Test Bank for Phlebotomy Essentials Eighth Edition Ruth E. McCall

TEST BANK FOR Phlebotomy Essentials Eighth Edition Ruth E. McCall Chapter 1-14

Chapter 1 Multiple Choice 1. Phlebotomy is defined as: A. the collection of blood specimens.

B. a technique for performing venipuncture.

C. an incision into a vein.

D. the practice of “bloodletting.”

ANS: C KEY: Topic: Phlebotomy general DIF: Level 1 Learning Objective: 1.2

2. Duties of a phlebotomist include all of the following except: A. transporting specimens.

B. interacting with hospital personnel.

C. transporting patients.

D. processing specimens.

ANS: C KEY: Topic: Phlebotomy general DIF: Level 1 Learning Objective: 1.1

3. The specimen collected by a phlebotomist is: A. amniotic fluid.

B. cerebrospinal fluid.

C. synovial fluid.

D. blood.

ANS: D KEY: Topic: Phlebotomy general DIF: Level 1 Learning Objective: 1.9 4. A phlebotomist who is teaching members of the nursing service how to correctly perform phlebotomy is participating in: A. accreditation.

B. certification.

C. cross-training.

D. both A and C. ANS: C KEY: Topic: Phlebotomy general DIF: Level 2 Learning Objective: 1.1

5. The goal of patient-focused care is to: A. facilitate collection of acceptable blood specimens.

B. increase the efficiency of personnel.

C. provide additional phlebotomy training.

D. increase the number of personnel on the nursing unit.

ANS: B KEY: Topic: Phlebotomy work settings DIF: Level 1 Learning Objective: 1.1

6. The health-care setting in which most phlebotomists are employed is: A. blood donor center.

B. physician office laboratory.

C. reference laboratory.

D. hospital.

ANS: D KEY: Topic: Phlebotomy work settings DIF: Level 1 Learning Objective: 1.12

7. A phlebotomist working in a laboratory that has decentralized the phlebotomy department may be required to: A. work primarily on a patient-care unit.

B. transport patients from a hospital unit to the laboratory.

C. perform point-of-care testing.

D. both A and C. ANS: D KEY: Topic: Phlebotomy work settings DIF: Level 2 Learning Objective: 1.1

8. Additional duties a phlebotomist may perform due to decentralization include all of the following except: A. performing an electrocardiogram.

B. measuring a patient’s blood pressure.

C. collecting arterial blood specimens.

D. performing patient coding and billing procedures.

ANS: D KEY: Topic: Phlebotomy work settings DIF: Level 2 Learning Objective: 1.1

9. A laboratory that performs highly specialized laboratory testing is a: A. reference laboratory.

B. physician’s office.

C. wellness clinic.

D. long-term care facility.

ANS: A KEY: Topic: Phlebotomy work settings DIF: Level 2 Learning Objective: 1.12

10. All of the following are components of communication except: A. body language.

B. verbal skills.

C. technical skills.

D. listening skills.

ANS: C KEY: Topic: Phlebotomist characteristics DIF: Level 1 Learning Objective: 1.4

11. Before placing a call on hold, a phlebotomist should: A. record the caller’s name.

B. check to see if it is an emergency.

C. transfer the call to the phlebotomy supervisor.

D. tell the caller his or her name.

ANS: B KEY: Topic: Phlebotomist characteristics

DIF: Level 1 Learning Objective: 1.7

12. A phlebotomist who takes an examination offered by a professional phlebotomy organization is seeking: A. certification.

B. registration.

C. accreditation.

D. licensure.

ANS: A KEY: Topic: Phlebotomist characteristics DIF: Level 1 Learning Objective: 1.2 13. A phlebotomist who is authorized to place the initials “PBT(ASCP)” after his or her name has been: A. licensed.

B. accredited.

C. registered.

D. certified.

ANS: D KEY: Topic: Phlebotomist characteristics DIF: Level 1 Learning Objective: 1.2

14. When communicating with a patient who is hearing impaired, it is important to: A. use medical terminology.

B. look directly at the patient and speak clearly.

C. locate a family member.

D. perform the procedure without talking.

ANS: B KEY: Topic: Phlebotomist characteristics DIF: Level 1 Learning Objective: 1.3

15. The most important characteristic to ensure job security and advancement in phlebotomy is: A. speaking slowly and clearly.

B. flexibility.

C. smiling.

D. speaking a second language.

ANS: B KEY: Topic: Phlebotomist characteristics DIF: Level 1 Learning Objective: 1.2

16. All of the following organizations provide a phlebotomist certification examination except: A. American Society of Clinical Pathology (ASCP).

B. American Medical Technologists (AMT).

C. American Society of Phlebotomy Technicians (ASPT).

D. The Joint Commission (TJC).

ANS: D KEY: Topic: Phlebotomist characteristics DIF: Level 1 Learning Objective: 1.2

17. A competent professional demeanor is shown by: A. neatness and cleanliness.

B. courtesy and cheerfulness.

C. pleasantness.

D. all of the above.

ANS: D KEY: Topic: Phlebotomist characteristics DIF: Level 1 Learning Objective: 1.2

18. A patient calls the laboratory to schedule an appointment for a chest x-ray. The phlebotomist should: A. record the patient’s name and phone number.

B. tell the patient to call radiology.

C. put the call on hold and call radiology.

D. give the caller radiology’s number and transfer the call.

ANS: D KEY: Topic: Phlebotomist characteristics DIF: Level 2 Learning Objective: 1.7

19. The hospital department that performs computerized axial tomography is: A. physical therapy.

B. radiology.

C. nuclear medicine.

D. cardiovascular testing.

ANS: B KEY: Topic: Healthcare organization DIF: Level 1 Learning Objective: 1.11

20. The department of the hospital that performs electrocardiograms (ECGs) and stress tests is: A. respiratory therapy.

B. radiology.

C. electrocardiography.

D. pharmacy.

ANS: C KEY: Topic: Healthcare organization DIF: Level 1 Learning Objective: 1.11

21. The department of the hospital that treats breathing disorders is: A. nuclear medicine.

B. physical therapy.

C. occupational therapy.

D. respiratory therapy.

ANS: D KEY: Topic: Healthcare organization DIF: Level 1 Learning Objective: 1.11

22. The physical therapy department specializes in: A. treating with water, heat, and exercise.

B. performing arterial blood gases.

C. dispensing medications and drugs.

D. performing biopsies.

ANS: A KEY: Topic: Healthcare organization DIF: Level 1 Learning Objective: 1.11

24. The hospital department that uses radionucleotides in diagnosing and treating disease is: A. radiation therapy.

B. nuclear medicine.

C. pharmacy.

D. electroencephalography.

ANS: B KEY: Topic: Healthcare organization DIF: Level 1 Learning Objective: 1.11

25. The department of the hospital that is the consultant on drug therapy is: A. radiology.

B. physical therapy.

C. electrocardiography.

D. pharmacy.

ANS: D KEY: Topic: Healthcare organization DIF: Level 1 Learning Objective: 1.11

26. The health-care professional who provides rehabilitating activities for patients with physical and mental disabilities is a(an): A. oncologist.

B. occupational therapist.

C. respiratory therapist.

D. nuclear medicine therapist.

ANS: B KEY: Topic: Healthcare organization DIF: Level 1 Learning Objective: 1.11

27. Phlebotomists should observe radiation precautions in all of the following departments except: A. physical therapy.

B. nuclear medicine.

C. radiation therapy.

D. diagnostic imaging.

ANS: A KEY: Topic: Healthcare organization DIF: Level 2 Learning Objective: 1.11

28. In which of the following patient care areas would the phlebotomist encounter the youngest patient?

A. Pediatrics.

B. Dialysis unit.

C. Nursery.

D. Neonatal nursery.

ANS: D KEY: Topic: Healthcare organization DIF: Level 2 Learning Objective: 1.11

29. Nontraditional or newer duties for the phlebotomist include all of the following except: A. collecting arterial blood specimens.

B. performing validation studies of point-of-care testing.

C. monitoring the quality of specimens collected.

D. performing patient tests using point-of-care testing.

ANS: B KEY: Topic: Phlebotomy general DIF: Level 2 Learning Objective: 1.1

30. A phlebotomist should minimize his or her use of perfumes and colognes because: A. patients may be allergic to certain fragrances.

B. perfumes and colognes may be prohibited by certain religions.

C. laboratory instruments may be affected by some fragrances.

D. perfumes and colognes may interfere with blood gas analysis results.

ANS: A KEY: Topic: Phlebotomy general DIF: Level 2

Learning Objective: 1.2

31. Which of the following is a valid reason to discourage phlebotomists from wearing long or dangling jewelry, including earrings?

A. Patients may confuse these with religious symbols and become uncomfortable.

B. Reflections from these may interfere with patient monitoring equipment.

C. These kinds of jewelry may contribute significantly to fatigue in the phlebotomist.

D. Such jewelry can be grabbed by a patient or become tangled in printers.

ANS: D KEY: Topic: Phlebotomy general DIF: Level 2 Learning Objective: 1.2

32. Upon the successful completion of a structured phlebotomy education program, the phlebotomist will have the opportunity to become: A. accredited.

B. validated.

C. certified.

D. inspected.

ANS: C KEY: Topic: Phlebotomy general DIF: Level 2 Learning Objective: 1.2

33. Failure to appear or late arrival by a phlebotomist can be characterized as: A. competent.

B. committed .

C. respectful.

D. undependable.

ANS: D KEY: TOPIC: Professionalism DIF: 1 Learning Objective: 1.2

34. All of the following are professional characteristics except:

A. working an extra shift when a colleague calls in sick.

B. wearing a wrinkled uniform.

C. being sensitive to a patient’s concerns.

D. protecting patient confidentiality.

ANS: B KEY: TOPIC: Professionalism DIF: 2 Learning Objective: 1.2

35. Which of the following is not true about the Health Insurance Portability and Accountability Act (HIPAA)?

A. Its primary goal is to protect the confidentiality of protected health information.

B. Health-care providers must obtain written consent to release patient information.

C. It is a federal law that was developed in 1996.

D. Violation of a HIPAA law can result in termination of employment.

ANS: C KEY: TOPIC: Professionalism DIF: 2 Learning Objective: 1.9

Matching

Match the following patient care areas with its description.

A. Acute cardiac disorders B. Children C. Newborns experiencing difficulty D. Postoperative patients E. Renal disorders

36. Critical care unit (CCU) 37. Recovery room 38. Neonatal nursery 39. Pediatrics 40. Dialysis unit

36. ANS: A KEY: Topic: Healthcare organization DIF: Level 1 Learning Objective: 1.11

37. ANS: D KEY: Topic: Healthcare organization DIF: Level 1 Learning Objective: 1.11

38. ANS: C KEY: Topic: Healthcare organization DIF: Level 1 Learning Objective: 1.11

39. ANS: B KEY: Topic: Healthcare organization DIF: Level 1 Learning Objective: 1.11

40. ANS: E KEY: Topic: Healthcare organization DIF: Level 1 Learning Objective: 1.11

Matching

Match the following hospital departments with the service area in which they are located.

A. Fiscal services B. Nursing services C. Professional services D. Support services

41. Purchasing 42. Physical therapy 43. Operating room 44. Admitting

41. ANS: D KEY: Topic: Healthcare organization DIF: Level 1 Learning Objective: 1.11

42. ANS: C KEY: Topic: Healthcare organization DIF: Level 1 Learning Objective: 1.11

43. ANS: B KEY: Topic: Healthcare organization DIF: Level 1 Learning Objective: 1.11

44. ANS: A KEY: Topic: Healthcare organization DIF: Level 1 Learning Objective: 1.11

Short Answers

45. Describe the three components of effective communication.

ANS: See Chapter 1, Page 7 KEY: Topic: Communication DIF: 1 Learning Objective: 1.4

46. State six rules of proper telephone etiquette.

ANS: See Chapter 1, Page 10 KEY: Topic: Communication DIF: 1 Learning Objective: 1.7

47. Describe the different health-care settings in which a phlebotomist may be employed.

ANS: See Chapter 1, Pages 13-18 KEY: Topic: Health care settings DIF: 1 Learning Objective: 1.12

48. Discuss the differences between certification and accreditation.

ANS: See Chapter 1, Pages 10-11 KEY: Topic: Professionalism DIF: 1 Learning Objective: 1.2 49. List some barriers to communication and how to overcome them.

ANS: See Chapter 1, pages 7-8 KEY: Communication DIF: 2 Learning Objective: 1.5

Chapter 2

Multiple Choice

1. The laboratory employee with a 2-year associate degree who performs clinical testing is the: A. medical laboratory technician.

B. clinical laboratory scientist.

C. phlebotomist.

D. medical technologist.

ANS: A KEY: Topic: Clinical laboratory employees

DIF: Level 1 Learning Objective: 2.2

2. The laboratory employee who prepares surgical specimen samples for microscopic examination is the: A. microbiologist.

B. histologist.

C. cytologist.

D. clinical laboratory technician.

ANS: B KEY: Topic: Clinical laboratory employees

DIF: Level 1 Learning Objective: 2.2

3. The primary liaison between the medical staff and the laboratory staff is the: A. laboratory manager.

B. pathologist.

C. section supervisor.

D. cytologist.

ANS: B KEY: Topic: Clinical laboratory employees

DIF: Level 1 Learning Objective: 2.2

4. The specialist in the study of disease of tissues and organs through biopsies is a(an):

A. internist.

B. cardiologist.

C. pathologist.

D. endocrinologist.

ANS: C KEY: Topic: Clinical laboratory employees

DIF: Level 1 Learning Objective: 2.2

5. The laboratory employee with a 4-year college degree who performs clinical analysis is the: A. phlebotomist.

B. medical laboratory technician (MLT).

C. medical laboratory scientist (MLS).

D. clinical laboratory assistant (CLA).

ANS: C KEY: Topic: Clinical laboratory employees

DIF: Level 1 Learning Objective: 2.2

6. A medical technologist may serve as all of the following except: A. educator.

B. laboratory manager.

C. pathologist.

D. section supervisor.

ANS: C KEY: Topic: Clinical laboratory employees

DIF: Level 2 Learning Objective: 2.2

7. The two major areas of the clinical laboratory are: A. chemistry and hematology.

B. cytology and histology.

C. anatomical and clinical.

D. urinalysis and microbiology.

ANS: C KEY: Topic: Clinical laboratory sections

DIF: Level 1 Learning Objective: 2.1

8. Another name for the blood bank is: A. immunology.

B. serology.

C. compatibility.

D. immunohematology.

ANS: D KEY: Topic: Clinical laboratory sections

DIF: Level 1 Learning Objective: 2.3

9. Mycology is the study of: A. fungi.

B. bacteria.

C. parasites.

D. microbiology.

ANS: A KEY: Topic: Clinical laboratory sections

DIF: Level 1 Learning Objective: 2.3

10. A cardiac risk profile is performed in: A. hematology.

B. serology.

C. coagulation.

D. chemistry.

ANS: D KEY: Topic: Clinical laboratory sections

DIF: Level 1 Learning Objective: 2.5

11. The histology department is included in: A. clinical chemistry.

B. immunohematology.

C. microbiology.

D. anatomical pathology.

ANS: D KEY: Topic: Clinical laboratory sections

DIF: Level 1 Learning Objective: 2.1

12. The laboratory department responsible for frozen sections is: A. microbiology.

B. cytology.

C. cytogenetics.

D. histology.

ANS: D KEY: Topic: Clinical laboratory sections

DIF: Level 1 Learning Objective: 2.1

13. The difference between plasma and serum is that: A. serum contains fibrinogen.

B. serum is obtained from a nonclotted specimen.

C. plasma is obtained from a clotted specimen.

D. plasma contains fibrinogen.

ANS: D KEY: Topic: Clinical laboratory specimens

DIF: Level 2 Learning Objective: 2.4

14. Which of the following tests should be returned to the laboratory first to ensure accurate results?

A. Prothrombin time.

B. Blood group and type.

C. Complete blood count.

D. Blood culture.

ANS: A KEY: Topic: Clinical laboratory specimens

DIF: Level 2 Learning Objective: 2.4

15. Specimens collected in serum separator tubes are most frequently delivered to: A. blood bank.

B. serology.

C. hematology.

D. chemistry.

ANS: D KEY: Topic: Clinical laboratory specimens

DIF: Level 1 Learning Objective: 2.4

16. To prevent blood from clotting, the specimen must be: A. collected in a tube containing an anticoagulant.

B. inverted right after collection.

C. centrifuged right after collection.

D. both A and B. ANS: D KEY: Topic: Clinical laboratory specimens

DIF: Level 2 Learning Objective: 2.4

17. The most common specimen analyzed in the hematology section is: A. plasma.

B. whole blood.

C. urine.

D. serum.

ANS: B KEY: Topic: Clinical laboratory specimens

DIF: Level 1 Learning Objective: 2.4

18. Which of the following pairings is wrong?

A. Icteric and yellow.

B. Lipemic and cloudy.

C. Hemolyzed and red.

D. Fasting and cloudy.

ANS: D KEY: Topic: Clinical laboratory specimens

DIF: Level 2 Learning Objective: 2.4

19. A serum separator tube should not be collected for: A. cholesterol.

B. cross-match.

C. bilirubin.

D. glucose.

ANS: B KEY: Topic: Clinical laboratory specimens

DIF: Level 2 Learning Objective: 2.4

20. The main anticoagulant for coagulation studies is: A. ethylenediaminetetraacetic acid (EDTA).

B. sodium citrate.

C. heparin.

D. oxalate.

ANS: B KEY: Topic: Clinical laboratory specimens

DIF: Level 2 Learning Objective: 2.4

21. Types of specimens collected for urinalysis include all of the following except: A. isolation.

B. random.

C. first morning.

D. clean-catch.

ANS: A KEY: Topic: Clinical laboratory specimens

DIF: Level 2

Learning Objective: 2.4

22. Each of the following is a component of the complete blood count (CBC) except: A. white blood cell count.

B. hemoglobin.

C. sedimentation rate.

D. differential.

ANS: C KEY: Topic: Clinical laboratory tests

DIF: Level 1 Learning Objective: 2.5

23. The routine urinalysis consists of all of the following except: A. physical examination.

B. culture and sensitivity.

C. reagent strip testing.

D. microscopic examination.

ANS: B KEY: Topic: Clinical laboratory tests

DIF: Level 1 Learning Objective: 2.5

24. A blood culture to evaluate septicemia is performed in: A. hematology.

B. microbiology.

C. urinalysis.

D. toxicology.

ANS: B KEY: Topic: Clinical laboratory tests

DIF: Level 1 Learning Objective: 2.5

25. An elevated bilirubin might indicate a disorder of the: A. heart.

B. kidney.

C. brain.

D. liver.

ANS: D KEY: Topic: Clinical laboratory tests

DIF: Level 2 Learning Objective: 2.5

26. A rapid plasma reagin (RPR) test is performed in: A. chemistry.

B. serology.

C. hematology.

D. urinalysis.

ANS: B KEY: Topic: Clinical laboratory tests

DIF: Level 1 Learning Objective: 2.5

27. The direct antiglobulin test is performed in: A. microbiology.

B. hematology.

C. serology.

D. blood bank.

ANS: D KEY: Topic: Clinical laboratory tests

DIF: Level 1 Learning Objective: 2.5

28. ABO and Rhesus (Rh) typing are performed in which laboratory section?

A. Hematology.

B. Blood bank.

C. Chemistry.

D. Cytology.

ANS: B KEY: Topic: Clinical laboratory tests

DIF: Level 1 Learning Objective: 2.5

29. The activated partial thromboplastin time (APTT) or partial thromboplastin time (PTT) test is performed in: A. coagulation.

B. chemistry.

C. urinalysis.

D. histology.

ANS: A KEY: Topic: Clinical laboratory tests

DIF: Level 1 Learning Objective: 2.5

30. Electrophoresis is performed in: A. cytology.

B. microbiology.

C. histology.

D. chemistry.

ANS: D KEY: Topic: Clinical laboratory tests

DIF: Level 1 Learning Objective: 2.5

31. People with diabetes mellitus are monitored using blood tests for glucose and: A. phosphorus.

B. hemoglobin A1C. C. uric acid.

D. bilirubin.

ANS: B KEY: Topic: Clinical laboratory tests

DIF: Level 2 Learning Objective: 2.5

32. All of the following are tests that measure cardiac risk except: A. alkaline phosphatase.

B. cholesterol.

C. triglycerides.

D. high-density lipids.

ANS: A KEY: Topic: Clinical laboratory tests

DIF: Level 2 Learning Objective: 2.5

33. Tests associated with pancreatitis are: A. calcium and phosphorus.

B. blood urea nitrogen (BUN) and glucose.

C. bilirubin and ammonia.

D. amylase and lipase.

ANS: D KEY: Topic: Clinical laboratory tests

DIF: Level 2 Learning Objective: 2.5

34. Tests for ketones, urobilinogen, nitrite, and pH are part of a: A. general health profile.

B. complete blood count.

C. urinalysis.

D. ova and parasites examination.

ANS: C KEY: Topic: Clinical laboratory tests

DIF: Level 2 Learning Objective: 2.5

35. Which test would a physician order on a patient with a suspected infection?

A. Glucose.

B. Complete blood count (CBC).

C. Cholesterol.

D. Antinuclear antibody (ANA).

ANS: B KEY: Topic: Clinical laboratory tests

DIF: Level 2 Learning Objective: 2.5

36. A chemistry test to evaluate kidney function is the: A. complete blood count (CBC).

B. glucose tolerance test (GTT).

C. blood urea nitrogen (BUN).

D. creatine kinase (CK) or creatine phosphokinase (CPK).

ANS: C KEY: Topic: Clinical laboratory tests

DIF: Level 2 Learning Objective: 2.5

37. A test that monitors an antidepressant medication is: A. creatine kinase (CK) or creatine phosphokinase (CPK).

B. blood urea nitrogen (BUN).

C. lithium.

D. alanine transaminase (ALT).

ANS: C KEY: Topic: Clinical laboratory tests

DIF: Level 2 Learning Objective: 2.5

38. An anemia is detected by a: A. glucose test.

B. blood culture.

C. urinalysis.

D. complete blood count.

ANS: D KEY: Topic: Clinical laboratory tests

DIF: Level 2 Learning Objective: 2.5

39. Sodium (Na), potassium (K), chloride (Cl), and carbon dioxide (CO2) are components of the test called: A. glucose tolerance.

B. electrolytes.

C. liver profile.

D. cardiac profile.

ANS: B KEY: Topic: Clinical laboratory tests

DIF: Level 2 Learning Objective: 2.5

40. Choose the hematology test that might be ordered to give additional information to the health-care provider caring for a patient with anemia. The patient has already had hemoglobin and hematocrit tests done, both separately and as part of a complete blood count.

A. Erythrocyte sedimentation rate (ESR).

B. Reticulocyte (Retic) count.

C. Eosinophil count.

D. Kleihauer-Betke.

ANS: B KEY: Topic: Clinical laboratory tests

DIF: Level 3 Learning Objective: 2.5

41. Choose the coagulation test that is used to monitor patients receiving Coumadin therapy.

A. Activated partial thromboplastin time (APTT).

B. Bleeding time (BT).

C. Prothrombin time (PT).

D. Platelet aggregation.

ANS: C KEY: Topic: Clinical laboratory tests

DIF: Level 2 Learning Objective: 2.5

42. Which of the following urine types is the most concentrated?

A. Random.

B. 24-hour.

C. First morning.

D. Catheterized.

ANS: C KEY: TOPIC: specimen collection

DIF: Level 2 Learning Objective: 2.4

43. Phlebotomists may be allowed to collect or instruct patients regarding the following microbiological specimens except: A. blood cultures.

B. throat cultures.

C. urine cultures.

D. wound cultures.

ANS: D KEY: TOPIC: specimen collection DIF: 2 Learning Objective: 2.4

Matching Match the following laboratory procedures with the section that performs them. Answers may be used more than once.

A. Blood bank B. Chemistry C. Coagulation D. Hematology E. Microbiology F. Serology 44. Activated partial thromboplastin time (APTT) 45. Gram stain 46. Rapid plasma reagin (RPR) 47. Antibody screen 48. Lead 49. Monospot 50. Lithium 51. D-dimer 52. Sickledex 53. Type and crossmatch 44. ANS: C KEY: Topic: Clinical laboratory sections

DIF: Level 1 Learning Objective: 2.5

45. ANS: E KEY: Topic: Clinical laboratory sections

DIF: Level 1 Learning Objective: 2.5

46. ANS: F KEY: Topic: Clinical laboratory sections

DIF: Level 1 Learning Objective: 2.5

47. ANS: A KEY: Topic: Clinical laboratory sections

DIF: Level 1 Learning Objective: 2.5

48. ANS: B KEY: Topic: Clinical laboratory sections

DIF: Level 1 Learning Objective: 2.5

49. ANS: F KEY: Topic: Clinical laboratory sections

DIF: Level 1 Learning Objective: 2.5

50. ANS: B KEY: Topic: Clinical laboratory sections

DIF: Level 1 Learning Objective: 2.5

51. ANS: C KEY: Topic: Clinical laboratory sections

DIF: Level 1 Learning Objective: 2.5

52. ANS: D KEY: Topic: Clinical laboratory sections

DIF: Level 1 Learning Objective: 2.5

53. ANS: A KEY: Topic: Clinical laboratory sections

DIF: Level 1 Learning Objective: 2.5

Short Answers

54. Describe the qualifications and functions of the personnel employed by the clinical laboratory.

ANS: See Chapter 2, Pages 24-27 KEY: Topic: Laboratory personnel DIF: Level 1 Learning Objective: 2.2

55. Explain the difference between plasma and serum and how you would collect to obtain both specimens.

ANS: The liquid portion of blood is called plasma and is obtained from a specimen that has been collected in a tube containing an anticoagulant. Plasma contains fibrinogen. Serum is the liquid portion of blood that does not contain fibrinogen (plasma minus fibrinogen) and is collected by drawing a tube that does not have a coagulant because the specimen needs to clot.

KEY: Topic: Clinical laboratory tests DIF: Level 2 Learning Objective: 2.4

56. Discuss the three areas the chemistry department is divided into. Provide the type of testing that is performed in each of the areas.

ANS: The three areas of chemistry are electrophoresis, toxicology, and immunochemistry. The electrophoresis area performs hemoglobin and protein electrophoreses. The toxicology area performs therapeutic drug monitoring and the identification of drugs of abuse. Immunochemistry uses enzyme immunoassay techniques to measure substances such as thyroid hormones, cortisol, and vitamin B12.

KEY: Topic: Clinical laboratory sections DIF: Level 1 Learning Objective: 2.3

Essays

57. Discuss the two main divisions of the laboratory and list the subsections within each of these divisions. Provide two tests performed in each subsection listed.

ANS: The two main divisions of the laboratory are anatomical and clinical. Anatomical is then divided up into the cytology and histology sections. Pap and Thin Prep tests are performed in cytology, whereas biopsies and frozen sections are performed in histology.

