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CPT-1 Final Exam
CPT-1 FINAL EXAM
| Question | Answer |
|---|---|
| What is ASPT | American society of Phlebotomy Technicians (national certifying organization) |
| What is AMT | American Medical Technologist (national certifying organization) |
| What is ASCP | American Society of Clinical Pathologist (national certifying organization) |
| What is NPA | National Phlebotomy Association (national certifying oranization) |
| What is NCCT | National Center for Competency Testing (National certifying organization) |
| What is NHA | National Healthcareer Association (national certifying organization) |
| How many CEU units do you need every two years to renew your state phlebotomy license? | 6 Continuing education units |
| Define Certification | Issuance by an official body of a certificate to a person indicating that he/she has met certain requirements |
| define Licensure | legal permission grated by the state to engage in an occupation or activity |
| define Reciprocity | One state recognizes the licensure granted by another state |
| Define integrity | Dedicated to maintaining high standards |
| define empathy | ability to understand another's feelings |
| define discretion | use of good judgement and prudence |
| define diplomacy | use of tact and understanding |
| define confidentiality | ability to safeguard patient privacy |
| define ethics | moral duty to determine the difference between right and wrong |
| define honesty | always telling the truth regardless of the situation |
| communication skills | verbal, non verbal, and active listening |
| define compassion | a gentle caring attitude |
| define dependability | being punctual and completing tasks in a timely manner |
| define accountability | being responsible for your actions |
| what does the LABORATORY DIRECTOR do | interprets results to diagnose disease...can be a pathologist or bioanalyst |
| what does the LABORATORY ADMINISTRATOR or AKA MANAGER do | Day to day operations of lab... liaison between director and lab staff |
| What do TECHNICAL SUPERVISORS do | daily work schedules and staffing ... |
| Define CLS | Clinical laboratory scientist |
| What does CLS do | Directs work of other lab staff...MAINTAIN QA standards ... |
| How do you become a CLS | 4year med tech program, 1yr. internship, board exam |
| What is MLT | Medical laboratory technicians |
| What are CLT | Clinical Laboratory tecnicians |
| What do MLT/CLT do | test BLOOD, URINE, LYMPH...report abnormal test values, train new employees..2YR trainins in medical lab program, certification for approved agency |
| What do Blood bank technologist do | Test for BLOOD GROUPS, ANTIGENS, and ANTIBODY IDENTIFICATION AND COMPATIBILITY |
| What are the major divisions within laboratory departments | Clinical analysis...Surgical/anatomical pathology |
| What is the purpose of the chemistry dept. | Makes test more efficient and quality assurance testing more accurate ...(ITS THE LARGEST DEPARTMENT) |
| What is the purpose of microbiology dept. | Analyzes for presence of microorganisms Ex. of tests C&S , GRAM STAIN TEST |
| What is the purpose of the immunology/serology dept. | Determines the antigen-antibody reaction of the body (identifies bacterial growth in blood culture bottles) |
| What is the purpose of the blood bank dept. | Blood typing and antibody tests..Blood from donors is tested here before being used for transfusions ..THE MAKE NO MISTAKES |
| what is the purpose of the Urinalysis dept | cam be performed in sevaral areas of the lab 3parts..PHYSICAL, CHEMICAL, MICROSCOPIC ex. of test....CLEAN CATCH SPECIMEN TEST |
| CLSI use to be called what | NCCLS National Committee For Clinical Laboratory Standards |
| What is CLSI | Clinical Laboratory Standards Institute |
| What does CLSI do | Establishes prcedural guidelines for all areas of the lab(GOLD STANDARD) |
| What is CAP | College of AMerican Pathologists |
| What does CAP do | Sets standards for phlebotomy ...Proficiency testing/lab testing by pathologist and CLSs.....Compares results to labs across country |
| Define JCAHO | Joint Commission on Accreditation Of Health care organization |
| What is the purpose of JCAHO | Accrediting agency for hospitals and nursing homes ..inspects every two years ..ENFORCE STANDARDS ESABLISHED BY CLSI ..WORKS WITH CAP to provide lab accreditation |
| Define CLIA | Clinical Laboratory Improvement Act of 1988 |
| What is the purpose of CLIA | Enacted by congress to regulate all labs..Include guidelines ...QUALITY CONTROL..QUALITY ASSURANCE...RECORD KEEPING,,PERSONAL QUALIFICATIONS NO AN ORGANIZATION |
| What is the objective of CLIA program | ENSURE QUALITY LAB TESTING |
| What is an Infection | Invasion of the body with pathogenic(diease causing) bacteria, fungi,viruses, protozoa or parasites |
| What is the primary goal of infection control program | Reduce the risk of endemic and epidemic infections in patients personnel and visitors |
| Define Bloodborne Pathogen | Pathogenic Organisms in blood that cause disease |
| define parenteral | Piercing mucous membranes or skin barriers |
| What is the CHAIN OF INFECTION | Infectious Agent...Reservoir..Exit Pathway..Means of Transmission...Entry Pathway..Susceptible Host |
| Define Pathogen | disease causing organism |
| give ex. of an infectious agent | Becteria, fungus, protozoon, rickettsia, virus |
| give ex. of RESERVOIR | animal, human, equiment, food, soil, water |
| give ex. of EXIT PATHWAY | Blood,exudates, excretions, secretions |
| give ex. of MEANS OF TRANSMISSION | airborne, contact, droplet, vector, vehicle |
| give ex. of ENTRY PATHWAY | body orficies, mucous membranes, broken skin |
| give ex. of susceptible host | elderly, newborn, acute/chronically ill patients, immune suppressed unvaccinated |
