TEST BANK for Phlebotomy: Worktext and Procedures Manual 5th Edition Robin S. Warekois; Richard Robi

TABLE OF CONTENTS Chapter 1. Introduction to Phlebotomy Chapter 2: Healthcare Structure Chapter 3: Safety Chapter 4: Infection Control Chapter 5: Medical Terminology Chapter 6: Human Anatomy and Physiology Chapter 7: Circulatory, Lymphatic, and Immune Systems Chapter 8: Venipuncture Equipment Chapter 9: Routine Venipuncture Chapter 10: Capillary Collection Chapter 11: Preanalytic Variables and Venipuncture Complications Chapter 12: Blood Collection in Special Populations Chapter 13: Arterial Blood Collection Chapter 14: Special Collections and Procedures Chapter 15: Special Nonblood Collection Procedures Chapter 16: Specimen Handling, Transport, and Processing Chapter 17: Point-of-Care Testing Chapter 18: Quality Phlebotomy Chapter 19: Legal Issues in Phlebotomy

TEST BANK for Phlebotomy: Worktext and Procedures Manual 5th Edition Robin S. Warekois; Richard Robinson; Pamela Primrose Chapter 01: Introduction to Phlebotomy Warekois et al.: Phlebotomy: Worktext and Procedures Manual, 5th Edition MULTIPLE CHOICE 1. What does the term phlebotomy actually mean? a. Removal of a vein b. Incision of a vein c. Testing of blood d. Withdrawal of red blood cells ANS: B

Phleb/o means “vein,” and -tomy means “to make an incision.”

DIF:

Cognitive Level: 1

REF: p. 2

OBJ: 1

2. A duty associated with routine blood collection includes a. ordering tests for patients. b. transporting sample to laboratory. c. performing complex point-of-care testing. d. setting HIPAA regulations for phlebotomy.

ANS: B

There are many job duties required for a phlebotomist; these vary by employer. In addition to collecting blood specimens, the phlebotomist is responsible for transporting the specimens to the lab in a timely manner using appropriate handling procedures. Phlebotomist do not order R .IPCAOAMregulations. tests or perform complex tT esE tinSgT; B noArNdK oS thEeyLL seE tH DIF:

Cognitive Level: 2

REF: p. 3

OBJ: 3

3. Which of the following acronyms is not a certification agency for phlebotomists? a. ASCP b. ASPT c. AMT d. NAACLS ANS: D

NAACLS is an accrediting agency for schools. All other agencies certify phlebotomists, and some also certify professionals in other fields.

DIF:

Cognitive Level: 1

REF: p. 7

OBJ: 5

4. Which of the following terms is evidence that an individual has demonstrated proficiency in a

particular area of practice? a. Accreditation b. Approval c. Certification d. Standardization ANS: C

Certification is evidence that an individual has demonstrated proficiency in a particular area of practice. Certification is awarded to an individual who has passed a voluntary proficiency examination given by a professional agency. Accreditation or approval is given to programs that train laboratory professionals according to specified standards.

DIF:

Cognitive Level: 1

REF: p. 6

OBJ: 5

5. A phlebotomist must ensure that the patient understands and agrees that his or her blood is

going to be drawn. What is the name of this process? a. Confidentiality b. Informed consent c. Legality d. Privacy ANS: B

This process is the definition of informed consent. Confidentiality is the protection of private information.

DIF:

Cognitive Level: 1

REF: p. 8

OBJ: 7

6. The Health Insurance Portability and Accountability Act of 1996 regulates which of the

following areas? a. Privacy of health information b. Health insurance transfers on changing jobs c. Informing patients of intended procedures d. Phlebotomy training ANS: A

HIPAA requires that healthcare agencies and personnel protect a patient’s private health information.

DIF:

Cognitive Level: 1

REF: p. 9

OBJ: 7

7. You have entered a patient’s room and explained that you need to draw blood, and the patient

repeatedly refuses. What should you do? a. Attempt to draw it anyhow because the physician ordered the test. b. Call for another phlebotomist to help you to convince the patient. c. Take the request form back to the laboratory after you have finished drawing your other patients. d. Notify the patient’s physician according to the institution’s written policies.

ANS: D

A patient must give informed consent. Refusal indicates that the patient does not give consent.

Inform the patient’s physician who ordered the test and document your actions.

DIF:

Cognitive Level: 3

REF: p. 8

OBJ: 7

8. The term informed consent means a. a patient must be informed of all intended treatments and risks before the treatment

is performed. b. a patient must inform the physicians concerning what procedures they need. c. a nurse informed by the phlebotomist can overrule a patient’s refusal.

d. as long as the patient is informed, he or she cannot refuse a treatment.

ANS: A

Informed consent means having all pertinent information concerning the procedure and giving consent. Only the patient can give consent, except in the case of a minor or an incapacitated patient.

DIF:

Cognitive Level: 1

REF: p. 8

OBJ: 7

9. Which of the following is true of phlebotomy? a. Phlebotomy is an ancient profession dating back at least 3500 years. b. Phlebotomy is a new profession arising during World War II. c. Phlebotomists today draw blood from patients for the same reasons as ancient

phlebotomists. d. Phlebotomy equipment has not changed since the original phlebotomists.

ANS: A

Phlebotomy originated at least 3500 years ago dating back to the ancient Egyptians.

“Bleeding” patients was once thought to cure many illnesses. Today’s equipment is very different.

DIF:

Cognitive Level: 1

REF: p. 2

OBJ: 1

10. Which of the following professionals performs a variety of tasks related to specimen

preparation in the clinical laboratory? a. Accessioner b. Laboratory assistant c. Medical assistant d. Medical technologist ANS: A

An Accessioner performs a variety of tasks related to specimen preparation in the clinical laboratory. A laboratory assistant assists in performing routine laboratory testing. A medical assistant works in a clinic or hospital to assist other staff in patient care facility preparation.

DIF:

Cognitive Level: 2

REF: p. 3

OBJ: 3

11. After becoming certified, what is a requirement to maintain that certification? a. Take an annual phlebotomy course. b. Complete a minimum of 500 sticks each year. c. Participate in continuing education programs. d. Take a bi-annual national certification examination.

ANS: C

Maintaining a certification requires participation in continuing medical education to remain certified. The other three choices are not required for maintaining a certification.

DIF:

Cognitive Level: 1

REF: p. 8

OBJ: 7

12. What is the term given to any information about the patient’s health status, treatment, or

payment for health care? a. Demographics

b. Protected Health Information c. Diagnosis d. Private Health Plan ANS: B

Any information about the patient’s health status, treatment, or payment for health care is the definition of Protected Health Information (PHI).

DIF:

Cognitive Level: 1

REF: p. 9

OBJ: 7

13. A successful quality healthcare professional is one who a. exhibits emotional stability. b. maintains professional aloofness. c. doesn’t get bogged down in the details. d. waits for problems to arise versus before they arise.

ANS: A

Emotional stability is important to the success of healthcare professionals due to the stress that arises from traumatic situations, suffering, and death of patients. Other attributes include being detail-oriented, exhibiting empathy not aloofness, and identifying problems quickly as they arise or before arising.

DIF:

Cognitive Level: 2

REF: p. 3

OBJ: 2

Chapter 02: Healthcare Structure Warekois et al.: Phlebotomy: Worktext and Procedures Manual, 5th Edition MULTIPLE CHOICE 1. The hospital laboratory falls under which of the following categories of administrative

services? a. Fiscal b. Nursing c. Professional d. Support ANS: C

The laboratory is a part of a hospital’s professional services. Fiscal services attend to financial matters; nursing services are in charge of the direct patient care; and support services include departments such as dietary and housekeeping.

DIF:

Cognitive Level: 1

REF: p. 14

OBJ: 1

2. Which abbreviation represents a certified laboratory professional? a. CCU b. CLIA c. MLS d. RN ANS: C

MLS stands for medical labToE raStoTryBA scN ieK ntSisEt L (aL lsE oR kn.oCwOnMas a medical technologist [MT] or medical laboratory technologist [MLT]); these are laboratory professionals. CCU stands for cardiac care unit, CLIA refers to the Clinical Laboratory Improvement Act, and RN stands for registered nurse.

DIF:

Cognitive Level: 2

REF: p. 15

OBJ: 4

3. Which abbreviation stands for a type of blood collection vacuum tube? a. CCU b. GTT c. RBC d. SST ANS: D

SST stands for serum separator tube. GTT stands for glucose tolerance test, RBC stands for red blood cell, and CCU stands for cardiac care unit.

DIF:

Cognitive Level: 2

REF: p. 18

OBJ: 7

4. Which of the following is the organization that accredits and inspects clinical laboratories? a. POL b. HMO c. TJC d. NAACLS

ANS: C

TJC (formerly JCAHO) stands for The Joint Commission which inspects and accredits laboratories, and this must be done every 2 years. POL is a physician office laboratory, HMO stands for health maintenance organization, and NAACLS is the National Accrediting Agency for Clinical Laboratory Sciences, which is an accrediting body for laboratory schools.

DIF:

Cognitive Level: 2

REF: p. 22

OBJ: 9

5. Which department of the laboratory processes Pap smears? a. Cytology b. Hematology c. Microbiology d. Serology ANS: A

Cytology looks for cancerous cells in Pap smears. Hematology performs blood counts, microbiology processes cultures, and serology studies serum to detect antibodies.

DIF:

Cognitive Level: 1

REF: p. 15

OBJ: 6

6. Which anticoagulant is used most often in collection tubes for hematology studies? a. Citrate b. EDTA c. Heparin d. Fluoride ANS: B

EDTA is used for blood coT unEtsS. T HB epAaN riK n S isEnL otLaEpR pr. opCrO iaM te for RBC and WBC counts. Citrate is used for coagulation studies. Fluoride is most often used for glucose testing.

DIF:

Cognitive Level: 1

REF: p. 19

OBJ: 7

7. Which of the following hematology tests measures the blood’s capacity to carry oxygen? a. Differential b. Hgb c. MCV d. WBC ANS: B

Hemoglobin (Hgb) is the oxygen-carrying protein of blood. For a differential (diff), a blood smear is examined to determine the types and morphology of blood cells. MCV is the mean cell volume of the patient’s red blood cells. WBC refers to the number of white blood cells.

DIF: Cognitive Level: 1

REF: pp. 19-20

OBJ: 7

8. Which laboratory department would normally perform a prothrombin time (PT) test? a. Coagulation b. Chemistry c. Serology d. Urinalysis ANS: A

PTs are normally performed in either the coagulation or the hematology department (in laboratories where coagulation is a section of the hematology department).

DIF:

Cognitive Level: 1

REF: p. 19

OBJ: 7

9. Which color tube may be used to obtain serum for a laboratory test? a. Green b. Gray c. Lavender d. Red ANS: D

Red-top tubes contain no anticoagulant and therefore allow the blood to clot. Serum is obtained upon centrifuging a clotted sample. Green-, gray-, and lavender-top tubes all contain anticoagulants and produce plasma upon centrifugation.

DIF:

Cognitive Level: 1

REF: p. 18

OBJ: 7

10. What term is used to describe serum that is darker yellow than normal? a. Clotted b. Hemolyzed c. Icteric d. Lipemic ANS: C

Icteric serum is yellow due to the presence of bilirubin. Hemolyzed serum is pink or slightly red due to the presence of plasma hemoglobin that has leaked out of broken RBCs. Lipemic samples are milky or cloudTyEinSaTpB pA eaN raKnS ceEdLuL eE toRi. ncCreOaM sed triglycerides.

DIF:

Cognitive Level: 1

REF: p. 18

OBJ: 7

11. Which term is used to describe serum that is cloudy or milky? a. Clotted b. Hemolyzed c. Icteric d. Lipemic ANS: D

Lipemic samples are milky or cloudy in appearance due to increased triglycerides. Hemolyzed serum is pink or slightly red due to the presence of plasma hemoglobin that has leaked out of broken RBCs. Icteric serum is yellow due to the presence of bilirubin.

DIF:

Cognitive Level: 1

REF: p. 18

12. Which term is used to describe serum that is pink-tinged? a. Clotted b. Hemolyzed c. Icteric d. Lipemic ANS: B

OBJ: 7

Hemolyzed serum is pink or slightly red due to the presence of plasma hemoglobin that has leaked out of broken RBCs. Icteric serum is yellow due to the presence of bilirubin. Lipemic samples are milky or cloudy in appearance due to increased triglycerides.

DIF:

Cognitive Level: 1

REF: p. 18

OBJ: 7

13. Sodium, potassium, and chloride are all part of which panel of tests? a. Electrolytes b. Immune function c. Lipid d. Liver function ANS: A

Electrolytes normally include sodium, potassium, chloride, and bicarbonate (or carbon dioxide).

DIF:

Cognitive Level: 1

REF: p. 17

OBJ: 7

14. Culture and sensitivity tests are performed by which of the laboratory departments? a. Chemistry b. Hematology c. Immunohematology d. Microbiology ANS: D

The microbiology department looks for the presence of bacteria in cultures. The chemistry department tests the chemical components of blood such as glucose and enzymes. The hematology department prT ocEesSsT esBCABNCKsS(cEoL mLpE leR te.bC loOoM d counts). The immunohematology department is the blood bank.

DIF:

Cognitive Level: 1

REF: p. 20

OBJ: 7

15. Which of the following is the term for blood donated by a patient for his or her own use

during a planned future surgical operation? a. Autologous donation b. Blood typing c. Compatibility testing d. Directed donation ANS: A

An autologous donation is for use by oneself. A directed donation is intended for another specific person’s use.

DIF:

Cognitive Level: 1

REF: p. 16

OBJ: 5

16. Which laboratory department uses genetic and biochemical techniques to analyze DNA in

specimens? a. Chemistry b. Hematology c. Histology d. Molecular diagnostics

ANS: D

The molecular diagnostics department detects DNA in samples. The histology department examines tissues from biopsies. The chemistry department tests the chemical components of blood, such as glucose and enzymes. The hematology department processes CBCs. DIF:

Cognitive Level: 1

REF: p. 21

OBJ: 7

17. The director of a hospital clinical laboratory is usually which of the following? a. Medical technologist b. Pathologist c. Phlebotomist d. Registered nurse ANS: B

A pathologist directs most clinical laboratories. Medical technologists and phlebotomists work in the laboratory.

DIF:

Cognitive Level: 1

REF: p. 15

OBJ: 4

18. Which laboratory department performs blood typing? a. Chemistry b. Hematology c. Immunohematology d. Urinalysis ANS: C

The immunohematology department is the blood bank. The chemistry department performs chemical analyses, the hemTaE toSloTgB yA deNpK arStm EeLnLt pEeRrf.orCmOsMblood counts, and the urinalysis department examines urine.

DIF:

Cognitive Level: 1

REF: p. 16

OBJ: 7

19. Which kind of laboratory is independent and analyzes samples from other healthcare

facilities? a. HMO laboratory b. POL laboratory c. PPO laboratory d. Reference laboratory ANS: D

A reference laboratory performs specialized tests for other healthcare facilities that cannot perform them. HMO and PPO are health insurance terms, and POL refers to a physician’s office laboratory.

DIF:

Cognitive Level: 1

REF: p. 23

OBJ: 10

20. In addition to the clinical laboratory, which professional service in a hospital may perform

arterial blood gases? a. Occupational therapy b. Nuclear medicine c. Radiology d. Respiratory therapy

ANS: D

Arterial blood gases are normally performed by either the laboratory or respiratory therapy depending on the facility.

DIF:

Cognitive Level: 1

REF: p. 15

OBJ: 5

21. Which department within the laboratory performs complete blood counts (CBCs)? a. Chemistry b. Hematology c. Immunohematology d. Microbiology ANS: B

The hematology department performs CBCs. The chemistry department performs chemical analyses, the immunohematology department is responsible for blood typing and transfusion services, and the microbiology department processes cultures.

DIF:

Cognitive Level: 1

REF: p. 19

OBJ: 7

22. Which section within the chemistry laboratory identifies unknown drugs within specimens? a. Electrophoresis b. Endocrinology c. Immunochemistry d. Toxicology ANS: D

The toxicology section performs all types of drug testing. Electrophoresis separates proteins BhAeNeKndSoEcrLinLoEloRg. based on their electrical chT arEgS esT .T y Cs eOc tMi o n measures hormones, and the immunochemistry section uses antigen/antibody reactions to detect certain substances within the blood.

DIF:

Cognitive Level: 1

REF: p. 18

OBJ: 7

23. What is another name for a reference laboratory? a. In-Patient laboratory b. Physician’s office laboratory c. Private testing laboratory d. Collection laboratory ANS: C

A reference laboratory can also be called a private testing laboratory.

DIF:

Cognitive Level: 1

REF: p. 23

OBJ: 10

24. What is an example of a clerical task? a. Obtaining a sample b. Patient registration c. Transporting a specimen d. Patient preparation for a UA ANS: B

Patient registration is a clerical task. All of the other tasks are clinical tasks.

DIF:

Cognitive Level: 1

REF: p. 23

OBJ: 10

25. How often do Joint Commission laboratories need to be inspected and accredited? a. Monthly b. Annually c. Every 2 years d. Every 5 years ANS: C

Joint commission laboratories need to be inspected and accredited every 2 years.

DIF:

Cognitive Level: 2

REF: p. 22

OBJ: 9

26. What are the proteins that help fight infection by binding to surface molecules of the infective

agent? a. Antibody b. Agglutinin c. Antigen d. Aerobe ANS: A

Proteins that help fight infection by binding to surface molecules of the infective agent are antibodies. The remaining choices are all infection causing organisms.

DIF:

Cognitive Level: 1

REF: p. 21

OBJ: 7

27. The role of Clinical & LabT orEaS toT ryBSAtaNnK daSrE dsLIL nsEtiR tu.teC(O CM LSI) is to a. accredit laboratories. b. work with CAP to accredit laboratories and hospitals. c. set standards for laboratories to ensure accurate patient results.

ANS: C

CLSI sets laboratory standards with the express goal of laboratories producing accurate patient test results.

DIF:

Cognitive Level: 1

REF: p. 22

OBJ: 9

28. CLSI standards are determined and set by a. accreditation agency professionals. b. volunteer members globally. c. pathologists and physicians. d. TJC and CAP inspectors.

ANS: B

Laboratory standards set by CLSI are determined by volunteer members of the global community.

DIF:

Cognitive Level: 1

REF: p. 22

OBJ: 9

29. Which of the following agencies provides proficiency testing of unknown samples to

laboratories?

a. b. c. d.

TJC CLSI CLIA CAP

ANS: D

Proficiency testing of unknown samples is provided by CAP and other approved proficiency organizations. TJC and CLIA require labs to enroll in a CMS (Centers for Medicare and Medicaid Services) approved proficiency testing program for each regulated analyte tested for in each laboratory.

DIF:

Cognitive Level: 1

REF: pp. 22-23

OBJ: 10

Chapter 03: Safety Warekois et al.: Phlebotomy: Worktext and Procedures Manual, 5th Edition MULTIPLE CHOICE 1. Which government agency is responsible for laboratory workplace safety? a. CLIA b. FDA c. MSDS d. OSHA ANS: D

OSHA is responsible for workplace safety, CLIA regulates laboratory testing, and FDA regulates drugs. An MSDS, as required by OSHA, is a sheet of information about any hazardous chemical being used in the workplace.

DIF:

Cognitive Level: 1

REF: p. 26

OBJ: 1

2. Infectious agents such as bacteria and viruses represent which type of safety hazard? a. Biological b. Chemical c. Flammable d. Physical ANS: A

Bacteria and viruses are living organisms and thus biological hazards. Chemical hazards KlS Em LaLbEleRh.aC include acids, bases, and cT arE ciS noTgB enAsN .F am zaO rdMs are substances that are likely to burn easily, such as alcohol. Physical hazards may include slippery floors or broken railings.

DIF:

Cognitive Level: 1

REF: p. 27

OBJ: 2

3. Needles and lancets are which type of safety hazard? a. Biological b. Electrical c. Physical d. Sharps ANS: D

Sharps hazards include used needles, lancets, and other sharp objects that can penetrate the skin. Bacteria and viruses are living organisms and thus biological hazards. Electrical hazards include items such as frayed or ungrounded electrical cords. Physical hazards may include slippery floors or broken railings.

DIF:

Cognitive Level: 1

REF: p. 27

OBJ: 2

4. Which of the following is the first action you should take if you have been stuck with a used

needle that has been in contact with blood? a. Flood the exposed area with water. b. Call 911. c. Report the injury to your supervisor.

d. Seek medical attention.

ANS: A

First aid of the injury is always the initial step in dealing with minor injuries. Washing the wound may also prevent infectious agents from entering it. Afterward, report the injury and fill out an incident report according to your institution’s policy.

DIF:

Cognitive Level: 1

REF: p. 29

OBJ: 5

5. Written information about a chemical, its hazards, and procedures for clean-up and first aid

are available in which of the following documents? a. Chemical label b. Safety Data Sheet (SDS) c. OSHA regulations d. NFPA diamond-shaped label ANS: B

Written information about a chemical, its hazards, and procedures for clean-up and first aid are available in the SDS, a document required by OSHA regulations for all hazardous chemicals in use in the workplace. Chemical labels and NFPA labels do not contain this information.

DIF:

Cognitive Level: 2

REF: p. 29

OBJ: 7

6. Which of the following is the first action you should take if you splash a chemical in your

eye? a. Report the incident to your supervisor b. Flush the eyes for 15 mTinEuS teTs BatAaNnKeS yeEwLaL shEsR ta. tiC onOM c. Go to the emergency department d. Clean-up the spill on the laboratory counter or floor ANS: B

Always treat the injury first. Immediately flooding the eye with water helps prevent damage to the eye that could occur during transport to an emergency department. Flush first, and then seek appropriate medical care. After receiving medical treatment, report the incident according to institutional policy.

DIF:

Cognitive Level: 3

REF: p. 31

7. What does the red area on the following label represent?

OBJ: 9

a. b. c. d.

Flammability Reactivity Health hazards Radioactivity

ANS: A

The information in the red portion always corresponds to flammability, with 4 being the most flammable and 0 being the least. The blue area contains health hazard information, the yellow area contains reactivity warnings, and the white area contains any additional relevant warning information.

DIF:

Cognitive Level: 1

REF: p. 31

OBJ: 6

8. Which type of hazard is indicated by the following label?

a. b. c. d.

Flammable Biological Reactivity Radioactive

ANS: D

This is the universal symbol for radioactivity.

DIF:

Cognitive Level: 1

REF: p. 32

OBJ: 10

9. Which term refers to a rapid, severe, life-threatening immune reaction? a. Anaphylaxis b. Allergic contact dermatitis c. Irritant contact dermatitis d. Sensitivity

ANS: A

Anaphylaxis is the most serious immune reaction, occurring rapidly and can result in death as airway may swell shut, blood pressure drop. The other listed reactions are immune reactions but are less severe than anaphylaxis.

DIF:

Cognitive Level: 1

REF: p. 36

OBJ: 13

10. A wet floor is which type of safety hazard? a. Biological b. Chemical c. Physical d. Sharps ANS: C

Physical hazards may include slippery floors or broken railings. Sharps hazards include used needles, lancets, and other sharp objects that can penetrate the skin. Bacteria and viruses are living organisms and examples of biological hazards. Chemical hazards include acids, bases, and carcinogens.

DIF:

Cognitive Level: 2

REF: p. 27

OBJ: 2

11. According to safety protocols, which of the following actions may be performed while

working in the laboratory? a. Chewing gum b. Applying lip balm c. Wearing a watch d. Wearing sandals ANS: C

It is acceptable to wear a watch that is not dangling or on a long chain. Eating, drinking, chewing gum, and applying makeup or lip balm are safety hazards, because of the chance of transferring infectious agents into your mouth. Open-toed shoes are not allowed due to the possibility of dropped tubes causing broken glass and blood spills.

DIF:

Cognitive Level: 3

REF: p. 27

OBJ: 2

12. Which of the following is an acceptable action according to safety standards? a. Add acid to water. b. Follow the chemical hygiene plan only when there is a spill. c. Use only extension cords that have a ground built into the plug. d. Ignore radioactive hazard symbols on hospital doors since all doses used on

patients are very weak.

ANS: A

Adding acid to water is the proper order; adding water to acid will generate heat and cause splashing. The chemical hygiene plan should always be followed, not just for spills. Extension cords should not be used. Radioactive hazard signs should be followed according to the institution’s policies.

DIF:

Cognitive Level: 2

REF: p. 31

13. What is the most common allergy in the healthcare field?

OBJ: 8

a. b. c. d.

Vinyl Nitrile Plastic Latex

ANS: D

Latex is one of the most common allergies in the healthcare field that is problematic since many medical materials are made from latex. Because of this vinyl and nitrile are replacing the use of latex.

DIF:

Cognitive Level: 1

REF: p. 35

OBJ: 13

14. What is the name given to the new labeling system for hazardous chemicals that was adopted

by OSHA in 2012? a. GHS b. CDC c. DOT d. NFPA ANS: A

As of June 2015 all labels on hazardous chemicals will be required to contain the new GHS— Globally Harmonized System of Classification and Labeling of Chemicals—labeling system.

The other choices are not labeling systems.

DIF:

Cognitive Level: 2

REF: p. 29

OBJ: 5

15. When operating electrical equipment, which of the following may reduce electrical hazards? a. Taping up frayed electrTicEaS l cToB rdAs NwKitS hE elL ecLtrEicRa. l tC apOeM b. Standing on antistatic mats c. Use a six outlet wall adapter for multiple plugs versus a power strip d. Wearing nitrile gloves at all times ANS: B

The buildup of static/sparks can be avoided by standing on antistatic mats when operating electrical equipment. Frayed cords should be reported and replaced. Overloading circuits with multiple plug outlets (wall adapter/strip) is not acceptable. The use of nitrile gloves protects against blood and body fluid exposure—only 100% pure rubber will protect against electrical shock.

DIF:

Cognitive Level: 2

REF: p. 32

OBJ: 11

16. Which of the factors listed determine severity of tissue damage due to electrical burns? a. Current b. Size of wall outlet c. Distance from outlet d. Weight of patient ANS: A

Four factors determine the severity of damage to produce burns: voltage, current, resistance, and frequency.

DIF:

Cognitive Level: 1

REF: p. 34

OBJ: 12

17. The “C” in the acronym RACE means a. call. b. confine. c. consult. d. confiscate.

ANS: B

The acronym RACE means: R—Rescue; A—Alarm; C—Confine; E—Extinguish.

DIF:

Cognitive Level: 1

REF: p. 33

OBJ: 12

18. Which of the following acronym/mnemonics represents proper use of a fire extinguisher? a. RACE b. CHP c. A,B,C,D,K d. PASS ANS: D

PASS represents the proper technique for use of a fire extinguisher: P—Pull pin; A—Aim at the base of the fire; S—Squeeze the handle; S—Sweep. Race is the mnemonic for how to minimize risk when a fire is present. CHP means Chemical Hygiene Plan, and A,B,C,D,K are types of fire extinguishers.

DIF:

Cognitive Level: 1

REF: p. 33

OBJ: 12

19. In the workplace, The Right to Know Law refers to a. chemical exposure. b. biohazards. c. electrical risks. d. fire hazards.

ANS: A

OSHA issued the Haz Com Standards to control the risk of exposure to dangerous chemicals in the workplace—known as the Right to Know Law. Employees are responsible for reading the SDS prior to handling chemicals.

DIF:

Cognitive Level: 1

REF: p. 29

OBJ: 5

20. Guidelines issued by the American Heart Association that initial CPR for all victims

regardless of age should include a. compressions only. b. rescue breaths only. c. compressions with rescue breaths. d. AED device.

