Chapter 10 Dermal (Capillary) Puncture: Phlebotomy, 5e (Booth)

Phlebotomy, 5e (Booth)
Chapter 10 Dermal (Capillary) Puncture
1)
Which of the dermal punctures in this image is performed correctly?

A) Image A
B) Image B
C) Both of these
D) Neither of these
Answer: A
Explanation: Dermal punctures for obtaining capillary blood should be performed with the cut
across the fingerprints.
Difficulty: 1 Easy
Topic: Performing a Dermal (Capillary) Puncture
Learning Objective: 10.03 Carry out the procedure for performing a dermal (capillary) puncture.
Bloom's: Remember
ABHES: 9.d.2 Perform capillary puncture
CAAHEP: I.P.2.c Perform: capillary puncture
1
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2)
While performing a dermal puncture on a patient's finger, the phlebotomist is having difficulty
forming a good drop of blood and blood is running everywhere except into the collection tube.
Which image represents the way in which the cut was made?
A) Image A
B) Image B
C) Both of these
D) Neither of these
Answer: B
Explanation: Dermal punctures for obtaining capillary blood should be performed with the cut
across the fingerprints. If the cut is made in line with the fingerprints, a good droplet of blood
will not form. The blood will run along the fingerprints and be very difficult to collect.
Difficulty: 1 Easy
Bloom's: Remember
2
3)
Which of the capillary punctures in this image are performed correctly? (Choose all that apply)
A) Image A
B) Image B
C) Image C
D) Image D
Answer: B, D
Heelsticks for obtaining capillary blood should be performed only at the sides of the heel's
plantar surface.
Difficulty: 1 Easy
Bloom's: Remember
3
4)
If a heelstick is performed with the cut applied as pictured in this image, what may result?
A) Blood will clot before it can be collected.
B) Blood will not form drops, but rather run along the back of the heel.
C) The calcaneus may be punctured.
D) No adverse situations will occur because this is the appropriate area for a heelstick.
Answer: C
Explanation: If heelsticks are performed at the back of the heel, the calcaneus may be punctured,
creating a site for bacterial infection.
Difficulty: 1 Easy
Bloom's: Remember
4
5)
If a heelstick is performed with the cut applied as pictured in this image, what may result?
A) Blood will clot before it can be collected.
B) Blood will not form drops, but rather run along the back of the heel.
C) The calcaneus may be punctured.
D) No adverse situations will occur because this is an appropriate area for a heelstick.
Answer: D
Explanation: Heelsticks for obtaining capillary blood should be performed at the sides of the
heel's plantar surface.
Difficulty: 1 Easy
Bloom's: Remember
6) A dermal puncture may NOT be used to collect a specimen to test for which of the following?
A) Glucose
B) Hemoglobin
C) Hematocrit
D) ESR (erythrocyte sedimentation rate)
Answer: D
Explanation: A dermal puncture will not produce a large enough amount of blood to meet the
necessary minimum to perform an ESR, a measurement of the erythrocyte settling rate.
Difficulty: 1 Easy
Topic: The Dermal (Capillary) Puncture
Learning Objective: 10.01 Explain why dermal (capillary) puncture is used instead of routine
venipuncture for some patients.
Bloom's: Remember
5
7) One drawback of a dermal puncture for the laboratory is:
A) the large amount of blood collected.
B) the small amount of blood collected.
C) the blood is always hemolyzed.
D) the method may not work for small children.
Answer: B
Explanation: The small amount of blood collected during a dermal puncture is a drawback for
laboratory testing. If the test requires a large amount of blood or needs to be repeated, the sample
will usually be insufficient.
Difficulty: 1 Easy
Bloom's: Remember
8) The best site for a dermal puncture on the fingers is the:

A) distal area of the middle finger and ring finger.
B) medial area of the middle finger and ring finger.
C) lateral area of the plantar surface.
D) medial area of the plantar surface.
Answer: A
Explanation: The sites to consider for dermal punctures in children and adults are the distal
regions of the middle finger (third finger) and ring finger (fourth finger).
Difficulty: 1 Easy
Topic: Preparing for a Dermal (Capillary) Puncture
Learning Objective: 10.02 Select an appropriate site for dermal (capillary) puncture and identify
the equipment needed.
Bloom's: Remember
6
9) The site(s) to consider for dermal punctures on the plantar surface of the heel in infants is/are:
(Choose all that apply):
A) the distal region.
B) the lateral region.
C) the medial region.
D) the proximal region.
Answer: B, C
In infants, the medial and lateral regions of the plantar surface of the heel are the sites to
consider.
Difficulty: 1 Easy
Bloom's: Remember
10) A poor choice for a dermal puncture on the finger is the: (Choose all that apply)
A) first finger.
B) middle finger.
C) ring finger.
D) plantar surface of the hand.
Answer: A, D
The thumb (first finger) and pointer finger (second finger) are poor choices for dermal punctures
because the area is often too thick and callused. The pinkie (fifth finger) is a poor choice due to
the proximity to a bone. The plantar surface of the heel is used in dermal punctures on infants.
Difficulty: 1 Easy
Bloom's: Remember
7
11) If an infant has several old puncture sites, you should:
A) use the most recently punctured area.
B) use an area near the calcaneus.
C) attempt a finger puncture.
D) attempt to find an unused area.
Answer: D
Explanation: If an infant has several old puncture sites, attempt to find an unused area. Using the
same site on the heel of an infant (or the finger on a child or adult) may cause the site to become
infected if microorganisms are present in the scar tissue from the previous puncture.
Difficulty: 2 Medium
Bloom's: Understand
12) Osteomyelitis is:

A) an infection of the bone and marrow.
B) the heel bone.
C) a buildup of fluids.
D) the bottom surface, or sole, of the foot.
Answer: A
Explanation: Osteomyelitis is an infection of the bone marrow and adjacent bone. In infants,
puncturing the calcaneus, or heel bone, can cause osteomyelitis.
Bloom's: Understand
ABHES: 3.c Apply medical terminology for each specialty; 2.b Describe common diseases,
symptoms, and etiologies as they apply to each system
CAAHEP: V.C.10 Define medical terms and abbreviations related to all body systems; I.C.8.c
Identify common pathology related to each body system including: etiology
8
13) If your patient has very cold hands, what is a good method to improve blood flow for a
dermal puncture?
A) Hold the patient's hand above his/her heart.
B) Squeeze the patient's finger.
C) Warm the patient's finger with a warm cloth or tissue warmer.
D) Immediately cut across the fingerprint.
Answer: C
Explanation: Slightly warming the patient's finger with a warm cloth or tissue warmer will
enhance blood flow.
Bloom's: Understand
14) If the finger to be punctured or cut for a dermal puncture is edematous, what action should
you take?
A) Have the patient hold his hand above his heart.
B) Squeeze the patient's finger.
C) Immediately cut across the fingerprint.
D) Check the other hand to see if it is edematous also.
Answer: D
Explanation: Check the other hand to see if it is edematous also. If both hands are edematous, a
venipuncture should be attempted.
Bloom's: Understand
9
15) The force that causes fluids to flow into tubes with small diameters is:
A) hemolysis.
B) centrifugal force.
C) capillary action.
D) clotting.
Answer: C
Explanation: Capillary action causes fluids to flow into tubes with small diameters.
Difficulty: 1 Easy
Bloom's: Remember
ABHES: 3.c Apply medical terminology for each specialty
CAAHEP: V.C.10 Define medical terms and abbreviations related to all body systems
16) Safety dermal puncture devices have a blade that retracts after the device is used. Why are
these safety devices recommended?
A) They help to prevent accidental needlesticks.
B) They help to prevent hemolysis.
C) They help to prevent clotting.
D) They help to cut across the fingerprint.
Answer: A
Explanation: Safety dermal puncture devices have a blade or puncture point that retracts after
the device is used. These devices are frequently spring-loaded to control the depth and to ensure
that the blade retracts to prevent accidental needlesticks.
Bloom's: Understand
10
17) In an invasive procedure, why is it important to allow the area to dry thoroughly after
cleaning it with an alcohol pad?
A) This will prevent scarring due to contact with the alcohol.
B) This will prevent hemolysis of the blood due to contact with the alcohol.
C) This will prevent an accidental contact with the alcohol.
D) This will prevent capillary action.
Answer: B
Explanation: It is very important to allow a site to dry prior to collecting the dermal puncture
specimen. This will prevent hemolysis of the blood due to contact with the alcohol.
Bloom's: Understand
18) Why are spring-loaded devices not recommended for glucose monitoring when collecting a
sample into a microcollection container?
A) These devices are too large for routine dermal punctures.
B) These devices are for patient use only.
C) These devices hemolyze all blood samples.
D) These devices produce only two or three drops of blood.
Answer: D
Explanation: The spring-loaded devices designed for glucose monitoring produce a smaller
puncture and will provide only two or three drops of blood. Most microcollection containers
need more than two or three drops of blood to fill.
Bloom's: Understand
11
19) Will a dermal puncture cause pain to the patient?
A) No
B) Yes
C) Only dermal punctures on fingers will hurt the patient.
D) Only heelstick punctures will hurt the patient.
Answer: B
Explanation: No matter which device or site you use, a dermal puncture will cause pain. It is
better to make the first puncture deep enough, using proper technique, than to have to puncture a
second time to obtain sufficient blood.
Difficulty: 1 Easy
Bloom's: Remember
20) In collecting a dermal puncture specimen into a microcollection container, tapping the
container on a hard surface is recommended. Why?
A) It will allow the blood to mix with the anticoagulant, if present.
B) It will distract the patient and cause less pain.
C) It will allow the specimen to clot.
D) It will cause the heavier cells to drop to the bottom.
Answer: A
Explanation: Some microcollection containers have an anticoagulant additive. After each drop
enters the container, gently tap the container on a hard surface to mix the blood with the
anticoagulant. Tapping should cause the blood to flow down the side or wall of the container.
Topic: Collecting the Dermal (Capillary) Specimen
Learning Objective: 10.04 Apply the procedure for collecting a dermal (capillary) specimen.
Bloom's: Understand
12
21) If a microcollection container contains an anticoagulant additive, it is ________ to collect to
the fill line.
A) not necessary
B) optional
C) dangerous
D) critical
Answer: D
Explanation: If a microcollection container has an anticoagulant additive, it is critical to collect
to the fill line. Do not underfill or overfill the container.
Bloom's: Understand
22) Once a microcollection container with an anticoagulant additive is filled correctly, what is
the next step?
A) Apply the cap and mix by inverting the container.
B) Apply the cap and shake the container.
C) Place the container in a cold place.
D) Place the container upright on the counter.
Answer: A
Explanation: After the microcollection container is correctly filled, apply the cap to the
container and mix by inverting the container according to the manufacturer's instructions.
Bloom's: Understand
13
23) After a dermal puncture, the step before collecting blood in the microcollection container is:
A) scrape the container against the site.
B) wipe the first drop of blood away.
C) squeeze the site.
D) hold gauze against the site.
Answer: B
Explanation: The first drop of blood is not collected because it contains interstitial fluid.
Difficulty: 1 Easy
Bloom's: Remember
24) Interstitial fluid is:

