Chapter 19 - Clinical Laboratory Flashcards
0
Q
What is the specific concern that is enacted by Congress and is enforced via the Departments of Health and Human Services (HHS) detailing how protected health information (PHI) may be transmitted and released?
A
Health Insurance Portability and Accountability Act (HIPAA)
1
Q
What Standard Form is the “Laboratory Report Display”?
A
SF 545
2
Q
What are the two principal method of obtaining blood specimens?
A
Capillary and venipuncture method
3
Q
For most of the clinical laboratory examinations, what is considered the preferred method of obtaining blood specimens?
A
Venipuncture
4
Q
Under what concept outlined by Occupational Safety & Health Administration (OSHA) are all human blood and certain other human body fluids are treated as if known to be infectious?
A
Universal Bloodborne Pathogen Precautions
5
Q
How often would the phlebotomy work site equipment and furniture be disinfected?
A
Daily or as needed after patient care
6
Q
What method of blood collection is performed when a small quantity of blood is needed for testing as in the case of some pediatric blood draws and when access are limited on a severely burned patient or ICU patient?
A
Capillary Blood Collection Method
7
Q
Where are most capillary blood collected from an adult?
A
Middle or ring finger
8
Q
Where are capillary blood collected from a newborn?
A
Heel or great toe
9
Q
Do you let the alcohol pad or povidone-iodine solution dry after cleansing the fingertip?
A
Yes
10
Q
Are the following rules the correct puncture procedure for collecting capillary blood:
- Puncture away from midline of the finger or heel.
- Do not puncture parallel to the groves or lines of the fingertip.
- Make a quick stab with the lancet no greater than 2 mm deep on the side of the finger (off-center).
True or False?
A
True
11
Q
When performing a finger or heel puncture, the first drop should be wiped away to avoid what?
A
Dilution of the specimen with tissue fluids.
12
Q
What is also known as the vacutainer method that is defined as the puncture of a vein for drawing blood in which the arm is considered the best site for obtaining blood?
A
Venipuncture
13
Q
If any arm veins cannot be used due to interference such as IV fluid or mastectomy, who must be consulted to use hand or foot veins?
A
Supervisor
14
Q
How far above the intended phlebotomy site should the tourniquet be placed?
A
3-4 inches above the site
15
Q
How far below should you “Anchor” the vein using your thumb of the free hand and slightly to the side of the intended venipuncture site, and pull the skin towards your wrist?
A
1-2 inches
16
Q
The correct needle position for venipuncture is (a) what degree angle and (b) with the bevel in what position?
A
(a) 15-30. (b) up
17
Q
A tourniquet is normally applied before to aid in the process of venipuncture. At what point in the venipuncture procedure should the tourniquet be removed?
A
Once blood flows freely into tubes
18
Q
In some difficult draw situations, the tourniquet is sometimes left on until the last tube is filled. How long would you leave the tourniquet on?
A
No more than one minute
19
Q
When should specimens be labeled?
A
Before leaving the patient
20
Q
Which color tube is the best choice for routine chemistry test?
A
Red top
21
Q
Which color tube is the best choice for Complete Blood Count (CBC)?
A
Lavender top
22
Q
What anticoagulant does the green top use for chemistry?
A
Heparin
23
Q
What anticoagulant does the grey top use for chemistry (plasma samples)?
A
Sodium Flouride
24
What anticoagulant does the light blue top use for coagulation studies?
Sodium citrate
25
What type of microscope is most often used in the laboratory?
Compound microscope
26
What anticoagulant does the lavender top use for Complete Blood Count (CBC)?
EDTA
27
What contains a system of lenses with sufficient magnification and resolving power allowing small elements close together in a specimen to appear larger and distinctly separated?
Compound microscope
28
What are the four parts of the compound microscope framework?
Arm, stage, mechanical (movable) stage, and base.
29
Which part of the compound microscope framework supports the magnification and focusing system and is the handle by which the microscope is carried?
Arm
30
Which part of the compound microscope framework is the platform on which a specimen is placed for examination and at the center is an aperture or hole that allows the passage of light from the condenser?
Stage
31
Which part of the compound microscope framework holds the specimen in place and is the means by which the specimen may be moved about on the stage to view the sample?
Mechanical (movable) Stage
32
Which part of the compound microscope framework is the structure on which the microscope rests?
