TEST BANK for Phlebotomy Handbook 10th Edition Blood Specimen Collection from Basic to Advanced by G

Phlebotomy Handbook 10th Edition Garza Test Bank Phlebotomy Handbook, 10e (Garza/Becan-McBride) Chapter 1 Phlebotomy Practice and Quality Assessment Multiple Choice Questions 1) The term phlebotomy is derived from Greek words that mean: A) droplet, vein B) vein, cut C) blood, droplet D) red, blood Answer: B 2) The terms venesection/venisectionare synonymous with (the same as) which of the following?

A) topside of a vein B) blood vein C) phlebotomy D) venous circulation Answer: C 3) An emergency care center is an example of which type of health care setting?

A) hospital-based clinic B) specialty hospital C) hospice D) ambulatory care (outpatient) setting Answer: D 4) What are competency statements for health care workers?

A) federal tax code for health care workers B) certification requirements C) precautions for reducing infections D) skills and abilities required for job performance Answer: D 5) Which of the following is the medical specialty that pertains to the diagnosis and treatment of skin disorders?

A) dermatology B) pathology C) immunology D) otolaryngology Answer: A 6) Which of the following specialties would relate to diagnosis and treatment of cancer?

A) dermatology B) oncology C) orthopedics D) infectious diseases Answer: B

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7) Which of the following medical specialists would only treat elderly patients?

A) pediatrician B) hematologist C) gerontologist D) pathologist Answer: C 8) Receiving an emergency lab test request is an example of which phase of laboratory testing?

A) preexamination/preanalytical B) examination/analytical C) postexamination/postanalytical D) notification/reporting Answer: A 9) Assessing a patient for a suitable vein to perform a venipuncture procedure is an example of which phase of laboratory testing?

A) preexamination/preanalytical B) examination/analytical C) postexamination/postanalytical D) notification/reporting Answer: A 10) Identification and labeling of a blood specimen after a venipuncture procedure is an example of which phase of laboratory testing?

A) preexamination/preanalytical B) examination/analytical C) postexamination/postanalytical D) notification/reporting Answer: A 11) Using an antiseptic for cleansing the skin prior to a venipuncture procedure is an example of which phase of laboratory testing?

A) preexamination/preanalytical B) examination/analytical C) postexamination/postanalytical D) notification/reporting Answer: A 12) Centrifugation of a blood specimen is an example of which phase of laboratory testing?

A) preexamination/preanalytical B) examination/analytical C) postexamination/postanalytical D) notification/reporting Answer: A

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13) Performing a laboratory test on a patient's blood specimen is an example of which phase of laboratory testing?

A) preexamination/preanalytical B) examination/analytical C) postexamination/postanalytical D) notification/reporting Answer: B 14) In which circumstances is the phlebotomist likely to collaborate with the pharmacy?

A) when the patient is overly angry or agitated B) when a patient requests a painkiller C) when asked to collect specimens for drug monitoring D) when looking for a suitable vein for the venipuncture procedure Answer: C 15) Which of the following would do the most to promote a professional appearance in a patient care setting?

A) good posture and personal hygiene B) quality control monitors C) documentation procedures D) use of a strong, assertive voice Answer: A 16) There are many professional expectations for phlebotomists, but one of the most important is following a code of ethics. Which of the following would be an example of ethical behavior?

A) good posture B) respect for patient's privacy C) ability to look at blood without fainting D) maintaining a healthy lifestyle Answer: B 17) The concept of meeting and exceeding customer expectations by resolving immediate problems, and finding opportunities for improvement where no problems are evident, is known as: A) continuous quality improvement (CQI) B) a code of ethics C) continuing education (CE) D) Clinical Laboratory Improvement Amendments of 1988 (CLIA 1988) Answer: A 18) Cleanliness and personal hygiene are important for: A) precision and accuracy B) personal and patient safety C) timeliness of test results D) personal liability Answer: B

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19) Professional certification typically refers to: A) passing a national examination and/or completing continuing education B) maintaining a good record of attendance at one's jobsite C) passing a state examination D) passing an examination given by a local hospital Answer: A 20) Licensure typically refers to: A) providing up-to-date income tax records B) maintaining all immunizations up to date C) passing a state-required examination and/or continuing education D) joining a professional organization Answer: C 21) The term right to know refers to: A) keeping the patient's condition confidential while outside the health care organization B) the patient's right to information about his procedures and who is performing them C) accountability of the phlebotomist to know details of every clinical test D) allowing employers to know personal details of each employee Answer: B 22) Health care for infants and children falls into which medical specialty?

A) oncology B) neonatology C) pediatrics D) cytology Answer: C 23) Which of the following is an important work-related characteristic that is helpful for phlebotomists?

A) a keen sense of direction B) enjoying work with small objects C) being very athletic D) involvement in community activities Answer: B 24) Which of the following is acceptable attire for a phlebotomist?

A) dangling earrings B) necklace tucked inside a collar C) fragrances and perfumes D) long, polished fingernails Answer: B 25) Six Sigma is an example of a: A) dress code policy B) customer satisfaction survey C) certification agency D) quality improvement framework Answer: D

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True/False Questions 1) Competencies for phlebotomists never vary from one employer to another.

Answer: FALSE 2) Written examinations are the only way to assess competence in a health care field.

Answer: FALSE 3) An example of quality assessment would be checking for multiple venipunctures on the same patient.

Answer: TRUE 4) The abbreviation CE usually refers to a certification examination.

Answer: FALSE 5) Verbal and nonverbal communication skills are considered essential for phlebotomists.

Answer: TRUE 6) The right to refuse treatment is considered a "patient right."

Answer: TRUE 7) Confidentiality is considered a "patient right."

Answer: TRUE 8) A phlebotomist should wear a name badge at all times while on duty.

Answer: TRUE 9) Sandals are permitted in the laboratory.

Answer: FALSE 10) Quality procedures for phlebotomy services do not involve turnaround times.

Answer: FALSE

Short Answer Questions 1) The term used to describe patients, other individuals, groups, or organizations that have an interest in or are influenced by the quality of care in a health care organization is customers or .

Answer: stakeholders 2) A patient who is hospitalized is an Answer: inpatient

.

3) CMS is an abbreviation for .

Answer: Centers for Medicare & Medicaid Services 4) Health care garb that includes gowns, gloves, masks, and face shields is known as Answer: personal protective equipment (PPE)

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.

5) The organization that develops international standards for the health care industry is the Answer: International Organization for Standardization (ISO) 6) Laboratory tests provided to individual consumers on request are referred to as Answer: direct access testing (DAT) or direct to customer (DTC)

.

.

7) NAACLS is an abbreviation for .

Answer: National Accrediting Agency for Clinical Laboratory Sciences 8) A specialist who performs laboratory tests and usually has a 2-year certificate or associate's degree is called a _.

Answer: medical laboratory technician (MLT) 9) The department that provides special diets for patients is called Answer: Nutrition and Dietetics

.

10) A physician who specializes in diagnosis and treatment of disorders in the tissues that produce hormones is an .

Answer: endocrinologist

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Essay Questions 1) Every health care worker must play a role on a health care team. Explain why teamwork is important in health care and describe several essential attributes that team members have in high-performance teams.

Answer: Most health care workers interact with numerous individuals in the health care setting as they perform their job functions. For phlebotomists, interactions occur prior to, during, and after the actual phlebotomy procedure takes place. At each stage, there are factors that can affect the quality of the laboratory test results, and hence the outcome of care given to patients. It is essential that all members of the health care team share the goal of providing quality care to patients. This is accomplished by team members who demonstrate the following attributes: ∙ Understand the mission of the organization, goals of the group, or project objectives ∙ Know the basic skills for group processes and team dynamics ∙ Understand relevance and commitment to team goals ∙ Be reliable and dependable ∙ Communicate effectively ∙ Actively and respectfully participate in decision making ∙ Learn how to be flexible in decision making ∙ Manage conflicts in a constructive manner ∙ Contribute to the cohesion of the team ∙ Contribute to problem-solving strategies ∙ Support and encourage other team members 2) Describe the four areas that shape the concept of professionalism for phlebotomists. Analyze your own views of professionalism, and give examples of how your view fits into each of the four areas.

Answer: Professionalism is the skill, competence, or character expected of someone in a trained profession. The four categories that can be used to interpret one's perspective of professionalism are: ∙ Respect–For others, in personal appearance and in organizational policies/procedures (e.g., patient confidentiality); for coworkers; and of cultural and/or racial differences ∙ Service–Shifting the focus from oneself to others, and commitment to job duties and to effective communication ∙ Support–Maintaining a clean workspace; reporting errors and damaged equipment or supplies; exhibiting courteous behavior; engaging one's employer by respectfully disagreeing and offering solutions to problems ∙ Growth–Learning more about one's job, other aspects of the organization, and the employees who help run it 3) The health care field is a very rewarding place to work; however, it can also be stressful. Describe situations that are likely to make you feel stressed and discuss ways that may help you alleviate workrelated stress.

Answer: Examples of stress-inducing scenarios may include dealing with terminally ill patients or angry patients/visitors, uncomfortable peer relationships, excessive overtime, pressure to work faster, and excessive changes in policy/procedure. Box 1-9 lists tips for dealing with stress, including finding time for privacy, planning rest/relaxation periods, associating with gentle people, seeking out humor, exercising regularly, eating a nutritious diet, taking vitamins, finding hobbies or enjoyable social activities, rearranging your schedule, keeping a journal, reading interesting books or articles to get new ideas, avoiding harmful habits, or seeking professional assistance if needed.

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Phlebotomy Handbook, 10e (Garza/Becan-McBride) Chapter 2 Communication, Computer Essentials, and Documentation Multiple Choice Questions 1) A patient's medical record can best be described as: A) a legal document that provides a chronological log of care B) a legal document that is available only to the patient's physician C) the procedure for a selected care plan D) public information that may be disclosed during a financial inquiry Answer: A 2) The "brain" of a machine, which executes activities, is known as: A) storage B) hardware C) the Internet D) software Answer: B 3) Health literacy refers to: A) the ability to translate medical terms in foreign languages B) positive feedback from a health care worker about a patient's health status C) geriatric patients' outlook on their own health D) written, spoken, or conceptual knowledge of health issues Answer: D 4) "Baby Boomers" are individuals who were born: A) prior to the mid-1940s B) from the mid-1940s to 1964 C) from 1965 to 1981 D) from 1982 to 2006 Answer: B 5) Generation Xers are individuals who were born: A) prior to the mid-1940s B) from the mid-1940s to 1964 C) from 1965 to 1981 D) from 1982 to 2006 Answer: C 6) Millennials are individuals who were born: A) prior to the mid-1940s B) from the mid-1940s to 1964 C) from 1965 to 1981 D) from 1982 to 2006 Answer: D

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7) Traditionalists are individuals who were born: A) prior to the mid-1940s B) from the mid-1940s to 1964 C) from 1965 to 1981 D) from 1982 to 2006 Answer: A 8) Instructions for the hardware, written in a computer-programming language, are known as: A) the network B) software C) storage D) the Internet Answer: B 9) If a non-English-speaking patient is scheduled to have a blood specimen collection, the health care worker should: A) find an interpreter or other method to communicate the information B) use sign language to communicate the message C) use a computer to show pictures of the procedure D) continue with the procedure knowing that the patient may partially understand Answer: A 10) What is Braille?

A) system of writing for sightless individuals B) a sound system that intensifies volume C) the level of deafness of an individual D) written instruction booklet for health care procedures Answer: A 11) Which of the following terms refers to the speed and urgency of one's voice?

A) STAT B) tone C) pace D) volume Answer: C 12) Which of the following terms refers to the intonation or pitch of one's voice?

A) STAT B) tone C) pace D) volume Answer: B

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13) Which of the following terms would communicate a critical patient condition?

A) STAT B) tone C) pace D) volume Answer: A 14) According to the National Federation of the Blind (NFB), blind individuals are entitled to: A) the same rights as sighted individuals and not more B) use a white cane or guide dog to walk independently C) have their laboratory tests performed free of charge D) have access to all parts of the laboratory without asking permission Answer: B 15) IDC codes are: A) not used for billing purposes B) used to describe tests, surgeries, and evaluations C) an example of cloud computing D) based on body system, medical conditions, or symptoms Answer: D 16) The space or distance between people during an interaction is called: A) range of motion B) area of definition C) zone of comfort D) safety zone Answer: C 17) After each 30 minutes of computer use, one should take a break of: A) 10 or 15 seconds B) 1 to 2 minutes C) 15 minutes D) 1 hour Answer: B 18) In a health care setting, which would be the preferred manner to place a caller on hold?

A) Pick up the phone and say, "Hold please."

B) Answer the phone and allow the caller to give the reason for calling, then ask him or her, "May I put you on hold for a few moments?"

C) Place the caller on hold without speaking to him or her so you can finish the other call faster.

D) Answer the phone and ask the caller to call back later.

Answer: B

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19) High-pitched voices are associated with: A) panic B) professionalism C) happiness D) melancholy Answer: A 20) What are "delta checks"?

A) competency checklists B) manual recording system for laboratory results C) QC that allows for detection of clinically significant changes in laboratory results D) QA methodology that allows for the monitoring of mislabeled specimens Answer: C

True/False Questions 1) Generational differences can affect the way coworkers communicate with each other.

Answer: TRUE 2) The most effective form of interpersonal communication is with a written document.

Answer: FALSE 3) The zone of comfort is a medical term to describe how much pain the patient is experiencing.

Answer: FALSE 4) Computerization decreases transcription errors.

Answer: TRUE 5) The "Q" in LGBTQ stands for "queer or questioning."

Answer: TRUE 6) High-pitched voices are often associated with panic and urgency.

Answer: TRUE 7) In all states, children are permitted to serve as translators if their parents do not speak English.

Answer: FALSE 8) EMR refers to a type of computerized medical record.

Answer: TRUE 9) In general, children do not like anyone to approach them except close relatives or friends.

Answer: TRUE 10) Terms always have the same meaning when presented to individuals from different generations.

Answer: FALSE

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Short Answer Questions 1) In a health care setting, the phone should be answered after no more than Answer: two

rings.

2) The writing system composed of raised-dot patterns and used by sightless individuals is called .

Answer: Braille 3) E-mail documents are considered Answer: legal

documents and are admissible evidence in court cases.

4) Health care workers are required to report laboratory Answer: critical

or panic values to a physician.

5) are the doctrine or faith of a person or group.

Answer: Beliefs 6) A summary is the plan for diet, treatment, or monitoring once a patient leaves the hospital.

Answer: discharge 7) Documentation in a clinical/medical record provides Answer: proof 8) Clinical documents must be kept private and Answer: confidential

that an action was performed.

.

9) With individuals, their gender identity or expression does not align with their assigned birth sex, and/or their gender identity is outside of the traditional male/female classification.

Answer: transgender 10) The manual typically details worker and patient precautions and procedures related to hand hygiene, and reducing the spread of infections.

Answer: Infection Control

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Essay Questions 1) Describe the measures a phlebotomist could take to improve communication in the following scenario.

A hospitalized elderly patient with a slight hearing impairment has several family members in the room trying to repeat all conversations to the patient, and the television is loudly broadcasting the patient's favorite program.

Answer: There is a variety of practical strategies that could facilitate communication in this scenario.

