Phlebotomy Exam Review Chapter 11

Questions and Answers

What is forensic toxicology concerned with?

Legal consequences of toxin exposure.

If only enough blood is collected from an adult to fill one blood culture bottle, where should it be added?

Aerobic bottle.

What test requires four special tubes collected using a special order of draw?

TB-Gold.

Which of the following blood culture collection steps are in the correct order?

Select equipment, perform friction scrub, cleanse bottle tops, and perform venipuncture. Signup and view all the answers

A lactose tolerance test is used to determine if a patient lacks which enzyme?

Enzyme needed to convert milk sugar into glucose and galactose. Signup and view all the answers

What is the preferred sample for parentage testing?

Blood sample. Signup and view all the answers

All those allowed to order paternity testing include all of the following EXCEPT?

Child who is a minor. Signup and view all the answers

What is the recommended disinfectant for blood culture sites in infants two months and older?

Chlorhexidine gluconate. Signup and view all the answers

Unused autologous units may be used by other patients.

False Signup and view all the answers

What does the phosphate additive in a donor unit of blood do?

Stabilizes the pH of the plasma. Signup and view all the answers

What can a transfusion of incompatible blood cause?

Lysis, or rupturing, of RBCs within the vascular system. Signup and view all the answers

What must blood from a cell-salvaging procedure be evaluated for before reinfusion?

Free hemoglobin. Signup and view all the answers

When a donor unit of blood is collected, what follows?

All of the above Signup and view all the answers

Which of the following are coagulation tests that can be monitored using a POC instrument?

Both A and B Signup and view all the answers

Why do pediatric blood cultures create challenges?

Most ill children have already received broad-spectrum antibiotics. Signup and view all the answers

What instrument can be used to monitor blood gases?

AVOXimeter. Signup and view all the answers

An autologous transfusion eliminates many risks of transfusion, such as?

All of the above Signup and view all the answers

What does hyperkalemia mean?

Increased potassium in the blood. Signup and view all the answers

What do all POC glucose analyzers approved for hospital use have in common?

Ability to use capillary, venous or arterial blood samples. Signup and view all the answers

What do ARD and FAN blood culture bottles do?

Remove any antibiotics that are in the blood. Signup and view all the answers

What is septicemia?

Presence of microorganisms in the blood. Signup and view all the answers

Which test is used as a marker of the severity of sepsis?

Lactate. Signup and view all the answers

To donate blood in most states, persons must be at least?

17 years old and weigh at least 110 lb. Signup and view all the answers

Which condition requires a unit of blood to be withdrawn from a patient as treatment?

Hemochromatosis. Signup and view all the answers

Which test requires especially strict identification and specimen labeling procedures?

Cross-match. Signup and view all the answers

Drugs of abuse include all of the following EXCEPT?

Phenobarbital Signup and view all the answers

What gauge needles are typically used to collect donor units of blood?

16- to 18-gauge. Signup and view all the answers

What is the volume of a typical unit of blood?

450 mL. Signup and view all the answers

Which test is collected from patients with FUO to rule out septicemia?

Blood culture times two. Signup and view all the answers

Which tubes can be used to collect blood bank specimens EXCEPT?

Large gel-barrier tubes Signup and view all the answers

Which test is collected using special skin decontamination procedures?

Set of blood cultures. Signup and view all the answers

Genetic fingerprinting can be used to determine?

All of the above Signup and view all the answers

Why would blood cultures be collected with an antimicrobial-absorbing resin?

The patient is taking a broad-spectrum antibiotic. Signup and view all the answers

Which specimen tube must contain a 9-to-1 ratio of blood to anticoagulation to be accepted for testing?

Coagulation. Signup and view all the answers

What is the best additive for collecting an ethanol specimen?

Sodium fluoride. Signup and view all the answers

Which blood culture bottle is inoculated first when the specimen has been collected by needle and syringe?

Anaerobic vial. Signup and view all the answers

What is the most critical aspect of blood culture collection?

Skin antisepsis. Signup and view all the answers

What can a site for blood cultures collection typically be cleaned with?

Chlorhexidine gluconate. Signup and view all the answers

Which additive is sometimes used to collect blood culture specimens?

SPS. Signup and view all the answers

Which type of specimen may require collection of a discard tube before the test specimen is collected?

Coagulation. Signup and view all the answers

The oral glucose challenge test does what?

All of the above Signup and view all the answers

Which test is used as a screening test for glucose metabolism problems?

2-hour PP. Signup and view all the answers

Which activities can negatively affect a glucose tolerance test (GTT)?