ANS: A

CPR for all victims is chest compressions only. Rescue breathing can be used by those who are properly trained to do so.

DIF:

Cognitive Level: 1

REF: p. 34

OBJ: 13

21. The mnemonic CAB used by the American Heart Association means a. call, assist, breathe. b. check airway blockage. c. compression, airway, breathing. d. cardiac arrest (no) breathing.

ANS: C

CAB stands for compression, airway, and breathing.

DIF:

Cognitive Level: 1

REF: p. 34

OBJ: 13

Chapter 04: Infection Control Warekois et al.: Phlebotomy: Worktext and Procedures Manual, 5th Edition MULTIPLE CHOICE 1. What is the term for invasion and growth of a disease-causing microorganism in the human

body? a. Fomite b. Infection c. Pathogen d. Reservoir ANS: B

Microorganisms can cause infection if they enter the body. A fomite is a contaminated object (such as a piece of equipment). A pathogen is a disease-causing organism. A reservoir is a person who, although not sick himself, carries a pathogen and can transmit it to others.

DIF:

Cognitive Level: 1

REF: p. 40

OBJ: 1

2. What is the term for an object that is contaminated by bacteria? a. Fomite b. Host c. Portal of entry d. Reservoir ANS: A

A fomite is a contaminatedToEb S j eT ctBs A u cNh Ka S s eEqLuL ipE mR en.tCoO r sMupplies. The host is the infected individual. The portal of entry is the method by which the microorganism enters the body. A reservoir is a person who is not sick himself but carries a pathogen and can transmit it to others.

DIF:

Cognitive Level: 1

REF: p. 42

OBJ: 3

3. A reservoir is a. a contaminated piece of equipment. b. an airborne droplet. c. a person who carries a disease agent but is not sick. d. a vector.

ANS: C

A reservoir is a person who is not sick but carries a pathogen and can transmit it to others. A fomite is a contaminated object such as equipment or food. An airborne droplet can transmit microorganisms through the air. A vector is an agent such as a tick or insect that carries an infectious agent.

DIF:

Cognitive Level: 1

REF: p. 42

OBJ: 3

4. What is the term for infections contracted by patients during hospitalization? a. Healthcare-associated b. Chains of infections

c. Nontransmitted infections d. Colonization ANS: A

Healthcare-associated or Nosocomial infections are acquired by patients during hospitalization (in contrast to community-acquired infections).

DIF:

Cognitive Level: 1

REF: p. 40

OBJ: 1

5. HEPA (high-efficiency particulate air) filters can help to prevent which type of disease

transmission? a. Airborne b. Common vehicle c. Contact d. Vector ANS: A

HEPA filters are designed to prevent airborne transmission.

DIF:

Cognitive Level: 1

REF: p. 43

OBJ: 3

6. The pathogen West Nile virus is carried by mosquitoes. What type of transmission is this? a. Airborne b. Common vehicle c. Contact d. Vector ANS: D

A vector is an agent such as a tick or insect that carries an infectious agent.

DIF:

Cognitive Level: 2

REF: p. 44

OBJ: 3

7. The most frequent and important transmission route for infections contracted by hospitalized

patients is a. airborne. b. common vehicle. c. contact. d. vector.

ANS: C

Direct contact is the most frequent and important transmission route for healthcare-associated infections. Direct contact involves transfer of microorganisms from an infected or colonized person by physical contact between the source and a susceptible host.

DIF:

Cognitive Level: 1

REF: p. 43

OBJ: 3

8. The transmission route of an infection acquired by ingestion of contaminated food is a. airborne. b. common vehicle. c. contact. d. vector.

ANS: B

Common vehicle transmission involves a common source that causes multiple cases of disease. Contaminated items such as food, water, equipment, or medications are examples.

DIF:

Cognitive Level: 1

REF: p. 43

OBJ: 3

9. What is the single most important means of preventing the spread of infection? a. Wearing gloves b. Wearing a mask c. Hand washing d. Isolation of infectious patients ANS: C

While the other options are important in certain instances, the most important means of preventing the spread of infection is hand washing.

DIF:

Cognitive Level: 1

REF: p. 44

OBJ: 4

10. Which of the following acronyms/mnemonics refers to barriers used to protect skin, mucous

membranes, and clothing from infectious agents? a. CDC b. MRSA c. PPE d. VRE ANS: C

PPE stains for personal protective equipment. CDC is the Centers for Disease Control and Prevention, a government agency. MRSA and VRE are types of infections that are resistant to some antibiotics and are coTmEm soK mSeEhL eaLltE hcRa. reCsO etM tings.

SoTnBinAN DIF:

Cognitive Level: 1

REF: p. 46

OBJ: 6

11. Proper hand-washing technique includes scrubbing hands together vigorously for at least a. 5 seconds. b. 15 seconds. c. 5 minutes. d. scrubbing hands is not necessary.

ANS: B

Proper routine hand-washing technique includes scrubbing the palms and backs of hands, between fingers, and under fingernails for at least 15 seconds.

DIF:

Cognitive Level: 1

REF: p. 45

OBJ: 5

12. Respirators must be certified by which of the following agencies? a. CDC b. CLIA c. NIOSH d. OSHA ANS: C

Respirators must be certified by NIOSH—the National Institute for Occupational Safety and Health and must be fit-tested for each specific individual.

DIF:

Cognitive Level: 1

REF: p. 47

OBJ: 6

13. When donning a gown, mask, respirator, face shield, and gloves, which item should be put on

last? a. Gloves b. Gown c. Mask d. Respirator ANS: A

Gloves are the last to be put on and the first to be taken off.

DIF:

Cognitive Level: 3

REF: p. 48

OBJ: 7

14. What is the term for infection control measures that use barrier protection and work practice

controls to prevent contact with infectious body fluids from all patients? a. Hospital precautions b. Isolation precautions c. Patient precautions d. Standard precautions ANS: D

Standard precautions are the minimum level of precautions applied when coming in contact with all patients.

DIF:

Cognitive Level: 1

REF: p. 47

OBJ: 11

15. When removing PPE, what is the last thing one should do? a. Remove gloves. b. Remove mask. c. Remove gown. d. Wash hands.

ANS: D

Gloves are the last to be put on and the first to be taken off. Next, remove the gown, and then the mask. Last, wash your hands.

DIF:

Cognitive Level: 3

REF: p. 50

OBJ: 7

16. The Bloodborne Pathogens Standards require an employer to provide which of the following

immunizations? a. Hepatitis A b. Hepatitis B c. HIV d. Tetanus ANS: B

Employers are required to provide hepatitis B immunizations to all employees free of charge.

Some institutions may choose to provide or require additional immunizations.

DIF:

Cognitive Level: 1

REF: p. 51

OBJ: 8

17. According to the Bloodborne Pathogens Standards, who is responsible for providing PPE to

an employee? a. The employee b. The employer provides PPE but may deduct the cost from the employee’s paycheck. c. The employer must provide and pay for PPE. d. The patient ANS: C

The employer is required to provide PPE free of charge to the employee.

DIF:

Cognitive Level: 1

REF: p. 51

OBJ: 8

18. According to the Bloodborne Pathogen Standard rules, which specimens are considered to be

potentially infectious? a. Only specimens from patients with HIV or hepatitis B b. Specimens from patients with any known infection c. Specimens that a physician has indicated are infectious d. All blood and body fluid specimens ANS: D

According to the Bloodborne Pathogen Standard rules, all blood and body fluid specimens should be considered as potentially infectious.

DIF:

Cognitive Level: 1

REF: p. 51

OBJ: 8

19. A diluted solution of whichTE ofSthTeBfA olN loKwSinEgLcL anEbRe.uCseOdMas a disinfectant against bloodborne

pathogens on countertops and work spaces? a. Acetic acid b. Bleach c. Iodine d. Lysol ANS: B

A 10% bleach solution is used to disinfect countertops and work surfaces.

DIF:

Cognitive Level: 1

REF: p. 42

OBJ: 3

20. Which of the following is the term for separation of an infectious source from its susceptible

hosts? a. Contact precautions b. Infection c. Isolation d. Protective environment ANS: C

Isolation breaks the chain of infection by separating an infectious source from its susceptible hosts. Contact precautions and protective environments are used in specific instances.

DIF:

Cognitive Level: 1

REF: p. 52

OBJ: 12

21. In addition to standard precautions, what type of precautions should also be used for patients

with such diseases as tuberculosis and measles? a. Airborne b. Bloodborne c. Contact d. Droplet ANS: A

Measles, varicella, and tuberculosis are transmitted through the air by droplet nuclei (very small), so they require airborne precautions. Droplet precautions are used for diseases transmitted by large droplets that can be deposited on mucous membranes or conjunctivae of a susceptible host within a few feet of the patient.

DIF:

Cognitive Level: 2

REF: p. 53

OBJ: 12

22. In addition to standard precautions, what type of precautions should also be used for patients

with such diseases as herpes or wound infections? a. Airborne b. Bloodborne c. Contact d. Droplet ANS: C

Contact precautions are used for conditions that are transmitted by direct contact.

DIF:

Cognitive Level: 2

REF: p. 53

OBJ: 12

caE utSioTnB s,AwNhK atStyEpLeLoE f pRr. ecCaO utM ions should be used for patients with 23. In addition to standard preT such diseases as HIV or hepatitis B? a. Airborne b. Bloodborne c. Contact d. Droplet ANS: B

Standard bloodborne precautions will protect healthcare workers from HIV infection or hepatitis B. DIF:

Cognitive Level: 2

REF: p. 42

OBJ: 10

24. For a phlebotomist, what is the principal occupational risk for infection? a. Infection from airborne diseases in patient rooms b. Infection from droplets in the emergency department c. Infection from an accidental needle stick d. Infection from a splash from a dropped specimen tube ANS: C

Accidental needle sticks are the most common occupational injury in phlebotomists due to the nature of the work performed. Phlebotomists are not likely to encounter the other situations on a regular basis.

DIF:

Cognitive Level: 1

REF: p. 41

OBJ: 10

25. A small blood spill from a specimen you are handling occurs on a laboratory countertop.

What is the usual procedure you should use to handle the spill? a. Use a handful of paper towels and wipe up the spill, being careful not to get any on your skin. b. Ask your supervisor to find someone to clean-up the spill. c. Wearing gloves and using 10% bleach as a disinfectant, clean-up visible blood first, then disinfect the entire area of potential contamination. d. Leave the spill alone so it can dry, which will make it easier to clean-up when you get time.

ANS: C

Choice C is the proper way to clean-up the spill. Do not leave the spill for someone else to clean-up.

DIF:

Cognitive Level: 3

REF: p. 42

OBJ: 10

26. For what duration can HBV survive in dried blood? a. 1 day b. 1 week c. 2 weeks d. 1 month ANS: B

HBV can survive in dried blood for up to 1 week.

DIF:

Cognitive Level: 3

REF: p. 42

OBJ: 10

27. What is an organism that remains alive despite the use of an antibiotic considered to be? a. Susceptible b. Nosocomial c. Bloodborne d. Resistant ANS: D

If an organism remains alive despite the use of an antibiotic, it is considered to be resistant to that antibiotic. Susceptible means that the antibiotic is strong enough to kill the infectious organism. Nosocomial is a hospital acquired infection. Bloodborne is an infectious agent carried by the blood.

DIF:

Cognitive Level: 2

REF: p. 40

OBJ: 1

28. Which of the following viruses can survive in dried blood for up to 3 weeks? a. HIV b. HBV c. HCV d. WNV ANS: C

HIV and HBV can survive for up to 1 week in dried blood. HCV, hepatitis C virus can survive for up to 3 weeks in dried blood.

DIF:

Cognitive Level: 1

REF: p. 42

OBJ: 10

Chapter 05: Medical Terminology Warekois et al.: Phlebotomy: Worktext and Procedures Manual, 5th Edition MULTIPLE CHOICE 1. Which prefix means “decreased”? a. Antib. Hypoc. Hyperd. IntraANS: B

The opposite of hypo- is hyper-, which means “increased.” Anti- means “against,” and intrameans “within.”

DIF:

Cognitive Level: 1

REF: p. 60

OBJ: 1 | 2

2. What is the meaning of the root word phleb? a. Cutting b. Injecting c. Needle d. Vein ANS: D

Phleb refers to a vein.

DIF:

Cognitive Level: 1

TESTBANKSREEFL:LE p .R61. COM

OBJ: 1 | 4

3. Which of the following prefixes means “after”? a. Antib. Megac. Polyd. PostANS: D

Post- means “after.” Anti- means “against,” mega- means “large,” and poly- means “many.”

DIF:

Cognitive Level: 1

REF: p. 60

OBJ: 1 | 2

4. Which suffix means “surgical removal”? a. -ectomy b. -emia c. -itis d. -pathy ANS: A

“Surgical removal” is indicated by the suffix -ectomy. “In the blood” is the meaning of -emia, -itis means “inflammation,” and -pathy means “disease.”

DIF:

Cognitive Level: 1

REF: p. 61

OBJ: 1 | 2

5. Which suffix means “inflammation”? a. -ectomy b. -emia c. -itis d. -pathy ANS: C

“Inflammation” is indicated by the suffix -itis. “In the blood” is the meaning of -emia, -ectomy means “surgical removal,” and -pathy means “disease.”

DIF:

Cognitive Level: 1

REF: p. 61

OBJ: 1 | 2

6. Which suffix means “blood condition”? a. -ectomy b. -emia c. -itis d. -pathy ANS: B

“In the blood” is the meaning of -emia. “Surgical removal” is indicated by the suffix -ectomy, -itis means “inflammation,” and -pathy means “disease.”

DIF:

Cognitive Level: 1

REF: p. 61

OBJ: 1 | 4

7. What is the medical term for “white blood cell”? a. Cyanosis b. Erythrocyte c. Leukocyte d. Thrombocyte ANS: C

Leukocyte is the medical term for “white blood cell.” Cyanosis is a blue tinge to the skin due to the lack of oxygen. An erythrocyte is a red blood cell, and a thrombocyte is a platelet.

DIF:

Cognitive Level: 1

REF: p. 61

OBJ: 1 | 4

8. What is the plural form of the word thrombus? a. Thrombi b. Thrombitis c. Thrombuces d. Thrombuses ANS: A

Thrombi is the plural form. The -us is dropped and an -i is added to form the plural form. All the other choices are made-up terms.

DIF:

Cognitive Level: 1

9. What does the abbreviation “CA” mean? a. Cancer b. Centigrade (or Celsius) c. Chest radiograph

REF: p. 61

OBJ: 1

d. Coronary ANS: A

CA is the common abbreviation for cancer. Centigrade is a temperature scale. Coronary refers to arteries of the heart.

DIF:

Cognitive Level: 1

REF: p. 62

OBJ: 5

10. Which suffix means “disease”? a. -ectomy b. -oma c. -pathy d. -penia ANS: C

The suffix -pathy refers to disease. The suffix -ectomy is “surgical removal,” -oma refers to a tumor, and -penia is a deficiency.

DIF:

Cognitive Level: 1

REF: p. 61

OBJ: 1 | 2

11. Which root means “kidney”? a. Hepat b. Necr c. Nephr d. Pneu ANS: C

Nephr refers to the nephron of the kidney. Hepat means “liver,” necr means “death,” and pneu-means “breath.”

DIF:

Cognitive Level: 1

REF: p. 61

OBJ: 1 | 2

12. Which abbreviation means “immediately”? a. ASAP b. ER c. NPO d. STAT ANS: D

STAT means “immediately.” ASAP means as soon as possible. NPO means nothing by mouth.

ER stands for emergency room.

DIF:

Cognitive Level: 1

REF: p. 63

OBJ: 12

13. What does the abbreviation “NPO” on a patient’s door mean? a. Bedridden b. Check with the nurses’ station c. Nothing by mouth d. No personal visitors ANS: C

NPO means the patient is to have nothing by mouth.

DIF:

Cognitive Level: 1

REF: p. 63

OBJ: 5

14. What does the root word cardio mean? a. Heart b. Kidney c. Liver d. Lungs ANS: A

The root word cardio means “heart.” The root for “kidney” is nephr, the root for “liver” is hepat, and the root for “lung” is pulmon-.

DIF:

Cognitive Level: 1

REF: p. 61

OBJ: 1

15. What does the root tox mean? a. Artery b. Oxygenated c. Poison d. Protein ANS: C

Tox means “poison,” arterio means “artery,” oxy is “oxygen,” and prot is “protein.”

DIF:

Cognitive Level: 1

REF: p. 61

OBJ: 1 | 4

16. Which prefix means “black”? a. Albib. Cyanc. Melanod. RubeANS: C

Melano- means “black.” Albi- is “white,” cyan- is “blue,” and rube- is “red.”

DIF:

Cognitive Level: 1

REF: p. 60

OBJ: 1 | 2

17. Which prefix means “blue”? a. Albib. Cyanc. Melanod. RubeANS: B

Cyan- is “blue,” albi- is “white,” melano- is “black,” and rube- is “red.”

DIF:

Cognitive Level: 1

18. What prefix means “increased”? a. Dysb. Hyperc. Hypod. Neo-

REF: p. 60

OBJ: 1 | 2

ANS: B

Hyper- is “increased,” hypo- is “decreased,” dys- is “difficulty,” and neo- is “new.”

DIF:

Cognitive Level: 1

REF: p. 60

OBJ: 1 | 2

19. What does the abbreviation “PRN” mean? a. As needed (as required) b. As soon as possible c. Every night d. Private duty nurse ANS: A

PRN means “as needed” or “as required.”

DIF:

Cognitive Level: 1

REF: p. 63

OBJ: 5

20. Which prefix means “inside”? a. Ectob. Endoc. Epid. ExoANS: B

Endo- means “inside.” Ecto- and exo- both mean “outside.” Epi- means “on” or “over.”

DIF:

Cognitive Level: 1

REF: p. 60

OBJ: 1

21. From what languages do mToE stSmTeB diAcal s oLrE igR in.atCe?OM NKteSrm EL a. Italian and French b. English and Spanish c. Latin and Greek d. German and Dutch ANS: C

Most medical terms originate from Latin and Greek descent.

DIF:

Cognitive Level: 1

REF: p. 64

OBJ: 5

22. What is the plural form of the word ovum? a. Ova b. Ovums c. Ovae d. Ovi ANS: A

Multiple ovum are called ova. The “-um” is dropped and an “-a” is added.

DIF:

Cognitive Level: 2

REF: p. 61

OBJ: 1

Chapter 06: Human Anatomy and Physiology Warekois et al.: Phlebotomy: Worktext and Procedures Manual, 5th Edition MULTIPLE CHOICE 1. What are the smallest living units in the body? a. Cells b. Organs c. Systems d. Tissues ANS: A

Systems are made up of organs, which are made up of tissues, which are made up of cells.

DIF:

Cognitive Level: 1

REF: p. 71

OBJ: 1

2. The body is constantly trying to maintain a dynamic steady state of health, which is called

what? a. Balance b. Homeostasis c. Interaction d. Regulation ANS: B

This is the definition of homeostasis.

DIF:

Cognitive Level: 1

TESTBANKSREEFL:LE p .R71. COM

OBJ: 1

3. The part of the cell contains most of the DNA: a. Cytoplasm b. Mitochondria c. Nucleus d. Plasma membrane ANS: C

DNA is found in the chromosomes, which are in the nucleus of the cell.

DIF:

Cognitive Level: 1

REF: p. 71

OBJ: 2

4. What is another name for striated voluntary muscle? a. Cardiac muscle b. Skeletal muscle c. Smooth muscle d. Tissue ANS: B

Striated voluntary muscle is also known as skeletal muscle, striated involuntary muscle is cardiac muscle, and nonstriated involuntary muscle is known as smooth muscle. Tissue is a nonspecific term that could apply to any of these choices.

DIF:

Cognitive Level: 1

REF: p. 73

OBJ: 3

5. Striated involuntary muscle is also known as a. cardiac muscle. b. skeletal muscle. c. smooth muscle. d. tissue.

ANS: A

Striated involuntary muscle is also known as cardiac muscle, striated voluntary muscle is known as skeletal muscle, and nonstriated involuntary muscle is known as smooth muscle.

Tissue is a nonspecific term that could apply to any of these choices.

DIF:

Cognitive Level: 1

REF: p. 73

OBJ: 3

6. Another name for nonstriated involuntary muscle: a. Cardiac muscle b. Skeletal muscle c. Smooth muscle d. Tissue ANS: C

Nonstriated involuntary muscle is also known as smooth muscle, striated voluntary muscle is known as skeletal muscle, and striated involuntary muscle is known as cardiac muscle. Tissue is a nonspecific term that could apply to any of these choices.

DIF:

Cognitive Level: 1

REF: p. 73

OBJ: 3

7. What is a term for a nerve T ceEllS? TBANKSELLER.COM a. Axon b. Neuron c. Neurotransmitter d. Synapse ANS: B

A neuron is an excitable cell of the nervous system. It consists of an axon, cell body, and dendrites. The bulb-like structures on the ends of the axons release chemicals called neurotransmitters, which carry messages across the synapse (the space between neurons).

DIF:

Cognitive Level: 1

REF: p. 73

OBJ: 3

8. A group of organs functioning together for a common purpose: a. Anatomy b. Physiology c. System d. Tissue ANS: C

A system is made up of organs that are working together for a common purpose. An organ is made up of tissues.

DIF:

Cognitive Level: 1

REF: p. 74

OBJ: 3

9. What term describes the wrist in relation to the shoulder? a. Distal b. Proximal c. Inferior d. Superior ANS: A

Distal means “farther away” from the point of attachment; it is the opposite of proximal.

Inferior means “below,” and superior means “above.”

DIF:

Cognitive Level: 1

REF: p. 76

OBJ: 4

10. What is the term for a vertical plane dividing the body into right and left sides? a. Frontal b. Sagittal c. Transverse d. Thoracic ANS: B

A sagittal plane divides the body into left and right sides. A frontal plane divides the body into front and back halves. Transverse divides the body into top and bottom. Thoracic is not a type of plane.

DIF:

Cognitive Level: 1

REF: p. 76

OBJ: 4

11. The term for a movement that bends a joint: a. Extension b. Flexion c. Lateral d. Medial ANS: B

A movement that bends a joint is called a flexion. A movement that straightens a joint is called an extension. Lateral means “to the side,” and medial means “toward the middle.”

DIF:

Cognitive Level: 1

REF: p. 76

OBJ: 4

12. The body cavity that contains the heart and lungs: a. Abdominal b. Pelvic c. Spinal d. Thoracic ANS: D

The thoracic cavity contains the heart and lungs. The pelvic cavity contains the bladder, rectum, and reproductive organs. The spinal cavity contains the spinal cord. The abdominal cavity contains the stomach, small and large intestines, spleen, liver, gallbladder, pancreas, and kidneys.

DIF:

Cognitive Level: 1

13. The body cavity that contains the spleen:

REF: p. 76

OBJ: 5

a. b. c. d.

Abdominal Pelvic Spinal Thoracic

ANS: A

The abdominal cavity contains the stomach, small and large intestines, spleen, liver, gallbladder, pancreas, and kidneys. The thoracic cavity contains the heart and lungs. The pelvic cavity contains the bladder, rectum, and reproductive organs. The spinal cavity contains the spinal cord.

DIF:

Cognitive Level: 1

REF: p. 76

OBJ: 5

14. Which anatomic term refers to a person lying on his or her back? a. Inferior b. Superior c. Prone d. Supine ANS: D

Supine means “lying on the back”; it is the opposite of prone, which means “lying face down.” Inferior is a term that means “below”; superior means “above.”

DIF:

Cognitive Level: 1

REF: p. 76

OBJ: 4

15. Bone is formed by which cells? a. Osteoblasts b. Osteoclasts c. Lymphoblasts d. Myeloblasts ANS: A

Bone is formed by osteoblasts. Osteoclasts break down bone and release minerals.

Lymphoblasts and myeloblasts are types of immature white blood cells and are found in bone marrow.

DIF:

Cognitive Level: 1

REF: p. 76

OBJ: 6

16. Muscles attach to bones via which structures? a. Ligaments b. Tendons c. Membranes d. Cartilage ANS: B

Muscles attach to bones via tendons. Two bones are held together by ligaments. There is cartilage on the ends of bones. Membranes are the outermost part of human cells.

DIF:

Cognitive Level: 1

REF: p. 79

17. Two bones are held together by which structures? a. Ligaments

OBJ: 6

b. Tendons c. Membranes d. Cartilage ANS: A

Muscles attach to bones via tendons. Two bones are held together by ligaments. There is cartilage on the ends of bones. Membranes are the outermost part of human cells.

DIF:

Cognitive Level: 1

REF: p. 78

OBJ: 6

18. Hematopoiesis occurs in what type of tissue? a. Bone b. Muscle c. Integumentary d. Nerve ANS: A

Hematopoiesis occurs in the bone. Hematopoiesis is the formation of blood cells that occurs in the red marrow of certain bones such as the hip and sternum in adults, and additional bones in children.

DIF:

Cognitive Level: 1

REF: p. 76

OBJ: 6

19. A dermatologist treats disorders of which system? a. Integumentary b. Muscular c. Respiratory d. Nervous ANS: A

The prefix derm- refers to “skin.” Skin is part of the integumentary system.

DIF:

Cognitive Level: 1

REF: p. 81

OBJ: 6

20. The esophagus is part of which system? a. Digestive b. Endocrine c. Integumentary d. Respiratory ANS: A

The esophagus is the tube that joins the oral cavity and throat to the stomach, and thus is part of the digestive system.

DIF:

Cognitive Level: 1

REF: p. 84

OBJ: 6

21. What is the term for the entire functional structure unit of the kidney, from glomerulus

through collecting tubule? a. Alveolus b. Larynx c. Nephron d. Urethra

ANS: C

The entire functional structure of the kidney from glomerulus through collecting tubule is called a nephron. The alveolus is found in the respiratory system, the larynx is the voice box, and the urethra carries urine from the bladder to the outside of the body.

DIF:

Cognitive Level: 1

REF: p. 88

OBJ: 6

22. Food is forced through the digestive system in a series of wavelike motions as smooth

muscles contract. What is the term for this motion? a. Digestion b. Excretion c. Peristalsis d. Respiration ANS: C

Peristalsis is a series of wavelike motions that occur as smooth muscles contract to force food through the digestive tract. Digestion is the chemical process of breaking down food material.

Respiration is a term for breathing. Excretion is the elimination of wastes via the urine or feces.

DIF:

Cognitive Level: 1

REF: p. 85

OBJ: 6

23. Which of the following is the protein within red blood cells that binds oxygen? a. Albumin b. Cilia c. Hemoglobin d. Hormone ANS: C

Hemoglobin is the oxygen-binding protein found in red blood cells. Oxygen binds to the hemoglobin, forming oxyhemoglobin. Albumin is the major protein found in blood plasma.

Cilia are microscopic hairlike structures that line the respiratory tract. A hormone is a chemical substance that is released by a gland and travels to a target tissue in the body to exert an action.

DIF:

Cognitive Level: 1

REF: p. 88

OBJ: 6

24. Chemical secretions produced by the endocrine system and released into circulation: a. Enzymes b. Hemoglobin c. Hormones d. Sweat ANS: C

Endocrine glands are ductless and secrete hormones directly into the blood. A hormone is a chemical substance that is released by a gland and travels to a target tissue in the body to exert an action. Sweat is excreted by sweat glands. Exocrine glands such as these secrete to the outside surface of the body via ducts. Hemoglobin is the oxygen-binding protein found inside red blood cells. Enzymes are proteins that speed up chemical reactions.

