Take Home Quiz Chapter 9

Drawing blood from an edematous extremity may cause erroneous specimen results because the excess fluid in the tissue can dilute the blood sample, leading to inaccurate test results. The edema can also affect the composition of the blood, potentially affecting the levels of various substances being measured. It is important to draw blood from a non-edematous area to ensure accurate and reliable test results.

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.

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.

An AV shunt, or arteriovenous shunt, is a surgical procedure that creates a direct connection between an artery and a vein. This pathway is specifically designed to provide access for dialysis, allowing for the removal and return of blood during the treatment process. It is a common and effective method used for long-term dialysis treatment. A CVC, or central venous catheter, is a different type of access pathway that involves inserting a catheter into a large vein. A Hep-lock is a device used to maintain the patency of an intravenous line, and a PICC, or peripherally inserted central catheter, is a long catheter that is inserted into a peripheral vein and threaded through to a central vein.

The best indication that you have accidentally punctured an artery is when blood pulses into the tube. This is because arteries carry oxygenated blood under high pressure, and when punctured, the blood will spurt out in rhythmic pulses due to the pumping action of the heart. This pulsating flow is a clear sign of arterial bleeding and requires immediate attention to control the bleeding and prevent further complications.

The patient who is awakened for a blood draw at 0600 after fasting since 0800 last night is closest to the basal state. This is because the patient has been fasting for a long period of time and has not engaged in any physical activity or eaten anything that could affect their metabolic state. The other options involve factors such as eating dinner, working all night, or resting, which can all have an impact on the patient's metabolic state and therefore are not as close to the basal state.

Vasovagal syncope is the correct answer because it refers to a medical term that describes a nervous system response to sudden pain, stress, or trauma. This response involves a temporary drop in blood pressure and heart rate, leading to fainting or loss of consciousness. It is a common reaction to triggers such as seeing blood, experiencing extreme pain, or feeling intense emotions.

During pregnancy, the body produces a higher volume of blood and increases the total amount of body fluids. This increased fluid volume can lead to the dilution of red blood cells (RBCs), resulting in lower reference ranges for RBC counts. The dilution effect occurs because the same number of RBCs is distributed in a larger volume of fluid, causing the concentration of RBCs to decrease. This is a normal physiological adaptation to support the needs of the growing fetus and ensure an adequate blood supply to both the mother and the baby.

The ratio of blood to anticoagulant is most critical for the Prothrombin time test. Prothrombin time measures how long it takes for blood to clot, and it is commonly used to monitor the effectiveness of anticoagulant medications like warfarin. The correct ratio of blood to anticoagulant is crucial for accurate test results. If the ratio is incorrect, it can affect the clotting time and lead to inaccurate interpretation of the test. Therefore, ensuring the correct ratio is particularly important for the Prothrombin time test.

The serum or plasma of a hemolyzed specimen appears pink or reddish because hemolysis refers to the breakdown of red blood cells, leading to the release of hemoglobin. Hemoglobin is a red pigment, so when it is released into the serum or plasma, it gives a pink or reddish color to the specimen. This can occur due to various reasons such as improper handling of the sample, vigorous mixing, or certain medical conditions.

The most likely explanation is that the bevel of the needle came out of the skin and the vacuum in the tube escaped. This would cause a hissing sound and a spurt of blood into the tube, followed by the cessation of blood flow. The bevel is the slanted opening at the tip of the needle that allows for easier insertion into the vein. If it comes out of the skin, it would disrupt the vacuum seal in the tube, leading to the described observations.

Failing to apply adequate pressure after the draw can cause a hematoma to form during venipuncture procedures. Applying pressure after the draw helps to prevent blood from leaking out of the vein and accumulating under the skin, which can lead to the formation of a hematoma. If pressure is not applied properly or for a sufficient amount of time, it increases the risk of blood pooling and causing a hematoma.

Hematocrit is a measure of the proportion of red blood cells in the blood. In general, males tend to have higher hematocrit levels than females. This is because testosterone, a male sex hormone, stimulates the production of red blood cells. Therefore, the reference range for hematocrit is typically higher for males compared to females.

