NCCT Phlebotomy questions fully solved 2023 graded A+

NCCT Phlebotomy questions fully solved 2023 graded A+What is the first step in performing a venipuncture? identify the patient To prevent error and maintain a culture of safety, at least 2 identifiers (ex. full name and date of birth) must be verified prior to performing a procedure. What is the proper way to identify a patient prior to performing a venipuncture? Ask the patient to state his/her full name and DOB and compare to the chart. Before a venipuncture, the medical assistant should ask the patient to state his/her full name and DOB (comparing what is stated to what is written in the chart or on a wrist band patient identifier). This minimizes the risk for mis-identification errors because it cross-checks what the patient says against written documentation. This provides a verified identity so that all tubes collected will be associated with the correct patient (provided the medical assistant labels them properly). Using the guidelines for any method of venipuncture, what action should the medical assistant perform directly after confirming patient identity? Review the requirements for collecting and handling the blood specimen as ordered by the physician To ensure accuracy and quality, it is important to anticipate your needs before beginning the actual venipuncture (i.e. tube color/size, minimum acceptable blood volume, whether or not the specimen needs to be placed on ice). Therefore, the medical assistant would identify the patient, then review the requirements for collecting and handling the blood specimen as ordered by the physician. Next, assemble the appropriate equipment and select the proper evacuated tubes for test to be performed. Then, apply the tourniquet and thoroughly palpate the selected vein. Finally, position the patient's arm and cleanse the site with an antiseptic wipe, then proceed with the venipuncture protocol. What should be avoided as a form of patient identification? insurance number An insurance number is not a common means of positive patient identification (entire families can share the same insurance policy number). Patients must be positively identified for medical services, whether they have insurance or not. Insurance information is necessary for billing purposes. The only true unique identifier listed among these choices is the social security number. Patient name and date of birth are also commonly used to confirm identification. Name the two most used patient identifiers. Patient's name/date of birth Name and DOB are most often used as positive patient identifiers as they are easily documented and work for inpatients or outpatients. Bed numbers should never be used as identifiers for inpatients or outpatients, nor should physician name associations. Medical record numbers are valuable for inpatients, with name and DOB being used most often. Prior to any type of inpatient specimen collection, a phlebotomist must correctly verify their patient's identity by using which two-step procedure? Check ID bracelet, and ask patient to verbally confirm their identity. The correct answer is to check the ID bracelet and ask the patient to verbally confirm his/her identity. Patients may not have foot bed charts or IV bags, and the goal is to select the BEST answer of all choices. If a patient has both an ID bracelet and can verify his/her own identity, it is ideal. The phlebotomist is drawing blood from a patient that is taking blood thinners. What is a necessary piece of additional equipment to have at the drawing station? non-adhering bandage Non-adhering bandage material would be helpful for patients on anticoagulant therapy who may bleed more extensively than typical patients after venipuncture. It is necessary to contain the bleed with a bandage, but adhesive might bruise once removed from a patient who has anticoagulated blood. In which of the following time frames should a tourniquet be routinely released on a patient while performing a blood draw? within one minute The standard time limit for having a tourniquet on a patient is one minute. Inaccurate laboratory test results may occur if a tourniquet is not removed within one minute. When a tourniquet is applied, the local blood flow is stopped. This leads to concentration of the blood and blood entering the surrounding tissue. This may result in falsely high values for all protein-based analytes, increased packed cell volume, and changes in other cellular elements. The most current edition of the CLSI Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture, H3-A6, states that the tourniquet application for preliminary vein selection should not exceed one minute. For most patients, it is easy to release the tourniquet within the one-minute period. Most veins are easily located and the venipuncture procedure can be completed quickly. A medical assistant has active symptoms of the common cold. Under which of the following conditions may he perform venipuncture? The medical assistant may perform venipuncture provided he is wearing a mask and afebrile. It is not uncommon for people to be able to work with the common cold. However, it is important for medical personnel to use good judgment and not