Chapter 34. Phlebotomy and Blood Specimens
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. As the nurse attempts venipuncture in the patient’s right hand, the vein rolls. To stabilize the vein, the
nurse will
1. Carefully apply enough pressure with the index and middle fingers to trap the rolling vein.
2. Use the index finger and thumb of the nondominant hand to anchor the vein above and
below the intended venipuncture site.
3. Use a winged-infusion set with a syringe rather than a Vacutainer.
4. Apply heat for several minutes to enhance the visibility of the vein.
2. An 86-year-old female patient has orders for a complete blood cell count this morning. As part of
gathering the necessary equipment to collect the patient’s blood, the nurse will correctly gather
1. A winged-infusion set.
2. A Vacutainer holder.
3. A 50-mL syringe.
4. An 18-gauge Vacutainer needle.
3. Before drawing the patient’s blood, the nurse carefully lines up evacuated tubes in the order in which they
will be filled. The nurse collects blood in the correct order because
1. Laboratory draws are time-consuming and collecting blood in the correct order will be a
more efficient use of time.
2. The medical technologist in charge of the laboratory has designated the order based on the
facility’s protocol.
3. Some tubes have additives that have the potential to contaminate each of the
remaining tubes to be filled.
4. The collection tube that is filled first has an anticoagulant, which prevents blood from
clotting in the remaining tubes to be collected.
4. A nurse has successfully inserted the Vacutainer needle into the patient’s right median cubital vein. Next,
the nurse will correctly
1. Draw the appropriate amount of blood.
2. Release the tourniquet to reduce pressure on the vein.
3. Transfer the collected blood into the appropriate evacuated tube.
4. Gently push the Vacutainer tube onto the sheathed end of the needle.
5. The nurse will not label an evacuated tube before entering the patient’s room because
1. The nurse could accidently use the labeled tube for the wrong patient.
2. Tubes should be labeled after they have all been filled and the nurse has left the
patient’s room, just before being sent to the laboratory.
3. Doing so would be less time efficient, although it would reduce the likelihood of an error.
4. Labeling the tube later ensures that the writing on the label is more legible.
6. The nurse is satisfied that a tourniquet is placed correctly on the patient’s arm when
1. The patient’s arm is cool to the touch.
2. The patient is not complaining of discomfort.
3. The arterial pulse distal to the tourniquet is palpable.
4. There is increased visibility of the veins.
7. To prevent rupturing an elderly patient’s vessel when performing venipuncture, the nurse will
, 1. Use the Vacutainer collection method.
2. Use a blood pressure cuff to occlude venous return.
3. Collect the patient’s blood with an 18-gauge needle.
4. Apply warm compresses to the arm for 20 minutes before venipuncture.
8. A patient has several blood tests ordered. The nurse determines that the best vein to use for the blood draw is
superficial and will correctly initiate the stick at a
1. 45-degree angle.
2. 30-degree angle.
3. 15-degree angle.
4. 5-degree angle.
9. A patient who was admitted with possible septicemia has orders to draw blood cultures. The nurse has
correctly drawn blood cultures when
1. Blood is collected in two separate bottles, one aerobic and the other anaerobic, while the
patient’s temperature is spiked.
2. Blood cultures are drawn on admission to the unit and again when febrile.
3. Two lavender collection tubes of blood have been collected while the patient’s
temperature is elevated above 101°F.
4. The patient’s blood cultures have been collected using either two anaerobic bottles or two
aerobic culture bottles.
