NHA Phlebotomy Exam-Answered, Exams of Nursing

Download NHA Phlebotomy Exam-Answered and more Exams Nursing in PDF only on Docsity! NHA Phlebotomy Exam-Answered OSHA Establishes regulations and guidelines to direct phlebotomists to work at the highest level of safety possible when handling bio hazards and chemicals. The blood borne pathogens standard (OSHA) - addresses use of PPE - availability to the Hep B immunization - Each workplace must have a exposure control plan - has guidelines to ensure safety - provides standard plans for after an exposure. - engineering controls and record keeping protocols PPE for venipuncture and capillary (OSHA) well fitting gloves Airborne infection PPE (OSHA) N99 or N95 mask What do you do when you have an accidental needle stick? (OSHA) First you wash the area with soap and water (basic first aid), then undergo medical examination that includes you and the patient get tested for HIV, HBV and HCV. Then document the exposure in sharps injury log. What do you include in a sharps injury log? (OSHA) date and time of incident, type of sharps used, who was involved (patient or staff w/o names), location and a detailed description of how it occurred. What is the joint commission? - accredits and certifies healthcare organizations - independent, nongovernmental, and nonprofit - focuses on continual improvement of patient safety and quality of care through regulations and standards The national patient safety goals program (JC) sets requirements for issues including training of health care professionals, communication of test results, and accurate IDs (2-factor method) Clinical and Laboratory Standards Institute (CLSI) -develops standards and guidelines in order for a laboratory to be accredited - provides guidelines for phlebotomists for better accuracy and patient care (like for the use of tubes and needles). standards include level of additives and their use for which tests, order of draw, processing and handling, depth of needle and location needed for capillary collection - provides guidelines for quality control, patient care, risk reductions, and time saving and cost cutting measures. Centers for Disease Control and Prevention (CDC) - helps ID and and educate about infections, illnesses and disease preventions. - IDs new disease and works to prevent spreads - Provides guidelines for PPE sharps handling and hand hygiene - recommends standard precautions when handling body fluids HIPPA - Protects every patients PHI (protected health info) which is any and all info that relates to the patients medical record or electronic health record. - details what info is confidential and any authorized release of that info Info protected under HIPPA demographic info, treatment, meds, diagnostic testing. Any info w/o a way to ID the patient is not protected When is the phlebotomist responsible for the patient? Before, during and immediately after venipuncture Chlorhexidine gluconate (ethanol, iodine tincture and isopropyl alcohol all has alcohol in it and would skew the results) If a centrifuge where to catch on fire, which class of fire would it be? Class C (it involves electrical equipment) What is the current procedure for CPR on an infant? 30 compressions, 1.5 in deep (using 2 fingers) What piece of PPE should a phlebotomist remove first after a draw in an isolation room? gloves (the most contaminated piece of PPE first) A phlebotomist gets a very large glucometer reading the first try and then is back in the normal range the second reading. What could have caused the first inaccurate reading? too much blood was used A phlebotomist comes in the get another set of blood for a GTT (glucose tolerance test) and the patient starts to cry and doesn't comply. What statement should you say? May I please perform the draw? A GTT requires multiple timed draws at set intervals. What department is responsible for processing cholesterol, troponin, and HDL tests? Chemistry (body chemistry) What substance is used to clean a cerebral spinal specimen spill? Chlorine bleach (1:10 bleach to water) What pieces of PPE are minimum requirements to wear for aliquoting a blood specimen? face shield and gloves What pathogen is the phlebotomist at most risk for in the case of an accidental needle stick? Hepatitis B virus (HBV) Who can order lab tests? Physicians, physician assistants, and nurse practitioners What info is on the requisition form? - Patients name, DOB, sex, and ID number - It can also have allergies, tendency to faint, excessive bleeding, and sites to avoid - it has space for date and time of collection, billing info and diagnostic coding What would you review the req form for? duplicate test orders or missing info What info needs to be on the tube label if there is no bar code? date and time of collection, your initials, the patients full name, DOB and other identifiers. What are two identifiers that you can use when IDing the patient? patients name, DOB, home address, phone number, or social (if available) - compare what they say with the req form How can you cross check patient identifiers you can cross check the patients drivers license with the req form, or their hospital band. Never use a patients room or bed number Exceptions for teenage consent married, in the military, emancipated, or