Phlebotomy Practice Exam 2
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The process of entering a password and gaining access to a computer is called
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Logging on
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Networking
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Interfacing
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About This Quiz
This test is for phlebotomy students to practice for final exams and state board.
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- 2.
Why should a laboratory report form indicate the fact that a specimen has been collected by capillary puncture?
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Because test results can vary depending on the method of collection
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To satisfy liability insurance requirements and for billing purposes
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So that the patients nurse can check the site for signs of infection
Correct Answer
A. Because test results can vary depending on the method of collectionExplanation
A laboratory report form should indicate the fact that a specimen has been collected by capillary puncture because test results can vary depending on the method of collection. Different collection methods can yield different results due to variations in sample composition or contamination. By indicating the method of collection, laboratory personnel can take this into account when interpreting the test results and ensure accurate diagnosis and treatment.Rate this question:
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- 3.
Parternity testing is performed to determine the probability that a specific individual fathered a particular child
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True
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False
Correct Answer
A. TrueExplanation
Paternity testing is a process used to establish the likelihood of a specific individual being the biological father of a particular child. This is done by comparing the DNA of the alleged father and the child to identify any genetic similarities. The test results provide a probability or likelihood that the tested individual is the biological father. Therefore, the statement "Paternity testing is performed to determine the probability that a specific individual fathered a particular child" is true.Rate this question:
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- 4.
The hormone detected in positive urine pregnancy tests is
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ACTH
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HCG
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TSH
Correct Answer
A. HCGExplanation
HCG, or human chorionic gonadotropin, is the hormone detected in positive urine pregnancy tests. HCG is produced by the placenta during pregnancy and its levels increase rapidly in the early stages. This hormone is responsible for maintaining the production of progesterone, which is vital for maintaining the pregnancy. Urine pregnancy tests work by detecting the presence of HCG in the urine, indicating that a woman is pregnant.Rate this question:
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- 5.
If a patient has cold hands, capillary puncture should be performed on the pinky(little, or 5th finger)
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True
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False
Correct Answer
A. FalseExplanation
Performing a capillary puncture on the pinky finger is not the correct approach if a patient has cold hands. Capillary puncture is a method used to collect small blood samples from the fingertips, earlobes, or heels. In the case of cold hands, blood flow to the extremities may be reduced, making it difficult to obtain an adequate sample from the pinky finger. It is recommended to warm the patient's hands before performing a capillary puncture to ensure proper blood flow and sample collection. Therefore, the correct answer is False.Rate this question:
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- 6.
ASAP or MED emerg specimens must be attended to before routine specimens?
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True
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False
Correct Answer
A. TrueExplanation
ASAP or MED emerg specimens must be attended to before routine specimens because they require immediate attention and are often time-sensitive. These specimens are usually from patients in critical condition or those requiring urgent medical intervention. Attending to these specimens first ensures that the necessary diagnostic tests and treatments can be initiated promptly, potentially saving lives or preventing further complications. Routine specimens, on the other hand, can be processed and analyzed later without significant impact on patient care.Rate this question:
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- 7.
What is the clinical and laboratory standards institute (CLSI) recommended maxium depth of heel puncture?
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1.0 mm
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1.4 mm
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2.o mm
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2.4 mm
Correct Answer
A. 2.o mmExplanation
The clinical and laboratory standards institute (CLSI) recommends a maximum depth of 2.0 mm for heel puncture. This depth allows for an adequate sample to be collected without causing excessive pain or potential complications for the patient. It is important to adhere to these standards to ensure accurate and safe collection of blood samples from infants.Rate this question:
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- 8.
Which of the following is the safest area for infant heel puncture?
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The area of the arch
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The lateral plantar surface
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The posterior curvature
Correct Answer
A. The lateral plantar surfaceExplanation
The lateral plantar surface is the safest area for infant heel puncture because it is less sensitive and has fewer nerve endings compared to other areas such as the arch or the posterior curvature. Puncturing the heel in this area reduces the risk of causing excessive pain or injury to the infant.Rate this question:
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- 9.
What is the purpose of warming the site before skin puncture?
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It is comforting to the patient
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It makes the veins more visible
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It increases blood flow up to seven times
Correct Answer
A. It increases blood flow up to seven timesExplanation
Warming the site before skin puncture increases blood flow up to seven times. This is beneficial because increased blood flow allows for easier identification and access to veins, making the process of skin puncture smoother and more efficient. Additionally, increased blood flow can help minimize discomfort for the patient during the procedure.Rate this question:
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- 10.