The clinical laboratory is divided into the following sections (answers may vary in the “two tests performed” section of the essay): Chemistry Hematology Coagulation Microbiology Immunohematology (Blood Bank) Serology (Immunology) Urinalysis KEY: Topic: Clinical laboratory sections

DIF: Level 2 Learning Objective: 2.5 Chapter 3

Multiple Choice

1. To complete the chain of infection, all of the following are required except a: A. source.

B. contaminated surface.

C. mode of transmission.

D. host.

ANS: B KEY: Topic: Chain of infection

DIF: Level 1 Learning Objective: 3.1

2. An infection contracted by a patient while in the hospital is termed: A. antibiotic resistant.

B. staphylococcal.

C. healthcare-associated infection.

D. biological hazard.

ANS: C KEY: Topic: Biologic hazards

DIF: Level 1 Learning Objective: 3.2

3. Transmission-based precaution isolation categories include all of the following except: A. blood and body fluids.

B. contact.

C. airborne.

D. droplet.

ANS: A KEY: Topic: Chain of infection

DIF: Level 1 Learning Objective: 3.8

4. Personal protective equipment (PPE) should be removed: A. before leaving an isolation room.

B. without touching the outside of the PPE. C. before double-bagging the specimen.

D. without touching the inside of the PPE.

ANS: B KEY: Topic: Personal Protective Equipment

DIF: Level 1 Learning Objective: 3.5

5. A patient with tuberculosis would be placed in: A. protective isolation.

B. body fluid isolation.

C. droplet isolation.

D. airborne isolation.

ANS: D KEY: Topic: Types of isolation

DIF: Level 1 Learning Objective: 3.8

6. Specimens collected from patients in contact isolation should be: A. collected in duplicate.

B. double-bagged.

C. delivered to microbiology.

D. collected wearing sterile gloves.

ANS: B KEY: Topic: Biologic hazards

DIF: Level 1 Learning Objective: 3.8

7. The recommended disinfectant for blood and body fluid contamination is: A. sodium hydroxide.

B. antimicrobial soap.

C. hydrogen peroxide.

D. sodium hypochlorite.

ANS: D KEY: Topic: Biologic hazards

DIF: Level 1 Learning Objective: 3.9

8. An employer who fails to provide sufficient personal protective equipment (PPE) for employees may be fined by the: A. Occupational Safety and Health Administration (OSHA).

B. Centers for Disease Control and Prevention (CDC).

C. Clinical and Laboratory Standards Institute (CLSI).

D. Food and Drug Administration (FDA).

ANS: A KEY: Topic: Personal Protective Equipment

DIF: Level 1 Learning Objective: 3.10

9. Antibody titers are performed on phlebotomists to detect immunity to all of the following except: A. tetanus.

B. hepatitis B. C. rubella.

D. chicken pox.

ANS: A KEY: Topic: Biologic hazards

DIF: Level 1 Learning Objective: 3.11

10. The term standard precautions refers to: A. universal blood donors.

B. mixing organic chemicals under a hood.

C. wellness clinics available to everyone.

D. treating all specimens as infectious.

ANS: D KEY: Topic: Biologic hazards

DIF: Level 1 Learning Objective: 3.6

11. Biohazardous materials include all of the following except: A. organic chemicals.

B. plasma.

C. wound cultures.

D. cerebrospinal fluid.

ANS: A KEY: Topic: Biologic hazards

DIF: Level 1 Learning Objective: 3.10

12. The first thing a phlebotomist should do when preparing to enter an isolation room is: A. put on gloves.

B. read the isolation sign.

C. assemble the equipment.

D. check with the nursing station.

ANS: B KEY: Topic: Types of isolation

DIF: Level 1 Learning Objective: 3.8

13. The purpose of protective isolation is to protect: A. a compromised patient from infection.

B. the phlebotomist after a needlestick.

C. the patient from family conflicts.

D. the phlebotomist from infection.

ANS: A KEY: Topic: Types of isolation

DIF: Level 1 Learning Objective: 3.8

14. Proper handwashing includes all of the following except: A. rubbing to create a lather.

B. using warm water.

C. rinsing hands in a downward position.

D. using a paper towel to turn the water on.

ANS: D KEY: Topic: Protective procedures

DIF: Level 1 Learning Objective: 3.3

15. The document designed to protect phlebotomists from contacting hepatitis is the: A. Safety Data Sheets.

B. Chemical Hygiene Plan.

C. procedure manual.

D. Bloodborne Pathogen Exposure Control Plan.

ANS: D KEY: Topic: Protective procedures

DIF: Level 1 Learning Objective: 3.10

16. A phlebotomist draws an outpatient without wearing gloves. The outpatient displays a badge and cites the laboratory for not following the law. The outpatient is an employee of the: A. Centers for Disease Control and Prevention (CDC).

B. National Fire Protection Association (NFPA).

C. Occupational Safety and Health Administration (OSHA).

D. The Joint Commission (TJC).

ANS: C KEY: Topic: Protective procedures

DIF: Level 1 Learning Objective: 3.10

17. In addition to changing gloves between every patient, phlebotomists should also: A. change their laboratory coats.

B. disinfect the phlebotomy tray.

C. double-bag the specimens.

D. sanitize their hands.

ANS: D KEY: Topic: Protective procedures

DIF: Level 2 Learning Objective: 3.7

18. Personal protective equipment (PPE) should be put on in the following order: A. gloves, gown, and mask.

B. mask, gloves, and gown.

C. gown, mask, and gloves.

D. gloves, mask, and gown.

ANS: C KEY: Topic: Personal Protective Equipment

DIF: Level 2 Learning Objective: 3.5

19. A phlebotomist who observes a rash on the hands when gloves are removed: A. should avoid washing hands in warm water.

B. may have developed a latex allergy.

C. should report this to a supervisor.

D. both B and C. ANS: D KEY: Topic: Personal Protective Equipment

DIF: Level 2 Learning Objective: 3.4

20. Phlebotomists may easily encounter a chemical hazard in the laboratory when: A. passing through the chemistry department.

B. preparing 24-hour urine specimen containers that require a preservative.

C. plugging microhematocrit tubes drawn by fingerstick.

D. drawing blood from a patient in the oncology unit.

ANS: B KEY: Topic: Chemical hazards

DIF: Level 2 Learning Objective: 3.12

21. The type of isolation category that always requires a gown to be worn is: A. contact.

B. airborne.

C. blood and body fluid.

D. droplet.

ANS: A KEY: Topic: Types of isolation

DIF: Level 2 Learning Objective: 3.8

22. In which isolation category should a phlebotomist remove personal protective equipment (PPE) after leaving the patient’s room?

A. Contact.

B. Protective.

C. Droplet.

D. Blood and body fluid.

ANS: B KEY: Topic: Personal Protective Equipment

DIF: Level 2 Learning Objective: 3.8

23. Centrifuging an uncapped specimen may produce a biologic hazard in the form of: A. vectors.

B. sharps contamination.

C. aerosols.

D. specimen contamination.

ANS: C KEY: Topic: Protective procedures

DIF: Level 2 Learning Objective: 3.7

24. Which is not a criteria for protective gowns?

A. They must be made of cotton.

B. They must cover the entire body.

C. They must have long sleeves.

D. They must have tightly fitting cuffs.

ANS: A KEY: Topic: Personal Protective Equipment

DIF: Level 2 Learning Objective: 3.4

25. Phlebotomists must be provided with free immunization for: A. hepatitis C. B. hepatitis A. C. hepatitis B.

D. HIV. ANS: C KEY: Topic: Sharp hazards

DIF: Level 1 Learning Objective: 3.10

26. The Needlestick Safety and Prevention Act requires employers to: A. allow phlebotomists to work flexible schedules.

B. involve phlebotomists in the selection of safety devices.

C. provide phlebotomists with plastic capillary tubes.

D. test phlebotomists annually for hepatitis B and HIV. ANS: B KEY: Topic: Sharp hazards

DIF: Level 1 Learning Objective: 3.10

27. A phlebotomist who receives an accidental needlestick should immediately: A. be given zidovudine.

B. receive an injection of hepatitis B immune globulin (HBIG).

C. notify a supervisor.

D. both B and C. ANS: C KEY: Topic: Sharp hazard

DIF: Level 1 Learning Objective: 3.11

28. To comply with the current Bloodborne Pathogens Standard, phlebotomists must: A. discard sharps only into containers attached to the wall.

B. activate the needle protection device before removing the needle from the holder.

C. decontaminate needle holders between each patient.

D. activate the needle protective device and discard the needle and the holder as one unit.

ANS: D KEY: Topic: Sharp hazards

DIF: Level 2 Learning Objective: 3.11

29. Following an accidental needlestick, the phlebotomist should be tested for all of the following except: A. hepatitis B virus (HBV).

B. human immunodeficiency virus (HIV).

C. hepatitis A virus (HAV).

D. hepatitis C virus (HCV).

ANS: C KEY: Topic: Sharp hazards

DIF: Level 2 Learning Objective: 3.11

30. A phlebotomist who accidentally spills acid on his or her arm should immediately: A. neutralize the acid with a base.

B. consult the Safety Data Sheets (SDS) for carcinogenic information.

C. hold the arm under running water for 15 minutes.

D. wrap the arm in gauze and go to the emergency department.

ANS: C KEY: Topic: Chemical hazards

DIF: Level 1 Learning Objective: 3.12

31. Before cleaning up a chemical spill, the phlebotomist should consult the: A. Safety Data Sheets (SDS).

B. procedure manual.

C. laboratory director.

D. National Fire Protection Association (NFPA) manual.

ANS: A KEY: Topic: Chemical hazards

DIF: Level 1 Learning Objective: 3.12

32. A phlebotomist who is pregnant should not collect specimens from patients: A. receiving chemotherapy.

B. receiving radiation therapy.

C. in labor and delivery.

D. in the nursery.

ANS: B KEY: Topic: Radiation hazards

DIF: Level 1 Learning Objective: 3.14

33. The code word PASS refers to: A. storage of volatile chemicals.

B. operation of a fire extinguisher.

C. labeling of hazardous material.

D. the presence of radioactive material.

ANS: B KEY: Topic: Fire hazards

DIF: Level 1 Learning Objective: 3.16

34. The system used by firefighters when a fire occurs in a laboratory is the: A. Safety Data Sheets (SDS).

B. National Fire Protection Association (NFPA).

C. Rescue-alarm-contain-extinguish (RACE).

D. Pull-aim-squeeze-sweep (PASS).

ANS: B KEY: Topic: Fire hazards

DIF: Level 1 Learning Objective: 3.16

35. A class ABC fire extinguisher contains: A. water.

B. acid.

C. sand.

D. dry chemicals.

ANS: D KEY: Topic: Fire hazards

DIF: Level 1 Learning Objective: 3.17

36. The first thing to do when encountering a fire is to: A. sound the fire alarm.

B. use the fire extinguisher.

C. evacuate the area.

D. remove anyone in danger.

ANS: D KEY: Topic: Fire hazards

DIF: Level 2 Learning Objective: 3.16

37. In the chain of infection, a fomite represents which of the following?

A. An infection almost ready to jump to a new host.

B. A mite or other arthropod.

C. Equipment and other objects soiled with blood or body fluids.

D. A patient identified as having a particular infection.

ANS: C KEY: Topic: Chain of infection

DIF: Level 2 Learning Objective: 3.1

38. The majority of healthcare-associated infections, or those acquired in a health-care setting, are caused by which of the following?

A. Personnel not following established infection-control procedures.

B. Blood transfusions carrying hepatitis.

C. Contaminated surgical instruments.

D. Radiation from radiology procedures.

ANS: A KEY: Topic: Biologic hazards

DIF: Level 2 Learning Objective: 3.2

39. Why is knowledge of the chain of infection important as a phlebotomist?

A. To protect from exposure to a pathogen.

B. To ensure test results are accurate.

C. To prevent errors in technique.

D. To enable proper selection of venipuncture equipment.

ANS: A KEY: TOPIC: Chain of infection DIF: Level: 2 Learning Objective: 3.1

40. A place where an infectious agent can live and multiply is called the: A. vector.

B. droplet.

C. pathogen.

D. reservoir.

ANS: D KEY: TOPIC: Chain of infection DIF: Level: 1 Learning Objective: 3.1

41. All of the following are infectious agents except: A. fungi.

B. rashes.

C. viruses.

D. bacteria.

ANS: BKEY: TOPIC: Chain of infection DIF: Level 1 Learning Objective: 3.1

42. Which of the following is true about healthcare-associated infections?

A. The term refers only to infections acquired by a patient as a result of being an inpatient.

B. The Health and Human Services Agency monitors and analyzes infection control in the health-care setting.

C. The majority of the reasons they occur is health-care personnel are not following infectioncontrol practices.

D. Most of the infections can be treated with antiviral medications.

ANS: C KEY: TOPIC: biological hazards DIF: Level 2 Learning Objective: 3.2

Matching

Match the type of burning material to the appropriate type of fire.

A. Class A B. Class B C. Class C D. Class D E. Class E

43. Combustible metal 44. Paper 45. Organic chemicals 46. Electrical

43. ANS: D KEY: Topic: Fire hazards

DIF: Level 1 Learning Objective: 3.17

44. ANS: A KEY: Topic: Fire hazards

DIF: Level 1 Learning Objective: 3.17

45. ANS: B KEY: Topic: Fire hazards

DIF: Level 1 Learning Objective: 3.17

46. ANS: C KEY: Topic: Fire hazards

DIF: Level 1 Learning Objective: 3.17

Short Answers

47. Explain the purpose of the Globally Harmonized System (GHS) labeling system.

ANS: The GHS Classification and Labeling of Chemicals is an international effort to standardize both the classification of hazardous chemicals and the symbols used to communicate these hazards on labels and in Safety Data Sheets (SDS) documentation. It includes criteria for the classification of health, physical, and environmental hazards. The standard label elements include GHS hazard pictograms, signal words, and a GHS hazard statement. The SDS under GHS provides a clear description of the data used to identify hazards and has 16 sections in a specified order. Occupational Safety and Health Administration (OSHA) aligned its Hazard Communication Standard with the GHS and requires that all employees be trained on the new label elements and SDS format. The adoption of the GHS in the United States has increased awareness and understanding of hazards in the workplace.

KEY: TOPIC: chemical hazards DIF: Level 2 Learning Objective: 3.13

48. List precautions observed by phlebotomists to avoid physical hazards.

ANS: General precautions that you should observe include: 1. Avoid running in rooms and hallways.

2. Be alert for wet floors.

3. Bend your knees when lifting heavy objects or moving patients.

4. Keep long hair tied back and remove dangling jewelry to avoid contact with equipment and patients.

5. Wear comfortable, closed-toe shoes with nonskid soles that provide maximum support.

6. Maintain a clean, organized work area.

KEY: TOPIC: DIF: Level 2 Learning Objective: 3.18

Essay

49. Describe the six components of the chain of infection and provide a way to break each segment of the chain.

ANS: The chain of infection requires a continuous link between six components. To prevent infection, it is necessary to understand the components that make up the chain and the methods by which the chain can be broken. The components in the chain are: 1. Infectious agent (pathogen) Infectious agents consist of bacteria, fungi, parasites, and viruses.

Breaking the chain: Early detection and treatment of infectious agents can stunt their opportunity for growth.

2. Reservoir The reservoir is a place where an infectious agent can live and possibly multiply. Humans and animals make ideal reservoirs. Equipment and other soiled objects, often called fomites, can serve as reservoirs, particularly when they contain blood or other body fluids. Some microorganisms form spores or become inactive when conditions are not ideal, such as in dried blood. They wait patiently until a suitable reservoir with favorable conditions is available, such as one with water and appropriate nutrients. Then spores can germinate to form pathogenic bacteria.

Breaking the chain: Disinfecting the work area kills the infectious agent and eliminates the reservoir.

3. Portal of exit An infectious agent must have a way to exit the reservoir to continue the chain of infection. When the reservoir is a human or an animal, this can be through the nose, mouth, and mucous membranes and in blood or other body fluids. Phlebotomists provide a portal of exit when they collect blood.

Breaking the chain: Dispose of needles and lancets in sealed sharps containers, and dispose of other contaminated materials in biohazard containers, keeping tubes and specimen containers sealed. When contaminated materials are in appropriate containers that remain sealed, the infectious agent still has a reservoir but no means of exit.

4. Means of transmission Once an infectious agent has left the reservoir, it must have a way to reach a susceptible host. Means of transmission include:  Direct contact: An unprotected host touches or is touched by the reservoir.  Droplet: The host inhales material from the reservoir, such as aerosol droplets from an infected person.  Airborne transmission: Dried aerosol nuclei circulating on air currents or attached to dust particles are inhaled.  Vehicle: Contaminated food or water is ingested.  Vector: Parasites such as malaria are transmitted by a mosquito bite.

Breaking the chain: Hand sanitizing, standard precautions (SPs), and transmission-based precautions are covered later in this chapter.

5. Portal of entry After an infectious agent has been transmitted to a new reservoir, it must have a means to enter the reservoir. The portal of entry can be the same as the portal of exit. This includes the nose, mouth, mucous membranes, and open wounds. Medical and surgical procedures provide a very convenient portal of entry for infectious agents. This is why all needles used in phlebotomy are packaged individually in sterile containers, and a needle is never used more than once or from a container that has been opened.

Breaking the chain: Disinfection, sterilization, and strict adherence to SPs and transmission-based precautions block the portal of entry.

6. Susceptible host This can be another patient or the health-care provider. Patients are ideal susceptible hosts because their immune systems, which normally provide defenses against infection, are already compromised with an illness. Patients receiving chemotherapy and immunocompromised patients are especially susceptible hosts. The immune system is still developing in newborns and infants, and begins to weaken as people age, making these groups of patients more susceptible to infection. The immune system also is depressed by stress, fatigue, and lack of proper nutrition—factors that can contribute to the susceptibility of the health-care provider.

Breaking the chain: Special precautions should be observed when working in a nursery and in isolation rooms designated for protection of susceptible patients. Workers must stay current with the required health-care workers’ immunizations and maintenance of a healthy lifestyle is very important for the health-care worker.

KEY: TOPIC: Chain of infection DIF: Level 2 Learning Objective: 3.1

Chapter 4

Multiple Choice

1. Medical terminology is primarily based on which of the following languages?

A. French and English.

B. Greek and Latin.

C. German and Latin.

D. Greek and French.

ANS: B

KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

2. All of the following prefixes mean outside except: A. extra-.

B. exo-.

C. endo-.

D. ecto-.

ANS: C KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

3. The prefix that means decreased is: A. hypo-.

B. hyper-.

C. hetero-.

D. haplo-.

ANS: A KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

4. The most commonly used combining vowel is: A. “i.”

B. “a.”

C. “o.”

D. “u.”

ANS: C KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.1

5. A combining vowel is not used:

A. between two root words.

B. when the suffix begins with a vowel.

C. when the second root word begins with a vowel.

D. both B and C. ANS: B KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.1

6. Word roots usually refer to: A. conditions.

B. procedures.

C. diagnoses.

D. body parts.

ANS: D KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.1

7. When defining a word, first define the: A. suffix.

B. prefix.

C. root word.

D. combining form.

ANS: A KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.1

8. The purpose of a combining form is to: A. identify the body system.

B. aid in pronunciation.

C. change the meaning of a word.

D. define the root word.

ANS: B KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.1

10. The term visceral refers to: A. internal organs.

B. lymphatic tissue.

C. bone marrow.

D. connective tissue.

ANS: A KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.4

11. The combining form for lung is: A. bronch/o.

B. pulmon/o.

C. pyel/o.

D. spir/o.

ANS: B KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.4

Matching

Match the following combining forms with their appropriate body system.

A. Circulatory B. Digestive C. Endocrine D. Lymphatic E. Nervous F. Renal G. Reproductive

H. Skeletal

12. oste/o 13. mening/o 14. nephr/o 15. gastr/o 16. gynec/o 17. coron/o 18. aden/o 19. immun/o

12. ANS: H KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

13. ANS: E KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

14. ANS: F KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

15. ANS: B KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

16. ANS: G KEY: Topic: Terminology

DIF: Level 1

Learning Objective: 4.3

17. ANS: A KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

18. ANS: C KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

19. ANS: D KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

Match the following suffixes with their definition.

A. Cell B. Enlargement C. Meal D. Pain E. Surgical opening F. Tumor G. Written record 20. -gram 21. -ostomy 22. -cyte 23. -oma 24. -megaly 25. -prandial 26. -algia

20. ANS: G

KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

21. ANS: E KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

22. ANS: A KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

23. ANS: F KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

24. ANS: B KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

25. ANS: C KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

26. ANS: D KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

Match the following combining forms with their definition.

A. Blood B. Blue C. Death D. Intestine E. Joint F. Knee cap G. Muscle H. Pus I. Stone J. Uterus

27. arthr/o 28. my/o 29. cyan/o 30. hyster/o 31. py/o 32. necr/o 33. hem/o 34. enter/o 35. lith/o 36. patell/o

27. ANS: E KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

28. ANS: G KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

29. ANS: B KEY: Topic: Terminology

DIF: Level 1

Learning Objective: 4.3

30. ANS: J KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

31. ANS: H KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

32. ANS: C KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

33. ANS: A KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

34. ANS: D KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

35. ANS: I KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

36. ANS: F KEY: Topic: Terminology

DIF: Level 1 Learning Objective: 4.3

Short Answers

37. Using the following word parts and combining forms, create five medical terms: AnHyperIntraDysEndoAntiDiploBio-

ven/o path/o erythr/o leuk/o later/o carcin/o hist/o cyt/o

ANS: answers will vary KEY: Topic: medical terms DIF: Level 3 Learning Objective: 4.2 38. Define the following abbreviations: a. DOB b. R/O c. asap d. Bx e. QNS f. pp g. IV h. PRN ANS: a. date of birth b. rule out c. as soon as possible d. biopsy e. quantity not sufficient f. postprandial (after a meal) g. intravenous

-ous -ia -emia -cyte -ology -gen -crine -coccus -al -gen

h. as needed KEY: Topic: medical terms DIF: Level 2 Learning Objective: 4.6

Chapter 5

Multiple Choice

1. The basic functioning unit of all organisms is the: A. organ.

B. tissue.

C. cell.

D. system.

ANS: C KEY: Topic: Introduction to the body

DIF: Level 1 Learning Objective: 5.1

2. The body is divided into right and left portions by the: A. superior plane.

B. frontal plane.

C. sagittal plane.

D. medial plane.

ANS: C KEY: Topic: Introduction to the body

DIF: Level 1 Learning Objective: 5.2

3. The dorsal part of the body is the: A. front.

B. back.

C. left side.

D. right side.

ANS: B KEY: Topic: Introduction to the body

DIF: Level 1 Learning Objective: 5.2

4. The body is described as having which one of the following positions when it is facing forward with the arms by the side and the palms of the hands and toes pointing forward?

