Take Home Quiz Chapter 9

A patient with a history of syncope should be asked to lie down during a blood draw because syncope refers to a temporary loss of consciousness caused by a drop in blood pressure. By lying down, the patient's risk of injury from falling during a potential fainting episode is reduced.

Performing a venipuncture through a hematoma can lead to inaccurate test results and potential complications. A hematoma is a collection of blood outside of blood vessels, usually caused by injury or trauma. When a venipuncture is performed through a hematoma, it can cause the blood sample to be contaminated with the surrounding blood, leading to inaccurate test results. Additionally, puncturing a hematoma can cause further bleeding, pain, and potential complications such as infection. Therefore, it is important to avoid performing a venipuncture through a hematoma to ensure accurate and safe blood sampling.

Applying a tourniquet on an arm with a shunt can obstruct blood flow and cause harm to the patient. A shunt is a medical device used to redirect blood flow, typically from an artery to a vein, in patients with certain medical conditions. Placing a tourniquet on an arm with a shunt can disrupt the intended blood flow and potentially lead to complications. Therefore, it is important to never apply a tourniquet on an arm with a shunt.

A patient with a high degree of jaundice typically has yellow skin and sclerae. Jaundice is a condition characterized by the yellowing of the skin and the whites of the eyes (sclerae) due to an excess of bilirubin in the blood. Bilirubin is a yellow pigment produced during the breakdown of red blood cells. When the liver is unable to properly process and excrete bilirubin, it builds up in the body, leading to the characteristic yellow discoloration. Bruising and petechiae are not typically associated with jaundice, while edematous extremities may be seen in certain conditions but are not specific to jaundice. Hemolyzed specimens are not directly related to jaundice.

The term "mastectomy" refers to the surgical procedure of removing the breast. It is commonly performed to treat breast cancer or as a preventive measure for individuals at high risk of developing breast cancer. The other options listed - biopsy, reduction, and surgery - do not specifically refer to the complete removal of the breast tissue, making "removal" the correct answer.

Syncope is the correct answer because it is the medical term for fainting. Syncope refers to a temporary loss of consciousness caused by a lack of blood flow to the brain. It is often a result of low blood pressure or a sudden drop in heart rate.

Pouring two partially filled additive tubes together to fill one tube can lead to inaccurate measurements or contamination. Each additive tube may have a specific concentration or volume that is necessary for a particular experiment or procedure. Mixing the contents of two tubes can result in an incorrect concentration or an unintended reaction. Therefore, it is best to avoid pouring two partially filled additive tubes together and instead use each tube separately as intended.

When collecting a specimen from an arm with a hematoma, it is best to collect the specimen distal to it. This means collecting the specimen below or after the hematoma, towards the end of the arm. This is because a hematoma is a localized collection of blood outside the blood vessels, which can interfere with the accuracy of the specimen. Collecting the specimen distal to the hematoma helps to ensure that the collected sample is not contaminated by the hematoma and provides a more accurate representation of the patient's condition.

After a blood draw, it is not uncommon for some patients to feel weak and pale due to a drop in blood pressure or a vasovagal response. To alleviate these symptoms, the phlebotomist should have the patient lie down until they have fully recovered. This position helps improve blood flow to the brain and prevents the patient from falling or injuring themselves. Offering a glass of water may also be helpful in rehydrating the patient, but it is not the primary action to take in this situation.

Lipemia results from a high fat content in the blood. Lipids, such as triglycerides, can cause the blood to appear turbid or milky, leading to lipemia. This can occur due to various factors, including a high-fat diet, certain medical conditions like hyperlipidemia, or genetic factors. When a blood sample is collected, the presence of lipemia can interfere with laboratory tests and affect the accuracy of the results. It is important to properly handle and process the specimen to minimize the occurrence of lipemia.

If a patient is severely allergic to latex, it is important to be cautious about the type of equipment brought into the room. Latex is a common material used in medical equipment such as gloves, catheters, and tubing. Exposure to latex can trigger an allergic reaction in sensitive individuals, ranging from mild symptoms like itching and rash to severe reactions like difficulty breathing and anaphylaxis. Therefore, it is crucial to ensure that latex-free equipment is used to prevent any adverse reactions in the patient.

The correct answer is False. If a patient vomits during a venipuncture procedure, it is important to remove the needle immediately to prevent any potential harm or injury. Continuing the procedure with the needle still in place can increase the risk of infection or other complications. It is necessary to prioritize the patient's safety and well-being in such situations.

