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Chapt. 8
Venipuncture procedures
| Question | Answer |
|---|---|
| When properly anchoring a vein, the | thumb is 1 to 2 in. below the intended site and is pulling the skin toward the wrist |
| Which of the following actions is unlikely to help a phleb. gain a patient's trust | collecting a specimen before the requested time |
| It is unlikely that misidentifying a patient specimen would result in | no reprimand if no one was hurt |
| Needle phobia is defined as a/an | intense fear of needles and being stuck |
| Symptoms of needle phobia can include | arrhythmia, fainting, light headedness |
| A basic step that can be taken to minimize any trauma associaated with a venipuncture is to | choose the most skilled phelb. available to perform the venipuncture |
| Proper use of hand sanitizer includes | allowing the alcohol to evapoate completely, rubbing it in between and around the fingers, using a very generous amount of the sanitizer |
| To examine by touch or feel is to | palpate |
| In most cases, needle insertion should be performed | using a smooth, steady motion foward |
| To seat the needle in the vein means to | thread part of the needle within the lumen |
| Going without food or drink except water for 8 to 12 hours is deined as | fasting |
| The reason a test is ordered timed is to | draw it at the best time for accurate results |
| Examples of timed test include | blood cultures, cardiac enzymens, and cortisol |
| A test is ordered fasting to | eliminate the effect of diet on test results |
| Bending the arm up to apply pressure to the site after venipuncture has not been shown to | enable the site to quickly stop bleeding after needle removal |
| The unique number asigned to a specimen request is called the | acession number |
| Failure of the patient to follow required diet restrictions before specimen collection could lead to | compromised patient care and treatment, erroneous and meaningless test results, misinterpreted test results by the physician |
| Which of the following individuals has legal authority to authorize patient testing | patient's physician |
| Test requisition information must include the | ordering physician |
| Which type of requisition often seves as a test request, report, and billing form | manual |
| Information represented by a patient ID bar code typically includes the patient's | medical record number and name |
| Outpatient requisitons are typically of this type | manual |
| When recived by the laboratory, inpatient requisition are typically sorted according to | collection priority, date and time, and patient location |
| Steps taken to unmistablably connect a specimen and the accompnaying paperwork to a specific individual are called | accessioning the specimen |
| Which priority does a timed test typically have | second |
| A test that is ordered stat should be collected | immedicately, without any hesitation |
| Which of the following tests is commonly ordered stat | lytes |
| If a test is ordered stat, it may mean that the patient is in | critical condition |
| When a test is ordered ASAP, it means that | results are needed soon for an approprate response |
| A preop patient | will soon be going to surgery |
| Tests are classified as routine if they are ordered | in the course of establishing a diagnosis |
| This term means the same as stat | med emerg |
| A patient who is NPO | cannot have any food or drinki |
| An example of a test that is commonly ordered fasting is | glucose |
| Which liquid is acceptable to drink when one is fasting | plain water |
| Which is a common postop test | H&H hemoglobin and hematcrit |
| You arrive to draw a specimen on an inpatient. The patient's door is closed. What do you do | knock lightly, open the door slowly, and ask whether it is all right to enter |
| There is a sign above the patient's beed that reads, No blood pressure or venipuncture, right arm. The patient has an intravenous line in the left forearm. You have a request to collect a complete blood count CBC on the patient. How should you proceed | Collect the specimen from the left hand by finger puncture |
| A code is a way to | convey important information without alarming the public, transmit messages over the facility's public address system, use numbers or words to represent important information |
| DNR means | do not resuscitate |
| You greet the patient in the following manner, Hello, my name is Jean and I am here to collect a blood specimen. if that is all right with you. The patient responds by saying , OK but I would rather not. How do you proceed | determine what the problem is before proceeding |
| Which one of the following tests is used to idenify protein disorders that lead to nerve damage | SPEP - serum protein electrophoresis |
| Your inpatient is asleep when you arrive tdo draw blood. What do you do | call out the patient's name softly and shake the bed gently |
| Laboratory results can be negatively affected if the phlebotomist | while preparing to collect a specimen, startles a patient who is asleep |
| In collecting a blood specimen from an unconscious patient, it is unnecessary to | move the patient to a speical phlebotomy collection area |
| What do you do if a physician is with the patient and the specimen is ordered stat | introduce yourself and ask for permission to draw the specimen |
| what is the best thing to do if family or visitors are with a patient | ask them to wait outside of the room until you are finished |
| Your patien is not in the room when you arrive to collect a timed specimen. The patient's nurse states that the patient will be unavailable for several hours. What should you do | fill out a delay slip stating you were unable to collect the specimen |
| Misidentification of a specimen on a patient named John Doe in 302B. How do you verify that the patient in 302B is indeed Johen Doe | ask him for his name and date of birth and match it to the requisition |