To make a thick blood smear you should take a large drop of blood and spread it to the size of a
Correct Answer
dimeExplanation
To make a thick blood smear, a large drop of blood should be taken and spread to the size of a dime. This means that the blood should be evenly distributed and spread out on a slide until it covers an area similar to the size of a dime. This technique allows for a concentrated sample of blood to be examined under a microscope, making it easier to detect and analyze any abnormalities or pathogens present in the blood sample.Rate this question:
- 11.
If a baby has a huge, fleshy big toe, it is exceptable to collect a bilirubin specimen from it
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True
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False
Correct Answer
A. FalseExplanation
Collecting a bilirubin specimen from a baby's big toe is not acceptable. Bilirubin is typically collected from the baby's heel, as it is a common site for blood collection in newborns. The big toe is not a suitable site for collecting a bilirubin specimen.Rate this question:
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- 12.
Which of the following is used by the laboratory to identify a specimen throughout the testing process?
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Accession number
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Hospital number
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Password ID
Correct Answer
A. Accession numberExplanation
The laboratory uses an accession number to identify a specimen throughout the testing process. This number serves as a unique identifier for the specimen and helps ensure accurate tracking and documentation. It allows the laboratory to easily associate all relevant information and test results with the specific specimen, facilitating efficient and reliable analysis. The accession number is typically assigned when the specimen is received and remains consistent throughout the testing process.Rate this question:
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- 13.
Which of the following statements describe proper centrifuge operation?
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Place tubes of equal size and volume opposite one another for balance
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Remove evacuated tube stoppers before placing them in centrifuge
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Centrifuge serum specimens before they start to form noticeable clots.
Correct Answer
A. Place tubes of equal size and volume opposite one another for balanceExplanation
Proper centrifuge operation requires placing tubes of equal size and volume opposite one another for balance. This ensures that the centrifuge spins evenly and prevents any imbalance that could potentially damage the equipment or cause inaccurate results.Rate this question:
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- 14.
Which test requires strict skin antiseptis procedures before specimen collection?
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Blood culture
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Type and crossmatch
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Complete blood count
Correct Answer
A. Blood cultureExplanation
Blood culture requires strict skin antiseptic procedures before specimen collection because it is a test used to detect the presence of bacteria or fungi in the bloodstream. Contamination of the sample with bacteria from the skin can lead to false positive results, so it is important to thoroughly clean the skin to reduce the risk of contamination. This is not necessary for type and crossmatch or complete blood count tests, as they do not involve the collection of a specimen from the bloodstream.Rate this question:
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- 15.
A 2-hour postprandial specimen should be drawn
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2 hours before the patient has a meal
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2 hours before patient arrives for the test
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2 hours after the patient has had a meal
Correct Answer
A. 2 hours after the patient has had a mealExplanation
A 2-hour postprandial specimen should be drawn 2 hours after the patient has had a meal because this allows enough time for the body to process and metabolize the food. Drawing the specimen at this time gives a more accurate representation of the patient's blood glucose levels after a meal, which is useful in diagnosing and managing conditions such as diabetes.Rate this question:
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- 16.
This test requires a specimen with a 9:1 ratio of blood to anticoagulant
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Ethanol
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Prothrombin time
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Red cell count
Correct Answer
A. Prothrombin timeExplanation
This test requires a specimen with a 9:1 ratio of blood to anticoagulant. Prothrombin time is a laboratory test that measures the time it takes for blood to clot. In order to accurately perform this test, it is important to have the correct ratio of blood to anticoagulant. If the ratio is not maintained, it can affect the clotting time and lead to inaccurate results. Therefore, prothrombin time is the correct answer as it directly relates to the requirement mentioned in the question.Rate this question:
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- 17.
What does the term calcaneous mean?
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Bone infection
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Ostoemyelitis
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Heel bone
Correct Answer
A. Heel boneExplanation
The term calcaneous refers to the heel bone.Rate this question:
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- 18.