When confronted with damaged veins, it is advisable to select a site distal to the damaged veins. This is because the damaged veins may not be able to adequately transport blood, and selecting a site proximal to them could further impede blood flow. By selecting a site distal to the damaged veins, blood flow can be maintained and potential complications can be avoided.

The best place to collect a specimen by venipuncture would be the right arm distal to the hematoma. This is because the hematoma in the antecubital area of the right arm may interfere with the collection process and potentially contaminate the specimen. Therefore, it is recommended to choose a location in the right arm that is away from the hematoma to ensure a clean and accurate sample.

An implanted port is a subcutaneous vascular access device that consists of a small chamber attached to an indwelling line. It is implanted under the skin and can be located by palpating the skin. This type of device allows for long-term access to the bloodstream for the administration of medications, fluids, or blood products. It is commonly used in patients who require frequent or continuous intravenous therapies.

An A-line is a type of line commonly used to monitor blood pressure and collect blood gas specimens. It is a catheter that is inserted into an artery, typically in the wrist or groin, to directly measure blood pressure and obtain blood samples. Unlike other options such as a CVC, IV, or PICC, an A-line is specifically designed for these purposes and is commonly used in critical care settings or during surgeries.

Having someone else collect the specimen is the best course of action in this situation. Since the phlebotomist has already attempted twice and was only able to collect a partial tube, it indicates that the patient's veins are difficult to access. By having another person with more experience or expertise in venipuncture attempt to collect the specimen, there is a higher chance of success in obtaining a complete tube for testing.

The best way to avoid reflux is to make certain that tubes fill from the bottom up. This means that when drawing blood, the tubes should be held at a slight angle with the needle pointing upwards, allowing the blood to flow into the tube from the bottom. This prevents air bubbles from entering the tube, which can cause hemolysis and affect the accuracy of test results. Drawing the specimen while the patient is supine, following the correct order of draw, and keeping the tourniquet on until the last tube is full are also important steps in blood collection, but they do not specifically address the issue of reflux.

Creatinine clearance is a test that measures how well the kidneys are functioning. It requires the patient's age because the results are adjusted based on age. As people age, their kidney function naturally declines, so it is important to take age into account when interpreting the results. This helps to provide a more accurate assessment of the patient's kidney function and overall health.

The statement suggests that cholesterol levels can increase by 5% after applying a tourniquet for 2 minutes. This implies that the restriction of blood flow caused by the tourniquet may lead to an increase in cholesterol levels. Therefore, the answer "True" indicates that the statement is correct and cholesterol levels can indeed elevate by 5% after 2 minutes of tourniquet application.

In this scenario, the phlebotomist suspects that they have collected an arterial specimen instead of a venous specimen. The correct answer suggests that the phlebotomist should see if the lab will accept the specimen and if so, label it as possibly an arterial specimen. This is because arterial blood samples have different characteristics than venous blood samples, and it is important for the lab to be aware of this possibility when analyzing the specimen. By labeling it as possibly arterial, the lab can take appropriate measures to ensure accurate testing and interpretation of the results.

An icteric blood specimen refers to a sample of blood that appears yellowish due to elevated levels of bilirubin. Bilirubin is a yellow pigment produced when red blood cells break down. Therefore, an icteric blood specimen indicates that the bilirubin test results could be elevated, suggesting potential liver or gallbladder dysfunction. The other options, such as fasting status, collection procedure, or hemoconcentration, do not directly relate to the presence of icteric blood.

Basal-state specimens are the best specimens to use for establishing inpatient reference ranges for blood tests. Basal-state refers to the body being in a resting state, typically in the morning after an overnight fast and without any recent physical activity or stress. Using basal-state specimens ensures that the results are not influenced by recent food intake or physical exertion, providing a more accurate baseline for establishing reference ranges. Fasting specimens are also commonly used, but they may not be as reliable as basal-state specimens since fasting can vary in duration and individuals may have different metabolic responses. Postprandial specimens, taken after a meal, and steady-state specimens, taken during a stable condition, are not ideal for establishing reference ranges as they can introduce additional variables and fluctuations in blood test results.

Iatrogenic refers to any illness or condition that is caused by medical intervention or treatment. In this case, anemia caused by the withdrawal of blood for testing purposes is considered iatrogenic. The act of drawing blood for testing purposes is a medical intervention, and the resulting anemia is a direct consequence of this procedure.