DIF:

Cognitive Level: 1

REF: p. 89

OBJ: 6

25. Which of the following is often called the “master gland” of the endocrine system? a. Adrenal b. Pancreas c. Pituitary d. Thyroid ANS: C

The master gland is the pituitary because it secretes many hormones, some of which go to the adrenal, thyroid, testes, and ovaries, causing them to secrete other hormones.

DIF:

Cognitive Level: 1

REF: p. 91

OBJ: 6

26. What is the principal hormone produced by the testes? a. Cortisone b. Estrogen c. Progesterone d. Testosterone ANS: D

Testosterone is the principal hormone produced by the testes. Progesterone and estrogen are the principal “female” hormones. Cortisone is secreted by the adrenal cortex glands.

DIF:

Cognitive Level: 1

REF: p. 91

OBJ: 6

27. Which hormone is detected by pregnancy tests? a. Estrogen b. HCG c. Testosterone d. Thyroxin ANS: B

The hormone detected by pregnancy tests is HCG (human chorionic gonadotropin), which is secreted at first by the developing embryo and later by the placenta.

DIF:

Cognitive Level: 1

REF: pp. 93-94

OBJ: 6

28. What position is being described when the body is erect and facing forward and the arms are

at the side with the palms facing forward? a. Supine position b. Anatomic position c. Physiologic position d. Standing position ANS: B

The body is erect and facing forward, and the arms are at the side with the palms facing forward is the definition of the Anatomic position.

DIF:

Cognitive Level: 1

REF: p. 75

29. What body system is responsible for thermoregulation? a. Integumentary

OBJ: 4

b. Cardiovascular c. Muscular d. Digestive ANS: A

Thermoregulation, or regulating the temperature of the body, is the responsibility of the integumentary system. The rest of the choices are body systems but they have different responsibilities and functions.

DIF: Cognitive Level: 2

REF: p. 80

OBJ: 6

Chapter 07: Circulatory, Lymphatic, and Immune Systems Warekois et al.: Phlebotomy: Worktext and Procedures Manual, 5th Edition MULTIPLE CHOICE 1. Which muscle contracts to push blood through the circulatory system? a. Biceps brachii b. Endometrium c. Myocardium d. Triceps brachii ANS: C

The myocardium is cardiac muscle in the heart that contracts to push blood through the circulatory system. The endometrium is the lining of the uterus. The biceps brachii and triceps brachii are both muscles of the upper arm.

DIF:

Cognitive Level: 1

REF: p. 101

OBJ: 1

2. The pulmonary circulation carries blood between which two organs? a. Heart and lungs b. Heart and all other body tissues c. Lungs and brain d. Lungs and all other body tissues ANS: A

The pulmonary circulation carries blood between the heart and lungs. When blood leaves the lungs, it returns to the hearTt E toSbT eB puAmNpKeS dE ouLtLtoEoRth.eC rO t i sMs u es .

DIF:

Cognitive Level: 1

REF: p. 101

OBJ: 1

3. Structures that carry blood away from the heart: a. Arteries b. Bronchioles c. Capillaries d. Veins ANS: A

Arteries carry blood away from the heart. Veins carry blood to the heart. The arteries and veins are joined via the capillaries. Bronchioles are structures in the lungs.

DIF:

Cognitive Level: 1

REF: p. 101

OBJ: 1

4. Structures that return blood to the heart: a. Arteries b. Bronchioles c. Capillaries d. Veins ANS: D

Veins carry blood to the heart. Arteries carry blood away from the heart. The arteries and veins are joined via the capillaries. Bronchioles are structures in the lungs.

DIF:

Cognitive Level: 1

REF: p. 101

OBJ: 1

5. The thin membranous sac that surrounds the heart: a. Endocardium b. Epicardium c. Myocardium d. Pericardium ANS: D

The thin membranous sac that surrounds the heart is the pericardium. The outermost layer of the heart is the epicardium. The middle layer of the heart is the myocardium. The innermost layer of the heart is the endocardium.

DIF:

Cognitive Level: 1

REF: p. 101

OBJ: 1

6. Instrument used to measure blood pressure: a. Pressometer b. Spectrophotometer c. Sphygmomanometer d. Thermometer ANS: C

A sphygmomanometer is used to measure blood pressure. A thermometer measures temperature. A spectrophotometer is a laboratory instrument that measures light. Pressometer is a made-up term.

DIF:

Cognitive Level: 1

p .R10.4COM TESTBANKSREEFL:LE

OBJ: 1

7. Sounds that are normally heard when listening to the heart through a stethoscope: a. Contraction of the heart muscle b. Closing of the heart valves c. Blood flowing through blood vessels d. The heart does not make any noise ANS: B

The sounds that are heard when listening to the heart through a stethoscope are associated with the closing of the heart valves.

DIF:

Cognitive Level: 1

REF: p. 104

OBJ: 1

8. What is the medical term for “heart attack”? a. Angina b. Ischemia c. Myocardial infarction d. Pericarditis ANS: C

The medical term for “heart attack” is myocardial infarction. Pericarditis is an inflammation of the sac surrounding the heart. Angina is chest pain due to a lack of oxygen in the heart muscle. Ischemia is an inadequate blood supply to the heart muscle.

DIF:

Cognitive Level: 1

REF: p. 104

OBJ: 2

9. The medical term for a reduced blood supply to heart tissue, thereby causing damage to the

heart muscle: a. Angina b. Ischemia c. Infarction d. Pericarditis ANS: B

Ischemia is a reduced blood supply to an area of the heart, thereby causing damage to the heart muscle. The medical term for “heart attack” is myocardial infarction. Pericarditis is an inflammation of the sac surrounding the heart. Angina is chest pain due to a lack of oxygen to the heart.

DIF:

Cognitive Level: 1

REF: p. 104

OBJ: 2

10. Which of the following is the major artery leaving the heart that takes oxygenated blood to

body tissues? a. Aorta b. Coronary artery c. Carotid artery d. Vena cava ANS: A

The aorta is the major artery leaving the heart to deliver oxygenated blood to body tissues.

The coronary arteries supply the heart muscle with blood, and the carotid artery supplies the head. The vena cava is theTmEaS joT rB veAinNtK haStEreLtuLrE nsRb.loCoO dMto the heart.

DIF:

Cognitive Level: 1

REF: p. 102

OBJ: 1

11. Blood returning to the heart from the lungs enters which chamber? a. Right atrium b. Left atrium c. Right ventricle d. Left ventricle ANS: B

Only blood returning to the heart from the lungs enters the left atrium. Blood returning from the rest of the body enters the right atrium. The ventricles receive their blood from their respective atria.

DIF:

Cognitive Level: 1

REF: p. 102

OBJ: 1

12. Blood returning to the heart from the various tissues of the body enters which chamber? a. Right atrium b. Left atrium c. Right ventricle d. Left ventricle ANS: A

Blood returning from the various body tissues enters the right atrium. Only blood returning to the heart from the lungs enters the left atrium. The ventricles receive their blood from their respective atria.

DIF:

Cognitive Level: 1

REF: p. 102

OBJ: 1

13. Where does blood go immediately after it leaves the right ventricle? a. Left atrium b. Left ventricle c. Lungs d. Rest of the body ANS: C

Blood leaving the right ventricle goes to the lungs. Blood leaving the left ventricle goes to the rest of the body via the aorta.

DIF:

Cognitive Level: 1

REF: p. 102

OBJ: 1

14. Where does blood go immediately after it leaves the left atrium? a. Right atrium b. Left ventricle c. Lungs d. Rest of the body ANS: B

When blood leaves the left atrium, it travels through the bicuspid (mitral) valve into the left ventricle. When blood leaves the right atrium, it travels through the tricuspid valve into the left ventricle.

DIF:

Cognitive Level: 1

REF: p. 102

OBJ: 1

15. Which blood vessels are the smallest, consisting of only a single layer of epithelial cells? a. Arteries b. Bronchioles c. Capillaries d. Veins ANS: C

Capillaries are the smallest blood vessels, consisting of only a single layer of epithelial cells.

Veins and arteries are larger and appear in various sizes. Bronchioles are not blood vessels.

DIF:

Cognitive Level: 1

REF: p. 104

OBJ: 2

16. What is the medical term for a bulge in an artery caused by a weakening of the wall? a. Aneurysm b. Arteriosclerosis c. Hemorrhoids d. Varicose veins ANS: A

The medical term for a bulge in an artery caused by a weakening of the artery’s wall is aneurysm. Hemorrhoids are prolapses of the anal cushions and, therefore, a condition of veins.

Arteriosclerosis is thickening and loss of elasticity of an artery wall.

DIF: Cognitive Level: 1 OBJ: 5

REF: p. 106|Table 7.1

17. CK-MB, myoglobin, and troponin are all measured in tests that can be used to diagnose a. congestive heart failure b. liver disease c. myocardial infarction d. stroke ANS: C

These tests are used to diagnose a heart attack, which is also known as a myocardial infarction.

DIF: Cognitive Level: 1 OBJ: 2

REF: p. 105|Box 7.1

18. The cephalic, basilic, and median cubital veins are all located in the a. antecubital fossa of the arm. b. anterior surface of the hand. c. capillary beds of the hand. d. radial surface of the wrist.

ANS: A

The cephalic, basilic, and m ubNitK alSvEeiLnL sE arR e. alC l lOo M c a t e d in the antecubital fossa of the TeEdSiaTnBcA arm. These are the veins most often used for venipuncture.

DIF:

Cognitive Level: 1

REF: p. 106

OBJ: 2

19. Plasma makes up approximately what percentage of whole blood in a healthy person? a. 10% b. 25% c. 55% d. 90% ANS: C

In a healthy person, plasma makes up about 55% of whole blood, and solid elements make up the other 45%.

DIF:

Cognitive Level: 1

REF: p. 107

OBJ: 6

20. How much water is found in plasma? a. 10% b. 25% c. 55% d. 90% ANS: D

Plasma is the liquid part of whole blood. About 90% of plasma is water.

DIF:

Cognitive Level: 1

REF: p. 107

OBJ: 6

21. What substance is produced when blood is collected in a tube, allowed to clot, and then

centrifuged? a. Antibodies b. Platelets c. Plasma d. Serum ANS: D

Serum is produced when blood is collected in a tube, allowed to clot, and then centrifuged.

Plasma is the liquid produced when anticoagulated whole blood is centrifuged.

DIF:

Cognitive Level: 1

REF: p. 108

OBJ: 6

22. Blood cells are formed in the bone marrow from the divisions of what long-lived progenitor

cells? a. Granulocytes b. Neutrophils c. Phagocytes d. Stem cells ANS: D

Stem cells are the progenitor cells of all the other cell types.

DIF:

Cognitive Level: 1

REF: p. 109

OBJ: 7

23. Another term for white blood cells (WBCs): a. Erythrocytes b. Leukocytes c. Thrombocytes d. Reticulocytes ANS: B

WBCs are also called leukocytes. Erythrocytes are red blood cells (RBCs), thrombocytes are platelets, and reticulocytes are immature RBCs. DIF:

Cognitive Level: 1

REF: p. 109

OBJ: 7

24. Another term for red blood cells (RBCs): a. Erythrocytes b. Leukocytes c. Thrombocytes d. Reticulocytes ANS: A

RBCs are also called erythrocytes. Leukocytes are WBCs, thrombocytes are platelets, and reticulocytes are immature RBCs. DIF:

Cognitive Level: 1

REF: p. 109

OBJ: 7

25. The formed elements constitute what portion of the blood volume? a. 5% b. 45% c. 75% d. 99% ANS: B

The formed elements constitute about 45% of the blood volume, and the plasma makes up the other 55%.

DIF:

Cognitive Level: 1

REF: p. 109

OBJ: 7

26. Cells that attack and digest bacteria and are found in increased numbers in the presence of

bacterial infection: a. Erythrocytes b. Lymphocytes c. Monocytes d. Neutrophils ANS: D

Neutrophils attack and digest bacteria; their numbers are increased in bacterial infections.

Lymphocytes produce antibodies and are often increased in viral infections. Monocytes are another type of WBC. Erythrocytes are RBCs and carry oxygen.

DIF:

Cognitive Level: 1

REF: p. 109

OBJ: 7

27. Cells that produce antibodies and are often found in increased numbers in the presence of viral

infection: a. Erythrocytes b. Lymphocytes c. Monocytes d. Neutrophils ANS: B

Lymphocytes produce antibodies and are often increased in viral infections. Monocytes are another type of WBC. Erythrocytes are RBCs and carry oxygen. Neutrophils attack and digest bacteria and are usually increased in bacterial infections.

DIF:

Cognitive Level: 1

REF: p. 110

OBJ: 7

28. Formed elements of the blood that play a role in blood coagulation: a. Erythrocytes b. Leukocytes c. Platelets d. Reticulocytes ANS: C

Platelets function in blood coagulation. Erythrocytes carry oxygen. Reticulocytes are immature RBCs. Leukocytes function as part of the immune system.

DIF:

Cognitive Level: 1

REF: p. 110

OBJ: 7

29. The process by which blood vessels repair after injury: a. Autoimmunity b. Hemostasis c. Inflammation d. Thrombophlebitis ANS: B

Hemostasis is the process by which blood vessels repair after injury. Autoimmunity and inflammation are immune processes. Thrombophlebitis is inflammation of a blood vessel related to a blood clot, or thrombus.

DIF:

Cognitive Level: 1

REF: p. 110

OBJ: 8

30. The enzyme that breaks down the fibrin in clots: a. Amylase b. Pepsin c. Plasmin d. Trypsin ANS: C

Plasmin is formed from plasminogen whenever a clot needs to be dissolved. Amylase breaks down starch. Pepsin and trypsin both digest proteins.

DIF:

Cognitive Level: 1

REF: p. 111

OBJ: 8

31. Which of the following is an inherited disease that causes decreased blood clotting? a. Anemia b. Hemophilia c. Leukemia d. Thrombocytopenia ANS: B

Hemophilia is an inherited disease of blood coagulation. Anemia is a lower than normal amount of RBCs and hemoglobin. Leukemia is a malignant disease of WBCs. Thrombocytopenia is a lower than normal number of platelets.

DIF:

Cognitive Level: 1

REF: p. 112

OBJ: 9

32. The term for an increase in the total number of RBCs: a. Anemia b. Leukemia c. Polycythemia d. Thalassemia ANS: C

An increase in RBCs is known as polycythemia. Anemia has decreased RBCs and hemoglobin. Leukemia is a malignant disease of WBCs. Thalassemia is a disorder of hemoglobin synthesis.

DIF:

Cognitive Level: 1

REF: p. 112

OBJ: 9

33. In what condition will one find an increased number of lymphocytes, in response to infection

with the Epstein–Barr virus? a. Hemophilia b. Mononucleosis c. Leukemia d. Thalassemia ANS: B

Infectious mononucleosis is a condition in which an increased number of lymphocytes are present, in response to infection with the Epstein–Barr virus. Hemophilia is an inherited disease of blood coagulation. Leukemia is a malignant disease of WBCs. Thalassemia is a disorder of hemoglobin synthesis.

DIF:

Cognitive Level: 1

REF: p. 113

OBJ: 9

34. What cells are infected and destroyed in HIV infection? a. Antigens b. Helper T cells c. Human leukocyte antigens d. Plasma cells ANS: B

Helper T cells are destroyed in HIV infection when the newly formed viruses emerge from those cells.

DIF:

Cognitive Level: 1

REF: p. 115

OBJ: 9

ssSelTs,BaA loNnK gS wE ithLL asE soRc. iaC teO dM organs, are all part of what system?

35. Lymph nodes, fluids, and vTeE a. Circulatory b. Immune c. Lymphatic d. Respiratory ANS: C

These are all part of the lymphatic system, which functions to absorb lipids from digestion and to return fluid from tissues to the blood, and which is an integral part of immune function.

DIF:

Cognitive Level: 1

REF: p. 113

OBJ: 12

36. The term for the accumulation of interstitial fluid in tissues due to a blocked lymphatic vessel: a. Lymphadenoma b. Lymphedema c. Lymphocytes d. Lymphoma ANS: B

Lymphedema is an accumulation of fluid in the tissues due to lymphatic vessel blockage.

Lymphomas, occasionally called lymphadenomas, are malignancies of lymphoid tissue.

Lymphocytes are a type of WBC. DIF:

Cognitive Level: 1

REF: p. 114

OBJ: 12

37. The term for an attack by the immune system on the body’s own tissues: a. Allergy b. Autoimmunity c. Immunity d. Immune deficiency ANS: B

The prefix auto- means “self,” so autoimmunity is the body’s immune system reaction against itself. Allergy is an overreaction of the immune system to a normal harmless substance.

Immunity is the body’s means of protecting itself from foreign invaders. In immune deficiency, the immune system does not function properly.

DIF:

Cognitive Level: 1

REF: p. 115

OBJ: 13

38. A blood specimen collected in a gold top tube will produce which of the following after

centrifuging? a. Plasma b. Whole blood c. Serum d. Anticoagulated blood ANS: C

A gold top tube has thixotropic gel as the additive which is not an anticoagulant. A tube with no anticoagulant will allow the blood to clot and thus result in a serum specimen after centrifuging. Plasma would result from a tube with an anticoagulant such as a lavender tube with EDTA additive. Whole blood is blood that has not been separated or centrifuged.

Anticoagulated blood is blood mixed with an anticoagulant and would also result in plasma.

DIF:

Cognitive Level: 2

REF: p. 108

OBJ: 6

39. What is the first stage of hemostasis? a. Coagulation b. Vascular spasm c. Vasodilation d. Fibrinolysis ANS: B

The first stage of hemostasis is vascular spasm which is the blood vessel constricting to slow the loss of blood. Coagulation and fibrinolysis are stages of hemostasis but not the first stages.

Vasodilation is not a stage of hemostasis.

DIF:

Cognitive Level: 2

REF: p. 111

40. Specific immunity involves molecular recognition of a. antigens. b. antibodies. c. haptens. d. CD4 receptors.

ANS: A

OBJ: 8

Antigens are on the surface of foreign substances. Recognition of antigens triggers activation of T and B cells. Antibodies are produced by B cells in response to antigens. Haptens are too small to elicit and immune response unless attached to a larger protein molecule such as an RBC. CD4 receptors are sites on T-lymphocytes for which HIV has an affinity.

DIF:

Cognitive Level: 1

REF: p. 115

OBJ: 13

41. Which of the following is a nonspecific immune response? a. Production of antibodies b. Inflammation c. Activation of T-cells d. Production of memory cells ANS: B

Inflammation is a coordinated, nonspecific defense against irritation or infection. The production of antibodies, activation of T-cells and production of memory cells are all related to specific immunity.

DIF:

Cognitive Level: 2

REF: p. 115

OBJ: 13

42. Antigens identified to determine organ transplant compatibility: a. CD4 b. HLA c. Interleukins d. PMN ANS: B

Human leukocyte antigensTaE reSiT deBnA tifNieKdSinEaLtLisE suRe.tyCpOinMg lab and are used to determine if a donor organ is compatible with the recipient. CD4 antigens are present on T-helper cells.

PMN is a polymorphonuclear cell, a type of WBC. Interleukin is a type of cytokine.

DIF:

Cognitive Level: 1

REF: p. 115

OBJ: 13

43. A nonspecific defense against infectious agents: a. Intact skin b. B-cells c. T-cells d. Interferon ANS: A

Intact skin is a nonspecific physical barrier that serves as a defense against infectious agents gaining entry into the body. B and T-cells are specific immunity cells. Interferon is a specific immunity chemical messenger.

DIF:

Cognitive Level: 1

REF: p. 115

OBJ: 13

Chapter 08: Venipuncture Equipment Warekois et al.: Phlebotomy: Worktext and Procedures Manual, 5th Edition MULTIPLE CHOICE 1. A substance used to clean surfaces other than living tissue: a. Antiseptic b. Bacteriostatic c. Disinfectant d. Sepsis ANS: C

A disinfectant is an agent used to clean a surface other than living tissue. Sepsis is another word for infection. An antiseptic is an agent used to clean living tissue. A bacteriostatic substance inhibits the growth of bacteria without killing them.

DIF:

Cognitive Level: 1

REF: p. 122

OBJ: 3

2. Which of the following is the most commonly used antiseptic for routine blood draws? a. Betadine b. Bleach c. Isopropyl alcohol d. Zephiran chloride ANS: C

Betadine, isopropyl alcohol, and Zephiran chloride are all antiseptics, but isopropyl alcohol is .sC. ODMi l u t e d bleach is used to clean the one most commonly usTedES foT rB roA utNinKeSbE loL odLE drR aw countertops.

DIF:

Cognitive Level: 1

REF: p. 122

OBJ: 3

3. Which of the following actions is the first that should be taken immediately after withdrawing

the needle from the patient? a. Apply pressure to the puncture site. b. Place an adhesive bandage on the puncture site. c. Take off the tourniquet. d. Wash your hands.

ANS: A

Pressure must be applied immediately. The tourniquet should have been removed sometime before withdrawing the needle. After the bleeding stops, an adhesive bandage can be applied if needed (except in the case of a small child, who may put a bandage in his or her mouth and choke on it). The last step before leaving the room is to wash your hands.

DIF:

Cognitive Level: 2

REF: p. 122

OBJ: 3

4. Which needle gauge is most commonly used for routine venipunctures? a. 16 b. 18 c. 21

d. 26 ANS: C

Gauges between 20 and 22 are normally used for venipuncture. Sometimes a 23-gauge needle is used for very small or fragile veins. A 26-gauge needle is used on tuberculin syringes for procedures such as TB tests. A 16-gauge needle is commonly used for drawing blood donations.

DIF:

Cognitive Level: 1

REF: p. 123

OBJ: 5

5. The term for the hollow tube inside a needle’s shaft: a. Bevel b. Gauge c. Hub d. Lumen ANS: D

The interior of the tube in the needle’s shaft is known as the lumen. The hub is where a needle attaches to a syringe or other collection device. The gauge refers to the diameter. The bevel is the slanted point of the tip.

DIF:

Cognitive Level: 1

REF: p. 123

OBJ: 4

6. The part of a needle that attaches to the collecting tube or syringe: a. Bevel b. Gauge c. Hub d. Lumen ANS: C

The hub is where the needle attaches to a syringe or other collection device. The interior tube is the lumen. The gauge refers to the diameter. The bevel is the slanted point of the tip.

DIF:

Cognitive Level: 1

REF: p. 123

OBJ: 4

7. What does the term multisample needle mean? a. The needle can be used more than once on different patients. b. The needle can be used more than once, as long as it is on the same patient. c. The needle has a retractable rubber sleeve that covers one end of the needle when a

blood collecting tube is not attached. d. The needle can be left in place in a vein to use in future collections.

ANS: C

A needle should never be used more than once on the same patient, nor should the same needle ever be used on different patients. A multisample needle allows multiple vacuum tubes to be attached successively to the needle. The needle has a retractable rubber sleeve that covers one end of the needle when a blood collecting tube is not attached.

DIF:

Cognitive Level: 1

REF: p. 124

OBJ: 6

8. Which of the following is the most common gauge of butterfly needle? a. 16

b. 18 c. 23 d. 26 ANS: C

Butterfly needles (23 gauge) are smaller than routine venipuncture needles (20–22 gauge) but not as small as tuberculin syringe needles (26 gauge).

DIF:

Cognitive Level: 1

REF: p. 124

OBJ: 7

9. The anticoagulant EDTA works by binding which substance needed for blood clotting? a. Calcium b. Iron c. Magnesium d. Potassium ANS: A

Calcium is the only one of these choices that is required for blood clotting. EDTA binds the calcium and prevents it from being used to form a clot.

DIF:

Cognitive Level: 1

REF: p. 126

OBJ: 10

10. Which anticoagulant is used for coagulation studies? a. EDTA b. Heparin c. SPS d. Sodium citrate ANS: D

Sodium citrate is used for coagulation studies. Heparin is used for blood gases and some chemistry tests. EDTA is used for complete blood counts (CBCs). SPS is used for blood cultures.

DIF:

Cognitive Level: 1

REF: p. 127

OBJ: 10

11. Which anticoagulant is used for blood gas determinations? a. EDTA b. Heparin c. SPS d. Sodium citrate ANS: B

Heparin is used for blood gases and some chemistry tests. Sodium citrate is used for coagulation studies. EDTA is used for CBCs in the hematology department. SPS is used for blood cultures.

DIF:

Cognitive Level: 1

REF: p. 127

12. What color tube should be collected for a CBC? a. Green b. Lavender c. Light blue

OBJ: 10

d. Red ANS: B

EDTA is used for CBCs. EDTA is in the lavender tube. The green tube contains heparin, the light blue tube contains sodium citrate, and the red tube contains no additives.

DIF:

Cognitive Level: 1

REF: p. 129

OBJ: 11

13. A tube containing thixotropic gel could be used to collect blood for which of the following

tests? a. CBC b. Coagulation testing c. Chemistry screen d. Blood cultures ANS: C

The gel separator tube, when centrifuged, leaves serum on the top, which is used for most chemistry tests. All the other tests listed require anticoagulated blood.

DIF:

Cognitive Level: 1

REF: p. 127

OBJ: 10

14. What color tube should be collected for coagulation studies? a. Green b. Lavender c. Light blue d. Red ANS: C

Citrate is used for coagulation studies. Citrate tubes are light blue. EDTA is used for CBCs. EDTA is in the lavender tube. The green tube contains heparin, and the red tube contains no additives.

DIF:

Cognitive Level: 1

REF: p. 128

OBJ: 11

15. Which of the following tubes should be drawn first? a. Green b. Lavender c. Light blue d. Red ANS: C

Tubes for coagulation tests (light blue) are drawn first (unless blood cultures [yellow] have been ordered, which would then be first). This is followed by plain tubes (red) and then by other anticoagulant tubes.

DIF:

Cognitive Level: 3

REF: p. 131

16. Which of the following tubes should be drawn first? a. Green b. Lavender c. Gray d. Red

OBJ: 12

ANS: D

Tubes for coagulation tests (light blue) are drawn first, unless there are blood cultures (yellow) ordered, which would then be first. These are followed by plain tubes (red) and then by other anticoagulant tubes.

DIF:

Cognitive Level: 3

REF: p. 131

OBJ: 12

17. Which of the following tubes should be drawn first? a. Blood culture tubes b. Lavender c. Light blue d. Red ANS: A

Tubes for blood cultures, if ordered, are drawn before any others. Coagulation tests are drawn next, then plain tubes, and finally other anticoagulant tubes.

DIF:

Cognitive Level: 3

REF: p. 131

OBJ: 12

18. Which of the following is the only tube that does not need to be inverted to mix after

drawing? a. Green b. Lavender c. Red glass d. Red plastic ANS: C

Red glass tubes are the only ones that contain no additives and do not need to be mixed.

DIF:

Cognitive Level: 2

REF: p. 131

OBJ: 12

19. For maximum effectiveness, an antiseptic should be left in contact with the skin for how long? a. 5–15 seconds b. 15–30 seconds c. 30–60 seconds d. 2 minutes ANS: C

For maximum effectiveness, an antiseptic should be left in contact with the skin for 30–60 seconds so the alcohol can penetrate the cell wall of the microorganism preventing it replicating.

DIF:

Cognitive Level: 1

REF: p. 122

OBJ: 3

20. What color vacuum tube should be drawn for trace metal analysis? a. Pink b. Red c. Royal blue d. Yellow ANS: C

Royal blue tubes are used for toxicology, trace metals, and nutritional analysis. Yellow tubes are used for blood cultures. Red tubes are used for chemistry, serology, and some blood bank studies. Pink tubes are used by the blood bank.