Base
33
The illumination system of the compound microscope evenly distributes light and contains what three parts?
Internal light source, condenser, and an iris diaphragm.
34
What part of the compound microscope illumination system is located in the base providing a precise and steady source of light into the microscope?
Internal light source
35
What part of the compound microscope illumination system is composed of a compact lens system, located below the stage, and concentrates and focuses light from the light source on the specimen?
Condenser
36
What part of the compound microscope illumination system is located on the condenser to control the amount and angle of light rays that will pass to the specimen and lens, which affects the overall resolution, or ability to observe and interpret a sample?
Iris Diaphragm
37
What are the two lens systems on the compound microscope magnification system?
Objective and ocular lenses
38
What is the approximate magnification of low-power objective lens?
10x
39
Which type of lens is responsible for the magnification and resolution of detail in a specimen, has a set of three lenses, and it is the lens nearest the specimen?
Objective lens
40
What is the approximate magnification for high-power objective lens?
40x
41
What is the approximate magnification for oil-immersion objective lens?
100x
42
What part of the compound microscope contains openings into which objective lenses are fitted, and revolves objectives into desired position?
Revolving Nosepiece
43
What part of the compound microscope is a tube that permits light to travel from the objective to the ocular lens?
Body Tube
44
Which type of lens, also known as "eyepiece" is located on top of the body tube and has a magnification power of 10x?
Ocular Lenses
45
When using the ocular lenses, how would you calculate the total magnification of a specimen?
Multiply ocular magnification power times objective magnification power
46
What are the two parts of the compound microscope that comprise of the focusing system?
Coarse and Fine Control Knob
47
Which control knob is the larger inner knob that when rotated, allows the image to appear in approximate focus?
Coarse Control Knob
48
Which control knob is the smaller outer knob that when rotated, renders the image clear and well-defined?
Fine Control Knob
49
When using the coarse adjustment knob, how many inches is objective lens away from the object?
1/4 inch
50
It is important to obtain a focus with the low-power first, then change to the higher objective. True or False?
True
51
What objective lens should be used for a detailed study of stained blood and bacterial smears?
Oil-immersion
52
How would you move or transport microscopes?
Holding the arm and base of the microscope
53
How would you remove (a) dust and (b) oil from compound microscopes?
(a) Lint-free lens tissue (b) lens cleaning solution with lens tissue
54
What must never be used to clean the microscope because it damages the lens assembly?
Alcohol
55
What consists of the following tests: total Red Blood Cell (RBC) count, Hemoglobin determination (Hgb), Hematocrit (Hct), total White Blood Cell (WBC) count, and White Blood Cell Differential count?
Complete Blood Count (CBC)
56
What are the two ways to perform a Complete Blood Count (CBC)?
Manually or automated hematology analyzers
57
What is defined as a red cell (erythrocytes) count below normal values?
Anemia
58
Hemoglobin determination, also known as hemoglobinometry is the measurement of what within the patient's red blood cells?
Concentration of hemoglobin
59
What is the function of hemoglobin in the body?
Delivers and releases oxygen to the tissues and facilitate carbon dioxide excretion
60
The formation of hemoglobin takes place during the development of red cells (erythrocytes) located where?
Bone marrow
61
What factors affect the hemoglobin determination values?
Age, sex, disease, and altitude
62
What are the normal hemoglobin determination values for (a) women and (b) men?
(a) women = 12-16 (b) men = 14-18 grams per 100 ml blood
63
In manual method for determining hemoglobin, blood is mixed with ______________. This process hemolyzes, or destroys red cells (erythrocytes), disrupting the integrity of erythrocytes membranes and causing the release of hemoglobin, which is converted to a brownish-colored solution.
Cyanomethoglobin
64
What is the term used for the volume of erythrocytes expressed as a percentage of the volume of whole blood in a sample?
Hematocrit
65
What are the normal values of hematocrit for a normal, healthy (a) female and (b) male?
(a) female = 37-47% (b) male = 42-52% of blood volume
66
What manual method is used when blood is centrifuged to determine the hematocrit?
Microhematocrit method
67
What sample medical conditions are determined for (a) below and (b) above hematocrit determinations?
(a) below = anemia (b) above = dehydration
68
What are the normal range of White Blood Cell (WBC) values in adults?