Distractions such as the television could be handled by asking the patient if he or she would mind turning the television off or putting the volume on "mute" for a short while. (The phlebotomist should remember to turn up the volume at the completion of the interaction.) If the patient does not want to miss the program, and if the timing of the interaction is not important, then the phlebotomist can offer to come back at a time when the program is over. Regarding the relatives, it is acceptable for the phlebotomist to ask them, "Would you mind if Mr. Smith (the patient) and I have a few minutes together; you may wait outside during the procedure and I will call you in as soon as we finish." The patient may prefer to have a relative in the room; this is acceptable if it does not interfere with the interaction. There are several options to cope with the patient's hearing loss, including speaking slightly louder (but not shouting) while facing the patient directly, or using written instructions.

2) Describe at least four nonverbal behaviors that might make you feel uncomfortable when you go for a health checkup, and indicate why they bother you. Describe how you personally react when confronted with these behaviors.

Answer: Individual answers will vary but are likely to include some of the following bothersome behaviors: ∙ Wandering or rolling eyes during a conversation ∙ Staring at the ceiling ∙ Squirming ∙ Tapping pencil or foot ∙ Peering over glasses ∙ Deep breath, sighs ∙ Wrinkled forehead ∙ Having someone point a finger at you ∙ Stretching, yawning Individuals also react differently to these "negative" behaviors, ranging from being intimidated, to having hurt feelings, to defensive anger.

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Phlebotomy Handbook, 10e (Garza/Becan-McBride) Chapter 3 Professional Ethics, Legal, and Regulatory Issues Multiple Choice Questions 1) Failure to act or perform duties according to the standard of care for phlebotomy is: A) battery B) negligence C) criminal action D) slander Answer: B 2) Which of the following describes bioethics but not ethics?

A) resolving conflicts in an orderly and nonviolent manner B) choosing one type of needle instead of another C) suing for monetary damages D) dealing with "life-and-death" issues such as when a patient should be allowed to die Answer: D 3) When a phlebotomist gives aid during an emergency, he or she is usually protected through: A) rightful action consent B) CLIA C) FDA D) implied consent Answer: D 4) For health care providers, liability insurance: A) must always be purchased individually B) is increasingly of less importance in today's world C) can sometimes be obtained at a reduced rate from professional organizations D) tends not be covered by a hospital's blanket liability insurance policy Answer: C 5) The standard of care presently used in phlebotomy malpractice legal cases involving health care providers is based on the conduct of the average phlebotomist in which area?

A) city B) state C) regional community D) national community Answer: D

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6) The federal law enacted that regulates the quality and accuracy of laboratory testing (including phlebotomy procedures) by creating a uniform set of provisions governing all clinical laboratories is referred to as: A) HCFA B) CLIA C) FDA D) The Joint Commission Answer: B 7) A young boy who refused to have blood collected from his arm was locked in a room by a health care worker and was forced to have the blood collection. This is an example of: A) implied consent B) assault and battery C) invasion of privacy D) informed consent Answer: B 8) Which of the following agencies administers CLIA? A) FDA B) CMS C) CPS D) EPA Answer: B 9) Which of the following branches of government writes laws that are called statutes?

A) judicial branch B) U.S. Supreme Court C) executive branch D) legislative branch Answer: D 10) Which of the following best describes the moral issues or problems that have resulted because of modern medicine, clinical research, and/or technology?

A) judicial law B) bioethics C) executive law D) patients' rights Answer: B 11) The legal term for improper or unskillful care of a patient by a member of the health care team, or any professional misconduct or unreasonable lack of skill, is: A) malpractice B) litigation C) liability D) invasion of privacy Answer: A

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12) According to a reputable study, if medical errors were tabulated similarly to diseases: A) they would rank as the third leading cause of death in the United States B) tort law would no longer be applicable C) they would rank as the fifth leading cause of death in the United States D) confusion of patient samples would no longer occur Answer: A 13) The doctrine or principle that "the thing speaks for itself" is: A) proximate causation B) res ipsa loquitur C) fraud D) battery Answer: B 14) Which of the following has recognized rights for patients in health care organizations through "The Patient Care Partnership"?

A) CLIA B) AHA C) CDC D) OSHA Answer: B 15) Under which of the following concepts are the supervisors and directors of laboratories held liable for the negligent actions of their employees?

A) misrepresentation B) res ipsa loquitur C) respondeat superior D) malice Answer: C 16) Examination of witnesses before a trial is referred to as: A) implied consent B) discovery C) statute of limitations D) respondeat superior Answer: B 17) In a malpractice lawsuit, the first statement of a case to be filed is by the: A) patient's case worker B) plaintiff C) defendant D) clinical laboratory administrator Answer: B

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18) Which of the following is the best example of setting the standard of care for blood collection?

A) Southwest Regional Phlebotomists' Association B) Texas Association for Clinical Laboratory Sciences C) California Clinical Laboratory Association D) The Joint Commission Answer: D 19) Release of a patient's drug abuse test results to anyone other than the attending physician or other authorized person can result in a negligence lawsuit because of the violation of: A) implied consent B) CMS requirements C) felony activities D) patient confidentiality Answer: D 20) A phlebotomist who routinely collects blood specimens from homebound patients should obtain information on the state's law regarding: A) moderately complex or highly complex lab testing B) alcohol abuse of the patient C) patient's confidentiality and HIV status D) drug abuse of the patient Answer: C 21) Which of the following legal concepts refers to the voluntary permission by a patient to allow touching, examination, and/or treatment by health care providers?

A) implied consent B) battery C) informed consent D) assault and battery Answer: C 22) A tort is a: A) criminal offence B) civil wrong committed against a person or a person's property C) court order for a person and documents to be brought to court proceedings D) form of consent Answer: B 23) A consent document to collect blood for research purposes from patients is established through: A) IRBs at institutions B) AHA C) The Joint Commission D) CLIA Answer: A

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24) Blood collection from patients and other individuals for research purposes is regulated through the: A) CMS regulations B) National Research Act C) AHA D) The Joint Commission Answer: B 25) A national organization that develops guidelines and safety measures and sets national standards specifically for laboratory procedures is: A) American Cancer Society B) American Hospital Association C) The Joint Commission D) American Diabetes Association Answer: C

True/False Questions 1) Ethics are societal rules or regulations that are obligatory to serve.

Answer: FALSE 2) Assault is the unjustifiable attempt to touch another person.

Answer: TRUE 3) Negligence is a violation of a duty to exercise reasonable skill and care in performing a task.

Answer: TRUE 4) A tort is a criminal wrong committed against a person.

Answer: FALSE 5) HIPAA was created to protect the public from substandard laboratory testing practices and provide a safe work environment for laboratory personnel.

Answer: FALSE 6) CMS enforces CLIA. Answer: TRUE 7) A laboratory performing only dipstick urinalysis is required to undergo a CLIA inspection.

Answer: FALSE 8) Implied consent occurs when the patient's nonverbal behavior indicates agreement.

Answer: TRUE 9) The statute of limitations defines how soon after a negligent act that the plaintiff must file the lawsuit or be forever barred from doing so.

Answer: TRUE 10) IRBs were established through the National Research Act. Answer: TRUE

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Short Answer Questions 1) The use of electronic transfer of patients' information is regulated by Answer: HIPAA

.

2) Malpractice, or , is defined as improper or unskillful care of a patient.

Answer: professional negligence 3) Supervisors may be held liable for the negligent actions of their employees under Answer: respondeat superior

.

4) The general term for criminal offenses not serious enough to be classified as felonies is Answer: misdemeanors

.

5) The health care worker or institution against whom the action or lawsuit is filed is the Answer: defendant

.

6) The law used for a plaintiff to sue for monetary damages is Answer: civil

law.

7) PHI stands for .

Answer: protected health information 8) All health care workers must conform to a specific Answer: standard of care

to protect patients.

9) The is the testimony of a witness that has been recorded in a written legal format.

Answer: deposition 10) Full explains the full nature of a research project and any risks.

Answer: disclosure

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Essay Questions 1) Explain the difference between informed consent and implied consent.

Answer: Implied consent occurs when the patient's nonverbal behavior indicates agreement, whereas informed consent is voluntary permission by a patient to allow touching, examination, and/or treatment by health care personnel only after signing an informed consent form.

2) List at least four problems that can lead to phlebotomy lawsuits.

Answer: 1. Patient falling after blood is collected 2. Hematoma/hemorrhage caused by inadequate pressure to the vein 3. Abscess or other infections at the venipuncture site 4. Injuries from fainting before, during, or after blood collection 5. Nerve damage due to poor venipuncture technique 6. Complications from collecting blood from the same side as a mastectomy (removal of breast) 7. Complications due to fat at the venipuncture site of obese patients and the resulting need to insert the needle at a slightly higher angle. When too elevated, the needle can go through the vein into a nerve or artery.

8. A wristband or identification error leading to wrong diagnosis and treatment and injury or death in some cases

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Phlebotomy Handbook, 10e (Garza/Becan-McBride) Chapter 4 Infection Control Multiple Choice Questions 1) Which of the following is designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in health care facilities?

A) Standard Precautions B) reverse isolation C) droplet precautions D) protective environment Answer: A 2) Which of the following organizations oversees the investigation and control of various diseases, especially those that are communicable?

A) The Joint Commission B) JCAHO C) CDC D) CLIA Answer: C 3) Which of the following is an agency of the U.S. Department of Labor that requires employers to provide measures that will protect workers exposed to biological hazards?

A) The Joint Commission B) OSHA C) CLSI D) CLIA Answer: B 4) In WHO's "My 5 Moments in Hand Hygiene," the first moment is: A) before touching a patient B) after touching any patient surroundings C) before aseptic or cleaning of the procedure site D) after touching a patient Answer: A 5) About how many patients acquire a nosocomial infection annually?

A) 1 to 1.5 million B) 1.7 to 3 million C) 4 to 5.5 million D) 6 to 7.2 million Answer: B

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6) Which of the following is a commonly identified pathogenic agent that affects the skin?

A) Shigella sp.

B) Clostridium difficile C) Vibrio cholerae D) Herpes virus Answer: D 7) Which of the following would require contact precautions?

A) scabies B) scarlet fever C) rubella D) tuberculosis Answer: A 8) Which of the following would require airborne precautions?

A) rubella B) hepatitis A C) rubeola D) scabies Answer: C 9) Which of the following is a commonly identified causative agent of nosocomial infections in the nursery unit?

A) Escherichia coli B) Haemophilus vaginalis C) Shigella D) Vibrio cholerae Answer: A 10) Protective (reverse) isolation is commonly used for patients who have: A) Vibrio cholerae B) immunodeficiency disorders C) hepatitis A D) whooping cough Answer: B 11) Which of the following is a commonly identified pathogenic microorganism that causes health careassociated skin infections?

A) Candida albicans B) Haemophilus influenzae C) Haemophilus vaginalis D) Moraxella lacunata Answer: A

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12) Antiseptics for skin include: A) hypochlorite solution B) formaldehyde C) iodine D) ethylene oxide Answer: C 13) Which of the following chemicals should be used to disinfect tourniquets and items contaminated with blood?

A) 70 percent isopropyl B) 1:10 dilution of chlorine bleach C) hydrogen peroxide D) iodophors Answer: B 14) The HICPAC transmission-based precautions include: A) airborne, droplet, and contact B) airborne, respiratory, and contact C) enteric, contact, and respiratory D) complete, droplet, and airborne Answer: A 15) Which of the following chemical compounds is an antiseptic for skin?

A) 1 percent phenol B) hexylresorcinol C) ethylene oxide D) chlorophenol Answer: B 16) Which of the following is the proper sequence for removal of isolation apparel after blood collection in an isolation room?

A) gloves, mask, gown B) goggles, gown, gloves C) mask, goggles, gloves D) gloves, gown, mask Answer: D 17) In the "chain of infection," the reservoir is: A) the pathogen B) the patient who is carrying the pathogen C) the patient who is exposed to the pathogen D) the invasive bacteria Answer: B

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18) In health care facilities, which of the following is a typical fomite?

A) laboratory coat B) 70% isopropyl alcohol C) hexachlorophene D) iodine for blood culture collection Answer: A 19) Which of the following is the most important procedure in the prevention of disease transmission in health care institutions?

A) use of appropriate waste disposal practices B) use of personal protective equipment C) handwashing D) reporting personal illnesses to supervisor Answer: C 20) In the process of preparing to enter a patient's isolation room, which of the following would occur first?

A) donning gloves B) untying gown at the neck C) discarding mask D) donning mask Answer: D 21) Which of the following is a factor that increases a host's susceptibility in the chain of infection?

A) drug use B) an immunization C) use of disposable equipment D) proper nutrition Answer: A 22) Which of the following is a vector in transmitting infectious diseases?

A) age B) mites C) rabies D) Salmonella Answer: B 23) The final "moment" in WHO's "My 5 Moments in Hand Hygiene" is: A) after blood of body fluid exposure B) after touching any patient surroundings C) before aseptic or cleaning of the procedure site D) after touching a patient Answer: B

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24) Nosocomial (health care-associated) infection occurs when: A) a source is detected B) the chain of infection is complete C) a means of transmission is maintained by disinfectants D) a susceptible host remains stable Answer: B 25) Disinfectants are: A) quaternary ammonium compounds B) chemicals that are used to remove or kill pathogenic microorganisms C) used frequently on skin for removal of microorganisms D) chemicals that are used to inhibit the growth and development of microorganisms but do not necessarily kill them Answer: B

True/False Questions 1) MRSA represents methicillin-resistant Staphylococcus aureus.

Answer: TRUE 2) A major factor that affects a host's susceptibility in the chain of infection is age.

Answer: TRUE 3) A flu vaccination is an example of a fomite.

Answer: FALSE 4) Infection control programs aim to link the infection chain.

Answer: FALSE 5) A mite is an example of a vector.

Answer: TRUE 6) Ebola virus can be carried by semen and vaginal secretions.

Answer: TRUE 7) Measles requires airborne precautions.

Answer: TRUE 8) A respirator is an alternative to PPE. Answer: FALSE 9) NIOSH stands for National Institute for Occupational Safety and Health.

Answer: TRUE 10) Removing the gloves is the final step in the complete procedure for removal of isolation PPE. Answer: FALSE

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Short Answer Questions 1) precautions are used for scabies infections.

Answer: Contact 2) OSHA requires that hands be washed with soap and water every Answer: third

time the hands are cleaned.

3) Droplet precautions are used for large-particle droplets, which are larger than _ an infected person.

Answer: 5

microns, from

4) The of transmission for the pathogen to pass directly from the source to the host is part of the chain of infection.

Answer: mode 5) For the chain of infection to occur, a Answer: pathogen

must be present.

6) infections occur when the chain of infection is complete.

Answer: Nosocomial 7) A doorknob is considered a transmit infections.

Answer: fomite

in health care facilities since it can harbor infectious agents and

8) Standard precautions have been designed through the microorganisms.

Answer: CDC

to decrease the risk of transmission of

9) precautions reduce the spread of infections from agents such as rubeola.

Answer: Airborne 10) Chemical compounds that are used to remove or kill pathogenic microorganisms are called Answer: disinfectants

.

Essay Questions 1) Describe the procedure to clean phlebotomy and laboratory surfaces.

Answer: Gloves should be placed on hands first. Then a dilute solution of chlorine bleach (1:100) can be used for routine cleaning of surfaces. All dilute solutions of chlorine bleach need to be made weekly to prevent the loss of germicidal activity.

2) What is a protective (reverse) isolation facility in a health care environment?

Answer: A protective (reverse) isolation facility is a hospital room that is completely sterile. All food and articles are sterilized before they are taken into the patient's room. These areas are for immunocompromised patients.

6

Phlebotomy Handbook, 10e (Garza/Becan-McBride) Chapter 5 Safety and First Aid Multiple Choice Questions 1) The health care provider is most likely to encounter which of the following hazards upon entering the nuclear medicine department to obtain a blood specimen from a patient?

