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Phlebotomy AMCA Test Review
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Whole blood consists of - ✔✔Mostly water 92% Blood cells responsible for gas exchange - ✔✔RBC Professional negligence - ✔✔Malpractice Most important thing to keep in mind during our daily routine as phlebotomist - ✔✔Confidentiality Which department performs chemical screening tests on urine specimen - ✔✔Urinalysis Which department monitors warfarin(blood thinner/anticoagulant) therapy - ✔✔Coagulation Blood cell responsible for immunity and defense - ✔✔WBC Liquid portion of the blood specimen without an anticoagulant is known as - ✔✔Serum Sanitation - ✔✔The scrubbing of instruments with special brushes and detergents. Disinfection - ✔✔The use of chemical germicides, 1:10 bleach solutions, and alcohol. Equipment is soaked and wiped clean. Kills microorganisms, it is not effective in destroying spores or some viruses. Sterilization - ✔✔Involves killing all microorganisms, both pathogenic and nonpathogenic. This is often accomplished through use of an autoclave, producing heat sterilization through steam and pressure.
Which blood test includes WBC, RBC, hemoglobin and hematocrit - ✔✔CBC Most common blood type - ✔✔O Petechiae - ✔✔Small, red, smooth, hemorrhagic spots appearing on a patient's skin, which indicates that minute amounts of blood have leaked in the skin epithelium. Caused by applying the tourniquet too tightly. Hemoconcentration - ✔✔A decrease in the plasma volume with an increased concentration of cells and molecules may be caused by prolonged tourniquet application, or massaging, squeezing, or probing a site. Tourniquet applied for more than 3 min what will become elevated - ✔✔Potassium Patient Identification cannot be done by - ✔✔Checking the chart Patient Identification - ✔✔Ask the patient to state and spell their name and date of birth, Checking their armband. Common venipuncture site area - ✔✔Antecubital area of the arm When would using a butterfly be beneficial - ✔✔On a geriatric patient (delicate skin & small veins) Warming the site - ✔✔Increases blood flow Diagnosis and treatment of diseases by joint inflammation is what specialty - ✔✔Rheumatology The total amount of blood pumped per minute - ✔✔Cardiac output (CO) Inflammation of a vein in conjunction with the blood clot - ✔✔Thrombophlebitis
Example of negligence - ✔✔Fails to report significant change in a patient's condition Specimen least likely to require special handling - ✔✔Cholesterol Critical values are also known as - ✔✔Panic values (considered life threatening) Pre-analytical error related to specimen storage - ✔✔Exposure to light to prevent the analyte from breaking down, cooling to slow metabolic process in the specimen, transport at body temperature 37℃ to prevent precipitation or agglutination. Transmission-Based Precautions used for a patient who has measles, tuberculosis, and varicella - ✔✔Airborne Transmission-Based Precautions used for a patient who has viral diseases: adenovirus, influenza, mumps, Parvovirus 1319, and rubella or bacterial diseases:Pertussis, pneumonia, and Haemophilus influenzae type b - ✔✔Droplet Transmission-Based Precautions used for someone who has skin infections: Diphtheria and Herpes simplex virus, Enteric infections: Clostridium difficile. Escherichia coli (E. Coil), Shigella, hepatitis A, rotavirus - ✔✔Contact Recovering from a virus and having antibodies - ✔✔Immune Hemolysis - ✔✔This occurs when RBC's are lysed; hemoglobin is released and serum, which is normally straw colored, becomes tinged with pink or red. Caused by drawing blood too quickly into a syringe, excessively or vigorously inverting tubes after collection, and using too small a needle with respect to vein size. The lab abbreviation PT stands for - ✔✔Prothrombin time How does heparin prevent blood from clotting - ✔✔By inhibiting thrombin
Purpose of an antiglycolytic agent - ✔✔Preserves glucose A patient with high degree of jaundice - ✔✔Yellow skin and sclera What is lymphostasis - ✔✔Obstruction of lymph flow Venous stasis - ✔✔Stoppage of the normal venous blood flow Hemoconcentration from prolonged tourniquet application increases - ✔✔Non-filterable analytes Difference between NPO and Fasting - ✔✔Fasting allows you to drink water while NPO does not The best specimens to use for establishing inpatient reference ranges for blood tests are - ✔✔Basal state specimens You can use a needle that does not have a safety feature- T/F - ✔✔False, It must be used with a safety feature Why do we state that a specimen was collected by capillary - ✔✔Results can vary by specimen source Order of draw - ✔✔Blood Cultures (yellow), Light Blue, Red, Gold/Tiger, Green, Lavender (Pink), Grey Not a phlebotomist duty - ✔✔Starting intravenous (IV) lines National organization that sets standards for phlebotomy procedures - ✔✔CLSI - Clinical Laboratory Science Institute Test of respiratory system - ✔✔Arterial blood gas (ABG)
