Phlebotomy Chapter 1 and 2
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Questions and Answers

What is the primary reason for performing an arterial puncture?

  • To draw a large volume of blood
  • To administer medication
  • To evaluate blood gases (correct)
  • To check blood pressure
  • What should a phlebotomist do if the patient requiring an ABG specimen is on a ventilator instead of breathing room air?

  • Consult with the patient's nurse (correct)
  • Use a different puncture site
  • Delay the collection until the patient is stable
  • Collect the specimen anyway
  • What does a weak or absent pulse distal to the site of arterial puncture suggest?

  • The puncture was successful
  • The blood sample is contaminated
  • The patient is experiencing shock
  • A thrombus may have formed (correct)
  • What is the purpose of performing the modified Allen test before arterial specimen collection?

    <p>To determine collateral circulation (D)</p> Signup and view all the answers

    Why is heparin used during arterial sample collection?

    <p>To prevent clotting of the specimen (D)</p> Signup and view all the answers

    What does the term 'proximal' refer to in anatomical terms?

    <p>Nearest to the point of attachment (C)</p> Signup and view all the answers

    Which anatomical position describes a person lying face up?

    <p>Supine (B)</p> Signup and view all the answers

    What is the primary function of the left ventricle in the circulatory system?

    <p>Delivering oxygenated blood into the aorta (B)</p> Signup and view all the answers

    Which layers of the skin is considered avascular?

    <p>Epidermis (C)</p> Signup and view all the answers

    Which of the following is an accessory organ of the digestive system?

    <p>Liver (B)</p> Signup and view all the answers

    What is the primary function of capillaries in the circulatory system?

    <p>Facilitating gas exchange between blood and tissues (C)</p> Signup and view all the answers

    Which body cavity houses the heart and lungs?

    <p>Thoracic cavity (C)</p> Signup and view all the answers

    What does hemostasis refer to in medical terms?

    <p>The coagulation process (D)</p> Signup and view all the answers

    What is the purpose of a tourniquet during venipuncture?

    <p>To constrict blood flow and make veins more visible (A)</p> Signup and view all the answers

    What is the function of tube vacuum in evacuated blood collection tubes?

    <p>To automatically fill the tube with blood (B)</p> Signup and view all the answers

    Why are gauze pads preferred over cotton balls after venipuncture?

    <p>Cotton balls can leave fibers that stick to the site (D)</p> Signup and view all the answers

    Which of the following veins is not classified as an antecubital vein?

    <p>Femoral (D)</p> Signup and view all the answers

    What is the main purpose of an antiglycolytic agent during blood collection?

    <p>To preserve glucose levels (C)</p> Signup and view all the answers

    What should not be done to improve vein selection during venipuncture?

    <p>Encouraging the patient to pump their fist vigorously (A)</p> Signup and view all the answers

    What is indicated by blood appearing in the hub of the needle during venipuncture?

    <p>The needle is correctly placed in a vein (B)</p> Signup and view all the answers

    Which chamber of the heart is responsible for receiving blood from the systemic circulation?

    <p>Right atrium (B)</p> Signup and view all the answers

    What is the maximum time a tourniquet should remain on during venipuncture?

    <p>1 minute (B)</p> Signup and view all the answers

    What is the primary function of heparin in blood collection?

    <p>Inhibits thrombin (A)</p> Signup and view all the answers

    In blood pressure measurements, what does the systolic pressure indicate?

    <p>Pressure when the first heart sounds are heard (B)</p> Signup and view all the answers

    Which situation requires you to check with a nurse before proceeding with a specimen collection?

    <p>If the patient has just eaten a meal before fasting (D)</p> Signup and view all the answers

    What is the most critical error a phlebotomist can make during the process?

    <p>Misidentifying a patient specimen (D)</p> Signup and view all the answers

    Which additive is typically found in a tube with a lavender stopper?

    <p>EDTA (D)</p> Signup and view all the answers

    What is the internal space of a blood vessel known as?

    <p>Lumen (C)</p> Signup and view all the answers

    Which government agency is responsible for regulating the quality of gloves used in phlebotomy procedures?