DIF:

Cognitive Level: 1

REF: p. 130

OBJ: 11

21. Shaking a tube rather than gently inverting it can have what effect on the blood? a. Hemolysis b. Hemoconcentration c. Hemostasis d. Hematoma ANS: A

Shaking a tube can cause damage and rupturing of the blood cells which is called hemolysis.

Tubes should be gently inverted to mix the blood with the additive and to prevent hemolysis.

Hemoconcentration is caused by a tight tourniquet. Hemostasis is the repair of a blood vessel after injury. Hematoma is a collection of blood under the skin due to inadequate pressure after removal of the needle.

DIF:

Cognitive Level: 2

REF: p. 127

OBJ: 10

22. Completely filling a light blue tube will maintain what ratio? a. 6 parts blood and 4 parts sodium citrate b. 9 parts blood and 1 part sodium citrate c. 4 parts blood and 6 parts sodium citrate d. 1 part blood and 9 parts sodium citrate ANS: B

When the light blue tube is filled to capacity it will result in 9 parts blood and 1 part additive which is sodium citrate.

DIF:

Cognitive Level: 3

REF: p. 128

OBJ: 11

23. What is the appropriate equipment selection when performing venipuncture on fragile, easy to

collapse veins? a. Multisample needle b. Winged infusion set c. Retractable lancet d. Needle and syringe set-up ANS: D

When veins are fragile and known to collapse easily a needle and syringe set-up would be the choice selection because the pull of the blood and the pressure in the vein can be controlled by the manual pulling of the plunger. A multisample needle and winged infusion set use vacutainer tubes which have automatic pull and increased pressure in the vein thus making it more likely to collapse. A retractable lancet would not be appropriate use for venipuncture.

DIF:

Cognitive Level: 3

REF: p. 124

OBJ: 6

24. Placement of the phlebotomy tray in a patient’s room a. does not matter as long as it is within reach. b. should be on a solid surface away from patient’s personal effects.

c. can be placed at the end of the patient’s bed. d. should be on the overbed table for easy access.

ANS: B

The phlebotomist’s tray should be placed on a flat, solid surface such as a chair or a vacant mayo tray to prevent contamination of the bottom/sides of the tray by patient’s personal effects. It should not be placed on the patient’s bedside table, overbed table, or on the bed.

Contaminants could be carried into other patient’s room.

DIF:

Cognitive Level: 2

REF: p. 121

OBJ: 1

25. The procedure for the proper disposal of used needles includes a. recapping the needle prior to disposal. b. removing needle from tube holder then discard. c. discarding safety needles/collection device as intact unit. d. engaging safety device and remove from collection unit.

ANS: C

The safety needle should be engaged and discarded as an intact unit with the collection device.

Needles should never be recapped, bent, or removed from the collection unit.

DIF:

Cognitive Level: 2

REF: p. 125

OBJ: 4

26. Selection of equipment for venipuncture depends on all of the following except a. age of patient. b. maximum volume of blood required. c. size of vein. d. condition of vein.

ANS: B

Determining which venipuncture to use depends on patient’s age, condition and size of vein, as well as minimum blood volume required to perform tests—not maximum. These factors influence needle gauge, evacuated tube system, syringe, or butterfly device, and tube size.

DIF:

Cognitive Level: 3

REF: p. 126

OBJ: 6

27. Underfilled sodium citrate tubes a. don’t affect test results as long as minimum sample volume met. b. require minimum 2 ml blood volume. c. will result in erroneous testing errors due to excess anticoagulant. d. will cause microclot formation of the sample.

ANS: C

When the required 9:1 ratio of blood to anticoagulant is incorrect—too much anticoagulant to blood—erroneous test results will occur. Microclots occur if tubes are overfilled.

DIF:

Cognitive Level: 3

REF: p. 127

OBJ: 10

Chapter 09: Routine Venipuncture Warekois et al.: Phlebotomy: Worktext and Procedures Manual, 5th Edition MULTIPLE CHOICE 1. Before drawing blood in an inpatient setting, information found on the requisition form should

be matched against which of the following? a. Information on the door of the patient’s room b. The patient’s chart c. The patient’s wristband d. Information obtained from the nurse ANS: C

Information on the requisition form and the patient’s wristband must match exactly.

DIF:

Cognitive Level: 1

REF: p. 137

OBJ: 1

2. What is the single most important step of the blood collection procedure? a. Selection of the proper tubes b. Appropriate vein selection c. Patient identification d. Application of the tourniquet ANS: C

Identification of the patient is the most important step. If the wrong patient’s blood is collected, none of the results will be valid, no matter how good the technique was.

DIF:

Cognitive Level: 1

REF: p. 139

OBJ: 3

3. At what angle should the venipuncture needle be inserted? a. 15–30 degrees b. 30–45 degrees c. 45–60 degrees d. 60–75 degrees ANS: A

Angles greater than 15–30 degrees are too steep and can result in the needle going through the back wall of the vein.

DIF:

Cognitive Level: 1

REF: p. 147

OBJ: 10

4. In which of the following choices are the steps in the correct order? a. Identify patient, select equipment, collect specimen, stop bleeding, label tubes. b. Select equipment, identify patient, label tubes, collect specimen, stop bleeding. c. Label tubes, select equipment, collect specimen, identify patient, stop bleeding,

label tubes. d. Lay out equipment, label tubes, identify patient, collect specimen, stop bleeding.

ANS: A

The patient should always be identified before beginning the procedure. Equipment is selected once the vein has been assessed and selected. Tubes should never be labeled prior to collecting the blood. Patient bleeding must be attended to immediately after withdrawing the needle.

DIF:

Cognitive Level: 2

REF: p. 142

OBJ: 2

5. If the number on the requisition does not match the arm band, what should you do? a. Collect the blood and then clear up the discrepancy with the patient’s nurse. b. Return to the laboratory and tell your supervisor. c. Ask the patient to state his name, and, if it matches the requisition, draw the blood. d. Contact the patient’s nurse to attach a proper ID wristband to the patient.

ANS: D

Do not draw the blood until the patient has an attached ID bracelet that agrees with the requisition.

DIF:

Cognitive Level: 3

REF: p. 139

OBJ: 3

6. If a blood test requires a fasting specimen, what is the best way to verify that the patient is

fasting? a. Assume the patient is fasting. b. Ask the ward clerk whether the patient is fasting. c. Ask the nurse if the patient ate breakfast. d. Ask the patient when the last time was that he had anything to eat or drink.

ANS: D

Asking patients when the laTsE t tSim eyEhRa. d Ca nOyMt h i n g to eat or drink is better than TeBwAaNsKthSaEt tLhL asking whether they are fasting. A patient may not understand your question but will say yes to be agreeable.

DIF:

Cognitive Level: 3

REF: p. 142

OBJ: 5

7. When you tell a patient that you need to draw blood, he says that he does not want to have his

blood drawn. What is the appropriate action? a. Explain the procedure and ask the patient if he will consent. b. Tell the patient the doctor ordered it, so he must have it collected. c. Call for help to restrain the patient, so you can get the specimen. d. Keep trying to convince the patient to have his blood drawn.

ANS: A

Patients must give consent to draw their blood. Drawing without their consent could lead to assault charges.

DIF:

Cognitive Level: 3

REF: p. 142

OBJ: 5

8. How far from the puncture site should the tourniquet be placed? a. 1–2 inches below the puncture site b. 1–2 inches above the puncture site c. 3–4 inches above the puncture site d. 5–6 inches above the puncture site

ANS: C

A tourniquet is normally placed 3–4 inches above the collection site.

DIF:

Cognitive Level: 1

REF: p. 143

OBJ: 7

9. What is the term for an increase in the ratio of formed elements to plasma? a. Hematoma b. Hemoconcentration c. Hemolysis d. Petechiae ANS: B

When there is an increase in the amount of formed elements of the blood in relation to the plasma, the blood is more concentrated than normal. This can be caused by a tourniquet that is too tight.

DIF:

Cognitive Level: 1

REF: p. 143

OBJ: 7

10. What is the term for the small red spots on the skin that are caused by a tightly tied

tourniquet? a. Hematoma b. Hemoconcentration c. Hemolysis d. Petechiae ANS: D

The small red spots are called petechiae and are a result of capillary stress if the tourniquet is left on too long.

DIF:

Cognitive Level: 1

REF: p. 144

OBJ: 7

11. What is the term for destruction of red blood cells due to a tightly tied tourniquet? a. Hematoma b. Hemoconcentration c. Hemolysis d. Petechiae ANS: C

Destruction of red blood cells is called hemolysis and can result if tourniquet is too tight or left on too long. Petechiae are small red spots on the skin. Hemoconcentration is an increase in the ratio of formed elements to plasma. A hematoma is bleeding under the skin at the site of a venipuncture.

DIF:

Cognitive Level: 1

REF: p. 144

OBJ: 7

12. Hemoconcentration can occur in which of the following situations? a. The tourniquet was too loose. b. The tourniquet was removed before withdrawing the needle. c. Pressure was not applied after withdrawal of the needle. d. The tourniquet was left on for 2 minutes.

ANS: D

Hemoconcentration can be caused by a tourniquet that is left on too long (longer than 1 minute). Not applying pressure after withdrawal of needle can cause a hematoma. The other two scenarios will not cause any injuries or specimen problems.

DIF:

Cognitive Level: 2

REF: p. 143

OBJ: 7

13. While having a blood sample collected, the patient complains of pain and tingling in the

fingers. What is the likely cause? a. The tourniquet is too tight or has been on too long. b. The tourniquet is too loose. c. The tourniquet was removed too soon. d. The tourniquet was placed too far from the collection site.

ANS: A

A tourniquet that is too tight or has been on too long can cause pain or tingling of the fingers.

DIF:

Cognitive Level: 2

REF: p. 143

OBJ: 7

14. Which of the following veins is the most common second choice when the median cubital

vein is not appropriate for withdrawing a blood sample? a. Basilic vein b. Cephalic vein c. Jugular vein d. Radial vein ANS: B

The cephalic vein is the next most commonly used vein. Although the basilic vein is acceptable to use, it shouldToEnS lyTbBeAuN seK d SwEhL enLnEoRo. thCerOvMein is accessible. The basilic vein is usually less firmly anchored and is also closer to the brachial artery, increasing the risk of accidental puncture. Furthermore branches of the median antebrachial cutaneous nerve may be located against this vein. Puncture of the nerve could result in severe and permanent nerve injury. The jugular vein should not be used by phlebotomists. Physicians sometimes use the jugular vein if no others can be located. There is no vein called the radial vein, only a radial artery.

DIF:

Cognitive Level: 1

REF: p. 144

OBJ: 8

15. Which vein lies on top of the brachial artery? a. Basilic b. Brachial c. Cephalic d. Median cubital ANS: A

The basilic vein lies on top of the brachial artery and thus should not be used.

DIF:

Cognitive Level: 1

REF: p. 144

16. How should a needle be inserted for venipuncture? a. Bevel up, in a smooth quick motion. b. Bevel up, very slowly. c. Bevel down, in a smooth quick motion.

OBJ: 8

d. Bevel down, slowly.

ANS: A

The bevel should be facing up, and the motion should be quick but smooth.

DIF:

Cognitive Level: 1

REF: p. 147

OBJ: 10

17. If the needle is withdrawn before the tourniquet is removed, what is likely to occur? a. Hematoma b. Hemoconcentration c. Hemolysis d. Petechiae ANS: A

Removing the needle before removing the tourniquet is likely to produce a hematoma—a collection of blood under the skin. Hemoconcentration, hemolysis, or petechiae can all be caused by a tourniquet that is left on too long.

DIF:

Cognitive Level: 1

REF: p. 149

OBJ: 11

18. When should the tourniquet be removed? a. After finding the vein to be used b. While the first tube is filling c. After all tubes have been filled d. After removing the needle ANS: B

Ideally, the tourniquet should be removed when the first tube is filling to ensure that it will not remain on the arm too long. It should always be off before removing the needle.

DIF:

Cognitive Level: 1

REF: p. 149

OBJ: 11

19. What is the term for a collection of blood under the skin at the site of a venipuncture? a. Hematoma b. Hemoconcentration c. Hemolysis d. Petechiae ANS: A

Removal of the needle before the tourniquet is removed is likely to produce bleeding under the skin at the venipuncture site. This is called a hematoma.

DIF:

Cognitive Level: 1

REF: p. 149

OBJ: 11

20. How should bleeding be stopped at a venipuncture site? a. Press on the site with gauze and then remove the needle. b. Have patient bend his or her arm back up over the puncture site to hold the gauze

in place. c. Remove the needle and apply pressure to gauze over the site. d. Immediately place an adhesive bandage on the site after withdrawal of the needle.

ANS: C

Pressure should be held on the site, but not until immediately after the needle is withdrawn.

Choices B and D are likely to cause a hematoma.

DIF:

Cognitive Level: 1

REF: p. 150

OBJ: 11

21. When should blood collection tubes be labeled? a. Before leaving the laboratory, to make sure there is a tube for every test requested

on the requisition b. At the patient’s bedside, before taking the blood c. At the patient’s bedside, immediately after taking the blood d. As soon as you return to the laboratory after collecting the blood ANS: C

Tubes should be labeled after collecting the blood but before leaving the patient’s room or in the drawing room in the presence of an outpatient.

DIF:

Cognitive Level: 1

REF: p. 151

OBJ: 12

22. Which of the following is the next step after removing your gloves? a. Thank the patient. b. Leave the room. c. Label the tubes. d. Wash your hands.

ANS: D

Hands are always washed after removing gloves.

DIF:

Cognitive Level: 1

p .R15.1COM TESTBANKSREEFL:LE

OBJ: 12

23. Which of the following steps should be taken with a syringe before using it to collect blood? a. Pull the plunger back to break the seal, then expel all the air. b. Loosen the hub of the needle to allow air to be able to enter during collection. c. Coat the inside of the syringe with an anticoagulant. d. Attach the syringe to a vacuum tube adapter.

ANS: A

The seal on a syringe usually needs to be broken or it will be difficult to pull the plunger back during collection of the blood.

DIF:

Cognitive Level: 1

REF: p. 153

OBJ: 13

24. When using a syringe, how do you tell when you have entered a vein? a. The plunger will begin to move on its own. b. The blood will automatically fill the syringe. c. A flash of blood will appear in the syringe hub. d. You have to pull the syringe back to see whether any blood enters the syringe.

ANS: C

A flash of blood should enter the syringe when you enter the vein. To withdraw blood, pull back slowly on the plunger. A plunger that moves on its own or a syringe that is automatically filling most likely means you have punctured an artery.

DIF:

Cognitive Level: 1

REF: p. 153

OBJ: 13

25. How should blood be transferred from a syringe to a vacuum tube? a. Using the needle that was used to draw the blood, insert the needle into the stopper

on the vacuum tube. b. Remove the needle and remove the tube stopper. Expel blood from the syringe into the tube. c. Activate the safety device on the needle, remove, and attach a needless transfer device to the syringe. d. Put a cap on the syringe and transfer it to the laboratory instead of putting in a vacuum tube.

ANS: C

After activating the safety device on the needle, remove the needle and attach a needleless transfer device to the syringe. The actions of using the needle that was used to draw the blood and inserting the needle into the stopper on the vacuum tube and of removing the needle, removing the tube stopper, and expelling blood from the syringe into the tube are safety violations. Putting a cap on the syringe and transferring it to the laboratory instead of putting in a vacuum tube is not used unless the sample is arterial blood for a blood gas analysis.

DIF:

Cognitive Level: 1

REF: p. 155

OBJ: 13

26. What is the abbreviation for the form that indicates a service may not be covered and requires

a signature by Medicare patients? a. PHI b. ABG c. CMS d. ABN ANS: D

An Advanced Beneficiary Notice of Nonpayment (ABN) is a form that is required to be signed

by Medicare patients prior to a service if the service is thought to be a noncovered service by Medicare. The patient signs the form indicating the patient understands that the service may not be reimbursed by Medicare.

DIF:

Cognitive Level: 2

REF: p. 139

OBJ: 1

27. Advance Beneficiary Notice of noncoverage may be required for what patient? a. Workers compensation b. Medicare c. Tricare d. Uninsured ANS: B

ABN is a form used by Medicare to indicate a service may not be covered. All the other insurances do not require an ABN to be signed.

DIF:

Cognitive Level: 1

REF: p. 139

OBJ: 1

28. What is true in the event that Medicare rejects a reimbursement claim and an ABN was not

signed by the patient?

a. b. c. d.

The service will remain unpaid.

The institution can bill the patient.

The institution can ask the patient to sign an ABN. The patient must send payment for the service to the insurance company.

ANS: A

If Medicare rejects a reimbursement claim and an ABN was not signed prior to the service, the service will remain unpaid. The practice or institution is not allowed to bill the patient in this case, and they cannot ask for an ABN to be signed after a service was rendered.

DIF:

Cognitive Level: 3

REF: p. 139

OBJ: 1

29. CLSI approved sites for venipuncture include all of the following except a. median cubital. b. cephalic. c. palmer side of wrist or forearm. d. dorsal hand veins.

ANS: C

Median cubital and cephalic veins, or dorsal hand veins are acceptable for venipuncture. The CLSI states the palmer side of the wrist or forearm is not to be used for venipuncture.

DIF:

Cognitive Level: 2

REF: p. 144

OBJ: 8

Chapter 10: Capillary Collection Warekois et al.: Phlebotomy: Worktext and Procedures Manual, 5th Edition MULTIPLE CHOICE 1. Which of the following is the preferred collection site for laboratory testing of a patient at

high risk for venous thrombosis? a. Arterial sample b. Dermal puncture c. Hand vein with butterfly needle and syringe d. Routine venipuncture of median cubital vein ANS: B

If a patient is at high risk for venous thrombosis, veins should be avoided. Arteries should not be used unless necessary. The best choice in most of these patients is, therefore, a dermal puncture, as long as the required testing can be done on this type of sample.

DIF:

Cognitive Level: 1

REF: p. 161

OBJ: 1

2. What is the preferred method of blood collection in newborns and infants? a. Arterial sample b. Dermal puncture c. Hand vein with butterfly needle and syringe d. Routine venipuncture of median cubital vein ANS: B

Infants have tiny veins andTaEreSdTifBfiA cuNltKtS oE acLcL esEs R ev.eC nO foMr experienced phlebotomists. If a venous sample is required (i.e., for blood cultures), a butterfly needle may be used. For most testing, however, the preferred method is dermal puncture.

DIF:

Cognitive Level: 1

REF: p. 161

OBJ: 1

3. Which of the following tests cannot be collected using a dermal puncture? a. Blood cultures b. CBC c. Glucose d. Sodium ANS: A

Dermal puncture is not appropriate for blood cultures because of the need to prevent contamination of the cultures with skin flora as well as the volume of blood needed for testing.

DIF:

Cognitive Level: 1

REF: p. 161

OBJ: 1

4. Which of the following has higher levels in capillary blood than in venous blood? a. Calcium b. Chloride c. Glucose d. Sodium

ANS: C

Glucose and hemoglobin values are higher in capillary blood than in venous blood. Potassium (plasma), calcium, and total protein levels are lower in capillary blood than in venous blood.

DIF:

Cognitive Level: 1

REF: p. 162

OBJ: 2

5. Which of the following has higher levels in venous blood than in capillary blood? a. Calcium b. Chloride c. Glucose d. Sodium ANS: A

Calcium, potassium, and total protein levels are higher in venous blood than in capillary blood. Glucose and hemoglobin levels are lower in venous blood than in capillary blood.

DIF:

Cognitive Level: 1

REF: p. 162

OBJ: 2

6. How long should a heel warmer be applied to an infant’s heel? a. 30 seconds b. 1–3 minutes c. 3–5 minutes d. 10 minutes ANS: C

Heel-warming devices should not exceed 42C and should be applied for 3–5 minutes.

DIF:

Cognitive Level: 1

p .R16.4COM TESTBANKSREEFL:LE

OBJ: 5

7. Puncture of a bone during dermal puncture can result in what potentially serious and

sometimes fatal bone infection? a. Osteochondritis b. Osteomalacia c. Osteomyelitis d. Osteoporosis ANS: C

Osteomyelitis is a serious bone infection that can occur if the bone is punctured during a heel stick. Osteochondritis is a painful inflammation of the bone or cartilage, and can arise from puncturing bone during a heel stick. Osteomalacia is a softening of the bone that results from low levels of calcium or vitamin D or high levels of PTH. In osteoporosis, there is a loss of bone mass and a decrease in bone density.

DIF:

Cognitive Level: 1

REF: p. 164

8. What is the maximum acceptable depth for a heel puncture? a. 1 mm b. 2 mm c. 3 mm d. 4 mm ANS: B

OBJ: 6

The maximum acceptable depth for a normal heel puncture is 2 mm, because the calcaneus bone (heel bone) can lie close to the surface.

DIF:

Cognitive Level: 1

REF: p. 164

OBJ: 7

9. What is the maximum acceptable depth for a dermal puncture on an adult? a. 1 mm b. 2 mm c. 3 mm d. 4 mm ANS: C

The maximum depth of a dermal puncture is 3 mm, so as to minimize the risk of inflammation and infection.

DIF:

Cognitive Level: 1

REF: p. 164

OBJ: 7

10. What is the recommended depth for a heel puncture on a premature infant? a. 0.65–0.85 mm b. 1.0–1.5 mm c. 1.5–2.0 mm d. 2.5–3.0 mm ANS: A

The maximum appropriate depth of a heel puncture on a premature infant is much less than that for a full-term infant, because of the premature baby’s small size and the possibility of encountering bone at a lesser depth.

DIF:

Cognitive Level: 1

REF: p. 164

OBJ: 7

11. Which of the following bones is close to the surface and at risk of being damaged during a

heel puncture? a. Calcaneus b. Metatarsal c. Navicular d. Tarsal ANS: A

The calcaneus bone, or heel bone, is the one most at risk for puncture. The other choices are also foot bones but are not in a location close to the heel stick site.

DIF:

Cognitive Level: 1

REF: p. 164

OBJ: 6

12. What is the maximum acceptable width for a dermal puncture? a. 0.5 mm b. 1.0 mm c. 2.4 mm d. 4.0 mm ANS: C

The maximum recommended width of a dermal puncture is 2.4 mm. This achieves adequate blood flow but does not endanger the patient.

DIF:

Cognitive Level: 1

REF: p. 164

OBJ: 7

13. Which of the following is the appropriate site for dermal puncture on an infant’s foot? a. Rear part of the arch of the foot b. Medial and lateral borders of plantar surface c. Fatty part of the middle toe d. Center of the plantar surface ANS: B

The medial and lateral borders of the plantar surface of the heel are the only areas where there is a low risk of puncturing a bone at the recommended depth of puncture.

DIF:

Cognitive Level: 2

REF: p. 165

OBJ: 6

14. Which of the following is an appropriate dermal puncture site for adults? a. Fleshy center of thumb b. Thumb side of index finger c. Ring finger, perpendicular to the ridges d. Middle finger, parallel to the ridges ANS: C

The best sites are the fleshy center of the middle and ring fingers, perpendicular to the ridges of the fingerprint. The thumb is likely to be callused, and the index finger has more nerve endings. Orientation of the puncture perpendicular to the ridges lessens the flow of blood into the ridges and makes the collection easier.

DIF:

Cognitive Level: 2

p .R16.5COM TESTBANKSREEFL:LE

OBJ: 6

15. Which antiseptic may affect the results of tests for bilirubin, uric acid, potassium, and

phosphorus from a dermal puncture and therefore should not be used on a dermal puncture? a. Isopropyl alcohol b. Chlorhexidine gluconate c. Povidone-iodine d. Sodium chloride ANS: C

Povidone-iodine (Betadine) may elevate the results of these tests.

DIF:

Cognitive Level: 1

REF: p. 167

OBJ: 8

16. Betadine may elevate results of which tests if used to clean the skin for a dermal puncture? a. Bilirubin, acid phosphatase, potassium, sodium b. Bilirubin, uric acid, phosphorus, potassium c. Sodium, potassium, chloride, bicarbonate d. Glucose, BUN, creatinine, uric acid ANS: B

Betadine (povidone-iodine) may elevate the results of tests for bilirubin, uric acid, phosphorus, and potassium.

DIF:

Cognitive Level: 2

REF: p. 167

OBJ: 8

17. Which of the following is an acceptable step during collection of blood by dermal puncture? a. Constantly massage near the site to keep the blood flowing. b. Keep the finger upright and collect as the blood flows downward. c. Wipe away the first drop of blood with an alcohol pad. d. Wipe away the first drop of blood with a dry, clean gauze pad.

ANS: D

Wipe away the first drop of blood with a clean, dry gauze pad for routine dermal punctures, in order to prevent contamination the sample with tissue fluid. A few of the newer point-of-care instruments instruct the collector not to do this for a specific instrument, but all other dermal collections should follow this rule. Wiping the drop with alcohol can cause hemolysis.

Constant massaging can cut off flow, cause hemolysis, and introduce tissue fluid back into the sample. The finger should be held in a downward position to encourage flow.

DIF:

Cognitive Level: 2

REF: p. 169

OBJ: 10

18. Which screening test measures the overall integrity of primary hemostasis? a. APTT b. Bleeding time c. FDP d. PT ANS: B

Primary hemostasis involves the function of platelets and the vascular system. The bleeding time test evaluates this. The APTT and PT are tests that evaluate secondary hemostasis. Fibrin degradation products (FDP) are products of fibrin clot breakdown.

DIF:

Cognitive Level: 1

REF: p. 173

OBJ: 13

19. Which of the following over-the-counter medications is known to increase bleeding times? a. Aspirin b. Benadryl c. Tums d. Tylenol ANS: A

Aspirin interferes with the function of platelets for 7–10 days after the last dose and prolongs the bleeding time.

DIF:

Cognitive Level: 1

REF: p. 170

OBJ: 13

20. Which of the following is the standard incision size for a bleeding time test? a. 0.1 mm deep by 5.0 mm long b. 1.0 mm deep by 5.0 mm long c. 0.5 mm deep by 1.0 mm long d. 5.0 mm deep by 0.1 mm long ANS: B

Incision size must be standardized in order to have reliable results for the bleeding time test.

An automated BT device must be used with a depth of 1mm and a length of 5 mm.

DIF:

Cognitive Level: 1

REF: p. 166

OBJ: 13

21. Which of the following would be interpreted as a normal bleeding time? a. 1 minute b. 6 minutes c. 12 minutes d. 20 minutes ANS: B

A normal bleeding time is usually between 2 and 10 minutes. Bleeding times between 15 and 20 minutes indicate the patient has a condition that interferes with normal platelet plug formation or the test was performed incorrectly.

DIF:

Cognitive Level: 2

REF: p. 166

OBJ: 13

22. When performing a bleeding time test, the blood pressure cuff should be inflated to a. 10 mm Hg. b. 40 mm Hg. c. 70 mm Hg. d. 100 mm Hg. ANS: B

The technique for performing a bleeding time test must be standardized in order to have reliable results to compare to normal levels. The blood pressure cuff is inflated to 40 mm Hg and maintained at that pressure throughout the procedure.

DIF:

Cognitive Level: 1

REF: p. 171

OBJ: 13

23. What is the usual site for performing a standard bleeding time test? a. Earlobe b. Finger c. Forearm, just below antecubital crease d. Forearm, just above the wrist ANS: C

The standard site is the forearm about 5 cm below the antecubital crease. The original bleeding time test in 1910 was performed on the earlobe.