| What is a NOSOCOMIAL INFECTION | infection acquired AFTER a person has enetered a hospital, clinic, nursing home, or rehab faciility |
| What is a common nosocomial infection | UTI ..Urinary tract infections |
| Standard/Universal precautions is enforced by | OSHA and established by CDC .center of disease control |
| you should change your gloves every | 30min |
| to disinfect equipment and surfaces use | 1:10 bleach solution |
| What are the body's natural barriers | Skin and mucous membranes |
| define STRICT ISOLATION | for HIGHLY contagious disease.EX. HIV. |
| Define Enteric Isolation | For patients with intestinal infections |
| define Contact Isolation | for patients with diseases that can be spread by direct contact ..ex MRSA,VRE, and C. Difficile |
| define Protective/reverse/neutropenic isolation | for non infectious patiets who may be susceptible to infection..ex..Geriatric patients.. newborns |
| define Airborne isolation | for patients with diseases spread by droplets that are smaller than 5micrometers example of diseases (TB) Varicela zoster (chicken pox) and measels (SPECIAL REQUIRMENT.NEGATIVE PRESSURE ROOM) |
| define droplet isolation | for patients with diseases spread droplets that are larger than 5 micrometers (example PERTUSSIS..meningitis, German measles |
| What is OSHA | occupational Safety and health administration |
| What is the purpose of OSHA | Assures every person safe and healthful working conditions (FEDERAL AGENCY) |
| If a glass is broken you should remove it with a | DUST PAN |
| Sharp containers should be replaced when they are | 2/3 full |
| what is the function of the Adrenal Glands | Prodeuce hormones .EPINEPHRINE and NOR EPINEPHRINE...located on top of each kidney |
| what is the function of the ALVEOLAR SACS | Aloow for diffusion between air and blood |
| What is Amoiotic fluid | Fluid from the AMONIOTIC SAC |
| what is the AORTA | Largest artery in the body |
| what are ARTERIES | Blood vessels that carry blood away from the heart |
| what are the ARTERIOLES | Smaller branches of the arteries |
| What is the ATRIA | Upper chambers of the heart |
| What are Blood vessels | The transport blood ..Include ARTERIES ARTERIOULES CAPILLARIES VENULES and VEINS |
| What are capollaries | Microscopic, Unicellular blood Vessels linking arteriols to venules |
| What does the INFERIOR VENA CAVA do? | Brings deoxygenated blood to the heart from lower parts of the body |
| What does the lymphatic system do | Maintains fluid balance, defends against disease, absorption of fats from blood stream |
| what is PERITONEAL FLUID | fluid from the abdominal cavity |
| What is PLEURAL FLUID | fluid from the lung cavity |
| What is the function of the superior vena cava | Brings deoxygenated blood from the head, neck, chest region of the heart |
| What is SYNOVIAL FLUID | fluid from joints |
| what do veins do | carry deoxygenated blood towards the heart |
| what are venules | smaller branches of veins |
| what are ventricles | they are the lower chambers of the heart |
| what is BLEEDING TIME | test to assess PLATELET PLUG formation in CAPILLARIES (pre surgical) |
| What is BUFFY COAT | after centrifuation of a specimen mixed with an anticoagulant, the layer between the plasma and erythrocytes..CONTAINS WBC and PLATELETS |
| what is a DIFFERENTIAL TEST | a test that categorizes blood cells and abnormalities present |
| what does EDTA do | prevents blood from clotting by binding calcium |
| Hematocrit is also known as | PCV ..Packed cell volume |
| what are LYMPHOCYTES | non-granulocytic WBCs( ASSIST IN IMMUNITY and PRODUCTION OF ANTIBODIES |
| what are MONOCYTES | Largest Leukocyte...Assist in IMMUNE SYSTEM |
| What is plasma | it is the liquid portion of whole blood |
| what is platelets | blood cells that aid in blood clot formation |
| what is serum | it is the liquid portion of CLOTTED blood |
| Define Hematoma | Localized leakage of blood into tissues (most common complication of phlebotomoy) |
| define OCCLUDED VEIN | Closed or constricted vein |
| Define Sclerosed Vein | Vein that becomes hardened (possible due to fatty deposits) |
| Define Bactermia | Presence of bacteria in the blood |
| What is the purpose of C&S test | a test to identify the microorganism and the antibiotic most effective for treamtent |
| define O&P | ova and parasites |
| define Septicemia | Presence of bacterial toxins |
| define ACIDOSIS | condition when blood pH is below 7.35 |
| define ALKALOSIS | condition when blood is pH is above 7.45 |
| What is a BUN TEST | test to determine amount of urea in blood |
| define LIPEMIC | Cloudy/milky appearance of serum due to excessive lipid content |
| what is POST PRANDIAL GLUCOST TEST | glucose test performed after ingestion of a meal |
| what is the PREANALYTICAL PHASE | when tests are ordered and specimens are collected and prepared for testing |
| define TDM | therapeutic drug monitoring |
| what is the purpose of Citrate | keeps blood from clotting by binding calcium |
| define fibrin | substance that makes up a clot |
| what is the purpose of heparin the green tubes | prevents blood clotting by inactivating thrombin and prothrombin |
| what is BASAL STATE | patients condition early in the morning.. 12hour after last ingestion of food (fasting) |
| define DHS | department of Health Services |
| What is a Fistula | an artificial shunt or passage(vein and artery fused together) |
| define Hemolysis | rupture of erthrocytes |
| define metabolic acidosis | condition when the kidneys cannot eliminate acid substances (can cause renal failure) |
| define metabolic alkalosis | condition resulting from excessive vomiting or an abnormal secretion of certain homrmones that cause excess elimination of hydtogen ions (too much base and not enough acid) |
| what is the purpose of OSHA | Ensures a safe working environment |
