General Flashcards
1
Q
What is Polycythemia Vera
A
is a rare type of blood cancer in which your body produces too many red blood cells.
2
Q
Therapeutic phlebotomy is commonly used when patients have:
A
Polycythemia Vera
3
Q
what is another word for phlebotomy?
A
venesection
4
Q
How long should someone fast for lab work?
A
10-12 hours
5
Q
where should the tourniquet be placed?
A
4-6 inches above the draw site
6
Q
What should you use to clean the puncture site?
A
70% isopropyl alcohol
7
Q
what is hemolysis
A
destruction of red blood cells
8
Q
how long can a tourniquet be left on?
A
no longer than 1 minute
9
Q
what causes hemoconcentration?
A
leaving the tourniquet on too long
10
Q
_________ is when a competent person gives voluntary permission for a medical procedure after receiving adequate information about the risk of, methods, used and consequences of the procedure.
A
informed consent
11
Q
_______ is permission given by the patient verbally or in writing for a procedure.
A
expressed consent
12
Q
give two examples of implied consent
A
patient going to the emergency room or holding out an arm when told need to draw blood
13
Q
_____ is when the patient’s actions permits the procedure without verbal or written consent
A
implied consent
14
Q
______ is special permission needed to administer a test that detects HIV
A
HIV consent
15
Q
______ is permission given by a parent or legal guardian that permits procedures administered to underage patients
A
Parental consent for Minors
16
Q
how do you identify a patient?
A
asking first name, last name, DOB or wrist band
17
Q
what is a syncopal episode?
A
fainting
18
Q
what is PPE?
A
Personal protective equipment
19
Q
what are mucous membranes?
A
eyes, nose, mouth
20
Q
what is barrier protection?
A
protective clothing (PPE) that provides a physical barrier against infection
21
Q
if latex gloves cause skin allergies in patients what should be used?
A
vinyl or nitrile
22
Q
the most commonly used personal protective equipment includes (5):
A
masks goggles face shields respirators gloves
23
Q
the amount of personal protective equipment you wear is directly correlated to the:
A
amount of exposure you anticipate
24
Q
____ in the lab is a direct OSHA violation
A
eating
25
What does OSHA stand for?
Occupational Safety and Health Administration
26
What does OSHA do?
to ensure safe and healthful working conditions for working people by setting and enforcing standards and by providing training, outreach, education and assistance.
27
T/F It is ok to recap needles
FALSE Needles should never be recapped
28
Where should needles be disposed?
Labeled sharps containers only
29
sharps containers should be locked and disposed of when they are ____ full as indicated on the outside of the container
2/3
30
What should you do if the sharps container is overflowing?
report the violation to the supervisor
31
broken glassware must be picked up by
mechanical means
32
decontamination can be accomplished by using (2):
a solution of sodium hypochlorite (bleach) and water at a ratio of 1:10
or
lysol or some other EPA-registered tuberculocidal disinfectant
33
when cleaning up a spill of blood on chairs, lab tables, or hard flooring what do you do?
carefully pour the 10% solution of bleach over the blood and leave it for at least 10 min
34
why do you leave the 10% bleach solution on blood spills for at least 10 min?
to ensure that any blood-borne pathogens are killed
35
If you are exposed to blood or any other potentially infectious material you should (4):
1. Wash the exposed area thoroughly with soap and running water.
2. Report the exposure to your supervisor as soon as possible
3. Refer to an MSDS
4. Fill out an exposure report form.
36
If blood is splashed in the eye or mucous membrane, flush the affected area with running water for:
at least 15 minutes
37
what is a MSDS
material safety data sheet
38
what is HBV
hepatitis B
39
there are ____ OSHA compliance inspections each conducted for a different reason
four
40
what are the four OSHA compliance inspections
1. Complaint inspection
2. the fatality/accidents inspections
3. the programmed inspection
4. the imminent danger inspection
41
_____ inspection occurs after an employees files a formal complaint with OSHA. It is the most common type of inspection.
Complaint inspection
42
_____ occurs after OSHA receives notice from the employer of a workplace fatality or an accident resulting in the hospitalization of three or more employees. OSHA also takes notice of media reports and will frequently investigate accidents that do not result in any fatalities or hospitalizations
the fatality/accidents inspections
43
______ is an inspection conducted of a randomly chosen workplace determined to be engaged in particularly hazardous types of work according to their standard industry classification (SIC) codes
programmed inspection
44
______ inspection occurs when OSHA receives a report that a condition of imminent danger exists in a workplace. This is the least common inspection type.