| Which requisistion information must match information on the patient's ID band | medical record number |
| The medical record number on the ID band mataches the number on your requisition, but the patient's name is spelled differently than the one on your requisition. What should you do | do not collect the specimen until the difference is resolved |
| An unconscious inpatient does not have an ID band. The name on an envelope on the patient's nightstand matches with the requiestion. what should you do | do not start any proedcure until the nurse attaches an ID bracelet |
| What would be the system of choice to identify laboratory specimens from an unconscious woman in the ER | use a three part identification band with special tube labels |
| Which type of inpatient is most likely to have more than on ID band | newborn |
| What is the most critical error a phlebotomis can make | misidentify the patient's specimen |
| Your patient is not wearing an ID band. You see that the ID band is taped to the nightstand. The information matches your requisition. What do you do | ask the patient's nurse to attach an ID band and proceed when it is attached |
| Which one of the following types of patients is least likely to need his or her identiy confimed by the patient's nurse or a relative | a geriatric patient |
| The lab recept. checks in the pt/hands u the request. The request is for a pt Mary Smith. You call the name, and a woman who was just checked in responds. She is also the only patient in the waiting room. How do you verify that she is the correct patient | ask the woman to state her complete name and date of birth to confim her identify |
| A cheerful, pleasant bedside manner and exchange of small talk are unlikely to | keep the patient from fainting during the venipuncture procedure |
| Your patient is cranky and rude to you. What do you do | Be as professional as you can and collect the specimen in a normal way |
| Which of the following is part of infomed consent for specimen collection | informing the patient that you are a student |
| The patient asks if the test you are about to draw is for diabetes. How do you answer | Explain that it is best to discuss the test with the physician |
| An inpatient vehemently refuses to allow you to collect a blood specimen. What should you do | notify the patient's nurse and document the patient's refusal |
| You arrive to draw a fasting specimen. The patient is just finishing breakfast. What do you do | check with the patient's nurse to see if the specimen should be collected or the draw rescheduled |
| If you assemble equipment after selecting and cleaning the blood collection site, you will | be more apt to allow sufficient time for the alcohol to dry, have a better idea of what equipment you will need to use, waste less equipment by knowing exactly what is needed |
| When performing a venipuncture, hand decontamination is requied | before and after each patient |
| Which of the following is the best thing to do if your hands are visibly contaminated | wash them with soap and water |
| You must collect a specimen on a 6 year old. The child is a little fearful. What do you do | explain what you are going to do to the child in simple terms |
| If the patient asks whether the procedure will hurt, you should say it | might hurt just a little, but only for a short time |
| What is the proper arm position for routine venipuncture | downward in a straight line from shoulder to wrist, palm up |
| Outpatients who have previously fainted during a blood draw should be | asked to lie down, or sit in a reclining drawing chair |
| Which of the following acts can lead to liability issues | lowering a bed rail to make access to the patient's arm easier |
| Never leave a tourniquet on for more than | 1 minute |
| Where is the best place to apply the tourniquet | about 3 to 4 in. above the venipuncture site |
| If the tourniquet is too tight | arterial flow below it may be stopped, blood below it many hemoconcentrate, the pressure can cause the arm to ache |
| Which of the following actions is prohibited during the vein slection process | having a pataient pump his or her first |
| In selecting a venipuncture site, how can you tell a vein from an artery | a vein has a lot less resilience |
| What does a sclerosed vein feel like | hard and cord like |
| It is acceptable to use an ankle vein if | the physician gives permission |
| Which of the following will help you avoid inadvertently puncturing an artery during venipuncture | avoid drawing the basilic vein in the antecubital area, do not select a site that is near where you feel a pulse, do not select a vein that overlies or is close to an artery |
| You must collect a light blue top tube for a special coagulation test from a patient who has an IV line in the L wrist area and dermatitis all over the R arm and hand. The veins on the R arm and hand are not readily visible. What is the best way proceed | apply a tourniquet on the right arm over a towel and do the draw |
| What is the best thing to do if the vein can be felt but not seen, even with the tourniquet on | look for visual clues on the skin to remind you where the vein is |
| Release the touniquet as soon as blood flow is established to | decrease hemoconcentration of the specimen |
| What is the CLSI recommended way to clean a venipuncture site | cleanse with a circular motion from the center to the periphery |
| Which of the following is the least important reason to wait 30 seconds for the alcohol to dry before the needle insertion | It gives the phlebotomist time to prepare equipment and supplies |
| What happens if hyou advance the tube past the guideline on the holder before needle insertion | the ETS tube will fail to fill with blood because of loss of tube vacuum |