A) fire hazard B) radiation hazard C) mechanical hazard D) electrical hazard Answer: B 2) The first step in controlling severe bleeding is to: A) send for medical assistance B) start cardiopulmonary resuscitation C) apply pressure directly over the wound or venipuncture site D) make the individual lie down and apply pressure to the person's forehead Answer: C 3) If a health care provider is in an area of the health care facility where a fire starts, she or he should first: A) block the entrances so that others will not enter the fire area B) close all the doors and windows before leaving the area C) attempt to extinguish the fire, using the proper equipment D) pull the nearest fire alarm Answer: D 4) In the hazardous labeling system developed by the NFPA, the blue quadrant of the diamond indicates a(n): A) flammability hazard B) health hazard C) specific hazard D) instability hazard Answer: B 5) If an electrical accident occurs involving electrical shock to an employee or a patient, the first thing that the health care provider should do is: A) shut off the electrical power B) move the victim away from the electricity C) start CPR D) place a blanket over the victim Answer: A

1

6) The use of the SDS format for hazard communication sheets is required by the: A) Environmental Protection Agency B) Global Harmonization System C) Hazard Communication Standard (29 CFR 1910.1200) D) CDC Answer: B 7) The abbreviation RACE is used in: A) electrical emergencies B) fire emergencies C) radiation emergencies D) mechanical emergencies Answer: B 8) If a fire extinguisher has to be used in a health care environment, the first step to perform is: A) aim extinguisher at the base of the fire B) squeeze the handle of the extinguisher to spray the solution on the fire C) pull the pin off of the extinguisher D) spray the solution toward the base of the fire Answer: C 9) The first step in giving mouth-to-mouth resuscitation is to: A) open the airway by checking for obstructions B) listen and feel for return of air from the victim's nose C) look at the victim's chest for rise and fall D) determine whether the victim is conscious by gently tapping the shoulders of the victim and speaking loudly, "Are you okay?"

Answer: D 10) Which of the following should not be done for a shock victim who seems to be not fully conscious?

A) keep the victim's airway open B) give fluids to keep the victim from becoming dehydrated C) call for emergency assistance D) elevate the victim's legs so that the head is lower than the trunk of the body Answer: B 11) Which organization developed a labeling system for hazardous chemicals that is frequently used in health care facilities?

A) OSHA B) NFPA C) CDC D) EPA Answer: B

2

12) The HazCom standard requires chemical manufacturers to supply: A) SDSs B) DOTs C) fire extinguishers D) nonlatex medical equipment Answer: A 13) What are the major principles of self-protection from radiation exposure?

A) distance, combustibility, and shielding B) time, distance, and shielding C) anticorrosive, shielding, and distance D) combustibility, anticorrosive, and distance Answer: B 14) A dosimeter badge is required in health care facilities for: A) electrical safety B) radiation safety C) fire safety D) mechanical safety Answer: B 15) High exposures of radioactivity have been shown to lead to: A) heart disease B) diabetes C) leukemia D) rheumatoid arthritis Answer: C 16) If a health care provider hears a fire alarm as she or he is collecting blood from a patient, she or he should not: A) close all of the doors and windows before leaving the area B) run C) attempt to extinguish the fire if it is small D) call the assigned fire number Answer: B 17) If a health care provider has a chemical spilled on him or her, he or she should immediately: A) rub the site vigorously with his or her hands B) wait to see if the chemical starts to burn the skin C) rinse the area with sodium chloride D) rinse the area with water Answer: D

3

18) According to the hazard labeling system developed by NFPA, the yellow quadrant of the diamond indicates a(n): A) flammability hazard B) health hazard C) instability hazard D) specific hazard Answer: C 19) Chemicals that are defined as explosives must be stored: A) in a separate storage room B) in small carrying containers C) in an explosion-proof or fireproof room D) on a high shelf away from light and heat Answer: C 20) SDS stands for: A) standard deviation sheet B) safety data sheet C) systematic delivery system D) simple data standard Answer: B 21) Class C fires are: A) electrical fires B) chemical fires C) wood fires D) paper fires Answer: A 22) If a phlebotomist is collecting blood specimens from a patient in the nuclear medicine department, he or she needs to be: A) aware of the potential mechanical hazards B) wearing a dosimeter badge C) aware of the SDSs for that area D) aware of the chemical spill procedures Answer: B 23) If a phlebotomist is exposed accidentally to a chemical spill on the floor, he or she should quickly go to which department for a chemical spill cleanup kit?

A) specimen collection B) clinical microbiology C) clinical chemistry D) clinical immunology Answer: C

4

24) Which of the following is needed for cleanup of a chemical spill?

A) nonlatex gloves B) NIOSH TB respirator C) rubber gloves D) chlorhexidine Answer: C 25) CPR stands for: A) cardiopulmonary rescue B) cardiopulmonary resuscitation C) cardiopulmonary recovery D) cardiopulmonary return Answer: B

True/False Questions 1) The dosimeter is a frequently used instrument for blood specimen preparation and testing.

Answer: FALSE 2) Severe bleeding from an open wound can be controlled by applying pressure directly below the wound.

Answer: FALSE 3) In case of a chemical spill in the eye, the victim should rinse his or her eyes with water for a minimum of 15 minutes.

Answer: TRUE 4) To save time, contact lenses should remain in the eyes prior to rinsing the eyes with water after a chemical spill to the eyes.

Answer: FALSE 5) Some tourniquets contain latex.

Answer: TRUE 6) All disposable gloves are latex-free.

Answer: FALSE 7) Class A fires require an ABC extinguisher.

Answer: TRUE 8) A carbon dioxide extinguisher can be used for Class B fires.

Answer: TRUE 9) The GHS requires the use of HazCom SDSs. Answer: FALSE 10) NFPA stands for National Fire Protection Association.

Answer: TRUE

5

Short Answer Questions 1) The components of fire are fuel, oxygen, and Answer: heat

.

2) The number of general classifications of fires adopted by NFPA is Answer: four 3) RACE for fire refers to rescue, Answer: alert

.

, confine, and extinguish.

4) A plug should be removed from a wall outlet by grasping the Answer: plug 5) In the RACE abbreviation, the "E" refers to Answer: extinguish

.

.

6) The to Know law is also referred to as the OSHA HazCom standard.

Answer: Right 7) In case of a chemical spill in the eye, the victim should rinse his or her eyes at the Answer: eyewash

station.

8) from a person's limb can be decreased by elevation.

Answer: Bleeding 9) The signs and symptoms of a(n) Answer: allergic

reaction to latex may include a skin rash.

10) A badge is needed if the health care provider collects specimens from patients in the nuclear medicine department.

Answer: dosimeter

Essay Questions 1) Describe what types of fires are Class B fires, and list the fire extinguisher(s) that can be used.

Answer: Class B fires include liquid, grease, and chemical fires; an ABC extinguisher or carbon dioxide extinguisher should be used.

2) What emergency procedures should occur if an accident occurs involving electrical shock to a health care worker?

Answer: First, the electrical power source must be shut off. If this is impossible, carefully remove the electrical contact from the victim, using something that does not conduct electricity. For example, place your hand in a glass beaker and push the power supply away from the victim. The rescuer should not attempt to touch the victim without heeding these precautions. Next, medical assistance should be called and cardiopulmonary resuscitation (CPR) started immediately. The victim should not be moved prior to the arrival of medical assistance. A fire blanket or warm clothing should be put over the victim to keep him or her warm until medical help arrives.

6

Phlebotomy Handbook, 10e (Garza/Becan-McBride) Chapter 6 Medical Terminology, Anatomy, and Physiology of Organ Systems Multiple Choice Questions 1) Hormones are produced in which of the following body systems?

A) respiratory B) digestive C) endocrine D) lymphatic Answer: C 2) Tuberculosis is generally considered a disease of which of the following body systems?

A) respiratory B) digestive C) endocrine D) lymphatic Answer: A 3) How many times per minute does the average person inhale and exhale?

A) 5 B) 15 C) 50 D) 100 Answer: B 4) Protection is the primary function of which of the following systems?

A) cardiovascular B) integumentary C) urinary D) muscular Answer: B 5) The term ventral refers to which part of the body?

A) back B) shoulder C) side D) front Answer: D 6) If a normal person breathes in, the oxygen travels through air passages to the lungs. Which of the following takes place?

A) Oxygen (O2) is exchanged for carbon dioxide (CO2).

B) The heart beats faster.

C) The lungs can fill with fluid.

D) The pulse rate changes.

Answer: A

1

7) Which structure governs the functions of the individual cell, such as growth, repair, reproduction, and metabolism?

A) membrane B) cytoplasm C) lysosome D) nucleus Answer: D 8) How many lobes does the human right lung have?

A) 2 B) 3 C) 4 D) 5 Answer: B 9) After oxygen crosses the respiratory membranes (in the lung) into the blood, about 97% of it combines with: A) hemoglobin B) carbon dioxide C) hypochloride D) carbaminohemoglobin Answer: A 10) As CO2 levels increase in the blood, the blood pH: A) decreases (becomes more acidic) B) increases (becomes less acidic) C) stays the same D) increases for the first few minutes, then drops to normal Answer: A 11) An XX pair of chromosomes means that the fetus will be a: A) baby boy B) baby girl C) brown-haired child D) blue-eyed child Answer: B 12) A test request for O & P refers to: A) chromosome analysis B) an evaluation for parasites C) oxygen and pH D) occult blood and pathogens Answer: B

2

13) An XY pair of chromosomes means that the fetus will be a: A) baby boy B) baby girl C) brown-haired child D) fraternal twin Answer: A 14) When a person breathes out, which of the following normally takes place?

A) O2 is exchanged for CO2.

B) The heart beats faster.

C) CO2 is expelled.

D) The pulse rate changes.

Answer: C 15) ESRD is caused by glomerulonephritis, tubular diseases, hypertension, and other conditions. What does the abbreviation ESRD stand for?

A) end-stage renal disease B) erythrocyte sedimentation rate for diagnosis C) estrogen stimulation D) extra-sensitive rapid detection Answer: A 16) Which of the following is produced in the adrenal glands, the glands that cause emotions such as fear and anger?

A) glucose B) hormones C) cholesterol D) electrolytes Answer: B 17) Which of the following controls skin pigmentation?

A) melanin B) hemoglobin C) glucose D) vitamin D Answer: A 18) Dermatitis is an inflammation of the: A) nails and hair B) forearm C) dermal layers of the skin D) superficial muscles of the arm Answer: C

3

19) The periosteum does which of the following?

A) transports oxygen into the muscles B) contains blood vessels to transport blood from inside the bone to outer layers C) cordlike structure that attaches to muscles D) causes rigidity in the bones Answer: B 20) Osteoarthritis, bursitis, and gout are conditions of which body system?

A) muscular B) lymphatic C) integumentary D) skeletal Answer: D 21) Muscular dystrophy is a condition characterized by: A) inflammation of the tendons B) a viral infection C) gradual wasting/weakened muscles D) excessive lactic acid production Answer: C 22) Specialized cells of the nervous system are: A) striated B) neurons C) tendons D) islet cells Answer: B 23) Protective layers around the brain and spinal cord that contain spinal fluid are called: A) motor neurons B) fluid coverings C) meninges D) vertebrae Answer: C 24) The vertebral canal has several regions called: A) anterior, posterior, dorsal B) upper, middle, lower C) superior, inferior D) cervical, thoracic, lumbar Answer: D

4

25) A degenerative disorder of the nervous system that is characterized by hand tremors, loss of facial expression, and a shuffling walk is called: A) epilepsy B) neuralgia C) hydrocephaly D) Parkinson's disease Answer: D 26) The "tail" of a sperm cell that enables it to move toward the ovum is the: A) flagellum B) cilia C) hair tubule D) vesicle Answer: A 27) The body cavity that houses the lungs is called the: A) abdominal cavity B) thoracic cavity C) pericardial cavity D) cranial cavity Answer: B

True/False Questions 1) STD is the acronym for sexually transmitted disease.

Answer: TRUE 2) Joints are the connective tissue that holds bones together.

Answer: TRUE 3) The female pelvis is deeper and narrower than the male pelvis.

Answer: FALSE 4) Physiology is the study of bodily structures.

Answer: FALSE 5) The term endocarditis refers to an inflammation of the endocrine glands.

Answer: FALSE 6) A lipoma is a fatty tumor.

Answer: TRUE 7) Scoliosis is a curvature of the lower limbs.

Answer: FALSE 8) Malignant melanoma is a skin cancer.

Answer: TRUE

5

9) The function of saliva is to begin the enzymatic breakdown of carbohydrates.

Answer: TRUE 10) "Genome" refers to the 46 chromosomes containing the DNA-coded blueprint of every individual.

Answer: TRUE

Short Answer Questions 1) Inflammation of the liver is called Answer: hepatitis 2) The "master gland" is the Answer: pituitary

.

gland.

3) The wave-like contractions in the intestines are called Answer: peristalsis 4) Exocrine glands secrete _ Answer: fluids

.

such as saliva, sweat, and mucus.

5) GTT stands for .

Answer: glucose tolerance test 6) Test refer to a battery of tests performed at one time to check for abnormalities.

Answer: panels 7) A bacterium that causes ulcers and possibly cancers of the stomach and small intestines is Answer: H. pylori 8) A common painful disorder whereby the bile duct is blocked is referred to as Answer: gallstones 9) Blood cell formation is called Answer: hematopoiesis 10) Skeletal muscles are attached to Answer: bones

.

.

.

.

Essay Questions 1) Review the respiratory system by characterizing the major functions, common disorders, and common laboratory tests.

Answer: Refer to Figure 6-10 in the textbook.

2) Review the urinary system by characterizing the major functions, common disorders, and common laboratory tests.

Answer: Refer to Figure 6-10 in the textbook.

6

Phlebotomy Handbook, 10e (Garza/Becan-McBride) Chapter 7 The Cardiovascular and Lymphatic Systems Multiple Choice Questions 1) Which of the following describes the term systole?

A) contraction of the heart B) relaxation of the heart C) blood tension D) a heart murmur Answer: A 2) Which of the following describes the term diastole?

A) contraction of the heart B) relaxation of the heart C) blood tension D) a heart murmur Answer: B 3) The atrioventricular valves function to prevent: A) backward blood flow through the heart B) blood flow from the arteries to the veins C) blood flow from the capillaries to the venules D) blood flow from the capillaries to the arteries Answer: A 4) A differential count refers to: A) blood pressure B) contraction of the heart C) specific types of WBCs D) a heart murmur Answer: C 5) How many times a minute does an average heart beat?

A) 35 to 40 times B) 45 to 55 times C) 60 to 80 times D) at least 90 times Answer: C 6) Which arteries provide blood to the heart?

A) hepatic B) subclavian C) coronary D) brachial Answer: C

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7) Which of the following veins is most commonly used for venipuncture?

A) median cubital B) femoral C) great saphenous D) brachial Answer: A 8) The liquid portion of blood and lymph is called: A) white blood cells B) plasma C) megakaryocytes D) platelets Answer: B 9) When blood exits the right ventricle, it travels to the: A) systemic circuit B) pulmonary circuit C) atrioventricular circuit D) head-and-neck circuit Answer: B 10) Basophils and neutrophils are: A) anticoagulants B) granulocytes C) eosinophils D) RBCs Answer: B 11) Which of the following is another name for leukocytes?

A) red blood cells B) white blood cells C) platelets D) sera Answer: B 12) Which of the following is another name for erythrocytes?

A) red blood cells B) white blood cells C) platelets D) sera Answer: A 13) Which of the following is another name for thrombocytes?