It is necessary to control depth of lancet insertion during capillary puncture to avoid
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Bacterial contamination
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Excessive bleeding
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Injuring the heel bone
Correct Answer
A. Injuring the heel boneExplanation
During a capillary puncture, it is necessary to control the depth of lancet insertion to avoid injuring the heel bone. The heel bone, also known as the calcaneus, is located in the heel area and is vulnerable to damage if the lancet is inserted too deeply. Injuring the heel bone can cause pain, discomfort, and potentially lead to complications such as fractures or infections. Therefore, proper control of the lancet depth is crucial to ensure the safety and well-being of the patient during a capillary puncture.Rate this question:
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- 19.
A phlebotomist should puncture a finger perpendicular to the finger print whorls.
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True
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False
Correct Answer
A. TrueExplanation
When a phlebotomist punctures a finger perpendicular to the finger print whorls, it allows for an easier and more accurate blood collection. Puncturing perpendicular to the whorls ensures that the needle is inserted into the capillaries located beneath the skin, which results in a smoother blood flow. This technique also reduces the chances of causing pain or discomfort to the patient. Therefore, it is important for a phlebotomist to puncture a finger perpendicular to the finger print whorls.Rate this question:
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- 20.
Which test is most likely to result in fatal consequences if the patient is misidentified?
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Blood cultures
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Type and crossmatch
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Drug screen
Correct Answer
A. Type and crossmatchExplanation
The type and crossmatch test is most likely to result in fatal consequences if the patient is misidentified. This test is performed before a blood transfusion to ensure compatibility between the donor and recipient blood types. If the patient is misidentified, and incompatible blood is transfused, it can lead to a severe immune reaction called a transfusion reaction, which can be life-threatening.Rate this question:
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- 21.
Which of the following test may require special chain of custody documentation when collected
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Drug screen
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TDM
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Crossmatch
Correct Answer
A. Drug screenExplanation
A drug screen may require special chain of custody documentation when collected. This is because drug screens are often used for legal or employment purposes, and it is important to maintain a strict chain of custody to ensure the integrity and validity of the test results. Chain of custody documentation ensures that the sample is properly collected, transported, and stored, and that it has not been tampered with or contaminated in any way. This documentation is crucial in legal proceedings or when the test results may have significant consequences for the individual being tested.Rate this question:
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- 22.
An autologous blood transfusion is a transfusion of blood
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Donated by the patient for the patient
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Directly from the donor to the patient
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Given by an anonymous donor
Correct Answer
A. Donated by the patient for the patientExplanation
An autologous blood transfusion refers to the process of donating blood by the patient for their own use. This eliminates the need for an external donor and reduces the risk of complications such as transfusion reactions or infections. By using the patient's own blood, there is a higher chance of compatibility and it can be specifically tailored to their individual needs. This method is commonly used in elective surgeries where blood loss is anticipated and allows for a safer and more efficient transfusion process.Rate this question:
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- 23.
Which of the following tubes can be used to collect blood for a type and crossmatch
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ETS gray top
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Royal blue top
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Pink top EDTA tube
Correct Answer
A. Pink top EDTA tubeExplanation
The pink top EDTA tube can be used to collect blood for a type and crossmatch. EDTA, or ethylenediaminetetraacetic acid, is an anticoagulant that prevents blood from clotting. This is important for a type and crossmatch test, as it requires the blood to remain in a liquid state for accurate testing. The pink top indicates that it contains EDTA, making it the appropriate tube for this purpose.Rate this question:
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- 24.
Which microcollection container would be used to collect a specimen for CBC?
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Gray top
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Green top
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Purple top
Correct Answer
A. Purple topExplanation
The purple top microcollection container would be used to collect a specimen for CBC (Complete Blood Count). The purple top tube contains the anticoagulant Ethylenediaminetetraacetic acid (EDTA), which prevents blood from clotting by binding calcium ions. This allows for the collection of whole blood for hematological testing, including CBC, which provides information about the different types and numbers of blood cells present.Rate this question:
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- 25.
When performing a GTT, the timing should begin
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As soon as the patient finishes the drink
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After the patient arrives in the lab
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When the fasting specimen is collected
Correct Answer
A. As soon as the patient finishes the drinkExplanation
The timing for a GTT (Glucose Tolerance Test) should begin as soon as the patient finishes the drink because this is when the body starts to metabolize the glucose. The purpose of the test is to measure how well the body processes sugar, so it is important to start the timing at the moment the glucose is consumed. Starting the timing after the patient arrives in the lab or when the fasting specimen is collected would not accurately measure the body's response to the glucose drink.Rate this question:
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- 26.