otherwise self supporting Most common pretesting preparations - fasting (8-12 hours not eating or drinking other than water) - Medications - basal state (first thing in the morning or after sleeping) before the blood collection make sure they completed the requirements Things to ask the patent before continuing allergies, fainting tendencies, blood thinners, what arm they wish for you the use, current medications, drug and alcohol use How long after a fainting spell should you stay with them? at least 15 minutes Complications that can occur with venipuncture Excessive bleeding or bruising, severe pain or lack of sensation, and infections What to do in the case of excessive bleeding apply pressure and ice to the site and call for What to do in the case of excessive bruising apply pressure and ice to the site and call for What to do in the case of severe pain or lack of sensation? It can indicate nerve damage. stop the procedure and use ice if available What to do in the case of infection? If the site becomes red, swollen and painful, they may have infection. Alert the patient to sign of infection and to contact a physician if they appear What are acceptable ways to position your patient while taking blood - On a bed (increases comfort and safety if they fall) - chair with arm rests and adjustable heights What are some examples of unacceptable ways to potion your patient while taking blood? - standing - sitting on a high stool - edge of an examination table When would you not use a finger for dermal puncture? If the finger is: - cold - make sure to be refrigerated if not immediately taken to the lab - after the cup is filled and cleaned from debris, but the label on the cup Clean catch urine specimen the sample has to be without any other contact except the urine. - no contact with body parts - men and women must clean the area around the urination opening before filling the cup - women must separate the labia while the sample is being collected - first start to urinate and then collect the urine - be very careful not to touch the inside of the container What is the normal range of pH for urine? 5.5 - 8.0 (bacteria grow easily in an alkaline environment) What does white blood cells or nitrites in urine mean? infection What is the normal range for specific gravity for urine? 1.003 - 1.030 (but is usually 1.010 - 1.025) specific gravity is concentration. - below 1.010 = diluted urine -above 1.010 = concentrated urine (dehydration) What does hemoglobin in urine mean? bleeding, infection, cancer, kidney disease, chemical poisoning, and other pathology What does ketones in urine mean? possibly diabetes, starvation or vomiting What does bilirubin in urine mean? possibly liver disease or red blood cell destruction What does protein in urine mean? inflammation, infection, kidney disease, or chemical poisoning What does glucose in urine mean? possibly diabetes What test can provide information on pH, specific gravity, white blood cells, hemoglobin, ketones, bilirubin, nitrites, and glucose? Urine reagent testing (test strips) What is the most common point of care test on stool? fecal occult blood test What does a fecal occult blood test test for? presence of blood in the stool that is not visible. It helps diagnose gastrointestinal lesions and colon cancer What else can be tested for on stool samples? bacteria, viruses, fungi, and parasites steps in collecting a stool sample - give the patient a sterile container (wide-mouth container w/ tight lid) - usually defecate directly into the specimen container - avoid getting urine in with the sample - avoid getting water into the sample (if given an FOBT, give the patient the kit w/ instructions and advice to not eat red meat, citrus fruit and raw veggies as well as take vitamin c subs or aspirin 3 days before collection) Why is sputum testing usually ordered? - for people w/ respiratory infection such as tuberculosis and pneumonia to confirm micro-organisms - to confirm treatment effectiveness (it likely contains infectious material) When should sputum be collected? first thing in the morning before eating or drinking what is sputum? material coughed from the lungs sputum testing instructions - provide a sterile container - instruct them to get sample before eating or drinking - breath deep, cough forcefully and deeply, and expectorate into the container - do not put saliva into the container - 1 or 2 teaspoons of sample is enough - close the lid, clean container, affix the label, and deliver to the lab A phlebotomist is preparing to collect a specimen from a 3-year old for a coagulation test. What method should the technician use? Winged butterfly needle, it is best for patients w/ small veins A phlebotomist is prepared to draw blood for a patient with life-threatening cardiac symptoms. How should the phlebotomist approach consent? An emergency situation removes the need for consent and the phlebotomist should proceed with the collection A phlebotomist is about to draw a patient with a history of syncope with previous draws. Should the technician: a. draw from the patients hand b. place the patient in a supine position c. place the patient in a prone position d. perform a capillary draw b. place the patient in a supine position A phlebotomist is instructing the patient about