A) red blood cells B) white blood cells C) platelets D) sera Answer: C

2

14) Approximately 99 percent of circulating blood cells in the body are: A) white blood cells (WBCs) B) platelets C) red blood cells (RBCs) D) eosinophils Answer: C 15) Leukemia is a condition in which: A) there is anemia due to excessive venipunctures B) WBCs are overproduced and do not function correctly C) clotting factors do not work properly D) there is a weakened area of the blood vessel wall Answer: B 16) Hemophilia is an inherited condition in which: A) anemia is due to excessive venipunctures B) WBCs are overproduced and do not function correctly C) clotting factors do not work properly D) there is a weakened area of the blood vessel wall Answer: C 17) Iatrogenic anemia is a condition in which: A) the anemia is due to excessive venipunctures B) WBCs are overproduced and do not function correctly C) clotting factors do not work properly D) there is a weakened area of the blood vessel wall Answer: A 18) An aneurysm is a condition in which: A) anemia is due to excessive venipunctures B) WBCs are overproduced and do not function correctly C) clotting factors do not work properly D) there is a weakened area of the blood vessel wall Answer: D 19) Thrombocytopenia is a condition in which there is a: A) high WBC count B) low platelet count C) high RBC count D) high BUN Answer: B 20) Polycythemia is a condition in which there is a: A) high WBC count B) low platelet count C) high RBC count D) high BUN Answer: C

3

21) Leukocytosis is a condition in which there is a: A) high WBC count B) low platelet count C) high RBC count D) high BUN Answer: A 22) A high cholesterol level is associated with which condition?

A) diabetes B) nephritis C) atherosclerosis D) dehydration or diarrhea Answer: C 23) Increased glucose levels are associated with which condition?

A) diabetes B) nephritis C) atherosclerosis D) dehydration or diarrhea Answer: A 24) Low electrolytes (sodium, potassium) are associated with which condition?

A) diabetes B) nephritis C) atherosclerosis D) diarrhea Answer: D 25) Increased creatinine levels are associated with which condition?

A) diabetes B) nephritis C) atherosclerosis D) dehydration and diarrhea Answer: B

True/False Questions 1) Blood flows to the lower body from the heart through the descending aorta.

Answer: TRUE 2) The cardiac cycle refers to the first half of a heartbeat.

Answer: FALSE 3) Blood pressure is the force of blood pushing against the walls of blood vessels.

Answer: TRUE 4) Tachycardia refers to absence of a heartbeat.

Answer: FALSE

4

5) Albumin and fibrinogen are examples of plasma proteins.

Answer: TRUE 6) Glucose is a respiratory gas needed for life.

Answer: FALSE 7) Sodium, magnesium, chloride, and potassium are electrolytes.

Answer: TRUE 8) Atrial fibrillation is a rapid and irregular heart rhythm.

Answer: TRUE 9) Palpation relates to a fast or irregular heartbeat.

Answer: FALSE 10) "Reference intervals" and "critical limits" are different terms for the same thing.

Answer: FALSE

Short Answer Questions 1) refers to a slow heartbeat.

Answer: Bradycardia 2) Arteries have Answer: thicker

(thicker or thinner) vessel walls than veins.

3) A blood clot that forms within the vascular system is a(n) Answer: thrombus

.

4) When a blood vessel is atherosclerotic and is completely blocked, it is Answer: occluded 5) The opposite of hemostasis is Answer: hemorrhage

.

.

6) Blood for all regions of the body, except for the heart, flows inside or through the Answer: heart

.

7) What substance in RBCs is responsible for oxygen transport?

Answer: hemoglobin 8) For a blood transfusion to be successful, the donor and recipient's blood types must be Answer: compatible 9) Lactic acid is produced in the Answer: muscles

.

5

.

10) Vinegar is an example of a(n) Answer: acidic

(basic or acidic) substance.

Essay Questions 1) Describe the phases of the hemostatic process.

Answer: 1. Vascular phase: injury to a vessel wall occurs 2. Platelet phase: platelets begin to aggregate at the site of the injury and adhere to the site 3. Coagulation phase: clotting factors are released and clot formation takes place 4. Clot retraction phase: after the bleeding has stopped, the clot begins to retract and heal torn edges by bringing them closer together 5. Fibrinolysis phase: eventually, as healing takes place, the body enzymatically destroys the clot 2) Explain the significance of axillary lymph nodes and implications after a mastectomy.

Answer: Axillary lymph nodes are in the armpit area near the breast. They are frequently removed during a mastectomy (surgical breast removal). Thus, these patients lose drainage ability on that side.

Phlebotomists should not collect blood specimens from the mastectomy side due to the accumulation of additional fluids resulting from the lack of lymph nodes in the area.

6

Phlebotomy Handbook, 10e (Garza/Becan-McBride) Chapter 8 Blood Collection Equipment for Venipuncture and Capillary Specimens Multiple Choice Questions 1) Which of the following is a microcollection system?

A) Microtome B) S-Monovette C) Venoscope D) BMP LeukoChek Answer: D 2) SPS tubes are used in the collection of: A) clinical chemistry specimens B) microbiology specimens C) microscopy specimens D) clinical immunology specimens Answer: B 3) Lithium heparin is a suitable anticoagulant for which of the following studies?

A) zinc level B) creatinine level C) lithium level D) erythrocyte sedimentation rate Answer: B 4) Which of the following additives is found in a tan-topped blood collection tube?

A) EDTA B) ammonium heparin C) lithium heparin D) sodium citrate Answer: A 5) The yellow-topped blood collection tube has which of the following additives?

A) EDTA B) sodium polyanethol sulfonate C) trisodium citrate D) lithium heparin Answer: B 6) The safety butterfly blood collection system is frequently used with a needle gauge size of: A) 21 B) 19 C) 18 D) 16 Answer: A

1

7) For newborns, the penetration depth of safety lancets for blood collection must be: A) 3.0 mm or less B) 2.6 mm or less C) 2.2 mm or less D) 2.0 mm or less Answer: D 8) The BMP LeukoChek can be used for: A) microcollection of blood for culture and sensitivity testing B) microcollection and dilution of blood samples for the WBC count C) ABO group and type blood collection D) microcollection of blood for hematocrit Answer: B 9) Which of the following additives prevent coagulation of blood by removing calcium through the formation of insoluble calcium salts?

A) EDTA, lithium heparin, sodium citrate B) potassium oxalate, EDTA, sodium heparin C) EDTA, sodium citrate, sodium heparin D) EDTA, potassium oxalate, sodium citrate Answer: D 10) Which of the following needle gauges has the smallest diameter?

A) 19 B) 20 C) 21 D) 23 Answer: D 11) Sharps disposal containers contain: A) a warning not to place multiple-sample needles into the container B) disposable latex-free gloves C) a biohazard sign D) sodium fluoride Answer: C 12) A blood cell count requires whole blood to be collected in a: A) lavender-topped tube B) gray-topped tube C) green-topped tube D) yellow-topped tube Answer: A

2

13) Which of the following tests usually requires blood collected in a tan-topped blood collection tube?

A) cortisol B) CBC C) lead D) CK Answer: C 14) Which of the following is a commonly used intravenous device that is sometimes used in the collection of blood from patients who are difficult to collect blood from by conventional methods?

A) BMP LeukoChek B) BD Microtainer C) butterfly needle D) Seraket Answer: C 15) Which of the following is a serum separation tube?

A) winged infusion set B) BD Microtainer green-topped tube C) S-Monovette D) VACUETTE serum tube Answer: D 16) The color coding for needles indicates the: A) length B) gauge C) manufacturer D) anticoagulant Answer: B 17) Which of the following anticoagulants is found in a green-topped blood collection tube?

A) EDTA B) sodium heparin C) sodium citrate D) potassium oxalate Answer: B 18) Which of the following is an anticoagulant used in blood donations?

A) sodium citrate B) citrate-phosphate-dextrose C) ethylene-diamine tetra-acetic acid D) lithium iodoacetate Answer: B

3

19) The gold-topped blood collection tube should be gently inverted how many times after blood is collected?

A) 2 times B) 5 to 8 times C) 10 times D) 12 to 15 times Answer: B 20) Don, a phlebotomist, was diagnosed with latex allergy. Which of the following actions should he take?

A) avoid nitrile gloves B) carry sterile gauze pads C) avoid areas where powdered latex gloves are being used D) keep the matter confidential so as not to alarm his employer Answer: C 21) Which of the following blood collection tubes is most appropriate for the sterile blood collection of trace elements and nutritional studies?

A) gold-topped tube B) royal-blue-topped tube C) purple-topped tube D) yellow-topped tube Answer: B 22) Which of the following blood collection tubes is most appropriate for the collection of blood for a DIFF? A) royal-blue-topped tube B) purple-topped tube C) gold-topped tube D) light-blue-topped tube Answer: B 23) How many times should the lavender-topped blood collection tube be inverted after blood collection?

A) 5 times B) 8 to 10 times C) 15 times D) 20 times Answer: B 24) Which of the following additives is not in a gray-topped blood collection tube?

A) sodium fluoride B) sodium citrate C) potassium oxalate D) EDTA Answer: B

4

25) Which of the following blood collection tubes is most appropriate for blood bank collections?

A) pink-topped tube B) gold-topped tube C) light-blue-topped tube D) royal-blue-topped tube Answer: A

True/False Questions 1) The BMP LeukoChek has a plastic reservoir containing a premeasured volume of reagent for dilution.

Answer: TRUE 2) The SPS additive is in the gray-topped blood collection tube.

Answer: FALSE 3) The light-blue-topped blood collection tube contains the additive sodium heparin.

Answer: FALSE 4) The PT procedure is performed on blood collected in a light-blue-topped blood collection tube.

Answer: TRUE 5) Blood bank procedures are collected on blood collected in pink-topped blood collection tubes.

Answer: TRUE 6) The gauge number for the syringe indicates the length of the needle.

Answer: FALSE 7) The S-Monovette Blood Collection System is a microcollection system.

Answer: FALSE 8) The Venoscope detects a vein for blood collection.

Answer: TRUE 9) Powdered gloves are the best to use in blood collection since they decrease the affects of latex allergies.

Answer: FALSE 10) The gray/yellow-topped vacuum blood collection tube contains the additive thrombin.

Answer: TRUE

5

Short Answer Questions 1) collection tubes are not desirable since risk of exposure to bloodborne pathogens is increased due to possible breakage.

Answer: Glass 2) A mucopolysaccharide, Answer: heparin

, prevents blood clotting by inactivating thrombin and Factor X.

3) The lavender-topped blood collection tube contains the additive Answer: EDTA 4) The tan-topped blood collection tube is used for Answer: lead 5) Sodium Answer: heparin

.

determinations.

is contained in green-topped blood collection tubes.

6) The number indicates the diameter of the needle.

Answer: gauge 7) The most common butterfly needle sizes are 21- and Answer: 23-

gauge.

8) The provides a barrier to slow down venous flow for use in venipuncture.

Answer: tourniquet 9) Disposable, sterile Answer: lancets

that are retractable are used to avoid bloodborne pathogen exposure.

10) For infants, a depth of less than bone.

Answer: 2

mm on heel sticks is recommended to avoid penetrating

6

Essay Questions 1) If a lavender-topped tube is underfilled, what problems can be encountered in the patient's test results?

Answer: If a lavender-topped tube is underfilled, the test results will show: ∙ Falsely low blood-cell counts ∙ Falsely low hematocrits ∙ Staining alterations on blood smears ∙ Erroneous morphologic changes to RBCs 2) Explain how the coagulation of blood can be prevented by the addition of oxalates, citrates, EDTA, or heparin.

Answer: Oxalates, citrates, and EDTA prevent the coagulation of blood by removing calcium and forming insoluble calcium salts. These three anticoagulants cannot be used in calcium determinations; however, citrates are frequently used in coagulation blood studies. EDTA prevents platelet aggregation and is therefore used for platelet counts and platelet function tests. Fresh EDTA-anticoagulated blood allows preparation of blood films with minimal distortion of white blood cells (WBCs). Heparin, a mucopolysaccharide used in assays, such as ammonia and plasma hemoglobin, prevents blood clotting by inactivating the blood-clotting chemicals thrombin and Factor X.

7

Phlebotomy Handbook, 10e (Garza/Becan-McBride) Chapter 9 Preexamination/Preanalytical Complications Causing Medical Errors in Blood Collection Multiple Choice Questions 1) A solid mass derived from blood constituents that occludes a blood vessel is a: A) lymphostasis B) thrombus C) petechia D) hemolysis Answer: B 2) If the tourniquet is applied to the arm for longer than 3 minutes, which of the following analytes will most likely become falsely elevated?

A) potassium B) blood urea nitrogen C) uric acid D) bilirubin Answer: A 3) When blood is to be collected for a glucose tolerance test, the patient should fast for: A) 3-5 hours B) 6-8 hours C) 8-12 hours D) 12-14 hours Answer: C 4) A basal state exists: A) after the evening meal B) in the early morning, 12 hours after the last ingestion of food C) immediately before lunch D) 3 hours after the ingestion of lunch Answer: B 5) Which of the following analytes is significantly increased in the blood with changes in position?

A) cortisol B) calcium C) glucose D) testosterone Answer: B

1

6) An abnormal accumulation of fluid in the intercellular spaces of the body that is localized or diffused is referred to as: A) hemoconcentration B) atherosclerosis C) hemolysis D) edema Answer: D 7) Which of the following laboratory test results is affected most if the patient is not fasting?

A) triglycerides B) cortisol C) ACTH D) testosterone Answer: A 8) Diurnal rhythm has a major effect on which of the following blood analytes?

A) creatinine B) ACTH C) cholesterol D) CK Answer: B 9) Which of the following is another term for fainting?

A) fomite B) lymphostasis C) thrombi D) syncope Answer: D 10) When the phlebotomist collected blood from the patient, the patient was in a supine position, meaning the patient was: A) sitting B) stooping C) standing D) recumbent Answer: D 11) Upon entering Ms. Newhouse's hospital room, the phlebotomist introduced herself and explained she was going to collect blood for laboratory tests requested by the physician. The patient became very anxious and said she was frightened of needles; then she started sweating from being frightened of the procedure. This patient's emotional stress could lead to a decrease in which of the following?

A) white blood cell count B) serum iron level C) albumin D) glucose Answer: B

2

12) Which of the following has been reported to erroneously affect laboratory test results in newborns, leading to falsely elevated WBC counts?

A) smiling B) syncope C) violent crying D) sneezing Answer: C 13) Swelling in the area around a venipuncture site usually leads to: A) lymphostasis B) atherosclerosis C) hematoma formation D) petechiae formation Answer: C 14) Which of the following should stop the health care worker from collecting blood from a patient's arm vein?

A) cardiac bypass surgery B) high blood pressure C) mastectomy on the same side D) heart attack that occurred the previous evening Answer: C 15) Which of the following would most likely not be an explanation for turbid serum?

A) elevated glucose B) elevated triglyceride levels C) elevated cholesterol levels D) bacterial contamination Answer: A 16) When hemoglobin is released from RBCs and serum becomes tinged as pink or red, this condition is referred to as: A) hyperlipidemia B) hemolysis C) hemoconcentration D) hemophilia Answer: B 17) A decrease in the plasma volume occurring with an increased concentration of cells and larger molecules such as cholesterol is referred to as: A) hemoconcentration B) hyperlipidemia C) hemophilia D) hemolysis Answer: A

3

18) Which of the following occurs as the result of inflammation and disease of the interstitial compartments?