DIF:

Cognitive Level: 1

REF: p. 171

OBJ: 13

24. Which of the following is a part of proper technique when performing a bleeding time test? a. Press the cutting device on the arm until the skin indents slightly. b. Start the timing after the first drop of blood forms on the incision. c. Touch the incision with filter paper every 30 seconds to blot blood. d. Record the time when blood is no longer absorbed by the filter paper.

ANS: D

The device should be placed on the arm but should not make any indention. Start the timing as soon as the cut is made. The blood should be wicked with filter paper every 30 seconds, but the incision should not be touched as this can disturb platelet aggregation at the site and prolong the bleeding time. The end time is when no more blood absorbs onto the filter paper.

DIF:

Cognitive Level: 2

REF: p. 172

OBJ: 13

25. At what intervals should blood be wicked with filter paper when performing a bleeding time

test? a. 15 seconds b. 30 seconds c. 45 seconds d. 60 seconds ANS: B

Blood should be wicked every 30 seconds without disturbing the puncture site.

DIF:

Cognitive Level: 1

REF: p. 172

OBJ: 13

26. What is another name for a dermal puncture? a. Arterial stick b. skin puncture c. Venipuncture d. Microspecimen ANS: B

Another name for a dermal puncture is skin puncture or capillary collection.

DIF:

Cognitive Level: 1

REF: p. 160

OBJ: 1

27. Drawing excessive amounts of blood from a patient puts them at risk for what type of anemia? a. Iatrogenic b. Pernicious c. Aplastic d. Sickle cell ANS: A

Anemia is the reduction of RBCs or hemoglobin in the blood. There are many causes of anemia but if it was the result of excessive blood draws from a patient it is considered to be iatrogenic. All other choices are types of anemia but not the result of excessive blood draws.

DIF:

Cognitive Level: 2

REF: p. 161

OBJ: 1

28. For which of the following cases would a capillary puncture be contraindicated? a. Obese patients b. Patients at risk for venous thrombosis c. Geriatric patients d. Severely dehydrated patients ANS: D

When patients are severely dehydrated they are not good candidates for a capillary puncture, because they may not have sufficient blood flow to the microscopic capillary vessels and test results would then be inaccurate. All other choices are ideal for capillary punctures.

DIF:

Cognitive Level: 3

REF: p. 161

OBJ: 1

29. For which of the following patients would a capillary puncture be preferred?

a. b. c. d.

A patient with compromised lymphatic drainage A patient requiring a blood culture A patient requiring frequent blood tests A patient requiring routine coagulation studies

ANS: C

Capillary punctures would be contraindicated in all of the above choices except for a patient requiring frequent blood testing.

DIF:

Cognitive Level: 2

REF: p. 161

OBJ: 1

30. Microcollection tubes a. are only used for heel punctures. b. are used to collect serum, plasma, or whole blood specimens. c. contain no anticoagulant. d. cannot be used for BURPP collections.

ANS: B

Microcollection tubes come in a variety of sizes with or without anticoagulants. They are used on all dermal punctures.

DIF:

Cognitive Level: 2

REF: p. 163

OBJ: 4

Chapter 11: Preanalytical Variables and Venipuncture Complications Warekois et al.: Phlebotomy: Worktext and Procedures Manual, 5th Edition MULTIPLE CHOICE 1. The emergency department has requested that blood alcohol level be drawn on a patient. What

is the proper way to obtain the specimen? a. Clean the site with alcohol and perform a routine venipuncture. b. Clean the site with Betadine (povidone-iodine) and perform a routine venipuncture. c. Call the laboratory to get a phlebotomist who is experienced in drawing from arteries. d. Use alcohol to clean the site and perform a dermal puncture.

ANS: B

Blood alcohol specimens are drawn from veins into a vacuum tube so they are protected from alcohol diffusion into the air. Alcohol should not be used to disinfect the skin for alcohol testing.

DIF:

Cognitive Level: 2

REF: p. 182

OBJ: 7

2. What is the medical term for fainting? a. Emesis b. Hematoma c. Lymphostasis d. Syncope ANS: D

Syncope is the term for fainting. Emesis means vomiting. A hematoma is bleeding under the skin at a venipuncture site. Lymphostasis is a condition of the lymphatic vessels.

DIF:

Cognitive Level: 1

REF: p. 186

OBJ: 9

3. What condition can be caused by the removal of lymphoid tissue as part of a mastectomy? a. Anemia b. Hemoconcentration c. Lymphostasis d. Syncope ANS: C

Lymphostasis is a condition of the lymphatic vessels. Anemia is a decrease in red blood cells and hemoglobin. Syncope is fainting. Hemoconcentration occurs in whole blood when there is an increase in the ratio of formed elements to plasma.

DIF:

Cognitive Level: 1

REF: p. 181

OBJ: 4

4. When you are unable to locate a vein after thoroughly examining a patient’s arm, what step

should be taken next? a. Examine the other arm for a vein. b. Try to collect the sample even though you do not see or feel a vein.

c. Decide to perform a dermal puncture. d. Call the laboratory for a more experienced phlebotomist.

ANS: A

The next step is to examine the other arm for a vein. If you still find no vein, then it may be appropriate to perform a dermal puncture or get a more experienced phlebotomist.

DIF:

Cognitive Level: 3

REF: p. 182

OBJ: 5

5. A patient has a seizure while you are performing a venipuncture. What should you do? a. Finish collecting the specimen and then call the nurse for help. b. Remove the tourniquet and needle immediately, apply pressure, and call the nurse

for help. c. Call the laboratory for help restraining the patient, so you can obtain the sample. d. Ignore the seizure and continue the procedure as usual.

ANS: B

Remove the tourniquet immediately and remove the needle. Hold pressure on the site if possible and push the bedside call button.

DIF:

Cognitive Level: 3

REF: p. 186

OBJ: 10

6. When collecting blood from a vein in the back of the hand, where should the tourniquet be

placed? a. Above the elbow as usual b. Just above the wrist c. Just below the wrist d. No tourniquet is used ANS: B

The tourniquet should be placed above the venipuncture site and around or just above the wrist.

DIF:

Cognitive Level: 1

REF: p. 183

OBJ: 5

7. Which of the following tests is most seriously affected by hemolysis? a. Chloride b. Creatine kinase (CK) c. Glucose d. Potassium ANS: D

Potassium levels inside the red blood cells are 23 times higher than in plasma, so even a small amount of hemolysis will cause extra potassium to enter the plasma. The other choices are not present in high levels inside the red blood cells.

DIF:

Cognitive Level: 1

REF: p. 189

OBJ: 13

8. Which of the following can cause hemolysis of a blood specimen? a. Using a needle with a larger gauge than necessary b. Not mixing the tubes that contain anticoagulant c. Using a small-gauge needle and a large vacuum tube

d. Using a syringe to draw the specimen ANS: C

Use of a small-gauge needle with a large vacuum tube will cause increased stress on cells as they go through the needle and can lead to hemolysis. Not mixing the tubes with anticoagulant can lead to small clots in the tube but will not cause hemolysis. Neither of the other options will cause problems with the specimen, although using a larger gauge needle may increase the pain or bleeding of the patient (depending on how large the needle is).

DIF:

Cognitive Level: 1

REF: p. 189

OBJ: 13

9. During a prolonged hospitalization, a patient requiring many laboratory tests may develop

what condition as a result of multiple blood samples being drawn? a. Anemia b. Edema c. Hemoconcentration d. Reflux ANS: A

During a prolonged hospitalization, a great deal of blood may be collected from a patient. This can cause anemia, especially in small patients (i.e., children). None of the other choices will result from having multiple samples drawn.

DIF:

Cognitive Level: 1

REF: p. 190

OBJ: 15

10. Which of the following may cause a hematoma? a. Going through the back side of the vein when inserting the needle b. Using a needle of too-sT mEaS ll T gaBuA gN e KSELLER.COM c. Using a needle of too-large gauge d. Leaving the tourniquet on for longer than 1 minute ANS: A

Puncturing the back side of the vein allows blood to escape into the surrounding tissue during collection and can cause a hematoma to arise. Another cause of a hematoma is removal of the needle while the tourniquet is still in place.

DIF:

Cognitive Level: 1

REF: p. 181

OBJ: 4

11. Collections for which department require a special patient identification system in addition to

the hospital ID bracelet? a. Blood bank b. Chemistry c. Coagulation d. Hematology ANS: A

The blood bank requires additional identification to help ensure the patient receives the correct unit of blood during transfusion. This helps prevent errors and transfusion reactions.

All the other departments use the hospital ID number.

DIF:

Cognitive Level: 1

REF: p. 180

OBJ: 3

12. A large amount of bleeding into the tissues surrounding a puncture site (i.e., in a patient who

takes anticoagulant medication) can cause what condition? a. Compartment syndrome b. Infection c. Nerve damage d. Vein collapse ANS: A

A small amount of bleeding around the site of venipuncture leads to a hematoma. A large amount of bleeding can cause compartment syndrome, a condition in which pressure within the tissue prevents blood from flowing freely in the blood vessels. This causes swelling, pain, and numbness followed by paralysis distal to the puncture site. There is a risk that this syndrome may cause permanent nerve damage. Compartment syndrome is most likely to be a problem in patients on high doses of anticoagulants or patients with coagulation disorders.

DIF:

Cognitive Level: 1

REF: p. 190

OBJ: 15

13. What is the maximum amount of time that a tourniquet can be left on? a. 30 seconds b. 1 minute c. 2 minutes d. 5 minutes ANS: B

Tourniquets left on longer than 1 minute can cause pain, hemoconcentration, hemolysis, and petechiae.

DIF:

Cognitive Level: 1

TESTBANKSREEFL:LE p .R18.2COM

OBJ: 8

14. What is the term used to describe a vein that is hardened due to repeated venipunctures,

chemotherapy, or disease? a. Blocked b. Edematous c. Occluded d. Sclerosed ANS: D

Sclerosed is the term used to describe a hardened vein. Occluded is another term for a blocked vein. Edematous describes tissue that is swollen due to excess fluid accumulation.

DIF:

Cognitive Level: 1

REF: p. 181

OBJ: 4

15. If an IV is in place and there are no other accessible sites, where should the blood specimen be

collected? a. From the IV port b. Proximal to the IV c. Above the IV d. Distal to the IV ANS: D

Blood should not be drawn from an IV site, IV port, above an IV or proximal to an IV. Drawing distal to an IV is acceptable.

DIF:

Cognitive Level: 3

REF: p. 181

OBJ: 4

16. If the antecubital space is inaccessible when venipuncture is required, what is the next best

site for specimen collection? a. Foot veins b. Jugular veins c. Dorsal hand veins d. Leg veins ANS: C

If the antecubital space is inaccessible in both arms the next best location would be the dorsal veins which are the veins on the back (dorsal) side of the hand.

DIF:

Cognitive Level: 2

REF: p. 191

OBJ: 16

17. If the bevel is stuck to the wall of the vein, what should be done? a. Switch tubes b. Slightly rotate the needle c. Pull back on the needle d. Terminate the procedure ANS: B

If the bevel of the needle is stuck to the wall of the vein, slight rotation of the needle will break the suction and allow for uninterrupted blood flow. Switching tubes would not help.

Pulling back on the needle would cause the needle to come out of the vein. Terminating the procedure in this case would not be necessary.

DIF:

Cognitive Level: 3

REF: p. 187

OBJ: 11

18. Which of the following veins should be avoided to reduce chances of nerve damage? a. Cephalic b. Median cubital c. Dorsal d. Basilic ANS: D

The basilic vein is close to the nerves in the antecubital space and should therefore be avoided when possible.

DIF:

Cognitive Level: 2

REF: p. 190

OBJ: 15

19. All of the following are reasons for specimen rejection except for what? a. Collection from the wrong vein b. Mislabeled specimen c. Incompletely filled tubes d. Hemolysis ANS: A

A specimen would likely be rejected for all of the above situations except collecting the specimen from the wrong vein. The laboratory is not aware of the vein in which a specimen is collected.

DIF:

Cognitive Level: 2

REF: p. 190

OBJ: 16

20. Preanalytic variables a. occur after the sample is collected. b. are not the responsibility of a phlebotomist. c. are recognized during the testing process. d. include site cleaning.

ANS: D

Preanalytic variables include factors that occur before sample collection such as patient access, site selection site cleaning, tourniquet application, sample collection, completion of the procedure, and sample integrity.

DIF:

Cognitive Level: 2

REF: p. 176

OBJ: 1

21. Basal state a. refers to body’s state after 8 to 12 hours of fasting. b. allows for variations in body’s normal fluctuations. c. occurs within 1 hour of eating a meal. d. is not affected by caffeine or nicotine.

ANS: A

Basal state is defined as the body’s state after 8 to 12 hours of fasting and abstention from strenuous exercise.

DIF:

Cognitive Level: 2

REF: p. 178

OBJ: 1

22. Timed specimens are useful in monitoring a. basal status. b. cardiac enzymes. c. viral loads. d. patient locations.

ANS: B

Time specimens are drawn to determine changes in the level of certain substances over time.

Some common timed specimens include medications such as digoxin, hemoglobin levels, cortisol (diurnal variation), and cardiac enzymes to rule out MI. DIF:

Cognitive Level: 2

REF: p. 178

OBJ: 2

23. Patient preparation includes verifying patient age on the requisition a. because lab reference ranges may be set based on age. b. for tracking patient demographics. c. to ensure and document equal access to health care. d. to assessing cognitive function of patient prior to draw.

ANS: A

The patient’s physical condition at the time of the draw influences sample quality and interpretation of test results. Some reference ranges for certain tests are set based on age and/or gender of the patient. Cholesterol and triglyceride values increase with age; infants have higher RBC/WBC values; hemoglobin levels differ by age and gender, etc.

DIF:

Cognitive Level: 2

REF: p. 178

OBJ: 2

24. What is the effect of dehydration on a patient’s test result? a. Hemolysis of analytes b. Diurnal variation of constituent tested c. Hemoconcentration d. False decrease in test result ANS: C

Dehydration due to prolonged diarrhea or vomiting or heat stroke, etc., results in hemoconcentration due to loss of water from plasma. This produces false elevation of many analytes in blood.

DIF:

Cognitive Level: 2

REF: p. 178

OBJ: 2

25. Blood tested from patients who have been in a supine position for an extended period of time

may exhibit what type of shift in certain blood test results a. elevated. b. decreased. c. no change in levels. d. diurnal.

ANS: B

Patients who have been in supine or recumbent position versus a patient who has been standing or moving around will exhibit shifts in body fluids based on position. For supine patients, fluid tends to stay in the bloodstream resulting in dilution of blood and lower test results. For those who are T staEnSdT inB g Ao rNsKi t S t i nEgLfLo rEl R o n.gCerOpMer i o d s , fluid shifts into the interstitial spaces thereby concentrating blood constituents.

DIF:

Cognitive Level: 3

REF: p. 179

OBJ: 2

26. Which of the following is not a preanalytical variable? a. Pregnancy b. Medications c. Exercise d. Reporting of test result ANS: D

Test results are post analytical variables—report correct value, patient, to correct physician, etc. Pregnancy, medications, and exercise are all preanalytical variables.

DIF:

Cognitive Level: 2

REF: p. 176

OBJ: 1

27. Which antiseptic is not recommended for children under the age of 2? a. 70% isopropyl alcohol b. Benzalkonium chloride c. Povidone-iodine d. Tincture of iodine ANS: B

Benzalkonium chloride is not recommended for children under the age of 2. Depending upon the test ordered, the other antiseptics are okay to use.

DIF:

Cognitive Level: 1

REF: p. 182

OBJ: 7

Chapter 12: Blood Collection in Special Populations Warekois et al.: Phlebotomy: Worktext and Procedures Manual, 5th Edition MULTIPLE CHOICE 1. What is the approximate blood volume of an average 150-pound adult? a. 1 liter b. 3 liters c. 5 liters d. 10 liters ANS: C

An average 150-pound adult has approximately a 5-liter blood volume.

DIF:

Cognitive Level: 1

REF: p. 195

OBJ: 1

2. Removal of greater than what percentage of a child’s blood volume can cause cardiac arrest? a. 1% b. 5% c. 10% d. 25% ANS: C

Removal of more than 10% of a child’s blood volume can cause cardiac arrest.

DIF:

Cognitive Level: 1

REF: p. 195

OBJ: 1

3. Infants should not have greater than what percentage of their blood volume removed in a

24-hour period? a. 1% b. 5% c. 10% d. 15% ANS: B

Infants and children should not have more than 5% of their blood volume removed in a 24-hour period.

DIF:

Cognitive Level: 1

REF: p. 195

OBJ: 1

4. What is the maximum amount of a child’s blood volume that may be removed over a 1-month

period? a. 1% b. 5% c. 10% d. 20% ANS: C

No more than 10% of a child’s blood volume should be removed over a 1-month period unless absolutely medically necessary. More than that will probably necessitate that the child be transfused.

DIF:

Cognitive Level: 1

REF: p. 195

OBJ: 1

5. A full-term newborn has a blood volume of 80 mL/kg of body weight. The infant weighs 3.2

kg. Your institution’s policy is that a maximum of 3% of a patient’s blood volume may be withdrawn without specific physician orders. How much blood can safely be withdrawn from the infant? a. 2.25 mL b. 4.76 mL c. 7.68 mL d. 10.41 mL ANS: C

The newborn’s blood volume is 80 mL/kg of body weight. A 3.2-kg newborn would thus have 3.2 kg  80 mL/kg = 256 mL blood volume. Multiply that result by 3%: 256 mL  0.03 = 7.68 mL. DIF:

Cognitive Level: 3

REF: p. 196

OBJ: 1

6. What is the primary reason that blood collection for a child should be kept as calm and

comfortable as possible? a. So the child does not become afraid of medical personnel b. The parents might not let you collect the sample if the child is upset. c. To reduce your work stress d. Prolonged crying can affect white blood cell counts and pH levels.

ANS: D

Prolonged crying can affecTt E wS hiT teBbAloNoK dS ceEllLcL ouEnRts.aCnO d Mp H levels.

DIF:

Cognitive Level: 2

REF: p. 196

OBJ: 2

7. Which of the following choices is inappropriate when collecting blood from a child? a. Explain what you are doing in age-appropriate terms. b. Give the child some choices such as which finger or which bandage to use. c. Tell the child the procedure will not hurt. d. Distract the child just before the stick.

ANS: C

You should be honest with the child and mention that it might hurt just a little. Telling the child that it will not hurt will cause the child not to trust medical personnel in the future.

DIF:

Cognitive Level: 1

REF: p. 196

OBJ: 2

8. Adhesive bandages are not used on children younger than what age due to the danger of

choking? a. 2 months b. 6 months c. 2 years d. 6 years ANS: C

Children aged 2 and under do not understand the dangers of choking on a loose adhesive bandage. If the bandage comes off, the child will most likely place it in his or her mouth.

DIF:

Cognitive Level: 1

REF: p. 197

OBJ: 3

9. What is the most commonly used anesthetic cream for venipuncture in pediatric patients? a. APTT b. EDTA c. EMLA d. PSA ANS: C

EMLA is the anesthetic cream most commonly used for venipuncture in pediatric patients. It must be applied 60 minutes before the venipuncture, so its use requires advance planning. It is not appropriate for emergency collections.

DIF:

Cognitive Level: 1

REF: p. 197

OBJ: 3

10. How is identification of a newborn established before collecting a specimen? a. By checking the name on the bassinet b. By confirming the name with the mother c. By checking the infant’s ID band d. By verifying the name with the nurse on duty ANS: C

The infant should have its own ID bracelet. The name may be identified as “Baby Smith,” for example, but the ID number and name used should match up just as it should on any patient collection. Be especially caTrE efS ulTwBiA thNtw s aLsLthEeR y.arCeOliM kely to have similar names (e.g. Twin KiSnE A and Twin B) and the ID numbers, although different, may be sequential.

DIF:

Cognitive Level: 1

REF: p. 197

OBJ: 3

11. Bilirubin is produced from the breakdown of which of the following? a. Red blood cells b. White blood cells c. Platelets d. Epithelial cells ANS: A

Bilirubin is the waste product of hemoglobin breakdown, which results from the breakdown of red blood cells.

DIF:

Cognitive Level: 1

REF: p. 198

OBJ: 5

12. What organ processes bilirubin to keep its level from becoming too high in the blood? a. Heart b. Kidney c. Liver d. Pancreas ANS: C

The liver conjugates bilirubin to make it water soluble so it is more easily excreted in the feces (or in the urine in some disease states).

DIF:

Cognitive Level: 1

REF: p. 198

OBJ: 5

13. What is the term for a buildup of bilirubin in the blood and skin? a. Anemia b. Edema c. Hematoma d. Jaundice ANS: D

A buildup of bilirubin in the skin results from a buildup of indirect bilirubin from hemoglobin breakdown. The amount of bilirubin being formed is too high for all of it to be transported in the blood. It therefore deposits in skin, resulting in a yellow color called jaundice. Anemia is a low level of hemoglobin and RBCs. Edema is swelling as a result of accumulation of fluid in the tissues. Hematoma is bleeding under the skin at the site of a venipuncture.

DIF:

Cognitive Level: 1

REF: p. 198

OBJ: 5

14. What special precaution must be taken with neonatal bilirubin samples? a. The infant should be fasting. b. The infant should not be crying. c. The specimen should be protected from light. d. Betadine (povidone-iodine) should be used instead of alcohol.

ANS: C

Bilirubin is light-sensitive,TsE oS thTeB blAoN odKsShE ouLldLE beRp.roCtO ecMted from light. Betadine should not be used to disinfect the puncture site, because it can affect bilirubin values.

DIF:

Cognitive Level: 1

REF: p. 198

OBJ: 5

15. What effect does hemolysis of the specimen have on bilirubin tests? a. It increases the bilirubin level. b. It decreases the bilirubin level. c. It interferes with the testing, so that no value can be obtained. d. It has no effect.

ANS: B

Hemolysis falsely lowers measured bilirubin values.

DIF:

Cognitive Level: 1

REF: p. 198

OBJ: 5

16. U.S. law requires states to test for a minimum of two inherited conditions. What are the two

conditions? a. Hypothyroidism and PKU b. PKU and diabetes c. Hypothyroidism and diabetes d. PKU and multiple sclerosis ANS: A

Both hypothyroidism and PKU can be easily treated if discovered early, before any damage has occurred. Some states have laws requiring additional tests.

DIF:

Cognitive Level: 1

REF: p. 199

OBJ: 6

17. Why must neonatal PKU testing be performed by heel stick rather than venipuncture? a. Phenylalanine levels are different between veins and capillaries. b. Dermal puncture is easier. c. Plastic in the collection tubes interferes with testing. d. Metal in the needle interferes with testing.

ANS: A

Phenylalanine levels are different between veins and capillaries and the normal levels for PKU testing were established using capillary blood.

DIF:

Cognitive Level: 1

REF: p. 199

OBJ: 6

18. How are neonatal screening samples usually collected? a. By dermal puncture absorbed onto filter paper b. By dermal puncture into a microtainer c. By routine venipuncture into a vacuum tube d. By venipuncture with butterfly needle and syringe ANS: A

Neonatal screening samples need to be done on capillary blood. They are normally absorbed onto special filter paper and allowed to dry before sending them to the state laboratory. This type of sample is easy and inexpensive to mail to the state laboratory.

DIF:

Cognitive Level: 1

REF: p. 199

OBJ: 6

19. If a venipuncture is required on a child younger than 2, what is the preferred site for a

phlebotomist using a butterfly needle to collect the sample? a. Dorsal hand vein b. Median cubital vein c. Cephalic vein d. Scalp vein ANS: A

The dorsal hand vein is the easiest site for collecting a venous sample from a small child.

DIF:

Cognitive Level: 1

REF: p. 199

OBJ: 4

20. In the geriatric patient, what body change may have the most impact on the safety and

effectiveness of venipunctures? a. Arthritis b. Diabetes c. Stroke d. Less collagen in the skin ANS: D

Because the amount of collagen in the skin is decreased, the skin becomes less elastic and the layers of the skin thinner. Bruising is more likely and healing takes longer. Veins may be apt to move due to less anchoring. Veins are closer to the surface so the angle of the needle may need to be reduced.

DIF:

Cognitive Level: 1

REF: p. 201

OBJ: 7

21. What is the best way to identify a geriatric patient named Jane Doe? a. Ask if she is Jane Doe. b. Match Jane Doe’s ID bracelet with Jane Doe’s requisition. c. Ask the nurse if this is Jane Doe. d. Match the ID card on the door with Jane Doe’s requisition.

ANS: B

Always match the requisition with the ID bracelet on the patient. Geriatric patients may be confused, and asking if she is Jane Doe may get a yes answer even if she is not Jane Doe. DIF:

Cognitive Level: 1

REF: p. 202

OBJ: 7

22. How should the tourniquet be applied to a geriatric patient? a. Tighter than usual b. Looser than usual c. The same as usual d. No tourniquet should be used on the geriatric patient ANS: B

Due to the changes in the geriatric patient’s skin, it is usually advisable to put the tourniquet on looser than normal. ApT plE yiSnT gB thA eN toKuS rnE iqLuL etEoR ve.rCclOoM thing can help to prevent bruising.

DIF:

Cognitive Level: 1

REF: p. 202

OBJ: 7

23. How long should pressure be applied to the venipuncture site of a geriatric patient? a. Less time than usual b. More time than usual c. The same amount of time as usual d. No pressure should be applied ANS: B

Pressure should be applied longer on geriatric patients to ensure that bleeding has stopped.

DIF:

Cognitive Level: 1

REF: p. 202

OBJ: 7

24. Which of the following is the most common type of vascular access device? a. Arterial line b. Central venous line c. Implanted port d. PICC ANS: B

A central venous line is the most common. It is also known as a central venous catheter. It is inserted into a large vein emptying into the heart.

DIF:

Cognitive Level: 1

REF: p. 203

OBJ: 9

25. Which of the following is used for dialysis patients to connect to the dialysis machine? a. Arteriovenous (AV) shunt b. Central venous line c. Heparin lock d. PICC ANS: A

An AV shunt is an artificial connection between an artery and a vein that has been created surgically to provide vascular access for dialysis procedures.

DIF:

Cognitive Level: 1

REF: p. 204

OBJ: 9

26. If a patient has an IV drip in one arm, what is the preferred site for venipuncture? a. The opposite arm b. Above the IV site c. Below the IV site d. Arterial collection ANS: A

The opposite arm is the preferred site to draw blood on a patient who has an IV line in one arm. If this is not possible, then follow your institution’s policies for drawing blood with an IV line present. Never draw above an IV site as most of the specimen at that point will be IV solution.

DIF:

Cognitive Level: 1

REF: p. 204

OBJ: 10

27. Only specially trained individuals are permitted to collect from which of the following? a. Geriatric patients b. Mentally ill patients c. Teenagers d. Vascular access devices ANS: D

Vascular access devices require special training to use them for blood collection.

DIF:

Cognitive Level: 1

REF: p. 194

OBJ: 10

28. What does the term jaundice mean? a. Bruising b. Infection c. Swelling d. Yellow color ANS: D

Jaundice means a yellow color of the skin, mucous membranes, and the whites of the eyes. It results from deposits of bilirubin.

DIF:

Cognitive Level: 1

REF: p. 198

OBJ: 3

29. If a patient appears jaundiced, which test may be requested to confirm the condition?

a. b. c. d.

Bilirubin CBC Glucose PTT

ANS: A

The yellow color in jaundice is a result of a buildup of bilirubin in the blood and skin.