4.8-10.8 X 10*6/ml (per cubic millimeter)
69
What is the condition referred to when WBC rises above normal values and occurs when systemic or local infections are present?
Leukocytosis
70
The following physiology conditions can cause what condition: shortly after birth; pregnancy; appendicitis; ulcers; emotional stress; anxiety; and strenuous activity?
Leukocytosis
71
What is the condition referred to when the WBC is abnormally low?
Leukopenia
72
The following conditions may cause what: severe or advance bacterial infections (typhoid, paratyphoid, and tularemia); infections caused by virus and rickettsiae (measles, rubella, smallpox, hepatitis, psittacosis, dengue fever, and influenza); anaphylactic shock; and radiation?
Leukopenia
73
What study consists of an examination of blood to determine the presence and the number of different types of white blood cells usually expressed in a percentage?
White Blood Cell Differential Count
74
Which study within the CBC often provides the most helpful information in determining the severity and type of infection?
White Blood Cell (WBC) Differential Count
75
What is the function of leukocytes (White Blood Cells)?
To control various disease conditions
76
What are the five types of White Blood Cells (WBCs) normally found in the circulating blood?
Neutrophils, Eosinophils, Basophils, Lymphocytes, and Monocytes.
77
What type of leukocyte compromises the largest percentage of cells in the circulating blood?
Neutrophil
78
Which leukocyte helps respond by ingesting invading bacteria?
Neutrophil
79
When performing a WBC Differential, which cell has a lilac-colored cytoplasm and a dark or reddish purple nucleus that may be oval, horseshoe or "S"-shaped, or segmented (lobulated)?
Neutrophil
80
Which neutrophil sub-classification is an older or intermediate neutrophil that started to elongate and has curved itself into a horseshoe, C or U-shaped and it's sometimes called "stab" cell?
Neutrophilic Band
81
Which neutrophil sub-classification is a mature neutrophil which the nucleus is separated into two, three, four, or five lobes?
Segmented Neutrophil
82
Which leukocyte destroys parasites and respond immediately to allergic reactions; the cytoplasm contains numerous large reddish-orange granules?
Eosinophil
83
Which leukocyte is associated with inflammatory disorders and certain leukemias?
Basophil
84
When performing a WBC Differential, which cell has the large, scattered deep bluish-purple granules that are darker than the nucleus and may overlay the nucleus as well as the cytoplasm?
Basophil
85
Which leukocyte is associated with immune response and the body's defense against viral infection?
Lymphocyte
86
Which leukocyte have cytoplasms that is clear sky blue, scanty, with few unevenly distributed, blue granules with a halo around them?
Lymphocyte
87
Which leukocyte is generally round, oval, or slightly indented, and the chromatin (a network of fibers within the nucleus) is lumpy and condensed at the periphery?
Lymphocyte
88
Which leukocyte is the largest of the normal White Blood Cells (WBC), controls microbial and fungal infections, and removes damaged cells from the body?
Monocyte
89
Which leukocyte has an indented nucleus and abundant pale bluish-gray cytoplasm?
Monocyte
90
The following are ways bacteria is classified: Disease-producing ability; growth requirements; morphologic characteristic; toxins produced; and gram's stain reaction. True or False?
True
91
What is the term used for bacteria that cause disease?
Pathogen
92
What are the four growth requirements for bacteria?
Temperature, oxygen, nutrition, and moisture.
93
What are the three categories for bacteria temperature requirements?
Psychrophilic, Mesophilic, and Thermophilic.
94
Which temperature requirement category are "cold loving" bacteria that reproduces best at low temperatures (4 degrees C)?
Psychrophilic
95
Which temperature requirement category are bacteria that reproduces best at body temperature (35 degrees C) and are the primary pathogens to man?
Mesophilic
96
Which temperature requirement category are bacteria that reproduces best at higher temperatures (42 degrees C)?
Thermophilic
97
What is the term used for organisms that reproduces in the presence of oxygen?
Aerobes
98
What is the term used for organisms that do not reproduce in the presence of oxygen?
Anaerobes
99
What is the term used to define bacteria that are spherical or round in shape?
Coccus (pl. cocci)
100
What is term used to define bacteria that are rod-shaped?
Bacillus (pl. bacilli)
101
What is the term used to define bacteria that is helical, spiral, or crockscrew-shaped?
Spirochetes (pl. spirilla)
102
What are the two types of toxins produced as waste products of metabolism in bacterial cell?
