Take Home Quiz Chapter 10

The calcaneus is a bone located in the heel. It is the largest bone in the foot and forms the prominence of the heel. This bone plays a crucial role in weight-bearing and helps to support the body's weight during activities such as walking, running, and jumping.

70% isopropanol is the recommended antiseptic for cleaning capillary puncture sites. Isopropanol is a commonly used antiseptic that effectively kills microorganisms on the skin. It is preferred over povidone-iodine, soap and water, and tincture of iodine for this purpose because it has a faster onset of action, is less irritating to the skin, and does not leave any residue that could interfere with subsequent procedures. Therefore, 70% isopropanol is the most suitable antiseptic for cleaning capillary puncture sites.

A lancet is a sharp-pointed device specifically designed for making capillary punctures. It is commonly used in medical procedures such as blood glucose testing or collecting small blood samples for laboratory analysis. Unlike bullets, lasers, or scalpels, a lancet is specifically designed for this purpose, making it the correct answer.

The required characteristics of capillary puncture lancets include a controlled depth of puncture, blades or points that are sterile, and permanently retractable blades. A controlled depth of puncture ensures that the lancet does not penetrate too deep, minimizing the risk of injury. Sterile blades or points are necessary to prevent infection or contamination. Permanently retractable blades enhance safety by reducing the risk of accidental needlestick injuries. Therefore, all of the above characteristics are required for capillary puncture lancets.

Warming the site before capillary puncture increases the flow of blood. When the site is warmed, the blood vessels dilate, allowing for a greater volume of blood to flow through the veins. This makes it easier to obtain a blood sample and reduces the chances of causing pain or discomfort to the patient. Additionally, increased blood flow can also help in obtaining a sufficient sample size for testing purposes.

Capillary specimens contain all of the above mentioned components, including arterial blood, tissue fluids, and venous blood. Capillaries are tiny blood vessels that connect arteries and veins, allowing for the exchange of oxygen, nutrients, and waste products between the bloodstream and surrounding tissues. As a result, capillary specimens can contain a mixture of arterial blood, which carries oxygen and nutrients to the tissues, venous blood, which has already passed through the tissues and carries waste products, and tissue fluids, which consist of interstitial fluid and other substances present in the surrounding tissues.

Excess anticoagulant in underfilled microtubes can negatively affect test results because it can alter the ratio of blood to anticoagulant, leading to inaccurate measurements. Anticoagulants prevent blood from clotting, and if there is too much anticoagulant, it can dilute the blood sample and affect the concentration of substances being measured. This can result in false readings and incorrect interpretations of the test results. Therefore, it is important to ensure proper filling of microtubes to maintain the correct blood-to-anticoagulant ratio for accurate testing.

The correct answer is "Let it dry naturally." When making a blood smear, it is important to let it dry naturally because blowing on it or waving it can cause the blood cells to spread unevenly or become distorted. Placing it in alcohol is also not necessary and may interfere with the accuracy of the smear. Allowing the blood smear to dry naturally ensures that the cells are properly fixed and preserved for microscopic examination.

The term "plantar" refers to the bottom surface of the heel. This term is commonly used in anatomy to describe the sole of the foot, including the heel area. It is the correct answer because the other options, "distal," "dorsal," and "lateral," do not specifically refer to the bottom surface of the heel.

A cyanotic extremity refers to a condition where the extremity, such as a finger or toe, appears bluish in color. This bluish hue is caused by a lack of oxygen in the blood, resulting in poor circulation. It is a sign of reduced blood flow or inadequate oxygenation. Jaundice refers to a yellowish discoloration of the skin and eyes, which is caused by a buildup of bilirubin in the blood. Erythema refers to redness of the skin, often caused by inflammation or increased blood flow. Pale yellow is not typically associated with cyanosis.

According to CLSI guidelines, the depth of heel puncture should not exceed 2.0 mm. This means that when performing a heel puncture for blood collection, healthcare professionals should ensure that the depth of the puncture does not go beyond 2.0 mm. This is important to prevent excessive pain, injury, and potential complications for the patient.

A blood smear is a technique used in laboratory medicine where a small drop of blood is spread out thinly on a microscope slide. This allows for the examination and analysis of the different components of blood, such as red blood cells, white blood cells, and platelets. By observing the appearance and arrangement of these cells under a microscope, healthcare professionals can gather valuable information about a patient's overall health and diagnose various blood disorders or infections.