A. Prone.

B. Lateral.

C. Anatomical.

D. Supine.

ANS: C KEY: Topic: Introduction to the body

DIF: Level 1 Learning Objective: 5.2

5. The plane of the body that divides it into upper and lower halves is the: A. frontal.

B. sagittal.

C. transverse.

D. posterior.

ANS: C KEY: Topic: Introduction to the body

DIF: Level 1 Learning Objective: 5.2

6. Located in the posterior area of the body are the: A. cranial and spinal cavities.

B. cranial and pelvic cavities.

C. spinal and abdominal cavities.

D. spinal and thoracic cavities.

ANS: A KEY: Topic: Introduction to the body

DIF: Level 1 Learning Objective: 5.2

7. The cavity in which the heart is located is the: A. cranial.

B. spinal.

C. thoracic.

D. abdominal.

ANS: C KEY: Topic: Introduction to the body

DIF: Level 1 Learning Objective: 5.3

8. The anterior portion of the body is the: A. right side.

B. front side.

C. back side.

D. left side.

ANS: B KEY: Topic: Introduction to the body

DIF: Level 1 Learning Objective: 5.2

9. Groups of organs function together to complete body: A. systems.

B. cavities.

C. planes.

D. directions.

ANS: A KEY: Topic: Introduction to the body

DIF: Level 1 Learning Objective: 5.1

10. The thigh bone joins the knee at the: A. distal end.

B. proximal end.

C. medial point.

D. inferior point.

ANS: A KEY: Topic: Introduction to the body

DIF: Level 2 Learning Objective: 5.2

11. A bilateral bone marrow aspiration would indicate aspiration: A. from both sides of the iliac crest.

B. from only the left side of the iliac crest.

C. above the iliac crest.

D. below the iliac crest.

ANS: A KEY: Topic: Introduction to the body

DIF: Level 2 Learning Objective: 5.2

12. A hard protein substance found in hair and nails is: A. melanin.

B. keratin.

C. sebum.

D. sweat.

ANS: B KEY: Topic: Integumentary system

DIF: Level 1 Learning Objective: 5.4

13. Fingerprints are formed from: A. collagen.

B. keratin.

C. papillae.

D. adipose.

ANS: C KEY: Topic: Integumentary system

DIF: Level 1 Learning Objective: 5.4

14. The pigment that gives skin color is: A. melanin.

B. heparin.

C. sebum.

D. keratin.

ANS: A KEY: Topic: Integumentary system

DIF: Level 1 Learning Objective: 5.4

15. A skin cancer associated with AIDS is: A. basal cell carcinoma.

B. melanoma.

C. Kaposi sarcoma.

D. lupus erythematosus.

ANS: C KEY: Topic: Integumentary system

DIF: Level 2 Learning Objective: 5.5

16. The main organ(s) of the integumentary system is(are) the: A. nails.

B. hair.

C. skin.

D. sweat glands.

ANS: C KEY: Topic: Integumentary system

DIF: Level 1 Learning Objective: 5.4

17. The outermost layer of skin is the: A. epidermis.

B. dermis.

C. subcutaneous.

D. follicle.

ANS: A

KEY: Topic: Integumentary system

DIF: Level 1 Learning Objective: 5.4

18. The layer of skin that contains the blood vessels is the: A. epidermis.

B. dermis.

C. keratinized epithelium.

D. root shaft.

ANS: B KEY: Topic: Integumentary system

DIF: Level 1 Learning Objective: 5.4

19. The oil glands are: A. sweat glands.

B. sebaceous glands.

C. dermal glands.

D. subcutaneous glands.

ANS: B KEY: Topic: Integumentary system

DIF: Level 1 Learning Objective: 5.4

20. The upper long bone of the leg is the: A. femur.

B. humerus.

C. tibia.

D. ulna.

ANS: A KEY: Topic: Skeletal system

DIF: Level 1 Learning Objective: 5.4

21. The long bone of the lower arm located opposite the thumb is the:

A. ulna.

B. radius.

C. metacarpal.

D. fibula.

ANS: A KEY: Topic: Skeletal system

DIF: Level 1 Learning Objective: 5.4

22. The small bones of the ankle are the: A. metacarpals.

B. phalanges.

C. vertebrae.

D. metatarsals.

ANS: D KEY: Topic: Skeletal system

DIF: Level 1 Learning Objective: 5.4

23. Joint fluid is called: A. peritoneal.

B. cerebrospinal.

C. pleural.

D. synovial.

ANS: D KEY: Topic: Skeletal system

DIF: Level 1 Learning Objective: 5.4

24. The abbreviations Ca, P, and ALP indicate: A. types of bones.

B. diseases of bones.

C. tests associated with bone disease.

D. bones of the hand.

ANS: C KEY: Topic: Skeletal system

DIF: Level 1 Learning Objective: 5.6

25. Functions of the skeletal system include all of the following except: A. hemostasis.

B. hematopoiesis.

C. mineral storage.

D. movement.

ANS: A KEY: Topic: Skeletal system

DIF: Level 1 Learning Objective: 5.4

26. The body system responsible for protection of soft tissues is the: A. muscular.

B. skeletal.

C. integumentary.

D. lymphatic.

ANS: B KEY: Topic: Skeletal system

DIF: Level 1 Learning Objective: 5.4

27. Bone-forming cells are called: A. osteoblasts.

B. osteoclasts.

C. osteoporosis.

D. osteomalacia.

ANS: A KEY: Topic: Skeletal system

DIF: Level 1 Learning Objective: 5.4

28. The arm bones belong to which type of bone?

A. Irregular bones.

B. Flat bones.

C. Short bones.

D. Long bones.

ANS: D KEY: Topic: Skeletal system

DIF: Level 1 Learning Objective: 5.4

29. A person bitten by a tick may develop: A. gout.

B. Lyme disease.

C. rickets.

D. rheumatoid arthritis.

ANS: B KEY: Topic: Skeletal system

DIF: Level 1 Learning Objective: 5.5

30. The blood-forming tissue found in the center of bone is called: A. synovial fluid.

B. bone marrow.

C. cartilage.

D. ligaments.

ANS: B KEY: Topic: Skeletal system

DIF: Level 1 Learning Objective: 5.4

31. The flexible part of the skeletal system is the: A. bone.

B. ligament.

C. joint.

D. cartilage.

ANS: D KEY: Topic: Skeletal system

DIF: Level 1

Learning Objective: 5.4

32. Joints are held together by: A. cartilage.

B. tendons.

C. ligaments.

D. bones.

ANS: C KEY: Topic: Skeletal system

DIF: Level 1 Learning Objective: 5.4

33. An autoimmune disorder affecting the joints is: A. rheumatoid arthritis.

B. Paget disease.

C. gout.

D. scoliosis.

ANS: A KEY: Topic: Skeletal system

DIF: Level 1 Learning Objective: 5.5

34. A bacterial infection of the bone is called: A. osteomalacia.

B. osteoarthritis.

C. osteomyelitis.

D. osteoporosis.

ANS: C KEY: Topic: Skeletal system

DIF: Level 1 Learning Objective: 5.5

35. When a broken bone protrudes through the skin, the fracture is: A. complicated.

B. comminuted.

C. closed.

D. compound.

ANS: D KEY: Topic: Skeletal system

DIF: Level 1 Learning Objective: 5.5

36. Inflammation of the joints caused by uric acid crystals is called: A. Lyme disease.

B. osteomalacia.

C. rheumatoid arthritis.

D. gout.

ANS: D KEY: Topic: Skeletal system

DIF: Level 2 Learning Objective: 5.5

37. Disease of the heart muscle is called: A. cardiomyopathy.

B. congestive heart failure.

C. arteriosclerosis.

D. atherosclerosis.

ANS: A KEY: Topic: Muscular system

DIF: Level 1 Learning Objective: 5.5

38. Blood vessels contain: A. cardiac muscle.

B. nonstriated muscle.

C. skeletal muscle.

D. striated muscle.

ANS: B KEY: Topic: Muscular system

DIF: Level 1 Learning Objective: 5.4

39. The abbreviations LD(LDH), CK(CPK), and AST(SGOT) refer to: A. electrolytes of the heart.

B. types of heart muscle.

C. enzymes from the heart muscle.

D. diseases of the heart.

ANS: C KEY: Topic: Muscular system

DIF: Level 1 Learning Objective: 5.6

40. The body system that maintains posture and produces heat is the: A. skeletal.

B. circulatory.

C. muscular.

D. lymphatic.

ANS: C KEY: Topic: Muscular system

DIF: Level 1 Learning Objective: 5.4

41. Body temperature is maintained by the heat produced in muscle: A. contraction.

B. relaxation.

C. insertion.

D. origin.

ANS: A KEY: Topic: Muscular system

DIF: Level 1 Learning Objective: 5.4

42. An infection of the nerves that control skeletal muscle movement is: A. muscular dystrophy.

B. myasthenia gravis.

C. poliomyelitis.

D. myalgia.

ANS: C KEY: Topic: Muscular system

DIF: Level 1 Learning Objective: 5.5

43. Muscles are attached to bones by: A. ligaments.

B. tendons.

C. cartilage.

D. joints.

ANS: B KEY: Topic: Muscular system

DIF: Level 1 Learning Objective: 5.4

44. Muscle tissue that has stripes when viewed under the microscope is said to be: A. smooth.

B. visceral.

C. striated.

D. nonstriated.

ANS: C KEY: Topic: Muscular system

DIF: Level 1 Learning Objective: 5.4

45. An inherited group of muscle disorders in which the muscle atrophies is: A. poliomyelitis.

B. muscular dystrophy.

C. myasthenia gravis.

D. carpal tunnel syndrome.

ANS: B KEY: Topic: Muscular system

DIF: Level 1 Learning Objective: 5.5

46. The nervous system that is made up of the brain and spinal cord is the: A. central nervous system.

B. peripheral nervous system.

C. autonomic nervous system.

D. voluntary nervous system.

ANS: A KEY: Topic: Nervous system

DIF: Level 1 Learning Objective: 5.4

47. The protective shock-absorbent coating covering the central nervous system is the: A. axon.

B. dendrite.

C. meninges.

D. myelin sheath.

ANS: C KEY: Topic: Nervous system

DIF: Level 1 Learning Objective: 5.4

48. The specialized cell of the nervous system is the: A. nephron.

B. neuron.

C. axon.

D. alveoli.

ANS: B KEY: Topic: Nervous system

DIF: Level 1 Learning Objective: 5.4

49. The fluid that fills the spaces of the meninges and acts as a cushion for the brain and spinal cord is: A. synovial fluid.

B. peritoneal fluid.

C. cerebrospinal fluid.

D. amniotic fluid.

ANS: C KEY: Topic: Nervous system

DIF: Level 1 Learning Objective: 5.4

50. The point where the axon of one neuron and the dendrites of another neuron comes together is called a: A. synapse.

B. neurojunction.

C. joint.

D. brain.

ANS: A KEY: Topic: Nervous system

DIF: Level 1 Learning Objective: 5.4

51. Inflammation of the meninges caused by a bacterial or viral infection is called: A. poliomyelitis.

B. chondrosarcoma.

C. meningitis.

D. cerebral palsy.

ANS: C KEY: Topic: Nervous system

DIF: Level 1 Learning Objective: 5.5

52. The largest part of the brain is the: A. cerebrum.

B. cerebellum.

C. medulla oblongata.

D. pons.

ANS: A KEY: Topic: Nervous system

DIF: Level 1 Learning Objective: 5.4

53. The neuron that carries impulses from the central nervous system is the: A. motor.

B. sensory.

C. central.

D. visceral.

ANS: A KEY: Topic: Nervous system

DIF: Level 1 Learning Objective: 5.4

54. Phlebotomists who are not immune to chickenpox may be infected by patients with: A. multiple sclerosis.

B. cerebral palsy.

C. neurofibromatosis.

D. shingles.

ANS: D KEY: Topic: Nervous system

DIF: Level 2 Learning Objective: 5.5

55. A stroke is called a(an): A. electroencephalogram (EEG).

B. electrocardiogram (ECG).

C. multiple sclerosis (MS).

D. cerebrovascular accident (CVA).

ANS: D KEY: Topic: Nervous system

DIF: Level 2 Learning Objective: 5.5

56. The small subdivision of the bronchus is the: A. bronchi.

B. pleura.

C. trachea.

D. bronchiole.

ANS: D KEY: Topic: Respiratory system

DIF: Level 1 Learning Objective: 5.4

57. The structure of the respiratory system that contains the vocal cords is the: A. pharynx.

B. larynx.

C. epiglottis.

D. throat.

ANS: B KEY: Topic: Respiratory system

DIF: Level 1 Learning Objective: 5.4

58. The condition of decreased oxygen in the tissues is: A. anoxia.

B. hypoxia.

C. eupnea.

D. apnea.

ANS: B KEY: Topic: Respiratory system

DIF: Level 1 Learning Objective: 5.5

59. Air enters the respiratory system and is filtered by the: A. larynx.

B. trachea.

C. nose.

D. bronchiole.

ANS: C KEY: Topic: Respiratory system

DIF: Level 1 Learning Objective: 5.4

60. The exchange of oxygen and carbon dioxide takes place in the: A. nose.

B. pharynx.

C. trachea.

D. lungs.

ANS: D KEY: Topic: Respiratory system

DIF: Level 1 Learning Objective: 5.4

61. The throat is called the: A. pharynx.

B. larynx.

C. trachea.

D. alveoli.

ANS: A KEY: Topic: Respiratory system

DIF: Level 1 Learning Objective: 5.4

62. A condition caused by allergies that produce difficult breathing is: A. pleurisy.

B. tuberculosis.

C. pulmonary edema.

D. asthma.

ANS: D KEY: Topic: Respiratory system

DIF: Level 1 Learning Objective: 5.5

63. A lung infection in which the alveoli become inflamed and filled with fluid is: A. laryngitis.

B. asthma.

C. pneumonia.

D. rhinitis.

ANS: C KEY: Topic: Respiratory system

DIF: Level 1 Learning Objective: 5.5

64. Congestive heart failure may produce: A. pleurisy.

B. chronic obstructive pulmonary disease.

C. infant respiratory distress syndrome.

D. pulmonary edema.

ANS: D KEY: Topic: Respiratory system

DIF: Level 1 Learning Objective: 5.5

65. A skin test (PPD) would be ordered for the detection of: A. bronchitis.

B. tuberculosis.

C. rhinitis.

D. tonsillitis.

ANS: B KEY: Topic: Respiratory system

DIF: Level 1 Learning Objective: 5.6

66. Chronic obstructive pulmonary disease can develop from: A. rhinitis.

B. laryngitis.

C. emphysema.

D. tuberculosis.

ANS: C KEY: Topic: Respiratory system

DIF: Level 1 Learning Objective: 5.5

67. The O2 and CO2 exchange between the air and blood occurs in the: A. arteries.

B. alveoli.

C. veins.

D. pharynx.

ANS: B KEY: Topic: Respiratory system

DIF: Level 2 Learning Objective: 5.4

68. The breakdown of food is called: A. digestion.

B. absorption.

C. elimination.

D. peristalsis.

ANS: A KEY: Topic: Digestive system

DIF: Level 1 Learning Objective: 5.4

69. Food is propelled to the stomach by: A. absorption.

B. digestion.

C. elimination.

D. peristalsis.

ANS: D KEY: Topic: Digestive system

DIF: Level 1 Learning Objective: 5.4

70. An accessory organ of the gastrointestinal tract is the: A. mouth.

B. stomach.

C. liver.

D. large intestine.

ANS: C KEY: Topic: Digestive system

DIF: Level 1 Learning Objective: 5.4

71. Digestion takes place in the: A. esophagus.

B. appendix.

C. gall bladder.

D. stomach.

ANS: D KEY: Topic: Digestive system

DIF: Level 1 Learning Objective: 5.4

72. An organ of the digestive system with no digestive function is the: A. appendix.

B. teeth.

C. salivary glands.

D. small intestine.

ANS: A KEY: Topic: Digestive system

DIF: Level 1 Learning Objective: 5.4

73. Inflammation of the stomach and intestinal tract is called: A. enteritis.

B. gastritis.

C. gastroenteritis.

D. peritonitis.

ANS: C KEY: Topic: Digestive system

DIF: Level 1 Learning Objective: 5.5

74. A laboratory test that evaluates liver function is: A. lipase.

B. bilirubin.

C. carotene.

D. amylase.

ANS: B KEY: Topic: Digestive system

DIF: Level 1 Learning Objective: 5.6

75. Hepatitis is a(an): A. inflammation of the stomach.

B. blood tumor.

C. inflammation of the liver.

D. tumor of the pancreas.

ANS: C KEY: Topic: Digestive system

DIF: Level 1 Learning Objective: 5.5

76. The unusable products of digestion are eliminated from the body as: A. bile.

B. urine.

C. feces.

D. fatty acids.

ANS: C KEY: Topic: Digestive system

DIF: Level 1 Learning Objective: 5.4

77. The digestive fluid found in the mouth is: A. bile.

B. saliva.

C. hydrochloric acid.

D. ascorbic acid.

ANS: B

KEY: Topic: Digestive system

DIF: Level 1 Learning Objective: 5.4

78. Inflammation of the gall bladder is called: A. cholecystitis.

B. cholelithiasis.

C. urethritis.

D. glossitis.

ANS: A KEY: Topic: Digestive system

DIF: Level 1 Learning Objective: 5.5

79. The digestion that begins in the mouth by the action of the teeth and tongue is called: A. peristalsis.

B. mechanical digestion.

C. chemical digestion.

D. elimination.

ANS: B KEY: Topic: Digestive system

DIF: Level 2 Learning Objective: 5.4

80. An amylase test is ordered to determine the condition of the: A. stomach.

B. small intestine.

C. liver.

D. pancreas.

ANS: D KEY: Topic: Digestive system

DIF: Level 2 Learning Objective: 5.6

81. The primary filtering organ(s) of the urinary system is(are) the:

A. ureters.

B. kidneys.

C. urethra.

D. bladder.

ANS: B KEY: Topic: Urinary system

DIF: Level 1 Learning Objective: 5.4

82. Inflammation of the filtering unit of the kidney is: A. pyelonephritis.

B. nephrolithiasis.

C. cystitis.

D. glomerulonephritis.

ANS: D KEY: Topic: Urinary system

DIF: Level 1 Learning Objective: 5.5

83. The tube that is inserted into the bladder for the removal of urine is a(an): A. IV. B. IM. C. catheter.

D. cannula.

ANS: C KEY: Topic: Urinary system

DIF: Level 1 Learning Objective: 5.4

84. A specialist in the study of the urinary tract and the male reproductive system is a(an): A. hematologist.

B. oncologist.

C. nephrologist.

D. urologist.

ANS: D KEY: Topic: Urinary system

DIF: Level 1 Learning Objective: 5.4

85. Lithotripsy is performed on patients with: A. renal calculi.

B. glomerulonephritis.

C. renal failure.

D. cystitis.

ANS: A KEY: Topic: Urinary system

DIF: Level 1 Learning Objective: 5.5

86. The main functioning unit of the kidney is the: A. nephron.

B. pelvis.

C. ureter.

D. axon.

ANS: A KEY: Topic: Urinary system

DIF: Level 1 Learning Objective: 5.4

87. An inflammation of the urinary bladder is called: A. pancreatitis.

B. urethritis.

C. pyelonephritis.

D. cystitis.

ANS: D KEY: Topic: Urinary system

DIF: Level 1 Learning Objective: 5.5

88. The main laboratory test to evaluate the urinary system is the: A. complete blood count (CBC).

B. human chorionic gonadotropin (HCG).

C. urinalysis (UA).

D. urinary tract infection (UTI).

ANS: C KEY: Topic: Urinary system

DIF: Level 1 Learning Objective: 5.6

89. A urinary tract infection (UTI) is usually caused by: A. glycosuria.

B. uremia.

C. bacterial infection.

D. hypoalbuminuria.

ANS: C KEY: Topic: Urinary system

DIF: Level 1 Learning Objective: 5.6

90. The kidneys are responsible for all of the following except: A. filtering waste products of metabolism.

B. regulating body fluids.

C. removing protein from the blood.

D. producing erythropoietin.

ANS: C KEY: Topic: Urinary system

DIF: Level 2 Learning Objective: 5.4

91. In the renal tubules, water and substances that are needed by the body are: A. filtered out of the blood.

B. reabsorbed into the blood.

C. secreted into the urine.

D. excreted out of the urine.

ANS: B KEY: Topic: Urinary system

DIF: Level 2

Learning Objective: 5.4

92. Chemicals secreted directly into the blood stream by endocrine glands are called: A. vitamins.

B. hormones.

C. proteins.

D. anticoagulants.

ANS: B KEY: Topic: Endocrine system

DIF: Level 1 Learning Objective: 5.4

93. T3, T4, and calcitonin are hormones secreted by the: A. thyroid gland.

B. adrenal gland.

C. parathyroid gland.

D. pancreas.

ANS: A KEY: Topic: Endocrine system

DIF: Level 1 Learning Objective: 5.4

94. Decreased secretion of insulin is associated with: A. acromegaly.

B. gigantism.

C. diabetes mellitus.

D. diabetes insipidus.

ANS: C KEY: Topic: Endocrine system

DIF: Level 1 Learning Objective: 5.5

95. Gigantism is caused by an oversecretion of: A. thyroid-stimulating hormone.

B. parathyroid hormone.

C. growth hormone.

D. epinephrine.

ANS: C KEY: Topic: Endocrine system

DIF: Level 1 Learning Objective: 5.5

96. The hormone increased in response to stress is: A. epinephrine.

B. growth hormone.

C. calcitonin.

D. antidiuretic hormone.

ANS: A KEY: Topic: Endocrine system

DIF: Level 1 Learning Objective: 5.4

97. An endocrinologist sees a patient with: A. hepatitis.

B. emphysema.

C. hypoglycemia.

D. gonorrhea.

ANS: C KEY: Topic: Endocrine system

DIF: Level 2 Learning Objective: 5.4

98. A condition of excessive thyroid hormone secretion is termed: A. hypothyroidism.

B. hyperthyroidism.

C. myxedema.

D. carcinoma.

ANS: B KEY: Topic: Endocrine system

DIF: Level 2 Learning Objective: 5.5

99. Increased production of adrenocorticotropic hormone (ACTH) is associated with: A. acromegaly.

B. Cushing disease.

C. gigantism.

D. myxedema.

ANS: B KEY: Topic: Endocrine system

DIF: Level 2 Learning Objective: 5.5

100. The function of the reproductive system is: A. regulation of body water.

B. transport of electrolytes to cells.

C. disposal of waste products.

D. sperm production and ovulation.

ANS: D KEY: Topic: Reproductive system

DIF: Level 1 Learning Objective: 5.4

101. The hormone that is responsible for secondary sex characteristics in females is: A. estrogen.

B. testosterone.

C. human chorionic gonadotropin.

D. androgen.

ANS: A KEY: Topic: Reproductive system

DIF: Level 1 Learning Objective: 5.4

102. The study of gynecology refers to treatment of: A. male genital disorders.

B. male and female urinary tract disorders.

C. children.

D. female genital disorders.

ANS: D KEY: Topic: Reproductive system

DIF: Level 1 Learning Objective: 5.4

103. Bleeding that occurs once a month for women is called: A. amenorrhagia.

B. menorrhagia.

C. menopause.

D. menstruation.

ANS: D KEY: Topic: Reproductive system

DIF: Level 1 Learning Objective: 5.5

104. The gonads of the female are: A. testes.

B. ovaries.

C. placenta.

D. uterus.

ANS: B KEY: Topic: Reproductive system

DIF: Level 1 Learning Objective: 5.4

105. The sex cells of the male are: A. testes.

B. ovaries.

C. spermatozoa.

D. ovum.

ANS: C KEY: Topic: Reproductive system

DIF: Level 1 Learning Objective: 5.4

106. The fluid surrounding body cells in the tissue spaces is: A. cerebrospinal fluid.

B. synovial fluid.

C. peritoneal fluid.

D. interstitial fluid.

ANS: D KEY: Topic: Lymphatic system

DIF: Level 1 Learning Objective: 5.4

107. The large lymph vessel in the chest that receives lymph from below the diaphragm and the left side of the body is the: A. lymph node.

B. thoracic duct.

C. right lymphatic duct.

D. tonsils.

ANS: B KEY: Topic: Lymphatic system

DIF: Level 1 Learning Objective: 5.4

108. Lymph nodes are located in all of the following areas of the body except the: A. inguinal.

B. cervical.

C. bone marrow.

D. axillary.

ANS: C KEY: Topic: Lymphatic system

DIF: Level 1 Learning Objective: 5.4

109. Specialized lymphatic tissue located in the throat is called the: A. thymus.

B. inguinal nodes.

C. spleen.

D. tonsils.

ANS: D KEY: Topic: Lymphatic system

DIF: Level 1 Learning Objective: 5.4

110. A laboratory procedure used to test for AIDS is the: A. complete blood count (CBC).

B. Western blot.

C. Monospot.

D. Creatine kinase (CK) or creatine phosphokinase (CPK).

ANS: B KEY: Topic: Lymphatic system

DIF: Level 1 Learning Objective: 5.6

111. The major white blood cell associated with the immune system is the: A. lymphocyte.

B. neutrophil.

C. eosinophil.

D. basophil.

ANS: A KEY: Topic: Lymphatic system

DIF: Level 1 Learning Objective: 5.4

112. Splenomegaly means: A. a tumor of the lymph nodes.

B. AIDS. C. enlarged spleen.

D. lack of immunity.

ANS: C KEY: Topic: Lymphatic system

DIF: Level 1

113. Humoral immunity is produced by: A. T cells.

B. neutrophils.

C. erythrocytes.

D. B cells.

ANS: D KEY: Topic: Lymphatic system

DIF: Level 1 Learning Objective: 5.4

114. The watery fluid that circulates through the lymphatic vessels is called: A. tissue fluid.

B. interstitial fluid.

C. synovial fluid.

D. lymph.

ANS: D KEY: Topic: Lymphatic system

DIF: Level 1 Learning Objective: 5.4

115. Tests for myocardial muscle damage help the clinician to determine the extent of damage to the patient’s: A. cardiac muscle.

B. cardiac nerves.

C. skeletal nerves.

D. skeletal muscle.

ANS: A KEY: Topic: Muscular system

DIF: Level 2 Learning Objective: 5.6

116. Endocrine glands secrete hormones: A. into the lymphatic system by means of ducts.

B. into the bloodstream without the use of ducts.

C. into the lymphatic system without the use of ducts.

D. into the bloodstream by means of ducts.

ANS: B KEY: Topic: Endocrine system

DIF: Level 2 Learning Objective: 5.4

Matching Match the following terms with their description.

A. Contagious bacterial infection B. Hard protein C. Inflammation of sebaceous glands D. Melanoma E. Oily secretion F. Ringworm G. Scaly skin H. Skin inflammation 117. Acne 118. Fungal infection 119. Sebum 120. Dermatitis 121. Psoriasis 122. Cancer 123. Keratin 124. Impetigo

117. ANS: C KEY: Topic: Integumentary system

DIF: Level 1 Learning Objective: 5.5

118. ANS: F KEY: Topic: Integumentary system

DIF: Level 1 Learning Objective: 5.5

119. ANS: E KEY: Topic: Integumentary system

DIF: Level 1 Learning Objective: 5.5

120. ANS: H KEY: Topic: Integumentary system

DIF: Level 1 Learning Objective: 5.5

121. ANS: G KEY: Topic: Integumentary system

DIF: Level 1 Learning Objective: 5.5

122. ANS: D KEY: Topic: Integumentary system

DIF: Level 1 Learning Objective: 5.5

123. ANS: B KEY: Topic: Integumentary system

DIF: Level 1 Learning Objective: 5.5

124. ANS: A KEY: Topic: Integumentary system

DIF: Level 1 Learning Objective: 5.5

Match the following tests with the target of their assessment.

A. Adrenal cortex B. Adrenal medulla

C. Ovaries D. Pituitary gland E. Testes 125. Growth hormone 126. Cortisol 127. Estrogen 128. Testosterone 129. Norepinephrine

125. ANS: D KEY: Topic: Endocrine system

DIF: Level 1 Learning Objective: 5.6

126. ANS: A KEY: Topic: Endocrine system

DIF: Level 1 Learning Objective: 5.6

127. ANS: C KEY: Topic: Endocrine system

DIF: Level 1 Learning Objective: 5.6

128. ANS: E KEY: Topic: Endocrine system

DIF: Level 1 Learning Objective: 5.6

129. ANS: B KEY: Topic: Endocrine system

DIF: Level 1 Learning Objective: 5.6

Match the following test with the system or disease it tests for.

A. ANA B. PAP smear C. Glucose D. BUN E. AST and ALT F. Sputum culture G. CFS analysis H. CK-MM and MB I. Calcium 130. Diabetes 131. Kidney function 132. Tuberculosis 133. Cervical cancer 134. Meningitis 135. Lupus 136. Muscle damage 137. Bone disorders 138. Liver disorders

130. ANS: C KEY: Topic: laboratory tests

DIF: Level 2 Learning Objective: 5.6

131. ANS: D KEY: Topic: laboratory tests

DIF: Level 2 Learning Objective: 5.6

132. ANS: F KEY: Topic: laboratory tests

DIF: Level 2 Learning Objective: 5.6

133. ANS: B KEY: Topic: laboratory tests

DIF: Level 2 Learning Objective: 5.6

134. ANS: G KEY: Topic: laboratory tests

DIF: Level 2 Learning Objective: 5.6

135. ANS: A KEY: Topic: laboratory tests

DIF: Level 2 Learning Objective: 5.6

136. ANS: H KEY: Topic: laboratory tests

DIF: Level 2 Learning Objective: 5.6

137. ANS: I KEY: Topic: laboratory tests

DIF: Level 2 Learning Objective: 5.6

138. ANS: E KEY: Topic: laboratory tests

DIF: Level 2 Learning Objective: 5.6

Match the following disease with the disease/condition.

A. Impetigo B. Cerebral palsy

C. Pyelonephritis D. Rhinitis E. Diabetes F. Gout G. Hepatitis H. Infectious mononucleosis I. Myalgia J. AIDS K. Pelvic inflammatory disease 139. Muscular 140. Skeletal 141. Digestive 142. Urinary 143. Reproductive 144. Lymphatic 145. Respiratory 146. Immune 147. Integumentary 148. Nervous 149. Endocrine

139. ANS: I KEY: Topic: body system disorders

DIF: Level 2 Learning Objective: 5.5

140. ANS: F KEY: Topic: body system disorders

DIF: Level 2 Learning Objective: 5.5

141. ANS: G KEY: Topic: body system disorders

DIF: Level 2 Learning Objective: 5.5

142. ANS: C

KEY: Topic: body system disorders

DIF: Level 2 Learning Objective: 5.5

143. ANS: K KEY: Topic: body system disorders

DIF: Level 2 Learning Objective: 5.5

144. ANS: H KEY: Topic: body system disorders

DIF: Level 2 Learning Objective: 5.5

145. ANS: D KEY: Topic: body system disorders

DIF: Level 2 Learning Objective: 5.5

146. ANS: J KEY: Topic: body system disorders

DIF: Level 2 Learning Objective: 5.5

147. ANS: A KEY: Topic: body system disorders

DIF: Level 2 Learning Objective: 5.5

148. ANS: B KEY: Topic: body system disorders

DIF: Level 2 Learning Objective: 5.5

149. ANS: E KEY: Topic: body system disorders

DIF: Level 2 Learning Objective: 5.5

Short Answers

150. Explain the levels of organization of the human body.

ANS: The human body develops into a complex organism through different levels of structure and function, from the simplest to the most complex. Each level builds on the previous level.

These levels of organization, in ascending order, are cells, tissues, organs, body systems, and the organism.

The smallest functioning unit of the body is the cell. More than 30 trillion cells provide the basic building blocks for the various structures that make up the human body. The size, shape, and composition of the cell determine its function. There are several different types of cells, each with a specialized function and the ability to carry out specialized chemical reactions to communicate with other cells throughout the body.

Groups of specific cells with a similar structure and function form the different types of body tissues and together perform specialized functions.

Organs are body structures formed by the combination of two or more different types of tissue.

For example, the heart is composed of four types of tissue: epithelial, muscular, nervous, and connective. Each organ is a specialized component of the body (e.g., the heart, brain, skin, and kidneys) and accomplishes a specific function.

Groups of organs functioning together for a common purpose make up the body systems. The major body systems are the integumentary, skeletal, muscular, nervous, respiratory, digestive, urinary, endocrine, reproductive, circulatory, and lymphatic.

Several body systems make up a complete living entity called an organism. The human body has attained the highest level of organization. The ability of these body systems to work together to sustain life and keep the body functioning normally, in spite of constantly changing conditions internally and in the external environment, is an essential function referred to as homeostasis.

KEY: Topic: body level of organization

DIF: Level 2 Learning Objective: 5.1

151. List the body cavities and name two main organs contained in each cavity.

ANS: Body cavities are hollow spaces containing the internal organs. Classified into two major groups depending on their location, the anterior and posterior cavities enclose five subcavities The ventral cavity (anterior) consists of the thoracic cavity, abdominal cavity, and pelvic cavity.

Pleural membranes line the organs of the thoracic cavity. A muscular wall called the diaphragm separates the thoracic and abdominal cavities.

The dorsal cavity (posterior) contains the cranial cavity and spinal cavity.

The abdominopelvic cavity combines the abdominal and pelvic cavities. For clinical evaluation and diagnostic purposes, the abdominopelvic cavity is divided into four quadrants formed by a transverse plane and a midsagittal plane that cross at the umbilicus. The four divisions are the right upper quadrant (RUQ), right lower quadrant (RLQ), left upper quadrant (LUQ), and left lower quadrant (LLQ).

