Deck 6: Dermal Puncture

Question 1

Warming the site of a dermal puncture will:

A) increase the flow of venous blood to the site.
B) increase the flow of arterial blood to the site.
C) increase the possibility of hemolysis.
D) produce excess tissue fluid contamination.

Answer 1

B

Question 2

When warming a dermal puncture site,the temperature should not exceed:

A) 32°C.
B) 42°C.
C) 52°C.
D) 62°C.

Answer 2

B

Question 3

Capillary punctures on newborns are performed on the:

A) index finger.
B) plantar area of the heel.
C) back of the heel.
D) earlobe.

Answer 3

B

Question 4

Collection of a complete blood count (CBC) by dermal puncture is most likely to be requested for a patient:

A) receiving chemotherapy.
B) with poor circulation.
C) with coronary artery disease.
D) receiving allergy injections.

Question 5

Using a lancet that produces a puncture deeper than recommended may cause:

A) septicemia.
B) hemolysis.
C) osteomyelitis.
D) sample contamination.

Question 6

The maximum safe length of lancets used for heel puncture is:

A) 1.5 mm.
B) 2.0 mm.
C) 2.75 mm.
D) 3.4 mm.

Question 7

Which of the following are microsample collection containers?

A) Heparin capillary tubes
B) Microtainer tubes
C) Micropipettes
D) All of the above

Question 8

Blood collected by dermal puncture most closely resembles:

A) venous blood.
B) anticoagulated blood.
C) arterial blood.
D) clotted blood.

Question 9

The major vascular area of the skin is located in the:

A) dermal layer.
B) cutaneous layer.
C) soft tissue.
D) dermal-subcutaneous juncture.

Question 10

Alternating between venipuncture and dermal puncture collection techniques is not recommended when comparing test results for:

A) bilirubin.
B) hemoglobin.
C) reticulocytes.
D) glucose.

Question 11

Which of the following are reasons why hemolysis is seen more frequently in samples collected by dermal puncture than by venipuncture?

A) Red blood cells of newborns are more fragile.
B) Newborns have high red blood cell counts.
C) Excessive squeezing may have been used.
D) All of the above

Question 12

Which of the following pairings is incorrect?

A) Thumb and calluses
B) Index finger and increased nerve endings
C) Third finger and increased possibility of bone puncture
D) Fifth finger and decreased tissue mass

Question 13

Dermal puncture is preferred over venipuncture in infants because:

A) superficial veins may not be large enough.
B) collection from deep veins is dangerous.
C) restraining the child can cause injury.
D) All of the above

Question 14

Selection of an improper heel puncture site can result in:

A) puncture of the calcaneus.
B) sample hemolysis.
C) the need for vigorous massaging.
D) increased blood flow.

Question 15

The depth of a dermal puncture must be controlled to:

A) prevent hemolysis.
B) ensure adequate blood flow.
C) prevent contact with bone.
D) obtain a representative sample.

Question 16

Which of these complications is associated with deep vein puncture in infants?

A) Danger to nearby organs
B) Venous thrombosis
C) Reflex arteriospasm
D) All of the above

Question 17

Collection of a sufficient amount of blood by dermal puncture is most difficult from:

A) obese patients.
B) geriatric patients.
C) severely dehydrated patients.
D) patients performing home glucose monitoring.

Question 18

To obtain the best flow of blood from a dermal puncture,the blood collector should:

A) alternately apply and release pressure to the site.
B) tightly squeeze the area above the site.
C) frequently wipe the site with alcohol.
D) firmly massage the area around the puncture site.

Question 19

The calcaneus is located at the:

A) posterior of the heel.
B) arch of the foot.
C) plantar surface of the heel.
D) lateral curvature of the heel.

Question 20

Collection of excess blood from a premature infant could cause:

A) hemorrhage.
B) venous thrombosis.
C) anemia.
D) gangrene.

Question 21

During dermal puncture,the first drop of blood is wiped away because it may be:

A) diluted with tissue fluid.
B) already clotted.
C) too concentrated because blood has not been flowing.
D) contaminated with skin bacteria.

Question 22

The major concern when determining the order of draw for a dermal puncture is the:

A) speed of sample collection.
B) amount of blood needed.
C) ability to adequately mix the sample.
D) adherence of platelets to the puncture site.

Question 23

Excessive squeezing of a dermal puncture site can cause which of the following?

A) Bruising of the area
B) Tissue fluid contamination
C) Hemolysis
D) All of the above

Question 24

A health-care provider questions the low bilirubin result on a jaundiced baby.This discrepancy may be due to:

A) puncturing too deeply into the heel.
B) exposing the sample to the bili light.
C) collecting in an amber container.
D) collecting too much blood.

Question 25

Reasons for selecting the fleshy areas located near the center of the third and fourth fingers on the palmar side of the nondominant hand as preferred sites for finger puncture include which of the following?

A) There is decreased tissue in the fifth finger.
B) Calluses may be present on the thumb.
C) The index finger naturally contains increased nerve endings.
D) All of the above

Question 26

Order of collection for a hematocrit,blood smear,and glucose by dermal puncture is:

A) hematocrit,glucose,and blood smear.
B) blood smear,hematocrit,and glucose.
C) glucose,hematocrit,and blood smear.
D) glucose,blood smear,and hematocrit.

