory results

1. Is it normal? If not, consider the (_____)
2. Is it significantly different from the previous result? If not, perform a (_____)
3. Is it consistent with the clinical findings? If not, do (_____)
4. Is your machine accurate and precise? f in doubt, perform (_____)

Answer 1

1. the panic value and critical value
2. delta check (post exam usually)
3. pattern recognition
4. randomized duplicate testing

Question 2

Which compares the result obtained for one specimen with the previous result(s) obtained for the same patient?
A. Randomized duplicate specimens
B. Average normal
C. Delta checks
D. Pattern Recognition

Answer 2

C

Question 3

Unusual result flowchat

1. Possible clinical review can lead to?
2. Do a (_____) if the results are unusual
3. After checking, if the result is still too high, then refer it to the (_____) .
4. If there is an error, (_____) .
5. If the same results, do (_____) .
   Once the result is corrected, you may release the result.

Answer 3

1. misidentification
2. Delta check
3. Pathologists
4. Repeat analysis
5. specimen and instrument analysis

Question 4

Test request is requested by a
A. nurse
B. pathologists
C. clinician
D. medical laboratory scientist

Answer 4

C

Question 5

A specimen was received in your section. You noticed that the first name and last name of the patient match the request from, but the middle name does not. Who should you ask about the specimen? This question is not book-based but instead made from an experience.

A. Receptionist
B. Nurse Ward
C. Medtech who received the specimen
D. Physician

Answer 5

A. Receptionist
B. Nurse Ward: Correct Answer if In-patient
C. Medtech who received the specimen: Correct answer based on Sir Retoriano
D. Physician: never answer

Question 6

The following analytes are affected by hemolysis:

1. The primary intracellular anion
2. Most affected enzyme in hemolysis; increased in RBC
3. 2ND MOST ABUNDANT ICF (Intracellular Fluid Cation)
4. MOST ABUNDANT ICF (Intracellular Fluid
   Cation)

Answer 6

1. Potassium
2. LDH
3. Magnesium
4. Phosphate

Question 7

Enumerate the analytes affected by hemolysis

Answer 7

KLAMPAT

K+: Potassium
L: LDH
A: AST, ACP, Aldolase
M2: Magnesium
PO4: Phosphate
A: Albumin
T: Total Protein

Question 8

LIPEMIA

1. creamy/opaque layer is caused by
2. turbid is caused by
3. If increase cholesterol = clear only, no turbidity is caused by

Answer 8

1. chylomicrons; exogenous Tg; APO B48, nonfasting
2. triglycerides (>400 mg/dL); VLDL; endogenous Tg; APO B100, fasting
3. rare case of hyperlipidemia (higher triglycerides)

Question 9

LIPEMIA

1. Chylomicrons: APO, fasting/non
2. Triglycerides: APO, fasting/non
3. Lipoprotein of Tg
4. Cholesterol: fasting/non
5. Collection tube for cholesterol evem without fasting

Answer 9

1. APO B58, nonfasting, exogenous
2. APO B100, fasting, endogenous
3. VLDL
4. Even without fasting
5. EDTA plasma

Question 10

Use (____) to resolve BHL

Answer 10

Bilirubin, Hemoglobin, and Lipids (BHL) - Blanks

Question 11

Bilirubin, Hemoglobin, and Lipids

1. When the color of the reagent is the problem; used before
2. Used during testing to identify if there is a problem in the color of the specimen/sample
3. Sets the spectrophotometer reading to 0; used before

Answer 11

1. Reagent blank
2. Sample blank
3. Water blank

Question 12

QUESTION 32: If 100% transmittance is not reached, the component of the spectrophotometer that has a problem is the…?

Light source
Monochromator
Photodetector
Readout device

Answer 12

Light source

Question 13

Types of Specimens

1. Liquid portion of the blood(plasma) from arterial and venous
2. Liquid portion of unclotted or anticoagulated blood. w/ fibrinogen; not used in enzyme assays because it inhibits the enzyme
3. Liquid portion of clotted blood w/o fibrinogen; Most commonly used sample; Reasons why serum is used: It is clearer than plasma, Without anticoagulant
4. Measures: Total Protein & Glucose
5. for Glomerular filtration rate & Creatinine clearance tests

Answer 13

1. Whole blood
2. Plasma
3. Serum
4. CSF
5. 24 Hour Urine

Question 14

Which level of triglyceride is difficult/hard to
measure?
A. 600 mg/dL
B. 400 mg/dL
C. 200 mg/dL
D. 100 mg/dL

Answer 14

600 mg/dL: This is already considered “milky.”