Hormone detected in pregnancy - ✔✔HCG The tube containing heparin (green) is drawn in the middle of - ✔✔Serum (gold) and EDTA (lavender) Fluid obtained by lumbar puncture - ✔✔Cerebrospinal A urine C & S is typically ordered to detect - ✔✔UTI symptoms and must be a mid-stream clean catch specimen. Proper centrifuge operation - ✔✔Place tubes of equal size and volume opposite one another Blood study that includes examining the blood for It's total number of formed elements and cell morphology - ✔✔Hematology Type of analysis used when processing blood for blood donor screening and transfusion - ✔✔Immunohematology Normal value range for hematocrit reading in Females - ✔✔ 37 - 47% Normal value range for hematocrit reading in Males - ✔✔ 40 - 52% Blood collected in a vacuum tube with no additive would be used for - ✔✔Blood chemistries Universal recipient - ✔✔AB+ Commonly used disinfectant in the medical field found to be effective against blood borne pathogens - ✔✔1:10% Bleach (Sodium hypochlorite) solution (1 part bleach 9 parts water)
Appropriate method for disposing contaminated needles - ✔✔Place it in biohazard sharps container located in the same room Most important step in achieving medical asepsis - ✔✔Washing hands Which solution will help prevent the transmission of hepatitis - ✔✔Household bleach How often should quality control tests be done For procedures performed in office - ✔✔Daily Organization developed guidelines for universal precautions - ✔✔CDC According to OSHA medical personnel must wear PPE when they have contact with - ✔✔Blood or Other Potentially Infectious Materials (OPIM) Reason for bracing hand with needle against patient's skin - ✔✔To prevent excess needle movement When would a capillary blood sample be diluted with tissue fluid - ✔✔If the finger is squeezed excessively Most common dermal puncture site on an adult - ✔✔Ring finger Lowering risk of bruising after venipuncture by - ✔✔Applying pressure to site After washing hands, putting on PPE, and assembling equipment what should be done - ✔✔Identify the patient Using a blood pressure cuff as a tourniquet it should be inflated to - ✔✔40mmHg A patient's right to refuse a medical procedure - ✔✔Bill of rights
Fasting glucose normal range - ✔✔ 74 - 100 mg/dL Sodium (Na+) Normal range - ✔✔ 136 - 145 mEq/L Potassium (K+) Normal range - ✔✔Males: 3.5-4.5 mEq/L Females: 3.4 - 4.4 mEq/L The substance inside a serum separator tube is called - ✔✔Thixotropic Gel ESR test is collected in what tube? - ✔✔Lavender What tube is used when testing for aluminum? - ✔✔Royal blue A sharps container should be replaced when how full? - ✔✔3/ 3 - hour GTT - ✔✔Draw 4 tubes (Fasting, 1 hr, 2 hr, and 3 hr) and it is used to diagnose hyperglycemia. 1 - hour GTT is used to diagnose - ✔✔Gestational Diabetes 2 - Hr GTT - ✔✔Draw 3 tubes (Fasting, 1 hr, and 2 hr) and it is used to diagnose Gestational Diabetes 5 - Hr GTT - ✔✔Draw 6 tubes (Fasting, 1 hr, 2 hr, 3 hr, 4 hr, and 5 hr) and it is used to diagnose hypoglycemia 2 - hour Post Prandial Glucose (Post Prandial, or PP, means after a meal.) - ✔✔This is used to test for diabetes mellitus. A fasting glucose level is compared to a glucose specimen that is collected 2 hours after the patient eats a meal. Standard time for SST to sit before being centrifuged - ✔✔30 minutes
After ___ unsuccessful attempts at obtaining a good blood sample, you should seek assistance from your supervisor or the doctor. - ✔✔ 2 A female patient should produce at least _____ ml of urine for a STD test - ✔✔ 20 - 30 Thyroid and HCG tests would be sent to which department? - ✔✔Chemistry Position which includes patient laying on their back with their head and torso raised between 15- 45 degrees - ✔✔Semi Fowler Sputum samples are typically collected from what secretions - ✔✔Mucus or phlegm that is ejected from the trachea, bronchi, and lungs through deep coughing for diagnosis or monitoring of lower respiratory tract infections. QNS - ✔✔Quantity non-sufficient FBS - ✔✔Fasting blood sugar Max time serum can sit out - ✔✔2 hours Tube color to use for Hepatic (liver) function panel (ALT, albumin, alkaline phosphates, AST, total bilirubin, total protein) - ✔✔Red What color tube for serum pregnancy HCG test - ✔✔Red Can you over or under fill a light blue tube - ✔✔No, it needs to be a 9:1 ratio CPR on adult - ✔✔30 Compressions; 2 Breaths What color tube for thyroid testing - ✔✔Tiger top/ red
Adding too much blood to a light blue sodium citrate tube can cause what? - ✔✔Shorter clotting time Patients who have undergone a mastectomy - ✔✔Surgical removal of the breast often have lymphedema (swelling caused by lymph accumulation in the tissues) on the side of the surgery because of lymph node removal. Do not draw blood or use a blood pressure cuff on that side. Immediately after an exposure incident (needlestick or splashed), the employee must - ✔✔Decontaminate the needlestick site or flush the exposed mucous membrane site for 15 minutes, report the incident and undergo medical evaluation. Standard Precautions - ✔✔Reduce the risk of transmission of microorganisms. Guidelines apply to all patients and all body fluids, nonintact skin, and mucous membranes and include