Endotoxin and Exotoxin
103
Which type of toxin compromises part of the cell wall and is released as the bacterial cell is destroyed and this type is considered to be less potent, but may effect the patient during antibiotic therapy?
Endotoxin
104
Which type of toxin is produced by bacteria, found outside the cell wall, and is considered highly poisonous and associated with septic shock?
Exotoxin
105
In Gram's stain, what color is the primary stain?
Crystal violet
106
Gram positive bacteria stain what color?
Deep blue or purple
107
Gram negative bacteria stain what color?
Deep pink
108
What cocci bacteria causes Pneumonia in a Gram-positive stain?
Streptococcus pneumoniae
109
What cocci bacteria causes strep throat in a Gram-positive stain?
Streptococcus pyogenes
110
What cocci bacteria causes Gonorrhea in a Gram-negative stain?
Neisseria gonorrhoeae
111
What cocci bacteria causes Meningitis in a Gram-negative stain?
Neisseria meningitis
112
What bacilli bacteria causes Diphtheria in a Gram-positive stain?
Corynebacterium diphtheria
113
What bacilli bacteria causes Gas gangrene, Tetanus, and Botulism in a Gram-positive stain?
Clostridium tetani
114
What bacilli bacteria causes the Bubonic plague in a Gram-negative stain?
Yersinia (Pasteurella) pestis
115
What bacilli bacteria causes Brucellosis in a Gram-negative stain?
Brucella abortus
116
What bacilli bacteria causes Whopping cough in a Gram-negative stain?
Bordetella pertussis
117
What is the method used in the laboratory to identify bacteria and that can be performed in isolated duty locations or onboard Naval vessels?
Smear method
118
What method are prepared from clinical specimens or from culture media spread across a glass slide for microscopic examination?
Smear
119
This test consists of procedures by which antigens and reacting serum globulin antibodies may be measured qualitatively and quantitatively based on agglutination reactions between an antigen and a specific antibody?
Serology
120
What is the term used for a substance that, when introduced into an individual's body, is recognized as foreign to the body, and causes a detectable reaction?
Antigen
121
Hat is the term used for specific defensive proteins produced by the host in response to the presence of an antigen and its primary function is to combine with antigens in body defenses?
Antibodies
122
What takes place when antibodies bind with specific antigens depending on a close three-dimensional fit?
Antigen-antibody reaction
123
What is widely used to detect and measure the presence of antigen-antibody reactions?
Agglutination tests
124
The Rapid Plasma Reagin (RPR) kit a specific test to diagnose what?
Syphilis
125
The Rapid Plasma Reagin (RPR) test to screen for syphilis is best used with what type of specimen?
Serum
126
In Rapid Plasma Reagin (RPR) Card test method of syphilis detection, what specific antigen detects "Reagin", a substance present in the serum of persons who are infected with syphilis or suffering from similar tissue damage?
Carbon-particle cardiolipin
127
How many weeks does Reagin usually develop after the appearance of a primary chancre?
1-4 weeks
128
Reactive specimens for Rapid Plasma Reagin (RPR) tests look like? Non-reactive?
Reactive = black clumps against white background
Non-reactive = even, light gray color
129
What test is an accurate, 2-minute disposable test designed to detect the presence of infectious mononucleosis antibodies in serum, plasma, or whole blood?
Monospot test
130
What test consists of specially prepared, stable sheep or horse erythrocyte antigen (dyed) and guinea pig antigen on a disposable slide?
Monospot Test
131
What are chlorophyll-free, heterotrophic (not self nourishing) of the same family of plants as algae and lichens; reproduced by spores that germinate into long filaments called hyphae?
Fungi
132
As hyphae continue to grow and branch, they develop into a mat of growth called?
Mycelium (pl. mycelia)
133
What are some common superficial infections of the skin caused by fungi?
Athlete's foot and ringworm of the scalp
134
What is the chemical preparations frequently used to detect fungi?
Potassium hydroxide (KOH)
135
What percent of Potassium hydroxide (KOH) is used to test for fungi?
10%
136
Fungi that appear refractile, or reflective, fragments of fungal elements are found on what part of the body?
Skin and nails
137
Fungi that appear as dense clouds are found in what part of the body or Linear rows?
Hair
138
What are the three types of urine specimens?