A) an anticoagulant.
B) another term for blood.
C) plasma.
D) the fluid between cells and tissues.
Answer: D
Explanation: Interstitial fluid is the fluid between cells and tissues.
Difficulty: 1 Easy
Bloom's: Remember
CAAHEP: V.P.3 Use medical terminology correctly and pronounced accurately to communicate
information to providers and patients
25) Microcollection containers fill by: (Choose all that apply)

A) gravity.
B) aspiration.
C) pipetting.
D) capillary action.
Answer: A, D
Microcollection containers will fill by gravity or capillary action, depending on the size of the
collection area.
Difficulty: 1 Easy
Bloom's: Remember
14
26) The first drop of a dermal puncture contains interstitial fluid and is wiped away. Why?
A) It is contaminated with alcohol.
B) It is hemolyzed.
C) It will contaminate the specimen.
D) It is insufficient.
Answer: C
Explanation: The first drop of blood in a dermal puncture containing interstitial fluid is wiped
away because it will contaminate the blood specimen.
Bloom's: Understand
27) What is the maximum allowable volume of blood that can be collected in one dermal
puncture on a 2.2-lb infant?
A) 0.5 mL
B) 2.5 mL
C) 0.25 mL
D) 5.0 mL
Answer: B
Explanation: The maximum allowable volume in milliliters in one blood draw is 2.5% of total
blood volume or 2.5 mL for a infant that weighs 2.2 lbs.
Difficulty: 1 Easy
Bloom's: Remember
15
28) The phrase "milk the finger" means:
A) gently squeeze and release the dermal puncture site.
B) let the blood flow by gravity.
C) let capillary action fill the container.
D) force and scrape the dermal puncture site.
Answer: D
Explanation: The phrase "milk the finger" means forcing and scraping the blood from the dermal
site into the microcollection container. This method should never be used to obtain a sufficient
volume of blood because it contaminates the specimen with interstitial fluid.
Bloom's: Understand
29) Using force to push blood from a dermal puncture will contaminate the specimen with
interstitial fluid. This substance will cause:
A) hemolysis or clotting.
B) red blood cells to settle.
C) white blood cells to settle.
D) scarring.
Answer: A
Explanation: Using force to push blood from, or milking, the dermal site will not enhance blood
flow but will contaminate the specimen with interstitial fluid, causing hemolysis or clotting.
Bloom's: Understand
16
30) A dermal puncture may NOT be used to collect a specimen for:
A) glucose.
B) hemoglobin.
C) hematocrit.
D) blood cultures.
Answer: D
Explanation: A large amount of blood is necessary to perform a blood culture.
Bloom's: Understand
31) If the blood specimen from a dermal puncture is clotted before being mixed with the
anticoagulant in the microcollection container, it will be:
A) acceptable for testing.
B) mixed after collection.
C) unsuitable for testing.
D) separated before testing.
Answer: C
Explanation: If the blood specimen from a dermal puncture is clotted before being mixed with
the anticoagulant in the microcollection container, it is unsuitable for testing.
Bloom's: Understand
17
32) When collecting a dermal puncture specimen, keep the site:
A) above the patient's heart.
B) resting on the collection area.
C) at your eye level.
D) below the level of the patient's heart.
Answer: D
Explanation: When collecting a dermal puncture specimen, keep the site below the level of the
patient's heart to increase blood flow.
Bloom's: Understand
33) After you complete the dermal puncture and mix the specimens (if necessary), what is your
next step?
A) Label the microcontainers and place in the collection area.
B) Thank the patient.
C) Dispose of the contaminated safety lancet in the sharps container.
D) Wash your hands and thank the patient.
Answer: C
Explanation: After you complete the dermal puncture and mix the specimens containing
anticoagulants, dispose of the contaminated safety lancet in the sharps container.
Difficulty: 1 Easy
Bloom's: Remember
ABHES: 9.d.2 Perform capillary puncture; 9.c Dispose of biohazardous material
CAAHEP: I.P.2.c Perform: capillary puncture; XII.P.2.c Demonstrate proper use of: sharps
disposal containers
18
34) Before you place a bandage over a dermal puncture site, you should:
A) wipe the site with alcohol.
B) check the site.
C) thank the patient.
D) squeeze the site for additional blood.
Answer: B
Explanation: Check the site of the puncture before applying a bandage, when appropriate. Small
children should not have bandages applied to their fingers due to a swallowing or choking risk.
Difficulty: 1 Easy
Bloom's: Remember
35) Why should small children not have bandages applied after a dermal puncture?
A) Because of a swallowing or choking risk
B) Because of the small area punctured
C) Because it will constrict the patient's finger
D) Because the bandages become contaminated
Answer: A
Explanation: Small children should not have bandages applied to their fingers because they have
a tendency to put their fingers in their mouths and run the risk of swallowing or choking on the
bandage.
Bloom's: Understand
19
36) Osteochondritis is defined as:
A) an infection of the bone and marrow.
B) the heel bone.
C) a buildup of fluids.
D) an inflammation of bone and cartilage.
Answer: D
Explanation: Osteochondritis is an inflammation of bone and cartilage. This condition can be
one of several complications of performing a dermal puncture through a previous site. If the site
becomes infected or if microorganisms are present in the scar tissue, osteochondritis or
osteomyelitis may occur.
Difficulty: 1 Easy
Bloom's: Remember
20
37)
What is the minimum acceptable level of blood to be collected in the PST tube above?
A) 250 microliters
B) 400 microliters
C) 500 microliters
D) 600 microliters
Answer: B
Explanation: The acceptable amount of blood for the PST (light green) tube is from 400 to 600
microliters. Filling between these two marks and mixing adequately will ensure that a quality
specimen is collected. The minimum acceptable volume is 400 microliters.
Bloom's: Understand
21
38)
The microcollection containers above both have a similar characteristic. What is that
characteristic?
A) Nothing is similar between these containers.
B) Both containers have an anticoagulant.
C) Both containers have an light barrier.
D) Both containers have a separator gel.
Answer: B
Explanation: The two microcollection containers pictured contain an anticoagulant (light green
contains heparin; lavender contains EDTA). Filling between the two marks indicated and mixing
adequately will ensure that a quality specimen is collected.
Bloom's: Understand
22
39)
Which of the following characteristics do the microcollection containers above have in common?
A) None of these
B) Anticoagulant type
C) Light barrier
D) Volume collected
Answer: A
Explanation: The light green microcollection container contains heparin, has light protective
coloring, and acceptable volume collected is between 400 and 600 microliters. The lavender
microcollection container contains EDTA, does not have a light barrier, and the acceptable
volume collected is between 250 and 500 microliters. Filling between the two marks indicated
and mixing adequately will ensure that a quality specimen is collected.
Bloom's: Understand
23
40) Iatrogenic anemia is:
A) caused by drawing more than the maximum amount of blood on an infant.
B) hereditary anemia.
C) not possible on outpatient collections.
D) caused by performing venipunctures on infants.
Answer: A
Explanation: Iatrogenic anemia is the result of drawing more than the established guideline for
the maximum amount of blood that can be collected from infants and children.
Bloom's: Understand
41) What percentage of blood, when removed from a patient, may become life-threatening?
A) 1%
B) 2%
C) 5%
D) 10%
Answer: D
Explanation: Iatrogenic anemia is the result of drawing too much blood for hospital tests or
other medical procedures. If the amount of blood removed for testing exceeds 10% of the
patient's total blood volume, it could become life-threatening; this is known as exsanguination.
Bloom's: Understand
24
42) An underfilled microcollection container may have too much anticoagulant for the amount of
blood collected. What is the result?
A) It will not have enough anticoagulant and will cause microclot formation.
B) The entire specimen may clot.
C) It will alter the anticoagulant-to-blood ratio and affect test results.
D) Nothing will happen.
Answer: C
Explanation: An underfilled microcollection container may have too much anticoagulant for the
amount of blood collected and will alter the anticoagulant to blood ratio and affect test results.
Bloom's: Understand
43) If a microcollection container with an anticoagulant is overfilled, how will that affect
specimen results?
A) The specimen may have microclots or may clot.
B) The specimen may have too much anticoagulant.
C) Nothing will happen.
D) The specimen will be tested as serum.
Answer: A
Explanation: An overfilled microcollection container will not have enough anticoagulant for the
volume of blood collected and will result in microclot formation or the entire specimen may clot.
Bloom's: Understand
25
44)
The site illustrated above is not acceptable for dermal punctures. What is the medical term for
the bone that could be punctured if a dermal puncture is performed here?
A) Radius
B) Calcaneus
C) Metatarsal
D) Patella
Answer: B
Explanation: The calcaneus, or heel bone, if punctured can cause osteomyelitis.
Difficulty: 1 Easy
Bloom's: Remember
26
45)
If the tubes shown need to be collected using the order of draw, please choose the first tube to be
collected.
A) Order of draw is not necessary for these tubes.
B) neither; a discard tube is to be collected first.
C) The light green tube is to be collected first.
D) The lavender tube is to be collected first.
Answer: D
Explanation: The recommended order of draw for capillary blood collection is (1) EDTA
(lavender or pink), (2) Heparin (green, light green), (3) Sodium fluoride (gray), and (4)
Nonadditive (red) or serum separator (gold).
Bloom's: Understand
27
46)
Which additive is included in the microcollection container shown on the right?