| what is the purpose of QC quality control | daily control used in analytic testing to determine accurace in precision |
| define QNS | quantity not sufficient |
| If you leave a tourniquet for more than one minute it can cause | Hemoconcentration |
| define ANATOMY | study of the structure of an organism |
| define Physiology | Study of how the body functions |
| define Pathophysiology | Study of disease and how it affects the body |
| Why do we need to draw blood | provided information about vital bodily function |
| Blood is the primary means of transport for | Nutrients, waste, oxygen, carbon dioxide, and hormones |
| What should a blood draw ALWAYS start with | a REQUISITION |
| a requisition can be written in what ways | Hand written, preprinted or computer generated |
| what information may not be found on a requisition | patient diagnosis ...patients gender...patients billing information .. |
| If any doubts at any time of a tube what should you do | DISCARD |
| what are the 3primary methods for venipuncture | Evacuated tube method (straight needle)....Butterfly Method...Syringe Method |
| Additives are usually either ..? | anticoagulant or preservative |
| Light Blue Tube | ANTICOAGULANT: sodium citrate Prevents coagulation by binding Ca+ ex. of test....PT, PTT |
| RED TUBE (Serum Tube) | No additive ..Commonly Requested tube .. (SEROLOGY, SERUM CHEMISTRY TESTS) ex. of test Cholesterol |
| Tiger Top (SST) | Clot Activator ...Gel Separator -SST=Serum separator tube ..(SEROLOGY, SERUM CHEMISTRY |
| Gold (SST) | Clot Activator..Gel Separator (SEROLOGY, SERUM CHEMISTRY TESTS) |
| Green Tube | Anticoagulant: Sodium Heparin, Lithium heparin, or Ammonia heparin ...Prevents coagulation by inhibiting the action of THROMBIN(a clotting factor) (PLASMA CHEMISTRY TEST) |
| Lavender Tube | Anticoagulant: Sodium or K+ EDTA ..Prevents clotting by binding Ca2+ ..Prevents platelet aggregation (clumping) ..Preserves the shape of the cells ..CANNOT be used for coagulation studies Tests: CBC (HEMATOLOGY STUDIES) "preserves glucose up to 5d |
| Gray Tube | Contains an anticoagulant and a preservative .. Anticoagulant=POTASSIUM OXALATE Binds Ca2+..Preservative: SODIUM FLOURIDE ..Ihibits the glycolytic activity in cells .. Tests collected EX. Glucose, ETOH (CHEMISTRY TEST) |
| Pink Tube | Additive: anticoagulant EDTA (USED FOR BLOOD BANK) |
| Black Tube | Additive: Anticoagulant Sodium Citrate.. Used for:WESTERGREN SEDIMENTATION RATE "4:1 Ratio" |
| Dark Blue Tube | Additive: either no additive, sodium heparin, or EDTA ... Used for trace metal assays "TOXICOLOGY STUDIES" |
| Brown Tube | Additive: anticoagulant Heparin Used for: Lead Testing |
| Yellow Tube | additive: anticoagulant SPS.. Used for Blood Cultures MUST BE STERILE |
| what is HEMATOLOGY | study of blood and blood forming tissues (includes are of hemostasis) |
| average person has how many liters of blood | 5.5-6 liters |
| Blood has to part ..which is ? | liquid portion-plasma .....Cellular portion-RBC ,WBC, Platelets(thrombocytes) |
| what is a routine hematology test? | CBC complete blood count |
| What is Erthrocyte Sedimentation Rate ESR | they measure the rate that RBCs fall to the bottom of a tube (also monitor inflammation and tissue injury) |
| what are the 4 main tests to determine hemostasis? | Platelet count test...Bleeding time test...PT test (PROTHROMBIN TIME)...aPTT/PTT test |
| What are some specialized Chemistry Areas | Toxicology (TDM and OD)..ABG..Serology .. |
| Random specimen is collected when ? | any time of the day |
| First Voided specimen is collected when? | in the morning as soon as the patient wakes up |
| Timed specimen must be collected when? | usually 8-24hrs .. |
| Clean-catch midstream specimen | patients are required to cleanse the urethral area with castile soap and towelette..first portion of urine ..urinate in tiolet then after in cup .. |
| A 24hr urine specimen must be collected in ? | a 2000mL graduated cylinder |
| What are RARE complications of venipuncture | Cardiac arrest...Hemorrhage ...Reflex arteriospasm...infection |
| taking 10ml of blood from a PREMATURE infant leads to a decrease percentage of what blood volume | 5-10% |
| What is the reason for a dermal puncture on an adult | Suitable vein cannot be found |
| When is skin puncture inappropriate | when patient is ..severly dehydrated ..has bad circulation |
| Most common size for adults on a skin puncture is | 2.4mm |
| skin puncture size on premature infants are | 0.85 to 3.0mm |
| Swollen areas are avoided for a venipuncture because | due to accumulation of tissue (interstitial) fluid |
| If a bone is punctured what may occur | Osteomyelitis (inflammation of bone or bone marrow, usually due to infection) |
| what are the two most commonly used finger sites on adults for a fingerstick | 3rd and 4th fingers towards tip of finger |
| Why is the index finger not used for a finger stick | causes calluses and discomfort |
| What is the CAPILLARY ORDER OF DRAW | Blood gases, EDTA tubes, Other additive tubes, Serum tubes |
| What is the appropriate depth lancet for this size of infant: 1-2kg(2.2-4.4 lbs.) | 0.75-1.0mm |
| What is the appropriate depth lancet for this size of infant: 2-3 kg (4.4-6.6 lbs.) | 1.0-2.0mm |
| What is the appropriate depth lancet for this size of infant: 3 kg (6.6 lbs.) or greater | 2.0-2.4mm "GREATER THAN 2.4mm MAY CAUSE OSTEOMYELITIS AND PERMANENT DAMAGE TO THE INFANTS FOOT" |
| What is the use of EMLA | Eutectuc Mixture of local Anesthetic, is used to relieve pain |
| Hematomas occur when | blood leaks from vein or capillaries and collects in tissues around puncture site |
| Removal of tourniquet AFTER removal of needle can cause | a Hematoma |
| What is PETECHIAE | Tiny red spots that appear under the skine and sign of platelet defects or week capillary walls (can be an indication of broken/bruised capillaries) |