DIF:

Cognitive Level: 1

REF: p. 198

OBJ: 3

30. How long should the heel of a neonate be warmed prior to a heel stick? a. 30–45 seconds b. 1–2 minutes c. 3–5 minutes d. 8–10 minutes ANS: C

The heel should be warmed long enough to establish good blood flow.

DIF:

Cognitive Level: 1

REF: p. 198

OBJ: 3

31. All of the following are examples of LTC facilities except what? a. Nursing home b. Adult daycare c. Assisted living d. Rehabilitation facility ANS: B

All of the above are long-term care facilities (LTC) except an adult daycare which is a day stay.

DIF:

Cognitive Level: 1

REF: p. 201

OBJ: 7

32. What is the purpose of an AV shunt? a. Dialysis b. Angioplasty c. Phlebotomy d. Medication instillation ANS: A

An atrioventricular (AV) shunt is an internal connection of an artery and a vein for the purpose of use during dialysis. It should not be used for any other procedures.

DIF:

Cognitive Level: 2

REF: p. 204

OBJ: 9

33. What is the required specimen amount when collecting a blood culture on an infant? a. 0.1–0.5 mL b. 0.8–1 mL c. 1–5 mL d. 8–10 mL ANS: C

Blood cultures on an infant require 1–5 mL of blood to be collected.

DIF:

Cognitive Level: 2

REF: p. 195

OBJ: 1

Chapter 13: Arterial Blood Collection Warekois et al.: Phlebotomy: Worktext and Procedures Manual, 5th Edition MULTIPLE CHOICE 1. Which artery is most commonly used for arterial blood gas collection? a. Radial b. Ulnar c. Brachial d. Femoral ANS: A

The radial artery is most often used because the ulnar artery can make up for any loss of blood supply to the tissues of the hand. It is also easy to access.

DIF:

Cognitive Level: 1

REF: p. 208

OBJ: 1

2. What is the normal pH of blood? a. 6.80–6.90 b. 7.20–7.30 c. 7.35–7.45 d. 7.55–7.65 ANS: C

The normal blood pH is 7.35–7.45. Values below that level represent acidosis, and values above it represent alkalosis.

DIF:

Cognitive Level: 1

REF: p. 209

OBJ: 2

3. Which pH value indicates acidosis? a. 7.25 b. 7.36 c. 7.40 d. 7.48 ANS: A

A pH of 7.25 is below normal and therefore indicates acidosis. Both 7.36 and 7.40 are normal pH values. A value of 7.48 is above normal and therefore indicates alkalosis.

DIF:

Cognitive Level: 1

REF: p. 209

OBJ: 2

4. Which pH value indicates alkalosis? a. 7.25 b. 7.33 c. 7.42 d. 7.49 ANS: D

A pH of 7.49 is above normal and therefore indicates alkalosis. A pH of 7.25 is below normal and therefore indicates acidosis. Both 7.36 and 7.40 are normal pH values.

DIF:

Cognitive Level: 1

REF: p. 209

OBJ: 2

5. Which blood parameter measures the acidity or alkalinity of the blood? a. pH b. PO2 c. PCO2 d. O2 saturation ANS: A

pH is a measure of acidity or alkalinity. PO2 is a measure of the amount of oxygen in the blood, and PCO2 is a measure of carbon dioxide in the blood. The O2 saturation expresses the amount of oxygen bound to hemoglobin.

DIF:

Cognitive Level: 1

REF: p. 209

OBJ: 2

6. Which blood parameter measures the amount of oxygen in the blood? a. pH b. PO2 c. PCO2 d. O2 saturation ANS: B

PO2 is a measure of the amount of oxygen in the blood. pH is a measure of acidity or alkalinity. The O2 saturation expresses the amount of oxygen bound to hemoglobin. PCO2 measures carbon dioxide levels in the blood.

DIF:

Cognitive Level: 1

REF: p. 209

OBJ: 2

7. Which blood parameter is a measure of carbon dioxide levels in the blood? a. pH b. PO2 c. PCO2 d. O2 saturation ANS: C

PCO2 measures carbon dioxide levels in the blood. PO2 measures the amount of oxygen in the blood. pH is a measure of the acidity or alkalinity. The O2 saturation expresses the amount of oxygen bound to hemoglobin.

DIF:

Cognitive Level: 1

REF: p. 209

OBJ: 2

8. What parameter is a measure of the percent of oxygen bound to hemoglobin? a. pH b. PO2 c. PCO2 d. O2 saturation ANS: D

The O2 saturation expresses the amount of oxygen bound to hemoglobin. PCO2 measures carbon dioxide levels in the blood. PO2 measures the amount of oxygen in the blood. pH is a measure of the acidity or alkalinity.

DIF:

Cognitive Level: 1

REF: p. 209

OBJ: 2

9. Which test measures the level of bicarbonate in the blood? a. PCO2 b. CO2 c. HCO3– d. H2CO3 ANS: C

HCO3– is the measure of bicarbonate in the blood. PCO2 measures carbon dioxide gas levels in the blood. CO2 measures the total amount of carbon dioxide in the blood, which is usually equal to the bicarbonate plus the carbonic acid (or dissolved CO2). H2CO3 is carbonic acid, which is the dissolved carbon dioxide in the blood and is equivalent to 3% of the PCO2 value.

DIF:

Cognitive Level: 1

REF: p. 209

OBJ: 2

10. Which anticoagulant is used for arterial blood gas collections? a. Citrate b. EDTA c. Heparin d. Oxalate ANS: C

Heparin is used for blood gases to prevent coagulation. Heparin is known not to affect blood gas values.

DIF:

Cognitive Level: 1

REF: p. 209

OBJ: 3

11. Where is the tourniquet placed for arterial blood gas collection? a. 2 inches above the puncture site b. 2 inches below the puncture site c. Just above the elbow d. No tourniquet is used ANS: D

Arterial blood is under pressure. Arteries can be identified by the presence of a palpable pulse.

No tourniquet is needed.

DIF:

Cognitive Level: 1

REF: p. 210

OBJ: 3

12. Where is the radial artery located? a. In the center of the bend of the elbow b. Thumb side of the wrist c. Pinkie finger side of the wrist d. Inner portion of the thigh ANS: B

The radial artery is on the thumb side of the wrist. The pinkie finger side is the site of the ulnar artery. The elbow bend is the site of the brachial artery. The upper thigh (groin) area is the site of the femoral artery.

DIF:

Cognitive Level: 1

REF: p. 212

OBJ: 4

13. Which artery has the best collateral circulation? a. Brachial b. Femoral c. Radial d. Ulnar ANS: C

The radial artery has the best collateral circulation because the ulnar artery supplies the same area. The brachial artery has adequate collateral circulation but is located deep in the arm close to the median nerve.

DIF:

Cognitive Level: 1

REF: p. 212

OBJ: 4

14. What test is most commonly used to assess the collateral circulation of the radial artery? a. Modified Allen test b. Modified Brown test c. Modified Jones test d. Modified Smith test ANS: A

The modified Allen test assesses the collateral circulation of the radial artery and should be done prior to doing an arterial puncture on the radial artery.

DIF:

Cognitive Level: 1

REF: p. 212

OBJ: 5

15. Which of the following possible complications of arterial puncture can close the artery,

thereby preventing oxygenTfE roSmTrBeaAcN hiKngS tEisLsuLeEs?R.COM a. Arteriospasm b. Hematoma c. Infection d. Thrombosis ANS: A

Arteriospasm is a spontaneous constriction of an artery in response to pain. It may close the artery and prevent oxygen from reaching the tissues.

DIF:

Cognitive Level: 1

REF: p. 212

OBJ: 8

16. Which of the following arterial sampling errors lowers pH values? a. Too much heparin b. Too little heparin c. Air bubbles in syringe d. Insufficient mixing ANS: A

Too much heparin can decrease pH values. The appropriate amount of heparin does not affect pH. Too little heparin can cause the specimen to clot. Air bubbles cause a loss of PCO2 into the air and will increase pH values. Insufficient mixing can result in clotting of the specimen.

DIF:

Cognitive Level: 1

REF: p. 213

OBJ: 9

17. A blood gas specimen that is not iced must be transported to the laboratory within what time

frame? a. 1–3 minutes b. 5–10 minutes c. 30 minutes d. 1 hour ANS: B

A blood gas specimen that is not on ice continues to metabolize, which causes PO2 and pH to decrease and PCO2 to increase. If not placed in an ice slurry, the specimen should be delivered to the laboratory within 30 minutes or less. Putting the sample on ice significantly slows the process of metabolism.

DIF:

Cognitive Level: 1

REF: p. 216

OBJ: 10

18. A blood gas sample on ice cannot be used to test for what analyte due to the effect of lower

temperature on the sample? a. Calcium b. Glucose c. Potassium d. Sodium ANS: C

Potassium is affected by lower temperatures.

DIF:

Cognitive Level: 1

REF: p. 212

OBJ: 9

inT geBw AiNllKcS auEsL e nLoEt R on.lC yO anMer ro r in the PO2 value but which 19. Air bubbles in a blood gasTsyErS other error? a. Decreased PCO2 b. Increased PCO2 c. Decreased pH d. No other changes ANS: A

CO2 will diffuse into the air space and thus lower the blood level.

DIF:

Cognitive Level: 1

REF: p. 213

OBJ: 9

20. Capillary blood gas specimens are collected in heparinized plastic pipettes, and they are

mixed using a magnet and what other metal device? a. Bug b. Flea c. Insect d. Mosquito ANS: B

A small piece of metal called a flea is inserted into the capillary tube. The magnet is used on the outside of the capillary tube to move the flea and thereby mix the sample.

DIF:

Cognitive Level: 1

REF: p. 215

OBJ: 10

21. For an arterial puncture, at what angle should the needle be inserted into the skin? a. 15–30 degrees b. 30–45 degrees c. 60–75 degrees d. 85–90 degrees ANS: B

For arterial punctures the angle is 30–45 degrees. This is a greater angle than is used for venipunctures.

DIF:

Cognitive Level: 1

REF: p. 214

OBJ: 9

22. What is the minimum amount of time that a phlebotomist should hold pressure on an arterial

puncture site? a. No pressure is needed. b. 2 minutes c. 5 minutes d. 10 minutes ANS: C

Arterial blood is under pressure from contractions of the heart that are pumping the blood through the arteries. Direct pressure must be held longer than for venipunctures. If the patient is on anticoagulants, pressure must be held even longer, usually around 15 minutes. Follow your institution’s policies for these patients.

DIF:

Cognitive Level: 1

REF: p. 214

OBJ: 9

odEgSaT sB saAmNpK leSiE nL aL s yEriR ng.eCbOe Mmixed?

23. How should an arterial bloT a. No mixing is necessary. b. By rolling between the fingers and thumb c. With a magnet and a flea d. By shaking the syringe vigorously ANS: B

The sample must be mixed with the heparin. The syringe is too thick to use the magnet and flea that are used in capillary collection. Shaking vigorously may cause hemolysis. Rolling the syringe in the hand is best.

DIF:

Cognitive Level: 1

REF: p. 214

OBJ: 9

24. What is commonly used to clean the site of an arterial blood draw? a. Alcohol or providone-iodine b. Chlorhexidine prep c. Tincture of alcohol d. Soap and water ANS: B

Puncturing an artery carries greater risk for infection and requires more stringent site preparation. For this reason both alcohol and providone-iodine have been used to prepare the site. Chlorhexidine prep (chlorhexidine/alcohol) is now commonly being used in many labs to clean the arterial site prior to puncture.

DIF:

Cognitive Level: 2

REF: p. 210

OBJ: 3

25. What is the recommended needle gauge for an arterial puncture? a. 18 g b. 21 g c. 25 g d. 27 g ANS: B

A 21 gauge needle is recommended for arterial punctures. 18 g is too large and 25 and 27 g are too small.

DIF:

Cognitive Level: 1

REF: p. 210

OBJ: 3

26. All of the following are possible complications of an arterial puncture except for what? a. Petechia b. Hematoma c. Thrombosis d. Hemorrhage ANS: A

All of the above are possible complications of an arterial puncture except petechia which is caused by a tourniquet, because a tourniquet is not used during an arterial collection.

DIF:

Cognitive Level: 2

REF: p. 212

OBJ: 8

Chapter 14: Special Collections and Procedures Warekois et al.: Phlebotomy: Worktext and Procedures Manual, 5th Edition MULTIPLE CHOICE 1. After 12 hours of fasting and abstention from strenuous exercise, the body is said to be in

what state? a. Basal b. Diurnal c. Peak d. Resting ANS: A

This is the definition of basal state. The term “diurnal” refers to the normal daily fluctuations in body chemistry related to hormonal changes and sleep-wake cycles.

DIF:

Cognitive Level: 1

REF: p. 219

OBJ: 1

2. Timed specimens are most likely to be requested for which of the following? a. Albumin b. Bilirubin c. Creatinine d. Digoxin ANS: D

Digoxin is a therapeutic medication. Requests may be timed based on when the patient takes doses of the medication.

DIF:

Cognitive Level: 1

REF: p. 220

OBJ: 3

3. A test requisition lists the glucose specimen to be collected as a 2-hour postprandial. When

should it be collected? a. After the patient has fasted for 2 hours b. Two hours after the patient takes diabetes medication c. Two hours after the patient exercises vigorously d. Two hours after the patient eats ANS: D

Postprandial means after eating. The 2-hour postprandial specimen is normally a glucose requested “2 hr pp.”

DIF:

Cognitive Level: 1

REF: p. 222

OBJ: 4

4. What does the term “hyperglycemia” mean? a. Decreased blood glucose b. Increased blood glucose c. Decreased blood glucagon d. Increased blood glucagon ANS: B

Hyper- is “increased,” glyc means “glucose,” and -emia means “in the blood.”

DIF:

Cognitive Level: 1

REF: p. 221

OBJ: 4

5. Which test is used to diagnose hypoglycemia? a. 2 hour pp (postprandial) glucose b. 1 hour oral GTT c. 3 hour oral GTT d. 5 hour oral GTT ANS: D

The 5 hour GTT may be used to diagnose reactive hypoglycemia where the glucose level is significantly decreased 2–5 hours after eating. The 3 hour GTT is usually not long enough to positively identify hypoglycemia. A variation of the 1 hour GTT is used to diagnose gestational diabetes. The 2 hour pp is a screening test for hyperglycemia.

DIF: Cognitive Level: 1 OBJ: 4

REF: p. 222|Table 14.3

6. What test is used to diagnose gestational diabetes? a. 2 hour pp glucose b. 1 hour oral GTT c. 3 hour oral GTT d. 5 hour oral GTT ANS: B

A variation of the 1 hour GTT is used to diagnose gestational diabetes. The 5 hour GTT may be used to diagnose reactive hypoglycemia where the glucose level is significantly decreased 2–5 hours after eating. TheT3EhSoT urBG t lO oM ng enough to positively identify ATNTKiSs EusLuLalElyRn.oC hypoglycemia. The 2 hour pp is a screening test for hyperglycemia.

DIF:

Cognitive Level: 1

REF: p. 222

OBJ: 4

7. How is 2:30 PM expressed in military time? a. 0230 b. 1230 c. 1430 d. 2300 ANS: C

The military clock is a 24-hour clock instead of the 12-hour clock that uses AM or PM. Once 1200 hours (noon) is passed, the clock continues to 1300 instead of reverting back to 1. So 1430 is equivalent to 2:30 PM; 0230 is 2:30 AM, 1230 is 12:30 PM, and 2300 is 11 PM. DIF:

Cognitive Level: 1

REF: p. 220

OBJ: 2

8. When does the timing of an oral glucose tolerance test begin? a. When the fasting blood is collected b. When the fasting urine is collected c. When the patient is given the glucose solution d. After the patient has finished drinking the glucose solution ANS: D

The time is started once the patient has finished the glucose solution. The blood glucose should go up and then return to a normal level in 11/2 to 2 hours.

DIF:

Cognitive Level: 1

REF: p. 222

OBJ: 4

9. During an oral GTT, what is the patient allowed to consume? a. Nothing b. Water only c. Water, black coffee, or diet cola d. Anything sugar-free ANS: B

Water is the only substance allowed.

DIF:

Cognitive Level: 1

REF: p. 219

OBJ: 1

10. In an oral GTT, how much time may the patient take to drink the glucose solution? a. 1 minute b. 5 minutes c. 10 minutes d. 15 minutes ANS: B

The solution should be finished within 5 minutes so that the timing can be accurate.

DIF:

Cognitive Level: 1

REF: p. 222

OBJ: 4

11. Which of the following sho igB niAfiN caKnS t dEiL urL naElRv. arC iaO tiM on?

TwEsSsT a. Cortisol b. Hemoglobin c. Potassium d. Uric acid ANS: A

The term diurnal refers to the normal daily fluctuations in body chemistry related to hormonal changes and sleep-wake cycles. Cortisol is highest in the morning and lowest later in the day.

DIF:

Cognitive Level: 1

REF: p. 220

OBJ: 2

12. Which of the following is a therapeutic drug that might be measured? a. Albumin b. Dilantin c. Hemoglobin d. Sodium ANS: B

Dilantin is an antiseizure drug. The others are not drugs.

DIF:

Cognitive Level: 1

REF: p. 220

OBJ: 3

13. Which of the following therapeutic drugs is typically drawn in timed pairs known as peaks

and troughs?

a. b. c. d.

Digoxin Heparin Theophylline Vancomycin

ANS: D

Drugs with short half-lives require close monitoring. The most common types are the aminoglycoside antibiotics, which include gentamicin, tobramycin, and vancomycin. The trough is drawn just prior to the next dose and the peak is drawn shortly after the dose (the exact timing depends on the route of administration of the drug).

DIF:

Cognitive Level: 1

REF: p. 221

OBJ: 3

14. For some therapeutic drugs with short half-lives, one of the specimens is drawn just before the

next dose of medication. What is this specimen called? a. Basal b. Normal c. Peak d. Trough ANS: D

The trough is drawn just prior to the next dose and the peak is drawn shortly after the dose (the exact timing depends on the route of administration of the drug).

DIF:

Cognitive Level: 1

REF: p. 221

OBJ: 3

15. What does the abbreviation FUO mean? a. Fever of unknown origT inESTBANKSELLER.COM b. Fibrin ulnar obstruction c. Fluid of umbilical origin d. Free unsaturated oxygen ANS: A

FUO means fever of unknown origin. The other choices are made-up terms. Blood cultures are sometimes drawn as a result of an FUO. DIF:

Cognitive Level: 1

REF: p. 223

OBJ: 5

16. What is the most important factor in preventing contamination of a blood culture? a. Aseptic collection technique b. Collection from multiple sites c. Size of the needle d. Timing of the collection ANS: A

The collection technique has the most influence on contamination. Any breach in aseptic technique can result in contamination.

DIF:

Cognitive Level: 1

17. What does the term anaerobic mean? a. Must have oxygen

REF: p. 223

OBJ: 5

b. A bacterial pathogen c. Without bubbles d. Without oxygen ANS: D

Anaerobic bacteria grow without oxygen. Most anaerobic organisms are killed by oxygen.

Aerobic organisms require oxygen.

DIF:

Cognitive Level: 1

REF: p. 224

OBJ: 5

18. What organizations set guidelines for blood donor collection procedures for blood banks? a. AABB and FDA b. ABA and OSHA c. OSHA and FDA d. AABB and AMA ANS: A

The American Association of Blood Banks (AABB) and the U.S. Food and Drug Administration (FDA) regulate blood banks.

DIF:

Cognitive Level: 1

REF: p. 224

OBJ: 6

Which of the following is true about blood donor screening?

It must be performed every time a person donates blood.

It can be shortened if the donor has donated before.

It can be omitted if the donor has donated regularly.

It consists of just a medical history.

19.

a. b. c. d.

ANS: A

Screening needs to be performed every time a person donates because there have been changes since the last time. Screening consists of registration and consent, an interview and medical history, and a physical examination. The blood test performed as part of the screening process is either a hemoglobin or a hematocrit, which checks for anemia in the donor.

DIF:

Cognitive Level: 1

REF: p. 224

OBJ: 6

20. What is the approximate volume of a unit of donor blood? a. 250 mL b. 450 mL c. 750 mL d. 1 L ANS: B

A unit of blood contains between 405 and 495 mL of blood in a sterile plastic bag.

DIF:

Cognitive Level: 1

REF: p. 226

OBJ: 6

21. Which of the following needle gauges would be appropriate for drawing a donor unit? a. 16 b. 20 c. 22 d. 25

ANS: A

The only one of the choices appropriate for blood donation is a 16-gauge needle. The range in use for blood donation is 16–18 gauge. Appropriate choices for routine venipuncture are in the range of 20–22 gauge. A 25-gauge needle is too small for blood collection; it is the size of a tuberculin syringe needle.

DIF:

Cognitive Level: 1

REF: p. 226

OBJ: 6

22. The blood donation center used a 2-step process to disinfect the skin. What is the second

cleaning agent used on the site? a. Alcohol b. Hibiclens c. Iodine d. Zephiran chloride ANS: C

The second cleaning is done with iodine or a Betadine (povidone-iodine) swab stick beginning at the site and moving in concentric circles outward from the site. The iodine should be allowed to dry for 1 minute to ensure sufficient time for the iodine to kill the surface bacteria.

Do not touch the site after cleaning.

DIF:

Cognitive Level: 1

REF: p. 226

OBJ: 6

23. What is the term for a blood donation that is intended to be used later on the donor? a. Autologous donation b. Directed donation c. Preprocedure donation d. Therapeutic donation ANS: A

An autologous donor is giving blood to be used for himself or herself at a specific later date (such as a surgical operation). A directed donor is giving blood for a specific patient. A therapeutic donor is having blood taken to improve the donor’s health (e.g., a polycythemia patient).

DIF:

Cognitive Level: 1

REF: p. 226

OBJ: 6

24. Which of the following conditions might be treated with a therapeutic phlebotomy? a. Hemophilia b. Hemochromatosis c. Thalassemia d. Toxoplasmosis ANS: B

Common conditions treated with therapeutic phlebotomy are polycythemia (increased RBCs) and hemochromatosis (increased iron levels). Therapeutic donations cannot be used for transfusion.

DIF:

Cognitive Level: 1

REF: p. 226

OBJ: 7

25. Which of the following conditions might be treated with a therapeutic phlebotomy?

a. b. c. d.

Anemia Bacteremia Polycythemia Thyrotoxicosis

ANS: C

Common conditions treated with therapeutic phlebotomy are polycythemia (increased RBCs) and hemochromatosis (increased iron levels). Therapeutic donations cannot be used for transfusion.

DIF:

Cognitive Level: 1

REF: p. 226

OBJ: 7

26. What is the common name for antibodies formed in response to an infection with Mycoplasma

pneumoniae? a. Autoantibody b. Cold agglutinins c. Cryoglobulin d. Cryofibrinogen ANS: B

Cold agglutinins are antibodies that are often formed in response to infection with M. pneumoniae. They will also react with red blood cells at temperatures below normal body temperature, causing them to stick together (i.e., agglutinate).

DIF:

Cognitive Level: 1

REF: p. 226

OBJ: 8

27. For which test does a blood sample need to be collected in a prewarmed tube and kept at body

temperature until deliveredTtE o SthTe BlaAb N orKatSorEyL? LER.COM a. Cold agglutinins b. Cryofibrinogen c. Cryoglobulin d. Warm agglutinins ANS: A

To prevent the cold agglutinins from reacting with RBCs at temperatures below normal body temperature during transport, the blood sample needs to be collected in a prewarmed tube and kept at body temperature until delivered to the laboratory.

DIF:

Cognitive Level: 1

REF: p. 226

OBJ: 8

28. Which test requires the blood sample to be chilled immediately after collection and delivered

to the laboratory on ice? a. Ammonia b. Bilirubin c. Cold agglutinins d. Vitamin A ANS: A

To prevent changes in the specimen values, samples for ammonia testing must be transported on ice and delivered immediately to the laboratory.

DIF:

Cognitive Level: 1

REF: p. 227

OBJ: 9

29. Which test requires the blood sample to be protected from light? a. Ammonia b. Arterial blood gases c. Bilirubin d. Lactic acid ANS: C

Bilirubin is light sensitive and must be protected from light. The other choices require ice transport but are not light sensitive.

DIF:

Cognitive Level: 1

REF: p. 227

OBJ: 10

30. What is the most important concept in handling forensic blood specimens? a. Having someone witness the blood collection b. Collecting urine to compare to the blood c. Chain of custody d. Patient consent ANS: C

The chain of custody is a protocol that documents who has control of the sample at all times to ensure proper handling and that no tampering has occurred with the specimen.

DIF:

Cognitive Level: 1

REF: p. 228

OBJ: 12

31. What agency has established standard requirements for handling forensic samples? a. American Bar Association b. American Medical AssT ocEiaStT ioB n ANKSELLER.COM c. National Institute on Drug Abuse d. FDA ANS: C

The National Institute on Drug Abuse has established standard requirements for handling forensic samples.

DIF:

Cognitive Level: 1

REF: pp. 228-229

OBJ: 12

32. When preparing blood smears at what degree should the spreader slide be? a. 10–15 degrees b. 25–30 degrees c. 40–45 degrees d. 60–65 degrees ANS: B

The proper angle is important in making good smears. An angle greater than 30 degrees will cause a smear to be too thick. An angle less than 25 degrees will cause a smear to be too thin.

DIF:

Cognitive Level: 1

REF: p. 230

OBJ: 13

33. Malaria is diagnosed with regular smears and a thick smear. How is a thick smear prepared? a. The same way as a thin smear but with a bigger drop of blood b. Prepare a thin smear, allow it to dry, then prepare another smear directly on top the

first one. c. With a syringe and needle, completely cover half the slide with blood. d. Use a larger drop of blood than a thin smear and spread the drop to the size of a

dime.

ANS: D

This is the proper way to prepare the thick smear for examination for malarial parasites.

DIF:

Cognitive Level: 2

REF: p. 229

OBJ: 14

34. Upon making a regular blood smear, there are many little holes on the smear. What is the

most likely cause? a. Dirty slide b. Drop of blood too large c. Drop of blood too small d. Wrong angle of spreader smear ANS: A

Holes on the smear are probably caused by a dirty slide. A drop too large will cause a smear that is too thick or too long. A drop that is too small will cause a smear that is too thin or too short. An angle greater than 30 degrees will cause a smear to be too thick. An angle less than 25 degrees will cause a smear to be too thin.

DIF:

Cognitive Level: 2

REF: p. 231

OBJ: 13

35. Most specimens collected for therapeutic drug monitoring are collected in a tube with what

color stopper? a. Blue b. Tiger c. Lavender d. Red ANS: D

Specimens collected for therapeutic drug monitoring are collected in a red top tube because it has no additive. All of the other tubes have additives.

DIF:

Cognitive Level: 2

REF: p. 221

OBJ: 3

36. Use of what blood culture collection method would require you to draw the aerobic tube

before the anaerobic tube? a. Butterfly collection b. Syringe collection c. Capillary collection d. Multisample needle collection ANS: A

When collecting blood cultures using a butterfly collection method the aerobic tube is collected before the anaerobic tube to prevent oxygen in the butterfly tube from getting into the anaerobic tube. The syringe and multisample needle method allow for anaerobic collection before aerobe collection. Capillary collection is not used for blood cultures.

DIF:

Cognitive Level: 3

REF: p. 224

OBJ: 5

37. What type of diabetes is insulin resistant? a. Juvenile diabetes b. Gestational diabetes c. Type I diabetes d. Diabetes insipidus ANS: B

Gestational diabetes is an insulin resistant form of diabetes. All of the other forms listed are not insulin resistant.