Question 15

1. Remedy for Milky specimen:
2. Reference range of Fasting for Lipid Profile is

Answer 15

1. Dilute sample
2. 10-12 hours

Question 16

In the Friedewald equation, how many hours of fasting are needed for a lipid profile?
A. 10 hours
B. 12 hours
C. both

Answer 16

B

Question 17

1. You can measure cholesterol without fasting? In what sample?
2. If bilirubin, hemoglobin, and lipids are high, what will you use?
3. If the sample is icteric, lipemic, or hemolyzed?
4. Which 3 analytes are the most seriously affected by hemolysis?

Answer 17

1. Answer : TRUE, in EDTA plasma, not serum.
2. Answer : Use Sample Blank
3. Answer : Use Sample Blank
4. Answer : Potassium, LDH, and AST

Question 18

1. For STAT and POCT
2. Best Sample of Choice for STAT

Answer 18

1. WHole blood
2. Plasma (lithium heparin)

Question 19

PATIENT FACTORS THAT AFFECT TESTING DIURNAL VARIATION

enumerate (9)

Answer 19

1. Cortisol
2. ACTH
3. Plasma Renin Activity
4. Aldosterone and Insulin
5. GH and ACP
6. Thyroxine
7. Prolactin
8. Iron
9. Calcium

Question 20

Cortisol

1. Peaks at (____) - (____)
2. Lowest at (____) - (____)
3. Increases with (____)
4. Best time to collect (____) to (____)
5. Cortisol and ACTH are both affected
6. ACTH is not affected

Answer 20

1. 4-6AM
2. 8PM-12AM
3. Stress
4. 6AM-8AM
5. Cushing disease
6. Cushing syndrome

Question 21

PATIENT FACTORS THAT AFFECT TESTING DIURNAL VARIATION

1. Lower at night, increases with stress
2. Lower at Night; Higher value while standing than supine
3. Higher in the afternoon and evening
4. Higher levels at 4 and 8 am and 8 - 10 pm; higher with stress
5. Peaks early to late morning, decreases up to 30% during the day
6. 4% decrease when in supine position

Answer 21

1. ACTH
2. Plasma renin activity
3. GH and ACP
4. prolactin
5. Iron
6. Calcium

Question 22

1. stress can cause a decrease in
2. Posture can cause a decrease in?
3. Alcool can cause a decrease in?
4. Alcool can cause an increase in?
5. Recent food intake can sause a decrease in?

Answer 22

1. HDL, Respirarory alkalosis
2. Lipids due to hemodilution
3. Glucoose due to ethanol
4. Tg and GGT
5. Cl, PO4, K

Question 23

Fasting

1. increase in plasma triglyceride; decrease in glucose
2. increase in serum bilirubin

Answer 23

1. > 72 hours
2. > 48hrs

Question 24

Non-Fasting

Answer 24

Increased: Glucose, triglycerides, aspartate aminotransferase (AST), bilirubin, blood urea nitrogen (BUN), phosphorus, uric acid, growth hormone, cholesterol, lipoproteins (high-density lipoprotein (HDL), low-density lipoprotein(LDL).

Question 25

# Diet 1. High Protein diet: 2. High protein and Low CHO: 3. Serotonin rich food:

Answer 25

1. Increased urea 2. Increased urine ketones 3. increased urine 5HIAA (makrer of carcinoid tumor)

Question 26

Prolonged tourniquet > 1 minute 1. decreased 2. Increased 3. Recommended interval between palpation and reapplication of tourniquet:

Answer 26

1. PO2, pH 2. potassium , albumin, total protein, enzymes, lactate, cholesterol and ammonia 3. 2 minutes

Question 27

Which isoenzyme is dominant in the heart?

