4 PHLEBOTOMY: COLLECTING AND PROCESSING PATIENT BLOOD SAMPLES

Question 1

One of the top five causes of preanalytical errors is:
a. Improperly filled blood collection tube
b. Patient incorrectly identified
c. Test request error
d. All the above

Answer 1

d. All the above

Question 2

Which transmission-based infection control precaution stops direct spread of bacteria by touching?
a. Contact precautions
b. Airborne precautions
c. Droplet precautions
d. Standard Precautions

Answer 2

a. Contact precautions

Question 3

Which transmission-based infection control precaution stops agents dispersed by talking, coughing, or
sneezing?
a. Contact precautions
b. Airborne precautions
c. Droplet precautions
d. Standard Precautions

Answer 3

c. Droplet precautions

Question 4

Which transmission-based infection control precaution provides protection from dust particles?
a. Contact precautions
b. Airborne precautions
c. Droplet precautions
d. Standard Precautions

Answer 4

b. Airborne precautions

Question 5

When the coagulation of fresh whole blood is prevented through the use of an anticoagulant, the straw-colored fluid that can be separated from the cellular elements is:
a. Serum
b. Plasma
c. Whole blood
d. Platelets

Answer 5

b. Plasma

Question 6

Which characteristic is inaccurate with respect to the anticoagulant dipotassium ethylenediaminetetraacetic acid
(K2 EDTA)?
a. Removes ionized calcium (Ca2+) from fresh whole blood by the process of chelation
b. Is used for most routine coagulation studies
c. Is the most often used anticoagulant in hematology
d. Is conventionally placed in lavender-stoppered evacuated tubes

Answer 6

b. Is used for most routine coagulation studies

Question 7

Heparin inhibits the clotting of fresh whole blood by neutralizing the effect of:
a. Platelets
b. Ionized calcium (Ca2+)
c. Fibrinogen
d. Thrombin

Answer 7

d. Thrombin

Question 8

An evacuated tube with EDTA has a ________ colored stopper.

a. Red
b. Lavender
c. Blue
d. Green

Answer 8

b. Lavender

Question 9

An evacuated tube with heparin has a ________ colored stopper.

a. Red
b. Lavender
c. Blue
d. Green

Answer 9

d. Green

Question 10

An evacuated tube with sodium citrate has a ________ colored stopper.

a. Red
b. Lavender
c. Blue
d. Green

Answer 10

c. Blue

Question 11

An evacuated tube with no anticoagulant has a ________ colored stopper.

a. Red
b. Lavender
c. Blue
d. Green

Answer 11

a. Red

Question 12

The first category of steps in performing a venipuncture
includes:

a. Select an appropriate site and prepare the site.
b. Identify the patient, check test requisitions, assemble equipment, wash hands, and put on latex gloves.
c. Remove tourniquet, remove needle, apply pressure to site, and label all tubes.
d. Introduce yourself and briefly explain the procedure to the patient.

Answer 12

d. Introduce yourself and briefly explain the procedure to the patient.

Question 13

The second category of steps in performing a venipuncture includes:
a. Select an appropriate site and prepare the site.
b. Identify the patient, check test requisitions, assemble equipment, wash hands, and put on latex gloves.
c. Remove tourniquet, remove needle, apply pressure to site, and label all tubes.
d. Introduce yourself and briefly explain the procedure to the patient.

Answer 13

b. Identify the patient, check test requisitions, assemble equipment, wash hands, and put on latex gloves.

Question 14

The third category of steps in performing a venipuncture
includes:
a. Select an appropriate site and prepare the site.
b. Identify the patient, check test requisitions, assemble equipment, wash hands, and put on latex gloves.
c. Remove tourniquet, remove needle, apply pressure to site, and label all tubes.
d. Introduce yourself and briefly explain the procedure to the patient.

Answer 14

a. Select an appropriate site and prepare the site.

Question 15

The fourth of five steps in performing a venipuncture includes:
a. Select an appropriate site and prepare the site.
b. Identify the patient, check test requisitions, assemble equipment, wash hands, and put on latex gloves.
c. Remove tourniquet, remove needle, apply pressure to site, and label all tubes.
d. Reapply the tourniquet and perform the venipuncture.

Answer 15

d. Reapply the tourniquet and perform the venipuncture.

Question 16

The final category of steps in performing a venipuncture includes:
a. Select an appropriate site and prepare the site.
b. Identify the patient, check test requisitions, assemble equipment, wash hands, and put on latex gloves.
c. Remove tourniquet, remove needle, apply pressure to site, and label all tubes.
d. Reapply the tourniquet and perform the venipuncture.