KEY: Topic: body cavities

DIF: Level 1 Learning Objective: 5.3 Chapter 6

Multiple Choice

1. The blood vessel with the thickest walls is the: A. capillary.

B. artery.

C. venule.

D. vein.

ANS: B KEY: Topic: Blood vessels

DIF: Level 1 Learning Objective: 6.2

2. The longest vein in the body is the: A. saphenous.

B. basilic.

C. superior vena cava.

D. cephalic.

ANS: A KEY: Topic: Blood vessels

DIF: Level 1 Learning Objective: 6.2

3. The largest artery in the body is the: A. aorta.

B. pulmonary.

C. carotid.

D. radial.

ANS: A KEY: Topic: Blood vessels

DIF: Level 1 Learning Objective: 6.2

4. The artery of choice for measuring the pulse rate in an adult is the: A. carotid.

B. radial.

C. brachial.

D. temporal.

ANS: B KEY: Topic: Blood vessels

DIF: Level 1 Learning Objective: 6.3

5. The blood vessels that carry deoxygenated blood to the heart are: A. arteries.

B. alveoli.

C. capillaries.

D. veins.

ANS: D KEY: Topic: Blood vessels

DIF: Level 1 Learning Objective: 6.1

6. The large vein that returns blood from the head, neck, thorax, and upper limbs to the right atrium of the heart is the: A. aorta.

B. inferior vena cava.

C. carotid artery.

D. superior vena cava.

ANS: D KEY: Topic: Blood vessels

DIF: Level 1 Learning Objective: 6.1

7. The only artery in the body that carries deoxygenated blood is the: A. aorta.

B. carotid.

C. coronary.

D. pulmonary.

ANS: D KEY: Topic: Blood vessels

DIF: Level 2 Learning Objective: 6.1

8. A weakness in an arterial wall is called: A. anemia.

B. thrombosis.

C. embolism.

D. aneurysm.

ANS: D KEY: Topic: Blood vessels

DIF: Level 2 Learning Objective: 6.11

9. Hardening of the arteries is called: A. necrosis.

B. ptosis.

C. dermatitis.

D. atherosclerosis.

ANS: D KEY: Topic: Blood vessels

DIF: Level 2 Learning Objective: 6.11

10. Blood is supplied to the heart muscle by the: A. cardiac arteries.

B. aorta.

C. right ventricle.

D. coronary arteries.

ANS: D KEY: Topic: Heart

DIF: Level 1 Learning Objective: 6.5

11. A sphygmomanometer is used to measure: A. heart muscle damage.

B. pulse rate.

C. blood pressure.

D. heart rate.

ANS: C KEY: Topic: Heart

DIF: Level 1 Learning Objective: 6.3

12. Another name for a heart attack is: A. phlebitis.

B. myocardial infarction.

C. pericarditis.

D. arteriosclerosis.

ANS: B KEY: Topic: Heart

DIF: Level 1 Learning Objective: 6.11

13. A heart murmur indicates a problem with the: A. heart muscle.

B. superior vena cava.

C. coronary arteries.

D. heart valves.

ANS: D KEY: Topic: Heart

DIF: Level 2 Learning Objective: 6.11

14. The normal contraction phase of the cardiac cycle is initiated by the: A. right ventricle.

B. bundle of His. C. Purkinje fibers.

D. sinoatrial node.

ANS: D KEY: Topic: Heart

DIF: Level 2 Learning Objective: 6.7

15. Inflammation of the lining of the heart is called: A. endocardium.

B. pericarditis.

C. myocardial infarction.

D. endocarditis.

ANS: D KEY: Topic: Heart

DIF: Level 2 Learning Objective: 6.11

16. All of the following are formed elements found in the blood except: A. erythrocytes.

B. platelets.

C. macrophages.

D. leukocytes.

ANS: C KEY: Topic: Blood

DIF: Level 1 Learning Objective: 6.8

17. Red blood cells are produced in the: A. thymus.

B. liver.

C. bone marrow.

D. spleen.

ANS: C KEY: Topic: Blood

DIF: Level 1 Learning Objective: 6.9

18. The two main types of lymphocytes are T cells and: A. neutrophils.

B. B cells.

C. A cells.

D. monocytes.

ANS: B KEY: Topic: Blood

DIF: Level 1 Learning Objective: 6.9

19. The leukocyte with the highest concentration in normal blood is the: A. monocyte.

B. eosinophil.

C. basophil.

D. neutrophil.

ANS: D KEY: Topic: Blood

DIF: Level 1 Learning Objective: 6.9

20. The primary role of the thrombocyte is to: A. transport nutrients.

B. promote blood clotting.

C. phagocytize bacteria.

D. produce antibodies.

ANS: B KEY: Topic: Blood

DIF: Level 1 Learning Objective: 6.9

21. An increase in the number of white blood cells (WBCs) is: A. anemia.

B. leukopenia.

C. leukocytosis.

D. polycythemia.

ANS: C KEY: Topic: Blood

DIF: Level 1 Learning Objective: 6.12

22. Functions of the blood include all of the following except: A. transport oxygen.

B. regulate pulse rate.

C. deliver nutrients.

D. transport waste products.

ANS: B KEY: Topic: Blood

DIF: Level 2 Learning Objective: 6.9

23. Most laboratory tests are performed using: A. arterial blood.

B. venous blood.

C. capillary blood.

D. oxygenated blood.

ANS: B KEY: Topic: Blood

DIF: Level 2 Learning Objective: 6.12

24. A person's blood type is determined by the presence of: A. antibodies on red blood cells (RBCs).

B. circulating antigens.

C. antibodies on white blood cells (WBCs).

D. antigens on red blood cells (RBCs).

ANS: D KEY: Topic: Blood

DIF: Level 2 Learning Objective: 6.9

25. The plasma of a person who is blood type A will contain: A. anti-B antibodies.

B. anti-A antibodies.

C. A antigens.

D. B antigens.

ANS: A KEY: Topic: Blood

DIF: Level 2 Learning Objective: 6.9

26. The function of hemoglobin in the red blood cell (RBC) is to: A. maintain the RBC membrane.

B. transport oxygen to cells.

C. remove carbon dioxide from cells.

D. both B and C. ANS: D KEY: Topic: Blood

DIF: Level 2 Learning Objective: 6.9

27. The prothrombin time is used to monitor: A. oxygen therapy.

B. polycythemia.

C. Coumadin therapy.

D. rheumatic heart disease.

ANS: C KEY: Topic: Coagulation

DIF: Level 1 Learning Objective: 6.10

28. Fibrin degradation products are elevated in: A. iron deficiency anemia.

B. hemophilia.

C. leukemia.

D. disseminated intravascular coagulation.

ANS: D KEY: Topic: Coagulation

DIF: Level 1 Learning Objective: 6.10

29. Pathways of the coagulation cascade are: A. platelets and thrombin.

B. intrinsic and extrinsic.

C. fibrinogen and prothrombin.

D. heparin and Coumadin.

ANS: B KEY: Topic: Coagulation

DIF: Level 1 Learning Objective: 6.10

30. All of the following are tests to monitor the coagulation system except the: A. reticulocyte count.

B. prothrombin time.

C. activated partial thromboplastin time.

D. D-dimer.

ANS: A KEY: Topic: Coagulation

DIF: Level 2 Learning Objective: 6.12

31. Coagulation requires all of the following except: A. prothrombin.

B. thrombin.

C. heparin.

D. fibrin.

ANS: C KEY: Topic: Coagulation

DIF: Level 2 Learning Objective: 6.10

32. The fluid that comprises approximately 55% of the total blood volume is made up of: A. hematocrit.

B. plasma.

C. tissue fluid.

D. serum.

ANS: B KEY: Topic: Blood

DIF: Level 1 Learning Objective: 6.8

33. When anemia is a possible diagnosis for a patient, the physician will most likely be interested in the results for which of the following cells analyzed in the complete blood count (CBC)?

A. Leukocytes.

B. Platelets.

C. Macrophages.

D. Erythrocytes.

ANS: D KEY: Topic: Blood

DIF: Level 2 Learning Objective: 6.12

34. Select the single answer below that correctly fills in the names of the coagulation tests described. The ______________________ test is performed to monitor patients on Coumadin therapy, and the _____________________ test is performed to monitor patients on Heparin therapy: A. fibrin degradation products (FDP)/prothrombin time (PT) B. prothrombin time (PT)/fibrinogen

C. prothrombin time (PT)/activated partial thromboplastin time (APTT or PTT) D. bleeding time (BT)/platelet count (plt) ANS: C KEY: Topic: Coagulation

DIF: Level 2 Learning Objective: 6.12

35. Which of the following is true of veins?

A. They are the smallest of blood vessels.

B. They are used for most venipunctures.

C. They propel oxygen-rich blood from the heart.

D. Gaseous exchange takes place in veins.

ANS: B KEY: Topic: blood vessels

DIF: Level 2 Learning Objective: 6.2

36. Which of the following blood test is associated with microbial infection?

A. Bilirubin.

B. Blood culture.

C. Cholesterol.

D. C-reactive protein.

ANS: B KEY: Topic: blood tests

DIF: Level 2 Learning Objective: 6.12

Short Answer

37. Describe the cardiac cycle and explain the function of the sinoatrial (SA) node.

ANS: The cardiac cycle comprises the contraction phase (systole) and the relaxation phase (diastole) of the cardiac muscle that occurs in one heartbeat. Cardiac muscle is under involuntary control; therefore, the electrical impulses of the cardiac cycle are essential to produce rhythmic contraction and relaxation of the heart muscle.

The steps in the cardiac cycle are: 1. The SA node, located in the upper right atrium, is the pacemaker of the heart and initiates the heartbeat.

2. The atrioventricular (AV) node, located in the lower interatrial septum, receives the electrical impulse, and both the right and left atria contract, forcing blood to the ventricles.

3. The impulse passes to the AV bundle that separates into right and left bundle branches.

4. In the right and left bundle branches, the impulse travels to the Purkinje fibers covering the ventricles, causing them to contract, forcing blood into the aorta and pulmonary artery.

5. The cycle starts again.

KEY: Topic: Heart

DIF: Level 2 Learning objective: 6.7

38. Explain the purpose of coronary circulation.

ANS: The purpose of the coronary circulation is to pump blood through the blood vessels that supply heart muscle.

DIF: Level 2 Learning Objective: 6.6

Matching Place the following in the order in which they receive the blood that enters the heart.

A. 1 B. 2 C. 3 D. 4 E. 5 F. 6 G. 7 39. Left ventricle 40. Right atrium 41. Pulmonary vein 42. Right ventricle

43. Aorta 44. Pulmonary artery 45. Left atrium 39. ANS: 6 KEY: Topic: Heart

DIF: Level 2 Learning objective: 6.5

40. ANS: 1 KEY: Topic: Heart

DIF: Level 2 Learning objective: 6.5

41. ANS: 4 KEY: Topic: Heart

DIF: Level 2 Learning objective: 6.5

42. ANS: 2 KEY: Topic: Heart

DIF: Level 2 Learning objective: 6.5

43. ANS: 7 KEY: Topic: Heart

DIF: Level 2 Learning objective: 6.5

44. ANS: 3 KEY: Topic: Heart

DIF: Level 2 Learning objective: 6.5

45. ANS: 5

KEY: Topic: Heart

DIF: Level 2 Learning objective: 6.5

Match the following leukocytes with their description or function.

A. Antibody production B. Becomes a macrophage C. Increased in allergies D. Increased in bacterial infections E. Releases histamine

46. Monocyte 47. Neutrophil 48. Eosinophil 49. Basophil 60. Lymphocyte 46. ANS: B KEY: Topic: Blood

DIF: Level 2 Learning objective: 6.9

47. ANS: D KEY: Topic: Blood

DIF: Level 2 Learning objective: 6.9

48. ANS: C KEY: Topic: Blood

DIF: Level 2 Learning objective: 6.9

49. ANS: E KEY: Topic: Blood

DIF: Level 2

Learning objective: 6.9

50. ANS: A KEY: Topic: Blood

DIF: Level 2 Learning objective: 6.9

Chapter 7

Multiple Choice

1. Phlebotomy equipment can be organized in all of the following except: A. trays.

B. mobile workstations.

C. infant cradle pads.

D. drawing stations.

ANS: C KEY: Topic: Equipment general

DIF: Level 1 Learning Objective: 7.1

2. The most economical and safest method for performing routine venipuncture is the use of: A. winged blood collection set.

B. plastic syringes.

C. glass syringes.

D. evacuated tube system (ETS).

ANS: D KEY: Topic: Equipment general

DIF: Level 1 Learning Objective: 7.5

3. All of the following can decrease the possibility of developing a latex allergy except: A. wearing powdered gloves.

B. wearing nonpowdered gloves.

C. sanitizing the hands as soon as gloves are removed.

D. wearing cotton gloves.

ANS: A KEY: Topic: Equipment general

DIF: Level 1 Learning Objective: 7.9

4. The primary antiseptic for routine venipuncture is: A. iodine.

B. chlorhexidine.

C. isopropyl alcohol.

D. Betadine.

ANS: C KEY: Topic: Equipment general

DIF: Level 1 Learning Objective: 7.10

5. A properly tied tourniquet: A. permits arterial flow and blocks venous flow.

B. blocks arterial and venous flow.

C. prevents backflow.

D. permits venous flow and blocks arterial flow.

ANS: A KEY: Topic: Equipment general

DIF: Level 1 Learning Objective: 7.9

6. The plastic tubing on a winged blood collection set may be attached to all of the following except a(n): A. syringe.

B. large red stopper tube.

C. intravenous line setup.

D. evacuated tube holder.

ANS: B KEY: Topic: Equipment general

DIF: Level 2 Learning Objective: 7.5

7. The color coding of evacuated tubes provides information about all of the following except the: A. volume of specimen collected.

B. type of specimen collected.

C. need to invert the tube.

D. presence of an anticoagulant.

ANS: A KEY: Topic: Evacuated tubes

DIF: Level 1 Learning Objective: 7.6

8. Which of the following tubes must always be filled to the correct capacity?

A. Gray.

B. Light blue.

C. Red. D. Pink.

ANS: B KEY: Topic: Evacuated tubes

DIF: Level 1 Learning Objective: 7.7

9. The purpose of sodium fluoride in gray stopper tubes is to: A. prevent hemolysis.

B. prevent clotting.

C. preserve glucose.

D. maintain cellular morphology.

ANS: C KEY: Topic: Evacuated tubes

DIF: Level 1 Learning Objective: 7.7

10. All of the following tubes contain a separation gel except:

A. pink.

B. light green.

C. white.

D. red/gray.

ANS: A KEY: Topic: Evacuated tubes

DIF: Level 1 Learning Objective: 7.7

11. The tube of choice for trace metal analysis is: A. light blue.

B. red.

C. gold.

D. royal blue.

ANS: D KEY: Topic: Evacuated tubes

DIF: Level 1 Learning Objective: 7.6

12. Tubes containing soybean trypsin inhibitor and thrombin are used to collect specimens for: A. glucose.

B. fibrin degradation products.

C. blood alcohol levels.

D. paternity tests.

ANS: B KEY: Topic: Evacuated tubes

DIF: Level 1 Learning Objective: 7.6

13. Serum separator tubes should not be used for: A. blood bank tests.

B. therapeutic drug tests.

C. serology tests.

D. all of the above.

ANS: D KEY: Topic: Evacuated tubes

DIF: Level 1 Learning Objective: 7.6

14. Yellow stopper tubes are used for all of the following except: A. blood cultures.

B. lead testing.

C. human leukocyte antigen (HLA) typing.

D. paternity testing.

ANS: B KEY: Topic: Evacuated tubes

DIF: Level 1 Learning Objective: 7.6

15. Packages of evacuated tubes manufactured at the same time are called a: A. batch.

B. set.

C. lot.

D. bundle.

ANS: C KEY: Topic: Evacuated tubes

DIF: Level 1 Learning Objective: 7.5

16. The ratio of blood to anticoagulant in a light blue stopper tube is: A. 2:1.

B. 5:1.

C. 9:1.

D. 10:1.

ANS: C KEY: Topic: Evacuated tubes

DIF: Level 1 Learning Objective: 7.6

17. The purpose of thixotropic gel in an evacuated tube is to: A. prevent clot formation.

B. prevent cellular contamination of serum.

C. increase clot formation.

D. facilitate blood bank testing procedures.

ANS: B KEY: Topic: Evacuated tubes

DIF: Level 1 Learning Objective: 7.7

18. Blood cultures may be collected in: A. yellow stopper tubes containing sodium polyanethole sulfonate (SPS).

B. yellow stopper tubes containing acid citrate dextrose (ACD).

C. yellow/gray stopper tubes containing thrombin.

D. plain, sterile red stopper tubes.

ANS: A KEY: Topic: Evacuated tubes

DIF: Level 1 Learning Objective: 7.6

19. The anticoagulant present in a light blue stopper tube is: A. Ethylenediaminetetraacetic acid (EDTA).

B. sodium citrate.

C. heparin.

D. potassium oxalate.

ANS: B KEY: Topic: Evacuated tubes

DIF: Level 1 Learning Objective: 7.7

20. In an evacuated tube, blood flow into the tube depends on: A. the vacuum in the tube.

B. gravity.

C. blood pressure.

D. air pressure.

ANS: A KEY: Topic: Evacuated tubes

DIF: Level 1

Learning Objective: 7.5

21. Most anticoagulants in blood collection tubes prevent clotting by: A. binding calcium.

B. acting as an antithrombin agent.

C. binding fibrinogen.

D. releasing heparin.

ANS: A KEY: Topic: Evacuated tubes

DIF: Level 1 Learning Objective: 7.7

22. Lavender stopper tubes can be used for all of the following except: A. coagulation tests.

B. platelet counts.

C. differential counts.

D. hematocrits.

ANS: A KEY: Topic: Evacuated tubes

DIF: Level 2 Learning Objective: 7.6

23. Which of the following tubes contains an anticoagulant that inhibits thrombin?

A. Lavender.

B. Light blue.

C. White.

D. Light green.

ANS: D KEY: Topic: Evacuated tubes

DIF: Level 2 Learning Objective: 7.7

24. When collecting coagulation tests from a patient with polycythemia, the: A. tube should not be inverted.

B. amount of anticoagulant is increased.

C. tube should contain thrombin.

D. amount of anticoagulant is decreased.

ANS: D KEY: Topic: Evacuated tubes

DIF: Level 2 Learning Objective: 7.7

25. The tube that will best prevent falsely increased potassium test results is: A. light green.

B. green.

C. red.

D. gold.

ANS: A KEY: Topic: Evacuated tubes

DIF: Level 2 Learning Objective: 7.6

26. To obtain a serum sample for a stat test on a patient receiving anticoagulant therapy, the recommended tube is: A. light green.

B. red/gray or gold.

C. orange.

D. red.

ANS: C KEY: Topic: Evacuated tubes

DIF: Level 2 Learning Objective: 7.6

27. The difference between glass and plastic red stopper tubes is that the: A. glass tubes cannot be used for serology tests.

B. glass tubes contain heparin.

C. plastic tubes contain a clot activator.

D. plastic tubes are recommended for blood bank tests.

ANS: C KEY: Topic: Evacuated tubes

DIF: Level 2

Learning Objective: 7.6

28. Which of the following is the most acceptable order of tube draw?

A. Green, red, and light blue.

B. Lavender, red, and yellow.

C. Light blue, red, and lavender.

D. Yellow, green, and light blue.

ANS: C KEY: Topic: Evacuated tubes

DIF: Level 2 Learning Objective: 7.8

29. Drawing a lavender stopper tube before a serum separator tube (SST) can cause a falsely: A. increased calcium value.

B. decreased glucose value.

C. decreased calcium value.

D. increased glucose value.

ANS: C KEY: Topic: Evacuated tubes

DIF: Level 2 Learning Objective: 7.8

30. A phlebotomist who used a light blue stopper tube after its expiration date may have the specimen rejected because: A. the specimen is clotted.

B. the differential does not stain properly.

C. the tube is not completely filled.

D. both A and C. ANS: D KEY: Topic: Evacuated tubes

DIF: Level 2 Learning Objective: 7.12

31. Failing to adequately invert a lavender stopper tube after collection will: A. cause hemolysis.

B. falsely elevate calcium results.

C. destroy coagulation factors.

D. produce a clotted specimen.

ANS: D KEY: Topic: Evacuated tubes

DIF: Level 2 Learning Objective: 7.12

32. Electrolytes can be performed on serum or plasma from all of the following tubes except: A. light green.

B. gray.

C. plastic red.

D. gold.

ANS: B KEY: Topic: Evacuated tubes

DIF: Level 2 Learning Objective: 7.6

33. The advantages of evacuated tube system (EST) over a syringe are: 1. no transfer of blood is necessary.

2. it is a closed system.

3. the holder can be reused.

4. you have more control over the vacuum.

A. 1 and 2.

B. 2 and 4.

C. 1, 2, and 3.

D. 1, 2, 3, and 4.

ANS: A KEY: Topic: Evacuated tubes

DIF: Level 2 Learning Objective: 7.5

34. To prevent leakage of blood when tubes are changed, evacuated tube needles: A. have a blunting device.

B. use a rubber sheathe.

C. are only used for single tube collections.

D. are used with safety holders.

ANS: B KEY: Topic: Needles and adapters

DIF: Level 1 Learning Objective: 7.3

35. The stopper-puncturing needle should be completely pushed into the evacuated tube: A. after the vein is entered.

B. while the equipment is being assembled.

C. just before the vein is entered.

D. prior to anchoring the vein.

ANS: A KEY: Topic: Needles and adapters

DIF: Level 1 Learning Objective: 7.3

36. Which of the following needles has the largest diameter?

A. 16 gauge.

B. 18 gauge.

C. 20 gauge.

D. 22 gauge.

ANS: A KEY: Topic: Needles and adapters

DIF: Level 2 Learning Objective: 7.3

37. Collecting a large evacuated tube using 23-gauge needle: A. is recommended for geriatric patients.

B. is required for certain automated tests.

C. may cause a hemolyzed sample.

D. may cause a loss of vacuum in the tube.

ANS: C KEY: Topic: Needles and adapters

DIF: Level 2 Learning Objective: 7.12

38. When collecting blood from a patient with small, fragile veins, the appropriate needle gauge is: A. 18.

B. 20.

C. 21.

D. 23.

ANS: D KEY: Topic: Needles and adapters

DIF: Level 2 Learning Objective: 7.13

39. Forcing blood from a syringe into an evacuated tube: A. prevents the blood from clotting.

B. can only be done when using a small syringe.

C. may hemolyze the specimen.

D. is required when using a transfer device.

ANS: C KEY: Topic: Syringes and winged blood collection sets

DIF: Level 2 Learning Objective: 7.5

40. The most important reason that the phlebotomist’s tray should not be carried into the room of a patient in isolation is: A. surfaces on the tray may act as a reservoir for infectious agents.

B. there is often no spare space available in an isolation room.

C. the tray should be left in the hallway so others may find the phlebotomist when needed.

D. supplies may be stolen from the tray.

ANS: A KEY: Topic: Equipment general

DIF: Level 2 Learning Objective: 7.1

Matching

Match the following evacuated tube stopper colors with the tube description.

A. Lavender B. Pink C. Red/gray or gold D. Royal blue E. Tan F. White G. Orange 41. Contains thrombin 42. Used for lead testing 43. Rubber stoppers are specially formulated 44. Contains thixotropic gel and a clot activator 45. Sedimentation rates 46. Designated for blood bank specimens 47. Used for molecular diagnostics 41. ANS: G KEY: Topic: Evacuated tubes

DIF: Level 1 Learning Objective: 7.6

42. ANS: E KEY: Topic: Evacuated tubes

DIF: Level 1 Learning Objective: 7.6

43. ANS: D KEY: Topic: Evacuated tubes

DIF: Level 1 Learning Objective: 7.6

44. ANS: C KEY: Topic: Evacuated tubes

DIF: Level 1 Learning Objective: 7.6

45. ANS: A KEY: Topic: Evacuated tubes

DIF: Level 1 Learning Objective: 7.6

46. ANS: B KEY: Topic: Evacuated tubes

DIF: Level 1 Learning Objective: 7.6

47. ANS: F KEY: Topic: Evacuated tubes

DIF: Level 1 Learning Objective: 7.6

Short Answers

48. Given the following blood test order scenarios, provide the proper order of draw for the tubes listed for each scenario: a. Blood culture bottles, gray and gold ANS: blood culture bottles, gold, gray KEY: Topic: order of draw DIF: 3 Learning Objective: 7.8 b. Lavender, light blue, and green ANS: light blue, green, lavender KEY: Topic: order of draw DIF: 3 Learning Objective: 7.8 c. Red/gray, orange, and lavender ANS: red/gray, orange, lavender

KEY: Topic: order of draw DIF: 3 Learning Objective: 7.8 d. Light blue, yellow (SPS), red ANS: yellow, light blue, red KEY: Topic: order of draw DIF: 3 Learning Objective: 7.8 List the items and their purpose for items that should be carried on a blood collections tray.

ANS: Evacuated tube system holders: part of the evacuated tube system. Holds needle and tube.

Syringes: used for blood collection Winged blood collection sets: used for blood collection Needles: used to puncture vein Needle disposal sharps containers: used to dispose of needles and other sharps Evacuated collection tubes: used to collect the blood in Transfer devices: used to transfer blood from syringes into blood tubes Tourniquets: used to help locate patient’s vein Gloves: required for all blood draws 70 percent isopropyl alcohol, iodine swabs, chlorhexidine gluconate swabs: used to clean area before venipuncture.

2-in. × 2-in. gauze pads: used to apply pressure to venipuncture site after removing the needle Bandages: to bandage venipuncture site Slides: to prepare blood film for certain hematology tests Antimicrobial hand gel: used to cleanse hands if unable to wash with soap and water Marking pen: to label tubes, microscope slides, specimen containers KEY: Topic: blood collection supplies DIF: 2 Learning Objective: 7.2

Chapter 8

Multiple Choice

1. Basic information that should be present on all requisition forms includes all of the following except the: A. patient’s location.

B. patient’s identification number.

C. tests requested.

D. type of collection tubes.

ANS: D KEY: Topic: Patient identification

DIF: Level 1 Learning Objective: 8.1

2. To aid in specimen processing, requisition forms may contain: A. special collection information.

B. the phlebotomist’s initials.

C. a bar code.

D. the patient’s date of birth.

ANS: C KEY: Topic: Patient identification

DIF: Level 1 Learning Objective: 8.1

3. The most important procedure in phlebotomy is to: A. organize equipment at the bedside.

B. introduce yourself to the patient.

C. initial the requisition form.

D. identify the patient correctly.

ANS: D KEY: Topic: Patient identification

DIF: Level 1 Learning Objective: 8.3

4. All of the following are used to identify a patient except the: A. bed sign.

B. requisition form.

C. identification band.

D. bar codes.

ANS: A KEY: Topic: Patient identification

DIF: Level 1 Learning Objective: 8.3

5. The most important purpose of a requisition form is: A. authorization to perform the procedure.

B. providing a system to report results.

C. location of the patient.

D. monitoring test result turnaround time.

ANS: A KEY: Topic: Patient identification

DIF: Level 1 Learning Objective: 8.1

6. Proper specimen collection begins with: A. sanitizing the hands.

B. locating the patient.

C. requisitioning.

D. organizing the equipment.

ANS: C KEY: Topic: Patient identification

DIF: Level 1 Learning Objective: 8.3

7. Before you draw a blood specimen, you must always: A. check the patient’s identification number and name on the wrist band.

B. label the tube.

C. ask the nurse in charge to identify the patient.

D. tell the patient what type of blood test you are going to perform.

ANS: A KEY: Topic: Patient identification

DIF: Level 1 Learning Objective: 8.3

8. When encountering a patient with casts on both arms and no wrist band, the phlebotomist should first: A. check the casts for the patient identification number.