A) There are no additives in the container on the right.
B) The container on the right has EDTA.
C) The container on the right has sodium citrate.
D) The container on the right has lithium heparin.
Answer: B
Explanation: The microcollection container on the right has the anticoagulant EDTA
(ethylenediaminetetraacetic acid). This microcollection container should be tapped on a hard
surface after each drop enters the container to mix the blood with the anticoagulant.
Difficulty: 1 Easy
Bloom's: Remember
28
47) If the calcaneus is punctured on an infant, the action may be considered:
A) negligence.
B) an error.
C) carelessness.
D) malpractice.
Answer: D
Explanation: Improper technique during a dermal puncture can be considered malpractice if the
calcaneus is punctured, creating a site for bacterial infections.
Difficulty: 3 Hard
Bloom's: Apply
CAAHEP: X.C.7.b Define: malpractice
48) If you were questioning the amount of blood withdrawn from an infant, where would you
look for that information?
A) The information is on the patient's wristband.
B) The information is in the patient's health record.
C) The information is in the laboratory's information system.
D) The information is not documented.
Answer: B
Explanation: Some facilities require anyone collecting blood specimens from infants to record
the amount withdrawn in the patient's health record or on a special document maintained at the
nursing unit.
Bloom's: Understand
29
49) The maximum depth of capillary puncture on a finger is
A) 1.0 mm
B) 2.0 mm
C) 3.0 mm
D) 4.0 mm
Answer: B
Explanation: The puncture depth for capillary puncture should never exceed 2.0 mm.
Bloom's: Apply
50) The maximum depth of capillary puncture on an infant's heel is

A) 1.0 mm
B) 2.0 mm
C) 3.0 mm
D) 4.0 mm
Answer: B
Explanation: The puncture depth for capillary puncture should never exceed 2.0 mm.
Bloom's: Apply
30

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Phlebotomy, 5e (Booth)

Chapter 10 Dermal (Capillary) Puncture

Which of the dermal punctures in this image is performed correctly?

8) The best site for a dermal puncture on the fingers is the:

12) Osteomyelitis is:

24) Interstitial fluid is:

25) Microcollection containers fill by: (Choose all that apply)

Which additive is included in the microcollection container shown on the right?

50) The maximum depth of capillary puncture on an infant's heel is

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