Deck 9: Routine Venipuncture

Question 1

When organizing equipment at the patient's 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 patient's bed.
D) have extra evacuated tubes readily available.

Answer 1

D

Question 2

A large, rigid cord located during palpation indicates:

A) an acceptable vein.
B) the brachial artery.
C) a tendon.
D) an unacceptable vein.

Answer 2

C

Question 3

All of the following are used to identify a patient except the:

A) bed sign.
B) requisition form.
C) identification band.
D) bar codes.

Answer 3

A

Question 4

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.

Question 5

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.

Question 6

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.

Question 7

The vein located on the thumb side of the arm is the:

A) brachial.
B) median cubital.
C) basilic.
D) cephalic.

Question 8

Prolonged application of a tourniquet will cause:

A) excessive bleeding.
B) difficulty locating a vein.
C) hemolysis.
D) both A and C

Question 9

Proper specimen collection begins with:

A) washing the hands.
B) locating the patient.
C) requisitioning.
D) organizing the equipment.

Question 10

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 patient's ankles.
D) look for the identification band on the nightstand.

Question 11

Before you draw a blood specimen you must always:

A) check the patient's 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.

Question 12

Failure to allow the alcohol to dry on the patient's 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.

Question 13

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.

Question 14

Basic information that should be present on all requisition forms includes all of the following except the:

A) patient's location.
B) patient's identification number.
C) tests requested.
D) type of collection tubes.

Question 15

To aid in specimen processing, requisition forms may contain:

A) special collection information.
B) the phlebotomist's initials.
C) a bar code.
D) the patient's date of birth.

Question 16

Palpate means to:

A) perform a venipuncture.
B) examine by touch.
C) examine by sound.
D) obtain a specimen from an intravenous line.

Question 17

The maximum time a tourniquet should remain on the patient's arm is:

A) 1 minute.
B) 2 minutes.
C) 3 minutes.
D) 5 minutes.

Question 18

Blood should not be drawn from a patient who is:

A) standing.
B) nervous.
C) unable to make a fist.
D) not fasting.

Question 19

The appearance of petechiae on a patient's 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.

Question 20

The vein of choice for routine venipuncture is the:

A) median cubital.
B) radial.
C) cephalic.
D) basilic.

Question 21

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 patient's arm.

Question 22

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.

Question 23

Bracing the hand holding the needle assembly against the patient's 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.

Question 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

Question 25

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

Question 26

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.

Question 27

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.

Question 28

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.

Question 29

Prior to leaving a patient's 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.

Question 30

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.

Question 31

Which specimen should be collected last?

A) STAT specimen
B) Specimen requiring special handling
C) Clotted specimen
D) Fasting specimen

Question 32

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.

Question 33

Two identifiers for patient identification before specimen collection are routinely secured by all the following means except:

A) verifying the patient's 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 patient's identification band with the information on the test requisition.

Question 34

When collecting specimens in a patient's room, tubes are routinely labeled:

A) prior to collecting the blood.
B) using preprinted labels.
C) after collecting the blood.
D) after leaving the patient's room.

Question 35

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.

Question 36

Hemoconcentration can be caused by:

A) prolonged tourniquet application.
B) intravenous therapy.
C) excessive probing.
D) failure to clench the fist.

Question 37

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.

Question 38

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.

Question 39

The veins that are the easiest to anchor are the:

A) hand veins.
B) cephalic veins.
C) basilic veins.
D) median cubital veins.

Question 40

A properly labeled tube must have all of the following information except:

A) patient location.
B) patient identification number.
C) date of collection.
D) phlebotomist's initials.

Question 41

Wireless handheld computers used to scan a bar code on the patient's 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 patient's identification has been correctly verified by scanning his or her identification band and not printed ahead of time.
D) the bar code on the patient's driver's license may be scanned for outpatients instead of scanning a wrist band.

Question 42

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
Identify the patient.

Question 43

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 patient's 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.

Question 44

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.

Question 45

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
Activate needle safety device.

Question 46

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

Question 47

Patients should be encouraged to pump their fists during venipuncture.

Question 48

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
Cleanse the site.

Question 49

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
Remove the needle and apply pressure.

Question 50

Tips to shorten the time the tourniquet is applied to the patient's 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.

Question 51

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
Anchor the vein.

Question 52

Hyperextending the patient's arm may make vein location more difficult.

Question 53

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
Label the tubes.

Question 54

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

Question 55

The most valuable piece of information on the wrist identification band is the patient's name.

Question 56

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

Question 57

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

Question 58

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
Obtain a requisition form.

Question 59

Swabbing the gloved palpating finger may aid in vein location.

Question 60

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

Question 61

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
Insert the needle.