Povidone-iodine is an antiseptic solution commonly used to disinfect the skin before medical procedures. If a capillary specimen is contaminated with povidone-iodine, it can affect the accuracy of test results for various substances. Phosphorus, potassium, and uric acid are all examples of substances that can be affected by povidone-iodine contamination. Therefore, the correct answer is that all of the above substances can be affected by povidone-iodine contamination of a capillary specimen.

Capillary puncture blood is a mixture of venous, arterial, and capillary blood. Capillary punctures are typically done by pricking the skin on the finger or heel, and the blood collected is a combination of blood from the small capillaries, as well as blood from nearby veins and arteries. This mixture is necessary to ensure an adequate sample for testing, as capillary blood alone may not provide enough volume or represent the overall blood composition accurately. Therefore, the correct answer is that capillary puncture blood is a mix of venous, arterial, and capillary blood.

Jaundice in a newborn is associated with high levels of bilirubin. Bilirubin is a yellow pigment that is produced when red blood cells are broken down. In newborns, the liver is still developing and may not be able to process bilirubin efficiently, leading to its accumulation in the blood. This can result in yellowing of the skin and eyes, known as jaundice. Glucose, ketones, and thyroxine are not directly associated with jaundice in newborns.

The term "feather" is used to describe the appearance of the thinnest area of a blood film. In a blood film, the feathered edge refers to the tapered and thin area where the blood has been spread thinly on the slide. This area is important for examining the morphology of blood cells, as it allows for better visualization and identification of different cell types.

The medial plantar heel is the safest area of an infant's foot for capillary puncture. This area has a thick layer of fat and is less likely to cause injury or discomfort to the infant. Puncturing the center of the big toe or any area of the arch can be more painful and have a higher risk of injury. The posterior curvature is also not recommended as it can cause discomfort and may not provide an adequate blood sample. Therefore, the medial plantar heel is the safest and most suitable area for capillary puncture in infants.

The reference values for this test are higher for capillary specimens because capillary blood, which is obtained from a finger prick, may have higher glucose levels compared to venous blood. This is because capillary blood is directly derived from the tissues and reflects the glucose levels in the immediate vicinity, whereas venous blood has undergone some metabolic processing by the liver. Therefore, when measuring glucose levels, it is important to consider the source of the blood sample to ensure accurate interpretation of the results.

When venous blood is placed in a microtube, it is important to label it as a venous specimen. This is necessary to ensure proper identification and tracking of the sample. The labeling helps in distinguishing it from other types of blood samples and prevents any confusion or mix-up during transportation and analysis. It is also important to shield the specimen from light, transport it to the lab as soon as possible, and vigorously mix the specimen, but these actions are not specifically related to the need for labeling it as a venous specimen.

UV light is known to have a photochemical effect on bilirubin, causing it to break down. This process is called photodegradation. When exposed to UV light, the chemical structure of bilirubin can be altered, leading to its degradation. Therefore, it is true that UV light can cause the bilirubin in a specimen to break down.

According to the CLSI standards, capillary punctures should not be performed on the fingers or earlobes of newborns. This is because these areas are more sensitive and delicate, and can result in pain, discomfort, and potential complications for the newborn. Instead, other areas such as the heel or big toe are recommended for capillary punctures in newborns. Therefore, the statement that capillary punctures must not be performed on fingers or earlobes of newborns is true.

A blood culture test must be collected by venipuncture because it requires a sample of blood to be collected directly from a vein. This method ensures that the sample is not contaminated and provides a more accurate representation of the patient's blood. The other options mentioned, such as electrolytes and placing it in alcohol or waving it until dry, do not pertain to the collection method for a blood culture test.

Inverting the microtube gently is the best way to mix blood in an additive microtube because it ensures thorough mixing without causing excessive hemolysis or clotting. Gentle inversion allows the blood and the additive to mix evenly without causing damage to the blood cells. Shaking it briskly or tapping it sharply can cause hemolysis, while rolling it in the hands may not provide sufficient mixing. Therefore, gently inverting the microtube is the most suitable method for mixing blood in an additive microtube.

Lavender-colored microtubes are used to collect a CBC (Complete Blood Count). A CBC is a common blood test that provides information about the different types of cells in the blood, including red blood cells, white blood cells, and platelets. The lavender microtube contains an anticoagulant called EDTA (Ethylenediaminetetraacetic acid), which helps prevent the blood from clotting and allows for accurate analysis of the blood cells.

PKU stands for Phenylketonuria, which is a genetic disorder that affects the body's ability to break down an amino acid called phenylalanine. This test is typically performed on capillary blood to diagnose PKU. By measuring the levels of phenylalanine in the blood, healthcare professionals can determine if a person has PKU and can provide appropriate treatment and dietary modifications.