| the cause of Petechiae can be sign of what kind of allergy | Possible latex allergy |
| Who should you contact if bleeding does not stop after 5min | Contact physician or nursing staff |
| Excessive bleeding can be due to what type of anticoagulants | Coumadin, Heparin (patient can have excessive bleeding as well due to clotting disorders) |
| Mastectomy patients are highly susceptible to ..? | INFECTIONS |
| In Mastectomy patients, due to edema some tests may be | Altered |
| If a patient has double mastectomy (each on one arm) ..what site would you perform a venipuncture | back of hands, legs, or a fingerstick (consult physician first) |
| Edema | Abnormal accumulation of fluid in the intracellular spaces of the body |
| The heart is the size of a ..... ?? | Mans fist |
| What is the normal heart rate of an adult | 60-80 times/min |
| What is the SEPTUM | Wall the separates the heart into right and left sides |
| what is the Pericardium | outer double walled sac to prevent friction |
| Right atrium fills with blood from ...? | the Superior and Inferior Vena Cava |
| the LEFT ATRIUM filles with blood from the | Pulmonary vein |
| Contraction of he heart pushes blood into the...? | Ventricles |
| the left and right atria are separated by | Interatrial septum |
| Ventricles receive blood from | ATRIA |
| Contracitons of the heart pushes what out | Blood |
| The right ventricle pushes blood through the | Pulmonary artery |
| The left and right ventricles are separated by | the interventricular septum |
| Sinoatrial (SA)node "pacemaker" causes ? | wave of impulses through muscle of atria (where heart begins) |
| What is the function of the ATRIOVENTRICULAR (AV)Node | sends impulses goes down the bundle of his-> R & L bundle branches ->Purkinje fibers-> Ventricles |
| Define Diastole | Relaxation phase of the cardiac cycle (VENTRICLES ARE FILLING WITH BLOOD FROM THE ATRIA) |
| define Systole | Contraction phase of cardiac cycle (VENTRICLES CONTRACT AND PUSH BLOOD THROUGH PULMONARY VALVE AND AORTIC VALVE TO DISTRIBUTE BLOOD TO LUNGS AND BODY) |
| The heart is controlled by | The autonomic nervous system |
| Bradycardia is considered at what heart rate | BELOW 60 |
| Tachycardia is considered at what heart rate | Above 100 |
| Tunica Adventitia is | Thick outer layer, mostly connective tissue (prevents rupture or bursting due to increased pressure) |
| Tunica Media is | Middle layer, smooth muscle and elastic fibers (helps maintain normal blood pressure;able to contrict) |
| Tunica Intima is | Inner layer, single later of endothelial cells, connetive tissue, and elastic fibers (smoothness prevents abnormal blood clotting) |
| Adult men have about how much blood | 5-6 liters of blood |
| how much blood does an adult women have | 4-5 liters of blood |
| whole blood is composed of approximately....? | 2.8(55%) of plasma and 1.9 liters (45%) of cells |
| Plasma is composed of | 90% water and 10% solid materials |
| Serum is composed of | same components as plasma EXCEPT FIBRINOGEN |
| What color is ICTERIC (liquid component) | Dark green/yellow |
| What color is HEMOLYZED (liquid component) | Pink/Red |
| What color is LIPEMIC )liquid component) | Milky/creamy/cloudy |
| Erthrocytes have a life spam of | 120days (circulating RBC have no nucleus) |
| Neutrophils are | PHAGOCYTES..they are the first responders to infection and have 3-5 lobed nucleus (fine light blue cytoplasmic granules) "45-70% in the body" |
| Eosinophils are | Bright RED/ORANGE cytoplasmic granules with a BILOBED NUCLEUS.. they INCREASE IN ALLERGIC REACTIONS AND PARASITIC INFECTIONS "0-5% percentage in the body" |
| Basophils are | DARK PURPLE-BLUE cytoplasmic granules..they have irregular S-shaped nucleus and dduring inflammation it releases histamine to dialte blood vessls(granules contain heparin and histamine) "0-1% in the body" |
| Lymphocytes are | Non-granular blue cytoplasm...LIGHT BRIGHT PURPLE NUCLEUS..2types T-destroy foreign material..B-produce antibodies to fight infection "20-40% in the body" |
| Monocytes are | Non-granular cytoplasm...KIDNEY BEANED SHAPED..PURPLE NUCLEUS ....phagocyte and becomes macrophage ...it is the LARGEST WBC ..."4-10% in the body" |
| What is the function of a THROMBOCYTE | it retracts after blood clot has formed ..transports needed chemical for clotting ...it has a life span of 9-12days |
| what is an antibody | A substance that is produced by the body in response to an antigen |
| RBCs with A antigen = | Type A ...plasma has antibodies to B antigen 40%common |
| RBCs with B antigen = | Type B... plasma has antibodies to A antigen 10% common |
| RBCs with A and B antigen = | Type AB ... plasma has NO antibodies to A or B antigens .. 4% common |
| RBCs without A or B antigen = | Type O... Plasma CONTAINS antibodies to A and B antigens ..46% common |
| PRESENCE of D antigens designatedd as | Rh+ |
| ABSENCE of D antigeens designate as | Rh- |
| Define break of duty | neglect or failure to perform an obligation |
| Define patients bill of rights | Rights that every patients has while undergoing treatment |
| define Stature of limitation | the period after the incident that a patient has to file a lawsuit (may begin after the problem is discovered) |
| define TORT | wrongful act(other than breach of contract) .."committed against another person or property" |
| define standard of care | The ordinary skill and care that medical practitioners such as physicians, nurses and phlebotomists must use that is commonly used by other medical practitioners when caring for patients |
| define Negligence | Failure to perform professional duties in accepted standard of care |
| deinfe Proximate cause | Natural continuous sequences of events, without an intervening cause, that produces an injury • Also referred to as direct cause |
| define Res ipsa loquitur | Latin phrase that means “the thing speaks for itself” • This is a doctrine of negligence law |
