Test Bank for Essentials of Medical Laboratory Practice, 1st Edition, Constance L Lieseke, E

Test Bank for Essentials of Medical Laboratory

Practice, 1st Edition, Constance L Lieseke, Elizabeth
A Zeibig,

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Chapter 8: Collection and Processing of Blood Samples

Matching

Match the most appropriate method of venipuncture with each situation. Some methods of
venipuncture may be used more than once or not at all.
A. Evacuated tube system
B. Winged Infusion set
C. Syringe System
____ 1. 20-year-old healthy male
____ 2. 9-year-old male, dehydrated from several days of vomiting
____ 3. 75-year-old male, excessive bruising in antecubital area from anticoagulant use and repeat blood
draws, small hand veins
____ 4. 50-year-old female, blood draw ordered for routine yearly physical
____ 5. 3-year-old healthy male

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

____ 6. When blood enters the heart from the systemic circulation, which chamber does it enter first?
A. Left ventricle
B. Right atrium
C. Left atrium
D. Right ventricle
____ 7. A butterfly system may be preferred to a blood draw in this situation:
A. Drawing blood from a vein in the back of the hand
B. Drawing from the median cubital vein on a healthy adult
C. Drawing blood from a small child
D. A and C
E. None of the above
____ 8. Which of these is a good practice when drawing blood from a child?
A. Request assistance from the adult who brought the child
B. Speak to the child directly using calming words he or she can understand
C. Prepare the venipuncture supplies quickly, and try not to show the child the needle
until immediately before the puncture
D. All of the above
____ 9. One way to avoid negative outcomes when drawing blood may be:
A. Anchoring veins firmly when inserting the needle
B. Puncturing a vein on both sides by going through the vein with the needle
C. Using the evacuated tube system for all draws, regardless of vein integrity or
location
 D. Drawing from the basilic vein
____ 10. Which of these terms usually describes an inappropriate blood specimen?
A. Serum
B. Hemolysis
C. Plasma
D. Whole blood
____ 11. A mass of blood caused by damage to a blood vessel is called:
A. Hematoma
B. Hemoconcentration
C. Hemolysis
D. Vasodilation
____ 12. Which of these tubes should be drawn last when performing a blood draw using the evacuated tube
system?
A. Gray-top tube
B. Light blue–top tube
C. Lavender-top tube
D. Green-top tube
____ 13. A peripheral blood smear may be utilized in this way:
A. To analyze the hematocrit level
B. To identify the types and percentages of the various types of white cells
C. To perform coagulation testing
D. To perform clinical chemistry testing
____ 14. When considering the veins of the antecubital area for a blood draw, the first vein of choice is the:
A. Basilic vein
B. Cephalic vein
C. Median cubital vein
D. Brachial vein
____ 15. Tubes that contain thixotropic gel to separate plasma from cells are ________ tubes.
A. SST
B. Lavender top
C. Microcollector
D. PST
____ 16. Which type of specimen may appear cloudy after centrifugation and is unacceptable for many
chemistry testing procedures?
A. Lipemic
B. Plasma
C. Serum
D. Whole blood
____ 17. Which of these structures is not part of the cardiovascular system?
A. Venules
B. Valves
 C. Capillaries
D. Alveoli
____ 18. Heparin is present as an anticoagulant in which tube?
A. Lavender-top tube
B. Gray-top tube
C. Green-top tube
D. Light blue–top tube
____ 19. Sodium citrate is present as an anticoagulant in which tube?
A. Lavender-top tube
B. Gray-top tube
C. Green-top tube
D. Light blue–top tube

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

____ 20. Many automated CLIA-waived tests utilizing point-of-care testing require capillary blood samples
for testing.

____ 21. Red cell morphology and various white cell types can easily be identified on a blood smear that is
properly created and stained appropriately.

____ 22. When drawing blood from geriatric patients, it may be necessary to collect a smaller specimen
volume than you would from a young adult.

____ 23. When preparing a peripheral blood smear for staining, a large drop of blood directly from a
capillary puncture is necessary.

____ 24. Veins have valves that help to move the blood through the system.

____ 25. All laboratory tests may be performed by obtaining a capillary sample.

____ 26. Edematous areas must be avoided when performing venipuncture.

____ 27. The most important aspect of the collection procedure is patient identification.

____ 28. Only lavender-top tubes require inversion after collection to avoid clot formation.

____ 29. Laboratory tests that require plasma for testing may be obtained using any tube with anticoagulant
added.

____ 30. Not all tests can be performed on samples collected from capillary puncture into microcollection
tubes.

____ 31. Reference ranges for arterial, venous, and capillary samples are often different.
Completion
Complete each statement.