Chewing sugarless gum, drinking tea without sugar, smoking low-tar cigarettes. Signup and view all the answers

When does the timing of specimen collection begin during a GTT?

When the patient has finished the glucose beverage. Signup and view all the answers

What should a phlebotomist do if they arrive for a 2-hour postprandial glucose specimen and discover 2 hours have not elapsed since the patient's last meal?

Ask the patient's nurse to verify the correct collection time. Signup and view all the answers

What should a phlebotomist do if a patient undergoing a GTT vomits within 30 minutes of drinking the glucose beverage?

Notify the nurse or physician immediately to see if the test should be rescheduled. Signup and view all the answers

What is increased blood glucose called?

Hyperglycemia. Signup and view all the answers

When does a blood glucose level in normal individuals typically peak after glucose ingestion?

In 30 to 60 minutes. Signup and view all the answers

What must remain consistent throughout an oral glucose test?

Blood specimen source. Signup and view all the answers

What does patient preparation before a GTT involve?

Eating meals with measured amounts of carbohydrate 3 days prior. Signup and view all the answers

Which of the following can be used to clean a site before a blood alcohol specimen is collected?

Zephiran chloride. Signup and view all the answers

Which specimens may require chain-of-custody documentation when collected?

Drug screen. Signup and view all the answers

What is the purpose of TDM?

Determine and maintain a beneficial drug dosage. Signup and view all the answers

Which test would not be subject to therapeutic drug monitoring?

Phenylalanine. Signup and view all the answers

What additional action is necessary if a peak drug level ordered for 0900 hours is drawn 10 minutes late?

Recording the actual time of specimen collection. Signup and view all the answers

When is a trough drug level collected?

Immediately before the next scheduled drug dose is given. Signup and view all the answers

Which test requires the collection of multiple specimens?

GTT. Signup and view all the answers

Timing of collection is most critical for drugs with short half-lives, such as?

Gentamicin. Signup and view all the answers

Molecular tests can be used to?

All of the above Signup and view all the answers

What is the most common reason for glucose monitoring through POCT?

Monitor glucose levels for diabetic care. Signup and view all the answers

Which one of the following tests can be collected using a tube other than a trace element-free tube?

Sodium Signup and view all the answers

What is the definition of toxicology?

The scientific study of poisons. Signup and view all the answers

Which test typically has the shortest turnaround time if performed by POCT?

BUN. Signup and view all the answers

Which of the following is not a POCT analyzer?

BacT/ALERT Signup and view all the answers

To prevent introducing a contaminating substance into a trace-element collection tube, it is suggested that you?

Draw it by itself using a syringe or evacuated tube system. Signup and view all the answers

Which of the following is one of the most common bedside or POCT tests?

Glucose. Signup and view all the answers

Which test is used to monitor heparin therapy?

ACT. Signup and view all the answers

Tan-top tubes containing K2EDTA can be used to collect specimens for which test?

Lead analysis. Signup and view all the answers

When should QC for waived tests be performed?

When test manufacturers specify. Signup and view all the answers

What is a noninvasive transcutaneous method used to measure?

Neonatal bilirubin. Signup and view all the answers

What accumulation in the blood can cause metabolic acidosis?

Lactate. Signup and view all the answers

POCT analyzer QC must be repeated if?

All of the above Signup and view all the answers

Ionized calcium plays a critical role in all of the following EXCEPT?

Glycation of Hb. Signup and view all the answers

What is below-normal blood pH referred to as?

Blood acidosis. Signup and view all the answers

Which is a protein that is specific to heart muscle?

TnT. Signup and view all the answers

What is B-type natriuretic peptide?

A cardiac hormone. Signup and view all the answers

What test is used to evaluate the long-term effectiveness of diabetes therapy?

Hemoglobin A1c. Signup and view all the answers

Which test is referred to as the packed cell volume?

HCT. Signup and view all the answers

What is a type of TB blood test?

T-Spot. Signup and view all the answers

What should you do with partial tubes if blood flow stops during collection?

Discard them both and try again to draw the specimen at a new site. Signup and view all the answers

What does POCT lipid testing include?

HDL. Signup and view all the answers

Which point-of-care blood analyzer uses a microcuvette instead of a test strip or cartridge?

HemoCue HB201+. Signup and view all the answers

An uncorrected imbalance of which analyte can quickly lead to death?

Potassium. Signup and view all the answers

What does the POC instrument VerifyNow do?

Platelet testing to determine response to aspirin therapy. Signup and view all the answers

What happens in the Lookback program?