DIF:

Cognitive Level: 3

REF: p. 222

OBJ: 4

38. The time it takes for half of the drug to be metabolized is referred to as what? a. Therapeutic time b. Trough level c. Half-life d. Peak level ANS: C

The time it takes for half of the drug to be metabolized is the definition of a drugs half-life.

DIF:

Cognitive Level: 1

REF: p. 220

OBJ: 3

39. How is the site prepared for a blood donor collection is a 1-step process? a. 2% chlorhexidine gluconate in 70% isopropyl alcohol b. Soap and water c. Tincture of iodine d. 70% isopropyl alcohol pad ANS: A

Site preparation for blood donor for a 1-step process typically uses 2% chlorhexidine gluconate in 70% isopropyl alcohol. Soap and water does not adequately disinfect the area.

Tincture of iodine is too strong; providone-iodine is used. An alcohol pad by itself does not adequately prepare the site for donation.

DIF:

Cognitive Level: 2

REF: p. 223

OBJ: 5

40. What happens when a patient with cold agglutinins body temperature falls? a. The antibodies die. b. The agglutinins attach to RBCs. c. The agglutinins attach to WBCs. d. The agglutinins attach to platelets.

ANS: B

When a patient with cold agglutinins body temperature falls the agglutinins attach to the patient’s RBCs. This is because low temperatures cause the antibodies to react to RBCs causing clumping. The antibodies do not die and they do not have a reaction to WBCs or platelets.

DIF:

Cognitive Level: 3

REF: p. 226

OBJ: 8

41. When implementing Chain of Custody protocols, when does the chain begin? a. When the specimen is collected. b. When the reference laboratory receives the specimen. c. When the courier picks the specimen up from the office. d. When the patient is identified.

ANS: D

Chain of Custody protocols are implemented at the time of patient identification and are valid through reporting of results.

DIF:

Cognitive Level: 2

REF: p. 228

OBJ: 12

42. All of the following can alter lactic acid levels except what? a. Using a tourniquet during collection b. Chilling the specimen after collection c. The patient making a fist during collection d. Maintaining the collected specimen at room temperature ANS: B

All of the above can alter lactic acid levels except chilling the specimen after collection because that is the appropriate specimen handling.

DIF:

Cognitive Level: 3

REF: p. 227

OBJ: 9

Chapter 15: Special Nonblood Collection Procedures Warekois et al.: Phlebotomy: Worktext and Procedures Manual, 5th Edition MULTIPLE CHOICE 1. Which of the following requires a sample of feces? a. C&S b. CSF c. NP d. O&P ANS: D

O&P stands for ova and parasites, which require a stool (feces) sample. NP is a nasopharyngeal swab. CSF stands for cerebrospinal fluid. C&S is culture and sensitivity, which can be done on many different samples depending on what the physician is looking for.

DIF:

Cognitive Level: 1

REF: p. 237

OBJ: 1

2. Which organ of the body creates urine? a. Bladder b. Liver c. Kidney d. Pancreas ANS: C

The kidneys form urine. The bladder stores urine until excretion. The liver and pancreas are not involved in urine p r o d uTcEt i oSnT. BANKSELLER.COM DIF:

Cognitive Level: 1

REF: p. 235

OBJ: 1

3. How soon after collection must a urine sample be delivered to the laboratory? a. Within 5 minutes b. Within 30 minutes c. Within 1 hour d. Within 24 hours ANS: C

A urine sample should be delivered within 1 hour to prevent the breakdown of unstable compounds.

DIF:

Cognitive Level: 1

REF: p. 235

OBJ: 1

4. What type of urine collection is commonly used for routine testing of metabolic

abnormalities? a. Catheterized b. First morning c. Random d. Times ANS: C

A random urine sample can be used for most testing.

DIF:

Cognitive Level: 1

REF: p. 235

OBJ: 1

5. What type of urine collection is best for pregnancy tests? a. Catheterized b. First morning c. Random d. Timed ANS: B

The first morning specimen is usually more concentrated and has higher levels of many constituents such as the hormone HCG. DIF:

Cognitive Level: 1

REF: p. 236

OBJ: 1

6. The most common timed urine collection is done over what time period? a. 1 hour b. 4 hours c. 24 hours d. 1 week ANS: C

While 1 hour and 4 hour collections are sometimes done, the most common timed urine is a 24 hour urine. A 1 week urine collection is not appropriate for any testing.

DIF:

Cognitive Level: 1

REF: p. 236

OBJ: 1

7. Which of the following is tThE eS prT opBeAr N wK ayStE oLcoLlE leR ct.aC2O 4-Mhour urine specimen, beginning at 9

AM Thursday? a. Collect and discard the first specimen (0900 Thursday). Collect and keep all the samples until 0900 Friday. At 0900 Friday, collect and keep the last sample. b. Collect and keep the 0900 Thursday urine and all the urine samples for 24 hours, and keep the 0900 Friday specimen. c. Collect and keep the 0900 Thursday urine and all the urine samples for 24 hours, and discard the 0900 Friday specimen. d. Collect and discard the Thursday 0900 urine. Collect and keep all urine samples for 24 hours, and discard the 0900 Friday specimen.

ANS: A

The first collection has been in the bladder for an unknown period of time so is discarded. The timing then starts and everything is collected for the next 24 hours including whatever is in the bladder when the time is up.

DIF:

Cognitive Level: 2

REF: p. 236

OBJ: 1

8. What collection technique is most often used to collect a urine sample for a urine culture? a. Clean catch b. First morning c. Random d. Timed ANS: A

A clean catch midstream urine is used for a urine culture. It involves cleaning the external genitalia and collecting the sample midstream (the early part of the urine passed is not collected as it may be flushing out contaminate bacteria from the urethra).

DIF:

Cognitive Level: 1

REF: p. 236

OBJ: 2

9. What urine collection technique requires a nurse or trained patient care assistant to collect the

specimen? a. Catheterized b. Clean catch c. First morning d. Suprapubic ANS: A

A catheterized urine is collected by trained patient care personnel. A physician collects a suprapubic tap specimen. Patients can collect clean catch and first morning specimens themselves if they have proper instructions.

DIF:

Cognitive Level: 1

REF: p. 236

OBJ: 1

10. What urine collection technique requires a physician to collect the specimen? a. Catheterized b. Clean catch c. First morning d. Suprapubic ANS: D

A physician collects a suprTaE puSbT icBtA apNsKpS ecE im .A LeLnE R .c aCt hOeMt e r i z e d urine is collected by trained patient care personnel. Patients can collect clean catch and first morning specimens themselves if they have proper instructions.

DIF:

Cognitive Level: 1

REF: p. 236

OBJ: 1

11. What type of urine testing usually requires a temperature-sensitive strip on the outside of the

container? a. C&S b. Drug test c. Pregnancy test d. Routine ANS: B

The temperature strip checks to see whether the urine is at body temperature just after the collection (as it should be). If it is not, the patient may have tried to substitute a sample other than his urine for the drug test.

DIF:

Cognitive Level: 1

REF: p. 237

OBJ: 1

12. What type of fecal testing is used to screen for colorectal cancer? a. Culture b. Fecal fat c. O&P d. Occult blood

ANS: D

Occult blood tests detect hidden blood that is not visible to the human eye. It may be positive in colon cancer or other causes of bleeding in the gastrointestinal tract.

DIF:

Cognitive Level: 1

REF: p. 237

OBJ: 4

13. What type of fecal testing is used to detect diarrhea-causing bacterial diseases such as

Salmonella? a. Culture b. Fecal fat c. O&P d. Occult blood ANS: A

Diarrhea-causing bacterial diseases can be detected by culturing the responsible bacteria from the sample.

DIF:

Cognitive Level: 1

REF: p. 237

OBJ: 4

14. What type of fecal testing is used to detect the amoeba Giardia? a. Culture b. Fat c. O&P d. Occult blood ANS: C

Giardia is a common parasite and can be detected by the O&P test.

TESTBANKSELLER.COM

DIF:

Cognitive Level: 1

REF: p. 237

OBJ: 4

15. Patients must be instructed to abstain from ingesting meat and avoid aspirin and vitamin C for

3 days for some brands of what type of fecal testing? a. Culture b. Fat c. O&P d. Occult blood ANS: D

Some occult blood testing can be affected by meat, aspirin, or vitamin C. These items should not affect the results of culture, fat, or O&P tests.

DIF:

Cognitive Level: 1

REF: p. 238

OBJ: 4

16. What fecal test requires a 72 hour stool specimen? a. Culture b. Fat c. O&P d. Occult blood ANS: B

The 72-hour stool sample can be used to quantitate the fat in the stool. It is rarely performed.

Many labs will no longer accept a request for this test.

DIF:

Cognitive Level: 1

REF: p. 238

OBJ: 4

17. What specimen sample is used to check the success of vasectomy procedures? a. Blood b. Saliva c. Semen d. Urine ANS: C

After a successful vasectomy, sperm numbers should significantly decline and within a few weeks drop to no sperm seen.

DIF:

Cognitive Level: 1

REF: p. 239

OBJ: 5

18. Which of the following is an acceptable specimen for semen analysis? a. A sample collected in a condom at the healthcare facility b. A sample collected in a sterile container at home and immediately delivered to the

laboratory c. A sample collected in a sterile container at home and refrigerated during transport d. A urine sample collected in a sterile container immediately after ejaculation ANS: B

Samples cannot be collected in condoms because many contain spermicidal compounds. The sample should be in a sterile container, kept at body temperature, and delivered to the laboratory immediately. Ideally, the sample should be collected at the healthcare facility into a sterile container. The sample must not be contaminated with urine.

DIF:

Cognitive Level: 2

REF: p. 239

OBJ: 5

19. What is the minimum period that a man should be instructed to wait after the last ejaculation

before collecting a semen sample for analysis? a. 12 hours b. 1 day c. 3 days d. 1 week ANS: C

Three days is the recommended minimum for accurate testing, especially for fertility testing.

DIF:

Cognitive Level: 1

REF: p. 239

OBJ: 5

20. What type of specimen is needed for a rapid strep test? a. Blood b. Sputum c. Throat swab d. Urine ANS: C

Rapid strep tests are performed for detection of strep throat, so the specimen should be a throat swab.

DIF:

Cognitive Level: 1

REF: p. 239

OBJ: 6

21. The sweat electrolyte test is used in the diagnosis of what condition? a. Cystitis b. Cystic fibrosis c. Chloride deficit d. Cholecystitis ANS: B

Patients with cystic fibrosis have increased electrolytes (sodium and chloride) in their sweat.

DIF:

Cognitive Level: 1

REF: p. 239

OBJ: 6

22. What is the procedure that induces sweating via application of a weak electric current? a. Ascites b. Electrophoresis c. Iontophoresis d. Pericarditis ANS: C

Iontophoresis uses a weak electric current to induce sweating. Pilocarpine applied to the test area will also cause increased sweating.

DIF:

Cognitive Level: 1

REF: p. 239

OBJ: 6

23. What drug is used to increase sweating for sweat collection studies? a. Aspirin b. Lidocaine c. Pilocarpine d. Trypsin ANS: C

Pilocarpine applied to the test area will cause increased sweating. Iontophoresis uses a weak electric current to induce sweating.

DIF:

Cognitive Level: 1

REF: p. 239

OBJ: 6

24. What type of specimen is tested in the diagnosis of meningitis? a. Amniotic fluid b. Cerebrospinal fluid (CSF) c. Pleural fluid d. Synovial fluid ANS: B

Levels of glucose and protein in cerebrospinal fluid (CSF) change in meningitis. In addition, the CSF is cultured to look for the presence of bacteria. CSF should be sterile.

DIF:

Cognitive Level: 1

REF: p. 240

25. Which type of fluid collection requires a physician? a. CSF b. Nasopharyngeal (NP) swab

OBJ: 8

c. Semen d. Sweat ANS: A

CSF collection requires a physician. Trained laboratory or patient care personnel usually collect NP swabs. The patient collects his own semen with proper instructions. Trained laboratory personnel usually perform the sweat test.

DIF:

Cognitive Level: 1

REF: p. 241

OBJ: 8

26. An amniotic fluid specimen must be protected from which of the following? a. Air b. Heat c. Light d. Moisture ANS: C

Amniotic fluid is often tested for bilirubin. Bilirubin is light sensitive so the fluid must be protected from light.

DIF:

Cognitive Level: 1

REF: p. 241

OBJ: 10

27. Amniotic fluid can be analyzed to detect the presence of what genetic chromosomal

abnormality in the fetus? a. Ascites b. Cleft palate c. Down syndrome d. Diabetes ANS: C

The only chromosomal disorder in the listed choices is Down syndrome, in which there are three copies of chromosome 21 instead of the normal two.

DIF:

Cognitive Level: 1

REF: p. 241

OBJ: 10

28. What specimen is collected to diagnose whooping cough and croup? a. CSF b. NP swab c. Throat swab d. Urine ANS: B

An NP swab is typically used to identify the bacteria that cause these conditions.

DIF:

Cognitive Level: 1

REF: p. 239

OBJ: 6

29. When four tubes are collected for cerebrospinal fluid testing what is the last tube used for? a. Gram stain and culture b. Protein and glucose analysis c. Repeat analysis d. Cell count ANS: C

Generally three tubes are collected for cerebrospinal fluid testing but if a fourth is collected it is used for repeat testing if it is necessary. Tube 1 is used for cell counts. Tube 2 is used for gram stain and culturing. Tube 3 is used for protein and glucose analysis.

DIF:

Cognitive Level: 3

REF: p. 241

OBJ: 8

30. How is a CSF specimen collected? a. Venipuncture b. Lumbar puncture c. Capillary puncture d. Arterial puncture ANS: B

A CSF specimen is collection of cerebrospinal spinal fluid which is collected by way of lumbar puncture.

DIF:

Cognitive Level: 1

REF: p. 241

OBJ: 8

31. What urine specimen tends to be the most concentrated? a. Clean catch midstream b. Random sample c. Catheter specimen d. First morning collection ANS: D

A first morning collection sample tends to be the most concentrated because it has sat in the bladder overnight.

DIF:

Cognitive Level: 2

REF: p. 236

OBJ: 1

32. A patient for occult blood testing was instructed to abstain from consuming all of the

following except a. vitamin C. b. motrin. c. chicken. d. broccoli.

ANS: C

Patient should not consume broccoli/turnips, melons, radishes, turnips, red meat, horseradish, Vitamin C, and pain relievers such as aspirin and motrin for at least 3 days prior to performing the test. Chicken is approved to eat.

DIF:

Cognitive Level: 1

REF: p. 238

OBJ: 4

33. If more than one O&P test is ordered on a patient, the fecal specimens should be collected a. 2 to 3 hours apart minimum. b. 24 hours apart. c. 72 hours apart. d. one per week.

ANS: B

Specimens for O&P must be collected a minimum of 24 hours apart if more than one specimen requested.

DIF:

Cognitive Level: 1

REF: p. 239

OBJ: 4

34. Analysis of breath is used to diagnose infections with a. H. pylori. b. Amoeba infections. c. Gastritis. d. Viruses.

ANS: A

H. pylori is detected by the presence of CO2 in the patient’s breath after consumption of a urea substrate. This organism causes infections and ulcers in the stomach and duodenum.

DIF:

Cognitive Level: 1

REF: p. 242

OBJ: 11

35. Saliva is collected for testing of a. hormone deficiencies. b. food allergies. c. vitamin A excess. d. antibiotic resistance.

ANS: A

Hormones such as estrogen, testosterone, or cortisol in saliva represent bioavailable hormone amounts and can identify deficiencies or excesses more accurately than a blood test.

DIF:

Cognitive Level: 1

p .R24.2COM TESTBANKSREEFL:LE

OBJ: 11

36. Gastric fluid analysis requires a sample of a. feces. b. stomach contents. c. tissue. d. saliva.

ANS: B

Stomach contents are used in gastric fluid analysis to examine not only the contents but acid concentration, presence of RBCs, pus, or yeast in order to diagnose disease processes in the stomach.

DIF:

Cognitive Level: 1

REF: p. 242

OBJ: 11

Chapter 16: Specimen Handling, Transport, and Processing Warekois et al.: Phlebotomy: Worktext and Procedures Manual, 5th Edition MULTIPLE CHOICE 1. How many times should tubes with additives be inverted after collection? a. None b. 1–5 c. 5–10 d. 10–15 ANS: C

It is recommended that additive tubes be inverted 5–10 times.

DIF:

Cognitive Level: 1

REF: p. 248

OBJ: 2

2. According to CLSI, what is the maximum amount of time that may be allowed to elapse

between collection of a blood sample and separation of cells from plasma or serum? a. 30 minutes b. 2 hours c. 12 hours d. 24 hours ANS: B

No more than 2 hours should pass between collection of the sample and separation of cells and plasma or serum. Values will change due to continued metabolism and cell breakdown.

DIF:

Cognitive Level: 1

REF: p. 248

OBJ: 2

3. What is the maximum amount of time a glucose sample collected in a gray top tube can be

held at room temperature without loss of viability? a. 2 hours b. 12 hours c. 24 hours d. 48 hours ANS: C

A gray tube contains sodium fluoride, which stabilizes the glucose level for 24 hours.

DIF:

Cognitive Level: 1

REF: p. 249

OBJ: 5

4. Which of the following is the term for the metabolic breakdown of sugar within cells? a. Glucagon b. Glycolysis c. Glucolysis d. Glycosuria ANS: B

Glycolysis is glucose breakdown in the body. Glucagon is a hormone. Glycosuria is glucose in the urine. There is no such term as glucolysis.

DIF:

Cognitive Level: 1

REF: p. 248

OBJ: 4

5. Which of the following tests is most affected by glycolysis in the tube after collection? a. Glucose b. Hemoglobin c. Potassium d. APTT ANS: A

White blood cells use up glucose during glycolysis, so glucose values will decrease (unless the specimen was collected in a gray top tube, which contains a substance that inhibits glycolysis).

DIF:

Cognitive Level: 1

REF: p. 248

OBJ: 4

6. Whole blood specimens collected in EDTA are stable for how long? a. 1 hour b. 12 hours c. 24 hours d. 48 hours ANS: C

Whole blood specimens collected in EDTA are stable for 24 hours. Blood smears from EDTA specimens must be made within 1 hour after collection to prevent distortion of cell morphology.

DIF:

Cognitive Level: 1

REF: p. 249

OBJ: 5

7. Blood smears from EDTA specimens must be made within what time period after collection

to prevent distortion of cell morphology? a. 30 minutes b. 1 hour c. 12 hours d. 24 hours ANS: B

Whole blood specimens collected in EDTA are stable for 24 hours, but blood smears made from EDTA specimens must be made within 1 hour after collection to prevent distortion of cell morphology.

DIF:

Cognitive Level: 1

REF: p. 249

OBJ: 5

8. Which of the following problems with a blood sample may be caused by extremes of

temperature? a. Clotting b. Glycolysis c. Hemoconcentration d. Hemolysis ANS: D

Temperature extremes can cause cells to hemolyze.

DIF:

Cognitive Level: 1

REF: p. 249

OBJ: 6

9. An analyte needs to be protected from light, but you do not have any amber tubes. What is

another way to protect the specimen? a. Transport it as soon as possible and it will be acceptable. b. Cover the specimen with aluminum foil. c. Turn out all the lights during sample collection and transport it to the laboratory right away. d. Stand the tube upright in a rack with other specimens on all sides surrounding the sample.

ANS: B

Aluminum foil or a thick paper bag is an acceptable alternative for protecting the specimen during transport.

DIF:

Cognitive Level: 2

REF: p. 250

OBJ: 8

10. Smaller portions of a specimen transferred into separate containers are called a. aliquots. b. accessioned samples. c. centrifuged parts. d. portions.

ANS: A

Small portions of a specimen transferred into separate containers are called aliquots. This is done so that different departments can each have part of the sample.

DIF:

Cognitive Level: 1

p .R25.2COM TESTBANKSREEFL:LE

OBJ: 9

11. A unique identifying number used for cataloging samples in the laboratory is referred to as

what kind of number? a. Accession b. Aliquot c. Laboratory d. Safety ANS: A

A unique identifying number used for cataloging samples in the laboratory is called an accession number. All aliquots should have the same number as the original specimen.

DIF:

Cognitive Level: 1

REF: p. 252

OBJ: 9

12. A small centrifuge head has 12 spots (holes) labeled in a manner similar to a clock face. There

are three tubes of equal volume that need to be centrifuged. In which of the following choices for tube placement would the centrifuge be balanced? a. 1, 2, 3 b. 1, 4, 7 c. 1, 5, 9 d. 1, 3, 8 ANS: C

The only choice that is balanced is 1, 5, 9. Another way would be to fill a balance tube to the appropriate level with water and place half the tubes on one side and the others directly opposite.

DIF:

Cognitive Level: 2

REF: p. 253

OBJ: 11

13. What is the major safety risk in removing stoppers from blood collection tubes? a. Aerosols b. Aliquots c. Breaking the tube d. Needle puncture ANS: A

Improper removal of stoppers can cause aerosols.

DIF:

Cognitive Level: 1

REF: p. 253

OBJ: 9

14. Before dividing a 24-hour urine sample into aliquots, what must be done with the sample

first? a. Place it in the refrigerator for 1 hour. b. Add anticoagulant to the container. c. Measure and record the volume of the sample. d. Mix it and then divide into aliquots as needed.

ANS: C

It is important for the laboratory to know the total volume of the sample in order to calculate the total amount of substances in the urine.

DIF:

Cognitive Level: 1

REF: p. 254

OBJ: 2

15. What notation is used to indicate that the sample volume is insufficient for testing? a. EDTA b. IFT c. QNS d. VIS ANS: C

QNS means “quantity not sufficient.”

DIF:

Cognitive Level: 1

REF: p. 248

OBJ: 13

16. Which of the following is an acceptable sample for laboratory testing? a. A half-full sodium citrate tube for coagulation testing b. A cold agglutinin test transported at 37 C c. A urine sample for C&S in a nonsterile clean container d. An EDTA tube for a calcium test ANS: B

The cold agglutinin sample needs to be collected in a prewarmed tube and kept warm during transport to prevent agglutination before the sample is tested. A half-full sodium citrate tube for coagulation testing will give erroneous results because the ratio of blood and anticoagulant is not correct. Cultures must be collected in sterile containers to prevent contamination by bacteria in the container. EDTA binds calcium to prevent coagulation, so the calcium is used up and greatly decreased in an EDTA sample.

DIF:

Cognitive Level: 2

REF: p. 249

OBJ: 6

17. If the stopper is removed from a tube before centrifugation, what effect will this have on the

carbon dioxide and pH levels in the sample? a. A decrease in CO2 and an increase in pH b. A decrease in CO2 and a decrease in pH c. An increase in CO2 and an increase in pH d. An increase in CO2 and a decrease in pH ANS: A

Carbon dioxide will diffuse into the atmospheric air. Loss of CO2 will cause the pH to rise.

DIF:

Cognitive Level: 1

REF: p. 252

OBJ: 9

18. Which of the following tubes can be centrifuged immediately after collection? a. Heparin tube b. Plain tube c. SST tube d. Thrombin tube ANS: A

Heparin is an anticoagulant, so a tube containing heparin can be centrifuged immediately to obtain plasma. These tubes are sometimes used for stat chemistry tests. The other three choices must clot before they are centrifuged.

DIF:

Cognitive Level: 2

REF: p. 253

OBJ: 10

19. What regulations must be adhered to when samples are being transported from an outside

laboratory? a. State and national b. Local and state c. Facility and state d. State and federal ANS: D

Samples from outside laboratories must adhere to both state and federal regulations that govern transportation of biological specimens.

DIF:

Cognitive Level: 2

REF: p. 252

OBJ: 2

20. What is the correct method for recording specimen volume when preparing an aliquot? a. Write the volume on the lid of the main specimen collected. b. Write the volume on the aliquot sample container. c. Write the volume on the aliquot transport bag. d. Write the volume on the aliquot sample lid.

ANS: B

When preparing an aliquot proper recording of the specimen volume is to write the volume on the aliquot sample container. You would never want to label a container lid or transport bag as those items can become separated from the container.

DIF:

Cognitive Level: 2

REF: p. 254

OBJ: 12

21. What specimen would not meet requirements and is likely to be rejected from the laboratory? a. Collecting a CBC in an EDTA tube b. Sending a light blue tube with 1 part additive and 9 parts blood c. A urine specimen for C&S collected in a clean container d. Specimen for cold agglutinin testing maintained in a warm environment ANS: C

All of the above specimens will meet requirements for testing except for a urine specimen for C&S testing collected in a clean container. It is must be collected in a sterile container.

DIF:

Cognitive Level: 2

REF: p. 254

OBJ: 13

22. The phlebotomist had difficulty getting an EDTA tube for a CBC and sed rate. Two

underfilled tubes were collected. The phlebotomist should a. mix the two tube volumes to get one full tube. b. reject at bedside and redraw the patient. c. take to the lab to see if they QNS the specimens. d. perform a dermal puncture.

ANS: B

Never mix the contents from 2 underfilled tubes regardless of the tubes containing the same anticoagulant. The blood additive ratio is incorrect and can cause erroneous results. A dermal puncture cannot be done for a sed rate test. The phlebotomist knows the sample is QNS so the venipuncture should be repeated by another phlebotomist if this phlebotomist already tried to times.

DIF:

Cognitive Level: 3

REF: p. 248

OBJ: 2

Chapter 17: Point-of-Care Testing Warekois et al.: Phlebotomy: Worktext and Procedures Manual, 5th Edition MULTIPLE CHOICE 1. What is another name for point-of-care testing (POCT)? a. Alternate site testing b. CLIA testing c. FDA testing d. Reference site testing ANS: A

POCT occurs in a location away from the laboratory, so it can also be called alternate site testing.

DIF:

Cognitive Level: 1

REF: p. 258

OBJ: 1

2. Which of the following agencies decides whether a given test is CLIA-waived? a. AMA b. CLIA c. FDA d. OSHA ANS: C

The Food and Drug Administration (FDA) has the responsibility for the CLIA-waived list.

DIF:

Cognitive Level: 1

TESTBANKSREEFL:LE p .R25.8COM

OBJ: 1

3. Which of the following procedures is important when drawing blood at a patient’s home and

is not necessary in a hospital building? a. Be sure the patient is sitting or reclining in a safe position. b. Carry a cell phone for emergencies. c. Make sure the patient has stopped bleeding before leaving. d. Ensure that the materials used during the procedure are properly removed and disposed of.

ANS: B

In a hospital there are other personnel nearby and emergency call buttons in the patient rooms.

If you are in a patient’s home, you must be able to call for help in an emergency.

DIF:

Cognitive Level: 2

REF: p. 258

OBJ: 1

4. A portable instrument for a simple, fast method of testing for anemia measures which of the

following? a. ACT b. Cholesterol c. Hemoglobin d. PTT ANS: C

Hemoglobin levels are a way to detect anemia. Arterial, venous, or dermal specimens can be tested for anemia using a hand-held hemoglobin analyzer or reagent dipstick.

DIF:

Cognitive Level: 1

REF: p. 259

OBJ: 1

5. Which of the following types of therapy is monitored by the activated clotting time (ACT)

test? a. Aspirin b. Heparin c. Insulin d. Warfarin ANS: B

An ACT is a measure of heparin activity in the patient. Warfarin activity is measured by the PT (prothrombin time) test.