10. After drawing the patient’s blood, the nurse will correctly
1. Have the patient bend his or her elbow to help stop the bleeding.
2. Apply pressure for at least 1 full minute.
3. Leave the tourniquet on until the patient has stopped bleeding.
4. Apply deep pressure for approximately 3 to 5 minutes.
11. The nurse has inserted the Vacutainer needle into the patient’s left median cubital vein, but when the tube
is activated, it does not fill with blood. The nurse correctly suspects that
1. There is no suction in the evacuator tube.
2. The bevel of the needle is damaged in some way.
3. The evacuated tube is too small.
4. The tourniquet is apparently too tight to allow blood to enter the tube.
12. When having difficulty drawing blood from a patient, the nurse knows that it is necessary to avoid leaving the
tourniquet on longer than 1 minute because
1. In patients with hypertension, doing so can cause an increase in blood pressure.
2. Doing so can cause discomfort if the patient’s skin is fragile.
3. Doing so can cause edema.
4. Doing so can alter laboratory results.
13. To prevent hemolysis after drawing blood, the nurse correctly
1. Massages the puncture site to produce sufficient blood flow.
2. Pulls back quickly on the plunger of the syringe when drawing blood.
3. Selects a 23-gauge needle or larger.
4. Selects a 24-gauge needle or smaller.
14. The following patients have had blood draws ordered. The nurse will not perform venipuncture on
1. The hand of an infant who does not have adequate hand veins.
2. The right arm of a mastectomy patient who has had a mastectomy on the right side.
3. The feet of patients with poor circulation in the extremities.
4. The arm of an elderly patient with edema.
, 15. The nurse will properly avoid performing venipuncture on all of the following sites except
1. The scalp veins of an infant.
2. Skin with incisions or sutures.
3. Veins that feel hard or ropey.
4. Skin with new tattoos.
16. The nurse recognizes that locating or accessing a vein is made more difficult by all of the following
conditions except
1. Obesity.
2. Low blood pressure.
3. Dehydration.
4. Rolling or collapsing veins.
17. The nurse is having difficulty finding a vein for venipuncture. An appropriate course of action is to
1. Have the patient drink fluids.
2. Apply cold packs to the venipuncture site.
3. Remove the blood pressure cuff from the arm to let the blood flow freely.
4. Let one of the patient’s arms hang below the heart for several minutes.
18. To minimize the risk for complications from phlebotomy, the nurse should
1. Remove the tourniquet after removing the needle from the vein.
2. Have the patient bend the elbow to keep up pressure on the site after removing the needle.
3. Keep the patient lying supine or sitting in the high Fowler position.
4. Allow the patient to stand during venipuncture if the patient is more comfortable that way.
19. If the nurse fails to obtain blood on the first attempt at venipuncture, she should avoid
1. Palpating the vein proximal to the needle and redirecting the needle.
2. Pulling back on or rotating the needle.
3. Removing and then reapplying the tourniquet.
4. Removing the needle and then reinserting it in the other arm.
20. The nurse correctly labels the tube containing a blood-draw specimen
1. Before entering the patient’s room.
2. In the patient’s room but before obtaining the specimen.
3. Immediately after obtaining the specimen.
4. After leaving the patient’s room.
21. Before performing a phlebotomy, a nurse correctly
1. Washes his hands and then puts on nonsterile gloves.
2. Washes his hands and then puts on sterile gloves.
3. Puts on nonsterile gloves (hand washing is not needed because the gloves prevent contact
with the patient).
4. Puts on sterile gloves (hand washing is not needed because the gloves prevent contact with
the patient).
22. The nurse explains the blood-drawing process to the patient before performing it
1. To reduce liability because an uninformed patient may sue for malpractice.
2. To reduce patient anxiety and gain cooperation.
3. To give patients the opportunity to refuse treatment if they so choose.
4. To educate the patient so he can perform the procedure at home.
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. As the nurse attempts venipuncture in the patient’s right hand, the vein rolls. To stabilize the vein, the
nurse will
1. Carefully apply enough pressure with the index and middle fingers to trap the rolling vein.
2. Use the index finger and thumb of the nondominant hand to anchor the vein above and
below the intended venipuncture site.
3. Use a winged-infusion set with a syringe rather than a Vacutainer.
4. Apply heat for several minutes to enhance the visibility of the vein.
2. An 86-year-old female patient has orders for a complete blood cell count this morning. As part of
gathering the necessary equipment to collect the patient’s blood, the nurse will correctly gather
1. A winged-infusion set.
2. A Vacutainer holder.
3. A 50-mL syringe.
4. An 18-gauge Vacutainer needle.
3. Before drawing the patient’s blood, the nurse carefully lines up evacuated tubes in the order in which they
will be filled. The nurse collects blood in the correct order because
1. Laboratory draws are time-consuming and collecting blood in the correct order will be a
more efficient use of time.
2. The medical technologist in charge of the laboratory has designated the order based on the
facility’s protocol.
3. Some tubes have additives that have the potential to contaminate each of the
remaining tubes to be filled.
4. The collection tube that is filled first has an anticoagulant, which prevents blood from
clotting in the remaining tubes to be collected.
4. A nurse has successfully inserted the Vacutainer needle into the patient’s right median cubital vein. Next,
the nurse will correctly
1. Draw the appropriate amount of blood.
2. Release the tourniquet to reduce pressure on the vein.
3. Transfer the collected blood into the appropriate evacuated tube.
4. Gently push the Vacutainer tube onto the sheathed end of the needle.
5. The nurse will not label an evacuated tube before entering the patient’s room because
1. The nurse could accidently use the labeled tube for the wrong patient.
2. Tubes should be labeled after they have all been filled and the nurse has left the
patient’s room, just before being sent to the laboratory.
3. Doing so would be less time efficient, although it would reduce the likelihood of an error.
4. Labeling the tube later ensures that the writing on the label is more legible.
6. The nurse is satisfied that a tourniquet is placed correctly on the patient’s arm when
1. The patient’s arm is cool to the touch.
2. The patient is not complaining of discomfort.
3. The arterial pulse distal to the tourniquet is palpable.
4. There is increased visibility of the veins.
7. To prevent rupturing an elderly patient’s vessel when performing venipuncture, the nurse will
, 1. Use the Vacutainer collection method.
