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Chapter 5. Special Blood Collection
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. The test order with the highest priority is classified as:
A. fasting.
B. timed.
C. stat.
D. postprandial.
____ 2. A patient who is not allowed to have food or water for a specified time is classified as:
A. fasting.
B. NPO.
C. preprandial.
D. basal.
____ 3. To monitor changes in a patient’s hemoglobin level, a blood collector may be requested to collect:
A. a fasting sample.
B. samples from both arms.
C. samples at specific times.
D. a sample as soon as possible.
____ 5. Plasma cortisol levels are scheduled to be drawn between 0800 and 1000 because:
A. patients must be in a basal state.
B. patients must not be fasting.
C. cortisol exhibits diurnal variation.
D. cortisol is only produced during the morning.
____ 7. The timing for an oral glucose tolerance test (OGTT) begins:
A. after collection of the fasting sample.
B. when the patient begins drinking the glucose.
C. when the patient finishes drinking the glucose.
D. 30 minutes after the glucose is finished.
____ 10. The number of samples collected from a patient receiving a 2-hour oral glucose tolerance test
(OGTT) is:
A. one.
B. two.
C. three.
D. four.
____ 11. The samples collected during the oral glucose tolerance test (OGTT) after the patient drinks the
glucose will be analyzed at the end of the test. The samples should be collected in:
A. gray stopper tubes.
B. serum separator tubes (SSTs).
C. plasma separator tubes (PSTs).
D. red stopper tubes.
____ 12. What information should be included on a peak or trough level requisition form?
A. Time the medication was given
B. Method of medication administration
C. Time the sample was drawn
D. All of the above
____ 13. The fasting sample for an oral glucose tolerance test (OGTT) is drawn at 0700, and the patient
finishes drinking the glucose at 0745. The correct time to draw the 1-hour sample is:
A. 0800.
B. 0815.
C. 0845.
D. 0915.
____ 14. A blood collector who cannot locate the patient on whom a cortisol level is scheduled for collection
at 1000 should:
A. return the requisition to the nursing station for rescheduling.
B. request that the nursing station to call the laboratory when the patient is available.
C. collect the sample 2 hours after the patient finishes lunch.
D. reschedule the test for 1600.
____ 15. Blood cultures are performed to detect the presence of:
A. septicemia.
B. spiking fevers.
C. fever of unknown origin.
____ 16. The most important consideration when collecting a blood culture is:
A. aseptic technique.
B. the puncture site.
C. minimizing the number of sticks.
D. the amount of blood collected.
____ 17. Some blood culture collection systems contain a resin to:
A. prevent clotting.
B. inactivate antibiotics.
C. concentrate the microorganism.
D. remove skin contaminates.
____ 18. The ideal time for collecting a blood culture is:
A. just before the patient’s temperature spikes.
B. after antibiotics have been given.
C. when the patient’s white blood cell count is the highest.
D. when the patient’s temperature is the highest.
____ 19. The purpose of sodium polyanetholsulfonate in a blood culture bottle is to:
A. inhibit bacterial growth.
B. prevent clotting.
C. prevent contamination.
D. identify bacterial growth.
____ 20. When blood is inoculated into blood culture bottles using a winged blood collection set, the:
A. anaerobic bottle is inoculated first.
B. safety device is activated first.
C. aerobic bottle is inoculated first.
D. volume of blood inoculated is increased.
____ 21. To inoculate blood culture media with blood drawn in a syringe, the blood collector:
A. vents an anaerobic container.
B. inoculates an aerobic bottle first.
C. mixes the syringe before inoculation.
D. inoculates an anaerobic bottle first.
____ 22. Samples that require chilling immediately after collection are placed in a:
A. container of ice cubes.
B. container of ice and water.
C. bag of dry ice.
D. flask of cold water.
____ 23. Samples for which of the following should be protected from light?
A. Beta-carotene
B. Vitamin A
C. Bilirubin
D. All of the above
____ 26. A blood sample for DNA analysis to determine paternity is considered a:
A. routine sample.
B. timed sample.
C. legal sample.
D. postprandial sample.
____ 28. A falsely decreased blood alcohol level may be obtained if:
A. blood is collected in a gray stopper tube.
B. the site is cleansed with Zephiran chloride.
C. the tube is only partially filled.
D. the tube is overfilled.
____ 29. A blood collector on the evening shift draws a sample for cold agglutinins and places it in the
refrigerator for the morning shift. Test results of this sample will:
A. be falsely decreased.
B. be falsely increased.
C. be unaffected.
D. represent the patient’s true condition.
____ 30. A blood collector required to testify in a legal proceeding may be asked about:
A. sample collection method.
B. patient identification procedure.
C. time of collection.
D. All of the above
____ 31. Select the response that lists the major steps of the 2-hour oral glucose tolerance test (OGTT) in the
proper order.