DIF:

Cognitive Level: 1

REF: p. 259

OBJ: 3

6. Coumadin (warfarin) therapy can be monitored using which of the following tests? a. ACT b. APTT c. Potassium d. PT ANS: D

Coumadin (warfarin) therapy can be monitored using the prothrombin time (PT). Both activated clotting times (ACT) and activated partial thromboplastin times (APTT) can measure heparin activity inTtE heSpTaB tiA enNt.KASpEoLtaLssEiuRm.C teO stMonly checks for potassium levels.

DIF:

Cognitive Level: 1

REF: p. 259

OBJ: 3

7. What is the most common chemistry test performed via POCT? a. CBC b. Glucose c. Potassium d. Sodium ANS: B

A glucose test on whole blood from a fingerstick is the chemistry test most often performed

by POCT. DIF:

Cognitive Level: 1

REF: p. 259

OBJ: 3

8. Blood levels of which of the following analytes rise within 4 hours after an acute myocardial

infarction? a. Cardiac troponins b. Cholesterol c. BNP d. PTT ANS: A

Cardiac troponins I and T are proteins that elevate following a myocardial infarction, due to heart muscle damage. B-type natriuretic peptide (BNP) is a hormone produced by the heart in response to volume and pressure overload. It is elevated in patients with congestive heart failure.

DIF:

Cognitive Level: 1

REF: p. 260

OBJ: 3

9. Blood levels of which of the following analytes are increased in congestive heart failure? a. APTT b. BNP c. Cardiac troponin d. PT ANS: B

BNP is a hormone produced by the heart in response to volume and pressure overload. It is elevated in patients with congestive heart failure. Cardiac troponins I and T are proteins that elevate following a myocardial infarction due to heart muscle damage. The APTT and PT are coagulation tests.

DIF:

Cognitive Level: 1

REF: p. 262

OBJ: 3

10. Which of the following is a recording of the electrical activity of the heart? a. Cardiac troponin b. BNP c. ECG d. PTT ANS: C

The electrocardiogram (ECG) is a recording of the electrical activity of the heart. BNP is a hormone produced by the heart in response to volume and pressure overload. It is elevated in patients with congestive heart failure. Cardiac troponins I and T are proteins that elevate following a myocardial infarction due to heart muscle damage. The PTT is a coagulation test.

DIF:

Cognitive Level: 1

REF: p. 262

OBJ: 5

11. A normal electrocardiogram (ECG) consists of a tracing of five prominent points, which are

identified in what manner? a. A B C D E b. J K L M N c. P Q R S T d. V W X Y Z ANS: C

A normal ECG consists of a tracing of five prominent points, which are identified as PQRST. DIF:

Cognitive Level: 1

REF: pp. 262-263

OBJ: 5

12. A complete heartbeat, consisting of depolarization and repolarization, is also known as which

of the following? a. Cardiac cycle b. Conduction cycle c. P-wave cycle

d. Sinoatrial cycle ANS: A

One complete cardiac cycle involves the contraction of the atria, then contraction of the ventricles, and then relaxation (also known as depolarization and repolarization of the heart muscle).

DIF:

Cognitive Level: 1

REF: p. 262

OBJ: 5

13. Most ECGs place how many electrodes on the body? a. 4 b. 8 c. 10 d. 16 ANS: C

A 12-lead ECG is the standard which consists of the placement of 10 electrodes on the patient’s body.

DIF:

Cognitive Level: 1

REF: p. 263

OBJ: 5

14. Which of the following is a POCT used to screen for colon cancer and gastric ulcers? a. Cardiac troponin T b. BNP c. Occult blood d. PTT ANS: C

A test for occult blood in feces can detect hidden bleeding due to colon cancer or ulcers.

Cardiac troponin T testing is used to detect damage to heart muscle. BNP is elevated in congestive heart failure. PTT is a test of blood coagulation.

DIF:

Cognitive Level: 1

REF: p. 264

OBJ: 3

15. Which type of sample is used for an occult blood test? a. Blood b. Feces c. Throat swab d. Urine ANS: B

A test for occult blood in feces can detect hidden bleeding due to colon cancer or ulcers.

DIF:

Cognitive Level: 1

REF: p. 264

OBJ: 3

16. Which group of Streptococcus bacteria is detected by the rapid strep test? a. A b. B c. C d. D ANS: A

The rapid strep test in general use detects group A streptococci, which are the most common cause of strep throat.

DIF:

Cognitive Level: 1

REF: p. 265

OBJ: 3

17. The detection of HCG in a patient sample is useful in the diagnosis of what condition? a. Anemia b. Heart attack c. Kidney disease d. Pregnancy ANS: D

HCG (human chorionic gonadotropin) is the hormone detected in pregnancy tests. It is produced by the newly forming placenta.

DIF:

Cognitive Level: 1

REF: p. 265

OBJ: 3

18. Before urinalysis testing, a urine specimen needs to be a. filtered and at refrigerator temperature. b. at room temperature and well-mixed. c. centrifuged and at room temperature. d. at body temperature and well-mixed.

ANS: B

The urine specimen should be mixed and at room temperature prior to testing. If it has been in the refrigerator, it needs to be given time to warm to room temperature before testing.

DIF:

Cognitive Level: 1

p .R26.4COM TESTBANKSREEFL:LE

OBJ: 3

19. A laboratory values that is well outside of the designated range is referred to as a a. high range value. b. panic value. c. low range value. d. bad value.

ANS: B

When a laboratory value is well outside of the designated range, it is considered to be a panic value. It is not called a high range value, a low range value, or a bad value.

DIF:

Cognitive Level: 1

REF: p. 261

OBJ: 4

20. What is the primary pacemaker of the heart? a. Sinoatrial node b. Atrioventricular node c. Bundle of His d. Purkinje fibers ANS: A

The primary pacemaker of the heart is the sinoatrial node (SA). The remaining choices are secondary and tertiary pacemakers.

DIF:

Cognitive Level: 1

REF: p. 262

OBJ: 5

21. What portion of the ECG depicts ventricular depolarization? a. T wave b. ST segment c. QRS complex d. P wave ANS: C

The QRS complex depicts ventricular depolarization. The T wave depicts ventricular repolarization, the ST segment depicts the end of ventricular depolarization and the start of ventricular repolarization, and the P wave depicts atrial depolarization.

DIF:

Cognitive Level: 2

REF: p. 263

OBJ: 5

22. Bedside glucose testing is usually performed on patients with what condition? a. Diabetes b. Hemophilia c. Kidney failure d. Liver disease ANS: A

Bedside glucose monitoring is performed on patients with diabetes for monitoring purposed.

DIF:

Cognitive Level: 1

REF: p. 260

OBJ: 3

23. According to CLIA, what is the classification of tests in which the procedure is simple and

erroneous results are unlikely? a. Waived level b. Low level c. Moderate complexity d. High complexity ANS: A

A test in which the procedure is simple and erroneous results are unlikely is considered by CLIA to be waived level. An example would be automated blood glucose testing by capillary stick.

DIF:

Cognitive Level: 1

REF: p. 258

OBJ: 1

24. What type of medication is Aspirin? a. Antidiarrhea b. Antidiuretic c. Antiplatelet d. Antianxiety ANS: C

Aspirin is an antiplatelet medication that causes thinning of the blood.

DIF:

Cognitive Level: 1

REF: p. 259

25. Which of the following is a bacterium found in the stomach? a. RSV

OBJ: 3

b. Mononucleosis c. EBV d. H. pylori ANS: D

H. pylori is a bacterium found in the stomach that can cause ulcerations. All of the other choices are viruses.

DIF:

Cognitive Level: 2

REF: p. 266

OBJ: 3

26. Tn1 reaches peak concentration within a. 4–8 hours. b. 12–16 hours. c. 24 hours. d. 3 days.

ANS: B

TnI can be detected as early as 4–8 hours following the onset of chest pain, peaks at 12–16 hours, and remains elevated for 5–9 days.

DIF:

Cognitive Level: 1

REF: p. 260

OBJ: 3

27. C-reactive protein is a a. predictor of cardiovascular risk due to inflammation. b. test for heart disease. c. protein used to monitor nutrition status. d. substance used to diagnose autoimmune diseases.

ANS: A

C-reactive protein is an inflammatory marker. It is used to monitor inflammation in autoimmune disease as well as monitor postoperative infections. It is also used as a predictor of cardiovascular risk due to inflammation. It is not diagnostic for any disease.

DIF:

Cognitive Level: 1

REF: p. 262

OBJ: 3

28. A consent form is required to perform which test? a. HBV b. CRP c. RPR d. HIV ANS: D

The CDC recommends that a general consent form that has an opt-out comment for patients who choose to decline HIV testing. HIV testing cannot be performed without the patient’s consent.

DIF:

Cognitive Level: 1

REF: p. 266

OBJ: 3

Chapter 18: Quality Phlebotomy Warekois et al.: Phlebotomy: Worktext and Procedures Manual, 5th Edition MULTIPLE CHOICE 1. The organization that mandates quality assurance programs: a. AMA b. ASCP c. Joint Commission d. OSHA ANS: C

The Joint Commission mandates quality assurance programs. The ASCP is a professional organization and a certifying body for laboratory professionals. OSHA is a government agency that monitors safety in the workplace. The AMA is a physicians’ professional organization.

DIF:

Cognitive Level: 1

REF: p. 270

OBJ: 1

2. Quantitative methods used to monitor the quality of procedures to ensure accurate test results: a. QA b. QC c. CQI d. TQM ANS: B

EeRth.oCdsOuMsed to monitor the quality of Quality control (QC) re f e r T s tEoSthTeBqA uaNnK tiS taE tivLeLm procedures to ensure accurate test results. Quality assurance (QA) is the larger set of methods used to guarantee quality patient care. Continuous quality improvement (CQI) is the major goal of total quality management (TQM) programs.

DIF:

Cognitive Level: 1

REF: p. 270

OBJ: 1

3. Represents the major goal of total quality management (TQM) programs: a. QA b. QC c. CQI d. QP ANS: C

Continuous quality improvement (CQI) is the major goal of TQM programs. Quality control (QC) refers to the quantitative methods used to monitor the quality of procedures to ensure accurate test results. Quality assurance (QA) is the larger set of methods used to guarantee quality patient care.

DIF:

Cognitive Level: 1

REF: p. 270

OBJ: 1

4. A larger set of methods used to guarantee quality patient care, including patient preparation

and specimen collection and transport protocols: a. QA

b. QC c. CQI d. TQM ANS: A

QA is the larger set of methods used to guarantee quality patient care, including patient preparation and specimen collection and transport protocols. QC refers to the quantitative methods used to monitor the quality of procedures to ensure accurate test results. CQI is the major goal of TQM programs.

DIF:

Cognitive Level: 1

REF: p. 270

OBJ: 2

5. A collection of the entire set of approaches used by the institution to provide patient

satisfaction: a. QA b. QC c. CQI d. TQM ANS: D

TQM is the term used to refer to the entire set of approaches used by the institution to provide patient satisfaction. It sees the potential for improvement in every area, no matter how high the current performance level. QA is the larger set of methods used to guarantee quality patient care, including patient preparation and specimen collection and transport protocols.

QC refers to the quantitative methods used to monitor the quality of procedures to ensure accurate test results. CQI is the major goal of TQM programs.

DIF:

Cognitive Level: 1

TESTBANKSREEFL:LE p .R27.0COM

OBJ: 1

6. The philosophy that sees the potential for improvement in every area, no matter how high the

current performance level: a. QA b. QC c. QP d. TQM ANS: D

TQM is the term used to refer to the entire set of approaches used by the institution to provide patient satisfaction. It sees the potential for improvement in every area, no matter how high the current performance level. QA is the larger set of methods used to guarantee quality patient care, including patient preparation and specimen collection and transport protocols.

QC refers to the quantitative methods used to monitor the quality of procedures to ensure accurate test results. CQI is the major goal of TQM programs.

DIF:

Cognitive Level: 1

REF: p. 271

OBJ: 1

7. Laboratory document that contains information about the principles underlying testing and

other protocols: a. Delta check b. Floor book c. Procedure manual

d. QA manual ANS: C

The procedure manual is a laboratory manual that contains all the pertinent information about performing each test. The floor book contains information about laboratory schedules, patient preparation, and specimen handling for nursing personnel.

DIF:

Cognitive Level: 1

REF: p. 271

OBJ: 2

8. Document containing information about laboratory schedules, patient preparation, and

specimen handling: a. Delta check b. Directory of services c. Procedure manual d. QA manual ANS: B

The directory of services contains information about laboratory schedules, patient preparation, and specimen handling for nursing personnel. The procedure manual is a laboratory manual that contains all the pertinent information about performing each test.

DIF:

Cognitive Level: 1

REF: p. 271

OBJ: 3

9. A phlebotomist is most responsible for controlling for which of the following types of

variables in test results? a. Analytic b. Preanalytic c. Postanalytic d. Quality monitors ANS: B

The preanalytic factors are those steps involved prior to the performance of the test, such as specimen collection and transport.

DIF:

Cognitive Level: 1

REF: p. 272

OBJ: 4

10. A delay in reporting test results is considered what type of variable? a. Analytic b. Preanalytic c. Postanalytic d. Quality monitors ANS: C

A delay in reporting results after a test is complete is a postanalytic factor.

DIF:

Cognitive Level: 2

REF: p. 272

11. An error in machine calibration is what type of variable? a. Analytic b. Preanalytic c. Postanalytic d. Quality monitors

OBJ: 4

ANS: A

An error in machine calibration is part of the actual performance of the test so it is an analytic factor.

DIF:

Cognitive Level: 2

REF: p. 278

OBJ: 4

12. Improper identification of the patient is considered what type of variable? a. Analytic b. Preanalytic c. Postanalytic d. Quality monitors ANS: B

The preanalytic factors are those steps involved prior to the performance of the test, such as specimen collection and transport.

DIF:

Cognitive Level: 1

REF: p. 273

OBJ: 4

13. Term that refers to a QA procedure that helps spot identification errors by comparing previous

results of the patient to current results: a. Analytic variable b. Chi-square c. Delta check d. Diurnal check ANS: C

A delta check is a QA procedure that helps spot identification errors by comparing previous results of the patient to curT reEnS t rT esBuA ltsN. KSELLER.COM DIF:

Cognitive Level: 1

REF: p. 274

OBJ: 8

14. A blood sample collected from a patient who is standing up will have higher levels of what

analyte compared to samples from a patient who is supine? a. Albumin b. Calcium c. Creatinine d. Urea ANS: A

A blood sample collected from a patient who is standing up will have higher levels of large molecules such as proteins, including enzymes and albumin, as well as higher levels of red and white blood cells.

DIF:

Cognitive Level: 1

REF: p. 274

OBJ: 9

15. Which of the following medications causes a prolonged bleeding time? a. Aspirin b. Accutane c. Benadryl d. Tylenol ANS: A

Aspirin interferes with platelet functioning and, for this reason, prolongs a patient’s bleeding time.

DIF:

Cognitive Level: 1

REF: p. 274

OBJ: 9

16. For a patient on anticoagulant therapy, pressure should be held on a venipuncture site longer

than normal to avoid which of the following complications? a. Compartment syndrome b. Hemolysis c. Infection d. Nerve damage ANS: A

Compartment syndrome can occur as a result of a large amount of bleeding under the skin at the venipuncture site (a small amount of bleeding causes a hematoma). This is more likely to occur in a patient on anticoagulant therapy. The pressure from the tissues prevents blood from flowing and can result in pain and nerve damage.

DIF:

Cognitive Level: 1

REF: p. 274

OBJ: 9

17. A sample drawn for which of the following requires special timing due to diurnal variation in

its blood levels? a. Cortisol b. Hemoglobin c. Potassium d. Sodium ANS: A

Cortisol is a diurnal hormone secreted by the adrenal cortex. It is at its highest level in the morning and lowest in the late afternoon or early evening.

DIF:

Cognitive Level: 1

REF: p. 275

OBJ: 9

18. A blood sample collected from a nonfasting patient may result in a plasma characteristic that

is called what? a. Hemolysis b. Icteric c. Lipemia d. Polycythemia ANS: C

If the patient has eaten, there may be cloudiness in the plasma due to triglycerides. This is known as lipemia.

DIF:

Cognitive Level: 1

REF: p. 275

OBJ: 9

19. Blood levels of which of the following often increase with age? a. Cholesterol and triglycerides b. Electrolytes c. RBC and WBC counts d. Thyroid hormones

ANS: A

Lipid levels often increase with age.

DIF:

Cognitive Level: 1

REF: p. 275

OBJ: 9

20. Values for which of the following are higher in infants than adults? a. Cholesterol and triglycerides b. Electrolytes c. RBC and WBC counts d. Thyroid hormones ANS: C

Cell counts are usually higher in infants than in adults.

DIF:

Cognitive Level: 1

REF: p. 275

OBJ: 9

21. Values for which of the following are higher in patients living at high altitudes? a. Cholesterol and triglycerides b. BUN and creatinine c. Hematocrit and hemoglobin d. Sodium and potassium ANS: C

The hematocrit, hemoglobin, and RBC counts are higher in people living at higher altitudes due to the body’s response to less oxygen in the air. Lower levels of oxygen cause the secretion of the hormone erythropoietin, which increases production of RBCs and hemoglobin. The hematocrit is a measure of the volume of RBCs present in a sample, so it also increases.

DIF:

Cognitive Level: 1

REF: p. 275

OBJ: 9

22. Anxiety can increase levels of which of the following hormones? a. Cortisol from the adrenal cortex b. Estrogen from the ovaries c. ADH from the pituitary gland d. Testosterone from the testes ANS: A

Cortisol is a stress hormone. It is elevated in conditions of stress.

DIF:

Cognitive Level: 1

REF: p. 275

OBJ: 9

23. Which of the following can occur in a blood sample if a patient has been suffering from

prolonged diarrhea or vomiting? a. Compartment syndrome b. Hemoconcentration c. Hemolysis d. Occluded veins ANS: B

Vomiting or prolonged diarrhea can cause dehydration in the patient. Dehydration results in blood that is more concentrated than usual.

DIF:

Cognitive Level: 1

REF: p. 275

OBJ: 9

24. Men have a higher level than women of which analyte? a. Calcium b. Glucose c. Hemoglobin d. Potassium ANS: C

Men have higher levels of hemoglobin and RBCs, and higher hematocrits than women.

DIF:

Cognitive Level: 1

REF: p. 275

OBJ: 9

25. How often should centrifuges be calibrated? a. Every week b. Every month c. Every 3 months d. Every year ANS: C

Centrifuge calibration should be done every 3 months to ensure they are spinning at the proper speed.

DIF:

Cognitive Level: 1

REF: p. 278

OBJ: 18

26. How often should refrigerator and freezer temperatures be recorded? a. Hourly b. Daily c. Weekly d. Monthly ANS: B

Temperatures must be monitored and recorded at least daily. They may be monitored more often if necessary. Blood bank storage refrigerators must be on a continuous monitoring system with an alarm.

DIF:

Cognitive Level: 1

REF: p. 278

OBJ: 19

Chapter 19: Legal Issues in Phlebotomy Warekois et al.: Phlebotomy: Worktext and Procedures Manual, 5th Edition MULTIPLE CHOICE 1. Which of the following types of law is created by a legislative body? a. Administrative law b. Case law c. Public law d. Statutory law ANS: D

Statutory law is created by a legislative body. Case law is determined by court decisions through interpretation of existing law. Administrative law is created by an agency through written regulations. All three are types of public law.

DIF:

Cognitive Level: 1

REF: p. 283

OBJ: 2

2. Which of the following types of law is determined by court decisions through interpretation of

existing law? a. Administrative law b. Case law c. Public law d. Statutory law ANS: B

Case law is law determineT dE byScToB urAt N deKcS isE ioLnsLtEhrRo. ugChOi M n terpretation of existing law.

Statutory law is created by a legislative body. Administrative law is created by an agency through written regulations. All three are types of public law.

DIF:

Cognitive Level: 1

REF: p. 283

OBJ: 2

3. Which of the following types of law is created by an agency through written regulations? a. Administrative law b. Case law c. Public law d. Statutory law ANS: A

Administrative law is created by an agency through written regulations. Case law is determined by court decisions through interpretation of existing law. Statutory law is created by a legislative body. All three are types of public law.

DIF:

Cognitive Level: 1

REF: p. 283

OBJ: 2

4. The violation of which type of law leads to a criminal action? a. Civil law b. Private law c. Public law d. Tort law

ANS: C

A violation of public law leads to a criminal action. A violation of a private law may lead to civil action.

DIF:

Cognitive Level: 1

REF: p. 283

OBJ: 2

5. An unjustifiable attempt to touch another person can lead to what charge? a. Assault b. Battery c. Civil action d. Tort ANS: A

Assault is defined as an unjustifiable attempt to touch another person. The intentional touching of another person without consent is battery. An injury to one person for which another person, who caused the injury, is legally responsible is a tort. A violation of a private law may lead to civil action, whereas a violation of public law leads to a criminal action.

DIF:

Cognitive Level: 1

REF: p. 283

OBJ: 2

6. The intentional touching of another person without consent can lead to what charge? a. Assault b. Battery c. Civil action d. Tort ANS: B

The intentional touching oT f aEnS otThB erApN erKsoSnEw thE ouRt.cC onOsM ent is battery. Assault is defined as an LiL unjustifiable attempt to touch another person. An injury to one person for which another person, who caused the injury, is legally responsible is a tort. A violation of a private law may lead to civil action, whereas a violation of public law leads to a criminal action.

DIF:

Cognitive Level: 1

REF: p. 283

OBJ: 2

7. A violation of a private law may lead to which of the following? a. Assault b. Battery c. Civil action d. Criminal action ANS: C

A violation of a private law may lead to a civil action, whereas a violation of public law leads to a criminal action. An unjustifiable attempt to touch another person is assault. The intentional touching of another person without consent is battery.

DIF:

Cognitive Level: 1

REF: p. 283

OBJ: 3

8. Which of the following is the term for an injury to one person for which another person, who

caused the injury, is legally responsible? a. Assault b. Battery c. Criminal action

d. Tort ANS: D

An injury to one person for which another person, who caused the injury, is legally responsible is a tort. A violation of a public law leads to a criminal action. A violation of a private law may lead to civil action. An unjustifiable attempt to touch another person is assault. The intentional touching of another person without consent is battery.

DIF:

Cognitive Level: 1

REF: pp. 283-284

OBJ: 3

9. Which of the following is the legal basis for most medical malpractice cases? a. Assault b. Battery c. Intentional tort d. Unintentional tort ANS: D

An unintentional tort is an unintentional injury to one person for which another person, who caused the injury, is legally responsible. This is the legal basis for most medical malpractice cases.

DIF:

Cognitive Level: 1

REF: p. 284

OBJ: 3

10. Which of the following is the legal term for a person claiming to have been harmed? a. Defendant b. Felon c. Plaintiff d. Victim ANS: C

The legal term for a person claiming to have been harmed is plaintiff. Victim is not a legal term. The defendant is the person who is claimed to have caused the harm.

DIF:

Cognitive Level: 1

REF: p. 283

OBJ: 3

11. What does the term “liable” mean? a. Legally responsible b. Likely to take c. Properly trained for d. Assigned to an individual ANS: A

The term “liable” means legally responsible.

DIF:

Cognitive Level: 1

REF: p. 284

OBJ: 4

12. Which of the following terms refers to the agreement of medical opinion on appropriate

patient care in a given situation? a. Accepted standard of care b. Best care available c. Correct care d. Consensus care

ANS: A

The accepted standard of care is the legal term that refers to the agreement of medical opinion on appropriate patient care in a particular situation.

DIF:

Cognitive Level: 1

REF: p. 285

OBJ: 5

13. Which of the following terms represents the failure to perform an action that is consistent with

the accepted standard of care? a. Assault b. Dereliction c. Liability d. Negligence ANS: D

Negligence is the failure to perform an action that is consistent with the accepted standard of care.

DIF:

Cognitive Level: 1

REF: p. 285

OBJ: 5

14. What is the legal term for the delivery of substandard care that results in harm to a patient? a. Damages b. Duty c. Liability d. Malpractice ANS: D

The delivery of substandard care that results in harm to a patient is malpractice.

DIF:

Cognitive Level: 1

REF: p. 285

OBJ: 6

15. When drawing blood, the usual standard of care is to perform a maximum of how many

unsuccessful punctures before calling for assistance? a. One b. Two c. Three d. Five ANS: B

The standard at most institutions for maximum unsuccessful venipunctures before calling for assistance is two.

DIF:

Cognitive Level: 1

REF: p. 285

OBJ: 5

16. In addition to good practice, what is one of the most important defenses against malpractice? a. Clear, complete medical records b. A good lawyer c. Proper training d. Witnesses ANS: A

Clear, complete medical records documenting all care given are the best defense against malpractice.

DIF:

Cognitive Level: 1

REF: p. 286

OBJ: 8

17. Which of the following is a violation of PHI (protected health information), as provided by

HIPAA? a. Requiring written consent to release medical records b. Discussing information concerning a patient with the patient’s nurse c. Asking patients whether they take anticoagulants d. Discussing a patient’s results with another laboratory worker in the cafeteria ANS: D

Protected health information cannot be released without consent of the patient. Discussing patient results where the conversation can be overheard by individuals not involved in the patient’s care is a violation of HIPAA. DIF:

Cognitive Level: 2

REF: p. 287

OBJ: 10

18. What is the term for medical information that is linked to a specific patient? a. Confidential health information b. Private information c. Protected health information d. Potable health information ANS: C

Medical information that is linked to a specific patient is called PHI (protected health information).

DIF: Cognitive Level: 1

p . R28.7COM TESTBANKSREEFL: LE

OBJ: 10

19. Who created the Patient Care Partnership? a. Joint Commission b. Center for Disease Control c. OSHA d. American Hospital Association ANS: D

The Patient Care Partnership was created by the American Hospital Association.

DIF:

Cognitive Level: 1

REF: p. 283

OBJ: 1

20. What is the term given to the period of time allowed to file a civil action? a. File time b. Statute of limitations c. Allotted law time d. Duration of action ANS: B

The period of time allowed to file a civil action is called the Statute of limitations.

DIF:

Cognitive Level: 1

REF: p. 284

21. What type of consent is acceptable in emergency situations?

OBJ: 3

a. b. c. d.

Implied consent Written consent Explained consent Informed consent

ANS: A

In emergency situations, it is acceptable to use implied consent as the form of consent.

Obtaining written, explained, and informed consent may not be possible in an emergency situation.

DIF:

Cognitive Level: 2

REF: p. 287

OBJ: 8

22. Which of the following is not considered PHI? a. Patient diagnosis b. Provider notes c. Accession number d. Patient payments ANS: C

PHI includes any information that is linked to other information that would identify the patient such as date of birth, social security number, address, medical and billing information, diagnosis of disease, provider notes in insurance filing, and patient payments. An identifier that describes a sample such as an accession number on its own is not considered PHI. DIF:

Cognitive Level: 2

REF: p. 287

OBJ: 10

23. Which of the following is not a penalty for HIPAA violation? a. Prison time terms b. Monetary fines c. Loss of job d. Liability ANS: D

Penalties issued by issued by the Department of Health and Human Services’ Office for Civil Rights (OCR) and state attorneys general for violating HIPAA include monetary fines and if found to be criminally liable, prison time. You can be fired from your job for violating HIPAA policies and procedures at your place of employment.

DIF:

Cognitive Level: 2

REF: p. 287

OBJ: 10

This Page is Intentionally Left Blank

This Page is Intentionally Left Blank