Whorls, as related to capillary puncture, refer to the spiral patterns that are commonly seen in fingerprints. This term is used to describe the specific fingerprint pattern where ridges form circular or spiral patterns. Capillary puncture is a technique used to collect small blood samples from the capillaries near the surface of the skin, and the presence of whorls in fingerprints can affect the accuracy of such punctures.

The correct order of action words associated with the capillary puncture procedure steps is: warm, clean, puncture, wipe, collect. This order ensures that the area is warmed to increase blood flow, then cleaned to prevent infection. After that, the puncture is made to obtain the blood sample, followed by wiping away any excess blood, and finally, the collected sample is handled appropriately.

The reason why a laboratory report form should state that a specimen has been collected by capillary puncture is because results can vary by specimen source. Different methods of specimen collection can yield different results, and it is important for the laboratory to know the source of the specimen in order to interpret the results accurately. By stating that the specimen was collected by capillary puncture, the laboratory can take into account the potential variations in results that may arise from this specific collection method.

Osteochondritis refers to the inflammation of the bone and cartilage. This condition involves the degeneration and subsequent inflammation of the cartilage and underlying bone in a joint. It typically occurs due to a lack of blood flow to the affected area, leading to the death of bone and cartilage cells. This inflammation can cause pain, swelling, and limited joint movement. It is important to note that osteochondritis is not related to abnormal bone formation and growth, an inherited bone metabolism disorder, or infection of the bone and bone marrow.

The term "arterialized" refers to the process of increasing the arterial content. It implies that the composition or content of something has been altered to resemble or match that of arterial blood. This could involve increasing the oxygen levels or other components found in arterial blood. It does not necessarily mean that venous blood flow has increased, as the focus is on the content rather than the flow.

Lancets with permanently retractable blades are disposed of in a sharps container because they pose a risk of injury due to their sharp blades. Sharps containers are specifically designed to safely collect and contain sharp objects such as needles, syringes, and lancets, preventing accidental injuries and the spread of infections. Autoclave waste is typically used for sterilizing medical equipment, biohazard trash is used for hazardous biological waste, and regular trash cans are not suitable for disposing of sharp objects.

Capillary puncture is a method of collecting blood samples from the capillaries, which are the smallest blood vessels in the body. Arterial blood is the oxygenated blood that is pumped from the heart to the rest of the body through the arteries. It contains a higher concentration of oxygen and nutrients compared to venous blood. Since capillaries are in close proximity to the tissues, the blood obtained by capillary puncture is more likely to resemble arterial blood in terms of its composition.

Bilirubin should be collected in an amber microtube when collected by capillary puncture. This is because bilirubin is light-sensitive and can degrade when exposed to light. Amber microtubes are designed to protect the specimen from light, ensuring accurate test results.

Blood culture bottles would be excluded from a list of capillary puncture equipment because capillary puncture is a method of collecting small amounts of blood from the capillaries, typically for diagnostic testing or monitoring purposes. Blood culture bottles, on the other hand, are used to collect larger volumes of blood for the purpose of culturing and identifying bacteria or fungi in the blood. Therefore, blood culture bottles are not typically used in capillary puncture procedures and would be excluded from a list of capillary puncture equipment.

Neonatal screening is the testing of newborns for certain disorders. This is done to identify any potential health issues or genetic conditions that may not be apparent at birth but can cause long-term complications if left untreated. By conducting these tests, healthcare professionals can intervene early and provide appropriate treatment, improving the overall health outcomes for newborns. The screening typically involves a blood test to detect conditions such as metabolic disorders, genetic diseases, and hormonal imbalances. It is an essential preventive measure in ensuring the well-being of newborns.

The correct answer is "Phalanx." Phalanx is the medical term used to refer to a finger bone. It is a term commonly used in anatomy to describe the bones of the fingers and toes. The other options listed are not related to finger bones. "Calcaneus" refers to the heel bone, "Clavicle" refers to the collarbone, and "Patella" refers to the kneecap.

During a heel puncture, it is necessary to control the depth of lancet insertion to avoid injuring the calcaneus. The calcaneus is the heel bone, and if it is punctured, it can cause significant damage and pain to the infant. Controlling the depth of insertion ensures that the lancet does not go too deep and avoids any potential harm to the calcaneus.

Capillary specimen collection differs from routine venipuncture in terms of the order of draw. The order of draw refers to the sequence in which different tubes are filled with blood during the collection process. In capillary specimen collection, the order of draw may be different compared to routine venipuncture. This is because capillary blood may contain tissue fluid or contaminants from the skin, which can affect the accuracy of certain tests. Therefore, the order of draw may be adjusted to minimize the risk of cross-contamination between tubes and ensure accurate test results.