A. Patient drinks a 75-g glucose solution within 5 minutes, a fasting glucose sample is
collected, and patient returns for an additional glucose test in 2 hours.
B. Patient drinks a 75-g glucose solution within 5 minutes, patient returns for an
____ 35. Blood collector training in the performance of arterial punctures should include which of the
following?
A. Safety precautions
B. Possible complications
C. Supervised practice
D. All of the above
____ 36. Arterial blood may be requested for which of the following?
A. Ammonia
B. PCO2
C. Lactic acid
D. All of the above
____ 38. A large artery located near the basilic vein and the median nerve is the:
A. ulnar.
B. brachial.
C. radial.
D. cephalic.
____ 39. An alternate pathway capable of supplying blood to an area if the main pathway is obstructed is
referred to as:
A. circulatory bypass.
B. collateral circulation.
C. shunt circulation.
D. an arterial fistula.
____ 40. Under normal conditions, arterial blood will have a(n):
A. higher PO2 than PCO2.
B. decreased PO2 and PCO2.
C. equal amount of PO2 and PCO2.
D. higher PCO2 than PO2.
____ 41. When performing an arterial puncture, the finger of the nondominant hand is:
A. used to anchor the artery.
B. placed where the needle enters the skin.
C. placed where the needle enters the artery.
D. used to measure the patient’s heart rate.
____ 42. Upon completion of an arterial puncture, the syringe is rotated to:
A. expel air from the syringe.
B. activate the needle safety device.
C. attach the Luer tip cap.
D. mix the anticoagulant.
____ 43. When collecting blood from an artery, the designated collector should:
A. ask the patient to make a tight fist.
B. tighten the tourniquet to stop arterial flow.
C. request a nurse to be present.
D. make sure that the patient is in a steady state.
____ 44. To achieve a steady state in a patient prior to collection of arterial blood gases, the patient should:
A. empty the bladder.
B. fast for 12 hours.
C. cough 5 to10 times to clear lungs.
D. rest for 30 minutes.
____ 46. The modified Allen test is used to determine collateral circulation in the:
A. ulnar artery.
B. brachial artery.
C. radial artery.
D. cephalic artery.
____ 47. Which of the following information is required on the requisition form when collecting arterial blood
gases (ABGs)?
A. Patient’s respiration rate
B. Type of ventilation the patient is receiving
C. Type of patient activity
D. All of the above
____ 48. When performing the modified Allen test, pressure is released from the:
A. radial and ulnar arteries.
B. ulnar and brachial arteries.
C. radial artery only.
D. ulnar artery only.
____ 49. When performing an arterial puncture, the needle is inserted bevel:
A. down at a 90-degree angle.
B. up at a 30- to 45-degree angle.
C. up at a 15- to 20-degree angle.
D. down at a 10-degree angle.
____ 50. After the artery has been entered, the syringe plunger:
A. will be pushed back by the blood.
B. should be rapidly pulled back.
C. must be rotated.
D. should be moved back and forth.
____ 51. Following arterial sample collection, pressure is applied to the puncture site for:
A. 2 minutes by the blood collector.
B. 2 minutes by the blood collector or patient.
C. 3 to 5 minutes by the blood collector.
D. 10 minutes by the blood collector or patient.
____ 52. Prior to completing an arterial puncture procedure, the blood collector should:
1. notify the nursing station.
2. check the site for hematoma.
3. check a radial pulse.
4. apply a pressure bandage.
A. 1 and 3
____ 53. A blood collector would be most likely to perform an accidental arterial puncture when attempting to
puncture the:
A. cephalic vein.
B. median cubital vein.
C. radial vein.
D. basilic vein.
____ 54. After pressure is released in the modified Allen test, if color returns to the patient’s palm within 5
seconds, the:
A. radial artery can be punctured.
B. ulnar artery can be punctured.
C. brachial artery should be used.
D. test must be repeated.
____ 56. Which of the following arterial puncture complications would cause a patient to lose consciousness
rapidly?