a 24 hour urine collection. Which of the following instructions should the technician give the patient? a. "avoid mixing or inverting the container after collection" A phlebotomist is preparing to collect specimens to determine peak and trough levels of a med. What action should the phlebotomist take? They would ask the nurse when the med was administered a phlebotomist is taking blood from a patient with hearing aids and seem distracted. What question should the phlebotomist ask to ensure understanding? "would you like me to repeat the directions?" asking them if they need the phlebotomist to talk slower, if they understand or if they heard what was said could be taken as offensive. A phlebotomist is preparing for blood collection in an outpatient setting. What info is required on the req form? patients billing info and test status What should you say if the patient asks why their blood is being drawn? "you should ask your provider about the test" The phlebotomist is instructing the patient on how to collect a urine specimen for a culture and sensitivity test. Which statement should be included? a. "you will need to collect a midstream clean catch specimen" b. "you will need to collect your first void of the morning" c. "you will need to fast for 12 hours prior" d. "you will need to collect the specimen 2 hours after eating" a. "you will need to collect a midstream clean catch specimen" to avoid cross contamination with other microbes. A phlebotomist is seeking consent from an older adult patient who was accompanied by a younger adult. Which action should the technician take? a. speak to the patient in a loud voice b. give the consent form to the accompanying adult c. speak to the patient in a normal tone d. stand close to the patient while speaking c. speak in a normal tone. always treat the patient with respect and not assume they are heard of hearing due to age What test results are affected when a phlebotomist uses providone-iodine to cleanse a site for dermal puncture? Potassium (it can cause a false elevation) Which of the following actions should a phlebotomist take to locate a vein using the warming technique? a. heat a clean bowl to 45*C b. wrap the warm towel around the site for 1 or 2 minutes c. encase the warm towel in a plastic bag d. ask the patient to rinse her hands in warm water for 2 minutes c. encase the warm towel in a plastic bag (it maintains the towels temp. and keeps the patients skin dry) How high above the antecubital area should the tourniquet be? 3 or 4 in above What should the phlebotomist do when applying the tourniquet? Tuck a partial loop of tourniquet underneath the tourniquet so it can be easily undone What temperature should a semen sample be transported in? 36 to 38 C (98.6*F) Which color signifies a health hazard in the National Fire Protection Association 704 Marking System? Blue A phlebotomist is using a point of care test system for a WBC count. Which results should the technician immediately notify the provider? 1.8/mm^3 (4.4-11 is the expected range) How should the phlebotomist transport blood to the lab? a. in a specimen collection tray b. in the trunk of a car c. in a lockable container d. near an air conditioning vent in a car c. in a lockable container to avoid spills Which tube should be collected first during a dermal sample? a. lavender b. green c. red d. light blue a. lavender (it minimizes platelet clumping and micro-clot formation) When preparing for a peak level draw, how long should the phlebotomist wait prior to drawing (after verifying when the meds are administered) 2 hr after administration What additive is used when the phlebotomist is to perform a chromosome analysis for a patient? Heparin The phlebotomist is using filter paper for a newborn capillary draw for phenylketonuria. What should the phlebotomist do? a. apply the blood to the printed side of the filter paper b. add a second drop of blood if a circle is not full c. touch the puncture site to the filter paper d. allow the blood spots to dry for a min. of 2 hours a. apply the blood to the printed side of the filter paper. While drawing a patient for donation, the collection bag fills half way and the vein collapses. What should they do? What is the proper collection order when obtaining a CBC, FSH and electrolyte test via capillary collection? Lavender, green, and then red which additives would be used while collecting for the following tests: coagulation, WBC, pregnancy and random glucose? Sodium citrate, SST and EDTA (EDTA for WBC, sodium citrate for coag. and SST for pregnancy and glucose) If the phlebotomist were to use povidone-iodine for a capillary specimen collection, what outcome should they expect? Increase potassium levels A phlebotomist is performing a dorsal venipuncture w/ the needle at a 15* angle, resulting in slow blood flow and the development of a hematoma. What was a cause of the hematoma? The needle went completely through the vein What can cause a vein to collapse? tying the tourniquet on too tightly Should you collect blood above or below an IV? Below What area is best for a dermal puncture? The middle and ring fingers of the non dominant hand Which vein is more pronounced in obese patients? Cephalic What can be used if a tourniquet is not available? a blood pressure