the use of personal protective equipment - PPE (gloves, gowns, lab coat, mask.), hand hygiene, and proper use and disposal of needles and other sharps. Accession number (accessing) - ✔✔Term sometimes used for the laboratory-generated unique identification number assigned to blood specimens after blood collection. It enables careful tracking of multiple specimens from the same patient in the laboratory. Lipemic specimen - ✔✔Is cloudy and milky, which indicates a high level of lipids (fat) in the blood. Universal Precautions - ✔✔An infection control concept of blood-borne disease control, requiring that all human blood and other potentially infectious materials be treated as if known to be infectious for HIV, HBV, HCV, or other blood-borne pathogens, regardless of the perceived risk. Blood-borne pathogens (BBPs) - ✔✔Pathogenic microorganisms, including hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV),Ebola virus, and Ebola virus that if present in blood, can cause disease in humans. Hematoma - ✔✔Occurs when blood is leaking into the surrounding tissues. Caused by advancing the needle too far or at the wrong angle, causing it to go through the vein, by failing to apply appropriate pressure after needle withdrawal, or by bending the arm at the antecubital area after needle withdrawal, and removing the needle before removing the tourniquet
Health Information Technology for Economic and Clinical Health (HITECH) Act - ✔✔Enforced by the HHS Office for Civil Rights (OCR). Increased the enforcement of the privacy and security of electronic transmission and health information, made business associates directly liable for compliance with HIPAA, prohibited the sale of PHI without the patient's authorization.and created a tiered violation categories: unknowing, reasonable cause, willful neglect-corrected, and willful neglect-uncorrected. Bleeding Time Test (BT) - ✔✔Performed on the forearm and uses a blood pressure cuff inflated to 40 mm Hg. Phlebotomist will use an automated incision device to puncture skin and will use filter paper to blot the blood drops. This is a timed test, and the phlebotomist will blot blood every 30 seconds until the patient stops bleeding. Medications that can cause excessive bleeding - ✔✔Aspirin, heparin, warfarin (Coumadin). Fingernails - ✔✔Do not wear artificial nails or extenders when collecting blood from patients in high-risk hospital areas (e.g., intensive care unit, premature nursery). Keep natural fingernails less than 1/4-inch long. Defamation - ✔✔Is injuring a person's name and reputation by making false statements to a third person. Libel - ✔✔Making false statements in print, writing, or through pictures. Slander - ✔✔Making false statements orally. Invasion of privacy - ✔✔Violating a person's right not to have his or her private affairs exposed. Fraud - ✔✔Saying or doing something to trick, fool, or deceive a person. Assault - ✔✔Intentionally attempting to touch or threaten a person's body without their consent. Battery - ✔✔Touching a person's body without their consent.
SST (Serum Separator Tubes) - ✔✔Speckled Red/Gray, Tiger top, or Gold BD Hemoguard. Clot activator and gel for serum separation. Chemistry testing. PST (Plasma Separator Tubes) - ✔✔Light Green top additive: Lithium heparin and gel for plasma separation Dark Green top - ✔✔additive: Sodium Heparin or Lithium Heparin which is a natural anticoagulant that inhibits thrombin. Commonly used for routine chemistry testing. EDTA Tube - ✔✔Lavender top ethylenediaminetetraacetic acid additive binds the calcium needed for clot formation. Commonly used for hematology testing (CBC, reticulocyte count, erythrocyte sedimentation rate ESR). Glycolytic Inhibitor Tube - ✔✔Gray top Additives used are sodium fluoride, a preservative that inhibits glycolic action, and potassium oxalate, an anticoagulant that binds calcium. Commonly used for glucose tolerance, blood alcohol, and lactic acid measurement. Patients with IVs, if no alternate site is available, follow these guidelines: - ✔✔Ask the nurse to turn off the IV drip and wait until the medication clears the line, Select a vein that is distal to the IV site. Collection should not be taken from the same vein that has the IV, The first 5mL of blood should be discarded, When the venipuncture is complete, ask the nurse to restart the IV, Document that the blood was drawn from an arm with an IV line. Dermal puncture is advisable when obtaining blood from the following types of patients: - ✔✔Children, especially those younger than 2 years of age, Geriatric patients with small, fragile veins, Obese patients, whose veins are difficult to find or access, Patients at risk for serious complications associated with deep venous puncture (such as iatrogenic anemia, hemorrhage, etc.), Patients at risk of venous thrombosis, Patients with burns or scars over venipuncture sites, and Patients requiring frequent glucose monitoring. Guidelines for accurate specimen labeling - ✔✔Patient's full name, Patient's ID number (if applicable), Time and date of collection, Phlebotomist's initials.