| define Respondeat superior | Latin phrase that means “let the master answer” • This means that the physician or employer is responsible for the acts of the employee |
| what are the three branches of government | Legislative, executive, and judicial |
| what are the three levels of law | – Federal – State – Local |
| what is negligence | • Violation of duty to not exercise reasonable skill and care when performing a task • Failure to perform professional duties in an accepted standard of care |
| what is MALPRACTICE | BAD PRACTICE ...Professional negligence, improper or unskillful care of a patient |
| What are the 4D's if Negligence | – Duty – Derelict – Direct Cause – Damage |
| If a phlebotomist becomes infected with HIV during employment, he/she will be covered by | Worker’s Compensation Benefits |
| What is HIPPA | • Health Insurance Portability and Accountability • Protects the privacy and security of a person’s health information when that information |
| In order for a provider to use or disclose PHI, the hospital/lab must give each patient a | “Notice of Privacy Practices” ..Describes how the hospital/lab may use and disclose the patient’s PHI |
| what are the 3 catergories that CLIA divides lab into: | Waived (level I)....Moderate (level II)...High (level III) |
| What is WAIVED (level I) | • Simple testing that requires minimum judgment or interpretation • Incorrect test results pose little risk for the patient • Examples – Dipstick urinalysis – Pregnancy testing |
| What is MODERATE (level II) | • Moderate complexity of testing • 75% of all lab tests • Certified by approved accrediting agency • Requires MLT or higher discipline • Must meet quality assurance standards |
| What is HIGH (level III) | • High complexity of testing • Highly sophisticated tests • High risk to patient if there is an incorrect test result • Certified by approved accrediting agency • Requires CLS or higher discipline • Must meet quality assurance standards |
| Most frequent reason for rejection in hematology is | Improperly mixed tubes causing clots in EDTA microtubes |
| a specimen for sedimentation rate is only stable for...? | 4hrs at room temperature and 12hrs refrigerated |
| What is MINOR MISLABELING | Truncated (cut off/shortened/abbreviated) name or medical record number, misspelled name, missing information as date and signature |
| what is MAJOR MISLABELING | Unlabeled specimens; mismatched information on specimens and requisitions; ABO/Rh results on current specimen not matching historical record on file • This category is known as Wrong Blood in Tube (WBIT) |
| 56% of lab errors occur during what phase | During the Pre-Analytical Phase of testing |
| What is the most potentially fatal pre-analytical error | Improper patient identification |
| An impatient should be asked to state his/her name, address, DOB and or unique ID number according to whos standards | CLSI (Clinical Laboratory Standards Institute) |
| Fasting specimens should be collected around how many hours? | 10-12 hours of complete fasting |
| How long do you pre-warm a site for capillary collection | 3-5minutes (can cause increased blood flow to the area SEVENFOLD |
| The ORDER OF DRAW is suggested by | CLSI |
| What happens if you under-fill a EDTA TUBE? | you result with RBC SHRINKAGE |
| What happens if you under-fill blue top tubes | You result with ELEVATED PT |
| What two analytes must be protected from the light? | -BILIRUBIN -CAROTENE |
| aPTT should be tested within...? | 4 HOURS |
| PT can remain stable for up to...? | 48 HOURS (at room temperature) |
| Blood cultures are essential in the diagnosis of .. | ENDOCARDITIS |
| Why are blood cultures done? | To detect the presence of bacteria or yeast |
| What happens if a patient comes back with a positive blood culture? | Physician might put the patient on broad-spectrum antibiotics, OFTEN I.V. |
| Septicemia may cause...? | Fever, chills, shock, tachycardia, hypertension |
| 50% of all positive blood cultures may be positive due to the process of | CONTAMINANTS |
| Intravascular | Organisms come from infected organs, cavities, fluids (CSF, synovial fluid, pericardial fluid), untreated superficial wounds, abscesses, U.T.I., or Respiratory infections |
| Extravascular | Vascualr access devides(atrial lines, central venous catheters, etc.) urinary catheters, needles, etc |
| Define TRANSIENT BACTEREMIA | Bacteria that exist momentarily in the bloodstream and then are engulfed by the cellular immune response |
| High risk contamination rates are an example of | Vascular access devices, arterial lines, central venous catheters, and heparin locks |
| Define edema | Swelling ...an accumuation of fluid in the intercellular spaces of the body (FLUID IS INTRACELLULAR) |
| Hematoma | (Bruise) ..Caused by the leakage of blood from veins and capillaries that collects the tissues (Blood accumulation) |
| Masectomies are usually accompanied by ... | REMOVAL OF LYMPH NODES (high susceptibility to infections) |
| Sclerosed Veins | Hardened Veins...due to inflammation, Disease, Repeated punctures (may be difficult to push the needle though) |
| If both arms have an IV, obtain the blood specimen ....? | BELOW the insertion point ofthe IV LINE |
| PKU tests are done to..? | rule out a hereditary metabolic disorder |
| If BILIRUBIN levels are too high babies are placed on...? | UV LIGHT |
| EACH newborn is kept in an | ISOLETTE |
| Newborns are extremely susceptible to ...? | INFECTIONS |
| Always remove supplies from the isolette, ESPECIALLY ..? | LANCETS |
| For children under two, ______puncture is the method of choice | DERMAL |
| Heel Punctures are considered for | Children under 1year/20pounds |
| Finger punctures are considered for | Children from 1-2years |
| Children over 2 may have what type of puncture | VENIPUNCTURE |