B. ask the patient if his name is John Jones.

C. check the patient’s ankles.

D. look for the identification band on the nightstand.

ANS: C KEY: Topic: Patient identification

DIF: Level 2 Learning Objective: 8.4

9. Blood should not be drawn from a patient who is: A. standing.

B. nervous.

C. unable to make a fist.

D. not fasting.

ANS: A KEY: Topic: Phlebotomist/patient preparation

DIF: Level 1 Learning Objective: 8.4

10. Patient reassurance includes: A. explaining the purpose of the tests ordered.

B. lowering the bedrails.

C. briefly explaining the procedure.

D. assuring the patient the procedure will not hurt.

ANS: C KEY: Topic: Phlebotomist/patient preparation

DIF: Level 1 Learning Objective: 8.2

11. Failure to check the requisition form prior to leaving the laboratory may cause the phlebotomist to: A. collect the wrong specimen.

B. have inadequate equipment.

C. misidentify the patient.

D. require assistance from the nurse.

ANS: B KEY: Topic: Phlebotomist/patient preparation

DIF: Level 2 Learning Objective: 8.5

12. When organizing equipment at the patient’s bedside, it is important to: A. place all the necessary equipment on the nightstand.

B. apply the tourniquet first.

C. set the phlebotomy tray on the patient’s bed.

D. have extra evacuated tubes readily available.

ANS: D KEY: Topic: Phlebotomist/patient preparation

DIF: Level 2 Learning Objective: 8.5

13. The maximum time a tourniquet should remain on the patient’s arm is: A. 1 minute.

B. 2 minutes.

C. 3 minutes.

D. 5 minutes.

ANS: A KEY: Topic: Site selection/preparation

DIF: Level 1 Learning Objective: 8.7

14. The vein of choice for routine venipuncture is the: A. median cubital.

B. radial.

C. cephalic.

D. basilic.

ANS: A KEY: Topic: Site selection/preparation

DIF: Level 1 Learning Objective: 8.6

15. The vein located on the thumb side of the arm is the: A. brachial.

B. median cubital.

C. basilic.

D. cephalic.

ANS: D KEY: Topic: Site selection/preparation

DIF: Level 1 Learning Objective: 8.6

16. A large, rigid cord located during palpation indicates: A. an acceptable vein.

B. the brachial artery.

C. a tendon.

D. an unacceptable vein.

ANS: C KEY: Topic: Site selection/preparation

DIF: Level 1 Learning Objective: 8.6

17. Palpate means to: A. perform a venipuncture.

B. examine by touch.

C. examine by sound.

D. obtain a specimen from an intravenous line.

ANS: B KEY: Topic: Site selection/preparation

DIF: Level 1 Learning Objective: 8.8

18. Prolonged application of a tourniquet will cause: A. excessive bleeding.

B. difficulty locating a vein.

C. hemolysis.

D. both A and C.

ANS: C KEY: Topic: Site selection/preparation

DIF: Level 2 Learning Objective: 8.7

19. The appearance of petechiae on a patient’s arm during site selection indicates that the: A. patient has deep veins.

B. tourniquet is tied too tightly.

C. basilic vein should not be used.

D. radial pulse beat is very strong.

ANS: B KEY: Topic: Site selection/preparation

DIF: Level 2 Learning Objective: 8.7

20. Failure to allow the alcohol to dry on the patient’s arm after site cleansing can cause all of the following except: A. increased bacteriostatic action.

B. a stinging sensation for the patient.

C. a possible unsterile site.

D. specimen hemolysis.

ANS: A KEY: Topic: Site selection/preparation

DIF: Level 2 Learning Objective: 8.9

21. Correct palpation of a vein includes all of the following except: A. determining the depth of the vein.

B. detecting a pulse using the thumb.

C. determining the direction of the vein.

D. probing with the index finger.

ANS: B KEY: Topic: Site selection/preparation

DIF: Level 2 Learning Objective: 8.8

22. Hemoconcentration can be caused by: A. prolonged tourniquet application.

B. intravenous therapy.

C. excessive probing.

D. failure to clench the fist.

ANS: A KEY: Topic: Site selection/preparation

DIF: Level 2 Learning Objective: 8.7

23. Firmly anchoring the vein prior to needle insertion is necessary to prevent: A. specimen hemolysis.

B. incompletely filled tubes.

C. an accidental needlestick.

D. the vein from rolling.

ANS: D KEY: Topic: Venipuncture technique

DIF: Level 1 Learning Objective: 8.10

24. Which of the following is performed first when the last tube is collected?

A. Gauze is placed over the needle.

B. The filled tube is removed from the holder.

C. The needle is removed.

D. Pressure is applied to the site.

ANS: B KEY: Topic: Venipuncture technique

DIF: Level 1 Learning Objective: 8.10

25. After needle removal, pressure is applied to the site: A. by having the patient bend the elbow.

B. after labeling the tubes.

C. prior to removing the tourniquet.

D. to prevent hematoma formation.

ANS: D KEY: Topic: Venipuncture technique

DIF: Level 1 Learning Objective: 8.10

26. When collecting specimens in a patient’s room, tubes are routinely labeled: A. prior to collecting the blood.

B. using preprinted labels.

C. after collecting the blood.

D. after leaving the patient’s room.

ANS: C KEY: Topic: Venipuncture technique

DIF: Level 1 Learning Objective: 8.10

27. Prior to bandaging the puncture site, the phlebotomist should: A. thank the patient.

B. instruct a fasting patient to eat.

C. examine the site for bleeding.

D. apply pressure for at least 5 minutes.

ANS: C KEY: Topic: Venipuncture technique

DIF: Level 1 Learning Objective: 8.10

28. An example of improper disposal of venipuncture supplies and equipment is: A. placing gauze and alcohol pads in a biohazard container.

B. recapping the needle.

C. removing gloves and sanitizing hands.

D. placing the plastic needle cover in the wastebasket.

ANS: B KEY: Topic: Venipuncture technique

DIF: Level 1 Learning Objective: 8.11

29. During the venipuncture, the phlebotomist should do all of the following except: A. anchor the vein above and below the puncture site.

B. insert the needle with the bevel up.

C. insert the needle at a 15- to 30-degree angle.

D. brace the hand holding the holder on the patient’s arm.

ANS: A KEY: Topic: Venipuncture technique

DIF: Level 2 Learning Objective: 8.10

30. Tubes are angled downward during blood collection to: A. ensure they fill completely.

B. prevent patient discomfort.

C. prevent blood refluxing into the needle.

D. ensure mixing of blood and anticoagulant.

ANS: C KEY: Topic: Venipuncture technique

DIF: Level 2 Learning Objective: 8.10

31. Bracing the hand holding the needle assembly against the patient’s arm: A. decreases the patient discomfort.

B. prevents excess needle movement.

C. decreases the possibility of hemolysis.

D. causes the tubes to fill more quickly.

ANS: B KEY: Topic: Venipuncture technique

DIF: Level 2 Learning Objective: 8.10

32. A properly labeled tube must have all of the following information except: A. patient location.

B. patient identification number.

C. date of collection.

D. phlebotomist’s initials.

ANS: A KEY: Topic: Specimen handling

DIF: Level 1 Learning Objective: 8.12

33. Which specimen should be collected last?

A. STAT specimen.

B. Specimen requiring special handling.

C. Clotted specimen.

D. Fasting specimen.

ANS: B KEY: Topic: Specimen handling

DIF: Level 2 Learning Objective: 8.13

34. Failure to deliver glucose drawn in a plasma separator tube (PST) to the laboratory within the recommended time will cause: A. a falsely decreased glucose value.

B. a falsely increased glucose value.

C. glycolysis.

D. both A and C. ANS: D KEY: Topic: Specimen handling

DIF: Level 2 Learning Objective: 8.13

35. Two identifiers for patient identification before specimen collection are routinely secured by all the following means except: A. verifying the patient’s identification number on the wrist or ankle identification band.

B. asking the patient to state his or her first name and last name.

C. asking the patient, “Are you John Doe?” or, “Are you Mary Doe?” D. comparing information obtained verbally and from the patient’s identification band with the information on the test requisition.

ANS: C KEY: Topic: Patient identification

DIF: Level 2 Learning Objective: 8.3

36. The Clinical Laboratory and Standards Institute (CLSI) recommends that all patient specimens are delivered to the laboratory no more than 2 hours after collection to reduce preexamination variables caused by cellular action and the effects of prolonged exposure of specimens to room temperatures, such as: A. glycolysis caused by cells’ use of glucose; hemolysis and leakage of potassium from the cells into the plasma or serum; and the destruction of coagulation factors from exposure to room temperatures.

B. leakage of coagulation factors into the serum or plasma by cellular metabolism; increased potassium values caused by exposure to room temperature; and increased glucose values caused by cellular metabolism.

C. glycolysis caused by leakage from cells; increased levels of coagulation factors caused by prolonged exposure to room temperatures; and decreased potassium levels caused by cellular metabolism.

D. glycolysis caused by exposure to room temperatures; hemolysis and leakage of coagulation factors from the cells; and decreased potassium levels in the serum and plasma by cellular utilization.

ANS: A KEY: Topic: Specimen handling

DIF: Level 2 Learning Objective: 8.13

Matching

Place the following steps of the venipuncture technique in the correct order.

A. 1 B. 2 C. 3 D. 4 E. 5 F. 6 G. 7 H. 8 37. Identify the patient.

38. Remove the needle and apply pressure.

39. Obtain a requisition form.

40. Activate the needle safety device.

41. Label the tubes.

42. Anchor the vein.

43. Cleanse the site.

44. Insert the needle.

37. ANS: B KEY: Topic: Venipuncture technique

DIF: Level 1 Learning Objective: 8.10

38. ANS: F KEY: Topic: Venipuncture technique

DIF: Level 1 Learning Objective: 8.10

39. ANS: A KEY: Topic: Venipuncture technique

DIF: Level 1 Learning Objective: 8.10

40. ANS: G KEY: Topic: Venipuncture technique

DIF: Level 1 Learning Objective: 8.10

41. ANS: H KEY: Topic: Venipuncture technique

DIF: Level 1 Learning Objective: 8.10

42. ANS: D KEY: Topic: Venipuncture technique

DIF: Level 1 Learning Objective: 8.10

43. ANS: C KEY: Topic: Venipuncture technique

DIF: Level 1 Learning Objective: 8.10

44. ANS: E KEY: Topic: Venipuncture technique

DIF: Level 1 Learning Objective: 8.10

Short Answers

45. List the three veins used most frequently for venipuncture. Which of these veins is the vein of choice?

ANS: The three veins are median cubital, cephalic, and basilic. The median cubital is the vein of choice.

KEY: Topic: Venipuncture technique DIF: Level 1 Learning Objective: 8.6

46. What is the purpose of the test requisition form?

ANS: The test requisition form is used to provide the phlebotomist with the information needed to correctly identify the patient, organize the necessary supplies, collect the appropriate specimens, and provide legal protection.

KEY: Topic: Test requisition form DIF: Level 2 Learning Objective: 8.1

47. Describe the reasons why a tourniquet should only be on an arm for one minute.

ANS: A tourniquet should not be left on for more than one minute due to issues that can happen

to the specimen and the patient’s arm. Hemoconcentration and hemolysis can occur and affect the test results. Bruising and pain can also be caused by leaving the tourniquet on too long.

KEY: Topic: Tourniquet application DIF: Level 2 Learning Objective: 8.7 Chapter 9

Multiple Choice

1. A phlebotomist can interrupt a physician-patient visit: A. when the physician is not examining the patient.

B. if the collection is a timed specimen.

C. if the patient has visitors present.

D. when the patient is scheduled for routine phlebotomy rounds.

ANS: B KEY: Topic: Patient preparation

DIF: Level 1 Learning Objective: 9.2

2. When encountering a patient who is sleeping, the phlebotomist should: A. return at another time.

B. try to collect the specimen without waking the patient.

C. notify the nursing station.

D. awaken the patient before collecting the specimen.

ANS: D KEY: Topic: Patient preparation

DIF: Level 1 Learning Objective: 9.2

3. Specimens for test substances that exhibit diurnal variation must be collected: A. at specific times.

B. from fasting patients.

C. when patients are lying down.

D. when patients are in a basal state.

ANS: A KEY: Topic: Patient preparation

DIF: Level 1 Learning Objective: 9.4

4. Patients taking diuretics frequently have blood drawn to monitor: A. cholesterol.

B. blood urea nitrogen (BUN).

C. potassium.

D. glucose.

ANS: C KEY: Topic: Patient preparation

DIF: Level 1 Learning Objective: 9.4

5. When a request for collection of a blood specimen is telephoned to the laboratory, the phlebotomist should: A. request delivery of a requisition form.

B. pick up the requisition form at the collection area.

C. notify the phlebotomy supervisor.

D. suggest that the nurse collect the specimen.

ANS: B KEY: Topic: Patient preparation

DIF: Level 1 Learning Objective: 9.4

6. If a patient refuses to have blood drawn, the phlebotomist should: A. send another phlebotomist to collect the specimen.

B. report the situation to the nursing station.

C. return the requisition form to the laboratory.

D. ask someone to hold the patient and collect the specimen.

ANS: B KEY: Topic: Patient preparation

DIF: Level 1 Learning Objective: 9.7

7. The best way to prevent fainting in a patient during blood collection is to: A. have the patient stand during the phlebotomy.

B. have the patient lie down during the phlebotomy.

C. have the patient pump the fist three times.

D. place a pillow under the patient’s head.

ANS: B KEY: Topic: Patient complications

DIF: Level 1 Learning Objective: 9.6

8. Patients are most likely to be in a basal state at: A. 0600.

B. 1000.

C. 1400.

D. 1800.

ANS: A KEY: Topic: Patient preparation

DIF: Level 2 Learning Objective: 9.4

9. A specimen collected from a patient who has recently eaten may appear: A. hemolyzed.

B. watery.

C. lipemic.

D. icteric.

ANS: C KEY: Topic: Patient preparation

DIF: Level 2 Learning Objective: 9.4

10. Blood tests that are affected by the patient’s posture are those that measure: A. electrolytes.

B. large molecules.

C. glucose.

D. small molecules.

ANS: B KEY: Topic: Patient preparation

DIF: Level 2 Learning Objective: 9.4

11. Collection of blood from a vigorously crying child may cause a falsely: A. decreased white blood cell count.

B. increased glucose level.

C. increased white blood cell count.

D. decreased glucose level.

ANS: C KEY: Topic: Patient preparation

DIF: Level 2 Learning Objective: 9.3

12. A phlebotomist encountering a comatose patient with no identification band should: A. notify the phlebotomy supervisor.

B. check the patient’s identity with the patient’s roommate.

C. leave the requisition form at the nurse’s station.

D. ask the nurse to band the patient.

ANS: D KEY: Topic: Patient preparation

DIF: Level 2 Learning Objective: 9.2

13. A phlebotomist with a request for a STAT glucose does not find the patient in the room. The phlebotomist should: A. return the requisition form to the laboratory.

B. check back after completing rounds.

C. check the patient’s location with the nursing station.

D. ask the hospital telephone operator to page the patient.

ANS: C KEY: Topic: Patient preparation

DIF: Level 2 Learning Objective: 9.2

14. A patient who appears pale and has cold, damp skin may develop: A. coagulation problems.

B. septicemia.

C. sclerosis.

D. syncope.

ANS: D KEY: Topic: Patient preparation

DIF: Level 2 Learning Objective: 9.6

15. When a phlebotomist enters a room to draw blood, the patient states that blood was just collected 20 minutes ago. The phlebotomist should: A. draw the patient and notify the nursing station.

B. check the patient’s arm for bleeding.

C. draw the patient from the other arm.

D. check the order with the nursing station before drawing.

ANS: D KEY: Topic: Patient preparation

DIF: Level 2 Learning Objective: 9.1

16. Recent strenuous exercise may affect the results of tests for: A. creatinine and creatine kinase.

B. bilirubin and alanine transaminase (ALT).

C. glucose and blood urea nitrogen (BUN).

D. amylase and uric acid.

ANS: A KEY: Topic: Patient preparation

DIF: Level 2 Learning Objective: 9.4

17. Physician approval is required when collecting blood from: A. patients with diabetes.

B. lower arm veins.

C. foot veins.

D. pediatric patients.

ANS: C KEY: Topic: Site selection

DIF: Level 1 Learning Objective: 9.10

18. Areas that should be avoided for venipuncture include all of the following except: A. hematomas.

B. deep cephalic veins.

C. sclerosed veins.

D. burns.

ANS: B KEY: Topic: Site selection

DIF: Level 1 Learning Objective: 9.11

19. When encountering a patient with a fistula, the phlebotomist should: A. apply the tourniquet below the fistula.

B. use the other arm.

C. collect the blood from the fistula.

D. attach a syringe to the T-tube connector.

ANS: B KEY: Topic: Site selection

DIF: Level 1 Learning Objective: 9.12

20. The surgical fusion of a vein and artery frequently seen in dialysis patients is called: A. an aneurysm.

B. hemoconcentration.

C. a fistula.

D. an angioplasty.

ANS: C KEY: Topic: Site selection

DIF: Level 1 Learning Objective: 9.12

21. The word meaning an abnormal accumulation of fluid in the tissues is: A. phlebitis.

B. edema.

C. anemia.

D. plasma.

ANS: B KEY: Topic: Site selection

DIF: Level 1 Learning Objective: 9.11

22. If a suitable vein is not located in the left arm, the phlebotomist should: A. check the right arm.

B. apply a blood pressure cuff.

C. apply the tourniquet above the hand.

D. puncture in the area of the median cubital vein.

ANS: A KEY: Topic: Site selection

DIF: Level 1 Learning Objective: 9.9

23. Incorrect collection of blood from a patient who has had a mastectomy can result in all of the following except the: A. patient developing lymphedema.

B. patient developing an infection.

C. specimens being affected by lymphostasis.

D. specimens being affected by chemotherapy.

ANS: D KEY: Topic: Site selection

DIF: Level 2 Learning Objective: 9.11

24. Fistulas are seen in patients who: A. are receiving dialysis.

B. have very fragile veins.

C. must be rapidly transfused.

D. are receiving frequent medications.

ANS: A KEY: Topic: Site selection

DIF: Level 2 Learning Objective: 9.12

25. Collection of specimens from leg veins is not recommended in all of the following except: A. patients with multiple fractures.

B. diabetic patients.

C. patients with coagulation disorders.

D. cardiac patients.

ANS: A KEY: Topic: Site selection

DIF: Level 2 Learning Objective: 9.10

26. When collecting blood from a patient with a very edematous right arm and a large hematoma in the antecubital area of the left arm, the phlebotomist should collect the specimen from: A. below the hematoma.

B. above the hematoma.

C. the antecubital area of the right arm.

D. the antecubital area of the left arm.

ANS: A KEY: Topic: Site selection

DIF: Level 2 Learning Objective: 9.5

27. Collecting blood from an area containing a fresh tattoo may result in: A. hemolysis.

B. an infection.

C. elevated test results.

D. syncope.

ANS: B KEY: Topic: Site selection

DIF: Level 2 Learning Objective: 9.5

28. Attempting to draw blood from a vein that is occluded may result in: A. patient syncope.

B. formation of a hematoma.

C. failure to obtain sufficient blood.

D. excessive bleeding.

ANS: C KEY: Topic: Site selection

DIF: Level 2 Learning Objective: 9.16

29. When collecting blood from a patient with an intravenous line, the phlebotomist should not: A. collect from the intravenous line after it has been stopped for 5 minutes.

B. draw from the opposite arm.

C. draw from above the intravenous line.

D. draw from below the intravenous line.

ANS: C KEY: Topic: Site selection

DIF: Level 2 Learning Objective: 9.5

30. Collection of blood from an area that is edematous: A. is acceptable for venipuncture.

B. may produce a hemoconcentrated specimen.

C. is acceptable for dermal puncture.

D. should be avoided.

ANS: D KEY: Topic: Site selection

DIF: Level 2 Learning Objective: 9.11

31. A phlebotomist may be required to obtain information from a second wrist band when collecting specimens for: A. a blood bank.

B. chemistry.

C. coagulation.

D. HIV. ANS: A KEY: Topic: Venipuncture technique

DIF: Level 1 Learning Objective: 9.5

32. If a patient begins to faint during the venipuncture, the phlebotomist should immediately: A. lower the patient’s head.

B. remove the tourniquet and needle.

C. summon a supervisor or nurse.

D. provide the patient with a sweet drink.

ANS: B KEY: Topic: Venipuncture technique

DIF: Level 1 Learning Objective: 9.6

33. When using a blood pressure cuff as a tourniquet, the cuff is inflated: A. below the systolic and above the patient’s diastolic pressure.

B. to 40 mm Hg. C. and deflated three times.

D. above the systolic and below the patient’s diastolic pressure.

ANS: A KEY: Topic: Venipuncture technique

DIF: Level 1 Learning Objective: 9.9

34. A tourniquet is not applied when collecting a specimen for: A. lactic acid.

B. cortisol.

C. ammonia.

D. glucose.

ANS: A KEY: Topic: Venipuncture technique

DIF: Level 1 Learning Objective: 9.8

35. The maximum number of attempts that a phlebotomist should make to collect a specimen is: A. one.

B. two.

C. three.

D. four ANS: B KEY: Topic: Venipuncture technique

DIF: Level 1 Learning Objective: 9.5

36. A patient’s identification band may contain special stickers to be applied to specimens for: A. blood bank.

B. chemistry.

C. microbiology.

D. hematology.

ANS: A KEY: Topic: Venipuncture technique

DIF: Level 1 Learning Objective: 9.1

37. Difficult-to-locate veins can be made more prominent by all of the following except: A. massaging the arm.

B. applying cold compresses.

C. applying hot compresses.

D. having the patient clench the fist.

ANS: B KEY: Topic: Venipuncture technique

DIF: Level 1 Learning Objective: 9.9

38. If a patient requests a drink of water, the phlebotomist should: A. report the request to the nursing station.

B. fill the patient’s water pitcher.

C. tell the patient they are to have nothing by mouth (NPO).

D. explain that water will affect the patient’s condition.

ANS: A KEY: Topic: Venipuncture technique

DIF: Level 1 Learning Objective: 9.5

39. A patient who presents with petechiae prior to tourniquet application may require: A. additional reassurance.

B. use of a blood pressure cuff.

C. blood to be drawn from a hand vein.

D. additional pressure following needle removal.

ANS: D KEY: Topic: Venipuncture technique

DIF: Level 2 Learning Objective: 9.5

40. Prolonged tourniquet application will cause: A. edema.

B. hemolysis.

C. hemoconcentration.

D. both B and C. ANS: D KEY: Topic: Venipuncture technique

DIF: Level 2 Learning Objective: 9.8

41. The puncture site may require additional pressure to stop bleeding when the patient: A. has low blood pressure.

B. is taking anticoagulants.

C. frequently takes aspirin.

D. both B and C. ANS: D KEY: Topic: Venipuncture technique

DIF: Level 2 Learning Objective: 9.5

42. Specimens are rejected by the laboratory for all of the following reasons except: A. clots in a lavender stopper tube.

B. collection in the wrong tube.

C. incompletely filled light-blue stopper tubes.

D. clots in a red stopper tube.

ANS: D KEY: Topic: Venipuncture technique

DIF: Level 2 Learning Objective: 9.19

43. After filling the first tube of a three-tube collection, blood does not flow into the second tube.

The phlebotomist should: 1. move the needle slightly.

2. remove the tube and try the third tube.

3. try a new second tube.

4. immediately discontinue the phlebotomy and stick the other arm.

A. 1 and 3.

B. 2 and 4.

C. 1 and 2.

D. 1, 2, and 3.

ANS: A KEY: Topic: Venipuncture technique

DIF: Level 2 Learning Objective: 9.15

44. Using a 20-gauge needle and a 10-mL evacuated tube on a small vein may cause: A. specimen hemolysis.

B. a hematoma.

C. a collapsed vein.

D. loss of tube vacuum.

ANS: C KEY: Topic: Venipuncture technique

DIF: Level 2 Learning Objective: 9.5

45. When an evacuated tube is pushed onto the needle, blood begins to flow and then stops. This could be caused by all of the following except: A. use of a 23-gauge needle.

B. collapsing of the vein.

C. the bevel of the needle resting on the vein wall.

D. an occluded vein.

ANS: A KEY: Topic: Venipuncture technique

DIF: Level 2 Learning Objective: 9.15

46. While performing a venipuncture, the phlebotomist notices bright red blood spurting into the tube. The phlebotomist should: A. immediately withdraw the needle.

B. immediately remove the tourniquet.

C. lower the patient’s head.

D. apply pressure for 10 minutes after withdrawing the needle.

ANS: D KEY: Topic: Venipuncture technique

DIF: Level 2 Learning Objective: 9.5

47. Which of the following patient conditions will prolong the time it takes to stop the bleeding from a venipuncture site?

A. Low blood pressure.

B. Low blood sugar.

C. Patient taking Coumadin.

D. Patient taking vitamin K. ANS: C KEY: Topic: Venipuncture technique

DIF: Level 2 Learning Objective: 9.5

48. To transfer blood from a syringe to an evacuated tube: A. do not puncture the evacuated tube stopper.

B. make sure all of the blood in the syringe enters the evacuated tube.

C. do not hold the tube in your hand while puncturing the rubber stopper.

D. attach a winged blood collection set to the syringe.

ANS: C KEY: Topic: Syringes

DIF: Level 1 Learning Objective: 9.13

49. The plastic wings on a winged blood collection set: A. help hold the needle in place after insertion.

B. allow the angle of insertion to be lowered.

C. allow the angle of insertion to be raised.

D. both A and B. ANS: D KEY: Topic: Winged Blood Collection Set

DIF: Level 1 Learning Objective: 9.14

50. When a patient is receiving an intravenous line, blood should be collected from: A. the other arm.

B. an area above the intravenous line.

C. an area below the intravenous line.

D. both A and C. ANS: D KEY: Topic: Indwelling lines

DIF: Level 1 Learning Objective: 9.5

51. Allowing blood to leak from a vein into the surrounding tissue will cause: A. hematoma.

B. hemolysis.

C. nerve damage.

D. syncope.

ANS: A KEY: Topic: Hematomas

DIF: Level 1 Learning Objective: 9.18

52. Failure to remove the tourniquet before removing the needle: A. may cause hemolysis.

B. is uncomfortable for the patient.

C. may produce hematoma.

D. affects specimen coagulation.

ANS: C KEY: Topic: Hematomas

DIF: Level 1 Learning Objective: 9.18

53. Hematomas can be caused by all of the following except: A. having the patient bend the elbow.

B. inserting the needle partially into the vein.

C. drawing below an intravenous line.

D. removing the tourniquet after removing the needle.

ANS: C KEY: Topic: Hematomas

DIF: Level 1 Learning Objective: 9.18

54. A tourniquet is placed on the patient’s arm, the vein is located, and the needle is inserted into the arm. No blood flows into the tube, but a dark bulge begins to appear at the puncture site. This describes: A. hemolysis.

B. hemodialysis.

C. hemoconcentration.

D. hematoma.

ANS: D KEY: Topic: Hematoma

DIF: Level 1 Learning Objective: 9.18

55. If the plunger of a syringe is pulled back too fast: A. the patient feels a stinging sensation.

B. the specimen may be hemolyzed.

C. the patient will develop a hematoma.

D. both A and B. ANS: B KEY: Topic: Hemolysis

DIF: Level 1 Learning Objective: 9.17

56. Using a small-gauge needle with a large evacuated tube can cause: A. a hematoma.

B. petechiae.

C. hemolysis.

D. patient discomfort.

ANS: C KEY: Topic: Hemolysis

DIF: Level 1 Learning Objective: 9.17

57. Forcing blood from a syringe into an evacuated tube may: A. increase potassium values.

B. decrease glucose values.

C. produce lipemic serum.

D. contaminate a blood culture.

ANS: A KEY: Topic: Hemolysis

DIF: Level 2 Learning Objective: 9.17

58. Serum appearing red suggests that: A. the patient was not fasting.

B. the specimen was exposed to light.

C. potassium values will be falsely elevated.

D. the patient is jaundiced.

ANS: C KEY: Topic: Hemolysis

DIF: Level 2 Learning Objective: 9.17

59. The best reason why the majority of patient specimens are drawn in the early morning hours is because: A. the patient will not be in the basal state early in the morning because this requires several hours of normal physical activity by the patient.