imminent danger inspection
45
venipuncture
The puncture of a vein, usually to withdraw blood or inject a solution.
46
vein selection is based on
the size and condition of the vein
47
Name the three major vein located in the antecubital fossa in order of preference:
median cubital
cephalic
basilic
48
this vein is most commonly used for venipuncture procedures. It is large and it does not tend to move when the needle is inserted.
median cubital
49
This vein can be more difficult to locate, however, it is the easiest vein to palpate in an obese patient.
cephalic vein
50
this vein is the least firmly anchored and located near the brachial artery. if the needle is inserted too deep you risk puncturing the brachial artery or a nerve
basilic vein
51
laboratory requisition
an order form that specifies what tests are being requested
52
accession number
a unique tracking number different for each sample
53
what is the solution that is becoming more commonly used as the primary antiseptic
chloraprep
54
what is the purpose of a tourniquet?
slows the venous outflow of blood from the arm causing the vein to bulge thereby making hem easier to locate
55
hemoconcentration
increased concentration of cells and solids in the blood usually resulting from loss of fluid to the tissues
56
tubes with additives must be _____ the appropriate amount of times in order to ensure proper mixing of blood and additive.
inverted
57
the _____ of a needle refers to the diameter or thickness of the needle
gauge
58
the lower the number of the gauge the ____ the needle,
larger
59
the larger the number of the gauge the ____ the needle
smaller/thinner
60
___ gauge is the larger/thicker bore and ___ gauge is small/thin
16, 23
61
needles smaller than ____ gauge are not recommended for drawing blood because they cause hemolysis.
23 gauge
62
needles smaller than 23 are not recommended for drawing blood because they cause ____.
hemolysis: the rupturing (lysis) of red blood cells (erythrocytes) and the release of their contents (cytoplasm) into surrounding fluid (e.g. blood plasma)
63
common needle size used for venipuncture is:
21 gauge
64
another name for "butterfly needle"
winged infusion set
65
Reasons to use a butterfly needle: (3)
- venipuncture on small veins such as those in the hand
- venipuncture procedures on elderly or pediatric patients
- needle phobic
66
entry with the butterfly should be at:
5 degrees
67
another name for needle disposal container
sharps container
68
When is it okay to recap a needle
never recap a needle whether it has a safety or not
69
true or false. It is necessary to disclose your level of experience to your patients
false
It is unnecessary to disclose your level of experience to your patients
70
true or false, if you have gloves on you do not have to wash your hands
false, always wash your hands
71
The patient should not pump their fist vigorously because:
it can affect some lab values such as potassium
72
Where do you place your thumb to anchor the vein?
place your thumb below the antecubital area slightly pulling the skin back
73
True or false, use a C shape to anchor your finger above the needle
FALSE never put your finger ahead of the needle
74
what direction should the bevel face?
facing up
75
insert the needle at a ____ angle when using a vac tube
15-30 degree
76
what does CLSI stand for?
Clinical and Laboratory Standards Institute
77
_____ guidelines state that the tourniquet should be removed as soon as blood flow is established rather that waiting until the last tube is filled.
