The Phlebotomy Textbook 3rd Edition by Strasinger Test bank

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The Phlebotomy Textbook 3rd Edition by Strasinger Test bank

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Chapter 9: Routine Venipuncture

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. Basic information that should be present on all requisition forms includes all of the following except the:
a.
patients location.
b.
patients identification number.
c.
tests requested.
d.
type of collection tubes.

____ 2. To aid in specimen processing, requisition forms may contain:
a.
special collection information.
b.
the phlebotomists initials.
c.
a bar code.
d.
the patients date of birth.

____ 3. The most important procedure in phlebotomy is to:
a.
organize equipment at the bedside.
b.
introduce yourself to the patient.
c.
initial the requisition form.
d.
identify the patient correctly.

____ 4. All of the following are used to identify a patient except the:
a.
bed sign.
b.
requisition form.
c.
identification band.
d.
bar codes.

____ 5. The most important purpose of a requisition form is:
a.
authorization to perform the procedure.
b.
providing a system to report results.
c.
location of the patient.
d.
monitoring test result turnaround time.

____ 6. Proper specimen collection begins with:
a.
washing the hands.
b.
locating the patient.
c.
requisitioning.
d.
organizing the equipment.

____ 7. Before you draw a blood specimen you must always:
a.
check the patients identification number and name on the wrist band.
b.
ask the patient his or her name.
c.
ask the nurse in charge to identify the patient.
d.
tell the patient what type of blood test you are going to perform.

____ 8. When encountering a patient with casts on both arms and no wrist band, the phlebotomist should first:
a.
check the casts for the patient identification number.
b.
ask the patient if his name is John Jones.
c.
check the patients ankles.
d.
look for the identification band on the nightstand.

____ 9. Blood should not be drawn from a patient who is:
a.
standing.
b.
nervous.
c.
unable to make a fist.
d.
not fasting.

____ 10. Patient reassurance includes:
a.
explaining the purpose of the tests ordered.
b.
lowering the bedrails.
c.
briefly explaining the procedure.
d.
assuring the patient the procedure will not hurt.

____ 11. Failure to check the requisition form prior to leaving the laboratory may cause the phlebotomist to:
a.
collect the wrong specimen.
b.
have inadequate equipment.
c.
misidentify the patient.
d.
require assistance from the nurse.

____ 12. When organizing equipment at the patients bedside, it is important to:
a.
place all the necessary equipment on the nightstand.
b.
apply the tourniquet first.
c.
set the phlebotomy tray on the patients bed.
d.
have extra evacuated tubes readily available.

____ 13. The maximum time a tourniquet should remain on the patients arm is:
a.
1 minute.
b.
2 minutes.
c.
3 minutes.
d.
5 minutes.

____ 14. The vein of choice for routine venipuncture is the:
a.
median cubital.
b.
radial.
c.
cephalic.
d.
basilic.

____ 15. The vein located on the thumb side of the arm is the:
a.
brachial.
b.
median cubital.
c.
basilic.
d.
cephalic.

____ 16. A large, rigid cord located during palpation indicates:
a.
an acceptable vein.
b.
the brachial artery.
c.
a tendon.
d.
an unacceptable vein.

____ 17. Palpate means to:
a.
perform a venipuncture.
b.
examine by touch.
c.
examine by sound.
d.
obtain a specimen from an intravenous line.

____ 18. Prolonged application of a tourniquet will cause:
a.
excessive bleeding.
b.
difficulty locating a vein.
c.
hemolysis.
d.
both A and C

____ 19. The appearance of petechiae on a patients arm during site selection indicates that the:
a.
patient has deep veins.
b.
tourniquet is tied too tightly.
c.
basilic vein should not be used.
d.
radial pulse beat is very strong.

____ 20. Failure to allow the alcohol to dry on the patients arm after site cleansing can cause all of the following except:
a.
increased bacteriostatic action.
b.
a stinging sensation for the patient.
c.
a possible unsterile site.
d.
specimen hemolysis.

____ 21. Correct palpation of a vein includes all of the following except:
a.
determining the depth of the vein.
b.
detecting a pulse using the thumb.
c.
determining the direction of the vein.
d.
probing with the index finger.

____ 22. The veins that are the easiest to anchor are the:
a.
hand veins.
b.
cephalic veins.
c.
basilic veins.
d.
median cubital veins.

____ 23. Hemoconcentration can be caused by:
a.
prolonged tourniquet application.
b.
intravenous therapy.
c.
excessive probing.
d.
failure to clench the fist.