A) sclerosed veins B) syncope C) hematoma D) hemoconcentration Answer: A 19) If a patient begins to have a seizure during venipuncture, the phlebotomist should immediately: A) place the patient on the floor B) run for a physician C) release the tourniquet D) hold pressure on the blood collection site Answer: C 20) When a patient is on IV therapy and the venipuncture must occur in the arm with the IV line, the: A) nurse should hold the arm up with the IV line as the phlebotomist performs the venipuncture B) nurse should shut off the IV for 2 minutes prior to the venipuncture C) tourniquet should be placed above the IV site D) nurse should hold the arm completely down as the phlebotomist performs the venipuncture Answer: B 21) Hemolysis in collected blood can cause a falsely decreased value for: A) hemoglobin B) phosphorus C) ammonia D) total protein Answer: A 22) Which of the following analytes will be falsely increased when a sodium citrate blood collection tube is underfilled?

A) BUN B) PT C) creatinine D) phosphorus Answer: B 23) Petechiae appear: A) any time blood is drawn B) when small amounts of blood escape into skin epithelium C) until pressure is applied D) only if the patient has a febrile illness Answer: B

4

24) The EDTA blood collection tube must not be underfilled, since it has been shown to lead to: A) high lithium levels B) low hematocrit levels C) low sodium levels D) high blood cell counts Answer: B 25) What additive destroys the enzymes in the blood when the gray-topped tube is used to collect blood?

A) sodium citrate B) sodium fluoride C) sodium heparin D) lithium heparin Answer: B 26) Positional pseudoanemia: A) affects hematocrit but not hemoglobin results B) is a type of syncope C) must be differentiated from the result of acute bleeding that can lead to "true" anemia D) is unrelated to posture Answer: C

True/False Questions 1) Basal state is approximately 16 hours after the last ingestion of food.

Answer: FALSE 2) The required fasting time for the fasting glucose blood collection is 8-12 hours.

Answer: TRUE 3) A healthy body mass index for adults is 20-25 kg/m2.

Answer: TRUE 4) A thrombus can occlude arteries, but not veins.

Answer: FALSE 5) A transient increase in serum iron levels can occur due to emotional stress.

Answer: FALSE 6) Diurnal rhythms are the same as circadian rhythms.

Answer: TRUE 7) Blood aldosterone levels are not affected by posture changes immediately before blood collection, but blood glucose levels are greatly affected by posture changes.

Answer: FALSE 8) An abnormal accumulation of fluid in the intercellular space is hemolysis.

Answer: FALSE

5

9) Tylenol taken by a patient can cause the patient to have abnormal laboratory liver panel results.

Answer: TRUE 10) If the patient pumps his or her fist prior to blood collection, this action can lead to falsely increased plasma phosphate concentrations.

Answer: TRUE

Short Answer Questions 1) Plasma cholesterol will be falsely Answer: elevated

if the tourniquet pressure is too tight or prolonged.

2) When RBCs are lysed, hemoglobin is released, and this results in Answer: hemolysis

.

3) Hemolyzed plasma that is used to measure the RBC count will cause the RBC count to be falsely .

Answer: decreased 4) Hemoconcentration is a(n) larger molecules.

Answer: decrease

in the plasma volume with an increased concentration of cells and

5) Hemolysis may be the result of physiological abnormalities such as Answer: sickle cell

disease.

6) Blood collected for a patient's lithium level cannot be collected in a green-topped tube containing heparin.

Answer: lithium 7) Antibody screens and cross-matching of blood run on blood from serum separator tubes will lead to falsetest results.

Answer: positive 8) Veins when blood is withdrawn too quickly or forcefully during venipuncture.

Answer: collapse 9) Syncope is another term for Answer: fainting

.

10) Venipuncture should never be performed on the _ Answer: same

6

side as that of a mastectomy.

Essay Questions 1) What should a phlebotomist do to avoid the risk of backflow of an anticoagulant from a blood vacuum tube into the patient's circulation during blood collection by venipuncture?

Answer: The phlebotomist needs to place the patient's arm in a downward position and the tube stopper (top) in the uppermost position to avoid the risk of backflow of an anticoagulant from a blood vacuum tube into the patient's circulation during venipuncture.

2) If a patient indicates that he or she has a tendency to faint during blood collection, what should the phlebotomist do when preparing for the blood collection?

Answer: The patient should be moved from a seated position to a recumbent position to avoid the possibility of falling during the blood collection procedure.

7

Phlebotomy Handbook, 10e (Garza/Becan-McBride) Chapter 10 Venipuncture Procedures Multiple Choice Questions 1) Prior to performing a venipuncture, why is it important to get information about whether or not the patient has eaten recently?

A) Laboratory tests can be affected by the ingestion of food and drink.

B) Meals tend to calm a patient down.

C) After eating, patients usually have enlarged veins.

D) To help evaluate on which side to perform the venipuncture.

Answer: A 2) Which of the following helps with needle phobia?

A) Place the patient in a standing position.

B) Tell the patient to hold his or her breath.

C) Assure the patient it won't hurt.

D) Show compassion.

Answer: D 3) If a patient is obese, what special equipment, if any, would be helpful in the specimen collection process?

A) specially sized collection tubes B) an oxygen mask in case of fainting C) a large blood pressure cuff D) no special equipment should be needed Answer: C 4) When a patient has "difficult" veins, which strategy can be used to improve the likelihood of a successful puncture?

A) Use ultrasound for vein mapping.

B) Have the patient hold the arm up and point the fingertips toward the ceiling.

C) Cool the site before venipuncture.

D) Do not use a tourniquet.

Answer: A 5) Arteries differ from veins in which of the following ways?

A) Veins have a thick wall.

B) Arteries pulsate.

C) Arteries are less elastic.

D) Veins pulsate.

Answer: B

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6) If arm veins cannot be used for a venipuncture, the preferred alternative veins are found in the: A) ankles or feet B) anterior surface of the hand or wrist C) dorsal side of the hand or wrist D) earlobe Answer: C 7) Where should the tourniquet be placed on the patient during the venipuncture procedure?

A) 1 inch above the venipuncture site B) over the venipuncture site C) 3 to 4 inches above the venipuncture site D) 3 to 4 inches below the venipuncture site Answer: C 8) During a typical venipuncture, the needle should be inserted at what angle to the skin?

A) 30 degrees or less B) 45 degrees C) 60 degrees D) 90 degrees Answer: A 9) During the venipuncture procedure, what should the phlebotomist do after the needle is inserted and blood begins to flow?

A) Release the tourniquet.

B) Withdraw the needle.

C) Release the adapter.

D) Adjust the hub of the needle.

Answer: A 10) When the evacuated tube method is used for venipuncture, select the correct order of collection for the following tubes: blood culture tubes, coagulation tube, and hematology tube. Choose the order of tubes by the color of their closures.

A) light blue, lavender, yellow B) lavender, light blue, yellow C) yellow, light blue, lavender D) light blue, yellow, lavender Answer: C 11) Which of the following information is essential for labeling a patient's specimen?

A) the patient's first and last name and identification number, date of collection, room number, and the phlebotomist's initials B) the patient's first and last name and identification number, date of collection, and time of collection C) the patient's first and last name and identification number, date and time of collection, and the phlebotomist's initials D) the patient's first and last name and identification number, date of collection, and the physician's name Answer: C

2

12) The term STAT refers to: A) abstaining from food over a period of time B) using timed blood collections for specific specimens C) using the early-morning specimens for laboratory testing D) emergency specimens Answer: D 13) Why is it important to get patient information about latex sensitivity?

A) Laboratory tests can be affected by the ingestion of latex particles.

B) In case of patient latex sensitivity, health care worker can use nonlatex tourniquet, gloves, and bandages.

C) Patients usually have preferences for special tourniquets.

D) This information is only important for the phlebotomist, not the patient.

Answer: B 14) The first step in the identification process is: A) ask the patient when the last time was when he or she ate or drank anything B) ask the patient to state and spell his or her name and give his or her birth date C) inquire about the patient's arm preference D) reassure the patient that the procedure is quick and painless Answer: B 15) If a patient is frail and has a tendency to faint, what equipment, if any, would be helpful in the specimen collection process?

A) a glass of juice B) an oxygen mask C) a recliner D) a commercial warming device Answer: C 16) If a patient has a bruise in the antecubital area of his right arm (his nondominant arm), what alternate site should be considered?

A) slight rotation of the patient's right arm to a different position B) the edge of the antecubital area of the right arm C) the antecubital area of the left arm D) forget alternate sites and do a fingerstick on the right hand Answer: C 17) One reason for hematoma formation during venipuncture is that the: A) medial cubital vein is used B) needle is parallel to the vein C) needle is partially inserted in the vein D) needle is too small Answer: C

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18) If a venipuncture procedure is almost completed and suddenly you see hints of a hematoma beginning to form, what should you do?

A) Finish collecting the tubes as quickly as possible.

B) Reinflate the blood pressure cuff in order to slow bleeding.

C) Remove the tube and try another one.

D) Discontinue the procedure and apply pressure with gauze.

Answer: D 19) How many more times should a phlebotomist try to perform a venipuncture on a patient if he has failed once already?

A) once B) twice C) three times D) four times Answer: A 20) When using the syringe method to collect a blood specimen, how is the blood added into additive and nonadditive tubes?

A) The needle is removed from the syringe, the caps are removed from the tubes, blood is pushed into each tube, and the tubes are then re-stoppered and mixed.

B) The syringe needle is used to puncture the cap of each tube, and then blood is pushed into each tube.

C) Using a clean needle, puncture all tubes to release the vacuum, and then remove the caps and gently fill each tube.

D) Using a syringe transfer device attached to the syringe, insert each tube into the device and allow the blood to flow freely.

Answer: D 21) Which specimen collection tube is commonly used for hematology tests?

A) EDTA B) heparin C) sodium citrate D) serum tube with clot activator Answer: A 22) Which specimen collection tube is commonly used for hemostasis tests?

A) EDTA B) heparin C) sodium citrate D) serum tube with clot activator Answer: C 23) Adding too much blood to a sodium citrate tube can cause: A) shorter clotting time B) elevated hemoglobin C) elevated glucose value D) WBCs to clump Answer: A

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24) When collecting a blood specimen with the butterfly method, and when PT and PTT tests are the only tests ordered, what is the correct procedure?

A) Use a single serum tube with clot activator.

B) Collect a sodium citrate tube first, and then the EDTA. C) Use a discard tube, and then collect a sodium citrate tube.

D) Collect a single blue-topped tube.

Answer: C 25) To avoid specimen hemolysis, the phlebotomist should: A) use a 24-gauge needle B) cleanse the site with alcohol and allow the site to air dry C) vigorously shake tubes containing additives D) keep the tourniquet on for at least three minutes Answer: B

True/False Questions 1) When preparing a patient for a venipuncture procedure, phlebotomists should reassure the patient by saying, "This won't hurt at all."

Answer: FALSE 2) Specimen tubes should always be prelabeled with patient information.

Answer: FALSE 3) HIV, HBV, and HCV are blood-borne pathogens.

Answer: TRUE 4) TDM refers to thyroid disease measures.

Answer: FALSE 5) The preferred way to stop blood flow is to ask the patient to hold a cotton ball over the site until it stops.

Answer: FALSE 6) If a patient is healthy and strong, she can be allowed to stand at a counter during the venipuncture procedure to speed up the process.

Answer: FALSE 7) After a venipuncture on a 1-year-old child, be sure to give them a colorful bandage.

Answer: FALSE 8) Recapping needles after a venipuncture is acceptable in many cases.

Answer: FALSE 9) Collection tube additives may be accidentally transferred from one specimen tube to the next when the tubes are not oriented in a downward position during filling.

Answer: TRUE

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10) You should release a tourniquet at the end of the procedure after removing the needle from the patient's arm.

Answer: FALSE

Short Answer Questions 1) All hospitalized patients should have a(n) Answer: unique

identification number.

2) The order for a laboratory test is often called a requisition or Answer: request 3) Every blood specimen should be treated as if it were hazardous and Answer: infectious 4) One way to cleanse your hands prior to phlebotomy is to use a(n) Answer: alcohol

.

.

-based hand sanitizer.

5) When washing hands with soap and water prior to performing a venipuncture, be used.

Answer: antimicrobial

soap should

6) Phlebotomists should monitor the patient closely during venipuncture because some patients may feel , nauseous, or queasy.

Answer: faint 7) After a venipuncture procedure, activation of the Answer: safety

device will prevent accidental needlesticks.

8) CPR stands for .

Answer: cardiopulmonary resuscitation 9) Paper and plastic wrappers that accumulate during the venipuncture procedure may be discarded in a(n) .

Answer: wastebasket 10) A blood specimen can be rejected if the collection tube is out-of-date. Another term for this is .

Answer: expired

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Essay Questions 1) Describe four strategies for reducing the incidence of iatrogenic anemia.

Answer: Blood volume losses due to phlebotomy can be a significant problem for hospitalized patients, especially for pediatric patients. All phlebotomists should be sensitive to the total number of daily venipunctures/phlebotomy procedures for patients. Strategies for reducing the likelihood of iatrogenic anemia include: ∙ Maintain a log of the frequency and volume of blood collected for each patient. ∙ Organize laboratory orders to try to coordinate draws. ∙ Monitor the number of times a patient can be punctured. ∙ Coordinate TDM tests with other testing requirements, if possible. ∙ Coordinate other timed tests with routine specimens, if possible. ∙ Be aware of patient transfers and if other tests are ordered after the transfer. ∙ Follow procedures for discarding blood from IV lines; do not discard too much. ∙ Participate in educational programs with nurses and physicians to remind them of volume requirements for panels of tests, how to coordinate timing of tests, etc.

2) Describe what you would do if you have made one unsuccessful venipuncture attempt on a patient and the patient refuses to let you try again.

Answer: It is understandable that some patients may not allow you to have another chance at their veins.

This is particularly true for patients who are sensitive to pain or become faint during such procedures, since their level of anxiety is already higher. Individuals have a right to refuse, and most health care facilities have procedures for documenting a patient's refusal. However, a phlebotomist can politely, calmly, and professionally explain to the patient that the lab results are used to help the physician make an accurate diagnosis, establish proper treatment, or monitor the patient's health status, so his or her cooperation would be appreciated. If the patient continues to refuse, the phlebotomist must remain professional and acknowledge this refusal, documenting the situation. The physician should also be notified of the situation.

7

Phlebotomy Handbook, 10e (Garza/Becan-McBride) Chapter 11 Capillary or Dermal Blood Specimens Multiple Choice Questions 1) Which of the following is identical for venipuncture and capillary puncture procedures?

A) site selection B) greeting, identification, and hand hygiene C) withdrawing the specimen D) puncture technique Answer: B 2) Skin puncture techniques are useful in which of the following conditions?

A) when large amounts of blood are needed for research testing B) when the patient is in the ICU and needs hourly lab testing C) when the patient is a neonate D) when the patient is morbidly obese Answer: C 3) When should capillary blood samples be labeled?

A) before the blood is collected B) before mixing C) when the phlebotomist has a few moments to spare D) after blood collection and mixing Answer: D 4) Biohazardous supplies should be discarded: A) after removing gloves B) during patient identification C) prior to removing gloves D) at the end of a shift Answer: C 5) Blood smears for evaluation of cells must be made carefully. Which of the following features should be present?

A) one-quarter of the slide being covered with the blood B) a feathered edge C) ridges and holes in the smear D) streaks of blood running the length of the slide Answer: B 6) Blood from a skin puncture is: A) mostly interstitial fluid B) a mix of blood and interstitial fluid C) mostly venous blood D) skin oils mixed with venous blood Answer: B

1

7) Which of the following sequences is the best method for performing a fingerstick?