Applying a bandage to a capillary puncture site on an infant or child younger than 2 years of age can have multiple negative effects. Firstly, the bandage can irritate an infant's tender skin, causing discomfort and potential skin damage. Secondly, the bandage can easily be pulled off by the child and become a choking hazard. Lastly, when the bandage is removed, it can tear the delicate skin of the infant or child. Therefore, all of the given options are correct and applying a bandage to a capillary puncture site on an infant or child younger than 2 years of age is inappropriate due to these reasons.

The correct answer is "Apply bandage." After performing an infant heel puncture, it is important to clean the site to prevent infection and to warm the site to increase blood flow for an easier blood draw. Identifying the patient is also crucial to ensure the correct procedure is being performed on the right individual. However, applying a bandage is not necessary after an infant heel puncture as it may hinder the healing process and make it difficult to monitor the site for any complications.

Interstitial fluid refers to the fluid that fills the spaces between the cells in the body. It is an essential component of the extracellular fluid and plays a crucial role in the transportation of nutrients, waste products, and immune cells. Interstitial fluid is responsible for maintaining the balance of nutrients and electrolytes in the tissues, and it also helps in the exchange of gases and other substances between the cells and the bloodstream. This fluid is distinct from intracellular fluid, which is the fluid inside the cells, lymphatic fluid, which is found in the lymphatic system, and peritoneal fluid, which is found in the abdominal cavity.

Osteomyelitis can be a complication of a heel puncture that is too deep. Osteomyelitis is an infection of the bone, which can occur when bacteria or other pathogens enter the body through a deep puncture wound. In the case of a deep heel puncture, if proper hygiene and wound care are not followed, bacteria can enter the bone, leading to osteomyelitis. This can cause inflammation, pain, and potentially serious complications if left untreated.

Heel warming devices are used to warm the heels of patients to prevent pressure ulcers. The temperature should never exceed 42C as higher temperatures can cause burns and skin damage. Temperatures above this threshold can be harmful to the patient and may lead to complications. Therefore, it is important to ensure that the temperature of heel warming devices is kept below 42C to ensure the safety and well-being of the patient.

Strong repetitive pressure, such as squeezing or milking a site during capillary specimen collection, can cause hemolysis of red blood cells and contamination of the specimen. Hemolysis refers to the rupture or destruction of red blood cells, which can release their contents into the specimen and affect the accuracy of test results. Contamination can occur if external substances, such as bacteria or dirt, are introduced into the specimen during the collection process. Therefore, it is important to avoid excessive pressure during capillary specimen collection to prevent hemolysis and contamination.

Exposure to light can cause the breakdown of bilirubin, leading to falsely decreased results. Bilirubin is a light-sensitive substance, and if the specimen is not protected from light during collection and processing, it can degrade, resulting in lower levels being measured. Therefore, failing to protect the specimen from light can be a potential cause for falsely decreased bilirubin results.

An acceptable routine blood smear should have a feathered edge. This means that the blood sample is spread out evenly across the slide, tapering off towards the edges. A feathered edge indicates that the blood smear is properly prepared and will allow for accurate examination of the blood cells under a microscope. It ensures that the cells are evenly distributed and prevents clumping or overlapping, which could affect the interpretation of the blood sample.

Scooping up blood as it runs down the finger would be considered an incorrect technique because it increases the risk of contamination. When filling microcollection tubes, it is important to let the blood flow directly into the tube without touching any surface, as this can introduce foreign particles and affect the accuracy of the specimen. Therefore, scooping up the blood as it runs down the finger would not adhere to proper collection protocols.

The distal segment of the middle finger is normally a proper site for finger puncture on an adult because it has a good blood supply and is less sensitive compared to other areas such as the thumb or index finger. Puncturing the distal segment of the middle finger allows for an easier and less painful blood collection process.

Capillary puncture is a poor choice for specimen collection if the patient is dehydrated because in a dehydrated state, the blood volume is reduced, making it difficult to obtain an adequate sample through capillary puncture. Dehydration can lead to decreased blood flow and can result in a smaller amount of blood being available for collection. Therefore, an alternative method of specimen collection, such as venipuncture, would be more suitable for a dehydrated patient.

Wiping away the first drop of blood during capillary specimen collection helps to reduce tissue fluid contamination. Tissue fluid can interfere with the accuracy of the test results by diluting the blood sample. By wiping away the first drop, any tissue fluid that may be present on the skin surface is removed, ensuring a more accurate blood sample for testing.