CK (creatine kinase) can remain elevated for 24 hours or more after exercise. CK is an enzyme found in various tissues, including skeletal muscle. During intense exercise, muscle damage occurs, leading to the release of CK into the bloodstream. Elevated levels of CK indicate muscle damage and can persist for a significant period after exercise. Therefore, CK is the analyte that can remain elevated for 24 hours or more after exercise.

When a needle goes through the back wall of a vein, it can cause blood to enter the tube slowly or not at all. This is because the needle is not properly inserted into the vein, and blood is unable to flow into the tube effectively.

Lymphostasis refers to the obstruction of the flow of lymph. This condition occurs when there is a blockage or impairment in the lymphatic system, which is responsible for draining excess fluid from tissues and transporting immune cells. When the flow of lymph is obstructed, it can lead to swelling, fluid retention, and impaired immune function. Therefore, the correct answer is obstruction of the flow of lymph.

Scarred or burned areas should be avoided as blood collection sites because circulation is typically impaired. Scar tissue and burn injuries can cause damage to blood vessels, leading to reduced blood flow in the area. This impaired circulation can make it difficult to obtain an adequate blood sample and may result in a lower quantity or quality of analytes in the specimen. Additionally, impaired circulation can increase the risk of complications during the blood collection process, such as hematoma formation or prolonged bleeding. Therefore, it is best to avoid scarred or burned areas when selecting a blood collection site.

The correct answer is to wrap the venipuncture site with self-adhering material. This is because the patient is allergic to the glue in adhesive bandages, so using a latex-free bandage or waiting 5 minutes to apply a bandage may not address the issue of the patient's allergy. Wrapping the site with self-adhering material eliminates the need for adhesive glue and provides a secure and comfortable bandage option for the patient.

Chronic smokers often have increased levels of hemoglobin. Smoking causes damage to the lungs and reduces the amount of oxygen that can be carried in the blood. In response, the body produces more hemoglobin to compensate for the decreased oxygen levels. This increased hemoglobin level is a common finding in chronic smokers and can be detected through blood tests.

A fever is a temporary increase in body temperature, usually caused by an infection. During a fever, the body's metabolic rate increases, leading to an increased demand for energy. Insulin is a hormone that regulates blood sugar levels and helps cells take in glucose for energy. When the body temperature rises during a fever, insulin sensitivity decreases, leading to a decrease in insulin production and an increase in blood sugar levels. Therefore, insulin is the hormone most affected by the presence of a fever.

Persistent diarrhea can lead to hemoconcentration because the continuous loss of fluid and electrolytes in the stool can result in dehydration. Dehydration causes a decrease in blood volume, leading to an increased concentration of red blood cells and other blood components in the bloodstream. This hemoconcentration can be measured by an increased hematocrit level.

Cleaning a finger stick site with isopropyl alcohol is least likely to cause contamination of the specimen because isopropyl alcohol is a disinfectant that helps to kill or inhibit the growth of microorganisms on the skin. By cleaning the finger stick site with isopropyl alcohol, any potential contaminants on the skin surface are effectively removed, reducing the risk of contamination during specimen collection.

Transferring blood from a syringe to a tube is least likely to cause specimen hemolysis because it involves a gentle and controlled method of transferring the blood. The process of transferring blood from a syringe to a tube can be done slowly and carefully, minimizing the chances of damaging the red blood cells and causing hemolysis. In contrast, drawing a large tube using a small needle, mixing a blood specimen too vigorously, and pulling back a syringe plunger too quickly can all exert excessive force on the red blood cells, leading to their rupture and hemolysis.

When a needle is inserted into a vein, the tube vacuum helps to hold the vein wall against the needle bevel, ensuring a successful blood draw. This prevents the vein from collapsing or moving away from the needle, making it easier to collect the blood sample. Therefore, the statement is true.

In this scenario, the phlebotomist is unable to collect a hemoglobin specimen from the patient's left arm due to the IV. Since there are no suitable veins in the right arm, the phlebotomist should consider alternative options. Performing a fingerstick on the right hand allows for the collection of a small amount of blood, which is sufficient for a hemoglobin test. This method is less invasive and can be easily done without interfering with the IV or causing discomfort to the patient.

