Blood Collection A Short Course 3rd

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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.

____ 4. A glucose tolerance test is performed to diagnose or evaluate:

A. hypoglycemia.
B. diabetes insipidus.
C. diabetes mellitus.
D. Both A and C

____ 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.

____ 6. Peak and trough levels are collected to monitor:

A. illegal drug use.
B. diurnal variation.
C. therapeutic drug levels.
D. basal metabolism.

____ 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.

____ 8. A trough level is drawn:

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 A. 30 minutes after drug administration.
B. while the patient is fasting.
C. prior to administering medication.
D. immediately after administering medication.
____ 9. The term diurnal variation is associated with:
A. blood cultures.
B. fasting samples.
C. forensic samples.
D. timed collections.

____ 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.

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 D. antibiotics.

____ 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

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____ 24. Which of the following tests must be placed on ice immediately after collection?
A. Cold agglutinins
B. Lactic acid
C. Cholesterol
D. Antibody identification

____ 25. Chain of custody refers to the:

A. method of infection control.
B. patient identification procedures.
C. documentation of sample handling for legal samples.
D. collection of samples for employment physicals.

____ 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.

____ 27. Samples for cold agglutinins must be:

A. transported on ice.
B. drawn in a green stopper tube.
C. processed in a refrigerated centrifuge.
D. kept warm.

____ 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

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 additional glucose test in 1 hour, and patient returns for an additional glucose test
in 2 hours.
C. A fasting glucose sample is collected, patient returns for an additional glucose test
in 2 hours, and patient drinks a 75-g glucose solution within 5 minutes.
D. A fasting glucose sample is collected, patient drinks a 75-g glucose solution within
5 minutes, and patient returns for an additional glucose test in 2 hours.
____ 32. To ensure patient safety and medication effectiveness, the blood levels of many therapeutic drugs are
monitored. The samples that are typically drawn to do this are:
A. a trough level drawn before the next scheduled dose is given and a peak level
drawn after the dose is given.
B. a trough level drawn as a fasting sample at 6:00 a.m. and a peak level drawn 2
hours later.
C. a peak level drawn before the next scheduled dose is given and a trough level
drawn after the dose is given.
D. a peak level drawn as a fasting sample at 6:00 a.m. and a trough level drawn 2
hours later.
____ 33. Blood cultures may be ordered on a stat basis because:
A. this makes collection of the samples more convenient for the blood collector.
B. the concentration of microorganisms fluctuates and is often highest at specific
times of the day.
C. the stat sample will act as a control for the cultures drawn at scheduled times.
D. the concentration of microorganisms fluctuates and is often highest just before the
patient’s temperature spikes.
____ 34. Which of the following statements regarding cold agglutinins testing is true?
A. The sample must be kept warm until it is processed because cold agglutinins act at
cold temperatures.
B. Cold agglutinins are autoantibodies produced by persons infected with
Mycoplasma pneumoniae.
C. Cold agglutinins are autoantibodies produced by persons with an autoimmune
hemolytic anemia.
D. All of the above

____ 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

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____ 37. The artery located on the thumb side of the wrist is the:
A. brachial.
B. ulnar.
C. radial.
D. femoral.

____ 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.

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____ 45. The artery of choice for collecting arterial samples is the:
A. ulnar.
B. brachial.
C. cephalic.
D. radial.

____ 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

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 B. 2 and 4
C. 3 and 4
D. 2, 3, and 4

____ 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.

____ 55. Collateral circulation is necessary to prevent complications caused by:

A. arteriospasm.
B. infection.
C. vasovagal reaction.
D. hemorrhage.

____ 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.

____ 59. Blood cultures should be mixed after collection.

____ 60. Administering a local anesthetic before performing an arterial puncture may interfere with arterial
blood gas (ABG) results.

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____ 61. When performing a modified Allen test, pressure is released on the radial artery.