If a patient feels faint during a blood draw, it is important for the phlebotomist to discontinue the draw and lower the patient's head. This is because feeling faint may indicate a drop in blood pressure, and lowering the head can help increase blood flow to the brain. Continuing the draw or keeping the patient upright could potentially worsen the situation and lead to fainting or injury. Using an ammonia inhalant to revive the patient is not necessary in this situation, as it is more appropriate for treating fainting spells caused by other factors such as dizziness or lightheadedness.

Putting the patient at ease with a little small talk can help minimize pain associated with venipuncture. This is because when patients are relaxed and distracted, they are less likely to focus on the pain of the procedure. Small talk can help to create a friendly and comforting environment, reducing anxiety and increasing patient comfort during the venipuncture process.

When a patient experiences marked pain during a needle insertion that radiates down their arm and does not subside, it suggests that there may be a nerve injury or irritation. Continuing the venipuncture in such a situation can potentially cause further harm to the patient. Therefore, the correct course of action is to discontinue the venipuncture immediately to prevent any additional pain or damage.

If a vein feels hard, cord-like, and lacks resiliency, it is most likely sclerosed. Sclerosis refers to the hardening and thickening of the walls of blood vessels, which can occur due to various factors such as aging, inflammation, or the buildup of plaque. This can cause the vein to lose its normal elasticity and become rigid, resulting in a hard, cord-like texture.

When blood pools beneath a vein, it can create pressure on the nerves that are located underneath. This pressure can cause discomfort and potentially lead to nerve damage or other complications. Therefore, the statement is true.

The correct answer is an active AV shunt or fistula. When selecting a venipuncture site, it is important to avoid using an arm with an active AV shunt or fistula. AV shunts or fistulas are created surgically to connect an artery and a vein, usually for dialysis access in patients with kidney failure. Using a site with an active AV shunt or fistula can lead to complications such as bleeding or infection. Therefore, it is crucial to choose an alternative site for venipuncture in such cases.

When a blood specimen is collected from a heparin lock, it is important to draw a 5-ml, discard tube before the specimen tubes are filled. This is necessary because the heparin lock contains a small amount of heparin, which is an anticoagulant. Drawing a discard tube helps to remove the heparin from the lock and ensures that the subsequent specimen tubes are not contaminated with heparin. This is important because heparin can interfere with certain laboratory tests, such as coagulation tests, leading to inaccurate results. Therefore, drawing a discard tube before filling the specimen tubes helps to ensure the integrity and accuracy of the blood specimen.

Continuing to redirect the needle without getting blood flow indicates that the needle is not properly positioned within the vein. Trying a new tube also confirms that the issue is not with the equipment. In this situation, it is best to discontinue the draw and try again at a new site to increase the chances of successfully obtaining blood flow.

Jaundice is a condition characterized by yellowing of the skin and eyes, which is caused by a buildup of bilirubin in the body. It is typically associated with liver dysfunction or obstruction of the bile ducts. Inflammation of the colon, on the other hand, is a condition known as colitis and is not directly related to jaundice. Therefore, jaundice in a patient does not indicate inflammation of the colon, making the answer false.

The RBC count is most affected by altitude. This is because at higher altitudes, there is a decrease in the partial pressure of oxygen, which can lead to an increase in the production of red blood cells in order to compensate for the lower oxygen levels. This is known as altitude-induced polycythemia. Therefore, the RBC count is directly influenced by the altitude at which the test is conducted.

When a patient has IVs in both arms, it is best to collect a protime specimen from below one of the IVs. This is because collecting the specimen above the IV may cause contamination of the sample with fluids from the IV line. Collecting from an ankle vein may not be practical or necessary in this situation. Collecting from one of the IVs may also lead to contamination or difficulty in obtaining an accurate sample. Therefore, collecting the specimen below one of the IVs is the most appropriate option.

When a vein rolls, it means that the vein moves or shifts while the needle is being inserted. In this case, the correct answer suggests that the needle slips beside the vein instead of going into it. This means that the needle does not penetrate the vein and instead ends up next to it, resulting in a failed attempt to access the vein for medical procedures such as blood draws or IV insertions.