    <p>FDA (D)</p> Signup and view all the answers

    What should you do if a member of the clergy is with a patient when you arrive to collect a routine specimen?

    <p>Come back later after the clergy member has gone (D)</p> Signup and view all the answers

    What is the recommended angle for needle insertion during a routine venipuncture?

    <p>15 degrees to 30 degrees (B)</p> Signup and view all the answers

    Which liquid is typically acceptable to consume while fasting?

    <p>Plain water (D)</p> Signup and view all the answers

    How can you determine that the needle is properly placed in the vein during venipuncture?

    <p>You will feel a slight 'give' (A)</p> Signup and view all the answers

    Where should labeling of routine inpatient blood specimens occur?

    <p>At the bedside immediately after collection (D)</p> Signup and view all the answers

    What is a critical reason for including the patient's identification number on the specimen tube label?

    <p>To avoid confusing specimens from patients with the same name (B)</p> Signup and view all the answers

    What complication may arise from prolonged application of a tourniquet?

    <p>Hemoconcentration (B)</p> Signup and view all the answers

    When drawing a protime specimen from a patient with IVs in both arms, what is the best practice?

    <p>Draw below an IV (C)</p> Signup and view all the answers

    What is the maximum depth of heel puncture recommended by the Clinical and Laboratory Standards Institute (CLSI)?

    <p>2.0 mm (B)</p> Signup and view all the answers

    Why should a blood smear made from an EDTA specimen be prepared within 1 hour of collection?

    <p>To maintain accurate cell morphology. (C)</p> Signup and view all the answers

    What is the purpose of wiping away the first drop of blood during a skin puncture?

    <p>To prevent contamination from tissue fluid. (B)</p> Signup and view all the answers

    Which micro collection container is specifically used for a Complete Blood Count (CBC)?

    <p>Lavender top tube (C)</p> Signup and view all the answers

    In which situation is a skin puncture preferred over a venipuncture?

    <p>When performing a glucose test. (B)</p> Signup and view all the answers

    What does the term 'calcaneus' refer to?

    <p>The heel bone. (B)</p> Signup and view all the answers

    Which test is NOT collectable by capillary puncture?

    <p>Blood culture. (C)</p> Signup and view all the answers

    What is the primary reason for collecting EDTA specimens before other specimens during skin puncture?

    <p>To avoid platelet clumping. (C)</p> Signup and view all the answers

    Flashcards

    Distal

    The farthest point from the point of attachment of a body part or structure.

    Frontal Plane

    The plane that divides the body into front (anterior) and back (posterior) sections.

    Accessory Organ of the Digestive System

    An organ that aids in digestion but is not part of the digestive tract itself.

    Proximal

    The point on a body part or structure that is closest to its point of attachment.

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    Epidermis

    The outermost layer of skin, lacking blood vessels.

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    Epithelial Tissue

    One of the four basic tissue types, responsible for covering and lining surfaces in the body.

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    Meninges

    Protective membranes that surround the spinal cord and brain.

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    Capillaries

    The smallest blood vessels, where gas exchange between blood and tissues occurs.

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    What's a key difference between arteries & veins?

    A major difference between arteries and veins is that veins have valves, which prevent blood from flowing backward.

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    Which heart chamber receives blood from the body?

    The chamber of the heart that receives blood from the systemic circulation, which is the blood that has circulated throughout the body.

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    What's the thick muscle layer of the heart called?

    Also known as the myocardium, is the thick muscular layer of the heart responsible for pumping blood.

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    What's systolic pressure?

    The systolic pressure is the first heart sound you hear as the blood pressure cuff is deflated.

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    What's the internal space of a blood vessel?

    The internal space of a blood vessel through which blood flows.

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    What's the liquid portion of a clotted specimen?

    The liquid portion of a clotted blood specimen, which is the plasma without the clotting factors.

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    What color tube is used for coagulation tests?

    A tube with a light blue stopper is used to collect blood for coagulation tests.

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    What additive is in a green-topped tube?