____ 24. Which of the following is not acceptable sterile technique?
a.
Cleansing the site in a circular motion
b.
Putting on gloves and palpating the cleansed area
c.
Allowing the alcohol to completely air-dry
d.
Cleansing the palpating finger

____ 25. Firmly anchoring the vein prior to needle insertion is necessary to prevent:
a.
specimen hemolysis.
b.
incompletely filled tubes.
c.
an accidental needlestick.
d.
the vein from rolling.

____ 26. Which of the following is performed first when the last tube is collected?
a.
Gauze is placed over the needle.
b.
Filled tube is removed from adapter.
c.
Needle is removed.
d.
Pressure is applied to the site.

____ 27. After needle removal, pressure is applied to the site:
a.
by having the patient bend the elbow.
b.
after labeling the tubes.
c.
prior to removing the tourniquet.
d.
to prevent hematoma formation.

____ 28. When collecting specimens in a patients room, tubes are routinely labeled:
a.
prior to collecting the blood.
b.
using preprinted labels.
c.
after collecting the blood.
d.
after leaving the patients room.

____ 29. Prior to leaving a patients room, a phlebotomist should do all of the following except:
a.
dispose of gauze and alcohol pads in a biohazard container.
b.
return bedrails to their original position.
c.
eject the needle from the adapter into a sharps container.
d.
discard the needle and adapter into a sharps container.

____ 30. Prior to bandaging the puncture site, the phlebotomist should:
a.
thank the patient.
b.
instruct a fasting patient to eat.
c.
examine the site for bleeding.
d.
apply pressure for at least 5 minutes.

____ 31. An example of improper disposal of venipuncture supplies and equipment is:
a.
placing gauze and alcohol pads in a biohazard container.
b.
recapping the needle.
c.
removing gloves and washing hands.
d.
placing the plastic needle cover in the wastebasket.

____ 32. During the venipuncture, the phlebotomist should do all of the following except:
a.
anchor the vein above and below the puncture site.
b.
insert the needle with the bevel up.
c.
insert the needle at a 15- to 30-degree angle.
d.
brace the hand holding the adapter on the patients arm.

____ 33. Tubes are angled downward during blood collection to:
a.
ensure they fill completely.
b.
prevent patient discomfort.
c.
prevent blood refluxing into the needle.
d.
ensure mixing of blood and anticoagulant.

____ 34. Bracing the hand holding the needle assembly against the patients arm:
a.
decreases the patient discomfort.
b.
prevents excess needle movement.
c.
decreases the possibility of hemolysis.
d.
causes the tubes to fill more quickly.

____ 35. A properly labeled tube must have all of the following information except:
a.
patient location.
b.
patient identification number.
c.
date of collection.
d.
phlebotomists initials.

____ 36. Which specimen should be collected last?
a.
STAT specimen
b.
Specimen requiring special handling
c.
Clotted specimen
d.
Fasting specimen

____ 37. Failure to deliver glucose drawn in a serum separator tube (SST) to the laboratory within the recommended time will cause:
a.
a falsely decreased glucose value.
b.
a falsely increased glucose value.
c.
glycolysis.
d.
both A and C

____ 38. Each phlebotomist develops his or her own style for which of the following parts of the routine venipuncture process?
a.
Dealing with patients and performing the actual venipuncture
b.
Identifying the patient
c.
Drawing multiple blood collection tubes in order
d.
Labeling the blood collection tubes.

____ 39. When properly used and organized before performing a venipuncture, the patient requisition forms will allow the phlebotomist to do all of the following except:
a.
review the tests ordered and the time/date for specimen collection.
b.
review previously ordered and collected tests for each patient.
c.
review any special conditions or patient preparation for this specimen collection.
d.
review if all requisitions for a particular patient are organized by the day/time of draw.

____ 40. Two identifiers for patient identification before specimen collection are routinely secured by all the following means except:
a.
verifying the patients identification number on the wrist or ankle identification band.
b.
asking the patient to state his or her first name and last name.
c.
asking the patient Are you John Doe? or Are you Mary Doe?.
d.
comparing information obtained verbally and from the patients identification band with the information on the test requisition.

____ 41. Wireless handheld computers used to scan a bar code on the patients identification band reduce preexamination variables in the routine venipuncture process because:
a.
patient identification can be verified by scanning requisitions before leaving the laboratory for the inpatient units.
b.
labels for all patient collection tubes may be printed in batches ahead of each collection on the patient floors, thus freeing up laboratory printers for other tasks.
c.
labels for a specific patient are generated only after the patients identification has been correctly verified by scanning his or her identification band and not printed ahead of time.
d.
the bar code on the patients drivers license may be scanned for outpatients instead of scanning a wrist band.