| Most elderly develop what type of anemia due to continuous phlebotomy | LATROGENIC ANEMIA |
| EPA (environmental protective agency) recommends noise level in hospitals not to exceed ...? | 40dB |
| Dialysis is performed on patients with | END STAGE RENAL DISEASE |
| What happens during dialysis | Waste products are removed from the blood |
| Venipunctures are prohibited from dialysis patients therefore you must perform..? | a FINGER STICK |
| How many identifiers is recommended for an outpatient? | 2 Identifiers |
| Its against "______regulations" to palpate a vein without gloves | OSHA |
| Tourniquet must be applied how many inches apart from the antecubital fossa | 3-4inches (restricts bloods flow, causes veins to distend) |
| Why should you allow chlorhexidine to dry completely before beginning a venipuncture | To prevent Hemolysis |
| You should insert a needle at what angle | 15-30 Degree angle (BEVEL UP) |
| All tubes with additives must be properly mixed as quickly as possible to prevent...? | PLATELET CLUMPING AND COAGULATION |
| Examples of special handeling regarding "KEPT COLD SPECIMEN" include: | Blood gases..ammonia |
| Examples of special handeling regarding "KEPT WARM SPECIMEN" include: | Cold Agglutinins |
| Examples of special handeling regarding "KEPT IN THE DARK SPECIMEN" include | Bilirubin...Carotene |
| What are some examples of Adverse Reaction | Syncope...Nausea...Vomiting |
| If bleeding continues for more than 5minutes call | PHYSICIAN |
| What are some communication strategies | Verbal communication Nonverbal communication Active Listening |
| What are the "Four Components Of Communication" | -THE SENDER(Person sending the message) -MESSAGE SENT(What the sender wants to convey) -SYMBOLS(How the sender communicates the message) -MESSAGE RECEIVED(How the message is perceived) |
| What is the measurement considered for "PERSONAL SPACE" | 18in.-4ft. (Interactions with friends and some patients) |
| What is the measurement considered for "SOCIAL SPACE" | 4ft.-12ft. (Most interactions of daily life) |
| What is the measurement considered for "PUBLIC SPACE" | >12ft. (lectures, speeches) |
| What is the "Zone of Comfort" | Area around patient that is private territory(CHILDREN may feel uncomfortable if you get to close) |
| What is the "GOLDEN RULE" | Treat patient as you would want yourself or a family member treated in a health care setting |
| What is "Culture Sensitivity" | System of values, beliefs and practices that stem from a person's concept to reality |
| Physical Impact of Stress can cause? | -Hypertension -Hyperglycemia -Stroke -Myocardial Infarction -Diabetes -Ulcers -Neck and back pain |
| What are the early signs of stress | Headaches/fatigue (due to burnout and overload) |
| Immediate physical signs of stress are? | -Cold -Nervousness -Tense -Sweaty Hands |
| What are some coping strategies for stress | -keep caffeine to a minimum -try not to use alcohol/nicotine(may increase level of stress) -exercise regularly -set aside time to relax each day |
| define ethics | Morales duty to determine right and wrong |
| define accountability | You are responsible for your actions |
| Define Hemophilia | Tendency to bleed |
| define Thrombophilia | tendency to clot |
| Define Hemostasis | Process of blood clotting and then the subsequent dissolution of the clot following repair of injured tissue |
| What are the 5 Steps of the hemostatic process | Platelet Phase .. Coagulation Phase.. Clot Reaction.. Fibrinolysis |
| What is Primary Hemostasis | -Process of forming a platelet plug at the sit of vessel injury -Consists of a vasoconstriction of platelet adhesion |
| Define Vasoconstriction(Vascular Phase) | "tightening" of blood vessels to divert blood flow around the damaged vessel -enhances contact activation of platelets and coagulation factors |
| Define Platelet Adhesion( Platelet Phase) | Platelets become activated and aggregate at the site of injury, forming a temporary loose, platelet plug |
| What happens in Secondary Hemostasis | Stabilizes the initially loose platelet plug, a sequence of enzymatic reaction is initiated which culminates in fibrin strands forming at the platelet plug |
| What happens in the "Coagulation Phase" | -Coagulation factors interact with each other to form a fibrin clot (reinforces the platelet plug...ADP, thromboxon, PFB) "FIBRIN FORMING SYSTEM |
| What are "Coagulation Factors" | Proteins normally presented in the blood (most are produced by the liver) ...normally "turned off" (inactive)..."A" signals the factor in its "active" form of coagulation cascade |
| What happens in the "Extrinsic Pathway" | Activated when endothelial cells are injured and tissue factor is released -activated factor VII and tissue factor bind to form a complex.(this complex, plus calcium, activates factor XTissue Factor) |
| What happens in the "Intrinsic Pathway" | Initiation occurs when factor XII is exposed to a negatively charged surface(termed the contact phase) "REQUIRES CLOTTING FACTORS VIII-XII |
| What is the "COMMON PATHWAY" | When factor Xa bigs to the platelet surface, a complex is formed composed of platelet phospholipid, calcium and factor Va...-Complex converts prothrombin to thrombin which in turn converts fibrinogen to fibrin |
| Explain Fibrinolysis | Bodys ways of keeping coagulation from becoming excessive and occluding the blood vessels |
| Thromboplastin activates what factor? | FACTOR 7 |
| define the REGULATION STAGE | Balance between coagulation and fibrinolyctic process must be maintained otherwise excess clotting or fibrinolysis will occur |
| Thrombophilia causes what | D.V.T. (Deep Venouse Thrombosis) or P.E. (Pulmonary Embolism) |
| define THROMBOPHILIA | Hypercoagulable state due to inherited(heriditary/genetic) defects or acquired defects in one or several factors of the coagulation cascade |