B. patients should have consumed a meal no less than three hours prior to the time of collection.

C. the patient will be in the basal state, having restrained from strenuous exercise and having fasted for approximately 12 hours.

D. patients are generally more agreeable with collection times scheduled early in the morning.

ANS: C KEY: Topic: Patient preparation

DIF: Level 2 Learning Objective: 9.4

Matching Match the following variables with the possible effect on test results.

A. Decreased glucose B. Decreased white blood cell (WBCs) and platelets C. Increased cholesterol and triglycerides D. Increased hemoglobin E. Increased partial pressure of oxygen (PO2) and white blood cells (WBCs) F. Increased prothrombin time (PT) and activated partial thromboplastin time (APTT)

60. Prolonged fasting 61. Posture change from supine to erect 62. Chemotherapy 63. Smoking 64. Stress 65. Herbal supplements 60. ANS: A KEY: Topic: Patient preparation

DIF: Level 2 Learning Objective: 9.4

61. ANS: C KEY: Topic: Patient preparation

DIF: Level 2 Learning Objective: 9.4

62. ANS: B KEY: Topic: Patient preparation

DIF: Level 2 Learning Objective: 9.4

63. ANS: D KEY: Topic: Patient preparation

DIF: Level 2 Learning Objective: 9.4

64. ANS: E KEY: Topic: Patient preparation

DIF: Level 2 Learning Objective: 9.4

65. ANS: F KEY: Topic: Patient preparation

DIF: Level 2 Learning Objective: 9.4

Short Answer

Narrative: Short Answer 9-1 A phlebotomist is making morning rounds in the medical-surgical patient unit. Patient A is an elderly man requiring venipuncture for glucose and electrolytes. Patient B has an intravenous line running in the left antecubital area, and a prothrombin time (PT) and liver profile are

requested. Patient C has a large hematoma in the right antecubital area and a fistula in the left arm. Answer the following questions in relation to these patients.

66. Where should the phlebotomist collect the specimen from patient C? ANS: Right arm below the hematoma.

NAR: Short Answer 9-1 KEY: Topic: Site selection DIF: Level 3 Learning Objective: 9.4, 9.5 and 9.18

67. The puncture site begins swelling while the specimen is being collected from patient A. What should the phlebotomist do?

ANS: Remove the tourniquet and needle and apply pressure.

NAR: Short Answer 9-1 KEY: Topic: Hematomas DIF: Level 3 Learning Objective: 9.5

68. How can the phlebotomist collect a specimen from patient A? ANS: Use a syringe and small-gauge needle.

NAR: Short Answer 9-1 KEY: Topic: Hematomas DIF: Level 3 Learning Objective: 9.5

Chapter 10

Multiple Choice

1. The test order with the highest priority is classified as: A. fasting.

B. timed.

C. STAT.

D. postprandial.

ANS: C KEY: Topic: Collection priorities

DIF: Level 1 Learning Objective: 10.1

2. Major phlebotomy rounds are scheduled early in the morning because: A. physicians make their rounds before 8:00 a.m.

B. most medications must be administered before 7:00 a.m.

C. patients will be in a basal state.

D. visitors are usually not present.

ANS: C KEY: Topic: Collection priorities

DIF: Level 1 Learning Objective: 10.1

3. A patient who is not allowed to have food or water for a specified time is classified as: A. fasting.

B. NPO. C. preprandial.

D. basal.

ANS: B KEY: Topic: Fasting specimens

DIF: Level 1 Learning Objective: 10.2

4. A phlebotomist who enters a patient’s room to collect a fasting specimen and finds the patient eating breakfast should: A. draw the specimen immediately.

B. reschedule the test in 12 hours.

C. return when the patient has finished breakfast.

D. notify the nursing station.

ANS: D KEY: Topic: Fasting specimens

DIF: Level 2 Learning Objective: 10.2

5. If a supervisor tells the phlebotomist to collect a fasting specimen from a nonfasting patient, the phlebotomist should: A. record “nonfasting” on the requisition form.

B. ask to speak to the physician.

C. tell the supervisor to collect the specimen.

D. inform the patient that the results may be inaccurate.

ANS: A KEY: Topic: Fasting specimens

DIF: Level 2 Learning Objective: 10.2

6. Lipemic serum appears: A. clear and pale yellow.

B. dark-yellow due to the presence of bilirubin.

C. clear and red.

D. cloudy due to the presence of fat.

ANS: D KEY: Topic: Fasting specimens

DIF: Level 2 Learning Objective: 10.3

7. Collection of a cardiac risk profile from an outpatient at 4:00 p.m. may result in: A. increased triglycerides.

B. decreased aspartate aminotransferase (AST).

C. increased blood urea nitrogen (BUN).

D. decreased cholesterol.

ANS: A KEY: Topic: Fasting specimens

DIF: Level 2 Learning Objective: 10.1

8. To monitor changes in a patient’s hemoglobin level, a phlebotomist may be requested to collect: A. a fasting specimen.

B. specimens from both arms.

C. specimens at specific times.

D. a specimen as soon as possible.

ANS: C KEY: Topic: Timed specimens

DIF: Level 1 Learning Objective: 10.3

9. A glucose tolerance test is performed to diagnose or evaluate: A. hypoglycemia.

B. diabetes insipidus.

C. diabetes mellitus.

D. both A and C. ANS: D KEY: Topic: Timed specimens

DIF: Level 1 Learning Objective: 10.4

10. Plasma cortisol levels are scheduled to be drawn between 08:00 a.m. and 10:00 a.m. because: A. patients must be in a basal state.

B. patients must not be fasting.

C. cortisol exhibits diurnal variation.

D. cortisol is only produced during the morning.

ANS: C KEY: Topic: Timed specimens

DIF: Level 1 Learning Objective: 10.5

11. Peak and trough levels are collected to monitor: A. illegal drug use.

B. diurnal variation.

C. therapeutic drug levels.

D. basal metabolism.

ANS: C KEY: Topic: Timed specimens

DIF: Level 1

Learning Objective: 10.6

12. A postprandial blood specimen should be collected: A. after the patient has eaten.

B. in the delivery room.

C. after the patient has been fasting for 12 hours.

D. while the patient is in a basal state.

ANS: A KEY: Topic: Timed specimens

DIF: Level 1 Learning Objective: 10.3

13. The timing for an oral glucose tolerance test (OGTT) begins: A. after collection of the fasting specimen.

B. when the patient begins drinking the glucose.

C. when the patient finishes drinking the glucose.

D. 30 minutes after the glucose is finished.

ANS: C KEY: Topic: Timed specimens

DIF: Level 1 Learning Objective: 10.4

14. A trough level is drawn: A. 30 minutes after drug administration.

B. while the patient is fasting.

C. prior to administering medication.

D. immediately after administering medication.

ANS: C KEY: Topic: Timed specimens

DIF: Level 1 Learning Objective: 10.4

15. The term diurnal variation is associated with: A. blood cultures.

B. fasting specimens.

C. forensic specimens.

D. timed collections.

ANS: D KEY: Topic: Timed specimens

DIF: Level 1 Learning Objective: 10.5

16. The number of specimens collected from a patient receiving a 2-hour postprandial glucose test is: A. one.

B. two.

C. three.

D. four.

ANS: B KEY: Topic: Timed specimens

DIF: Level 2 Learning Objective: 10.4

17. The specimens collected during the oral glucose tolerance test (OGTT) after the patient drinks the glucose will be analyzed at the end of the test. The specimens should be collected in: A. gray stopper tubes.

B. serum separator tubes (SSTs).

C. plasma separator tubes (PSTs).

D. red stopper tubes.

ANS: A KEY: Topic: Timed specimens

DIF: Level 2 Learning Objective: 10.4

18. All of the following should be included on a peak or trough level requisition form except: A. time the medication was given.

B. method of medication administration.

C. time the specimen was drawn.

D. name of the person giving the medication.

ANS: D KEY: Topic: Timed specimens

DIF: Level 2 Learning Objective: 10.6

19. The fasting specimen for an oral glucose tolerance test (OGTT) is drawn at 7:00 a.m., and the patient finishes drinking the glucose at 7:45 a.m. The correct time to draw the 1-hour specimen is: A. 8:00 a.m.

B. 8:15 a.m.

C. 8:45 a.m.

D. 9:15 a.m.

ANS: C KEY: Topic: Timed specimens

DIF: Level 2 Learning Objective: 10.1

20. A phlebotomist who cannot locate the patient on whom a cortisol level is scheduled for collection at 10:00 a.m. should: A. return the requisition form to the nursing station for rescheduling.

B. request the nursing station to call the laboratory when the patient is available.

C. collect the specimen 2 hours after the patient finishes lunch.

D. reschedule the test for 4:00 p.m.

ANS: A KEY: Topic: Timed specimens

DIF: Level 2 Learning Objective: 10.5

21. Blood cultures are performed to detect the presence of: A. septicemia.

B. spiking fevers.

C. fever of unknown origin (FUO).

D. antibiotics.

ANS: A KEY: Topic: Blood cultures

DIF: Level 1 Learning Objective: 10.7

22. The most important consideration when collecting a blood culture is: A. aseptic technique.

B. the puncture site.

C. minimizing the number of sticks.

D. the amount of blood collected.

ANS: A KEY: Topic: Blood cultures

DIF: Level 1 Learning Objective: 10.8

23. The order in which cleansing solutions are applied to the patient’s arm before and after the collection of a blood culture is: A. soap, alcohol, and iodine.

B. alcohol, iodine, and alcohol.

C. iodine, alcohol, and soap.

D. alcohol, alcohol, and iodine.

ANS: B KEY: Topic: Blood cultures

DIF: Level 1 Learning Objective: 10.7

24. After collection, blood cultures are delivered to: A. blood bank.

B. hematology.

C. serology.

D. microbiology.

ANS: D KEY: Topic: Blood cultures

DIF: Level 1 Learning Objective: 10.7

25. Some blood culture collection systems contain a resin to: A. prevent clotting.

B. inactivate antibiotics.

C. concentrate the microorganism.

D. remove skin contaminates.

ANS: B KEY: Topic: Blood cultures

DIF: Level 1 Learning Objective: 10.7

26. Two blood cultures from a patient requiring ASAP administration of antibiotics are collected: A. every 30 minutes.

B. before and after the antibiotic is administered.

C. immediately from two different sites.

D. before and after the fever spikes.

ANS: C KEY: Topic: Blood cultures

DIF: Level 2 Learning Objective: 10.7

27. The ideal time for collecting a blood culture is: A. just before the patient’s temperature spikes.

B. after antibiotics have been given.

C. when the patient’s white blood cell (WBC) count is the highest.

D. when the patient’s temperature is the highest.

ANS: A KEY: Topic: Blood cultures

DIF: Level 2 Learning Objective: 10.7

28. The purpose of sodium polyanetholsulfonate in a blood culture bottle is to: A. inhibit bacterial growth.

B. prevent clotting.

C. prevent contamination.

D. identify bacterial growth.

ANS: B KEY: Topic: Blood cultures

DIF: Level 2 Learning Objective: 10.7

29. When blood is inoculated into blood culture bottles using a winged blood collection set, the: A. anaerobic bottle is inoculated first.

B. safety device is activated first.

C. aerobic bottle is inoculated first.

D. volume of blood inoculated is increased.

ANS: C KEY: Topic: Blood cultures

DIF: Level 2 Learning Objective: 10.7

30. To inoculate blood culture media with blood drawn in a syringe, the phlebotomist: A. vents an anaerobic container.

B. inoculates aerobic media first.

C. mixes syringe before inoculation.

D. inoculates anaerobic media first.

ANS: D KEY: Topic: Blood cultures

DIF: Level 2 Learning Objective: 10.7

31. Specimens that require chilling immediately after collection are placed in a: A. container of ice cubes.

B. container of ice and water.

C. bag of dry ice.

D. flask of cold water.

ANS: B KEY: Topic: Specimen handling procedures

DIF: Level 1 Learning Objective: 10.11

32. Specimens for all of the following should be protected from light except: A. beta-carotene.

B. vitamin A. C. gastrin.

D. bilirubin.

ANS: C KEY: Topic: Specimen handling procedures

DIF: Level 1 Learning Objective: 10.12

33. Specimens for cold agglutinins must be: A. transported on ice.

B. drawn in a green stopper tube.

C. processed in a refrigerated centrifuge.

D. kept warm.

ANS: D KEY: Topic: Specimen handling procedures

DIF: Level 1 Learning Objective: 10.10

34. A falsely decreased blood alcohol level may be obtained if: A. blood is collected in a gray stopper tube.

B. the site is cleansed with Zephiran chloride.

C. the tube is only partially filled.

D. the tube is overfilled.

ANS: C KEY: Topic: Specimen handling procedures

DIF: Level 2 Learning Objective: 10.14

35. A phlebotomist on the evening shift draws a specimen for cold agglutinins and places it in the refrigerator for the morning shift. Test results of this specimen will: A. be falsely decreased.

B. be falsely increased.

C. be unaffected.

D. represent the patient’s true condition.

ANS: A KEY: Topic: Specimen handling procedures

DIF: Level 2 Learning Objective: 10.10

36. When locating a venipuncture site in a geriatric patient, all of the following techniques are acceptable except: A. applying heat.

B. using a blood pressure cuff.

C. swabbing the area with alcohol or iodine.

D. tapping the antecubital area.

ANS: D KEY: Topic: Geriatric patients

DIF: Level 1 Learning Objective: 10.16

37. Geriatric patients are more prone to infection of the venipuncture site because: A. epidermal cells are replaced more slowly.

B. their veins are closer to the surface.

C. their immune systems are weakened.

D. both A and C. ANS: D KEY: Topic: Geriatric patients

DIF: Level 2 Learning Objective: 10.16

38. Extra care may have to be taken when positioning the arm of patients with: A. Alzheimer’s disease.

B. arthritis.

C. paralysis.

D. both B and C. ANS: D KEY: Topic: Geriatric patients

DIF: Level 2 Learning Objective: 10.16

39. The best choice of equipment for venipuncture from a geriatric or pediatric patient with small fragile veins is a: A. 23-gauge needle and a winged blood collection set with a syringe.

B. 23-gauge needle and a winged blood collection set and evacuated tubes.

C. 21-gauge needle and a small syringe.

D. 25-gauge needle and an evacuated tube.

ANS: A KEY: Topic: Geriatric and pediatric patients

DIF: Level 1 Learning Objective: 10.16

40. Performing venipunctures on pediatric patients may require all of the following except: A. assistance from a parent to hold the arm.

B. telling the child it will not hurt.

C. using toys to demonstrate the procedure.

D. obtaining identification from the parents.

ANS: B KEY: Topic: Pediatric patients

DIF: Level 2 Learning Objective: 10.16

Short Answer

Narrative: Short Answer 10-1 At 0900 a phlebotomist receives requisition forms for three different patients for the following tests: A peak theophylline level at 1000 in Room 401, a stat complete blood count (CBC) in L & D, and a cortisol level in Room 321.

41. In what order should the phlebotomist collect these specimens?

ANS: Complete blood count (CBC), cortisol level, and theophylline level.

NARR: Short Answer 10-1 KEY: Topic: Collection priorities DIF: Level 3Learning Objective: 10.3

42. Which specimen should be delivered immediately to the laboratory?

ANS: Complete blood count (CBC).

NARR: Short Answer 10-1

KEY: Topic: Collection priorities

DIF: Level 3 Learning Objective: 10.3

43. If the cortisol level was not collected until 1:00 a.m., how would the results be affected?

ANS: They would be decreased.

NARR: Short Answer 10-1 KEY: Topic: Timed specimens DIF: Level 3 Learning Objective: 10.5

Narrative 10-2 A phlebotomist is requested to collect two sets of blood cultures from a patient on a STAT basis.

44. Why is this collection schedule requested?

ANS: The patient must receive antibiotics.

NARR: Short Answer 10-2 KEY: Topic: Blood cultures DIF: Level 3 Learning Objective: 10.7

45. Where should the phlebotomist collect these specimens?

ANS: Collect them from two different sites NARR: Short Answer 10-2 KEY: Topic: Blood cultures DIF: Level 3 Learning Objective: 10.7

46. If the phlebotomist collects both sets using a winged blood collection set, and an anaerobic organism grows in one set and not the other, which error could have caused this?

ANS: The anaerobic bottle was inoculated first in the negative set.

NARR: Short Answer 10-2 KEY: Topic: Blood cultures DIF: Level 3 Learning Objective: 10.8

47. If a known skin contaminant grows in both aerobic bottles, which error in technique is indicated?

ANS: Improper site cleansing, not using sterile technique NARR: Short Answer 10-2 KEY: Topic: Blood cultures DIF: Level 3 Learning Objective: 10.8

Chapter 11

Multiple Choice

1. Dermal puncture is preferred over venipuncture in infants because: A. superficial veins may not be large enough.

B. collection from deep veins is dangerous.

C. restraining the child can cause injury.

D. all of the above.

ANS: D KEY: Topic: Dermal puncture general

DIF: Level 1 Learning Objective: 11.2

2. Collection of a sufficient amount of blood by dermal puncture is most difficult from: A. obese patients.

B. geriatric patients.

C. severely dehydrated patients.

D. patients performing home glucose monitoring.

ANS: C KEY: Topic: Dermal puncture general

DIF: Level 1 Learning Objective: 11.2

3. Which of these complications is not associated with deep vein puncture in infants?

A. Danger to nearby organs.

B. Collapsing of superficial veins.

C. Reflex arteriospasm.

D. Cardiac arrest.

ANS: B KEY: Topic: Dermal puncture general

DIF: Level 1 Learning Objective: 11.1

4. Collection of a complete blood count (CBC) by dermal puncture is most likely to be requested for a patient: A. receiving chemotherapy.

B. with poor circulation.

C. with coronary artery disease.

D. receiving allergy injections.

ANS: A KEY: Topic: Dermal puncture general

DIF: Level 1 Learning Objective: 11.2

5. Blood collected by dermal puncture from a warmed site most closely resembles: A. venous blood.

B. anticoagulated blood.

C. arterial blood.

D. clotted blood.

ANS: C KEY: Topic: Dermal puncture general

DIF: Level 1 Learning Objective: 11.3

6. The major vascular area of the skin is located in the:

A. dermal layer.

B. cutaneous layer.

C. soft tissue.

D. dermal-subcutaneous juncture.

ANS: D KEY: Topic: Dermal puncture general

DIF: Level 1 Learning Objective: 11.3

7. Collection of excess blood from a premature infant could cause: A. hemorrhage.

B. venous thrombosis.

C. anemia.

D. gangrene.

ANS: C KEY: Topic: Dermal puncture general

DIF: Level 2 Learning Objective: 11.1

8. Warming the site of a dermal puncture will: A. increase the flow of venous blood to the site.

B. increase the flow of arterial blood to the site.

C. increase the possibility of hemolysis.

D. produce excess tissue fluid contamination.

ANS: B KEY: Topic: Dermal puncture general

DIF: Level 2 Learning Objective: 11.6

9. Alternating between venipuncture and dermal puncture collection techniques is not recommended when comparing test results for: A. bilirubin.

B. hemoglobin.

C. reticulocytes.

D. glucose.

ANS: D

KEY: Topic: Dermal puncture general

DIF: Level 2 Learning Objective: 11.3

10. All of the following are reasons why hemolysis is seen more frequently in specimens collected by dermal puncture than venipuncture except: A. lancets make a wider incision.

B. newborns have high red blood cell counts.

C. excessive squeezing may have been used.

D. red blood cells of newborns are more fragile.

ANS: A KEY: Topic: Dermal puncture general

DIF: Level 2 Learning Objective: 11.12

11. The depth of a dermal puncture must be controlled to: A. prevent hemolysis.

B. ensure adequate blood flow.

C. prevent contact with bone.

D. obtain a representative sample.

ANS: C KEY: Topic: Dermal puncture equipment

DIF: Level 1 Learning Objective: 11.4

12. The maximum safe length of lancets used for heel puncture is: A. 1.5 mm.

B. 2.0 mm.

C. 2.75 mm.

D. 3.4 mm.

ANS: B KEY: Topic: Dermal puncture equipment

DIF: Level 1 Learning Objective: 11.12

14. Plastic beads are present in some microcollection tubes to facilitate: A. clotting.

B. mixing.

C. serum and cell separation.

D. plasma and cell separation.

ANS: B KEY: Topic: Dermal puncture equipment

DIF: Level 1 Learning Objective: 11.4

16. Which of the following is not used in microcollection?

A. Lancet.

B. Capillary tubes.

C. Tourniquet.

D. Microtainer.

ANS: C KEY: Topic: Dermal puncture equipment

DIF: Level 1 Learning Objective: 11.4

17. Natelson pipettes and microhematocrit tubes differ with respect to: A. color coding.

B. ability to produce plasma.

C. size.

D. ability to produce serum.

ANS: C KEY: Topic: Dermal puncture equipment

DIF: Level 1 Learning Objective: 11.4

20. Using a lancet that produces a puncture deeper than recommended may cause: A. septicemia.

B. hemolysis.

C. osteomyelitis.

D. specimen contamination.

ANS: C

KEY: Topic: Dermal puncture equipment

DIF: Level 2 Learning Objective: 11.1

21. The calcaneus is located at the: A. posterior of the heel.

B. arch of the foot.

C. plantar surface of the heel.

D. lateral curvature of the heel.

ANS: A KEY: Topic: Dermal puncture site selection

DIF: Level 1 Learning Objective: 11.5

22. Which of the following pairings is incorrect?

A. Thumb and calluses.

B. Index finger and increased nerve endings.

C. Third finger and increased possibility of bone puncture.

D. Fifth finger and decreased tissue mass.

ANS: C KEY: Topic: Dermal puncture site selection

DIF: Level 1 Learning Objective: 11.5

23. Capillary punctures on newborns are performed on the: A. index finger.

B. plantar area of the heel.

C. back of the heel.

D. earlobe.

ANS: B KEY: Topic: Dermal puncture site selection

DIF: Level 1 Learning Objective: 11.5

24. All of the following are acceptable dermal puncture sites except the:

A. third finger on a 6-month-old infant.

B. arch of the foot.

C. heel of an infant.

D. index finger of an adult.

ANS: B KEY: Topic: Dermal puncture site selection

DIF: Level 1 Learning Objective: 11.5

25. What is the most acceptable puncture site for a 6-month-old infant?

A. Heel.

B. Antecubital vein.

C. Middle finger.

D. All of the above.

ANS: A KEY: Topic: Dermal puncture site selection

DIF: Level 1 Learning Objective: 11.5

26. To obtain the best flow of blood from a dermal puncture, the phlebotomist should: A. alternately apply and release pressure to the site.

B. tightly squeeze the area above the site.

C. frequently wipe the site with alcohol.

D. firmly massage the area around the puncture site.

ANS: A KEY: Topic: Dermal puncture site selection

DIF: Level 2 Learning Objective: 11.12

27. Selection of an improper heel puncture site can result in: A. puncture of the calcaneous.

B. specimen hemolysis.

C. the need for vigorous massaging.

D. increased blood flow.

ANS: A KEY: Topic: Dermal puncture site selection

DIF: Level 2 Learning Objective: 11.5

28. When warming a dermal puncture site, the temperature should not exceed: A. 32°C. B. 42°C. C. 52°C. D. 62°C. ANS: B KEY: Topic: Dermal puncture technique

DIF: Level 1 Learning Objective: 11.6

29. Failure to puncture across the fingerprint during a finger puncture will cause: A. blood to run down the finger.

B. hemolysis.

C. contamination of the specimen.

D. additional patient discomfort.

ANS: A KEY: Topic: Dermal puncture technique

DIF: Level 1 Learning Objective: 11.8

30. Following a dermal puncture, the phlebotomist should first: A. prepare the blood smear.

B. massage the site.

C. wipe away the first drop of blood.

D. fill the lavender stopper Microtainer.

ANS: C KEY: Topic: Dermal puncture technique

DIF: Level 1 Learning Objective: 11.12

31. Which of the following statements is wrong?

A. Phlebotomists perform extensive handwashing in the nursery.

B. Only necessary equipment is carried to a nursery patient.

C. Infants are identified by the bassinet label.

D. Isolation procedures are followed in the nursery.

ANS: C KEY: Topic: Dermal puncture technique

DIF: Level 1 Learning Objective: 11.

32. How many attempts should a phlebotomist make to obtain an adequate amount of blood by dermal puncture before requesting assistance from another phlebotomist?

A. One. B. Two. C. Three.

D. Four.

ANS: B KEY: Topic: Dermal puncture technique

DIF: Level 1 Learning Objective: 11.2

33. The possibility of infection is increased when: A. the thumb is punctured.

B. alcohol is used to cleanse the site.

C. a puncture is made through a previous site.

D. the palmar side of the finger is punctured.

ANS: C KEY: Topic: Dermal puncture technique

DIF: Level 1 Learning Objective: 11.5

34. The heel of an infant with ecchymoses will appear: A. jaundiced.

B. bruised.

C. edematous.

D. cyanotic.

ANS: B KEY: Topic: Dermal puncture technique

DIF: Level 1 Learning Objective: 11.5

35. Upon completion of a heel puncture on a 4-month-old infant, all of the following are acceptable except: A. raising the heel and applying pressure.

B. placing capillary pipettes in a large tube for transport.

C. applying a bandage to the site.

D. thanking the parents for their cooperation.

ANS: C KEY: Topic: Dermal puncture technique

DIF: Level 1 Learning Objective: 11.12

36. To produce a rounded drop of blood, finger punctures should be made: A. on the index finger.

B. on the fingerprint.

C. before the alcohol is dry.

D. across the fingerprint.

ANS: D KEY: Topic: Dermal puncture technique

DIF: Level 1 Learning Objective: 11.5

37. During dermal puncture, the first drop of blood is wiped away because it may be: A. diluted with tissue fluid.

B. already clotted.

C. too concentrated because blood has not been flowing.

D. contaminated with skin bacteria.

ANS: A KEY: Topic: Dermal puncture technique

DIF: Level 1 Learning Objective: 11.9

38. The presence of air bubbles will most seriously affect a:

A. bilirubin collected in a Caraway pipette.

B. complete blood count (CBC) collected in a microcollection tube.

C. hematocrit collected in a microtube.

D. capillary blood gases.

ANS: D KEY: Topic: Dermal puncture technique

DIF: Level 2 Learning Objective: 11.9

39. Vigorous massaging of the area during dermal puncture will result in: A. decreased blood flow to the site.

B. a hematoma.

C. specimen contamination by tissue fluid.

D. increased glucose results.

ANS: C KEY: Topic: Dermal puncture technique

DIF: Level 2 Learning Objective: 11.12

40. Falsely elevated dermal puncture bilirubin results may be caused by: A. contamination with tissue fluid.

B. collection under an ultraviolet light.

C. collection from an agitated patient.

D. cleansing the site with iodine.

ANS: D KEY: Topic: Dermal puncture technique

DIF: Level 2 Learning Objective: 11.13

41. A phlebotomist is recollecting a dermal puncture specimen because of hemolysis. The patient complains about a stinging sensation from the first puncture. The most probable cause of the hemolysis in the first specimen is: A. not allowing alcohol to dry.

B. excessive massaging.

C. vigorous mixing of the microcollection tube.

D. use of a small lancet.

ANS: A KEY: Topic: Dermal puncture technique

DIF: Level 2 Learning Objective: 11.7

42. The order of draw for a bilirubin, blood smear, and complete blood count (CBC) by dermal puncture is: A. CBC, blood smear, and bilirubin.