When the blood service is made aware of a transfusion infection. Signup and view all the answers

What is a hemoglobin A1c performed for?

To monitor the effectiveness of therapy in diabetes. Signup and view all the answers

Which of the following is an example of an immunosuppressant drug?

Cyclosporine. Signup and view all the answers

What test is important in the management of patients with anemia?

Hb. Signup and view all the answers

What was the international normalized ratio (INR) created to solve?

Differences in results on the same patient using PT test from different companies. Signup and view all the answers

Which point-of-care test helps a physician detect low-grade inflammation even in asymptomatic individuals?

hsCRP. Signup and view all the answers

What is a chain of custody?

A special protocol used when collecting forensic specimens. Signup and view all the answers

What regulates glucose levels in the blood?

Insulin produced by the pancreas. Signup and view all the answers

What is the time required for the body to metabolize half the amount of a drug called?

Drug half-life. Signup and view all the answers

Which test identifies individuals at future risk of heart disease?

hsCRP. Signup and view all the answers

What is the order of draw if drawing a protime and CBC with a blood culture specimen?

Blood culture, protime, CBC. Signup and view all the answers

What do rapid syphilis tests detect?

Treponema pallidum. Signup and view all the answers

What is initial specimen diversion?

A technique used in the collection of blood cultures. Signup and view all the answers

What type of specimen was collected in a royal blue-top tube with a lavender stripe on the label?

Trace element, EDTA. Signup and view all the answers

Which of the following is a type of 'good' cholesterol?

HDL Signup and view all the answers

When should the 1-hr specimen be collected after administering glucose in a GTT?

<ol start="715"> <li></li> </ol> Signup and view all the answers

Study Notes

Forensic Toxicology

Forensic toxicology involves the legal implications of toxin exposure.

Blood Culture Collection

When collecting blood cultures, if only one bottle can be filled, prioritize adding to the aerobic bottle.
Correct order for blood culture collection: select equipment, perform friction scrub, cleanse bottle tops, and perform venipuncture.
Pediatric blood culture challenges arise due to prior antibiotic administration.
Initial specimen diversion is a technique used when collecting blood cultures.

Lactose Tolerance Test

The lactose tolerance test assesses if a patient lacks the enzyme to convert lactose into glucose and galactose.

Parentage Testing

Blood samples are the preferred specimens for parentage testing.
A child who is a minor cannot order paternity testing.

Blood Donation and Transfusions

Autologous donation acknowledges that unused units are not shared with other patients.
Blood transfusions may be fatal if incompatible blood is given due to red blood cell lysis.
TDM (therapeutic drug monitoring) helps maintain appropriate drug dosages across various medications.

Blood Specimen Collection and Tests

The phosphate additive in blood ensures plasma pH stability.
Coagulation testing requires a specific ratio of blood to anticoagulant in the specimen tube.
Blood alcohol specimens can be cleaned using Zephiran chloride.
Tests like hemoglobin A1c are essential for managing diabetes and monitoring treatment effectiveness.
Collection of multiple specimens is necessary for glucose tolerance tests (GTT).

Glucose Metabolism

Hyperglycemia indicates increased blood glucose levels.
Glucose levels typically peak 30 to 60 minutes after ingestion.
Timing of specimen collection during GTT begins after the glucose beverage is finished.
Patients complete meals with controlled carbohydrate intake 3 days prior to GTT for accurate results.

Point-of-Care Testing (POCT)

Popular tests include glucose monitoring for diabetic management and cardiac assessments using TnT and B-type natriuretic peptide.
POCT can use diverse blood sample types, allowing devices to download data and verify operator IDs for security.
HemoCue HB201+ uses microcuvettes for testing instead of traditional strips.

Infection and Sepsis Monitoring

Lactate levels serve as markers for sepsis severity.
Septicemia refers to the presence of microorganisms in the bloodstream.

Anemia and Hematology

Hemoglobin is crucial in anemia management.
Blood specimens for lead analysis require tan-top tubes with K2EDTA.

Miscellaneous

Chain-of-custody protocols apply to forensic specimens, ensuring integrity during testing.
Rapid tests like those for syphilis detect specific pathogens like Treponema pallidum.
Good cholesterol is represented by HDL, while drugs like phenobarbital are not categorized as typical abuse substances.

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Test your knowledge of Chapter 11 in your Phlebotomy studies with these flashcards. This quiz covers topics like forensic toxicology, blood collection techniques, and specific tests such as TB-Gold. Perfect for preparing for your upcoming phlebotomy exam!