CLSI
78
what is the proper way to dispose of a needle?
activate the needle and put it into a biohazard sharps container right away
79
What four things go on the specimen label?
patient full name, number identifier such as a DOB
date
time of collection
initials
80
what do you do if a specimen has been collected from the wrong patient?
immediately report the incident to the supervisor
81
the proper steps to end a blood draw (5)
```
remove the tourniquet
remove the tube
place gauze/cotton the site
remove the needle
activate the safety
```
82
name 5 factors that can influence a tough draw
```
hard to find veins
scarred and sclerosed veins
unconscious patient
rolling collapsing veins
quantity not sufficient
```
83
how do you help a needle phobic person (4)
use smaller needle
lay them down
conceal the needle and limit extended observation
cover tube filled with blood
84
Where are draws done on children under 2 years of age?
median cubital vein
85
how many attempts does a phlebotomist have to draw blood on a patient?
2
86
where do you draw in relation to an IV
below the IV
87
What is an edema?
an accumulation of fluid in the tissues
88
if your patient has had a mastectomy, where should you draw from?
avoid drawing from the associated arm (left mastectomy, no draws from left arm)
in case of double mastectomy draw blood from the foot if possible or consult the patient's nurse or physician
89
what is a fistula
a permanent surgical connection between an artery and a vein
90
True or false: It is ok to use a fistula to draw blood?
FALSE
91
What is a tortuous vein
winding or crooked vein and are susceptible to infection because blood flow is impaired. The sample may produce erroneous results.
92
what is the most common complication from phlebotomy?
hematoma: caused when the bevel of a needle is not completely in the vein and some blood releases into the tissue under the skin
93
what is the first thing you do if the patient faints?
remove the needle
94
what is vasovagal syncope
faint or experience dizziness before, during, or after venipuncture
95
true or false: when someone is experiencing vasovagal syncope you should put their head between their knees
FALSE. Never put their head between their knees as they can fall over and hit their head
96
what is a capillary?
a microscopic blood vessel
97
true or false: with a capillary collection always wipe away the first drop of blood with gauze
TRUE
98
where do you do a heel stick?
medial and lateral portions of the plantar surface of the foot
99
The American Academy of pediatrics recommends that heel puncture not exceed ___ mm for infants and ___mm for premies
2.0mm and 0.85mm
100
In a dermal puncture always ___ and never puncture deeper than ___ in an adult.
always wipe away the first drop of blood
| never puncture deeper than 3.0mm in adult.
101
____ is a common test done on babies via heel stick
billirubin
102
When collecting bilirubin minimize exposure to light by:
collect in an amber tube
| clear tube must be immediately protected from light by wrapping in foil or in a dark bag
103
what is hemostasis?
process by which blood vessels are repaired after injury
104
how many stages in hemostasis?
4
105
What are the four phases of hemostasis?
Vascular Phase
Platelet Phase
Coagulation Phase
Fibrinolysis
106
Which phase of hemostasis: injury to a blood vessel causes it to constrict, slowing the flow of blood.
Vascular Phase
107
Which phase of hemostasis: injury to the endothelial lining causes platelets to adhere to it. additional platelets stick to the site forming a temporary platelet plug in a process called "aggregation"
Platelet Phase
108
What are the two primary stages of hemostasis?
Platelet Phase
| Vascular Phase
109
What test is used to evaluate the primary stages of hemostasis and when is it done?
Bleeding time test (BTT)
| Performed prior to surgery
110
Which phase of hemostasis: this involves a cascade of interactions between coagulation factors that converts the temporary platelet plug to a stable fibrin clot.
Coagulation Phase
111
Which phase of hemostasis: the breakdown and removal of the clot.
Fibrinolysis
112
As tissue repair begins ____ (an enzyme) starts braking down the fibrin clot.
pepsin
plasmin
pepsinogen
plastin
plasmin
113
What are FDPs?
fibrin degradation products
114
what are fibrin degradation products used to monitor?
rate of fibrinolysis
115
Prothrombin time test (PT/INR) is used to evaluate the _____ pathway.
extrinsic
116
what does PT/INR stand for?
Prothrombin time/international normalized ratio
117
what does INR stand for?
international normalized ratio
118
What does PTT stand for?
Partial Thromboplastin Time
119
PTT is used to evaluate the _____ pathway.
intrinsic
120
What tube is used for the PTT or PT test? How much should it be filled?
light blue
| completely filled
121
blood vessels, blood platelets and the coagulation factors all must be in working order for ____ to occur.
hemostasis
122
What is a device used in point of care testing (POCT) regarding PT/INR?
hemochron signature elite
123
what does POCT stand for?