A) squeeze the finger, decontaminate, puncture the skin B) decontaminate, squeeze the finger, puncture the skin, collect the first drop C) decontaminate, puncture the skin, wipe the first drop, collect the sample D) apply tourniquet, puncture the skin, wipe the first drop, collect the sample Answer: C 8) Generally speaking, what should the phlebotomist do with the first drop of blood after a fingerstick is performed?

A) Use it for coagulation studies.

B) Make a blood smear or slide.

C) Wipe it off with gauze.

D) Use it for hematology testing.

Answer: C 9) What is the best angle for spreading a blood smear by using two glass slides?

A) 0 degrees, or completely flat B) 30 degrees C) 40 degrees D) 90 degrees Answer: B 10) Which of the following chemical agents should be used to cleanse a patient's finger before skin puncture?

A) isopropanol B) povidone-iodine C) diluted Clorox D) methanol Answer: A 11) What is the average skin puncture depth appropriate for an adult?

A) 0.5-1.0 mm B) 2-3 mm C) 3-5 mm D) 5.5 mm Answer: B 12) Excessive massaging or milking of the finger during a skin puncture procedure can cause: A) an adequate supply of blood for filling several capillary tubes B) increased venous blood flow to the puncture site C) hemolysis and contamination of the specimen with tissue fluids D) helpful results in glucose screening tests Answer: C

2

13) Osteomyelitis is defined as: A) infection of the blood B) infection of the spinal fluid C) inflammation of the bone D) inflammation of the finger Answer: C 14) In making a blood smear or slide, after the drop of blood has been spread across the glass slide, what is the next step?

A) Gently blow on it to aid in drying.

B) Hold it over a heating element to promote cellular adhesion to the glass.

C) Add a drop of saline to the slide to preserve it.

D) Allow it to air-dry.

Answer: D 15) When performing a fingerstick on the middle finger, what part of the finger should be punctured?

A) the area to the side of the nail B) off-center of the thickest part of the fingertip C) near the crease of the finger D) at the most extreme tip of the finger Answer: B 16) Nails can grow at a rate of about: A) 1 mm per day B) 0.5 mm per day C) 0.1 mm per day D) 0.01 mm per day Answer: C 17) Fingerstick procedures cannot be performed when which test is ordered?

A) hematology tests B) electrolytes C) glucose screening D) blood cultures Answer: D 18) Another instance when a fingerstick should not be performed on a patient is when the following has been ordered: A) cholesterol screening B) coagulation tests C) complete blood cell count D) electrolyte testing Answer: B

3

19) It is best to use which type of bandage on an adult after a fingerstick?

A) latex B) hypoallergenic C) clear D) cotton Answer: B 20) Phlebotomists should ask about which of the following prior to a fingerstick?

A) if the patient would prefer a stick on his or her earlobe B) if the patient has had anything to eat or drink lately C) if the noise of the device is bothersome D) how deep the patient would like the stick Answer: B

True/False Questions 1) Alcohol that has not dried prior to a skin puncture can prevent a round drop from forming.

Answer: TRUE 2) Alcohol that has not dried prior to a skin puncture can cause hemolysis of blood cells.

Answer: TRUE 3) Alcohol that has not dried prior to a skin puncture can cause erroneous results for some laboratory tests.

Answer: TRUE 4) Patients can be allowed to stand during a fingerstick.

Answer: FALSE 5) Nonretractable lancets are not recommended for acquiring capillary specimens.

Answer: TRUE 6) Pediatric devices can be used on adults.

Answer: FALSE 7) The puncture made during a fingerstick should be parallel to the fingerprint.

Answer: FALSE 8) Fingernails are formed like hair, from a root.

Answer: TRUE 9) The pinkie finger is the preferred site for a fingerstick for children.

Answer: FALSE 10) Some point-of-care instruments require different wipe-off procedures for the first drops.

Answer: TRUE

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Short Answer Questions 1) The hand should be used for a fingerstick, if possible.

Answer: nondominant 2) The term used for a finger that appears blue in color due to oxygen depletion is Answer: cyanotic

.

3) capillary tubes are not recommended for use due to the likelihood of breakage.

Answer: Glass 4) The name of the fingertip bone is the distal Answer: phalanx 5) Another name for microhematocrit is Answer: packed cell volume

.

.

6) When performing a fingerstick, the puncture should be oriented ridges.

Answer: perpendicular

to or across the fingerprint

7) If hematology tests are ordered and a fingerstick is to be performed, when should they be collected in the order of draw?

Answer: first 8) One strategy for improving circulation prior to a fingerstick is to Answer: warm 9) During a skin-puncture procedure, small tubes are filled by Answer: capillary 10) The lancet on retractable puncture devices cannot be Answer: used

the site.

action.

repeatedly.

Essay Questions 1) Alcohol is used to cleanse patients' fingers in preparation for a capillary/skin puncture. Describe possible effects if the alcohol is not allowed to dry completely before performing the puncture.

Answer: Alcohol that has not dried on a skin puncture can prevent a round drop from forming, cause hemolysis of blood cells, and/or cause erroneous results for glucose determinations.

2) For which specific laboratory tests should capillary punctures not be used? Why? Answer: Capillary blood samples are not recommended for coagulation studies, blood cultures, and erythrocyte sedimentation rate (ESR) determination. For coagulation studies, possible contamination with interstitial fluid could cause erroneous results. Blood cultures require more volume, and there are sterility concerns about skin contamination. Erythrocyte sedimentation rate (ESR) determination requires more blood volume.

5

Phlebotomy Handbook, 10e (Garza/Becan-McBride) Chapter 12 Specimen Handling, Transportation, and Processing Multiple Choice Questions 1) In the triple packaging system for infectious substances being shipped by air, the third layer is: A) a sealed plastic bag B) a rigid secondary container with cushioning C) aluminum foil D) a receptacle containing the specimen Answer: B 2) The TAT refers to: A) the time it takes for laboratory test results to be completed B) the patient's temperature at 10:00 A.M. C) transfusion-associated testing D) delays due to transportation of a specimen Answer: A 3) Which of the following is a possible occurrence if a blood specimen tube for hematology tests is filled correctly but not mixed long enough?

A) Hemolysis will occur.

B) Hemoconcentration will occur.

C) Tiny clots will form in the specimen.

D) The specimen will be lipemic.

Answer: C 4) Which of the following is a possible occurrence if a blood specimen tube for hematology tests is filled correctly but mixed too long or too vigorously?

A) Hemolysis will occur.

B) Hemoconcentration will occur.

C) Tiny clots will form in the specimen.

D) The specimen will be lipemic.

Answer: A 5) Which of the following is a new type of transportation for blood samples that is being evaluated?

A) pneumatic tube systems B) virtual transport C) hand delivery D) drones Answer: D 6) Glycolytic action refers to: A) hemolysis B) hemostasis C) breakdown of glucose D) breakdown of hemoglobin Answer: C

1

7) Serum should be transported to the laboratory for testing and separated from blood cells within which of the following time periods to prevent erroneous test results?

A) 5 hours B) 4 hours C) 3 hours D) as soon as possible Answer: D 8) Cooling a blood specimen causes: A) slowing of metabolic processes B) hemolysis C) hemoconcentration D) hemostasis Answer: A 9) What is the first thing a health-care worker should do when a centrifuge is showing imbalance vibrations or making an unusually loud noise, suggesting that a tube has broken in the centrifuge?

A) Turn the centrifuge off.

B) Open the centrifuge.

C) Report the problem to a supervisor.

D) Put on a mask and thick gloves.

Answer: A 10) When do the phlebotomist's duties end?

A) when the test results are reported B) when the venipuncture is completed C) when the specimen is transported D) once the specimen enters the clinical laboratory Answer: A 11) Which of the following is considered confidential patient information?

A) clinical laboratory results of a patient B) the name of the phlebotomist who draws a specimen C) the name of the laboratory supervisor D) the name of the patient's physician Answer: A 12) Assays that require a chilled specimen include: A) glucose, cholesterol, and prostatic-specific antigen B) gastrin, ammonia, catecholamines, and lactic acid C) tests for electrolytes D) all hematology tests Answer: B

2

13) To chill a blood specimen as it is transported, the health care worker should use: A) tepid water B) a small freezer unit C) icy water or commercial ice pack D) blocks of ice Answer: C 14) Specimens that require protection from light include those for: A) CBC, diff, and platelet counts B) PT and PTTs C) bilirubin and folate D) hormone analyses Answer: C 15) Specimens that require transport at 37°C include: A) vitamin A B) lactic acid C) parathyroid hormone D) cryofibrinogen Answer: D 16) When designing a report form for laboratory results, what key elements would not be included?

A) patient and physician identification B) date and time of collection C) reference ranges D) physician's home address and phone number Answer: D 17) Specimens being tested would not usually require centrifugation in which of the following areas?

A) chemistry B) coagulation and hematology C) blood bank donors D) urinalysis Answer: B 18) For specimens that require centrifugation, serum or plasma should be removed from the cells within what period of time?

A) 5 hours B) 4 hours C) 3 hours D) 2 hours Answer: D

3

19) It is preferable to make blood smears from EDTA specimens within what period of time after the specimen is collected?

A) 4 hours B) 3 hours C) 2 hours D) 1 hour Answer: D 20) How long does it usually take for a serum specimen (without additives) to form a clot?

A) 5-10 minutes B) 15-20 minutes C) 20-25 minutes D) 30-60 minutes Answer: D

True/False Questions 1) It is best to mix a blood specimen in an additive tube 60 minutes after the venipuncture has occurred.

Answer: FALSE 2) It is important to shake the specimen tube vigorously to thoroughly mix blood with an additive.

Answer: FALSE 3) A patient's stress/anxiety can affect the pre-examination phase of laboratory testing.

Answer: TRUE 4) Blood specimen tubes without additives do not require mixing.

Answer: TRUE 5) It is preferable for a blood specimen tube to be maintained in a vertical position during handling after the venipuncture.

Answer: TRUE 6) A thermolabile specimen should be gently heated.

Answer: FALSE 7) Blood culture specimens should be delivered to the laboratory as soon as possible.

Answer: TRUE 8) Ice packs should be used when transporting coagulation specimens.

Answer: FALSE 9) Coagulation specimens may be rejected if they are clotted.

Answer: TRUE 10) Aluminum foil can be used to protect specimens from heat.

Answer: FALSE

4

Short Answer Questions 1) Most laboratories require blood specimens to be transported in a(n) Answer: leakproof

plastic biohazard bag.

2) An amber/brown biohazard bag is used for transporting specimens that will decompose if they are exposed to .

Answer: light 3) Sensitivity to light is called Answer: photosensitivity

.

4) specimens may be centrifuged immediately.

Answer: Plasma 5) A(n) is a small portion of a blood specimen that is separated for additional testing.

Answer: aliquot 6) Blood specimens from patients on Answer: anticoagulant 7) The Answer:

therapy will take longer to clot.

of specimen tubes should remain in place during centrifugation. stopper or closure or cap

8) Room temperature is 22-25° Answer: Celsius

.

9) Refrigeration temperature for specimen storage should be between Answer: 2 10) All specimen refrigerators should be labeled with Answer: biohazard

and 8°C.

warnings.

Essay Questions 1) Describe the effects of overshaking or vigorous mixing of a specimen.

Answer: Excessive agitation causes hemolysis of the specimens when the RBCs rupture as a result of the rough handling. Hemolysis causes numerous chemical interferences with the laboratory test results.

2) Describe how a centrifuge should be properly loaded with blood specimens, and what happens if it is not loaded properly.

Answer: Blood specimens should be loaded in a balanced orientation; each tube is loaded directly across from another tube of a similar volume/size. If the centrifuge is not properly balanced, this can result in breakage or in excessive vibrations that can potentially damage cells.

5

Phlebotomy Handbook, 10e (Garza/Becan-McBride) Chapter 13 Pediatric and Geriatric Procedures Multiple Choice Questions 1) Which of the following sites is recommended to collect capillary blood gases on a newborn?

A) lateral posterior area of the heel B) lateral anterior area of the elbow C) the great toe D) the ball of the finger Answer: A 2) Which of the following is the specimen of choice for testing the pH, pO2, and pCO2 of the blood?

A) arterial blood B) venous blood C) heparinized plasma D) skin puncture blood Answer: A 3) EMLA, sometimes used for pediatric venipuncture procedures, is a: A) local anesthetic applied with a small needle to the child's arm before venipuncture B) topical anesthetic applied to the child's arm before venipuncture C) topical lotion applied to the child's arm after venipuncture to stop bleeding at the venipuncture site D) topical lotion applied to the child's arm before venipuncture to assist the phlebotomist in finding a vein Answer: B 4) The best location for performing venipuncture on a hospitalized 7-year-old is: A) in a hospital playroom especially designed for children B) at the child's bedside or in a chair in the child's hospital room C) in a treatment room D) in his or her bed Answer: C 5) The optimal depth of a fingerstick in a child is: A) greater than 2.4 mm B) less than 0.5 mm C) less than 0.24 mm D) less than 2.0 mm Answer: D 6) Children often fear needles. Saying to the child, "Look at Daddy," or "Tell the nurse about your doll" are examples of: A) explanation B) positive reinforcement C) emotional support D) distraction Answer: D

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7) Specimen collection in a patient's home may involve unusual positioning of the patient. What is the preferred position or location from which to collect a blood specimen from a homebound patient?

A) in the bathtub B) whatever location that the patient suggests C) in a comfortable, reclining position D) standing in the living room, near a sofa or a chair Answer: C 8) Considerations in home care blood collection include: A) removing all trash and used supplies after the procedure B) giving the patient instructions on what to do if the puncture site does not stop bleeding C) leaving immediately if you cannot identify the patient D) working in pairs when in a high-crime area Answer: A 9) Which of the following suggestions applies to working with older individuals?

A) Remove the patient's glasses before collection.

B) Shout, in order to be heard despite any known hearing loss.

C) Treat patients with the utmost respect and dignity.

D) "Slap" the arm when trying to locate a vein.

Answer: C 10) Which of the following is a debilitating disease causing tremors, particularly in elderly individuals?

A) Parkinson's disease B) anemia C) Alzheimer's disease D) diabetes mellitus Answer: A 11) Which of the following is an emotional factor associated with the aging process?

A) anemia B) depression C) diabetes D) cystic fibrosis Answer: B 12) Extra supplies and equipment are needed by home health care workers who collect specimens from homebound patients that are not necessary for workers in a hospital. These include: A) biohazard container for disposables B) gloves C) a weapon, if working in a high-crime area D) gauze Answer: A

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13) Which of the following is a complication that can result from deep heelsticks on an infant?

A) HIV infection B) hepatitis A C) osteomyelitis D) pneumonia Answer: C 14) Which of the following is a commonly inherited disease that is detectable through a newborn screening process in neonates?

A) sickle cell disease B) spina bifida C) neurogenic bladder abnormality D) anemia Answer: A 15) In a child, when using ultrasound or infrared light for direct visualization to cannulate with the needle requires: A) no restraint B) absence of the parent from the room C) free movement of the patient's arm D) a partner to secure the arm Answer: D 16) After the blood collected from a heelstick is placed on the neonatal screening card, the card must dry in a horizontal position for a minimum of: A) 1 hour B) 2 hours C) 3 hours D) 4 hours Answer: D 17) When a skin puncture is performed on an infant, which of the following specimens is collected first?

A) chemistry specimens B) hematology specimens C) clinical immunology specimens D) blood bank specimens Answer: B 18) Which of the following is needed for blood collection by skin puncture on an infant?