A capillary puncture should be done rather than a venipuncture in all of the following situations except when
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A light blue top tube is needed
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The patient has difficult veins
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The test uses very litle blood
Correct Answer
A. A light blue top tube is neededExplanation
In this scenario, a capillary puncture should be done rather than a venipuncture in all situations except when a light blue top tube is needed. Capillary puncture is typically preferred when the patient has difficult veins or when the test requires very little blood. However, a light blue top tube is specifically used for coagulation tests, which usually require a larger volume of blood that can be obtained more efficiently through a venipuncture. Therefore, in the case of needing a light blue top tube, a venipuncture would be more appropriate.Rate this question:
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- 27.
A good blood smear should exhibit a _, edge.
Correct Answer
featheredExplanation
A good blood smear should exhibit a feathered edge. This means that the edge of the blood smear should be smooth and gradually taper off, resembling the shape of a feather. A feathered edge indicates that the blood has been spread evenly and thinly across the slide, allowing for better visualization and analysis of the blood cells under a microscope. It also suggests that the technique used to create the blood smear was accurate and precise.Rate this question:
- 28.
The most critical aspect of blood culture is
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Amount of specimen
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Specimen handling
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Skin antisepsis
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The needle gauge
Correct Answer
A. Skin antisepsisExplanation
Skin antisepsis is the most critical aspect of blood culture because it helps prevent contamination of the blood sample with bacteria or other microorganisms that may be present on the skin. Properly cleaning and disinfecting the skin before collecting the blood sample reduces the risk of introducing external pathogens into the culture, which could lead to false-positive results or misdiagnosis. Therefore, ensuring effective skin antisepsis is crucial for obtaining accurate and reliable blood culture results.Rate this question:
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- 29.
This organization develops standards for specimen handling and processing
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CDC
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CLSI
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FDA
Correct Answer
A. CLSIExplanation
CLSI, or the Clinical and Laboratory Standards Institute, is an organization that develops standards for specimen handling and processing. They provide guidelines and best practices for laboratories and healthcare professionals to ensure accurate and reliable testing procedures. CLSI's standards cover a wide range of areas including specimen collection, transport, storage, and processing, with the aim of promoting quality and safety in laboratory testing. The other options, CDC (Centers for Disease Control and Prevention) and FDA (Food and Drug Administration), are important organizations in the field of public health and regulatory affairs respectively, but they are not specifically focused on developing standards for specimen handling and processing.Rate this question:
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- 30.
Which of the following specimens needs to be chilled?
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Ammonia
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Serum protein
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Bilirubin
Correct Answer
A. AmmoniaExplanation
Ammonia needs to be chilled because it is a volatile compound that can easily evaporate at room temperature. Chilling the specimen helps to prevent the evaporation and degradation of ammonia, ensuring accurate and reliable test results.Rate this question:
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- 31.
A specimen arrives with less volume than is needed for the test. It will be noted why the specimen was rejected by using the abbreviation _.
Correct Answer
QNSExplanation
The abbreviation "QNS" stands for "Quantity Not Sufficient." In this scenario, the specimen received does not have enough volume to conduct the required test. The abbreviation QNS is used to indicate that the specimen was rejected due to insufficient quantity.Rate this question:
- 32.
Capillary puncture blood reference ranges are higher for this analyte.
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Calcium
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Total protein
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Glucose
Correct Answer
A. GlucoseExplanation
Capillary puncture blood reference ranges for glucose are higher because capillary blood samples may contain a higher concentration of glucose compared to venous blood samples. This is because capillary blood is obtained from the capillaries, which are closer to the site of glucose utilization in the tissues. Therefore, glucose levels in capillary blood may reflect the immediate glucose status of the body and can be higher than venous blood glucose levels.Rate this question:
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- 33.
At what intervals is the blood blotted during a bleeding time test?
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15 seconds
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30 seconds
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45 seconds
Correct Answer
A. 30 secondsExplanation
During a bleeding time test, the blood is blotted at 30-second intervals. This is done to monitor the rate at which the blood stops bleeding. By blotting the blood at regular intervals, healthcare professionals can determine how quickly the blood is clotting and assess the individual's overall hemostatic function. The 30-second interval allows for a sufficient amount of time to observe any changes in bleeding and make accurate assessments.Rate this question:
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- 34.
