Pre-Examination Variables And Chapter 9 Exam Questions

Chapter 9: Pre-examination Variables and Venipuncture Complications

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.

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.

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.

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

A. cholesterol.

B. blood urea nitrogen (BUN).

C. potassium.

D. glucose.

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.

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.

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.

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

A. 0600.

B. 1000.

C. 1400.

D. 1800.

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

A. hemolyzed.

B. watery.

C. lipemic.

D. icteric.

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.

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.

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.

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.

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

A. coagulation problems.

B. septicemia.

C. sclerosis.

D. syncope.

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.

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.

17. Physician approval is required when collecting blood from:

A. patients with diabetes.

B. lower arm veins.

C. foot veins.

D. pediatric patients.

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.

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.

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.

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

A. phlebitis.

B. edema.

C. anemia.

D. plasma.

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.

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.

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.

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.

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.

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

A. hemolysis.

B. an infection.

C. elevated test results.

D. syncope.

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.

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.

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.

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.

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.

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.

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

A. lactic acid.

B. cortisol.

C. ammonia.

D. glucose.

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

A. one.

B. two.

C. three.

D. four

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.

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.

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.

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.

40. Prolonged tourniquet application will cause:

A. edema.

B. hemolysis.

C. hemoconcentration.

D. both B and C.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

A. hematoma.

B. hemolysis.

C. nerve damage.

D. syncope.

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.

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.

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.

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.

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

A. a hematoma.

B. petechiae.

C. hemolysis.

D. patient discomfort.

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.

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.

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.

60. Prolonged fasting

61. Posture change from supine to erect

62. Chemotherapy

63. Smoking

64. Stress

65. Herbal supplements

KEY: Topic: Patient preparation

DIF: Level 2

Learning Objective: 9.4

KEY: Topic: Patient preparation

DIF: Level 2

Learning Objective: 9.4

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?

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

68. How can the phlebotomist collect a specimen from patient A?