Random, first morning, and 24-hour
139
Which urine specimen is the most commonly (routine) used because of the ease of collection and convenience for the patient and considered the least valid specimen?
Random Urine Specimen
140
Which urine specimen is the first urine voided upon rising is considered the most ideal screening because it is usually concentrated?
First Morning Urine Specimen
141
The following steps are for what urine specimen: (1) have the patient empty bladder and discard urine; (2) collect urine for 24 hours; (3) instruct patient to empty bladder at 0800 the following day and add the urine to the collection?
24-Hour Urine Specimen
142
What would you want to do with the urine during the 24-Hour urine collection?
Refrigerate
143
What is the normal daily urine volume for an adult?
600-2,000 ml
144
The best urine specimen for screening purposes is that taken as?
First morning
145
What two methods of preservation are used to delay the decomposition of urine?
Refrigeration and preservatives (hydrochloric acid)
146
What type of urinalysis includes the examination of physical characteristics, chemical characteristics, and microscopic structures in the sediment?
Routine urinalysis
147
What is the desired urine sample volume for routine testing?
12 ml
148
What are the three physical characteristics when routine urinalysis is being evaluated?
Color, appearance, and specific gravity
149
What is the normal color of urine?
Varies from straw to amber
150
What does red or red-brown urine indicate the presence of?
Blood
151
What does yellow or brown urine indicate the presence of?
Bile
152
What does olive green to brown-black urine indicate the presence of?
Phenols
153
What does dark orange urine indicate the presence of?
Pyridium
154
Freshly passed urine is usually clear or transparent. True or False?
True
155
Upon what activity do all urine specimens will develop a faint cloud composed of mucus, leukocytes, and epithelial cells?
Standing and cooling
156
What is defined as the density of a solution compared to an equal volume of distilled water?
Specific gravity
157
A report of transparency is of value only if the specimen is
Fresh
158
What is the normal ranges of specific gravity?
1.015-1.030
159
What equipment is used to measure specific gravity?
Index refractometer
160
What type of strips consist of chemical impregnated absorbent pads attached to a plastic strip?
Urinalysis Reagent Strips
161
Formed elements such as red and white blood cells sink to the bottom of the specimen and will be undetected by the reagent strips unless?
Urine is mixed
162
How is the strip held to ensure against run-over, when comparing it with the color chart?
Horizontal from the color chart
163
Specimens that have been refrigerated must be allowed to return to room temperature prior to reagent testing, since some enzymatic reactions on the strips are temperature dependent. True or False?
True
164
What is the magnification of microscopic examination of urine sediment that is fresh as possible in addition to routine chemical procedures?
40x
165
What is the normal number of leukocytes per high-power filed seen on a microscopic examination?
0-3 leukocytes per high-power field
166
More than 3 leukocyte cells per high-power field may indicate disease where?
Urinary tract
167
What urine sediment cell is not normally found in urine?
Red Blood Cells (Erythrocytes)
168
The addition of one drop of 2% acetic acid to urine sediment will disintegrate what urine sediment cell?
Red Blood Cells (Erythrocytes)
169
What urine sediment cell are derived from the linings of the genitourinary system?
Epithelial cells
170
What are the urinary sediment that are formed by coagulation of albuminous material in the kidney tubules; they are cylindrical and vary in diameter, sides are parallel, and the ends are rounded?
Casts
171
Casts in the urine always indicate some form of what type of disorder?
Kidney disorder
172
Large numbers of casts in the urine is almost sure to be positive for?
Albumin
173
White Blood Cell (WBC) count above 50,000 indicate?
Acute infection
174
Hemoglobin concentration below 7 indicates severe anemia and may require?
Blood transfusion
175
Glucose and ketones both positive on the urine reagent strip may indicate?
Uncontrolled diabetes
176
What operational program may be used on some operational platforms to treat critical patients in a mass casualty situation when delay of blood products would cause a critical delay?
Walking Blood Bank (WBB)
177
Who is responsible for coordinating a well-planned transfusion program?
Senior Medical Department Representative (SMDR) and embarked laboratory personnel
178
What is the minimum file percentage of certain ship's company is required to be enrolled in the Walking Blood Bank?
10%
179
What are the 5 items collected and documented upon creation of a treatment record at the point of accession?
G6PD, Sickle Cell, ABO/Rh (Blood Type), DNA, and current HIV.