32. The _______________ keep the blood in the heart and the veins from flowing backwards.

Short Answer

33. When preparing to draw blood for a CBC on an elderly female patient, the medical assistant sees a
large vein in her antecubital area. The MA quickly cleans the site, applies a tourniquet, and
attempts a blood draw. She is not successful with the blood draw, even though she feels certain
that the needle is within the vein.
What important step did the MA skip when she started the process that may have resulted in a
successful blood draw?

34. Emma is a new medical assistant who has been called to the laboratory area in a busy family
practice clinic because the lab is so busy. The regular lab employee has been drawing patients one
after another for the past 2 hours and has not had an opportunity to process any of the samples so
that they can be transported to the reference laboratory when the courier comes to pick them up.
She asks Emma to help with the specimen processing.
Emma gathers all the red-top and tiger-top tubes that are in the specimen rack and puts them into
the centrifuge to begin spinning. She is very careful to balance the centrifuge appropriately,
because she remembers that this was an important part of the process emphasized in lab class in
school.
When the centrifuge has completed the cycle, Emma removes the tubes. She notices that two of the
tiger-top tubes do not look like the others. The part of the tube where plasma should be evident is
somewhat cloudy and solid, and she is not able to separate off much plasma when she attempts to
pour the specimen into another transfer tube.
What is a likely explanation for the appearance of these tubes? What could Emma have done to
avoid this problem?

35. Cora Lydell learned phlebotomy as part of her medical assistant training a few years ago. She has
not worked in the laboratory environment since that time, but today her office manager asked her
to work in the lab because of some staffing issues. Cora’s morning is uneventful until a few hours
after she starts her shift. A patient comes in with orders for coagulation studies, iron levels, a CBC,
and electrolytes. Cora remembers that there is a certain order of draw that should be performed,
but she cannot remember which tube should be drawn in what order. She decides to draw the
tiger-top tube required for the iron studies first, then the lavender-top tube for the CBC, followed
by the green-top tube for the electrolytes.
Did Cora follow the correct order of draw?
Chapter 8: Collection and Processing of Blood Samples
Answer Section

MATCHING

1. ANS: A PTS: 1 KEY: Blooms: Evaluating | Outcome: 8-9

2. ANS: B PTS: 1 KEY: Blooms: Evaluating | Outcome: 8-9
3. ANS: B PTS: 1 KEY: Blooms: Evaluating | Outcome: 8-9
4. ANS: A PTS: 1 KEY: Blooms: Evaluating | Outcome: 8-9
5. ANS: B PTS: 1 KEY: Blooms: Evaluating | Outcome: 8-9

MULTIPLE CHOICE

6. ANS: B
Blood follows a specific route as it passes through the heart. The first chamber encountered is the
right atrium.

PTS: 1 KEY: Blooms: Remembering | Outcome: 8-2

7. ANS: D
A butterfly (winged infusion set) may be preferable for a blood draw from the back of the hand or
for drawing blood from a small child because of the smaller needle diameter and length and
increased flexibility of the device.

PTS: 1 KEY: Blooms: Understanding | Outcome: 8-9

8. ANS: D
Dealing with children may be challenging, and every effort should be made to communicate
effectively with the child and his or her parent to help with the process. Showing the needle to the
child in many situations will increase the anxiety of the patient.

PTS: 1 KEY: Blooms: Evaluating | Outcome: 8-12

9. ANS: A
Anchoring of the vein is essential to keeping it from moving out of the way with needle insertion.

PTS: 1 KEY: Blooms: Evaluating | Outcome: 8-20

10. ANS: B
If a blood specimen is grossly hemolyzed, it is inappropriate for many laboratory testing
procedures.

PTS: 1 KEY: Blooms: Remembering | Outcome: 8-19

11. ANS: A
Hematoma formation is the result of blood leaking from the vein during or immediately after the
blood draw.

PTS: 1 KEY: Blooms: Remembering | Outcome: 8-1

 12. ANS: A
The order of draw must be followed to avoid contamination with unwanted anticoagulants and
potential erroneous chemistry results.

PTS: 1 KEY: Blooms: Remembering | Outcome: 8-11

13. ANS: B
Blood smears may be utilized in several ways, but the most common reason for them to be set up
is to identify the types and percentages of the various types of white cells.

PTS: 1 KEY: Blooms: Understanding | Outcome: 8-16

14. ANS: C
The median cubital vein is the best anchored and often is the largest vein in the antecubital area.

PTS: 1 KEY: Blooms: Evaluating | Outcome: 8-5

15. ANS: D
PST stands for plasma separator tube.

PTS: 1 KEY: Blooms: Remembering | Outcome: 8-1

16. ANS: A
Lipemic specimens have excess fat floating in the specimen. The presence of these molecules
make the specimen unacceptable for many chemistry testing procedures.