    A tube with a green stopper typically contains heparin, an anticoagulant that prevents blood from clotting.

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    Skin Puncture

    The process of obtaining a blood sample by pricking the skin, usually the fingertip or heel.

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    Lateral Plantar Surface

    The preferred site for skin puncture on infants, located on the outer side of the heel.

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    Heel Lancet

    A specialized lancet designed to collect blood from the heel of infants.

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    Plantar Surface

    The bottom surface of the heel.

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    PKU (Phenylketonuria)

    A hereditary disorder that prevents the body from breaking down phenylalanine, an amino acid.

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    Jaundice

    A condition in newborns characterized by yellowish skin and eyes caused by high levels of bilirubin.

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    Lancet

    A needle-like instrument used to make a small puncture in the skin for blood collection.

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    Microcollection Container

    A special container used for collecting small blood samples, often used for skin puncture.

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    What is a tourniquet used for in venipuncture?

    A tourniquet is a device that constricts blood flow in a vein, making it easier to locate and draw blood.

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    What causes evacuated tubes to fill with blood automatically?

    The vacuum inside the tubes pulls the blood in automatically.

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    What is a butterfly needle typically used for?

    Butterfly needles are specifically designed for drawing blood from difficult or hand veins due to their smaller size and flexibility.

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    What are needles color-coded by?

    Needles are categorized by their gauge, which indicates the diameter of the needle's opening.

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    What does OSHA require for disposal after a venipuncture?

    According to OSHA regulations, the tube holder with the attached needle must be disposed of as a single unit after use to prevent sharps injuries and contamination.

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    What part of a syringe shows measurements?

    The barrel of a syringe is the part that shows measurements in cc or mL, allowing for precise volume control during blood collection.

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    Why are gauze pads better than cotton balls for holding pressure after venipuncture?

    Gauze pads are preferred over cotton balls because cotton fibers can stick to the venipuncture site, causing discomfort and potentially affecting the specimen quality.

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    What is a venoscope?

    A venoscope is a device that uses transillumination to make veins more visible under the skin, aiding in vein location during venipuncture.

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    Optimal Needle Insertion Angle

    The most suitable angle for needle insertion during venipuncture. It helps to ensure that the needle properly enters the vein and minimizes the risk of tissue damage.

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    Needle Bevel Orientation

    During venipuncture, the bevel of the needle should be facing upwards. This allows the needle to enter the vein smoothly and minimizes the chances of damaging the vein wall.

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    Tourniquet Release Timing

    The ideal time to release the tourniquet during venipuncture is as soon as blood starts flowing into the tube. This ensures proper blood flow while minimizing venous stasis.

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    Blood Collection Near Hematoma

    When a hematoma is present, the blood collection should be done distally (away from) the hematoma. This avoids drawing blood from the affected area and minimizes the risk of further complications.

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    Prolonged Tourniquet Application

    Prolonged tourniquet application can lead to hemoconcentration, a condition where the blood becomes thicker and concentrated. This can affect the accuracy of lab test results.

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    Preventing Reflux

    Reflux refers to the backward flow of blood from the collection tube into the vein. This can contaminate the sample and affect test results. The best way to prevent reflux is to ensure the tubes fill from the bottom up and avoid any pressure on the tube.

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    Basal State

    A basal state refers to a resting metabolic state where the body is at its most stable and predictable condition. This state is typically achieved after a night of fasting and rest.

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    Blood Collection from Crying Infant

    Collecting blood from a screaming infant can lead to a falsely elevated white blood cell count. This is because stress and crying release hormones that can increase the number of white blood cells in the blood.

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    Arterial Puncture Site Prep

    The site should be prepped with a suitable disinfectant like povidone-iodine to minimize the risk of infection.

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    Modified Allen Test

    The modified Allen test is used to assess the adequacy of collateral circulation in the hand, ensuring that the radial artery is safe to puncture.

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    Suspecting a Thrombus

    A thrombus, or blood clot, in the radial artery can be suspected if the pulse distal to the puncture site (away from the heart) is weak or absent. This means the clot is obstructing blood flow.