A. Arteriospasm
B. Nerve damage
C. Vasovagal reaction
D. Hemorrhage
____ 57. Failure to locate a radial pulse after arterial puncture of the radial artery indicates:
A. venous blood was collected.
B. the ulnar artery is occluded.
C. a possible arteriospasm.
D. the patient has expired.
True/False
Indicate whether the statement is true or false.
____ 58. When performing a glucose tolerance test (GTT), the fasting blood sample is tested before the
patient drinks the glucose.
____ 60. Administering a local anesthetic before performing an arterial puncture may interfere with arterial
blood gas (ABG) results.
Matching
Match the following arterial puncture complications with the possible cause or collection error.
A. Arteriospasm
B. Hematoma
C. Hemorrhage
D. Infection
E. Nerve damage
F. Vasovagal reaction
MULTIPLE CHOICE
TRUE/FALSE
MATCHING
Title: Gloria
Illustrator: C. M. Relyea
Language: English
Credits: Al Haines
BY C. M. RELYEA
NEW YORK
DODD, MEAD AND COMPANY
1910
COPYRIGHT, 1910, BY
DODD, MEAD AND COMPANY
CHAPTER
ILLUSTRATIONS
"I've got some sort of an idea," he said at length (page 122) ... Frontispiece
"The lady wants to be seen home—and I'm going to do it if I swing for it!"
"If I see so much as an inch of blade, this little hand-grenade of mine will
play havoc with your handsome features"
"I drink to our success to-night, I drink to the devil in the devil's own
tipple"
CHAPTER ONE
THE PATIENT AND HIS DOCTOR
To his vexation, however, he found that others likewise had left their
seats. In fact, the general exodus had already set in before, even, he had
reached the top of the aisle. And yet, despite his being thoroughly aware
that any attempt to pass from one side of the house to the other was sure to
be resented,—so delirious is the haste in which a metropolitan audience
takes leave of the theatre for the invariable restaurant-supper after the play,
—he continued to make strenuous efforts to cut his way through, until
realising, finally, that it was useless, he let himself be borne along by the
crowd. But his chance came when the carriage-vestibule on Sixty-Fifth
Street was reached. And there, quick to take advantage of an almost
imperceptible cessation of the onward movement—consequent upon the
people searching the ingeniously-devised board to ascertain whether the
desired motors or carriages headed the long line—he again started in to
elbow his way through the crush; and so successfully this time that
presently comparatively few persons separated him from an undeniably
blond and dashing young woman, in a magnificent opera-cloak of Russian
sables, who was laughing and chatting with half a dozen or more vapid
youths while following the lead of a portly and somewhat red-faced old
gentleman.
So far his task had been easy enough. But at the fateful moment, face to
face with his divinity, and doubtless for the first time perceiving that no
relenting glance softened the faultless contours of her carven features, that
no spark of warmth glinted in her big, blue eyes,—eyes that, on the
contrary, were brimful of scornful laughter,—his indomitable spirit failed
him utterly, was crushed, for once, at least, and he stood gaping at her, to
everyone's surprise, more like a country yokel than the man-of-the-world
that he undoubtedly was. For the briefest of intervals he remained thus. And
then, apparently pulling himself together, he suddenly wheeled round on his
heel, and shouldering his way through the press,—heedless alike of a
friendly hail, which came in an unmistakably English accent from someone
back in the crowd, and of the protesting looks, if not words, of the people
he jostled,—he left an ostentatiously, almost vulgarly, ornate limousine to
slam its door and move rapidly away with its fair occupant and her
admirers.
Into Central Park West the young man turned and walked north. Despite
a heavy fur overcoat, his gait was extraordinarily fast, and his face appeared
white, almost ghastly, in the thin, yellow fog that was pushing its way under
his eyelids, into the penetralia of nose and ears, and depositing superfluous
matter on his lungs, larynx, and reckless expanse of linen. A few blocks
above the theatre he came to a small apartment-hotel, mounted at a run to
the first floor, and quickly entering the sitting-room of the suite, he
carelessly tossed his irreproachable high hat on to a lounge. Then he went
over to a window and stood gazing out at the sea of fog before drawing the
curtain against the gamboge of the December evening. And his countenance
was at once savage and inexpressibly sad.