A) Eclipse safety needle B) red-topped evacuated blood collection tube C) Seraket tourniquet D) puncture-resistant sharps container Answer: D

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19) Blood spot testing for neonatal screening disorders should be performed before the newborn is: A) 12 hours old B) 24 hours old C) 48 hours old D) 72 hours old Answer: D 20) Which of the following is an acceptable intervention to alleviate pain during venipuncture on a 5year-old child?

A) xylocaine B) ice pack C) EMLA D) sucrose nipple Answer: C 21) Which is the preferred site for a heelstick?

A) anteromedial section of the heel B) medial or lateral section of the heel C) posterior curve D) a previous puncture site on the heel Answer: B 22) Which of the following disorders can be detected through neonatal screening?

A) cystic fibrosis B) Parkinson's disease C) diabetes mellitus D) polycythemia Answer: A 23) Which of the following equipment is necessary for newborn screening blood collection?

A) 2-mL lavender-topped vacuum tube B) blood pressure cuff C) disposable gloves D) safety holder/needle device Answer: C 24) Approximately how many inherited disorders can neonatal tandem mass spectrometry screening (MS/MS) detect today?

A) five B) fifteen C) fifty D) five hundred Answer: C

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25) Which of the following is true of congenital hypothyroidism?

A) screened for through the neonatal screening blood collection procedure B) another term for Parkinson's disease C) screened for through the capillary blood gas test D) another term for HIV Answer: A

True/False Questions 1) Cystic fibrosis is detected by the capillary blood gas test.

Answer: FALSE 2) A minute metal filing and magnet are necessary for the capillary blood gas procedure.

Answer: TRUE 3) EMLA is a topical anesthetic used after venipuncture in children.

Answer: FALSE 4) Sucrose is effective in reducing pain and crying time during a blood collection procedure for an infant.

Answer: TRUE 5) The EMLA application can provide anesthesia for 1 to 3 hours.

Answer: TRUE 6) A 10-mL blood sample collected from a newborn is equivalent to 5-10 percent of the infant's total blood volume.

Answer: TRUE 7) An incision for a heelstick on an infant should not go deeper than 3.0 mm.

Answer: FALSE 8) Parkinson's disease often occurs in elderly individuals.

Answer: TRUE 9) A physical problem common in elderly individuals is loss of feeling.

Answer: TRUE 10) The central area of the infant's heel is the best site for a heelstick blood collection.

Answer: FALSE

Short Answer Questions 1) For children older than _ Answer: 1

year, a fingerstick is appropriate for blood collection.

2) If an incision for a heelstick goes deeper than Answer: 2.0

mm in a newborn, it can lead to osteomyelitis.

5

3) blood is the specimen of choice for blood gas testing.

Answer: Arterial 4) Blood specimens in newborn screening collections must be dried for Answer: 4 5) Children with spina bifida are particularly sensitive to Answer: latex 6) Use of a(n) Answer: bandage

hours before mailing.

.

over a skin puncture site is not recommended for children less than 2 years old.

7) In the hospital, it is best to perform a blood collection procedure on a child in a(n) Answer: treatment 8) The horizontal position to immobilize a child is also referred to as the Answer: supine 9) Eutectic mixture of local anesthetics is also called Answer: EMLA

room.

position.

.

10) For the newborn screening blood collection procedure, only be used.

Answer: one

6

side of the filter paper should

Essay Questions 1) Describe at least four types of interference that can occur in newborn screening collections.

Answer: ∙ Blood specimen not properly dried before mailing ∙ Filter paper circles not completely filled, not saturated with blood, or not all circles filled ∙ Contamination of filter paper circles before or after blood collection by substances such as hand lotion, powder, alcohol, antiseptic hand solution; touching of areas with gloved or ungloved hands ∙ Blood applied to both sides of filter paper ∙ Excess blood applied (usually occurs with a capillary tube) ∙ Heelstick is squeezed or milked, resulting in "tissue-diluted" specimens ∙ Alcohol is not wiped off from heelstick site before puncture is made 2) List the blood collection equipment needed for newborn screening.

Answer: ∙ Sterile, automatic, disposable pediatric skin-puncture safety devices in different manufacturers' incision depths (0.65-0.85 mm for premature neonates, 1.0 mm for larger infants) ∙ 70% percent isopropyl alcohol swabs ∙ Sterile 2" × 2" gauze sponges ∙ Newborn screening cards–appropriate collection cards are kept in the hospital laboratory or the nursery. (Do not use if beyond expiration date on filter paper!) ∙ Puncture-resistant sharps container ∙ Disposable gloves (nonlatex) ∙ Warming packs of compresses (towel or washcloth) to warm heel if necessary ∙ Marking pen ∙ Laboratory requisitions or labels

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Phlebotomy Handbook, 10e (Garza/Becan-McBride) Chapter 14 Point-of-Care Collections Multiple Choice Questions 1) Which of the following is true about HIV testing?

A) An HIV POC test uses a drop of blood on a USB stick to check for HIV. B) Current HIV POC tests are not disposable.

C) HIV can be tested on a POC basis, but there is no electronic connectivity between the test device and other electronic devices.

D) As of today, no POC test for HIV had been developed.

Answer: A 2) What is detected by measuring troponin T? A) T4 B) heart damage C) kidney damage D) problems with bleeding Answer: B 3) Which of the following terms is synonymous with POCT? A) blood culture testing B) near-patient testing C) capillary blood gas testing D) neonatal screening Answer: B 4) Most rapid methods for glucose testing require: A) serum B) plasma C) skin puncture blood D) red blood cells Answer: C 5) Which of the following refers to the term hematocrit?

A) CBC B) Hemo scan C) PCV, crit D) Hgb Answer: C 6) Which of the following blood assays can assist in the diagnosis and evaluation of anemia?

A) hemoglobin B) troponin T C) glucose D) insulin Answer: A

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7) Approximately how many of the nearly 13 billion laboratory tests performed annually in the United States are point-of-care tests?

A) one-tenth B) one-third C) one-half D) three-fourths Answer: B 8) SD stands for: A) shared diameter B) standard deviation C) standard dimension D) short dimension Answer: B 9) Which of the following is released from the pancreas and has a major effect on blood glucose levels?

A) thyroxine B) troponin T C) insulin D) renin Answer: C 10) Interpretation of a quality control chart is based on the fact that for a normal distribution: A) 99% of the values are within 3 SD of the mean B) 99% of the values are within 2 SD of the mean C) 95% of the values are within 3 SD of the mean D) 95% of the values are within 1 SD of the mean Answer: A 11) Na+, Cl—, HCO3—, and K+ are usually referred to as: A) electrolytes B) blood gases C) hormones D) coagulation factors Answer: A 12) The Accu-Chek Aviva monitor is used to test: A) heart damage B) glucose C) bilirubin D) hemoglobin Answer: B

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13) All POCT analyzers require: A) gloves B) reagent strips C) microcuvettes D) glucose controls Answer: A 14) Control material should be analyzed how many times in order to determine the mean and SD? A) 10-15 B) 20-30 C) 35-45 D) 50-60 Answer: B 15) In POCT quality control, tolerance limits are determined by pooling the data obtained during which test period?

A) 10-day test period B) 20-day test period C) 30-day test period D) 40-day test period Answer: C 16) Which of the following is recommended to use to routinely clean the POCT instruments?

A) 5% bleach solution B) 45% ethyl alcohol C) 25% chorohexidine D) 95% isopropyl alcohol Answer: A 17) The blood pH determines whether the blood: A) is glycemic B) is too acidic or too alkaline C) is high in electrolytic content D) has elevated bilirubin levels Answer: B 18) The Cholestech LDX system measures: A) total cholesterol B) cholesterol and bilirubin C) LDL triglycerides D) HDL triglycerides Answer: A

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19) Which of the following is referred to as "bad cholesterol"?

A) HDL cholesterol B) LDL cholesterol C) cholesterol ratio D) total cholesterol Answer: B 20) A yellow substance that the body synthesizes to replace old RBCs is called: A) insulin B) quality control material C) bilirubin D) cholesterol Answer: C 21) The CoaguChek XS System measures which of the following?

A) PT/INR B) glucose C) pCO2 D) pH Answer: A 22) In laboratory abbreviations, PCV stands for: A) prothombin corpuscular volume B) packed cell volume C) protime cell volume D) patient's cellular volume Answer: B 23) A less than normal number of erythrocytes in a patient is referred to as: A) polycythemia B) anemia C) myloproliferative disorder D) neutropenia Answer: B 24) The HbA1c assay is used to monitor a patient's: A) hemoglobin level B) hemoglobin A level C) glycemic control D) blood hematocrit level Answer: C 25) Which of the following measures a cardiac monitoring analyte?

A) One Touch Ultra 2 B) HemoSense INRatio Meter C) CoaguChek System D) ROCHE TROPT sensitive rapid assay Answer: D

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True/False Questions 1) The PT and INR testing is used in glucose monitoring.

Answer: FALSE 2) A cardiac POCT is the ROCHE TROPT rapid assay.

Answer: TRUE 3) Hct is the same as packed cell volume.

Answer: TRUE 4) Hematocrit values are obtained to aid in the diagnosis of diabetes mellitus.

Answer: FALSE 5) High-density lipoprotein is referred to as the "good cholesterol."

Answer: TRUE 6) Triglycerides are fatty acids and glycerol that circulate in the blood.

Answer: TRUE 7) A test for the maintenance of blood glucose levels is the troponin T test.

Answer: FALSE 8) Hemoglobin is the same as hematocrit.

Answer: FALSE 9) The purpose of EQC is to test the electronics of a POCT instrument.

Answer: TRUE 10) Diabetes mellitus is an acute disease, not a chronic disease.

Answer: FALSE

Short Answer Questions 1) Bedside testing is also referred to as Answer: POCT

, or point-of-care testing.

2) Diabetes mellitus is a disease in which the Answer: pancreas

cannot produce enough insulin.

3) causes the glucose to be absorbed from the blood into the body tissues.

Answer: Insulin 4) The HemoCue beta-glucose analyzer can obtain test results from capillary, venous, or Answer: arterial

5

blood.

5) Glucose-monitoring instruments must be monitored with quality-control materials for accuracy and of patients' test results.

Answer: reliability 6) Some POCT instruments have EQC, which stands for Answer: electronic quality control

.

7) pCO2 stands for .

Answer: partial pressure of carbon dioxide 8) The abbreviation Na+ stands for Answer: sodium

.

9) PT stands for .

Answer: prothrombin time 10) The ROCHE TROPT rapid assay is a Answer: cardiac

point-of-care test.

Essay Questions 1) Why are PT and INR run frequently as POC tests?

Answer: Monitoring blood coagulation (i.e., prothrombin time [PT] and International Normalized Ratio [INR]) through point-of-care testing provides immediate results that can be used to control bleeding or clotting disorders in patients.

2) Explain the difference between HDL cholesterol and LDL cholesterol.

Answer: High-density lipoprotein (HDL) cholesterol is referred to as the "good cholesterol," because increased blood values protect the patient from heart disease. Low-density lipoprotein (LDL) cholesterol is referred to as the "bad cholesterol," because high values are usually linked to heart disease.

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Phlebotomy Handbook, 10e (Garza/Becan-McBride) Chapter 15 Blood Cultures, Arterial, Intravenous (IV), and Special Collection Procedures Multiple Choice Questions 1) Which of the following is the specimen of choice for testing acid-base balance and respiratory status of a patient?

A) arterial blood B) venous blood C) capillary blood D) heparinized plasma Answer: A 2) By far, the most Americans die each year from: A) AIDS B) breast cancer C) septicemia D) prostate cancer Answer: C 3) When blood is collected from the radial artery for an arterial blood gas collection, the needle should be inserted at an angle of: A) 10-25 degrees B) 20-30 degrees C) 30-45 degrees D) 40-50 degrees Answer: C 4) Which of the following supplies is not needed during an arterial puncture for an ABG determination?

A) syringe B) tourniquet C) latex-free gloves D) lidocaine Answer: B 5) Which of the following is the most frequently used site for blood collection for arterial blood gases?

A) radial artery B) ulnar artery C) subclavian artery D) femoral artery Answer: A 6) Which of the following is used to help in the diagnosis of diabetes mellitus?

A) ABG analysis B) HbA1c C) PT D) TDM Answer: B

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7) Postprandial refers to: A) before eating B) after eating C) 2-hour fasting D) 12-hour fasting Answer: B 8) What is the rationale for performing the Allen test?

A) to test for the possibility of edema B) to determine whether the patient has high blood pressure C) to determine whether the radial and ulnar arteries are providing collateral circulation D) to determine whether the carbon dioxide concentration in the radial and ulnar arteries is elevated Answer: C 9) Which of the following blood collection vacuum tubes is preferred for the collection of arterial blood gas analysis?

A) light blue-topped blood collection tube B) green-topped blood collection tube C) yellow-topped blood collection tube D) no blood collection tube Answer: D 10) Which of the following evacuated tubes is appropriate for the collection of a blood culture specimen?

A) yellow-topped evacuated tube B) light blue-topped evacuated tube C) gold-topped evacuated tube D) green-topped evacuated tube Answer: A 11) What is a cannula?

A) a good source of capillary blood B) the fusion of the vein and an artery C) a tubular instrument used to gain access to venous blood D) an artificial shunt that provides access to arterial blood Answer: C 12) To obtain the blood trough level for a medication, the patient's blood should be collected: A) immediately after administration of the medication B) immediately before administration of the medication C) 15 minutes after administration of the medication D) 30 minutes after administration of the medication Answer: B

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13) Which of the following is the minimum hematocrit value a blood donor must have to give a blood donation?

A) 50 percent B) 48 percent C) 38 percent D) 35 percent Answer: C 14) Which of the following procedures often requires blood collection for trough and peak-level determinations?

A) skin test for allergies B) blood collection via IV C) therapeutic drug monitoring D) GTT Answer: C 15) The health care worker's thumb should not be used for palpating arteries in the arterial puncture procedure because the thumb: A) does not have the same sensitivity as the other fingers B) has a pulse that may be confused with the patient's pulse C) has more neurons for touching, which interfere in the process of finding the patient's pulse D) has less sensitivity than the other fingers Answer: B 16) In order for a donor to give blood, his or her hemoglobin value must be no less than: A) 15.5 g/dL B) 14.5 g/dL C) 13.5 g/dL D) 12.5 g/dL Answer: D 17) Which of the following procedures requires two 10-mL disposable syringes filled with sterile normal saline, one 3-mL disposable syringe filled with injectable heparinized saline, and two 10-mL disposable syringes with needleless cannula?

A) skin test for allergies B) blood collection from a blood donor C) blood collection for GTT D) blood collection through CVCs Answer: D 18) Which of the following guidelines must the patient abide by to properly prepare for the GTT? A) The patient must not eat anything for 8 hours before the GTT but should not fast for more than 12 hours before the test.

B) The patient should take cortisol 2 days before the GTT. C) The patient needs to exercise vigorously 3 days before the GTT. D) The patient must not eat anything for 14 hours before the GTT. Answer: A

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19) Which of the following medications has a shorter half-life and therefore requires exact timing in blood collection for its therapeutic level?

A) gentamicin B) phenobarbital C) digoxin D) Tylenol Answer: A 20) Normally, after an adult ingests the 75 grams of glucose for the glucose tolerance test, the glucose level should return to normal within how many minutes?

A) 15 minutes B) 30 minutes C) 60 minutes D) 120 minutes Answer: D 21) Before a blood donation, the phlebotomist must always check the blood donor's: A) urine glucose value B) RBC count C) blood pressure D) WBC count Answer: C 22) Which of the following is a milk sugar that sometimes cannot be digested by healthy individuals?