Answer 16

c. Remove tourniquet, remove needle, apply pressure to site, and label all tubes.

Question 17

The appropriate veins for performing a routine venipuncture are the:
a. Cephalic, basilic, and median cubital
b. Subclavian, iliac, and femoral
c. Brachiocephalic, jugular, and popliteal
d. Saphenous, suprarenal, and tibial

Answer 17

a. Cephalic, basilic, and median cubital

Question 18

A blood sample is needed from a patient with intravenous (IV) fluid lines running in one arm. Which of the
following is an acceptable procedure?
a. Any obtainable vein is satisfactory.
b. Disconnect the IV line.
c. Obtain sample from the other arm.
d. Do not draw a blood specimen from this patient.

Answer 18

c. Obtain sample from the other arm.

Question 19

How should the bevel of the needle be held during a venipuncture?
a. Sideways
b. Upward
c. Downward
d. In any direction

Answer 19

b. Upward

Question 20

A hematoma can form if:
a. Improper pressure is applied to a site after the venipuncture.
b. The patient suddenly moves, and the needle comes out of the vein.
c. The needle punctures both walls of the vein.
d. All the above.

Answer 20

d. All the above.

Question 21

Phlebotomy problems can include:
a. The use of improper anticoagulants
b. Misidentification of patients
c. Inadequate filling of an evacuated tube containing anticoagulant
d. All the above

Answer 21

d. All the above

Question 22

Which of the following area(s) is (are) acceptable for the
collection of capillary blood from an infant?
a. Previous puncture site
b. Posterior curve of the heel
c. The arch
d. Medial or lateral plantar surface

Answer 22

d. Medial or lateral plantar surface

Question 23

The proper collection of capillary blood includes:
a. Wiping away the first drop of blood
b. Occasionally wiping the site with a plain gauze pad to avoid the buildup of platelets
c. Avoiding the introduction of air bubbles into the column of blood in a capillary collection tube
d. All the above

Answer 23

d. All the above

Question 24

Blood specimens are unacceptable for laboratory testing
when:
a. There is no patient name or identification number on the label.
b. The label on the request form and the label on the collection container do not match.
c. The wrong collection tube has been used (for example, anticoagulant additive instead of tube for serum).
d. All the above.

Answer 24

d. All the above.

Question 25

If serum is allowed to remain on the clot for a prolonged period, which of the following effects will be noted?
a. Elevated level of serum potassium
b. Decreased level of serum potassium
c. Elevated level of glucose
d. None of the above

Answer 25

a. Elevated level of serum potassium

Question 26

A red-pink appearance of serum/plasma can be caused by:
a. Elevated bilirubin (jaundice; icteric serum)
b. Lysis of red blood cells (hemolyzed serum)
c. Presence of lipids or fat (lipemic serum)
d. Dehydration

Answer 26

b. Lysis of red blood cells (hemolyzed serum)

Question 27

A dark-yellow appearance of serum/plasma can be
caused by:
a. Elevated bilirubin (jaundice; icteric serum)
b. Lysis of red blood cells (hemolyzed serum)
c. Presence of lipids or fat (lipemic serum)
d. Dehydration

Answer 27

a. Elevated bilirubin (jaundice; icteric serum)

Question 28

A milky white appearance of serum/plasma can be due to:
a. Elevated bilirubin (jaundice; icteric serum)
b. Lysis of red blood cells (hemolyzed serum)
c. Presence of lipids or fat (lipemic serum)
d. Dehydration

Answer 28

c. Presence of lipids or fat (lipemic serum)

Question 29

Sarah works as a phlebotomist in a local hospital. Her neighbor John Englant shows up to have his blood drawn. Because Sarah knows him, she glances at the specimen labels she’s been given, but does not notice the labels say England, John. Sarah proceeds with the venipuncture procedure. First, she dons her gloves and visually inspects both arms. She applies the tourniquet, finds a site, and cleanses it with 70% alcohol. Next, Sarah inserts the needle into the skin and draws blood into a lavender-top tube. As soon as blood flows into the tube, Sarah releases the tourniquet and removes the needle once the tube is full. She applies pressure to the site with a gauze pad, mixes the tube, and labels the tube as required by the laboratory.