A hematoma refers to a swelling or mass of blood. It occurs when blood vessels rupture or leak, leading to the accumulation of blood in the surrounding tissues. This swelling or mass of blood can cause pain, tenderness, and discoloration in the affected area. It is different from a blood clot inside a vein, which is known as a thrombus. A hematoma can occur due to various reasons such as trauma, surgery, or underlying medical conditions.

A vein with walls that have temporarily drawn together and shut off blood flow during venipuncture is called a collapsed vein. This happens when the vein collapses due to various reasons such as excessive pressure applied during the procedure or weak vein walls. It can make it difficult to draw blood or administer medication through that particular vein.

The correct answer is "Timed." This means that the test influenced by diurnal variation is typically ordered at a specific time of the day. Diurnal variation refers to the natural fluctuations that occur in various biological processes over a 24-hour period. By ordering the test at a specific time, healthcare professionals can account for these fluctuations and obtain more accurate results. This is particularly important for tests that are affected by factors such as hormone levels, blood pressure, or body temperature, which can vary throughout the day.

The correct answer is "Healthy people." Reference ranges for laboratory tests are typically based on values obtained from healthy individuals. These ranges represent the normal values for specific tests and are used as a comparison to determine if a patient's results fall within the expected range. Fasting patients, treated patients, and individuals with illnesses or diseases may have different test values that deviate from the normal range, making it less suitable for establishing reference ranges.

Touching the site after cleaning it can result in infection of a venipuncture site. Even though the site has been cleaned, touching it introduces bacteria from the skin, increasing the risk of infection. It is important to maintain a sterile environment and avoid touching the cleaned site to minimize the chances of contamination.

Collecting a CBC from a screaming infant is not a good idea because the WBCs may be temporarily elevated. When an infant is screaming, it can cause stress and agitation, leading to an increase in the production and release of white blood cells. This temporary elevation in WBC count can affect the accuracy of the CBC results, making it difficult to interpret the true WBC count. Therefore, it is recommended to collect a CBC from an infant when they are calm and not in a distressed state.

The small non-raised red spots that appear on the patient's skin below where the tourniquet has been tied are called petechiae. These petechiae are caused by capillary or platelet defects. Capillary defects can occur due to increased pressure on the blood vessels caused by the tightness of the tourniquet, leading to the leakage of blood into the surrounding tissues. Platelet defects can result in inadequate clotting, leading to the formation of petechiae.

When the second tube fails to fill with blood and the needle is unable to collect blood even after various attempts, it indicates that there is an issue with the vein or the needle placement. Continuing to try and redirect the needle may cause further discomfort or injury to the patient. Therefore, the best course of action would be to discontinue the draw and try again at a new site where the chances of successful blood collection are higher.

Triglycerides are a type of fat found in the blood. Testing for triglyceride levels usually requires a 12-hour fast because eating can temporarily increase triglyceride levels in the blood. By fasting for 12 hours, the test results will provide a more accurate reflection of a person's baseline triglyceride levels. This fasting requirement helps to ensure the reliability and accuracy of the test results.

When the skin around the venipuncture site starts to swell and the blood is filling the tube slowly, it indicates that there might be a leakage of blood into the surrounding tissues. This can be due to the needle not being properly inserted into the vein or the vein being damaged. To prevent further complications and ensure patient safety, it is important to stop the draw immediately and apply pressure to the site. This will help control any bleeding and minimize the risk of hematoma formation.

Exsanguination refers to life-threatening loss of blood. This term is used to describe a condition where a person loses a significant amount of blood, which can lead to severe hemorrhage, shock, and ultimately death if not treated promptly. It is not related to autologous blood donation, iatrogenic blood depletion, or therapeutic removal of blood.

The drug should be discontinued for 4-24 hours before the blood test for RBC counts because it is known to interfere with the test results. This time frame allows for the drug to be cleared from the system and ensures more accurate and reliable test results.

Edematous is the correct term to describe a swollen arm. Edema refers to the accumulation of excess fluid in the tissues, leading to swelling. In this case, the patient's arm is swollen, indicating the presence of edema. Cyanotic refers to a bluish discoloration of the skin due to inadequate oxygenation, sclerosed refers to the hardening or thickening of tissues, and thrombosed refers to the formation of a blood clot in a blood vessel. None of these terms accurately describe the condition of a swollen arm.

Bilirubin is a product of the breakdown of red blood cells (RBCs). When RBCs reach the end of their lifespan, they are broken down in the liver and spleen. Bilirubin is a yellow pigment that is produced during this breakdown process. It is then transported to the liver where it is processed and eventually excreted in bile. Elevated levels of bilirubin in the blood can indicate liver or gallbladder dysfunction.