Answer 27

CK-MM: 80% CK-MB: 20% *But CK-MB is more specific to the heart

Question 28

# Jaundice 1. Indicative of jaundice: 2. Icteric serum: 3. Normal value of hemoglobin in plasma:

Answer 28

1. 2 mg/dL 2. 25 mg/dL 3. 2-4 mg/dL

Question 29

Increased: Glucose, triglycerides, aspartate aminotransferase (AST), bilirubin, blood urea nitrogen (BUN), phosphorus, uric acid, growth hormone, cholesterol, lipoproteins (high-density lipoprotein (HDL), low-density lipoprotein(LDL).

Answer 29

Non fasting

Question 30

Increased: fatty acids, hormone levels, glycerol. Lipoproteins and serum gastrin

Answer 30

Coffee

Question 31

Increased: Creatinine, fatty acids, lactate, AST, creatine kinase (CK), lactate dehydrogenase (LD), uric acid, bilirubin, HDL, hormones(GH),cortisol, aldosterone, renin, angiotensin, and WBC

Answer 31

Short term exercise

Question 32

Short term exercise causes a decrease in

Answer 32

Arterial pH and pCO2

Question 33

Increased: Aldolase, Creatinine, Sex hormones, AST, CK, LD

Answer 33

Long-term Exercise

Question 34

**Increased**: Glucose, BUN, triglycerides, cholesterol, alkaline phosphatase (ALP), catecholamines, cortisol, IgE, hemoglobin, hematocrit, RBCs, and WBCs

Answer 34

Smoking

Question 35

Smoking can cause a decrease in

Answer 35

**Decreased**: IgG, IgM, IgA

Question 36

Insulin Increased: Protein, ALP, estradiol, free fatty acids, iron, and RBCs Decreased: Erythrocyte sedimentation rate (ESR), and factors II, V, VII, IX, X Glucagon, Cortisol

Answer 36

Fever

Question 37

Increased: Protein, ALP, estradiol, free fatty acids, iron, and RBCs Decreased: Erythrocyte sedimentation rate (ESR), and factors II, V, VII, IX, X

Answer 37

Pregnancy

Question 38

# SPECIMEN TRANSPORT AND STORAGE REQUIREMENTS 1. Blood gases, ACTH, acetone, ammonia, gastrin, glucagon, lactic acid, pyruvate, PTH, renin, catecholamines 2. Bilirubin, beta-carotene, folate, porphyrins, erythrocyte protoporphyrin, vitamin A (retinol) and vitamin B12 (cyanocobalamin) 3. Cold Agglutinins, cryoglobulins 4. FBS, lipid profile, gastrin, insulin A. Fasting B. Chilling C. Warming D. Protection from direct light

Answer 38

1. **B** Place in a slurry of crushed ice & water. Do not use ice cubes alone because RBCs may lyse 2. D (Wrap in aluminum foil) 3. C (Use 37ºC heat block, heel warmer, or hold in hand) 4. A (All are 8 hours except lipid profile (10-12 hours)

Question 39

# SPECIMEN TRANSPORT AND STORAGE REQUIREMENTS 1. Affects LD and ALP 2. 45 minutes after collection except for ABG (30 minutes) 2. DNA analysis A. Chain of custody B. Freezing of sample C. Delivery time

Answer 39

1. B - LD4 and LD5 - labile at low temperature (falsely decrease) - ALP inc. activity at low temperature (false increase) 2. C - Centrifuged within 1 hour or up to 2 hours - Minimize glycolysis - Must be analyzed within 4 hours (Except glucose and electrolytes) - Store at 4 ºC for 8 hrs (Except LDH, ALP, ACP, CK) - Freeze at -20 ºC for longer storage 3. A - Fill up chain of custody form - Purpose: identifies personnel who handled the specimen - Blood alcohol, drug screens, DNA analysis

Question 40

# REMEMBER: BLOOD COLLECTION 1. Use opposite arm or perform fingerstick if possible; Stop IV for 2 – 5 minutes 2. Draw from opposite arm 3. Draw first 5 ml then discard; Draw blood below the IV line if nothing is being transfused 4. Select other site A. Fistula B. IV C. Sclerosed veins D. Indwelling lines and catheters, heparin locks, cannulas

Answer 40

1. B 1. A 1. D 1. C

Question 41

1. Draw below 2. Hold pressure until bleeding has stopped 3. Select another site 4. Draw from the opposite arm 5. Ask nurse to ID before drawing A. Unidentified patient B. Mastectomy C. Edema, scars, burns, tattoos D. Streptokinase/tissue plasminogen activator (TPA) E. Hematoma