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    Heparin in ABG Samples

    Heparin is essential in arterial blood gas samples to prevent clotting. Clotting would alter the gas content of the blood making the results inaccurate.

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    Radial Artery Location

    The radial artery is located on the thumb side of the wrist, making it a common site for arterial blood gas collection.

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    Study Notes

    Chapter One

    • Blood Bank Synonym: Immunohematology
    • Therapeutic Drug Monitoring Coordination: Pharmacy
    • Electrolyte Testing Components: Sodium, potassium
    • Phlebotomist Role: Promoting good public relations, building harmonious relationships with visitors, staff, and patients.
    • Outpatient Phlebotomy Code: APC (Ambulatory Payment Categories)
    • Oxygen Therapy Department: Respiratory Therapy
    • Sophisticated Medical Care Term: Tertiary Care
    • Phlebotomy Greek Meaning: Incise a vein
    • Non-Phlebotomist Duty: Starting intravenous (IV) lines
    • Early Bloodletting Equipment Exclusion: Hemostat
    • Laboratory Scientist Classification: Clinical laboratory scientist
    • Continuing Education Certification: Continuing education units

    Chapter Two

    • Barrier to Communication: Emotional upset, inability to speak English, or being a child
    • Confirming Response: Understanding the patient's feelings, empathizing
    • Negative Kinesics: Frowning
    • Professional Appearance Component Exclusion: Wearing strong cologne
    • Improper Telephone Protocol: Hanging up on angry callers
    • Local Public Health Agency Duty Exclusion: Licensure of healthcare personnel
    • Professional Conduct Term: Ethics
    • Protected Health Information Exchange Law: HIPAA
    • Federally Funded Insurance: Medicaid
    • Specialty for Treating Older Adults: Gerontology
    • Brain Wave Recording Department: Electroneurodiagnostics

    Chapter Three

    • Specimen Collection Documents: Procedure Manual
    • Legal Period for Filing Lawsuits: Statute of limitations
    • Accreditation Agency: JCAHO
    • Procedure Standards Organization: CLSI
    • Incident Report Form Exclusion: Suggestion for new guidelines
    • Quality Assurance Indicator Example: Blood cultures will not exceed the national contamination rate
    • Unfamiliar Procedure Handling: Refer to the user manual
    • Quality Management Principle Exclusion: Reduction in staff.
    • Protected Health Information Exchange Legislation: HIPAA
    • Insurance Term: Medicaid

    Chapter Four

    • Deceptive Practice Term: Fraud
    • Specimen Mislabeling: Incident report form exclusion: Suggestions for new guidelines
    • Procedure Standards Organization: CLSI
    • Professional Conduct Term: Ethics

    Chapter Five

    • Severe External Bleeding Control: Applying direct pressure and elevating the extremity
    • Fire Classification: Class C fire involves electrical equipment
    • Vaccination Type: Two or more vaccine doses, one month and 6 months later, to be effective. Employee screening example: PPD test
    • Fire Response System: National Fire Protection Association (NFPA).

    Chapter Six

    • Left Ventricle Function: Delivering oxygenated blood to the aorta
    • Heart Receiving Chambers: Atria
    • Cardiac Cycle Relaxing Phase: Diastole
    • Circulatory System Vessel Exclusion: Pulmonary artery
    • Blood Flow Direction: Arterioles, capillaries, and venules
    • Blood Clot in Circulation: Embolus
    • Blood Vessel Wall Passage: Leukocytes
    • Blood Type Determination: Antigen present on red blood cells
    • Serum vs. Plasma Difference: Plasma contains fibrinogen; serum does not.
    • Body Fluid Origin: Excess tissue fluid.
    • Healthcare Worker Exposure to Bloodborne Pathogens: All of the answers are correct.

