What questions should you ask the patient before performing a venipuncture?

An epidemiologic study is performed with subjects who are health care workers. The types and numbers of accidental injuries are reviewed. It is observed that needlestick injuries occur amongst all health care workers. Which of the following groups of health care workers is most likely to have the highest rate of needlestick injury?

A Nurses

B Phlebotomists

C Physicians

D Medical students

E Laboratory technologists

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Of the following vacutainer tubes, which should be drawn first:

A Yellow top for blood culture

B Light-blue top for coagulation studies

C Gray top for glucose

D Purple top for CBC

E Red top for electrolytes

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When drawing a blood specimen using a light-blue top tube, a set of rules are employed. Which of the following rules DOES NOT apply to use of a blue-top tube?

A It should never be the first tube drawn

B It must be used only for coagulation tests

C It must be filled completely (full draw)

D It must always be the first tube drawn

E It must not be drawn from an IV line

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At which of the following sites can venipuncture be performed without potentially affecting test results?

A In the region of a hematoma

B At a mastectomy site

C Near a tattoo

D In edematous extremities

E Above an IV line

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Which of the following vacutainer tubes may be partially filled without affecting test results?

A Red top for total protein

B Gray top for glucose

C Light-blue top for protime

D Purple top for CBC

E Black top for sed rate

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Which of the following procedures is NOT part of universal precautions when performing phlebotomy?

A Wear a lab coat or gown

B Change gloves between each patient.

C Do not recap, break, or resheath needles

D Use sharps containers for disposal of ALL needles

E Inform the patient of your HIV status

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Performance of phlebotomy can create potential risks to the patient. Failure to follow which of the following procedures creates the greatest real or potential hazard to the patient when performing phlebotomy?

A Wearing gloves

B Properly identifying the patient

C Using the correct vacutainer tube

D Transporting specimens to the lab in less than 1 hour

E Preventing hematoma formation

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A student in a hurry does not wait for the site on the skin cleaned with antiseptic to dry before probing the phlebotomy site about 8 times with too small a needle before finally managing to get blood by using a syringe and drawing back forcefully on the plunger. Which of the following specimen artefacts is most likely to be caused in this situation?

A Hemoconcentration

B Elevation in WBC count

C Clotting

D Increase in creatine kinase

E Hemolysis

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Which of the following procedures is NOT done to obtain blood if a problem occurs during collection?

A Reposition the needle

B Use an IV line

C Try another vacutainer tube

D Re-anchor the vein

E Loosen the tourniquet

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A purple-top tube contains EDTA as an additive. Which of the following is the most likely mechanism of action of the EDTA?

A Inhibit glycolysis within RBC's

B Remove calcium by forming calcium salts

C Inactivate thrombin in the plasma

D Activate the extrinsic coagulation pathway

E Inactivate complement

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In performing venipuncture on a 79-year-old woman with Cushing syndrome, a hematoma forms. Correct statements regarding this phenomenon include all of the following EXCEPT:

A Test results may be affected when blood is drawn from a hematoma

B If a venipuncture area begins to swell, stop drawing blood

C If another venipuncture site is unavailable, draw distally from the hematoma

D The hematoma forms when blood leaks from the vein into surrounding tissues

E Remove the needle before removing the tourniquet to prevent hematoma formation

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A light-gray stoppered tube contains sodium fluoride. Which of the following is the most likely mechanisms of action of sodium fluoride?

A Inhibit glycolysis

B Activate thrombin to promote clotting

C Form calcium salts to remove calcium

D Inactivate complement

E Prevent microbial growth

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While performing a venipuncture on a hospital board member, the blood suddenly stops flowing into a vacutainer tube. Which of the following is the best corrective action to take in this situation?

A Rotate the needle holder clockwise 1/4 turn

B Pull back slightly on the holder

C Have the patient open and close his/her hand slowly

D Push in slightly on the holder

E Take the tube off and replace with a new tube

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A clinical study is performed to determine the optimal time for application of the tourniquet during phlebotomy. It is observed that if the tourniquet is left on longer than 2 minutes, changes in the value of a total protein test occur. Which of the following is the most likely mechanism for alteration in protein values in this situation?

A Hemolysis

B Hemoconcentration

C Glycolysis

D Hemostasis

E Complement activation

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A venipuncture procedure is performed that results in hemolyis of the specimen drawn into a red-top tube. Which of the following test results is most likely to be obtained in this situation?

A Total protein 2.5 g/dl

B Glucose 40 mg/dl

C Sodium 165 meq/L

D Potassium 7.8 meq/L

E Ammonia 100 micromol/L

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Quality assurance guidelines require that no more than which of the following percentages of specimens sent to the laboratory be unlabelled or mislabelled?

A None

B <1%

C <5%

D 5 TO 10%

E <25%

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A 45-year-old woman has a bileaflet tilting disc mitral valve mechanical prosthesis. She is taking coumadin. She has a laboratory test ordered to determine the effectiveness of her coumadin therapy. Which of the following tubes should be drawn for this test?

A Yellow top

B Light-blue top

C Gray top

D Black top

E Purple top

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When collecting blood for laboratory testing, which of the following procedures should NEVER be done?

A Send a partially filled red or light-green top tube to the laboratory

B Draw blood for microbiologic culture first

C Pour blood from a purple to a light blue top tube

D Draw blood distal to the site of a hematoma

E Wait for the venipuncture site to dry after cleansing

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An 8-year-old boy is suspected of having an acute leukemia. Which of the following vacutainer tubes should be drawn for the workup of this patient?

What is the most important step before performing venipuncture on a patient?

What questions will you ask your patient that will help you decide on which vein to use?

What important precautions must be observed when doing venipuncture?

What 4 variables should be examined before venipuncture testing can take place?