cuff pumped to 40 mm/Hg What are some replacements for 70% alcohol if none is available? providone-iodine or chlorhexidine gluconate What is the lumen of the vein? the middle order of draw blood culture (yellow SPS), light blue (sodium citrate), red (none), SST (t-gel), orange (thrombin), green (sodium or lithium heparin), green pst (t-gel + lithium heparin), lavender (EDTA), pink (EDTA), grey (NaFL + K oxalate), light yellow (ACD), dark blue (Na2 EDTA), brown (sodium heparin) Which tube needs to be filled 100%? light blue Which tube needs a red throw away tube when using a butterfly needle? light blue how long do specimens need to clot? 30 minutes What does the blood need to do in order to produce serum? clot What does the blood need to do in order to produce plasma? not clot What are all the common anti-coagulants? EDTA, heparin, sodium citrate, NaFL + K oxalate Why should the phlebotomist warn the patient when the needle is coming? So they don't jerk when it happens What are some things you can do if someone faints? discontinue the draw, lay them down in a safe area, make sure that their airway is clear and apply a cold compress to their neck or forehead How long after someone becomes unconscious should the phlebotomist call for help? 2 minutes What are the common complications that can happen during a venipuncture? - nerve damage (severe pain, pins and needles, or numbness. They may need medical attention if it continues) - hematoma - phlebitis - thrombosis (blood clot) - petechiae - hemoconcentration - collection/processing errors (misID, wrong tube, mislabel, etc) - syncope - seizure - shock (cold, clammy and pale skin, rapid pulse, shallow breathing, blank stare. - nausea (bring them a bag/bucket - diaphoresis (severe sweating What should you do if someone is in shock? call for help, ensure they have an open airway, lower their head below the body if possible, and keep them safe and warm until help arrives What should you do if someone has a seizure? stop procedure, call 911, document event, remove anything to cause injury, do not restrain or put anything in their mouth, do not bring additional attention to them, stay with them until help arrives How many times do you invert each tube? - blood culture: 8-10 - light blue: 3-4 - SST: 5 - green top: 8-10 - lavender: 8-10 - grey: 8-10 c. collect one set from the left arm and one set from a different site on the same arm A phlebotomist is taking blood from a 3 year old child who weighs 15.9 kg (35 lbs), what blood collection amount is within total volume guidelines for a 1 month period for this patient? 100 mL or less When a phlebotomist receives a forensic specimen, what info should they verify matches the req form? Case number (along with type of specimen and name, age and sex of the specimen donor) What type of test is usually ordered to help diagnose someone with a fever of unknown origin? Blood cultures Should/can you ask a patient to clench their fist right before the venipuncture for a blood culture? yes (and unclench after blood enters the tube or bottle) When are screenings for newborns performed? before 72 hrs old Which conditions can be detected with screenings of newborns? - cystic fibrosis - hypothyroidism - phenylketonuria (PKU) - galactosemia - biotinidase deficiency - sickle cell disease - HIV - toxoplasmosis How are newborn screenings collected? with a heel stick and a newborn screening card where you fill circles with capillary blood How long should the lancet be for a newborn capillary stick? 2 mm How long should a newborn screen dry? at least 3 hours at room temp. What would make a newborn screening unusable and rejected? - oversaturation - circles are not completely filled - expired form - form is not received within 14 days of collection - contamination w/ foreign substance (avoid touching skin to filter paper) - it does not dry throughly - circles have serum rings what is an autologous transfusion? when a patient donates their own blood to use for a transfusion or upcoming surgery What is therapeutic phlebotomy? the intentional removal of blood to lower red blood cells or lower iron levels What are some general requirements for blood donation? - 17 or older (16 in some states) - at least 110 pounds) - donations at least 56 days apart what is apheresis? techniques that allow the removal of one or more blood products during blood collection via special equipment What are the requirements for donation via apheresis? Males: - 17 or older - 130 lbs or greater - 61 inches or taller Females: - 17 or older - 150 lbs or greater - 65 inches or greater What conditions must be tests for before being able to donate blood? HIV, AIDS, and hepatitis what is iatrogenic anemia? it is caused by blood loss due to repeated venipuncture in a short period of time who are most susceptible to iatrogenic anemia? - older adults (medications can suppress bone marrow production) - pediatric patients (lower volume of blood) - underweight patients (decrease in nutritional intake) what percentage of blood volume can be collected from infants? 10% How much blood can be collected from an adult? no more than 100 mL What is a random urine collection? - no prep or time restriction is needed - time of collection must be recorded What is a glucose tolerance test? (gtt)