Point of Care Testing
124
True or false the Hemochron Signature Elite is the industry standard for comprehensive point of care coagulation monitoring system
FALSE
| practitioners may use an alternative
125
What is the basal state?
fasting, nothing by mouth and refrain from strenuous exercise for 8-12 hours prior to the blood draw.
126
Is water ok when basal state is required?
yes
127
whose responsibility is it to verify that the patient has followed the test guidelines?
the phlebotomist
128
what is post prandial?
after meal
129
What state should the patient be in and what tube is used for a lipid panel?
fasting state
| SST tube
130
What step do you need to take if your facility allows patients to do a lipid panel unfasted?
mark on the tube that they were not fasting
131
the following are examples of what?
1. to measure blood levels of substances exhibiting dinural variation
2. to monitor changes in patients condition
3. to determine levels of medication in the bloodstream, therapeutic drug monitoring
timed specimens
132
What tube is required for testing digoxin?
red
133
What is digoxin?
a drug for cardiovascular disease
134
Blood is drawn to coincide with the ____ (lowest chemical blood level) and/or ____ (highest chemical blood level.
trough
| peak
135
when are trough levels collected?
15 min before the scheduled pharmaceutical dose.
136
In therapeutic drug monitoring, it is essential for the lab to know what?
the time of the last dose when collecting blood
137
Regarding warmed specimens, how long must the tube be pre-warmed?
30 min
138
What methods are used to pre-warm tubes for warmed specimens?
incubator or chemical hand warmer
139
some tests require that the specimens be kept warm until:
the serum is separated from the cells
140
____ _____ are antibodies produced in response to mycoplasma pneumonia infection (atypical pneumonia).
cold agglutinins
141
Cold agglutinins must be collected in ___ tubes, pre-warmed in the incubator at ____ degrees for ___ minutes.
red-topped
37 degrees celsius
30 minutes
142
What is the proper way to chill a specimen?
slurry of crushed ice water
143
What is a common test that needs to be chilled and is drawn in a dark green tube?
ammonia
144
Wrap ____ specimens in aluminum foil immediately after the specimen is drawn. If available transport these samples in an ____ ____.
light-sensitive
| amber bag
145
with stasis means:
with a tourniquet
146
without stasis means:
without a tourniquet
147
a lactic acid blood test must be drawn _____ stasis
without
148
True or False: a without stasis test can use a tourniquet to find a vein.
FALSE no tourniquet can be used.
149
Name three specimens that require chilling
```
ammonia
lactic acid
arterial blood gas (ABG)
Gastrin
glucagon
parathyroid hormone
Partial thromboplastin time
prothrombin time
```
150
```
The following tests require what special handeling?
ammonia
lactic acid
arterial blood gas (AGB)
Gastrin
glucagon
parathyroid hormone
Partial thromboplastin time
prothrombin time
```
chilling
151
Name three specimens that require warm collection and transportation.
cryoglobulin
cryofibrinogen
cold agglutinin
152
name three specimens that require protection from light
```
bilirubin
Vitamin B12
Vitamin B6
urine porphyrins
carotene
red cell folate
serum folate
```
153
name one specimen that requires a draw without stasis
lactic acid
154
True or false: some samples can be placed on dry ice
FALSE, never place samples on dry ice
155
__ __ is define as the skills and procedures prior to a specimen being analyzed.
pre- analytical phase
156
what is the most critical error a phlebotomist can make?
improperly identifying the patient prior to sample collection
157
what does OGTT stand for
oral glucose tolerance test
158
what hour windows are used for the OGTT?
1hr, 2hr, 3hr, 5hr
159
What is OGTT used to diagnose? (2)
diabetes mellitus and gestational diabetes
160
How much time dose a patient have to consume the glucola drink prior to a OGTT?
5 min
161
When is the first draw taken for OGTT?
before consuming the glucola
162
What is the first OGTT blood draw called?
basline test
163
a 3-hour OGTT will have how many blood draws?