A) glucose B) glucagon C) lactate D) lactose Answer: D 23) Therapeutic phlebotomy is used in the treatment of: A) megaloblastic anemia B) polycythemia C) chronic anemia D) iron-deficiency anemia Answer: B 24) Which of the following items is not usually kept on file for every blood donor indefinitely?

A) age B) a written consent form signed by the donor C) a record of reason for deferrals D) a written consent form signed by the donor's parent Answer: D

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25) For a donor to donate blood, his or her oral temperature must not exceed: A) 35°C B) 37.5°C C) 38.7°C D) 39.5°C Answer: B

True/False Questions 1) All donated blood is classified and labeled by type.

Answer: TRUE 2) For the postprandial glucose test, a blood specimen is collected 2 hours after a meal.

Answer: TRUE 3) The preferred, noninvasive method for testing lactose tolerance is measuring breath hydrogen content.

Answer: TRUE 4) Therapeutic phlebotomy is the intentional removal of blood for therapeutic reasons.

Answer: TRUE 5) If a potential blood donor looks ill or under the influence of alcohol or drugs, he or she can still donate.

Answer: FALSE 6) Most TDM assays should be performed on serum or plasma.

Answer: TRUE 7) The radial artery is the most frequently used artery for ABG analysis.

Answer: TRUE 8) The modified Allen test is performed prior to HbA1c screening.

Answer: FALSE 9) Rapid breathing is the same as hypoventilation.

Answer: FALSE 10) Infrared light can be used to locate veins.

Answer: TRUE

Short Answer Questions 1) Blood cultures are often collected from patients who have fevers of Answer: unknown 2) Presence of bacteria in the blood is referred to as Answer: bacteremia

.

5

origin.

3) The blood culture bottle must be inoculated first in all procedures except the butterfly assembly method.

Answer: anaerobic 4) Major arteries of the arm are the brachial, ulnar, and Answer: radial 5) For the GTT, it is not recommended to exercise for _ Answer: 12

arteries.

hours before the test procedure.

6) A central intravenous line, and a peripherally inserted central catheter, are examples of devices.

Answer: vascular access 7) ABGs stands for .

Answer: arterial blood gases 8) The artery is located in the groin area and sometimes is used by the physician for ABGs. Answer: femoral 9) A, B, AB, and O are blood Answer: types 10) A(n) Answer: fistula

.

is an artificial shunt in which the vein and artery have been fused through surgery.

Essay Questions 1) Explain the procedure(s) that are used for obtaining hematocrit or hemoglobin values in preparation for a blood donation. Include the values required for a person to be qualified as a donor.

Answer: A fingerstick is commonly used to collect blood for such determinations. The health care worker may collect blood in a plastic hematocrit tube for centrifuging and reading, measure hemoglobin spectrophotometrically, or use the copper sulfate method. The hematocrit value must be no less than 38 percent for donors, and the hemoglobin value must be no less than 12.5 g/dL. 2) How can veins be located in the difficult-access patient without the need to repalpate?

Answer: In the difficult-access patient, veins can be located without the need to repalpate by using near infrared light devices or ultrasound.

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Phlebotomy Handbook, 10e (Garza/Becan-McBride) Chapter 16 Urinalysis, Body Fluids, and Other Specimens Multiple Choice Questions 1) Which of the following is obtained through a lumbar puncture?

A) pleural fluid B) cerebrospinal fluid C) peritoneal fluid D) synovial fluid Answer: B 2) Nasopharyngeal culture collection may be used to diagnose: A) Salmonella infection B) Shigella infection C) whooping cough D) Cryptococcus infection Answer: C 3) Creatinine clearance is determined through the use of: A) CSF specimen B) synovial fluid C) pericardial fluid specimen D) urine specimen Answer: D 4) A fluid examined to determine the effectiveness of a vasectomy, investigate the possibility of sexual criminal charges, and assess fertility is: A) semen B) CSF C) synovial fluid D) pleural fluid Answer: A 5) Which of the following types of urine specimens is the "cleanest," or least contaminated?

A) first morning specimen B) timed specimen C) midstream specimen D) random specimen Answer: C 6) Amniotic fluid can be found: A) around the heart after a heart attack B) around the fetus in the uterus C) around the lungs D) surrounding the liver, the pancreas, and other parts of the gastrointestinal area Answer: B

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7) A 24-hour urine specimen can be collected to test for: A) glucose B) bacteria C) creatinine clearance D) creatine kinase Answer: C 8) Pericardial fluid is collected from the: A) joints B) heart cavity C) abdominal cavity D) sac around the lungs Answer: B 9) Throat cultures are most commonly obtained to determine the presence of a: A) Streptococcus infection B) Neisseria infection C) Staphylococcus infection D) Bacillus infection Answer: A 10) The fluid collected from a joint cavity is: A) pericardial fluid B) synovial fluid C) amniotic fluid D) peritoneal fluid Answer: B 11) The sweat chloride test is performed on infants with a positive: A) gastric analysis B) newborn screen C) urine glucose test D) H. pylori test Answer: B 12) Helicobacter pylori is a type of bacteria that causes: A) cystic fibrosis B) diabetes mellitus C) peptic ulcers D) malaria Answer: C 13) The FOBT is an abbreviation for the test to detect: A) TB B) cystic fibrosis C) gastric ulcers D) occult blood Answer: D

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14) Skin tests are used to determine whether a patient has ever had contact with: A) a particular antigen and has produced antibodies to that antigen B) the disease polycythemia C) a particular antibody and has produced antigens to that antibody D) the disease leukemia Answer: A 15) A urine C&S should be performed on a: A) random urine sample B) clean-catch midstream sample C) routine urine sample D) 24-hour urine specimen Answer: B 16) Peritoneal fluid is located: A) around the lungs B) in the abdominal cavity C) in the joints D) in the sac around the heart Answer: B 17) Presence of ketone bodies in the urine can indicate: A) infection of the kidney B) diabetes mellitus C) malaria D) infection of the urethra Answer: B 18) The most convenient type of urine specimen to collect is the: A) clean-catch midstream specimen B) fasting specimen C) timed specimen D) random specimen Answer: D 19) Which of the following types of specimens is most frequently collected for analysis?

A) CSF B) peritoneal fluid C) urine D) fecal specimens Answer: C 20) The O&P analysis is requested on: A) fecal specimens B) CSF specimens C) synovial fluid specimens D) throat cultures Answer: A

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21) What type of urine specimen is needed to detect an infection?

A) random B) routine C) clean-catch D) 2-hour timed Answer: C 22) Occult blood analysis is frequently requested on: A) synovial fluid specimens B) seminal fluid specimens C) fecal specimens D) CSF specimens Answer: C 23) The sweat chloride test is used to diagnose: A) cerebral palsy B) cystic fibrosis C) diabetes mellitus D) multiple sclerosis Answer: B 24) Which of the following can be used in children and infants to diagnose whooping cough?

A) O&P test B) H. pylori test C) sweat chloride test D) nasopharyngeal culture Answer: D 25) The guaiac smear test is used for: A) occult blood detection B) cystic fibrosis analysis C) TB detection D) diagnosis of pneumonia Answer: A

True/False Questions 1) Sputum is fluid from the pericardial area.

Answer: FALSE 2) CSF is fluid that circulates around the outside of the brain.

Answer: TRUE 3) Fecal specimens are commonly collected in order to detect parasites.

Answer: TRUE 4) Seminal fluid is examined to detect sexual criminal charges.

Answer: TRUE

4

5) The fluid that surrounds the fetus in the uterus is peritoneal fluid.

Answer: FALSE 6) Occult blood tests are also known as H. pylori tests.

Answer: FALSE 7) The "prick technique" is used for the determination of tuberculosis infection.

Answer: FALSE 8) An allergy skin test is usually performed on the patient's foot or leg.

Answer: FALSE 9) BUN is an abbreviation for blood urea nitrogen.

Answer: TRUE 10) UA is an abbreviation for timed urine.

Answer: FALSE

Short Answer Questions 1) Throat swab collections are most commonly obtained to determine the presence of Answer: streptococcal 2) The "prick technique" can be performed to detect food-specific immunoglobin E Answer: antibodies 3) The abbreviation PPD stands for Answer: purified protein derivative 4) Peptic ulcers can be detected by the Answer: H. pylori

.

test.

5) analysis determines how much acid is produced in an individual's stomach.

Answer: Gastric 6) To detect cystic fibrosis, the more recent test is Answer: DNA

analysis.

7) The presence of ketone bodies in urine is referred to as Answer: ketosis 8) The strip is used to check urine for ketone bodies.

Answer: chemistry urine 9) C&S stands for .

Answer: culture and sensitivity

5

.

infections.

.

10) CSF stands for .

Answer: cerebrospinal fluid

Essay Questions 1) What is included in the routine UA? Answer: The routine UA includes a physical, chemical, and sometimes microscopic analysis of the urine sample. The physical properties include color, transparency versus cloudiness, odor, and concentration as detected through a specific gravity measurement. The chemical analysis for abnormal constituents is determined by using plastic reagent strips that test for the presence of glucose, protein, red blood cells, hemoglobin, white blood cells, ketones, bacteria, bilirubin, and other constituents.

2) What are sputum specimens collected for?

Answer: Sputum specimens are collected for microbiology specimens to test for pathogenic organisms including TB. Also, sputum is collected for cytology testing.

6

Phlebotomy Handbook, 10e (Garza/Becan-McBride) Chapter 17 Drug Use, Forensic Toxicology, Workplace Testing, Sports Medicine, and Related Areas Multiple Choice Questions 1) Testing based on DNA analysis to determine a mother's identity is known as: A) paternity testing B) OTC testing C) maternity testing D) chain of custody Answer: C 2) At which life stage do most drug addictions first develop?

A) infancy B) adolescence C) young adults D) midlife adults Answer: B 3) Crime laboratories are involved in: A) analyzing trace evidence at a crime scene B) routine laboratory screening C) federal workplace drug programs D) DNA testing exclusively Answer: A 4) Another term for a medical examiner's office is the: A) crime scene B) CSI C) coroner's office D) custody office Answer: C 5) In the past decade, rates of drug abuse, addiction, and deaths from lethal overdoses have: A) declined dramatically B) declined slightly C) remained about the same D) increased Answer: D 6) The chain of custody means: A) the specimen is tracked at every step B) that a special plastic chain is attached to the specimen C) that only law enforcement personnel can transport the specimen D) there is no legal guardian for a child Answer: A

1

7) In 2015, how many deaths due to opioid or heroin poisoning were there per 100,000 U.S. residents?

A) 3.1 B) 6.2 C) 11.0 D) 23.3 Answer: B 8) Random drug testing programs are commonly used for safety- or security-sensitive jobs. In these programs, drug tests are performed: A) on the same day of each month B) every other day for 2 weeks C) every 6 weeks D) at unpredictable times Answer: D 9) Which of the following has an effect on the ability to detect drugs in an individual?

A) metabolic rate, dosage, and testing cutoffs B) whether or not the individual wants to be tested C) smoking cigarettes D) how much coffee the individual drinks Answer: A 10) Which of the following is an acceptable form of identification for an individual being tested for drugs?

A) identification by peer or coworker B) use of a faxed license due to forgetting to bring it C) an employer-issued photo identification badge D) health worker's union membership card Answer: C 11) A sensory examination of a urine specimen for drug testing should include: A) adding bluing to the specimen B) checking the color and odor of the specimen C) taking the specific gravity D) splitting the specimen Answer: B 12) If testing a urine specimen for drugs, when should the temperature of the specimen be taken?

A) no longer than 30 seconds after the donor provides the specimen B) within 1 minute after the donor provides the specimen C) within 4 minutes after the donor provides the specimen D) exactly 10 minutes after the donor provides the specimen Answer: C

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13) EPO enhances athletic performance by: A) making the athlete more alert B) increasing oxygen-carrying capacity and endurance C) building muscle mass D) giving a sense of well-being and optimism Answer: B 14) Confirmatory testing is: A) the first part of the process of testing for drugs of abuse B) another term for initial screening C) the second part of the process of testing for drugs of abuse D) done if the screening test is negative Answer: C 15) When driving your personal vehicle, the legal limit in all 50 states for blood alcohol content (BAC) is: A) 0.01% B) 0.04% C) 0.08% D) 0.80% Answer: C 16) BAC is most commonly measured using which of the listed specimens: A) gastric fluids B) breath, blood, and urine C) hair and nails D) saliva and tears Answer: B 17) The period of time after using a drug that the drug is still detectable is the: A) window of detection B) standardized cutoff level C) period of adulteration D) binge index Answer: A 18) Which of the following statements is true?

A) Drug tests measure the frequency of drug usage.

B) As a rule, drug tests can tell if an individual has a disorder that requires treatment or a prescription.

C) Drug tests usually cannot distinguish between prescription, over-the-counter, and illicit street drugs.

D) Blood alcohol analysis is usually done together with other drug screening tests.

Answer: C 19) One way commonly used to assess sobriety is: A) having the police officer state the laws and testing the driver for comprehension B) having the police officer check the suspicious vehicle inside and out C) asking the driver to walk a straight line, heel to toe D) asking the driver to remove his or her shoes, then skip in a line Answer: C

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20) A device for screening BAC whereby the subject breathes into a mouthpiece is called a: A) hemolyzer B) manometer C) triptometer D) breathalyzer Answer: D

True/False Questions 1) Testing for drugs of abuse is a two-part process.

Answer: TRUE 2) A laboratory report that is either "positive or negative" would be considered a quantitative result.

Answer: FALSE 3) Drug testing and substance abuse testing mean the same thing.

Answer: TRUE 4) The threshold for intoxication for one marijuana user is the same as the threshold for other users.

Answer: FALSE 5) Reasonable suspicion or for-cause drug tests can be performed in the workplace.

Answer: TRUE 6) If someone tests positive for marijuana use, this may be legally acceptable in some states.

Answer: TRUE 7) Alcohol is an illicit drug.

Answer: FALSE 8) Sometimes soap is used as an adulterant for urine specimens that are to be tested for drugs.

Answer: TRUE 9) Performance-enhancing drugs are good for all student-athletes.

Answer: FALSE 10) Anabolic steroids are banned for student-athletes by the NCAA. Answer: TRUE

Short Answer Questions 1) The term used for intoxicated driving is Answer: DUI or DWI

.

2) Another term for tampering with a specimen is Answer: adulteration

.

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3) A very specific analytical method for drug detection and measurement is spectrometry.

Answer: gas chromatography 4) A term used to mean after death is Answer: postmortem

or mass

.

5) A device used to test the breath of a suspected drunk driver is a(n) Answer: breathalyzer

.

6) are analytical screening methods that have a low cost and a rapid turnaround time.

Answer: Immunoassays 7) is the same in all cells of the body.

Answer: DNA 8) Binge drinking in women is defined as least one day in the past 30 days.

Answer: four

or more alcoholic drinks on the same occasion on at

9) A drug is a compound produced after the body processes a drug.

Answer: metabolite 10) The eCCF is an electronic version of the Answer: Custody and Control

Form.

Essay Questions 1) Name three categories of drugs that can be detected with drug tests, and give a one or two examples of each.

Answer: Three categories of drugs that can be detected with drug tests are depressants, stimulants, and hallucinogens. Depressants include opioids, barbiturates, benzodiazepines, and alcohol. Stimulants include amphetamines and cocaine. Hallucinogens include LSD, mescaline, phencyclidine, and cannabinoids.

2) There are three standardized field sobriety tests that law-enforcement officers perform when they stop a driver whom they suspect of being impaired. Name the three types of tests.

Answer: The three standardized field sobriety tests used by law-enforcement officers when they stop someone who was driving as if they were impaired are the walk-and-turn test, the one-leg stand test, and the horizontal gaze nystagmus test.

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