The preanalytical phase of the testing process begins for the laboratory when a test is ordered by a patient's physician. This is because the preanalytical phase refers to all the activities that occur before the actual testing of the specimen takes place. In this phase, the laboratory receives the test order, verifies the patient's information, and prepares the necessary supplies and equipment for specimen collection. Therefore, the ordering of the test by the physician initiates the preanalytical phase.

Hematomas are swellings or masses of blood that can occur due to injury or trauma. They can lead to inaccurate test results because they can interfere with the normal flow and composition of blood. Additionally, hematomas can cause an obstruction of blood flow in the affected area, leading to further complications. Therefore, all of the given statements about hematomas are true.

When a needle is inserted into the skin, it is common to clean the area with alcohol to prevent infection. If the alcohol is not allowed to dry thoroughly before the needle is inserted, it can cause a stinging sensation. This is because the alcohol may still be wet and can irritate the skin when the needle is inserted.

Cortisol is a hormone that exhibits diurnal variation, meaning its levels fluctuate throughout the day. The peak levels of cortisol occur in the morning, typically within the first few hours after waking up. This is known as the cortisol awakening response, which helps to prepare the body for the day ahead. Cortisol plays a role in regulating various physiological processes, including metabolism, immune function, and stress response.

The correct answer is "Normal fluctuations throughout the day." Diurnal variation refers to the natural changes in certain blood components that occur over a 24-hour period. These fluctuations are considered normal and can be influenced by factors such as sleep-wake cycles, physical activity, and hormone levels. It is important to understand these variations when interpreting blood test results, as they can help differentiate between normal and abnormal values.

Prolonged tourniquet application can affect blood composition by causing hemoconcentration. When a tourniquet is applied for an extended period, it restricts blood flow to the area, leading to the accumulation of red blood cells and other formed elements in the blood vessels. This hemoconcentration results in an increased concentration of blood components, such as red blood cells and proteins, while the plasma volume decreases. This can alter the blood composition and potentially affect laboratory test results.

Venous stasis refers to the stoppage or slowing down of normal blood flow in the veins. This can occur due to various factors such as blood clots, weak or damaged vein valves, or immobility. When blood flow is hindered, it can lead to pooling of blood in the veins, causing swelling, pain, and potentially leading to complications such as deep vein thrombosis. Therefore, the correct answer is "Stoppage of the normal venous blood flow."

The correct answer is Cloudy White. When a specimen is lipemic, it means that it contains a high concentration of lipids (fats). This can occur due to several reasons, such as recent food intake or a metabolic disorder. The lipids cause the serum or plasma to appear cloudy and white. It can interfere with the accuracy of laboratory tests, as it may affect the measurement of certain analytes. Therefore, lipemic specimens are often rejected or additional steps are taken to remove the lipids before testing.

Temperature and humidity control in a laboratory is important because it maintains the integrity of specimens. Fluctuations in temperature and humidity can cause changes in the physical and chemical properties of specimens, leading to inaccurate results. By controlling these factors, the laboratory ensures that the specimens remain stable and unaffected, allowing for reliable and consistent test results.

If a cenipuncture site continues to bleed after 5 minutes, it is important to report it to the patient's physician or nurse. This is because persistent bleeding may indicate a potential complication or underlying issue that needs to be addressed by a healthcare professional. They can assess the situation, provide appropriate interventions, and ensure the patient's safety and well-being. Holding pressure or applying a pressure bandage may not be sufficient in this case, as it requires medical attention.

Petechiae are small red or purple spots on the skin caused by bleeding underneath the skin. If petechiae appear below the tourniquet, it indicates that the tourniquet is too tight and is causing blood vessels to rupture. This may suggest poor technique or excessive pressure during venipuncture. However, the presence of scarring from a deep burn, slight edema in the arm, or a vein that feels hard and cord-like does not necessarily impede venipuncture and can still allow for successful blood collection.

A lipemic specimen refers to a blood sample that appears cloudy or milky due to the presence of high levels of lipids (fats). This can occur when a patient has not fasted before the blood test, as the ingestion of fatty foods can temporarily increase lipid levels in the blood. Lipemic specimens are commonly seen in non-fasting patients, and it is an indication that the patient was not fasting prior to the blood draw.