Complete Test Bank Strasinger Dermal Puncture Chapter 11

Chapter 11: Dermal Puncture

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.

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.

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.

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.

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.

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.

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

A. hemorrhage.

B. venous thrombosis.

C. anemia.

D. gangrene.

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.

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.

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.

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.

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.

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.

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

A. Lancet.

B. Capillary tubes.

C. Tourniquet.

D. Microtainer.

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.

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

A. septicemia.

B. hemolysis.

C. osteomyelitis.

D. specimen contamination.

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.

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.

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.

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.

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.

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.

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.

28. When warming a dermal puncture site, the temperature should not exceed:

A. 32°C.

B. 42°C.

C. 52°C.

D. 62°C.

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.

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.

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.

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.

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.

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

A. jaundiced.

B. bruised.

C. edematous.

D. cyanotic.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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).

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.

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.

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.

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.

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.

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.

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.

54. Most states require testing of newborns for:

A. Down syndrome.

B. cystic fibrosis.

C. sickle cell anemia.

D. phenylketonuria.

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.

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.

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.

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.

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.

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.

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.

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.

63. Blood smears are important for evaluating:

A. the coagulation system.

B. blood cell morphology.

C. neonatal bilirubin concentration.

D. autoimmune disorders.

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.

65. Multiplication of parasites within red blood cells occurs in:

A. anemia.

B. septicemia.

C. malaria.

D. leukemia.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

76. What is the first mistake made by the phlebotomist?

77. What should the phlebotomist have done differently when collecting the CBC?

78. How will the CBC collected by the phlebotomist be affected?

79. Will the CBC results be falsely increased or decreased?

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.

81. What is the primary cause of falsely decreased neonatal bilirubins?

82. How will an infant with a falsely negative phenylketonuria (PKU) test be affected?

83. Describe the correct labeling of capillary specimens.

84. Explain why certain tests cannot be performed on capillary specimens?