When a patient goes from a supine to a standing position, there is an increase in hydrostatic pressure in the lower extremities. This causes fluid to shift from the blood vessels into the interstitial spaces, leading to an increase in non-filterable elements in the bloodstream. Red blood cell counts may decrease due to the pooling of blood in the lower extremities, but this is not the primary change that occurs. The level of calcium and the volume of plasma do not directly change as a result of the change in body position.

The most apt cause of vein collapse during venipuncture is when the tube vacuum is too great for the size of the vein. This means that the pressure inside the tube is too strong for the vein to handle, causing it to collapse. This can happen if the tube used has a higher vacuum pressure than what the vein can tolerate.

Collecting blood specimens from an arm on the same side as a mastectomy without permission from the patient's physician is prohibited because tourniquet application may injure it. After a mastectomy, the arm on the affected side may have compromised lymphatic and circulatory systems, making it more susceptible to injury. Applying a tourniquet to this arm can cause further damage and complications. Therefore, it is necessary to obtain permission from the patient's physician before collecting blood specimens from that arm to ensure the safety and well-being of the patient.

The median vein is often the easiest to feel on obese patients because it is located in the middle of the forearm, close to the surface of the skin. This makes it more accessible and easier to palpate compared to other veins such as the basilic, brachial, or cephalic veins, which may be deeper or harder to locate.

Geographic locale is automatically accounted for when reference ranges are established because different regions can have variations in factors such as altitude, temperature, and environmental conditions, which can affect basal state. Therefore, reference ranges are established based on the specific geographic locale to ensure accurate interpretation of laboratory test results for individuals in that particular region.

A Broviac is a type of central venous catheter (CVC) used for long-term intravenous access. It is inserted into a large vein, typically the superior vena cava, and is used to administer medications, fluids, or blood products, as well as for drawing blood samples. The Broviac catheter has multiple lumens, allowing for different functions such as infusion, aspiration, or blood sampling. It is often used in patients who require frequent or prolonged intravenous therapy, such as those with cancer, chronic illnesses, or undergoing long-term antibiotic treatment.

If an outpatient tells you before a blood draw that she is feeling nauseated, advising her to begin slow, deep breathing can help her to relax and potentially alleviate the nausea. Deep breathing can help to regulate the body's autonomic nervous system, reducing feelings of anxiety and promoting a sense of calm. This may help to alleviate the nausea she is experiencing and make the blood draw more manageable for her.

If a drug competes with the test reagents for the test analyte, it can lead to a falsely decreased test result. This means that the drug interferes with the accuracy of the test by competing with the reagents that are supposed to detect the analyte being tested. As a result, the test may underestimate the actual levels of the analyte in the specimen, leading to a false decrease in the test result.

Prolonged tourniquet application can lead to hemoconcentration, which means an increase in the concentration of blood components due to a decrease in plasma volume. This can cause an increase in the concentration of non-filterable analytes, such as proteins, electrolytes, and other substances that are normally found in the plasma. These analytes cannot be filtered out by the kidneys and therefore their concentration increases in the blood.

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Preventing the patient from injuring himself is the wrong thing to do in this situation. When a patient goes into convulsion, it is important to immediately discontinue the blood draw to ensure their safety. Continuing the draw could potentially worsen the convulsion or cause further harm to the patient. Once the blood draw is stopped, the next step should be to notify the appropriate first-aid personnel who can provide immediate assistance and medical attention to the patient.

The most likely explanation for the slow filling of the tube and the rapid formation of a hematoma is that the tube is slowly losing vacuum. When a vacuum is lost, it can impede the flow of blood into the tube, causing it to fill slowly. The hematoma formation suggests that blood is leaking into the surrounding tissue, which can occur if the vacuum is not maintained. This scenario is more plausible than the other options mentioned, such as the needle being partly in the vein or against a vein wall, or the patient having a clotting disorder.

Probing to locate a missed vein is least likely to impair vein patency because it involves searching for a vein that was not initially found. While it may cause some discomfort or bruising, it is not likely to cause significant damage to the vein or impair its patency. On the other hand, improperly redirecting the needle, leaving a tourniquet on too long, and multiple draws from the same vein can all potentially cause damage to the vein, leading to impaired patency.