| Visual inspection of the needle tip before inserting it in a patient vein would be unable to detect | that the needle is out of date |
| Which of the following steps are in the right order for the venipuncture procedue | clean the site, prepare equipment, put on gloves, apply tourniquet |
| You are about to draw blood from a patient. you touch the needle to the skin but change your mind and pull the needle away. what do yo do next | stop and obtain a new needle before tryingt again |
| What is the best angle to use for needle insertion during routine venipuncture | 30 degrees or less |
| In performing venipuncture, the needle is inserted | bevel facing up |
| How can you tell when the needle is in the vein as you insert it into the patient's arm | you will feel a slight "give" |
| When is the best time to release the tournique during venipuncture | as soon as blood begins to flow into the tube |
| Which of the following analytes is least affected by prolonged tourniquet application | prothromnin PT |
| Which of the following would be considered improper specimen collection technique | position the arm so tubes fill from stopper end first |
| It is important to fill anticoagulant tubes to the proper level to ensure that | there is a proper ratio of blood to anticoagulant additive |
| It is important to mix anticoagulant tubes immediately after filling them to | avoid microclot formation |
| You are in the middle of drawing blood specimen using the evacuated tube method when yo realize that you just filled an EDTA tube and still have a green top tube to collect. what do you do | draw several milliliters into a discard tube then fill the green one |
| How many times do yo mix nonaddditive tubes | none |
| What may happne if you mix tubes too vigorously | hemolysis |
| Use several layers of gauze during needle removal so that | blood will not contaminate your gloved hand |
| It is better to use gauze and not cotton balls for pressure over the site because cotton balls | may pull the platelet plug away from the puncture site upon removal |
| A needle safety feature, other than a blunting needle, should be activated | immedicatley after the needle is withdrawn |
| Which of these steps are in the right venipuncture procedure order | establish blood flow, release tourniquet, fill and mix tubes, remove needle |
| Proper needle desposal involves | disposing of the needle and tube holder in the sharps container as one unit |
| Labeling of routine inpatient blood specimen should take place | at the bedside immediately after collection |
| Which of the following information on a specimen label would be considered optional | patient room number and bed |
| The patient's idenification number is included on specimen tube labels to | avoid confusing specimens from patient's with the same name |
| The following precautionary information was given to an outpatient after venipuncture. No other tests were scheduled. Which information was unnecessary | do not drink or eat for 2 hours after collection |
| Which of the following specimens requires routine normal handling | Cholesterol |
| Which of the following is not a valid reason for failure to obtain a blood specimen | you did not have the right equipment on your tray |
| You have just made two unsuccessful attempts to collect a fasting blood specimen from an outpatient. The patient rotates his arm, and you note a large vein that you have not sen before. How do you proceed | ask another phlebotomist to collect the fasting specimen |
| Where is the tourniquet applied when drawing hand vein | proximal to the wirst bone |
| A patient has difficult vein and you decide to use a butterfly for the draw. Butterfly is another name for a | winged infusion set |
| What is the advantaage of using a butterfly | Butterflies make it easier to draw difficult veins |
| Although the evacuated tube system ETS is the preferred method of blood collection, it may be necessary to use a syringe when | the patient's veins are very fragile |
| Speciman hemolysis can result from | using a large volume tube with a 23 gauge needle |
| How can you tell that you are in a vein when you are using a syringe | a flash of blood will appear in the hub of the needle |
| Success of pediatric blood collection is most dependent on | patient immobilization |
| Doing this before obtaining a blood specimen from a child is a bad idea | telling the child it will not hurt |
| A butterfly and 23 gauge need is the best choice to use for venipuncture on a young child because | flexible tubing allows for arm movement |
| In transferring blood from a syringe to evacusted tubes, which is the proper technique | use a specially designed engineering device called a syringe transfer device |
| Which of the following is the least efective way to immobilize a pediatric patient before a blood draw | allowing the child to sit with one arm bracing the other |
| In drawing blood from an older child, the most important consideration is | explaining the importance of holding still |
| Criteria used to decide which needle gauge to usse for venipuncture include | the size and condition of the vein |
| An additive should be mixed | as soon as it is removed rom the tube holder |
| Tremors associated with this disease can make blood collection difficuit | parkinson's |
| A diabetc outpatient has had a mastectomy on her right side and cannot straighten her right arm becuase of arthritis. The best place to collect a blood specimen is | the left forearm or hand, using a butterfly |
| Which of the following is proper procedure when dealing with an elderly adult patient | refrain from drawing older adult patients if you have a cold, or else wear a mask |
| The most common reason a patient must undergo dialysis treatment is | end stages of renal disease |
| A type of care for patients who are terminally ill is | hospice care |
Created by:
mmfleischer