| FACTOR 1(fibrinogen) ...define .AFIBRINOGENEMIA | Total absense of measurable fibrinogen (RARE CONGENITAL DISORDER) |
| FACTOR 1(fibrinogen)...define HYPOFIRINOGENEMIA | Below normal levels of fibrinogen -treated by cryoprecipitate or FFP |
| FACTOR 1(fibrinogen)...define DYSFIBRINOGENEMIA | altered structure of the fibrinogen molecule -usually asymptomatic but has been associated with both bleeding and thrombotic events |
| explain ...FACTOR V (proaccelerin)GENE DEFECT | (MOST COMMON CAUSE OF THROMBOPHILIA) coafactor in coagulation cascade..defieceny causes bleeding but factor V mutation causes thrombotic events due to impaired degradation of factor V resulting in continued thrombin generation |
| what does MTHFR do ? | Breaks down homo cysteine |
| deficiency of MTHFR causes ? | increase of homocysteine leading to thrombosis |
| Acquired Homo cysteine is due to | deficiency of vitamin B6 and B12 |
| What happens if Prothrombin does not break down | keeps on activating thrombin to convert fibrinogen into a fibrin clot |
| deficiency in vWF causes (FACTOR VIII) | vonWillebrand's Disease |
| Defect or absense of coagulant portion causes | Classic Hemophilia A |
| Acute Phase Reactant | Increase in inflammation, stress, pregnancy and infectin which can lead to clot formation |
| What is the purpose of Quality Assurance | Gathering/evaluating information and data about services/tests provided |
| Quality Assurance is also known for | QUALITY IMPROVEMENT QUALITY ASSESSMENT PROFICIENCY IMPROVEMENT PERFORMANCE IMPROVEMENT |
| define T.A.T. | TURN AROUND TIME |
| What is the purpose of P.I. | Implement an interdisciplinary approach to collection, analysis and reporting of performance measures |
| What is the overall goal of P.I. | Effect quality improvement including accuracy and precision |
| Where does P.I. begin in a hospital setting | Begins in the lab before specimen is collected |
| What are Logbooks | Logs examined in quality assurance meeting to determine problem areas (also document problem areas with incident reports) |
| Define INCIDENT REPORTS | a formal written description of an incident/unusual occurrence |
| What is the purpose of incident reports | To objectively document exactly what happened (GOAL is to prevent another episode) |
| Define DELTA TEST | comparison between current results of the lab test and previous test results for same patient (CLS) |
| What are FLOOR BOOKS | Containcs information that lists the name of each test/procedure (useful to aid in consistency of testing for quality control purposes "AKA PROCEDURE, REFERENCE or TEST MANUAL) |
| what does JCAHO stand for | Joint commission on accrediation of healthcare organization (PRIVATE NON-GOVERNMENT AGENCY) |
| What does JCAHO do | Establishes guidelines for healthcare agencies regarding quality of care |
| What is CQI | Continuous Quality Improvement |
| What does CQI do ? | Framework and management commitment to improve healthcare structure, processes, outcomes, and customer satisfaction |
| What is the ultimate goal for CQI | IMPROVE PATIENT OUTCOMES |
| what are the "Poor patient outcomes (5 D's)" | -DEATH -DISEASE -DISABILITY -DISCOMFORT -DISSATISFACTION |
| Define P.D.C.A. | Plan-Do-Check-Act |
| What is the purpose of PDCA | Cycle for assessing, making changes, then reassessing and putting in action |
| What is the primary goal during a specimen collection | obtain accurate samples for analysis |
| Occupational Safety and Health Administration (OSHA) was established when ? | 1970 by US Congress |
| What is the goal of OSHA | Assures every working person in the nation a safe and healthful working condition |
| Center of Disease Control establishes ? | Universal Precautions (OSHA enforces them) |
| What are Bloodborne Pathogens | Microorganisms that cause disease in humans and are transmitted only through contact with infectious body fluids (NOT urine or feces..unless blood is visible) examples:HIV/AID, malaria, syphilis, ebola virus |
| What is the main symptom for Hepatitis B | Jaundice (other symptoms may be ..fatigue abdominal pain, anorexia, nausea and vomiting) |
| How many vaccines are required for Hep. B? | 3 shots over 6month period |
| What disease is the leading cause for liver transplants | Hepatitis C |
| What are the symptoms for Hepatitis C | Fatigue and Abdominal Pain |
| What are some symptoms for Human Immunodeficiency Virus | Swollen lymph nodes, weight loss, night sweats, opportunist infections, skin lesions (can eventually lead to AIDS) |
| Define Prophylaxis | The prevention of disease |
| Highest number of phlebotomy injuries occur with ? | Butterflies |
| What does the bacteriology dept. do | deals with identification, study, and cultivation of bacteria and their application in medicine, agriculture, industry, and biotechnology |
| What is Mycology | The study of FUNGI (fungi break down dead organic material and continue the cycle of nutrients through ecosystems) |
| What is Virology | The study of biological viruses |
| What is Serology | The study antigens and antibodies in serum (red top tubes, may base use as well for the detection of an antigen-antibody reaction) |
| What is Immunology | The study of immune process and immunity (immunology lab IDs antibodies that are produced due to a disease state) |
| What is the purpose of the infection control system | Meant to break chain of infection |
| define asepsis | destruction of organisms after they leave the body (hand washing, disposable equipment, gloves) |
| What does fire need in order to start | Needs Oxygen, heat, and fuel |
| What are the four categories of fires | Class A,B,C,D |
| What is Class A based on the "category of fires" | Paper, wood, cloth and plastics |
| What is Class B based on the "category of fires" | Flammable solvents such as gases, oils, paints, and grease and an interaction with air and vapors |