Question 27

Vigorous massaging of the area during dermal puncture will result in:

A) decreased blood flow to the site.
B) a hematoma.
C) sample contamination by tissue fluid.
D) increased glucose results.

Question 28

A bilirubin collected from a jaundiced infant has a normal result.This result:

A) should be expected because the infant is jaundiced.
B) may indicate that the sample was collected under the bili light.
C) can be accepted if a control has been run.
D) should be called immediately to the health-care provider.

Question 29

The presence of air bubbles will most seriously affect a:

A) bilirubin collected in a Caraway pipette.
B) complete blood count (CBC) collected in a microcollection tube.
C) hematocrit collected in a microhematocrit tube.
D) blood gas collected in a micropipette.

Question 30

Amber-colored Microtainer tubes are used to collect samples for:

A) glucose.
B) thyroid tests.
C) platelet counts.
D) bilirubin.

Question 31

Newborns who appear jaundiced:

A) have increased red blood cells.
B) are always premature.
C) have increased bilirubin levels.
D) will develop liver disease.

Question 32

Laws in all U.S.states require testing for which of the following diseases in newborns using a heel stick sample?

A) Galactosemia
B) Congenital hypothyroidism
C) Phenylketonuria (PKU)
D) All of the above

Question 33

Which of the following can affect the quality of newborn bilirubin results?

A) Hemolysis
B) Exposure to light
C) Collection at the wrong time
D) All of the above

Question 34

A blood collector is recollecting a dermal puncture sample because of hemolysis.The patient complains about a stinging sensation from the first puncture.The most probable cause of the hemolysis in the first sample is:

A) not allowing alcohol to dry.
B) excessive massaging.
C) vigorous mixing of the microcollection tube.
D) use of a small lancet.

Question 35

The order of draw for a bilirubin,blood smear,and complete blood count (CBC) by dermal puncture is:

A) CBC,blood smear,and bilirubin.
B) blood smear,CBC,and bilirubin.
C) bilirubin,blood smear,and CBC.
D) blood smear,bilirubin,and CBC.

Question 36

How many attempts should a blood collector make to obtain an adequate amount of blood by dermal puncture before requesting assistance from another blood collector?

A) One
B) Two
C) Three
D) Four

Question 37

Following a dermal puncture,the blood collector should first:

A) prepare the blood smear.
B) massage the site.
C) wipe away the first drop of blood.
D) fill the lavender stopper Microtainer.

Question 38

Upon completion of a heel puncture on a 4-month-old infant,which of the following actions are acceptable?

A) Raising the heel and applying pressure
B) Placing capillary pipettes in a large tube for transport
C) Thanking the parents for their cooperation
D) All of the above

Question 39

To produce a rounded drop of blood,finger punctures should be made:

A) on the index finger.
B) on the fingerprint.
C) before the alcohol is dry.
D) across the fingerprint.

Question 40

Failure to puncture across the fingerprint during a finger puncture will cause:

A) blood to run down the finger.
B) hemolysis.
C) contamination of the sample.
D) additional patient discomfort.

Question 41

Failure to wipe away the first drop of blood when collecting a newborn filter paper screening test could:

A) cause a false-negative result.
B) enhance bacterial growth.
C) destroy the filter paper.
D) cause a false-positive result.

Question 42

Which of the following statements about newborn filter paper screening tests is true?

A) One large drop of blood is used to fill a circle.
B) Stacking of samples will cause cross-contamination.
C) Samples are dried in a suspended,horizontal position.
D) All of the above

Question 43

Microhematocrit capillary tubes are held horizontally while being filled.

Question 44

Scraping a microcollection tube across the puncture site is acceptable if the first drop of blood has been wiped away.

Question 45

The width of the dermal puncture is more important than the depth to produce adequate blood flow.

Question 46

Failure to completely fill the filter paper circle for a newborn screening test:

A) is only important for phenylketonuria (PKU) tests.
B) can cause a false-positive result.
C) can cause a false-negative result.
D) occurs when the circle has been contaminated.

Question 47

Microcollection tubes are color-coded in the same way as evacuated tubes.

Question 48

Which is the right way to handle samples for filter paper newborn screening tests?

A) Stack samples after drying
B) Dry samples in sunlight
C) Suspend samples horizontally to air-dry
D) Stack samples while they are drying

Question 49

Puncturing through a previous puncture site may cause an infection.

Question 50

All U.S.states require testing of newborns for:

A) Down syndrome.
B) cystic fibrosis.
C) sickle cell anemia.
D) phenylketonuria.

Question 51

The patient identification number is not required on microcollection tube labels.

Question 52

A microhematocrit tube with a red band contains the same additive as a red stopper Microtainer.

Question 53

Microcollection tubes containing separation gel are available.

Question 54

When collecting newborn filter paper screening tests,blood should be visible on both sides of the filter paper.

Question 55

Samples for newborn filter paper tests are collected from the:

A) plantar area of the heel.
B) volar surface of the arm.
C) back of the heel.
D) arch of the foot.

Question 56

Bandages are not recommended for newborns following heel puncture.

Question 57

Puncture devices should be firmly placed on the skin before activation.

Question 58

The acceptable amount of blood used to fill a filter paper circle for newborn screening tests is:

A) one drop.
B) three drops.
C) 0.5 mL.
D) 1.0 mL.