____ 42. Tips to shorten the time the tourniquet is applied to the patients arm and therefore to reduce preexamination variables when performing venipunctures include all of the following except:
a.
feeling for veins with a stroking motion.
b.
feeling for the characteristic spongy, resilient, tube-like feel of veins.
c.
feeling for veins with a pushing motion.
d.
feeling for veins with the tip of the index finger on the nondominant hand.

____ 43. The Clinical Laboratory and Standards Institute (CLSI) recommends that all patient specimens are delivered to the laboratory no more than 2 hours after collection to reduce preexamination variables caused by cellular action and the effects of prolonged exposure of specimens to room temperatures, such as:
a.
glycolysis caused by cells use of glucose; hemolysis and leakage of potassium from the cells into the plasma or serum; the destruction of coagulation factors from exposure to room temperatures.
b.
leakage of coagulation factors into the serum or plasma by cellular metabolism; increased potassium values caused by exposure to room temperature; increased glucose values caused by cellular metabolism.
c.
glycolysis caused by leakage from cells; increased levels of coagulation factors caused by prolonged exposure to room temperatures; decreased potassium levels caused by cellular metabolism.
d.
glycolysis caused by exposure to room temperatures; hemolysis and leakage of coagulation factors from the cells; decreased potassium levels in the serum and plasma by cellular utilization.

____ 44. Specimens for blood bank testing may require a unique extra step to be carried out after specimen collection is complete. This extra step that is only required for blood bank testing is:
a.
labeling of all tubes after collection is complete.
b.
verbally asking an outpatient to confirm the name (last and first) on the label of each tube.
c.
attachment of an additional label from the patients blood bank identification band to the blood bank tube.
d.
label any additional tubes drawn because of a loss of vacuum in the original tubes.

True/False
Indicate whether the statement is true or false.

____ 45. The most valuable piece of information on the wrist identification band is the patients name.

____ 46. The phlebotomist should not tell the patient that the procedure is painless.

____ 47. The phlebotomist should be prepared to tell the patient the purpose of the tests that have been ordered.

____ 48. The most difficult vein to anchor in the antecubital area is the basilic vein.

____ 49. Swabbing the gloved palpating finger may aid in vein location.

____ 50. Hyperextending the patients arm may make vein location more difficult.

____ 51. Patients should be encouraged to pump their fists during venipuncture.

____ 52. After needle removal the patient can apply pressure to the site by bending the elbow.

____ 53. Specimens that require mixing should be inverted after they have been labeled.

____ 54. The tourniquet is applied twice during the venipuncture procedure.

Matching

Place the following steps of the venipuncture technique in the correct order.
a.
1
e.
5
b.
2
f.
6
c.
3
g.
7
d.
4
h.
8