Answer 41

E D C B A

Question 42

If both arms are unavailable, the next option must be the

Answer 42

feet

Question 43

# PHLEBOTOMY SOURCES OF ERROR 1. Treatment error, possibility of transfusion fatality 2. Treatment errors if samples for certain tests aren’t drawn at appropriate time. 3. Infection at site if puncture. Contamination of blood culture and blood components 4. Dilution of sample with tissue fluid 5. Increase K+, lactic acid, Ca2+ , phosphorus, decreased pH A. Fist pumping during venipuncture B. Drawing from edematous site C. Improper skin disinfection D. Drawing at incorrect time E. Misidentification patient

Answer 43

EDCBA

Question 44

# PHLEBOTOMY SOURCES OF ERROR 1. Increase K+, total protein, lactic acid 2. Increase glucose, electrolytes 3. Carryover from one tube to another. Possible additive contamination 4. Micro-clots fibrin, platelet clumping can lead to erroneous results A. Tourniquet > 1 minute B. IV fluid contamination C. Failure to hold bottom of tube lower than top during collection D. Inadequate mixing of anticoagulant tube

Answer 44

1. **A** 1. **B** For every 10% contamination of D5W (dextrose-5 water), the glucose will increase by up to 500 mg/dL 1. C 1. D

Question 45

# Incorrect anticoagulant or contamination from incorrect order of draw 1. Decreases Ca & Mg 2. erroneous results of PT and APTT 3. Increase Na 4. Increase Lithium 5. Decreases Tricyclic 6. Falsely decreased values due to attaching to the thixotropic gel A. Increase K+ Contamination of citrate tube with clot activator B. K2 EDTA before serum or heparin tube C. Lithium Heparin D. Sodium Heparin E. Antidepressants and trace metals F. Gel separator

Answer 45

B A D C F E

Question 46

If you’re the phlebotomist, which of the following will you prioritize? a. FBS b. Cortisol c. CBC

Answer 46

A Rationale : FBS and cortisol are both timed, but the most correct answer is A. FBS. If FBS was not prioritized, the patient might become hyperglycemic or miss intake of their medicines or procedures.

Question 47

# Needle gauge What is the effect on draw volume if evacuated tubes are stored at high temperatures? Decrease None Indeterminate Increase

Answer 47

**Decrease**

Question 48

QUESTION 40: If blood was collected using an anticoagulant, how would the volume of plasma be usually described compared to blood collected without the anticoagulant and serum is obtained instead? Same Lower Greater Indeterminate

Answer 48

Greater

Question 49

# Gauge 1. PPD skin tests; not commonly used 1. Intramuscular injections; not commonly used 1. Butterfly or syringe collection pediatric patient 1. Syringe or ETS 1. IV for blood donation

Answer 49

1. 27 2. 25 3. 23 4. 20, 21, 22 5. 18, 16

Question 50

What is antiseptic used in ethanol testing?

Answer 50

Benzalkonium Cl or Zephiran

Question 51

Which of the following is not used as antiseptic during venipuncture? A. Benzalkonium chloride B. Sodium Hypochlorite (Zonrox) C. Gauze D. 70% alcoho

Answer 51

B

Question 52

What analyte is significantly affected by repeated and vigorous fist exercise during venipuncture causing falsely increased levels? A. Potassium B. Sodium C. Magnesium D. Calcium

Answer 52

A. Potassium

Question 53

What is the effect on draw volume if evacuated tubes are stored at high temperatures? A. Decrease B. None C. Indeterminate D. Increase

Answer 53

A

Question 54

If blood was collected using an anticoagulant how would the volume of plasma be usually described compared to blood collected without the anticoagulant and serum is obtained instead? A. Same B. Lower C. Greater D. Indeterminate

Answer 54

C

Question 55

# Order of draw Tube size: 1. Pedia 2. Adult

Answer 55

1. 150uL 2. up to 7mL

Question 56

# ORDER OF DRAW 1. ETS 2. Syringe 3. Capillary puncture 4. Catheter/Central venous access

Answer 56

1. B C N H E S ● B = Blood culture ● C = Citrate ● N = Non-additive ● H = Heparin ● E = EDTA ● S = Sodium Fluoride 2. B C H E F R 3. E O S 4. B A P