4
164
a 5 hour OGTT will have how many blood draws?
6
165
for a OGTT how long should a patient fast prior to collection?
10-12 hours
166
__ ___ are ordered to detect the presence of microorganisms in the patient's blood
blood cultures
167
what does FUO stand for?
fever of unknown origin
168
_____ is a systemic infection associated with the presence of pathogenic organisms introduced during venipuncture. It is a bacterial infection spread through the entire vascular system of the body.
Septicemia
169
blood cultures are usually ordered
```
STAT
Warm
Chilled
Light protected
Timed specimen
```
STAT or Timed specimen
170
what does aseptic mean?
preventing infection
171
Blood cultures requires strict aseptic technique. This is done using ____
Chloraprep or its generic equivalent - chlorhexidine gluconate
172
Improper skin preparation for blood cultures is the most common cause of _____ when drawing blood cultures.
contamination
173
___ ___ are usually ordered in multiple sets from multiple sites at various times.
blood cultures
174
1 blood culture consists of ___ ___ bottles, ___ and ___
2 bottles anaerobic, 2 bottles aerobic
175
what does aerobic mean?
with oxygen
176
what does anaerobic mean?
without oxygen
177
when do coritosl levels peak?
around 8am
178
___ ____ are the daily cyclic variations of levels within the body during a 24-hour period
dinural variations
179
cortisol blood tests will be ordered and drawn between ____ and ____
8 and 10am
| and midnight
180
what is PKU
phenylketonuria
181
PKU testing is done on blood from where on a newborn?
Or with what other kind of test?
heel (medial or lateral plantar surface)
| urine
182
who usually draws a arterial blood gas test?
a respiratory therapist, nurse, or physician
183
a ABG sample must be run with in ____ of collection
15 min
184
what are the 4 primary tests performed on arterial samples?
pH, carbon dioxide, oxygen and bicaronate
185
When drawing an ABG it is imperative that nothing else takes place between the ____ and the ____.
collection
| testing
186
____ is the liquid portion of un-clotted blood and still contains the clotting factors
plasma
187
____ is the liquid portion of the blood that has been allowed to clot.
serum
188
are there clotting factors present in serum?
no they have been allowed to clot
189
name the tubes with anticoagulants
lavender, green, pink royal blue with light blue stripe, light blue, and gray
190
lavender, green, pink royal blue with lt. blue stripe, light blue, and gray tubes will produce ____ when separated in a centrifuge
plasma
191
red, tiger top, gold tubes, speckled tubes and royal blue with a red stipe tubes will produce ___ when separated in a centrifuge.
serum
192
name the tubes without anticoagulants (3)
red, tiger top, and royal blue with a red stipe tubes
193
collecting specimens in the incorrect order of draw can result in
cross contamination
194
who has defined the order of draw to minimize cross-contamination?
CLSI, clinical laboratory standards institute
195
what tubes is chemistry responsible for? (5)
```
red
tiger top
mint green
dark green
gray
```
196
What tests can be done with a red tube top? (3)
serum pregnancy
digoxin
cold agglutinins
197
What causes a hematoma in regards to phlebotomy?
when the bevel of a needle is not completely in the vein and some blood releases into the tissue under the skin
198
The following tests require what special handling?
```
ammonia
lactic acid
arterial blood gas (AGB)
Gastrin
glucagon
parathyroid hormone
Partial thromboplastin time
prothrombin time
```
Chilling
Protection from light
Warm collection
Without stasis
Chilling
199
The following tests require what special handling?
cryoglobulin
cryofibrinogen
cold agglutinin
warm collection, 37 degrees C for 30 min
200
The following tests require what special handling?
```
bilirubin
Vitamin B12
Vitamin B6
urine porphyrins
carotene
red cell folate
serum folate
```
Chilling
Protection from light
Warm collection
Without stasis
Protection from light
201
Lactic acid specimens require what special handling?
Chilling
Protection from light
Warm collection
Without stasis
Without stasis