B. blood smear, CBC, and bilirubin.

C. bilirubin, blood smear, and CBC. D. blood smear, bilirubin, and CBC. ANS: B KEY: Topic: Dermal puncture technique

DIF: Level 2 Learning Objective: 11.10

43. The major concern when determining the order of draw for a dermal puncture is the: A. speed of specimen collection.

B. amount of blood needed.

C. ability to adequately mix the specimen.

D. adherence of platelets to the puncture site.

ANS: D KEY: Topic: Dermal puncture technique

DIF: Level 2 Learning Objective: 11.10

44. Complications associated with skin puncture include: 1. hemolysis due to alcohol.

2. osteomyelitis.

3. tissue fluid contamination.

4. hematoma.

A. 1 and 3.

B. 1, 2, and 3.

C. 1 only.

D. 4 only.

ANS: B KEY: Topic: Dermal puncture technique

DIF: Level 2 Learning Objective: 11.12

45. Blood collected by dermal puncture closely resembles the composition of arterial blood for all of the following reasons except: A. warming the site increases blood flow in the area.

B. capillary samples come from the capillaries, arterioles, and venules.

C. arteries naturally lie near the surface of the collection sites used for dermal puncture.

D. because of the action of arterial pressure.

ANS: C KEY: Topic: Dermal puncture general

DIF: Level 2 Learning Objective: 11.3

46. Laws in all states of the United States require testing for all of the following diseases in newborns using a heel stick specimen except: A. galactosemia.

B. congenital hypothyroidism.

C. jaundice or elevated bilirubin.

D. phenylketonuria (PKU).

ANS: C KEY: Topic: Dermal puncture general

DIF: Level 2 Learning Objective: 11.14

47. Select the response that describes how the collection of a dermal puncture specimen for capillary blood gasses from a newborn or a young child differs from other capillary collections.

A. Plugs or clay sealants are used to seal the capillary tube.

B. A commercial heel warmer or warm, moist washcloth is used to arterialize the specimen.

C. The specimen is collected from the plantar area of the heel or the palmar area of the fingers.

D. A magnetic stir bar is inserted into the specimen tube.

ANS: D KEY: Topic: Dermal puncture technique

DIF: Level 2 Learning Objective: 11.15

48. Preparing smears of the patient’s blood specimen on glass microscope slides can present special hazards to the phlebotomist. All of the following responses are example of these special hazards except: A. the blood must be forced from the needle onto the slide.

B. gloves must be worn when handling the slides.

C. the needle cannot be disposed of until the smear has been made.

D. the blood smears are considered infectious until they have been fixed with alcohol.

ANS: B KEY: Topic: Dermal puncture technique

DIF: Level 2 Learning Objective: 11.4

49. All of the following can affect the quality of newborn bilirubin results except: A. hemolysis.

B. exposure to light.

C. collection at the wrong time.

D. puncturing the plantar surface of the heel.

ANS: D KEY: Topic: Newborn bilirubin

DIF: Level 1 Learning Objective: 11.13

50. A physician questions the low bilirubin result on a jaundiced baby. This discrepancy may be due to: A. puncturing too deeply into the heel.

B. exposing the specimen to the bili light.

C. collecting in an amber container.

D. collecting too much blood.

ANS: B KEY: Topic: Newborn bilirubin

DIF: Level 1 Learning Objective: 11.13

51. Newborns who appear jaundiced:

A. have increased red blood cells.

B. are always premature.

C. have increased bilirubin levels.

D. will develop liver disease.

ANS: C KEY: Topic: Newborn bilirubin

DIF: Level 2 Learning Objective: 11.13

52. The acceptable amount of blood used to fill a filter paper circle for newborn screening tests is: A. one drop.

B. three drops.

C. 0.5 mL. D. 1.0 mL. ANS: A KEY: Topic: Newborn screening

DIF: Level 1 Learning Objective: 11.14

53. Collection of blood for newborn screening in a capillary pipette and transferring it to the filter paper circle is not recommended because: A. the blood is heparinized.

B. the circle cannot be filled on both sides.

C. two pipettes must be used.

D. the pipette may scratch the filter paper.

ANS: D KEY: Topic: Newborn screening

DIF: Level 1 Learning Objective: 11.14

54. Most states require testing of newborns for: A. Down syndrome.

B. cystic fibrosis.

C. sickle cell anemia.

D. phenylketonuria.

ANS: D KEY: Topic: Newborn screening

DIF: Level 1 Learning Objective: 11.14

55. Specimens for newborn filter paper tests are collected from the: A. plantar area of the heel.

B. volar surface of the arm.

C. back of the heel.

D. arch of the foot.

ANS: A KEY: Topic: Newborn screening

DIF: Level 1 Learning Objective: 11.14

56. Failure to wipe away the first drop of blood when collecting a newborn filter paper screening test could: A. cause a false-negative result.

B. enhance the bacterial growth.

C. destroy the filter paper.

D. cause a false-positive result.

ANS: A KEY: Topic: Newborn screening

DIF: Level 2 Learning Objective: 11.14

57. Failure to completely fill the filter paper circle for a newborn screening test: A. is only important for phenylketonuria (PKU) tests.

B. can cause a false-positive result.

C. can cause a false-negative result.

D. occurs when the circle has been contaminated.

ANS: C KEY: Topic: Newborn screening

DIF: Level 2 Learning Objective: 11.14

58. Which is the right way to handle specimens for filter paper newborn screening tests?

A. Stack specimens after drying.

B. Dry specimens in sunlight.

C. Suspend specimens horizontally to air-dry.

D. Stack specimens while they are drying.

ANS: C KEY: Topic: Newborn screening

DIF: Level 2 Learning Objective: 11.14

59. Blood smears are prepared for all of the following tests except: A. differential counts.

B. special stains.

C. reticulocyte counts.

D. red blood cell counts.

ANS: D KEY: Topic: Blood smears

DIF: Level 1 Learning Objective: 11.16

60. When preparing a blood smear, the correct angle of the spreader slide is: A. 10 to 20 degrees.

B. 20 to 30 degrees.

C. 30 to 40 degrees.

D. 40 to 50 degrees.

ANS: C KEY: Topic: Blood smears

DIF: Level 1 Learning Objective: 11.16

61. The purpose of a thick malaria smear is to: A. increase parasite multiplication.

B. detect the presence of Plasmodium species.

C. identify the Plasmodium species.

D. produce better staining reactions.

ANS: B KEY: Topic: Blood smears

DIF: Level 1 Learning Objective: 11.16

62. A suitable blood smear should: A. cover the entire slide.

B. have two thick ends.

C. dry within 5 minutes.

D. have a feathered edge.

ANS: D KEY: Topic: Blood smears

DIF: Level 1 Learning Objective: 11.16

63. Blood smears are important for evaluating: A. the coagulation system.

B. blood cell morphology.

C. neonatal bilirubin concentration.

D. autoimmune disorders.

ANS: B KEY: Topic: Blood smears

DIF: Level 1 Learning Objective: 11.16

64. Specimens collected by venipuncture that require preparation of a blood smear are collected in: A. blue stopper tubes.

B. lavender stopper tubes.

C. green stopper tubes.

D. gray stopper tubes.

ANS: B KEY: Topic: Blood smears

DIF: Level 1 Learning Objective: 11.16

65. Multiplication of parasites within red blood cells occurs in: A. anemia.

B. septicemia.

C. malaria.

D. leukemia.

ANS: C KEY: Topic: Blood smears

DIF: Level 1 Learning Objective: 11.16

66. Detection and identification of parasites in red blood cells requires: A. preparation of thick and thin blood smears.

B. a blood smear with two feathered edges.

C. culturing of hemolyzed blood.

D. blood collection by venipuncture.

ANS: A KEY: Topic: Blood smears

DIF: Level 1 Learning Objective: 11.16

67. When preparing a blood smear, the spreader is placed: A. in the frosted area of the slide.

B. behind the drop of blood.

C. at the edge of the frosted area.

D. in front of the drop of blood.

ANS: D KEY: Topic: Blood smears

DIF: Level 2 Learning Objective: 11.16

68. All of the following will affect the quality of a blood smear except: A. pushing the spreader slide the complete length of the smear.

B. increased pressure on the spreader slide.

C. pushing the spreader slide too slowly.

D. using a dirty spreader slide.

ANS: A KEY: Topic: Blood smears

DIF: Level 2 Learning Objective: 11.16

69. When preparing a blood smear, raising the angle of the spreader slide will: A. cause streaks in the feathered edge.

B. increase the length and thickness of the smear.

C. produce a thin smear.

D. decrease the length of the smear.

ANS: B KEY: Topic: Blood smears

DIF: Level 2 Learning Objective: 11.16

70. Preparation of a blood smear using a slide that is not clean will result in: A. streaks in the feathered edge.

B. holes in the smear.

C. a smear that is too thick.

D. ridges in the smear.

ANS: B KEY: Topic: Blood smears

DIF: Level 2 Learning Objective: 11.16

71. Pushing instead of pulling the blood with the spreader slide produces a blood smear that: A. is too thick.

B. is too thin.

C. has streaks in the feathered edge.

D. contains holes.

ANS: C KEY: Topic: Blood smears

DIF: Level 2 Learning Objective: 11.16

72. A patient is experiencing symptoms of fever and chills. Which of the following procedures might the phlebotomist be requested to perform?

A. A PT B. An APTT C. An ancillary glucose test D. Collection of thick and thin blood smears ANS: D KEY: Topic: Blood smears

DIF: Level 2 Learning Objective: 11.16

73. Capillary blood drawn from a site that has been warmed: A. closely resembles venous blood.

B. tends to clot rapidly.

C. may be contaminated.

D. closely resembles arterial blood.

ANS: D KEY: Topic: Capillary specimens

DIF: Level 1 Learning Objective: 11.15

74. A major source of error in capillary blood gas specimens is: A. mixing with a magnetic “flea.”

B. warming the site for 10 minutes.

C. the presence of air bubbles.

D. collection in a heparinized pipette.

ANS: C KEY: Topic: Capillary specimens

DIF: Level 1 Learning Objective: 11.15

Short Answer

75. A phlebotomist stocks the phlebotomy tray with both red and blue banded microhematocrit tubes. Explain the differences between the blue and red banded microhematocrit tubes. Does the phlebotomist need both tubes in the tray? Explain your answer.

ANS: The blue tubes do not contain any anticoagulant. The red tubes contain the anticoagulant heparin. The phlebotomist only needs the red tubes for dermal punctures.

KEY: Topic: Dermal puncture equipment DIF: Level 3 Learning Objective: 11.4

Narrative: 11-1 A phlebotomist has a requisition form to collect a bilirubin and a complete blood count (CBC) from a newborn. The phlebotomist collects the bilirubin first but is unable to fill the second microcollection tube for the CBC. The phlebotomist performs a second puncture and finishes filling the tube for the CBC. 76. What is the first mistake made by the phlebotomist?

ANS: Collecting the bilirubin first.

NARR: Short Answer 11-1 KEY: Topic: Dermal puncture technique DIF: Level 3 Learning Objective: 11.10

77. What should the phlebotomist have done differently when collecting the CBC? ANS: Collect the blood for the CBC first and use a new collection container for the second dermal puncture.

NARR: Short Answer 11-1 KEY: Topic: Dermal puncture technique DIF: Level 3 Learning Objective: 11.4

78. How will the CBC collected by the phlebotomist be affected?

ANS: Hemolysis and microclots will occur and render the specimen unacceptable.

NARR: Short Answer 11-1 KEY: Topic: Dermal puncture technique DIF: Level 3 Learning Objective: 11.9

79. Will the CBC results be falsely increased or decreased?

ANS: Falsely decreased.

NARR: Short Answer 11-1 KEY: Topic: Dermal puncture technique DIF: Level 3 Learning Objective: 11.12

80. A phlebotomist does not allow the alcohol to dry before performing a dermal puncture.

Explain how this procedure will affect the blood specimen, the patient, and the specimen collection.

ANS: The specimen will be hemolyzed and contaminated with alcohol and render the specimen unacceptable. The patient will feel a stinging sensation and the collection of the specimen will be difficult since the blood will be runny and rounded drops for collection will not be formed.

KEY: Topic: Dermal puncture technique DIF: Level 3 Learning Objective: 11.7

81. What is the primary cause of falsely decreased neonatal bilirubins?

ANS: Prolonged exposure to light.

KEY: Topic: Newborn bilirubin DIF: Level 2 Learning Objective: 11.13

82. How will an infant with a falsely negative phenylketonuria (PKU) test be affected?

ANS: An infant whose PKU test was falsely negative may not be diagnosed with PKU and thus not be given the proper treatment in time. If this infant goes untreated for PKU, they may have developmental delays.

KEY: Topic: Newborn screening DIF: Level 2 Learning Objective: 11.14

83. Describe the correct labeling of capillary specimens.

ANS: Microspecimens must be labeled with the same information required for venipuncture specimens. Labels can be wrapped around microcollection container tubes or groups of capillary pipettes.

KEY: Topic: Specimen processing DIF: Level 2 Learning Objective: 11.11

84. Explain why certain tests cannot be performed on capillary specimens?

ANS: Tests that cannot be performed on capillary specimens include coagulation studies, erythrocyte sedimentation rate (ESR), and blood cultures. The reason is that large amounts of blood are required for these tests.

KEY: Topic: Specimen processing DIF: Level 2 Learning Objective: 11.2 Chapter 12

Multiple Choice

1. Phlebotomist training in the performance of arterial punctures should include all of the following except: A. safety precautions.

B. possible complications.

C. femoral puncture procedures.

D. supervised practice.

ANS: C KEY: Topic: Arterial puncture general

DIF: Level 1 Learning Objective: 12.1

2. Arterial punctures should be performed: A. on pediatric patients.

B. only when authorized.

C. only from the radial artery.

D. after an unsuccessful venipuncture.

ANS: B KEY: Topic: Arterial puncture general

DIF: Level 1 Learning Objective: 12.1

3. Arterial blood may be requested for all of the following except: A. ammonia.

B. potassium.

C. lactic acid.

D. PCO2.

ANS: B KEY: Topic: Arterial puncture general

DIF: Level 1 Learning Objective: 12.2

4. Arterial punctures would be most frequently requested on patients located in: A. labor and delivery.

B. outpatient testing.

C. critical care.

D. orthopedics.

ANS: C KEY: Topic: Arterial puncture general

DIF: Level 1 Learning Objective: 12.2

5. The artery located on the thumb side of the wrist is the: A. brachial.

B. ulnar.

C. radial.

D. femoral.

ANS: C KEY: Topic: Arterial puncture general

DIF: Level 1 Learning Objective: 12.5

6. Which of the following tests requires anaerobic conditions?

A. Glucose.

B. Blood gases.

C. Blood urea nitrogen (BUN).

D. Sodium.

ANS: B KEY: Topic: Arterial puncture general

DIF: Level 1 Learning Objective: 12.2

7. A large artery located near the basilic vein and the median nerve is the: A. ulnar.

B. brachial.

C. radial.

D. cephalic.

ANS: B KEY: Topic: Arterial puncture general

DIF: Level 1 Learning Objective: 12.5

8. An alternate pathway capable of supplying blood to an area if the main pathway is obstructed is referred to as: A. circulatory bypass.

B. collateral circulation.

C. shunt circulation.

D. arterial fistula.

ANS: B KEY: Topic: Arterial puncture general

DIF: Level 1 Learning Objective: 12.5

9. Under normal conditions, arterial blood will have a(an): A. higher PO2 than PCO2.

B. decreased PO2 and PCO2.

C. equal amount of PO2 and PCO2.

D. higher PCO2 than PO2.

ANS: A KEY: Topic: Arterial puncture general

DIF: Level 2 Learning Objective: 12.2

10. Syringes used to collect arterial blood gases (ABGs): A. are coated with mineral oil.

B. are designed to inject the specimen into an analyzer.

C. must be made of glass.

D. should hold at least 10 mL of blood.

ANS: B KEY: Topic: Arterial puncture equipment

DIF: Level 1 Learning Objective: 12.3

11. The anticoagulant in syringes used to collect arterial blood gases (ABGs) is also found in: A. gray stopper tubes.

B. green stopper tubes.

C. light blue stopper tubes.

D. yellow stopper tubes.

ANS: B KEY: Topic: Arterial puncture equipment

DIF: Level 2 Learning Objective: 12.3

12. When performing an arterial puncture, the finger of the nondominant hand is: A. used to anchor the artery.

B. placed where the needle enters the skin.

C. placed where the needle enters the artery.

D. used to measure the patient’s heart rate.

ANS: C KEY: Topic: Arterial puncture technique

DIF: Level 1 Learning Objective: 12.7

13. Upon completion of an arterial puncture, the syringe is rotated to: A. expel air from the syringe.

B. activate the needle safety device.

C. attach the Luer tip cap.

D. mix the anticoagulant.

ANS: D KEY: Topic: Arterial puncture technique

DIF: Level 1 Learning Objective: 12.7

14. When collecting blood from an artery, the designated collector should: A. ask the patient to make a tight fist.

B. tighten the tourniquet to stop arterial flow.

C. request a nurse to be present.

D. make sure the patient is as calm as possible.

ANS: D KEY: Topic: Arterial puncture technique

DIF: Level 1 Learning Objective: 12.7

15. The thumb should not be used to palpate an artery for arterial punctures because it: A. is too large.

B. lacks nerve endings.

C. contains a pulse.

D. cannot be adequately disinfected.

ANS: C KEY: Topic: Arterial puncture technique

DIF: Level 1 Learning Objective: 12.7

16. To achieve a steady state in a patient prior to collection of arterial blood gases, the patient should: A. empty the bladder.

B. fast for 12 hours.

C. cough 5 to 10 times to clear lungs.

D. rest for 30 minutes.

ANS: D KEY: Topic: Arterial puncture technique

DIF: Level 1 Learning Objective: 12.4

17. The modified Allen test is used to determine collateral circulation in the: A. ulnar artery.

B. brachial artery.

C. radial artery.

D. cephalic artery.

ANS: A KEY: Topic: Arterial puncture technique

DIF: Level 1 Learning Objective: 12.6

18. Additional information required on the requisition form when collecting arterial blood gases (ABGs) includes all of the following except: A. patient’s respiration rate.

B. type of ventilation the patient is receiving.

C. type of patient activity.

D. initials of the requesting physician.

ANS: D KEY: Topic: Arterial puncture technique

DIF: Level 1 Learning Objective: 12.4

19. When performing the modified Allen test, pressure is released from the: A. radial and ulnar arteries.

B. ulnar and brachial arteries.

C. radial artery only.

D. ulnar artery only.

ANS: D KEY: Topic: Arterial puncture technique

DIF: Level 1 Learning Objective: 12.6

20. When performing an arterial puncture, the needle is inserted bevel: A. down at a 90-degree angle.

B. up at a 30- to 45-degree angle.

C. up at a 15- to 20-degree angle.

D. down at a 10-degree angle.

ANS: B KEY: Topic: Arterial puncture technique

DIF: Level 1 Learning Objective: 12.7

21. The site of an arterial puncture is cleansed with: A. soap and water to prevent irritation.

B. alcohol in the same manner as for a venipuncture.

C. iodine followed by alcohol and air-drying.

D. iodine and air-drying.

ANS: B KEY: Topic: Arterial puncture technique

DIF: Level 1 Learning Objective: 12.7

22. After the artery has been entered, the syringe plunger: A. will be pushed back by the blood.

B. should be rapidly pulled back.

C. must be rotated.

D. should be moved back and forth.

ANS: A KEY: Topic: Arterial puncture technique

DIF: Level 1 Learning Objective: 12.

23. Following arterial specimen collection, pressure is applied to the puncture site for: A. 2 minutes by the phlebotomist.

B. 2 minutes by the phlebotomist or patient.

C. 3 to 5 minutes by the phlebotomist.

D. 10 minutes by the phlebotomist or patient.

ANS: C KEY: Topic: Arterial puncture technique

DIF: Level 1 Learning Objective: 12.7

24. Prior to completing an arterial puncture procedure, the phlebotomist should: 1. notify the nursing station.

2. check the site for hematoma.

3. check a radial pulse.

4. apply a pressure bandage.

A. 1 and 3.

B. 2 and 4.

C. 3 and 4.

D. 2, 3, and 4.

ANS: D KEY: Topic: Arterial puncture technique

DIF: Level 1 Learning Objective: 12.7

25. An error that would falsely elevate a patient’s PO2 reading is: A. failing to seal the syringe needle after specimen collection.

B. failing to expel excess heparin from the syringe.

C. delayed analysis of a specimen not on ice.

D. both A and C. ANS: A KEY: Topic: Arterial puncture technique

DIF: Level 2 Learning Objective: 12.8

26. A phlebotomist would be most likely to perform an accidental arterial puncture when attempting to puncture the: A. cephalic vein.

B. median cubital vein.

C. radial vein.

D. basilic vein.

ANS: D KEY: Topic: Arterial puncture technique

DIF: Level 2 Learning Objective: 12.9

27. The presence of excess heparin in the syringe used to collect arterial blood gases (ABGs) will: A. increase clotting speed.

B. decrease the pH. C. decrease the anticoagulant effect of heparin.

D. increase the pH. ANS: B KEY: Topic: Arterial puncture technique

DIF: Level 2 Learning Objective: 12.8

28. During an arterial puncture, a hypodermic syringe with a 25-gauge needle is used for: A. collecting the specimen.

B. administering an anesthetic.

C. transferring the specimen to a tube.

D. transporting the specimen to the laboratory.

ANS: B KEY: Topic: Arterial puncture technique

DIF: Level 2 Learning Objective: 12.3

29. Extended pressure may need to be applied to the arterial puncture site when patients are receiving all of the following except: A. streptokinase.

B. tissue plasminogen activator (t-PA).

C. insulin.

D. Coumadin.

ANS: C KEY: Topic: Arterial puncture technique

DIF: Level 2 Learning Objective: 12.9

30. Collateral circulation is necessary to prevent complications caused by: A. arteriospasm.

B. infection.

C. vasovagal reaction.

D. hemorrhage.

ANS: A KEY: Topic: Arterial puncture complications

DIF: Level 2 Learning Objective: 12.9

31. Which of the following arterial puncture complications would cause a patient to lose consciousness rapidly?

A. Arteriospasm.

B. Nerve damage.

C. Vasovagal reaction.

D. Hemorrhage.

ANS: C KEY: Topic: Arterial puncture complications

DIF: Level 2 Learning Objective: 12.9

32. Failure to locate a radial pulse after arterial puncture of the radial artery indicates: A. venous blood was collected.

B. the ulnar artery is occluded.

C. a possible arteriospasm.

D. the patient has expired.

ANS: C KEY: Topic: Arterial puncture complications

DIF: Level 2 Learning Objective: 12.9

33. Examples of diseases and patient conditions that require the collection of a blood specimen by arterial puncture include all of the following except: A. newborn metabolic disease screening.

B. diabetic coma.

C. cardiac and respiratory failures.

D. chronic obstructive pulmonary disease (COPD).

ANS: A KEY: Topic: Arterial puncture general

DIF: Level 2 Learning Objective: 12.2

Matching Match the following arterial puncture complications with the possible cause or collection error.

A. Arteriospasm B. Hematoma C. Hemorrhage D. Nerve damage E. Vasovagal reaction

34. Deep puncture 35. Tissue destruction 36. Failure to apply adequate pressure 37. Coagulation disorders 38. Apprehensive patient

47. ANS: D KEY: Topic: Arterial puncture complications

DIF: Level 2 Learning Objective: 12.9

34. ANS: A KEY: Topic: Arterial puncture complications

DIF: Level 2 Learning Objective: 12.9

35. ANS: B

KEY: Topic: Arterial puncture complications

DIF: Level 2 Learning Objective: 12.9

36. ANS: C KEY: Topic: Arterial puncture complications

DIF: Level 2 Learning Objective: 12.9

37. ANS: E KEY: Topic: Arterial puncture complications

DIF: Level 2 Learning Objective: 12.9

38. ANS: D KEY: Topic: Arterial puncture complications

DIF: Level 2 Learning Objective: 12.9

Short Answers

39. List eight reasons why a specimen for arterial blood gases determination may be rejected.

ANS: Reasons a specimen for arterial blood gases determination may be rejected are unlabeled or mislabeled specimen, inadequate volume, wrong type of syringe used, air bubbles in the specimen, clotted specimen, hemolyzed specimen, improper handling during transportation, and delay in delivery to the laboratory.

KEY: Topic: specimen rejection DIF: 2 Learning Objective: 12.10

40. State four factors that should be considered when selecting a site for arterial puncture and name the preferred site.

ANS: Four factors that should be considered when selecting a site for arterial puncture are the artery must be large enough to select a 25-gauge needle, the artery must be located hear the skin surface so that deep puncture is not required, the artery must be in an area where injury to surrounding tissues will not be critical, and the artery must be located in an area where other arteries are present to supply blood in case the punctured artery is damaged. The preferred artery is the radial artery.

KEY: Topic: site selection DIF: 2 Learning Objective: 12.5 Chapter 13

Multiple Choice

1. Which of the following statements does not refer to point-of-care testing (POCT)?

A. Testing is performed at the patient’s bedside.

B. Portable instruments are available for testing.

C. A central laboratory must be present.

D. Phlebotomists are trained to perform POCT. ANS: C KEY: Topic: POCT general

DIF: Level 1 Leaning Outcome: 13.1

2. Point-of-care testing (POCT) is routinely performed in all of the following areas except the: A. physician’s office.

B. intensive care unit.

C. clinical laboratory.

D. operating room.

ANS: C KEY: Topic: POCT general

DIF: Level 1 Leaning Outcome: 13.1

3. Advantages of point-of-care testing (POCT) include all of the following except: A. faster turnaround time of test results.

B. providing faster patient treatment.

C. limiting the amount of blood needed for testing.

D. providing a wider variety of laboratory tests.

ANS: D KEY: Topic: POCT general

DIF: Level 2 Leaning Outcome: 13.2

4. Proficiency testing is required for all levels of Clinical Laboratory Improvement Amendments (CLIA) complexity except: A. waived.

B. provider-performed microscopy procedures.

C. moderate.

D. high.

ANS: A KEY: Topic: POCT regulation

DIF: Level 1 Leaning Outcome: 13.3

5. The Clinical Laboratory Improvement Amendments (CLIA) regulations are administered by the: A. College of American Pathologists (CAP).

B. Centers for Medicare and Medicaid Services (CMS).

C. COLA. D. The Joint Commission (TJC).

ANS: B KEY: Topic: POCT regulation

DIF: Level 1 Leaning Outcome: 13.3

6. According to Clinical Laboratory Improvement Amendments (CLIA), a test that can be purchased over the counter for home use is called: A. waived.

B. moderate complexity.

C. inaccurate.

D. high complexity.

ANS: A

KEY: Topic: POCT regulation

DIF: Level 1 Leaning Outcome: 13.3

7. A phlebotomist is authorized to perform all of the following tests on urine except: A. physical examination.

B. chemical examination.

C. microscopic examination.

D. pregnancy test.

ANS: C KEY: Topic: POCT regulation

DIF: Level 1 Leaning Outcome: 13.3

8. A phlebotomist running a test on a standardized specimen received from a monitoring agency is performing: A. proficiency testing.