    Chapter Seven

    • Ethanol Specimen Collection Tube: Sodium fluoride
    • Largest Lumen Needle Gauge: 18 Gauge
    • Light Blue Stopper Tube Test Classification: Coagulation
    • Green Stopper Tube Contents: General Blood collection

    Chapter Eight

    • Patient Identification Method: Looking at his ID band and asking his name, etc.
    • Priority Specimen Collection: STAT electrolytes in the ER
    • Vein Preparation Enhancement Method Exclusion: Having the patient vigorously pump his or her fist
    • Patient Procedures Before Blood Draw: tell patient it will not hurt.
    • Specimen Collection After Patient Consumes Food: If specimen is collected still write 'nonfasting' on the slip.

    Chapter Nine

    • Accidental Artery Puncture Identification: Blood pulsing into the tube
    • Specimen Identification Error: Misidentifying patient specimen
    • Specimen Collection from Dorsal Hand Vein Method: Butterfly and small pediatric ETS tubes
    • Unconscious Patient Specimen Identification: Use a three-part identification band and labels
    • Patient with Difficult Veins: Have another phlebotomist attempt to draw the specimen
    • Timed Blood Test: Prothrombin time (PTT).
    • Patient with High Red Blood Cells: Pregnant patients.
    • Specimen Collection Technique: Sterile, antiseptic procedure method is needed
    • Blood Test Collection Method: Vein

    Chapter Ten

    • EDTA Specimen Blood Smear Production Deadline: Within 1 hour
    • Capillary Blood Gases Less Desirable Than Arterial Blood Gases: All of the options are correct.
    • Heel Puncture Depth: 2.0 mm
    • EDTA Specimen Collection Priority: Before other specimens when collected by skin puncture.
    • Skin Puncture Test Result Variation: Because test results may vary depending on the method of collection.
    • Infant Heel Puncture Location: Lateral plantar surface
    • Skin Puncture Procedure Step Exclusion: When a light blue stopper tube is needed.
    • Blood Draw Cleaning Procedure: 70% isopropyl alcohol.

    Chapter Eleven

    • Collection Sites: Distal segment of the middle finger
    • Difficult Blood Collection Cases: have another phlebotomist attempt to draw the specimen.
    • Skin Antiseptic Needed: Blood cultures

    Chapter Twelve

    • Computer Access Procedure: Logging on.
    • Input Data Handling: Press the Enter key.
    • Specimen Identification Tracking Procedure: Accession number.
    • Chemical Reaction Analysis Procedure: Metabolism
    • Improper Procedure Test Results: Inadequate mixing of an EDTA tube.

    Chapter Thirteen

    • 24-Hour Urine Collection Method: Void the first morning specimen; start the timing; and collect all the specimens, including the next morning’s specimen.
    • Lumbar Puncture Fluid: Cerebrospinal fluid
    • Peritoneal Aspiration Fluid: Ascites
    • Specimen Identification Requirements: Specify the specimen type and source.

    Chapter Fourteen

    • Artery to Use for Blood Collection During Low Cardiac Output: Femoral artery
    • Artery Released Primarily in Allen Test: Ulnar artery
    • Blood Specimen Storage at Room Temperature: Blood cells continue to consume oxygen; levels of carbon dioxide increase
    • Pulse Check Location: Distal to the puncture site
    • Arterial Puncture Complication: Arteriospasm
    • Common Radial Artery Needle Gauge: 22 gauge
    • ABG Specimen Storage Time: Analyzed within 30 minutes of collection

    Chapter Fifteen

    • Patient Blood Collection: A patient who has been asleep for 30 minutes while breathing room air is in a steady state for blood collection.
    • Needle Angle for Artery Puncture: 45 degrees.
    • Arterial Blood Specimen Identification: Blood should pump into the syringe as it is collected.
    • Arterial Puncture Site Cleaning: Povidone-iodine
    • Respiratory Support Device and Blood Collection: Consult with the patient’s nurse.
    • Purpose of Arterial Puncture: Evaluate blood gases.

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    Test your knowledge of key concepts in phlebotomy from Chapters One and Two. This quiz covers essential topics such as blood bank terminology, the role of phlebotomists, communication barriers, and therapeutic drug monitoring. Perfect for students and healthcare professionals looking to reinforce their understanding.

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