What potential adverse outcome may occur as a result of this venipuncture procedure?
a. Infection
b. Incorrect results
c. Hematoma
d. Blood loss

Answer 29

b. Incorrect results

Question 30

Sarah works as a phlebotomist in a local hospital. Her neighbor John Englant shows up to have his blood drawn. Because Sarah knows him, she glances at the specimen labels she’s been given, but does not notice the labels say England, John. Sarah proceeds with the venipuncture procedure. First, she dons her gloves and visually inspects both arms. She applies the tourniquet, finds a site, and cleanses it with 70% alcohol. Next, Sarah inserts the needle into the skin and draws blood into a lavender-top tube. As soon as blood flows into the tube, Sarah releases the tourniquet and removes the needle once the tube is full. She applies pressure to the site with a gauze pad, mixes the tube, and labels the tube as required by the laboratory.

A second error occurred during this procedure. What was
it?
a. Patient was subjected to unnecessary pain.
b. Phlebotomist did not wear gloves.
c. The wrong anticoagulant tube was drawn.
d. The tourniquet was removed prematurely

Answer 30

c. The wrong anticoagulant tube was drawn.

Question 31

Andy is working second shift, and it is almost time for him to go home. He goes into a patient’s room to perform a routine venipuncture for a chemistry profile, which requires a green top. Andy properly identifies the patient and assembles all the necessary equipment. Next, he inspects both arms and thinks he has a good vein within the antecubital area of the right arm. He applies the tourniquet and inserts the needle into the skin and draws blood into a green-top tube. As soon as blood flows into the tube, Andy releases the tourniquet and removes the needle once the tube is full. He applies pressure to the site with a gauze pad, mixes the tube, and labels the tube as required by the laboratory.

What potential adverse outcome may occur as a result of an error in the venipuncture procedure?
a. Infection
b. Incorrect results
c. Hematoma
d. Bruising of the skin

Answer 31

a. Infection

Question 32

Andy is working second shift, and it is almost time for him to go home. He goes into a patient’s room to perform a routine venipuncture for a chemistry profile, which requires a green top. Andy properly identifies the patient and assembles all the necessary equipment. Next, he inspects both arms and thinks he has a good vein within the antecubital area of the right arm. He applies the tourniquet and inserts the needle into the skin and draws blood into a green-top tube. As soon as blood flows into the tube, Andy releases the tourniquet and removes the needle once the tube is full. He applies pressure to the site with a gauze pad, mixes the tube, and labels the tube as required by the laboratory.

A second error occurred during this procedure. What was it?
a. Patient was subjected to unnecessary pain.
b. Phlebotomist did not wear gloves.
c. The wrong tube was drawn.
d. The wrong venipuncture site was chosen.

Answer 32

b. Phlebotomist did not wear gloves.

Question 33

Meg has been performing venipunctures all day, and her tray is depleted of supplies. She decides to draw one more patient before she takes a break, so she calls back the next patient and asks him to take a seat. Meg notices she is out of regular venipuncture needles, but she does have a butterfly needle available. The order is for a CBC. Meg dons her gloves and visually inspects both arms. She applies the tourniquet just above the patient’s wrist, finds a site in his hand, and cleanses it with 70% alcohol. Next, Meg inserts the needle into the skin and draws blood into a purple-top tube. Meg removes the needle once the tube is full and applies pressure to the site with a gauze pad, but forgets to remove the tourniquet. As she mixes the tube and prepares to label it as required by the laboratory, the patient points out that the tourniquet is still on his arm.

What potential adverse outcome may occur as a result of this venipuncture procedure?
a. Infection
b. Incorrect results
c. Hematoma
d. Bruising of the skin

Answer 33

c. Hematoma

Question 34

Meg has been performing venipunctures all day, and her tray is depleted of supplies. She decides to draw one more patient before she takes a break, so she calls back the next patient and asks him to take a seat. Meg notices she is out of regular venipuncture needles, but she does have a butterfly needle available. The order is for a CBC. Meg dons her gloves and visually inspects both arms. She applies the tourniquet just above the patient’s wrist, finds a site in his hand, and cleanses it with 70% alcohol. Next, Meg inserts the needle into the skin and draws blood into a purple-top tube. Meg removes the needle once the tube is full and applies pressure to the site with a gauze pad, but forgets to remove the tourniquet. As she mixes the tube and prepares to label it as required by the laboratory, the patient points out that the tourniquet is still on his arm.

A second error occurred during this procedure. What was
it?
a. Patient was subjected to unnecessary pain.
b. Phlebotomist did not wear gloves.
c. The wrong tube was drawn.
d. The wrong venipuncture site was chosen.

Answer 34

a. Patient was subjected to unnecessary pain.