FISCHBACH'S A MANUAL OF
LABORATORY AND DIAGNOSTIC TESTS.
11TH EDITION
• AUTHOR(S)FRANCES FISCHBACH;
MARGARET FISCHBACH; KATE STOUT
TESTBANKS
Ch. 1 — Specimen Identification & Labeling
Stem: A 62-year-old inpatient is scheduled for morning blood
tests. The nurse draws blood and places the label on the tube
before confirming the patient's second identifier (DOB). Which
action is the most appropriate next step?
A. Send the labeled tube to the lab since the name is present.
B. Remove the label, confirm patient identifiers at bedside, and
re-label the tube correctly.
C. Ask a coworker to confirm the identity later and send the
tube.
D. Attach a temporary handwritten label and document the
verification later.
,Correct answer: B
Rationales:
• Correct (B): Specimen misidentification is a common,
potentially dangerous preanalytic error; re-identifying the
patient at bedside using two identifiers and then re-
labeling the tube immediately prevents wrong-patient
results and aligns with safe-practice standards.
• Incorrect (A): Having only a name without a second
identifier risks misidentification and patient harm.
• Incorrect (C): Delaying confirmation or delegating it later
risks sending an unlabeled/mislabeled specimen.
• Incorrect (D): Temporary handwritten labels and
retrospective documentation increase risk of error and are
not acceptable practice.
Teaching point: Always verify two patient identifiers at bedside
and label specimen immediately.
Citation: Fischbach, F., Fischbach, M., & Stout, K. (2021). A
Manual of Laboratory and Diagnostic Tests (11th ed.). Ch. 1.
Ch. 1 — Preanalytic Phase (Common Errors)
Stem: A clinic audit found that 40% of rejected specimens were
due to hemolysis or clotting. Which preanalytic nursing action
would most reduce hemolysis during routine venipuncture?
A. Use a smaller-gauge needle to reduce pain.
,B. Vigorous shaking of collection tubes to mix additives.
C. Allow alcohol on the skin to air-dry and use appropriate
gauge needle.
D. Use a prolonged tourniquet time to ensure good flow.
Correct answer: C
Rationales:
• Correct (C): Allowing alcohol to dry prevents sample
contamination; selecting appropriate needle gauge and
gentle technique reduce hemolysis. These preanalytic
steps reduce specimen rejection.
• Incorrect (A): Smaller-gauge needles may actually increase
hemolysis if too small for the specimen needed.
• Incorrect (B): Vigorous shaking causes hemolysis; tubes
should be gently inverted per tube instructions.
• Incorrect (D): Prolonged tourniquet increases
hemoconcentration and can affect many analytes.
Teaching point: Gentle venipuncture technique and proper skin
prep minimize hemolysis and preanalytic errors.
Citation: Fischbach, F., Fischbach, M., & Stout, K. (2021). Ch. 1.
Ch. 1 — Order of Draw
Stem: A nurse must draw multiple tubes for coagulation
studies, chemistry panels, and CBC during one venipuncture.
, Which tube-drawing sequence best reduces additive
contamination and erroneous results?
A. EDTA (purple) → serum (red/tiger) → citrate (light blue).
B. Blood culture bottles → citrate (light blue) → serum
(red/tiger) → EDTA (purple).
C. Serum (red/tiger) → EDTA (purple) → citrate (light blue).
D. Citrate (light blue) → blood cultures → EDTA (purple).
Correct answer: B
Rationales:
• Correct (B): The recommended general sequence starts
with blood culture bottles (if indicated), then citrate for
coag tests, then serum tubes, then anticoagulant tubes
(e.g., EDTA) to avoid additive carryover. This order prevents
cross-contamination of additives and erroneous results.
• Incorrect (A): EDTA before citrate can contaminate
coagulation tubes with EDTA and invalidate coag tests.
• Incorrect (C): Serum first then EDTA then citrate is
incorrect order and risks additive contamination.
• Incorrect (D): Citrate should not precede blood culture
bottles; blood cultures should be collected first if ordered.
Teaching point: Follow CLSI-based order of draw: blood cultures
→ citrate → serum → anticoagulants.
Citation: Fischbach, F., Fischbach, M., & Stout, K. (2021). Ch. 1.