Tests that can be performed using special POCT instruments or test kits include
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Aterial blood gases
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Glucose
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Occult blood
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All of the above
Correct Answer
A. All of the aboveExplanation
Special POCT instruments or test kits can be used to perform tests for arterial blood gases, glucose, and occult blood. These instruments and kits are designed to provide quick and accurate results for these specific tests. Therefore, the correct answer is "all of the above" as all three tests can be performed using special POCT instruments or test kits.Rate this question:
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- 35.
The purpose of wiping away the first drop of blood during skin puncture is to
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Avoid bacterial contamination
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Reduce effects of hemoconcentration
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Eliminate tissue fluid contamination
Correct Answer
A. Eliminate tissue fluid contaminationExplanation
Wiping away the first drop of blood during skin puncture helps to eliminate tissue fluid contamination. Tissue fluid can contain contaminants that may interfere with the accuracy of the blood sample, so removing it ensures a cleaner and more reliable sample. By eliminating tissue fluid contamination, the subsequent drops of blood collected will be more representative of the actual blood composition, allowing for more accurate testing and analysis.Rate this question:
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- 36.
Capillary puncture blood resembles
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Arterial blood
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Tissue fluid
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Venous blood
Correct Answer
A. Arterial bloodExplanation
Capillary puncture blood resembles arterial blood because both types of blood are oxygenated. Capillaries are tiny blood vessels that connect arteries and veins, and they are responsible for the exchange of oxygen and nutrients between the blood and surrounding tissues. Arterial blood is the oxygen-rich blood that is pumped by the heart to deliver oxygen to the body's tissues. Therefore, capillary puncture blood, which is obtained from capillaries, will also contain oxygen and closely resemble arterial blood.Rate this question:
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- 37.
A patient who is suspected of having lead poisoning should have his or her lead test specimen drawn in a light blue tube
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True
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False
Correct Answer
A. FalseExplanation
a dark blue EDTA tubeRate this question:
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- 38.
Glycolysis by erythrocytes and leukocytes in blood specimens can lower glucose values at a rate of up to 10 mg/dl per hour
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True
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False
Correct Answer
A. TrueExplanation
Glycolysis is a metabolic process that breaks down glucose to produce energy. Erythrocytes (red blood cells) and leukocytes (white blood cells) are capable of carrying out glycolysis. In blood specimens, the presence of these cells can lead to the consumption of glucose through glycolysis, causing a decrease in glucose levels. This process can occur at a rate of up to 10 mg/dl per hour, indicating that the statement is true.Rate this question:
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- 39.
A patient who is lactose intolerant will have a normal glucose curve after ingesting a dose of lactose
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True
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False
Correct Answer
A. FalseExplanation
A patient who is lactose intolerant lacks the enzyme lactase, which is needed to break down lactose (a sugar found in milk and dairy products) into glucose and galactose. Without lactase, lactose cannot be properly digested and absorbed by the body. Therefore, when a lactose intolerant patient ingests lactose, they will not have a normal glucose curve because the lactose will not be properly metabolized into glucose. Hence, the correct answer is False.Rate this question:
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- 40.
A bar code is?
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Series of bars and spaces representing numbers and letters
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Confidential computer code that is required by the HIPPA
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Unique number given to each test for ID purposes
Correct Answer
A. Series of bars and spaces representing numbers and lettersExplanation
A bar code is a series of bars and spaces representing numbers and letters. It is a visual representation of data that can be scanned and read by a bar code reader. The bars and spaces vary in width and arrangement to encode the information, which can include product details, identification numbers, or other data. Bar codes are commonly used in retail, inventory management, and logistics to quickly and accurately track and identify items.Rate this question:
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- 41.
A blood smear made from an EDTA specimen should be made
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Anytime after collection
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Within 4 hours of collection
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Within 12 hours of collection
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Within 1 hour of collection
Correct Answer
A. Within 1 hour of collectionExplanation
A blood smear made from an EDTA specimen should be made within 1 hour of collection because EDTA is an anticoagulant that prevents blood clotting by binding calcium ions. After 1 hour, the blood cells may start to deteriorate, making it difficult to obtain accurate results from the blood smear. Therefore, it is important to make the blood smear as soon as possible after collection to ensure the integrity of the blood cells and obtain reliable test results.Rate this question:
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- 42.