Throwing off his coat, Trafford fumbled in his waistcoat for a key. A
moment later he was opening a small mahogany medicine-cupboard that
was fixed against the wall over his book-case. His searching hand groped
about in its recesses and then brought out—something. For a second he held
this "something" at arms length, conning it with curious eyes, as a dilettante
might study a precious cameo, or a bit of rare porcelain.
Then he put it carefully on the table. The electric light shone on a small,
compact object, dark of colour and sinister of shape—a revolver!
Nervy Trafford took pen and paper and wrote; and as he wrote the
curious light grew in his wild eyes, and a sad smile played about his
sensitive mouth.
"Dearest," he began:—"You say you can never love me. I say that I can
never cease to love you. You have spoken a lie, even as I have spoken the
truth, for when the mists of life are dispelled by the glorious radiance
beyond the grave, you will love me as I love you, perfectly, entirely, with the
triple majesty of soul, mind and spirit. Till then, farewell.
So this was to be his end!—an ending, he well knew, that none of his
friends had ever dreamed of. A man on whom advice was thrown away,
who seldom if ever thought twice, in other words, a creature of impulse, yes
—they would admit all that; but on the other hand would they not recall
many instances of his extricating himself from tight places through nothing
else but this very impulsiveness and nerve of his? Inevitably, then, they
would refuse to believe that a man like that, however hopeless his
infatuation, would take his own life. All of which merely goes to show how
ridiculous it is for our best friends to scoff at the notion that an affair of the
heart may be taken seriously.
Trafford's arm fell limp to his side, and a look of sick pain shuddered
across his face. Then, an idea, a wafted air of recollection, fanned the light
of understanding into his dull eyes. A ghost of a smile hovered at the corner
of his lips, and again the cold hand raised the deadly mechanism to his
pulsing temple. Even as it did so the door of his room was opened, and with
a gesture of annoyance Trafford tossed the unused weapon on to the table
and facing the intruder burst out with:
"Who on earth——"
"Hullo, Nervy, old chap!" was the familiar greeting that came from a big
and genial man, clean-shaved, about thirty years of age, and dressed
seasonably in a dark, astrachan-trimmed overcoat. In a word, the speaker
was a faultlessly attired Englishman, whose great frame and smiling
features seemed to bring into the tragic atmosphere a most desirable air of
commonplace.
"The same," affirmed the other, throwing off his overcoat and sinking
lazily into the most comfortable chair he could find; "Robert Saunders, old
cricket blue, devoted husband of a peerless wife, the friend of kings and the
king of friends—voila!"
"What in the deuce are you doing over here? How did you find——"
"As bad as that?" he asked. He was genuinely shocked, but his tone was
commonplace, almost casual.
"Oh, yes it is," returned Saunders bluntly, extracting the letter from its
envelope. "Sit down, sick man, and wait until I have diagnosed your case."
"Angela Knox!" repeated Saunders cruelly. "Ye gods! Oh, yes, I know
the lady. We met her at Newport—a big, buxom blonde, with the intellect of
a sparrow. Tissue, tissue, my boy, and no soul! Features, millions also, I
concede, but no sense of humour. In six weeks she would bore you; in six
months you would bore her; in a year the machinery of the law—your
obliging American divorce courts——"
"Silence!" roared Trafford. "You would poke fun at the holiest corner of
a man's heart. I tell you, Bob, I so love this woman that had it not been for a
miracle, I should have died five minutes ago with her name on my lips."
"Miracle number two," replied the American, sinking into a chair. "That
gun was kept for burglars. To preclude the possibility of an accident through
some fool of a servant's mishandling, I kept the first chamber empty. Idiot
that I am!—I forgot the precaution. But a second and doubtless more
conclusive attempt would have been made had not you butted in——"
"And for Angela Knox!" cried Saunders with an unfeeling grin. "Now
had it been a brunette——"
"So I'm to take you seriously, Nervy? Well, then, listen, my dear,
irresponsible, melodramatic friend. Love is a wonderful thing. It is rightly
considered the beginning and the end of all things. I say so, moi qui vous
parle, though I've been married nearly two years. But this infatuation—this
calf-love of yours for a hypertrophied blonde with the conversational
powers of a turnip, is, ipso facto, ridiculous. You will love some day, friend
of my youth, but if your love is unrequited you will not turn to the revolver
for solace."