| What is Class C based on the "category of fires" | In or near electrical equipment |
| What is Class D based on the "category of fires" | Combustible metals such as lithium and magnesium |
| What is the use of Class A FIRE EXTINGUISHERS | For ordinary combustible fires (contains soda and H2o) |
| What is the use of Class B FIRE EXTINGUISHERS | For fires from solvents and air-vapor mixtures (contains foam, dry chemical, or CO2) |
| What is the use of Class C FIRE EXTINGUISHERS | Used for electrical fires (contains dry chemicals) |
| What is the use of "Halon" FIRE EXTINGUISHERS | For computer fires |
| What does R.A.C.E. stand for | Remove the patient, activate the alarm and alert other staff, contain or confine the fire by closing all doors, extinguish the fire if its safe to do so |
| What does P.A.S.S. stand for | PULL the pin, AIM the nozzle just above the base of the fire, SQUEEZE the trigger of the extinguisher, SWEEP the nozzle over the fire |
| Any chemical that comes into contact with the skin or eyes must be treated | STAT |
| What is the use for Material Safety Dada Sheets (MSDS) | Detailed information about identity of chemical, physical characteristics, physical hazards and how to handle them, reactivity and dangerous reactions, health hazards, handling precautions and control measure (MUST BE KEPT IN A PROMINENT PLACE) |
| What does CHP stand for | Chemical Hygiene Plan |
| What are the four types of biological hazards and waste | Solid, Chemical, Radioactive, Infectious |
| Alcohol can become what type of hazard | flammable, poisonous |
| Cytotoxic drugs can be what type of hazard | Carcinogenic |
| Nitrous Oxide can be what type of hazard | Oxidizer and irritant |
| Formalin can be what type of hazard | Carcinogenic irritant |
| Bleach can be what type of hazard | Skin irritant, can compromise the respiratory tract |
| Betadine is what type of hazard | Thyroid/renal disturbance |
| Mercury can be what type of hazard | poisonous, corrosive |
| Glutaraldehyde can be what type of hazard | Skin irritant, can be harmful to asthma patients (can cause deterioration of latex gloves) |
| White out can be become what type of hazard | Flammable, and can lead to tumors |
| What blood levels are HIGH in the morning ? | Hormones: testosterone, cortisol, adrenocorticotropic hormone (ACTH, iron and insulin |
| What blood levels are LOW in the morning | Eosinophil count, creatine, glucose, triglycerides |
| What are some specimens that have to be kept cold during transport | Blood gases, gastrin, amoonia, lactic acid, renin |
| What color will plasma or serum be if there is a leakage of hemoglobin | Pink or red |
| Rupture of RBC membrane causes a leakage of hemoglobin which imparts a pink or red color to the serum/plasma and may affect values of certain tests like? | CBC..LD..AST..K+..Fe..T4 |
| Additive-containing tubes must be inverted gently how many times ? | 8-10times |
| What is the Analytic phase | Takes place during testing the specimen |
| What is post analytic phase | reporting results and follow up |
| What are the most common fasting specimens | Triglycerides, cholesterol, and glucose |
| what is the purpost of Two-Hour Postprandial Glucose Test | Screens for Diabetes |
| What is the purpose of a Glucose Tolerance Test | Diagnoses diabetes mellitus and hypoglycemia (similar to epinephrine tolerance test but glucagon is INJECTED INSTEAD) |
| What is the purpose of a Lactose Tolerance Test | Diagnoses lactose intolerance |
| what is the purpose of epinephrine tolerance test | determines the amount of GLYCOGEN stored in the liver (epinephrine helps break down glycogen stores and are used for energy when needed) |
| What is the purpose of Therapeutic Drug Monitoring (TDM) | Measures amount of specific medication in a patient's system |
| Why are blood cultures performed | Aids in the diagnosis of SEPTICEMIA |
| When is it best to draw a blood culture | When FEVER SPIKES |
| What is the purpose of a Bleeding time Test | Assesses status of patient's hemostasis (detects platelet function disorders "PART OF STANDARD PRE-SURGICAL WORK UP" |
| Blood smears can be performed using what type of blood? | Capillary blood or blood from lavendar tube within 1hr or being drawn into tube (part of CBC) |
| What is Neonatal Screening? ... | a state that requires infants to be tested for phenylketonuria (PKU) and congenital hypothyroidism (should be tested 24-72 hours after birth) |
| What is the purpose of ABG | Monitors patients respiration status (obtaines for measuring Po2, PCO2, and pH of blood..which tells the degree of oxygenation and acid base balance of blood. |
| What are the most common specimens collected in legal cases | ETOH, Drug screening, DNA analysis |
| POINT OF CARE TESTING is performed where | at patients bed side (falls under CLIA) |
| What is the most common test done for POINT OF CARE TESTING | Glucose level, PT, aPTT/PTT,cardiac enzymes (reduces TAT) |
| What are the common tests for common pathologies | Troponin, Amylase, lipase, ABG, BUN, Creatinine , Hct, Hgb, RBC Count |
| What is the duty of College of American Pathologist (CAP) | Sets standards for phlebotomy ...profeciency testing lab testing by pathologist and CLSs REGULATION OF CLINICAL LABORATORIES |
| What is the duty of CLSI | Establishes procedural guidelines for all areas of the lab |
| What is the duty of JCAHO | Accredits agency for hospitals and nursing homes ..inspects every 2 years ..enforces standards established by CLSI ..works with CAP to provide lab accreditation |
| What is the purpose of CLIA | Ensure quality lab testing |
| What is the duty of Survey and certification group(SCG) | has responsibiliyu of implementing CLIA program |
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moralesm05
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