PTS: 1 KEY: Blooms: Remembering | Outcome: 8-19

17. ANS: D
Alveoli are located in the lungs; they are not part of the cardiovascular system.

PTS: 1 KEY: Blooms: Remembering | Outcome: 8-1

18. ANS: C
Each tube type (differentiated by the color of the tube top) is unique as to the additive present in
the tube. Heparin is in the green-top tubes as an anticoagulant.

PTS: 1 KEY: Blooms: Remembering | Outcome: 8-10

19. ANS: D
Each tube type (differentiated by the color of the tube top) is unique as to the additive present in
the tube. The light blue–top tubes include sodium citrate.

PTS: 1 KEY: Blooms: Remembering | Outcome: 8-10

TRUE/FALSE

20. ANS: T
Capillary blood is acceptable for many of the CLIA-waived testing procedures; some of them may
also be performed using whole blood collected via venipuncture.

PTS: 1 KEY: Blooms: Understanding | Outcome: 8-13

21. ANS: T
The differentiation of the types of white cells present and the morphology of the red cells are two
of the most common assessments performed on a stained blood smear.

PTS: 1 KEY: Blooms: Understanding | Outcome: 8-16

22. ANS: T
Care should be taken to only collect what is needed, especially from patients with complicated
health issues or those who require frequent blood draws.

PTS: 1 KEY: Blooms: Understanding | Outcome: 8-12

23. ANS: F
Anticoagulated venous blood may also be used.

PTS: 1 KEY: Blooms: Understanding | Outcome: 8-16

24. ANS: T
Blood is moved through veins using the valves and also the action of the skeletal muscles.

PTS: 1 KEY: Blooms: Remembering | Outcome: 8-3

25. ANS: F
Many laboratory tests require larger specimen volumes than those attainable through capillary
puncture.

PTS: 1 KEY: Blooms: Remembering | Outcome: 8-13

26. ANS: T
Edema is present when trapped fluid is present between the cells. If possible, these areas should be
avoided when performing a venipuncture.

PTS: 1 KEY: Blooms: Understanding | Outcome: 8-7

27. ANS: T
If a patient is not identified properly, the rest of the collection process (and subsequent testing and
reporting procedures) is all without value.

PTS: 1 KEY: Blooms: Evaluating | Outcome: 8-15

28. ANS: F
All tubes with additives should be inverted after collection.

PTS: 1 KEY: Blooms: Remembering | Outcome: 8-19

29. ANS: F
Specific types of anticoagulants are necessary for chemical testing. A laboratory directory should
be consulted to verify the required specimen type.

PTS: 1 KEY: Blooms: Evaluating | Outcome: 8-19

30. ANS: T
For instance, coagulation studies cannot be performed on specimens collected into microcollection
tubes.
Test Bank for Essentials of Medical Laboratory Practice, 1st Edition, Constance L Lieseke, E

PTS: 1 KEY: Blooms: Understanding | Outcome: 8-19

31. ANS: T
Reference ranges may vary dependent on the type of specimen collected (venous, arterial, or
capillary).

PTS: 1 KEY: Blooms: Evaluating | Outcome: 8-6

COMPLETION

32. ANS:
valves
Rationale: Valves are critical to avoid backflow.

PTS: 1 KEY: Blooms: Remembering | Outcome: 8-2

SHORT ANSWER

33. ANS:
The medical assistant should have palpated the vein before continuing with the process. Many
veins may appear to be appropriate for an invasive procedure, but palpation must always be part of
the selection process to choose the best vein.
Rationale: Palpation is always necessary when making a choice for a venipuncture site.

PTS: 1 KEY: Blooms: Applying | Outcome: 8-14

34. ANS:
The specimens in the tiger-top tubes were probably not allowed to clot fully after they were drawn.
Emma should have verified the time of draw before she put the tubes in the centrifuge. She could
also have tilted the tubes to check for clot formation, after which she could have allowed them to
sit longer if they were not fully clotted before centrifugation.
Rationale: Tiger-top tubes need to clot thoroughly before centrifugation to allow for complete
separation of the formed elements from the liquid portion of the blood.

PTS: 1 KEY: Blooms: Applying | Outcome: 8-17

35. ANS:
No, Cora did not follow the correct order of draw.
Rationale: She should have drawn the light blue–top tube first for the coagulation studies,
followed by the tiger-top tube, the green-top tube, and finally the lavender-top tube. She may have
problems because of cross-contamination of the anticoagulants, especially for the tube
immediately following the lavender-top tube.

PTS: 1 KEY: Blooms: Applying | Outcome: 8-11

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