"I mean," went on Saunders with slow emphasis, "that if you demand
what your heart really desires and the response is 'no,' you will, in the words
of the prehistoric doggerel, try, try again. Love that accepts defeat is an
unhealthy passion; Love that tries to find relief in death is a disease. You are
diseased, cher ami. Buck up! and listen to the words of your good doctor."
"Good! To begin with, you are sound physically. Muscles firm, energy
splendid, and your tongue would probably shame a hot-house geranium.
But your psychic self is out of gear. Wheels are racing in your poor old
brain! Little troubles become great tragedies! Vital things seem small and
insignificant! You need a potent remedy."
"Let it come over speedy then!" the American replied with some show
of interest.
"Not a bit of it! Why, old man, you'll forget the very meaning of the
word boredom. You're a skater?—well, then, why not enter for the King's
Cup which is skated for on the King's birthday—the second Saturday of the
New Year at Weidenbruck. If you're beaten, as is probable,—for the
Grimlanders are a nation of skaters,—there is tobogganing, curling, ski-ing
and hockey-on-the-ice to engross your mind. All are exhilarating, most are
dangerous. Furthermore, you will have my society—as my wife and I will
be guests of King Karl at the Neptunberg. However, for you, since you have
not my advantages, I recommend the Hôtel Concordia. You will sail with us
to-morrow?" he wound up confidently.
"Wait till you've got a pair of skates on your feet and the breath of zero
air in your nostrils! Wait till you've had a toss or two ski-ing, and a spill on
the 'Kastel' toboggan run! There will be meaning enough in things then."
"It's a go, then!" declared Trafford, but without enthusiasm. "I'll make a
getaway."
"The Lusitania to-morrow," he said in far heartier tones than he had yet
employed. "Till then——" He held the other's hand in a long grip.
"And you don't balk at leaving me with that?" Trafford pointed with a
pale smile at the revolver on the table.
"Not in the least," laughed Saunders. "Take it abroad with you. Only, get
out of the habit of leaving the first chamber empty. Such a practice might be
fatal in Grimland."
CHAPTER TWO
"I can't see that this is such a vast improvement on little old New York!"
was Trafford's growling comment as he strolled the streets of Weidenbruck
the evening of his arrival.
"Ah, but Weidenbruck is the city of the plain!" returned Saunders, who
was accompanying him in his perambulations. "As soon as this skating
competition is over——"
"Hot," retorted the other. "At Weissheim the sun shines unobscured by
mist. The air there is dry and bracing. The thermometer may stand at zero,
but your warm gloves will be a mockery, your great coat an offence."
A gust from a side street blew a whirl of powdered snow in the faces of
the two men. Trafford buried his chin in the warm collar of his overcoat; he
swore, but without undue bitterness. The cold indeed was poignant, for the
unfrozen flood of the Niederkessel lent the atmosphere a touch of moisture
that gave malice to the shrill frost, a penetrating venom to the spiteful
breeze that swept the long length and broad breadth of the straight, prosaic
Bahnofstrasse. The trams that rushed noisily up and down this thoroughfare
were the only things that still moved on wheels. Cabs, carriages, omnibuses,
perambulators even, had discarded wheels in favour of runners; and arc-
lamps shone coldly from an interminable line of iron masts, while a cheerier
glow blazed from the windows of innumerable shops which still displayed
their attractive wares for the benefit of the good citizens of Weidenbruck,
who have raised the science of wrapping up to the level of a fine art.
"The latter I can dispense with. Cut it out!" the American exclaimed
with much bitterness, and then went on: "I did not come to Grimland
merely for sport, as you well know, but because you hinted at political
troubles. Moreover, I have taken your advice literally, and have brought my
gun along."
"Keep it loaded then," said Saunders curtly. "I hear Father Bernhardt has
returned."
"A renegade priest. In the troubles of 1904 he eloped with the Queen,
who had been plotting her husband's downfall with the Schattenbergs."
"Yes, kinsmen of King Karl's who have always cherished a secret claim
to the throne. They very nearly made their claim good, too, in 1904."