B. quality control.

C. waived testing.

D. documentation.

ANS: A KEY: Topic: POCT regulation

DIF: Level 2 Leaning Outcome: 13.4

9. Quality control of point-of-care testing (POCT) should be performed by: A. the POCT supervisor.

B. the person performing patient testing.

C. a POCT performer and a supervisor.

D. a medical technologist.

ANS: B KEY: Topic: Quality control

DIF: Level 1 Leaning Outcome: 13.5

10. A procedure manual differs from a package insert by containing: A. reagent storage requirements.

B. sources of error.

C. test procedure steps.

D. instructions for recording results.

ANS: D KEY: Topic: Quality control

DIF: Level 1 Leaning Outcome: 13.5

11. The standardization of an instrument used for point-of-care testing (POCT) is called: A. quality control.

B. calibration.

C. documentation.

D. reliability.

ANS: B KEY: Topic: Quality control

DIF: Level 1 Leaning Outcome: 13.5

12. To determine the proper maintenance of a glucometer, the phlebotomist should: A. attend a proficiency class.

B. read the package insert.

C. contact the manufacturer.

D. consult with another phlebotomist.

ANS: B KEY: Topic: Quality control

DIF: Level 1 Leaning Outcome: 13.6

13. When performing point-of-care testing (POCT), a phlebotomist must be sure to document results of: A. patient tests.

B. quality control.

C. electronic controls.

D. all of the above.

ANS: D KEY: Topic: Quality control

DIF: Level 1 Leaning Outcome: 13.6

16. If a phlebotomist is not performing a test correctly, this will be detected through: A. documentation.

B. calibration.

C. panic values.

D. quality control.

ANS: D KEY: Topic: Quality control

DIF: Level 2 Leaning Outcome: 13.5

17. A HemoCue instrument can be used to measure: A. cholesterol.

B. glucose.

C. hemoglobin.

D. both B and C. ANS: D KEY: Topic: POCT tests

DIF: Level 1 Leaning Outcome: 13.8

18. The recommended specimen for urine pregnancy testing is a: A. random specimen.

B. first morning specimen.

C. midstream clean-catch specimen.

D. timed specimen.

ANS: B KEY: Topic: POCT tests

DIF: Level 1 Leaning Outcome: 13.8

19. Immunoassay kits must contain all of the following except: A. reaction cards.

B. positive and negative controls.

C. extraction solution.

D. color developer.

ANS: C KEY: Topic: POCT tests

DIF: Level 1 Leaning Outcome: 13.8

20. Which of the following patients may have anemia?

A. Male patient with a hemoglobin of 15 g/dL. B. Female patient with a hemoglobin of 12 g/dL. C. Female patient with a hemoglobin of 17 g/dL. D. Male patient with a hemoglobin of 12 g/dL. ANS: D KEY: Topic: POCT tests

DIF: Level 1 Leaning Outcome: 13.8

21. The physical examination of urine includes reports on: A. odor and turbidity.

B. color and appearance.

C. clarity and foam color.

D. color and blood.

ANS: B KEY: Topic: POCT tests

DIF: Level 1 Leaning Outcome: 13.8

22. Chemical results of a urinalysis are read: A. using a microscope.

B. under ultraviolet light.

C. by comparing with a specified color chart.

D. by placing the reagent strip into a cuvette.

ANS: C

KEY: Topic: POCT tests

DIF: Level 1 Leaning Outcome: 13.6

23. The appearance of a blue color in a Hemoccult test is indicative of: A. specimen contamination.

B. the presence of blood.

C. a normal result.

D. expired guaiac reagent.

ANS: B KEY: Topic: POCT tests

DIF: Level 1 Leaning Outcome: 13.6

24. When instructing a patient prior to the collection of a specimen for occult blood testing, the phlebotomist should: A. stress the need to fast for 12 hours.

B. explain the significance of the test.

C. provide a schedule for collection times.

D. provide a list of foods not to be eaten.

ANS: D KEY: Topic: POCT tests

DIF: Level 1 Leaning Outcome: 13.6

25. The advantage of rapid group A streptococcus kits is that: A. they detect small numbers of bacteria.

B. false-negative reactions do not occur.

C. cultures are frequently contaminated.

D. the results are available sooner.

ANS: D KEY: Topic: POCT tests

DIF: Level 1 Leaning Outcome: 13.8

26. Two swabs are collected for rapid streptococcus testing so that: A. a routine culture can be performed, if necessary.

B. the test can be repeated, if necessary.

C. they can be rotated together for even distribution.

D. the test can be run in duplicate.

ANS: A KEY: Topic: POCT tests

DIF: Level 1 Leaning Outcome: 13.8

27. Point-of-care testing (POCT) for cholesterol testing is performed primarily: A. to monitor patients in the intensive care unit (ICU).

B. following transplant surgery.

C. on patients taking steroids.

D. as a health screening test.

ANS: D KEY: Topic: POCT tests

DIF: Level 1 Leaning Outcome: 13.8

28. If the Cholestech LDX goes into “locking” mode, the phlebotomist must: A. rerun the quality control.

B. clean the calibrating magnetic strip.

C. perform an optics check.

D. contact a technical service representative.

ANS: D KEY: Topic: POCT tests

DIF: Level 1 Leaning Outcome: 13.6

29. Specimens for activated clotting times performed on the HEMOCHRON Jr. are obtained by: A. venipuncture.

B. dermal puncture.

C. arterial puncture.

D. both A and B. ANS: B

KEY: Topic: POCT tests

DIF: Level 1 Leaning Outcome: 13.6

30. Transcutaneous bilirubin testing: A. is an invasive procedure.

B. cannot be used to monitor the need for an exchange transfusion.

C. is not recommended as a screening procedure.

D. is performed on the plantar surface of the heel.

ANS: B KEY: Topic: POCT tests

DIF: Level 2 Leaning Outcome: 13.8

31. Errors in performance of a chemical examination of urine include all of the following except: A. incompletely dipping the strip in the urine.

B. leaving the reagent strip in the urine for 2 minutes.

C. comparing the color reactions to a chart after 10 minutes.

D. reading the color reactions at specified times.

ANS: D KEY: Topic: POCT tests

DIF: Level 2 Leaning Outcome: 13.6

32. Which of the following immunoassay kits are designed to detect antibodies?

A. Infectious mononucleosis and Helicobacter pylori.

B. Troponin T and group A streptococcus.

C. Troponin T and Helicobacter pylori.

D. Pregnancy tests and group A streptococcus.

ANS: A KEY: Topic: POCT tests

DIF: Level 2 Leaning Outcome: 13.8

33. All of the following are point-of-care testing (POCT) for coagulation except the:

A. prothrombin time (PT).

B. activated clotting time (ACT).

C. partial pressure of oxygen (PO2).

D. activated partial thromboplastin time (APTT).

ANS: C KEY: Topic: POCT tests

DIF: Level 2 Leaning Outcome: 13.8

34. All of the following results from the Cholestech LDX are measured except the: A. triglycerides.

B. high-density lipoprotein (HDL).

C. low-density lipoprotein (LDL).

D. total cholesterol.

ANS: C KEY: Topic: POCT tests

DIF: Level 2 Leaning Outcome: 13.8

35. All of the following tests can be performed by point-of-care testing (POCT) instruments except: A. electrolytes.

B. platelet counts.

C. hematocrits.

D. arterial blood gases.

ANS: B KEY: Topic: POCT tests

DIF: Level 2 Leaning Outcome: 13.8

36. A patient’s glucose result of 350 mg/dL is considered: A. out of control.

B. normal.

C. hypoglycemic.

D. a critical value.

ANS: D

KEY: Topic: POCT tests

DIF: Level 2 Leaning Outcome: 13.6

37. Failure to obtain quality control results that are within acceptable limits when performing a blood glucose test may be caused by all of the following except: A. storing the reagent strips in the refrigerator.

B. the control covering half of the testing area.

C. setting the reagent strip code on the monitor.

D. prolonged exposure of reagent strips to room air.

ANS: C KEY: Topic: POCT tests

DIF: Level 2 Leaning Outcome: 13.6

38. Blood glucose point-of-care testing (POCT) instruments work on the principle of: A. reflectance of color intensity.

B. light transmittance through a colored solution.

C. electrical potential of the glucose reaction.

D. both A and C. ANS: D KEY: Topic: POCT tests

DIF: Level 2 Leaning Outcome: 13.8

39. A decrease in the amount of oxygen reaching the cells can be detected using a(an): A. reagent strip.

B. HEMOCHRON Jr. C. HemoCue. D. Accu-Chek.

ANS: C KEY: Topic: POCT tests

DIF: Level 2 Leaning Outcome: 13.8

40. The HemoCue can accurately measure hemoglobin concentration in patients with high white blood cell counts because the reaction: A. takes place in a cuvette.

B. is read in a photometer.

C. is read at two different wavelengths.

D. produces a colored complex.

ANS: C KEY: Topic: POCT tests

DIF: Level 2 Leaning Outcome: 13.8

41. A urinalysis should be performed: A. within 10 minutes of specimen collection.

B. within 2 hours of specimen collection.

C. before the end of the shift.

D. when laboratory personnel are present.

ANS: B KEY: Topic: POCT tests

DIF: Level 2 Leaning Outcome: 13.6

42. The purpose of enzyme immunoassay tests for pregnancy is the: A. detection of human chorionic gonadotropin.

B. reaction of placental cells with enzymes.

C. conjugation of antibodies and urine or serum.

D. reaction of human chorionic gonadotropin with antibody to produce a color.

ANS: A KEY: Topic: POCT tests

DIF: Level 2 Leaning Outcome: 13.8

43 The program established by a laboratories to improve quality of laboratory services through all three phases of patient testing is: A. quality control.

B. accreditation.

C. quality management D. continuous quality improvement.

ANS: C KEY: Topic: Quality assurance variables

DIF: Level 1 Learning Objective: 13.4

44. The pre-examination phase associated with point-of-care testing (POCT) include all of the following except: A. reporting results.

B. transporting and storing of specimens.

C. collection supplies.

D. proper identification of the patient.

ANS: A KEY: Topic: Quality assurance variables

DIF: Level 2 Learning Objective: 13.7

45. All of the following are advantages of point-of-care testing (POCT) testing except: A. increased turnaround time for results.

B. decreased length of hospital stays.

C. patient can be diagnosed and treated more quickly.

D. ease of use of instruments.

ANS: A KEY: Topic:

DIF: Level 1 Learning Objective: 13.2

46. The accrediting agencies that the Centers for Medicare and Medicaid Services (CMS)grant deemed status include all of the following except: A. College of American Pathologists (CAP).

B. Centers for Disease Control and Prevention (CDC).

C. the Joint Commission (TJC).

D. COLA. ANS: B KEY: Topic: CLIA

DIF: Level 1 Learning Objective: 13.3

Short Answers

47. Discuss the three phases of laboratory testing. Which of the phases should the phlebotomist really focus on? Explain your answer.

ANS: The three phases of testing are pre-examination, examination, and post-examination. Preexamination includes all of the procedures performed prior to testing such as proper identification of the patient, proper tube and specimen collection, and proper storage and transport. Examination phase is the phase when the testing is actually being performed.

Postexamination deals with the interpretation and documentation of the results. It is the preexamination phase that is most important for the phlebotomist to focus on.

KEY: Topic: POCT procedures DIF: Level 3 Learning Objective: 13.7

48. List some common point-of-care testing (POCT) errors.

ANS: Some of the most common POCT errors are misidentification of the patient, incorrect specimen collection, incorrect storage of the reagents used for POCT, not performing or inaccurately performing quality control, improper specimen application, incorrect interpretation of results, and incorrect documentation.

KEY: Topic: POCT procedures DIF: Level 2 Learning Objective: 13.6

49. List the tests and instruments commonly used in point-of-care testing (POCT).

ANS: See Table 13-1.

KEY: Topic: POCT tests

DIF: Level 3 Learning Objective: 13.8

Chapter 14

Multiple Choice

1. Clean-catch midstream urine specimens are delivered to: A. hematology.

B. microbiology.

C. chemistry.

D. urinalysis.

ANS: B KEY: Topic: Urine specimens

DIF: Level 1 Learning Objective: 14.1

2. Documentation of the correct handling of a urine drug collection specimen is provided by the: A. urinalysis supervisor.

B. donor picture identification.

C. physician.

D. chain-of-custody forms.

ANS: D KEY: Topic: Urine specimens

DIF: Level 1 Learning Objective: 14.1

3. Urine specimens that cannot be tested within 2 hours should be: A. frozen.

B. refrigerated.

C. recollected.

D. incubated.

ANS: B KEY: Topic: Urine specimens

DIF: Level 1 Learning Objective: 14.1

4. To obtain an accurate timed specimen, the patient is instructed to: A. urinate into the container containing the preservative.

B. abstain from drinking fluids during the collection period.

C. begin and end the collection with an empty bladder.

D. empty the bladder after beginning the collection timing.

ANS: C KEY: Topic: Urine specimens

DIF: Level 2 Learning Objective: 14.1

5. All of the following suggest possible tampering with a urine drug collection specimen except a: A. temperature of 34°C. B. pH of 9.5.

C. specific gravity of 1.002.

D. blue-green urine color.

ANS: A KEY: Topic: Urine specimens

DIF: Level 2 Learning Objective: 14.

6. Analysis of an incomplete 24-hour urine specimen will produce: A. falsely increased results.

B. acceptable results after centrifugation.

C. errors in bar code comparisons.

D. falsely decreased results.

ANS: D KEY: Topic: Urine specimens

DIF: Level 2 Learning Objective: 14.1

7. All of the following may be given to outpatients for the collection of fecal specimens except: A. plastic hat style containers.

B. bedpans.

C. filter paper mailing kits.

D. wax-coated cardboard containers.

ANS: B KEY: Topic: Fecal specimens

DIF: Level 1 Learning Objective: 14.2

8. A patient with a requisition for a semen analysis should be instructed to do all of the following except: A. abstain from sexual activity for 3 days.

B. keep the specimen warm while delivering it to the laboratory.

C. collect the specimen in a condom.

D. deliver the specimen to the laboratory within 1 hour.

ANS: C KEY: Topic: Semen specimens

DIF: Level 1 Learning Objective: 14.3

9. When a semen specimen is delivered to the laboratory, the phlebotomist should: A. place the specimen in the refrigerator.

B. record the time of delivery.

C. place the specimen in an incubator.

D. record the time of collection.

ANS: D KEY: Topic: Semen specimens

DIF: Level 1 Learning Objective: 14.3

10. The technique for collecting a throat culture does not include: A. use of a tongue depressor.

B. swabbing the inside of the cheek.

C. swabbing the back of the throat.

D. releasing transport media into the swab container.

ANS: B KEY: Topic: Throat cultures

DIF: Level 1 Learning Objective: 14.4

11. Which of the following would not be needed when collecting a throat culture?

A. Flashlight.

B. Blood agar culture plate.

C. Tongue depressor.

D. Sterile swab.

ANS: B KEY: Topic: Throat cultures

DIF: Level 1 Learning Objective: 14.4

12. All of the following may be used to collect sweat electrolytes except: A. coils.

B. syringes.

C. gauze.

D. filter paper.

ANS: B KEY: Topic: Sweat electrolytes

DIF: Level 1 Learning Objective: 14.6

13. The sweat electrolyte test is used in the diagnosis of: A. multiple sclerosis.

B. cystic fibrosis.

C. muscular dystrophy.

D. electrolyte imbalance.

ANS: B KEY: Topic: Sweat electrolytes

DIF: Level 1 Learning Objective: 14.6

14. The technique used to collect sweat electrolytes is called: A. electrophoresis.

B. sweat chloride.

C. electrolyte stimulation D. pilocarpine iontophoresis.

ANS: D KEY: Topic: Sweat electrolytes

DIF: Level 1 Learning Objective: 14.6

15. When collecting sweat electrolytes, the collection site is cleansed before and after stimulation with: A. isopropyl alcohol.

B. deionized water.

C. soap and water.

D. iodine.

ANS: B KEY: Topic: Sweat electrolytes

DIF: Level 1 Learning Objective: 14.6

16. Failure to tightly seal specimens for sweat electrolytes during collection and transport will cause: A. decreased values due to exposure to air.

B. decreased values due to exposure to light.

C. increased values due to evaporation.

D. increased values due to cellular contamination.

ANS: C KEY: Topic: Sweat electrolytes

DIF: Level 2 Learning Objective: 14.6

17. Specimens collected using pilocarpine iontophoresis are used in the diagnosis of: A. diabetes mellitus.

B. multiple sclerosis.

C. cystic fibrosis.

D. phenylketonuria.

ANS: C KEY: Topic: Sweat electrolytes

DIF: Level 2 Learning Objective: 14.6

18. When a patient has a unit of blood drawn prior to surgery with the understanding that the unit may be given back during surgery, the collection is called:

A. therapeutic.

B. replacement.

C. transfusion.

D. autologous.

ANS: D KEY: Topic: Blood donors

DIF: Level 1 Learning Objective: 14.8

19. The amount of blood collected from a person donating a unit of blood is: A. 20 to 30 mL. B. 100 to 200 mL. C. 300 to 400 mL. D. 400 to 500 mL. ANS: D KEY: Topic: Blood donors

DIF: Level 1 Learning Objective: 14.8

20. Which of the following would disqualify a person from donating blood?

A. Temperature of 98°F. B. Weight of 200 pounds.

C. Blood pressure of 140/85 mm Hg. D. Hemoglobin of 11.0 gm/dL. ANS: D KEY: Topic: Blood donors

DIF: Level 1 Learning Objective: 14.8

21. Collection of donor blood differs from routine venipuncture in which way(s)?

1. The site is cleansed twice.

2. Veins in the antecubital area are preferred.

3. Patients open and close their fists.

4. The arm is elevated when pressure is applied.

A. 1 and 3.

B. 2 and 4.

C. 1 and 2.

D. 3 and 4.

ANS: A KEY: Topic: Blood donors

DIF: Level 1 Learning Objective: 14.9

22. When persons donate blood for themselves in preparation for surgery, it is called: A. therapeutic phlebotomy.

B. autologous donation.

C. directed donation.

D. plateletpheresis.

ANS: B KEY: Topic: Blood donors

DIF: Level 1

23. The process in which a person donates a specific blood component and the remainder of the blood is returned to him or her is called: A. apheresis.

B. therapeutic phlebotomy.

C. autologous donation.

D. component therapy.

ANS: A KEY: Topic: Blood donors

DIF: Level 2 Learning Objective: 14.8

24. Reasons for interviewing potential blood donors include all of the following except: A. protecting the donor from physical harm.

B. protecting the phlebotomist from bloodborne pathogens.

C. screening for possible exposure to bloodborne pathogens.

D. screening for conditions that might adversely affect the recipient.

ANS: B KEY: Topic: Blood donors

DIF: Level 2 Learning Objective: 14.8

25. To prevent hemolysis of donor blood: A. hemostats are used to stop the flow of blood.

B. donors are not asked to clench their fists.

C. large-bore needles are used for collection.

D. alcohol is not used during site preparation.

ANS: C KEY: Topic: Blood donors

DIF: Level 2 Learning Objective: 14.8

26. Fluid collected from a joint is called: A. amniotic.

B. ascitic.

C. synovial.

D. peritoneal.

ANS: C KEY: Topic: Miscellaneous specimens

DIF: Level 1 Learning Objective: 14.10

27. A phlebotomist who is unsure of the instructions to give a patient regarding collection of a specimen should: A. check the laboratory procedure manual.

B. check with the physician’s office.

C. look up the procedure in a reference manual.

D. ask the patient to return when the supervisor is present.

ANS: A KEY: Topic: Miscellaneous specimens

DIF: Level 1 Learning Objective: 14.11

28. Amniotic fluid received in the central processing area should be: 1. protected from light for bilirubin analysis.

2. delivered immediately to cytogenetics.

3. measured and an aliquot sent to hematology.

4. frozen for shipment to a reference laboratory.

A. 1 and 3.

B. 2 and 4.

C. 1 and 2.

D. 3 and 4.

ANS: C KEY: Topic: Miscellaneous specimens

DIF: Level 1 Learning Objective: 14.11

29. A lumbar puncture is performed to collect: A. synovial fluid.

B. amniotic fluid.

C. cerebrospinal fluid.

D. pleural fluid.

ANS: C KEY: Topic: Miscellaneous specimens

DIF: Level 1 Learning Objective: 14.10

30. A special precaution to be taken with an amniotic fluid specimen is to: A. deliver the specimen on ice.

B. keep the specimen at room temperature.

C. centrifuge the specimen within 1 hour.

D. protect the specimen from light.

ANS: D KEY: Topic: Miscellaneous specimens

DIF: Level 2 Learning Objective: 14.10

31. The distribution of a cerebrospinal fluid (CSF) specimen in tubes labeled #1, #2, and #3 should be: A. #1 to hematology, #2 to chemistry, and #3 to microbiology.

B. #1 to chemistry, #2 to microbiology, and #3 to hematology.

C. #1 to microbiology, #2 to hematology, and #3 to chemistry.

D. #1 to hematology, #2 to microbiology, and #3 to chemistry.

ANS: B KEY: Topic: Miscellaneous specimens

DIF: Level 2 Learning Objective: 14.10

32. Serum or plasma should be separated from cells by centrifugation within: A. 20 minutes.

B. 60 minutes.

C. 90 minutes.

D. 120 minutes.

ANS: D KEY: Topic: Specimen processing

DIF: Level 1 Learning Objective: 14.12

33. Interstate shipping of infectious material is regulated by the: A. Centers for Disease Control and Prevention.

B. U.S. Department of Transportation.

C. Occupational Safety and Health Administration.

D. U.S. Department of Health.

ANS: B KEY: Topic: Specimen processing

DIF: Level 1 Learning Objective: 14.11

34. Which of the following pieces of equipment is located in the specimen processing area?

A. Microscope.

B. Blood gas analyzer.

C. Differential stainer.

D. Centrifuge.

ANS: D KEY: Topic: Specimen processing

DIF: Level 1 Learning Objective: 14.12

35. Correct procedure for processing specimens to be sent to a reference laboratory is to: A. freeze the specimens.

B. send whole blood at all times.

C. check the reference laboratory manual.

D. refrigerate specimens and transport on ice.

ANS: C KEY: Topic: Specimen processing

DIF: Level 1 Learning Objective: 14.11

36. Accessioning refers to: A. a test performed in the chemistry section.

B. organization of requisition forms for morning sweeps.

C. assigning of identification numbers and distribution of specimens.

D. processing of specimens requiring special handling.

ANS: C KEY: Topic: Specimen processing

DIF: Level 1 Learning Objective: 14.11

37. Protective apparel worn in the specimen processing area should include all of the following except: A. masks.

B. fluid-resistant laboratory coats.

C. gloves.

D. full-face shields.

ANS: A KEY: Topic: Specimen processing

DIF: Level 1 Learning Objective: 14.12

38. All of the following are necessary when operating the centrifuge except: A. firmly securing the lid before operating.

B. placing uncapped tubes across from each other.

C. checking for excessive vibration before walking away.

D. making a final check of balancing before closing the lid.

ANS: B KEY: Topic: Specimen processing

DIF: Level 1 Learning Objective: 14.13

39. Which of the following tubes can be centrifuged immediately after collection?

A. Gold Hemogard stopper.

B. Light blue stopper.

C. Red stopper.

D. Yellow/gray stopper.

ANS: B KEY: Topic: Specimen processing

DIF: Level 2 Learning Objective: 14.13

40. A phlebotomist in specimen processing receives a serum separator tube (SST) with a requisition form for tests performed in chemistry and at a reference laboratory. The phlebotomist should: A. collect another SST. B. send the serum to chemistry and request that they return it when finished.

C. ask the reference laboratory driver to return the specimen.

D. aliquot the specimen for both laboratories.

ANS: D KEY: Topic: Specimen processing

DIF: Level 2 Learning Objective: 14.11

41. A major safety concern when processing specimens is the: A. production of aerosols.

B. use of transfer systems.

C. autoclaving of specimen.

D. volume and type of specimen.

ANS: A KEY: Topic: Specimen processing

DIF: Level 2

Learning Objective: 14.12

42. International Classification of Diseases, 10th Revision (ICD-10) codes and current procedural terminology (CPT) codes must be consistent with: A. the type of laboratory information management system (LIMS).

B. bar codes on patient samples.

C. medical necessity.

D. the hospital computer system.

ANS: C KEY: Topic: Computers

DIF: Level 1 Learning Objective: 14.14

43. Phlebotomists may be required to classify tests using a: A. current procedural terminology (CPT) code.

B. bar code.

C. International Classification of Diseases, 10th Revision (ICD-10) code.

D. Centers for Disease Control and Prevention (CDC) code.

ANS: A KEY: Topic: Computers

DIF: Level 1 Learning Objective: 14.14

44. When using laboratory computer systems, phlebotomists are concerned with: A. the path of information flow.

B. development of software packages.

C. entry and retrieval of data.

D. overall preventive maintenance.

ANS: C KEY: Topic: Computers

DIF: Level 1 Learning Objective: 14.14

45. Prior to obtaining information from a laboratory information system (LIS), phlebotomists must:

A. obtain a requisition form.

B. learn the mnemonic codes.

C. understand the bar code system.

D. enter their assigned password.

ANS: D KEY: Topic: Computers

DIF: Level 1 Learning Objective: 14.14

46. When giving instructions to a patient before collecting a timed 24-hour urine specimen, all of the following considerations are important. Select the response that describes the most important consideration (except for proper patient and specimen identification).

A. The container must contain the proper preservative if required.

B. The collection period must be carefully timed.

C. All urine produced during the collection period must be placed into the container.

D. The specimen label must contain the start and stop date and time.

ANS: C KEY: Topic: Urine specimens

DIF: Level 2 Learning Objective: 14.1

47. All of the following are types of serous fluid except: A. synovial.

B. pleural.

C. pericardial.

D. peritoneal.

ANS: A KEY: Topic: Miscellaneous specimens

DIF: Level 2 Learning Objective: 14.10

48. Buccal swabs are collected for which one of the following determinations?

A. Meningitis.

B. Tuberculosis.

C. DNA analysis.

D. Crystal identification.

ANS: C

KEY: Topic: Miscellaneous specimens

DIF: Level 2 Learning Objective: 14.10

Matching Match the following types of urine specimens with their purpose.

A. Confirmatory testing B. Quantitative tests C. Routine testing D. Urine culture 49. Timed specimen 50. Random specimen 51. Clean-catch midstream specimen 52. First morning specimen

49. ANS: B KEY: Topic: Urine specimens

DIF: Level 1 Learning Objective: 14.1

50. ANS: C KEY: Topic: Urine specimens

DIF: Level 1 Learning Objective: 14.1

51. ANS: D KEY: Topic: Urine specimens

DIF: Level 1 Learning Objective: 14.1

52. ANS: A KEY: Topic: Urine specimens

DIF: Level 1 Learning Objective: 14.1

Short Answers

53. Discuss some pre-examination considerations when performing specimen processing.

ANS: See Chapter 14, Pages 407-408 KEY: Topic: Specimen processing DIF: Level 3 Learning Objective: 14.11

54. State the rules for safe operation of a centrifuge.

ANS: Be sure that tubes placed in the cups of the rotor head are equally balanced. This is accomplished by placing tubes of equal size and volume directly across from each other. Failure to follow this practice will cause the centrifuge to vibrate and possibly break the tubes. Perform a final check for balancing just before closing the centrifuge lid. Never operate a centrifuge until the top has been firmly fastened down, and never open the top until the rotor head has come to a complete stop. Should a tube break during centrifugation, pieces of glass and biohazardous aerosols will be sprayed from a rotating centrifuge that is not covered. Do not walk away from a centrifuge until it has reached its designated rotational speed and no evidence of excessive vibration is observed. When a tube breaks in the centrifuge, immediately stop the centrifuge and unplug it before opening the cover. Don puncture-resistant gloves before beginning the cleanup.

Be sure to completely empty the cup containing the broken glass into a puncture-resistant container, and then disinfect the cup. Also clean the inside of the centrifuge of broken glass and disinfect it. Deposit any cleaning materials that may contain broken glass into a punctureresistant container. Do not recentrifuge specimens. This can cause hemolysis and erroneous test results. When serum or plasma has been removed from the tube, the volume ratio of plasma to red blood cells (RBCs) has been altered. Substances from the cellular leakage or exchange, caused by the blood clotting, will then be centrifuged into the serum or plasma and alter test results.

KEY: Topic: Centrifuge DIF: Level 2 Learning Objective: 14.13