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

____ 62. Deep puncture

____ 63. Tissue destruction
____ 64. Failure to apply adequate pressure
____ 65. Coagulation disorders
____ 66. Apprehensive patient
____ 67. Not cleansing the site

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Chapter 5. Special Blood Collection
Answer Section

MULTIPLE CHOICE

1. ANS: C PTS: 1 DIF: Level 1 OBJ: 5-1

TOP: Collection priorities
2. ANS: B PTS: 1 DIF: Level 1 OBJ: 5-1
TOP: Fasting samples
3. ANS: C PTS: 1 DIF: Level 1 OBJ: 5-1
TOP: Timed samples
4. ANS: D PTS: 1 DIF: Level 1 OBJ: 5-2
TOP: Timed samples
5. ANS: C PTS: 1 DIF: Level 1 OBJ: 5-3
TOP: Timed samples
6. ANS: C PTS: 1 DIF: Level 1 OBJ: 5-4
TOP: Timed samples
7. ANS: C PTS: 1 DIF: Level 1 OBJ: 5-2
TOP: Timed samples
8. ANS: C PTS: 1 DIF: Level 1 OBJ: 5-4
TOP: Timed samples
9. ANS: D PTS: 1 DIF: Level 1 OBJ: 5-3
TOP: Timed samples
10. ANS: B PTS: 1 DIF: Level 2 OBJ: 5-2
TOP: Timed samples
11. ANS: A PTS: 1 DIF: Level 2 OBJ: 5-2
TOP: Timed samples
12. ANS: D PTS: 1 DIF: Level 2 OBJ: 5-4
TOP: Timed samples
13. ANS: C PTS: 1 DIF: Level 2 OBJ: 5-2
TOP: Timed samples
14. ANS: A PTS: 1 DIF: Level 2 OBJ: 5-3
TOP: Timed samples
15. ANS: A PTS: 1 DIF: Level 1 OBJ: 5-5
TOP: Blood cultures
16. ANS: A PTS: 1 DIF: Level 1 OBJ: 5-5
TOP: Blood cultures
17. ANS: B PTS: 1 DIF: Level 1 OBJ: 5-5
TOP: Blood cultures
18. ANS: A PTS: 1 DIF: Level 1 OBJ: 5-5
TOP: Blood cultures
19. ANS: B PTS: 1 DIF: Level 2 OBJ: 5-5
TOP: Blood cultures
20. ANS: C PTS: 1 DIF: Level 2 OBJ: 5-5
TOP: Blood cultures
21. ANS: D PTS: 1 DIF: Level 2 OBJ: 5-5
TOP: Blood cultures

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22. ANS: B PTS: 1 DIF: Level 1 OBJ: 5-9
TOP: Sample handling procedures
23. ANS: D PTS: 1 DIF: Level 1 OBJ: 5-10
TOP: Sample handling procedures
24. ANS: B PTS: 1 DIF: Level 1 OBJ: 5-9
TOP: Sample handling procedures
25. ANS: C PTS: 1 DIF: Level 1 OBJ: 5-11
TOP: Sample handling procedures
26. ANS: C PTS: 1 DIF: Level 1 OBJ: 5-11
TOP: Sample handling procedures
27. ANS: D PTS: 1 DIF: Level 1 OBJ: 5-8
TOP: Sample handling procedures
28. ANS: C PTS: 1 DIF: Level 2 OBJ: 5-11
TOP: Sample handling procedures
29. ANS: A PTS: 1 DIF: Level 2 OBJ: 5-8
TOP: Sample handling procedures
30. ANS: D PTS: 1 DIF: Level 2 OBJ: 5-11
TOP: Sample handling procedures
31. ANS: D PTS: 1 DIF: Level 2 OBJ: 5-2
TOP: Timed samples
32. ANS: A PTS: 1 DIF: Level 2 OBJ: 5-4
TOP: Timed samples
33. ANS: D PTS: 1 DIF: Level 2 OBJ: 5-5
TOP: Blood cultures
34. ANS: D PTS: 1 DIF: Level 2 OBJ: 5-8
TOP: Sample handling procedures
35. ANS: D PTS: 1 DIF: Level 1 OBJ: 5-6
TOP: Arterial puncture general
36. ANS: D PTS: 1 DIF: Level 1 OBJ: 5-6
TOP: Arterial puncture general
37. ANS: C PTS: 1 DIF: Level 1 OBJ: 5-6
TOP: Arterial puncture general
38. ANS: B PTS: 1 DIF: Level 1 OBJ: 5-6
TOP: Arterial puncture general
39. ANS: B PTS: 1 DIF: Level 1 OBJ: 5-6
TOP: Arterial puncture general
40. ANS: A PTS: 1 DIF: Level 2 OBJ: 5-6
TOP: Arterial puncture general
41. ANS: C PTS: 1 DIF: Level 1 OBJ: 5-6
TOP: Arterial puncture technique
42. ANS: D PTS: 1 DIF: Level 1 OBJ: 5-6
TOP: Arterial puncture technique
43. ANS: D PTS: 1 DIF: Level 1 OBJ: 5-6
TOP: Arterial puncture technique
44. ANS: D PTS: 1 DIF: Level 1 OBJ: 5-6
TOP: Arterial puncture technique
45. ANS: D PTS: 1 DIF: Level 1 OBJ: 5-6
TOP: Arterial puncture technique
46. ANS: A PTS: 1 DIF: Level 1 OBJ: 5-6