____ 55. Identify the patient.

____ 56. Remove the needle and apply pressure.

____ 57. Obtain a requisition form.

____ 58. Activate needle safety device.

____ 59. Label the tubes.

____ 60. Anchor the vein.

____ 61. Cleanse the site.

____ 62. Insert the needle.
Chapter 9: Routine Venipuncture
Answer Section

MULTIPLE CHOICE

1. ANS: D PTS: 1 DIF: Level 1 TOP: Patient identification

2. ANS: C PTS: 1 DIF: Level 1 TOP: Patient identification

3. ANS: D PTS: 1 DIF: Level 1 TOP: Patient identification

4. ANS: A PTS: 1 DIF: Level 1 TOP: Patient identification

5. ANS: A PTS: 1 DIF: Level 1 TOP: Patient identification

6. ANS: C PTS: 1 DIF: Level 1 TOP: Patient identification

7. ANS: A PTS: 1 DIF: Level 1 TOP: Patient identification

8. ANS: C PTS: 1 DIF: Level 2 TOP: Patient identification

9. ANS: A PTS: 1 DIF: Level 1 TOP: Phlebotomist/patient preparation

10. ANS: C PTS: 1 DIF: Level 1 TOP: Phlebotomist/patient preparation

11. ANS: B PTS: 1 DIF: Level 2 TOP: Phlebotomist/patient preparation

12. ANS: D PTS: 1 DIF: Level 2 TOP: Phlebotomist/patient preparation

13. ANS: A PTS: 1 DIF: Level 1 TOP: Site selection/preparation

14. ANS: A PTS: 1 DIF: Level 1 TOP: Site selection/preparation

15. ANS: D PTS: 1 DIF: Level 1 TOP: Site selection/preparation

16. ANS: C PTS: 1 DIF: Level 1 TOP: Site selection/preparation

17. ANS: B PTS: 1 DIF: Level 1 TOP: Site selection/preparation

18. ANS: C PTS: 1 DIF: Level 2 TOP: Site selection/preparation

19. ANS: B PTS: 1 DIF: Level 2 TOP: Site selection/preparation

20. ANS: A PTS: 1 DIF: Level 2 TOP: Site selection/preparation

21. ANS: B PTS: 1 DIF: Level 2 TOP: Site selection/preparation

22. ANS: D PTS: 1 DIF: Level 2 TOP: Site selection/preparation

23. ANS: A PTS: 1 DIF: Level 2 TOP: Site selection/preparation

24. ANS: B PTS: 1 DIF: Level 2 TOP: Site selection/preparation

25. ANS: D PTS: 1 DIF: Level 1 TOP: Venipuncture technique

26. ANS: B PTS: 1 DIF: Level 1 TOP: Venipuncture technique

27. ANS: D PTS: 1 DIF: Level 1 TOP: Venipuncture technique

28. ANS: C PTS: 1 DIF: Level 1 TOP: Venipuncture technique

29. ANS: C PTS: 1 DIF: Level 1 TOP: Venipuncture technique

30. ANS: C PTS: 1 DIF: Level 1 TOP: Venipuncture technique

31. ANS: B PTS: 1 DIF: Level 1 TOP: Venipuncture technique

32. ANS: A PTS: 1 DIF: Level 2 TOP: Venipuncture technique

33. ANS: C PTS: 1 DIF: Level 2 TOP: Venipuncture technique

34. ANS: B PTS: 1 DIF: Level 2 TOP: Venipuncture technique

35. ANS: A PTS: 1 DIF: Level 1 TOP: Specimen handling

36. ANS: B PTS: 1 DIF: Level 2 TOP: Specimen handling

37. ANS: D PTS: 1 DIF: Level 2 TOP: Specimen handling

38. ANS: A PTS: 1 DIF: Level 2 TOP: Venipuncture technique

39. ANS: B PTS: 1 DIF: Level 2 TOP: Phlebotomist/patient preparation

40. ANS: C PTS: 1 DIF: Level 2 TOP: Patient identification

41. ANS: C PTS: 1 DIF: Level 2 TOP: Patient identification

42. ANS: A PTS: 1 DIF: Level 2 TOP: Site selection/preparation

43. ANS: A PTS: 1 DIF: Level 2 TOP: Specimen handling

44. ANS: C PTS: 1 DIF: Level 2 TOP: Specimen handling

TRUE/FALSE

45. ANS: F PTS: 1 DIF: Level 1 TOP: Patient identification

46. ANS: T PTS: 1 DIF: Level 1 TOP: Phlebotomist/patient preparation

47. ANS: F PTS: 1 DIF: Level 1 TOP: Phlebotomist/patient preparation

48. ANS: T PTS: 1 DIF: Level 1 TOP: Site selection/preparation

49. ANS: T PTS: 1 DIF: Level 1 TOP: Site selection/preparation

50. ANS: T PTS: 1 DIF: Level 1 TOP: Site selection/preparation

51. ANS: F PTS: 1 DIF: Level 1 TOP: Venipuncture technique

52. ANS: F PTS: 1 DIF: Level 1 TOP: Venipuncture technique

53. ANS: F PTS: 1 DIF: Level 1 TOP: Venipuncture technique

54. ANS: T PTS: 1 DIF: Level 2 TOP: Venipuncture technique

MATCHING

55. ANS: B PTS: 1 DIF: Level 1 TOP: Venipuncture technique

56. ANS: F PTS: 1 DIF: Level 1 TOP: Venipuncture technique

57. ANS: A PTS: 1 DIF: Level 1 TOP: Venipuncture technique

58. ANS: G PTS: 1 DIF: Level 1 TOP: Venipuncture technique

59. ANS: H PTS: 1 DIF: Level 1 TOP: Venipuncture technique

60. ANS: D PTS: 1 DIF: Level 1 TOP: Venipuncture technique

61. ANS: C PTS: 1 DIF: Level 1 TOP: Venipuncture technique

62. ANS: E PTS: 1 DIF: Level 1 TOP: Venipuncture technique

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