LABORATORY AND DIAGNOSTIC TESTS.
11TH EDITION
• AUTHOR(S)FRANCES FISCHBACH;
MARGARET FISCHBACH; KATE STOUT
TESTBANKS
Ch. 1 — Specimen Identification & Labeling
Stem: A 62-year-old inpatient is scheduled for morning blood
tests. The nurse draws blood and places the label on the tube
before confirming the patient's second identifier (DOB). Which
action is the most appropriate next step?
A. Send the labeled tube to the lab since the name is present.
B. Remove the label, confirm patient identifiers at bedside, and
re-label the tube correctly.
C. Ask a coworker to confirm the identity later and send the
tube.
D. Attach a temporary handwritten label and document the
verification later.
,Correct answer: B
Rationales:
• Correct (B): Specimen misidentification is a common,
potentially dangerous preanalytic error; re-identifying the
patient at bedside using two identifiers and then re-
labeling the tube immediately prevents wrong-patient
results and aligns with safe-practice standards.
• Incorrect (A): Having only a name without a second
identifier risks misidentification and patient harm.
• Incorrect (C): Delaying confirmation or delegating it later
risks sending an unlabeled/mislabeled specimen.
• Incorrect (D): Temporary handwritten labels and
retrospective documentation increase risk of error and are
not acceptable practice.
Teaching point: Always verify two patient identifiers at bedside
and label specimen immediately.
Citation: Fischbach, F., Fischbach, M., & Stout, K. (2021). A
Manual of Laboratory and Diagnostic Tests (11th ed.). Ch. 1.
Ch. 1 — Preanalytic Phase (Common Errors)
Stem: A clinic audit found that 40% of rejected specimens were
due to hemolysis or clotting. Which preanalytic nursing action
would most reduce hemolysis during routine venipuncture?
A. Use a smaller-gauge needle to reduce pain.
,B. Vigorous shaking of collection tubes to mix additives.
C. Allow alcohol on the skin to air-dry and use appropriate
gauge needle.
D. Use a prolonged tourniquet time to ensure good flow.
Correct answer: C
Rationales:
• Correct (C): Allowing alcohol to dry prevents sample
contamination; selecting appropriate needle gauge and
gentle technique reduce hemolysis. These preanalytic
steps reduce specimen rejection.
• Incorrect (A): Smaller-gauge needles may actually increase
hemolysis if too small for the specimen needed.
• Incorrect (B): Vigorous shaking causes hemolysis; tubes
should be gently inverted per tube instructions.
• Incorrect (D): Prolonged tourniquet increases
hemoconcentration and can affect many analytes.
Teaching point: Gentle venipuncture technique and proper skin
prep minimize hemolysis and preanalytic errors.
Citation: Fischbach, F., Fischbach, M., & Stout, K. (2021). Ch. 1.
Ch. 1 — Order of Draw
Stem: A nurse must draw multiple tubes for coagulation
studies, chemistry panels, and CBC during one venipuncture.
, Which tube-drawing sequence best reduces additive
contamination and erroneous results?
A. EDTA (purple) → serum (red/tiger) → citrate (light blue).
B. Blood culture bottles → citrate (light blue) → serum
(red/tiger) → EDTA (purple).
C. Serum (red/tiger) → EDTA (purple) → citrate (light blue).
D. Citrate (light blue) → blood cultures → EDTA (purple).
Correct answer: B
Rationales:
• Correct (B): The recommended general sequence starts
with blood culture bottles (if indicated), then citrate for
coag tests, then serum tubes, then anticoagulant tubes
(e.g., EDTA) to avoid additive carryover. This order prevents
cross-contamination of additives and erroneous results.
• Incorrect (A): EDTA before citrate can contaminate
coagulation tubes with EDTA and invalidate coag tests.
• Incorrect (C): Serum first then EDTA then citrate is
incorrect order and risks additive contamination.
• Incorrect (D): Citrate should not precede blood culture
bottles; blood cultures should be collected first if ordered.
Teaching point: Follow CLSI-based order of draw: blood cultures
→ citrate → serum → anticoagulants.
Citation: Fischbach, F., Fischbach, M., & Stout, K. (2021). Ch. 1.