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 TOP: Arterial puncture technique
47. ANS: D PTS: 1 DIF: Level 1 OBJ: 5-6
TOP: Arterial puncture technique
48. ANS: D PTS: 1 DIF: Level 1 OBJ: 5-6
TOP: Arterial puncture technique
49. ANS: B PTS: 1 DIF: Level 1 OBJ: 5-6
TOP: Arterial puncture technique
50. ANS: A PTS: 1 DIF: Level 1 OBJ: 5-6
TOP: Arterial puncture technique
51. ANS: C PTS: 1 DIF: Level 1 OBJ: 5-6
TOP: Arterial puncture technique
52. ANS: D PTS: 1 DIF: Level 1 OBJ: 5-6
TOP: Arterial puncture technique
53. ANS: D PTS: 1 DIF: Level 2 OBJ: 5-6
TOP: Arterial puncture technique
54. ANS: A PTS: 1 DIF: Level 2 OBJ: 5-6
TOP: Arterial puncture technique
55. ANS: A PTS: 1 DIF: Level 2 OBJ: 5-6
TOP: Arterial puncture complications
56. ANS: C PTS: 1 DIF: Level 2 OBJ: 5-6
TOP: Arterial puncture complications
57. ANS: C PTS: 1 DIF: Level 2 OBJ: 5-6
TOP: Arterial puncture complications

TRUE/FALSE

58. ANS: T PTS: 1 DIF: Level 1 OBJ: 5-2

TOP: Timed samples
59. ANS: T PTS: 1 DIF: Level 1 OBJ: 5-5
TOP: Blood cultures
60. ANS: F PTS: 1 DIF: Level 1 OBJ: 5-6
TOP: Arterial puncture technique
61. ANS: F PTS: 1 DIF: Level 1 OBJ: 5-6
TOP: Arterial puncture technique

MATCHING

62. ANS: E PTS: 1 DIF: Level 2 OBJ: 5-6

TOP: Arterial puncture complications
63. ANS: A PTS: 1 DIF: Level 2 OBJ: 5-6
TOP: Arterial puncture complications
64. ANS: B PTS: 1 DIF: Level 2 OBJ: 5-6
TOP: Arterial puncture complications
65. ANS: C PTS: 1 DIF: Level 2 OBJ: 5-6
TOP: Arterial puncture complications
66. ANS: F PTS: 1 DIF: Level 2 OBJ: 5-6
TOP: Arterial puncture complications
67. ANS: D PTS: 1 DIF: Level 2 OBJ: 5-6

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TOP: Arterial puncture complications

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