transmit diseases to their patients. Medical personnel should take precautions and handle patient contact in a responsible manner. They should not have patient contact if they are febrile, since that is when colds are highly contagious. In this instance, the medical assistant may perform venipuncture provided he/she is wearing a mask and afebrile. The medical assistant should wear the mask to keep from transmitting the cold via coughing or sneezing on a patient. What is an appropriate alternative to using a rubber tourniquet when attempting a venipuncture on a known patient who is difficult to obtain a sample from? blood pressure cuff The only acceptable choice among the listed options is the blood pressure cuff. Occlusion pressure may be adjusted as needed as an alternative to ensure circulation. In compliance with CLSI (Clinical and Laboratory Standards Institute) standards, the blood pressure cuff can provide uniform constriction, as long as the phlebotomist doesn't inflate the cuff beyond 40 mm of mercury. What evacuated tube should the medical assistant select for collection of electrolytes? green-top A green top tube contains heparin. Green tops are used for collection of heparinized plasma or whole blood for special tests. Note: After the tube has been filled with blood, the tube is inverted several times to prevent coagulation. Note: Green top tubes can contain ammonium, lithium, and sodium in addition to the heparin. In this instance, lithium heparin would be the green-top of choice (and sodium heparin would NOT be used for an electrolyte test). Electrolytes can also be collected in a red-top tube. What additive protects serum from interacting with red blood cells after a specimen has been centrifuged? gel separators Gel separators create a barrier between the serum and formed elements of the blood. Prolonged contact of serum with formed elements can lead to pre-analytical variations in certain tests (such as serum glucose levels). Tubes with clot activators, such as thrombin, actually expedite the clotting process. Anticoagulant tubes keep the blood from clotting, yielding plasma instead of serum. Sulfosalicylic acid is used in urine testing to precipitate proteins. The medical assistant is instructed to perform a capillary stick for newborn screening. What collection devices should the medical assistant use? Heel stick lancet The heel stick lancet (e.g., Tenderfoot) is required for infants. If a heelstick in an infant is being performed, the phlebotomist should apply a warming device for approximately 3-5 minutes to the heel to increase blood flow to the area, which will facilitate the collection of the capillary specimen. The bones of the distal phalanx (located in the thickest part of the finger) may be injured or damaged by a traditional finger stick lancet puncture. What site should the medical assistant use for newborn screening blood collection? plantar surface of the heel A heel stick should be performed on the lateral or medial portions of the plantar surface of the heel-skin surface (left and right). Never stick the center area of heel, the arch, or the back of the heel. Avoid puncturing the bone by targeting the plantar surface. Draw an imaginary line starting in the middle of the big toe to the back of the heel. Then draw another imaginary line between the small toes to the back of the heel. The proper collection sites will be the fleshy portions outside those lines and below where the arch meets the heel. The anteromedial aspect, lateral surfaces and plantar curvature do not provide good flesh for a proper collection. The appropriate needle gauge to use for most venipuncture collections is 21 The 21 gauge needle is long enough and thin enough to access most veins and the internal diameter (bore size) is wide enough to permit blood collection with little concern about mechanical hemolysis when using evacuated tubes. Butterfly collection sets (wing sets) typically use needles of a higher gauge, and blood donation centers typically use needles of a lower gauge. Remember, the higher the gauge, the smaller the bore (opening). After several minutes of searching the medical assistant can only palpate a small vein. The patient is prepared and the venipuncture is performed. The blood is filling the tube, but slows and then stops even though the patient and medical assistant remained still. What actions should the medical assistant take? Use a smaller tube because the vein has collapsed. Since blood was once filling the tube, the needle was once in the vein. Since the phlebotomist knew this was a small vein at palpation, the fragility of the vein may have caused the vein to collapse if the vacuum of a regular size collection tube was too strong. Putting a smaller tube on the multi-sample needle would decrease the force of the vacuum pulling blood from the vein. If blood flowed easily again, problem is solved! Presuming the phlebotomist had a steady hand during the draw, the other causes could be ruled out. Since blood filled the tube normally for a time and slowed to a stop, there is no reason to believe the needle had been moved. And if the bevel was still in the vein at all, blood would still be able to trickle into the tube.