2. Use a blood pressure cuff to occlude venous return.
3. Collect the patient’s blood with an 18-gauge needle.
4. Apply warm compresses to the arm for 20 minutes before venipuncture.
8. A patient has several blood tests ordered. The nurse determines that the best vein to use for the blood draw is
superficial and will correctly initiate the stick at a
1. 45-degree angle.
2. 30-degree angle.
3. 15-degree angle.
4. 5-degree angle.
9. A patient who was admitted with possible septicemia has orders to draw blood cultures. The nurse has
correctly drawn blood cultures when
1. Blood is collected in two separate bottles, one aerobic and the other anaerobic, while the
patient’s temperature is spiked.
2. Blood cultures are drawn on admission to the unit and again when febrile.
3. Two lavender collection tubes of blood have been collected while the patient’s
temperature is elevated above 101°F.
4. The patient’s blood cultures have been collected using either two anaerobic bottles or two
aerobic culture bottles.
10. After drawing the patient’s blood, the nurse will correctly
1. Have the patient bend his or her elbow to help stop the bleeding.
2. Apply pressure for at least 1 full minute.
3. Leave the tourniquet on until the patient has stopped bleeding.
4. Apply deep pressure for approximately 3 to 5 minutes.
11. The nurse has inserted the Vacutainer needle into the patient’s left median cubital vein, but when the tube
is activated, it does not fill with blood. The nurse correctly suspects that
1. There is no suction in the evacuator tube.
2. The bevel of the needle is damaged in some way.
3. The evacuated tube is too small.
4. The tourniquet is apparently too tight to allow blood to enter the tube.
12. When having difficulty drawing blood from a patient, the nurse knows that it is necessary to avoid leaving the
tourniquet on longer than 1 minute because
1. In patients with hypertension, doing so can cause an increase in blood pressure.
2. Doing so can cause discomfort if the patient’s skin is fragile.
3. Doing so can cause edema.
4. Doing so can alter laboratory results.
13. To prevent hemolysis after drawing blood, the nurse correctly
1. Massages the puncture site to produce sufficient blood flow.
2. Pulls back quickly on the plunger of the syringe when drawing blood.
3. Selects a 23-gauge needle or larger.
4. Selects a 24-gauge needle or smaller.
14. The following patients have had blood draws ordered. The nurse will not perform venipuncture on
1. The hand of an infant who does not have adequate hand veins.
2. The right arm of a mastectomy patient who has had a mastectomy on the right side.
3. The feet of patients with poor circulation in the extremities.
4. The arm of an elderly patient with edema.
, 15. The nurse will properly avoid performing venipuncture on all of the following sites except
1. The scalp veins of an infant.
2. Skin with incisions or sutures.
3. Veins that feel hard or ropey.
4. Skin with new tattoos.
16. The nurse recognizes that locating or accessing a vein is made more difficult by all of the following
conditions except
1. Obesity.
2. Low blood pressure.
3. Dehydration.
4. Rolling or collapsing veins.
17. The nurse is having difficulty finding a vein for venipuncture. An appropriate course of action is to
1. Have the patient drink fluids.
2. Apply cold packs to the venipuncture site.
3. Remove the blood pressure cuff from the arm to let the blood flow freely.
4. Let one of the patient’s arms hang below the heart for several minutes.
18. To minimize the risk for complications from phlebotomy, the nurse should
1. Remove the tourniquet after removing the needle from the vein.
2. Have the patient bend the elbow to keep up pressure on the site after removing the needle.
3. Keep the patient lying supine or sitting in the high Fowler position.
4. Allow the patient to stand during venipuncture if the patient is more comfortable that way.
19. If the nurse fails to obtain blood on the first attempt at venipuncture, she should avoid
1. Palpating the vein proximal to the needle and redirecting the needle.
2. Pulling back on or rotating the needle.
3. Removing and then reapplying the tourniquet.
4. Removing the needle and then reinserting it in the other arm.
20. The nurse correctly labels the tube containing a blood-draw specimen
1. Before entering the patient’s room.
2. In the patient’s room but before obtaining the specimen.
3. Immediately after obtaining the specimen.
4. After leaving the patient’s room.
21. Before performing a phlebotomy, a nurse correctly
1. Washes his hands and then puts on nonsterile gloves.
2. Washes his hands and then puts on sterile gloves.
3. Puts on nonsterile gloves (hand washing is not needed because the gloves prevent contact
with the patient).
4. Puts on sterile gloves (hand washing is not needed because the gloves prevent contact with
the patient).
22. The nurse explains the blood-drawing process to the patient before performing it
1. To reduce liability because an uninformed patient may sue for malpractice.
2. To reduce patient anxiety and gain cooperation.
3. To give patients the opportunity to refuse treatment if they so choose.
4. To educate the patient so he can perform the procedure at home.