Capillary bilirubin specimens should be protected from_
Correct Answer
UV lightExplanation
Capillary bilirubin specimens should be protected from UV light because exposure to UV light can cause the breakdown of bilirubin, leading to inaccurate test results. UV light can cause photoisomerization of bilirubin, converting it into a different form that may not be accurately measured. Therefore, protecting the specimens from UV light ensures that the bilirubin levels are measured correctly and accurately reflects the patient's condition.Rate this question:
- 43.
All POC glucose analyzers approved for hospital use have which of the following in commom?
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All of the answers are correct
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Data can be downloaded to a data management program
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They require the use of an authorized operator ID number
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The ability to use capillary, venous, or arterial blood samples
Correct Answer
A. All of the answers are correctExplanation
All POC glucose analyzers approved for hospital use have all of the answers mentioned in common. This means that they have the ability to download data to a data management program, require the use of an authorized operator ID number, and can use capillary, venous, or arterial blood samples.Rate this question:
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- 44.
This is a permanent computer memory that instructs the computer to carry out user requested operations
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ROM
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LIS
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CPU
Correct Answer
A. ROMExplanation
ROM stands for Read-Only Memory. It is a type of permanent computer memory that contains instructions or data that cannot be modified or erased by normal computer operations. ROM is responsible for storing firmware or software instructions that instruct the computer to carry out user requested operations. Unlike RAM (Random Access Memory), ROM retains its data even when the computer is powered off. Therefore, ROM plays a crucial role in booting up the computer and initiating the necessary operations for the user.Rate this question:
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- 45.
Which of the following specimens are least likely to require special handling?
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Cholesterol and uric acid
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Gastrin and lactic acid
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Bilirubin and serum folate
Correct Answer
A. Cholesterol and uric acidExplanation
Cholesterol and uric acid are least likely to require special handling because they are stable compounds that do not degrade easily. They can be stored and transported at room temperature without significant changes in their properties. On the other hand, specimens like gastrin and lactic acid are sensitive to temperature and require special handling to prevent degradation or alteration of their concentrations. Bilirubin and serum folate may also require special handling due to their sensitivity to light and temperature.Rate this question:
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- 46.
A pneumatic tube is a
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Pressurized air transportation system
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Type of collection tube for blood gases
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Tube connection between two computers
Correct Answer
A. Pressurized air transportation systemExplanation
A pneumatic tube is a pressurized air transportation system that is used to transport items such as documents, small packages, or samples between different locations within a building or facility. It operates by using compressed air to propel a carrier through a network of tubes, allowing for quick and efficient transportation. This system is commonly used in hospitals, banks, or offices where there is a need for fast and secure delivery of items.Rate this question:
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- 47.
Which of the following would not be considered a preanalytical error?
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Misreporting patient results
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Using the wrong order of draw
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Failing to mix an additive tube
Correct Answer
A. Misreporting patient resultsExplanation
Misreporting patient results would not be considered a preanalytical error because it does not involve any error or issue related to the collection, handling, or processing of the patient's sample. Preanalytical errors typically occur before the actual analysis of the sample and can include errors such as using the wrong order of draw or failing to mix an additive tube, which could potentially affect the accuracy and reliability of the test results. However, misreporting patient results would fall under the category of post-analytical errors, which involve mistakes in the interpretation or communication of the test results.Rate this question:
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- 48.
The handling of a specimen before it is actualy tested is part of the _ phase
Correct Answer
preanalyticalExplanation
The handling of a specimen before it is actually tested is part of the preanalytical phase. This phase involves all the steps and processes that occur prior to the actual analysis of the specimen, including collection, transportation, labeling, and preparation. It is crucial to ensure proper handling during this phase to maintain the integrity and quality of the specimen, as any errors or contamination during this stage can significantly affect the accuracy and reliability of the test results.Rate this question:
- 49.
What is PKU?
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A hereditary inability to metabolize phenylalanine
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A contagious condition caused by lack of phenylalanine
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An inherited condition caused by lack of thyroid hormone
Correct Answer
A. A hereditary inability to metabolize phenylalanineExplanation
PKU stands for Phenylketonuria, which is a hereditary condition characterized by the inability to metabolize phenylalanine. This means that individuals with PKU are unable to break down an amino acid called phenylalanine, leading to a buildup of this substance in the body. If left untreated, this can cause intellectual disability, developmental delays, and other health problems. Therefore, the correct answer is that PKU is a hereditary inability to metabolize phenylalanine.Rate this question:
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Mar 04, 2024Quiz Edited by
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Oct 15, 2011Quiz Created by
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