Chapt 1-3

TEST ABBREVIATION TEST NAME DEPARTMENT RBC Red blood count Hematology Hgb Hemoglobin Hematology FDP Fibrin degradation products Coagulation BUN Blood urea nitrogen Chemistry PT Physical Therapist/Therapy Coagulation CBC Complete blood count Hematology AST Aspartate aminotransferase Chemistry RF Rheumatoid factor Serology/immunology UA Urinalysis Urinalysis C&S Culture and Sensitivity Microbiology Chapter 1 SKILLS DRILL 1-1: REQUISITION ACTIVITY A test requisition contains the following test abbreviations. Write the complete name of the test and the department that will perform the test on the corresponding line next to the abbreviation. Chapter Review Questions: 1.In the 17th century, the name given to the bloodletting tool or lancet was a) cup. b) hemostat. c) fleam. d) leech. 2.A factor that contributes to the overall professional impression made by the phlebotomist is a) compassion. b) self-confidence. c) dependability. d) all of the above. 3.After successful completion of the American Medical Technologists phlebotomy examination, the initials for the title granted are a) CPT. b) CLT.

c) PBT. d) RPT. 4.Understanding the ____________ of a diverse population is important in providing healthcare. a) history b) motivation c) traditions d) All the above 5.The evidence that an individual has mastered fundamental competencies in his or her technical area is called a) certification. b) esteem. c) ethics. d) tort. 6.Which was developed by AMA to provide a terminology and coding system for physician billing? a) APC b) CPT c) DRG d) Medicare 7.Which of the following is the responsibility of a phlebotomist? a) Analyze specimens b) Dispatch samples c) Obtain vital signs d) Transport patients 8.Which of the following is an example of proxemics? a) Eye contact b) Facial expressions c) Personal hygiene d) Zone of comfort 9.Which of the following is improper telephone technique? a) Listening and restating information b) Putting an irritated caller on hold c) Referring the caller elsewhere if uncertain d) Taking notes as the caller is talking 10.A healthcare facility that provides ambulatory services is a(n) a) acute care hospital. b) assisted living home.

a) administration of drug abuse programs. b) consistent use of primary care physicians. c) elimination of ambulatory services. d) increased use of emergency medicine. 18.Managed care systems’ attempts to control costs include a) allowing patients to choose their own providers. b) discouraging preventative medicine. c) permitting patient unlimited healthcare service. d) using case managers to monitor patients. 19.The serology department in a clinical laboratory performs tests that a) assess blood clotting problems. b) detect antigens and antibodies. c) identify bacteria in body fluids. d) recognize cancer in tissue cells. 20.Healthcare providers who do not recognize diversity are a) increasing innovation and teamwork. b) promoting interpersonal relations. c) risking a civil rights violation. d) supporting greater job satisfaction. Chapter 2 MATCHING 2-2: TYPE OF CONSENT Type of Consent 1.__C __ Informed consent 2.__E __ Expressed consent 3.__B __ Implied consent 4.__F __ HIV consent 5.__D __ Minor consent Description A. Constitutional right to decline a medical procedure B. Consent is suggested by actions C. Implies voluntary and competent permission D. Parental/guardian consent required for medical treatment E. Required before surgery or high-risk procedures F. State laws specify the information that must be given.

6.__A __ Refusal of consent MATCHING 2-3: NATIONAL STANDARD AND REGULATORY AGENCIES Match the organizations and regulatory agencies to the service they provide to the laboratory community. Choices may be used more than once. Services Provided 1._ E _ Developed NPSGs as an overall CQI requirement for accreditation 2._ B _ Federal regulations establishing quality standards for all laboratories including physicians’ offices 3._ E _ Accredits and certifies healthcare organizations and programs throughout the United States 4.__ C __ CLIAC was formed to assist in administering these regulations 5._ C _ Develops voluntary guidelines and standards for all areas of the laboratory 6.__ D _ An authority on quality clinical laboratory education 7.__ A _ An exclusively pathologists’ organization that inspects and accredits laboratories 8._ E __ Developed sentinel event policy for patient safety in healthcare settings 9.__ D _ Performs external peer reviews for accreditation and approval of laboratory programs 10._ A __ Inspects and accredits laboratories other than The Joint Commission LABELING EXERCISES LABELING EXERCISE 2-1: MICROBIOLOGY QUALITY ASSESSMENT FORM Answers to the following questions can be found on the Quality Assessment and Improvement Tracking form here. Circle the answer on the form; write the number of the question in or near the circle; then write out the answer on the appropriate line. Organizations and Regulatory Agencies A. CAP B. CLIA C. CLSI D. NAACLS E. TJC

Describe what each numbered item on the underlined portion of the reference manual page tells the reader about the laboratory test. Write the answer on the corresponding lines below. Underlined portion Meaning BILIRUBIN, TOTAL 1) Be sure barrier forms a complete separation between serum and cells Total bilirubin is a serum test that requires blood plasma that is separated from the blood cells. The blood sample for the BILIRUBIN test is collected in a tube that contains a specific gel that helps for quick clotting of blood and separates the clotted cells from serum (liquid part of the blood). * The gel in the SST (Serum separator tube) forms a barrier between the blood cells and serum after clotting of blood cells. So before obtaining the serum from the SST, the person should make sure that the serum is completely separated from the blood cells and a barrier is formed in between the serum and

cells. 2) CPT: 82247 Current Procedure Terminology (CPT) is a code set by American Medical Association for each medical, surgical, and diagnostic procedure and services for the identification by the physicians, health insurance companies and accreditation organizations. CPT:82247 is the code for BILIRUBIN, TOTAL. BILIRUBIN, TOTAL & DIRECT 3) Serum Separator Tube (SST) (1ml minimum) Serum Separator Tube (SST) is a test tube that contains a specific gel in it. It is used to collect blood samples that require serum for testing like biochemistry tests. The gel in the SST helps for easy clotting of blood cells and separates serum from the clotted cells by forming a barrier between the serum and cells. This makes it easier for the lab technician to collect serum. 4) Wrap in foil to protect the specimen from light The test tube with the blood sample should be wrapped with a foil to protect it from light. Bilirubin when exposed to visible light absorb light and undergo chemical changes like isomerization and oxidation that affect the values of TOTAL BILIRUBIN. 5) Total Bilirubin: 0.2 - 1.3 mg/dL The normal range of Total Bilirubin is 0.2- 1.3mg/dL. Below 0.2mg/dL is hyperbilirubinemia and more than 1.3mg/dL is hyperbilirubinemia. BISMUTH, URINE RANDOM 6) Patient should refrain from taking mineral supplements and bismuth preparations such as Pepto-Bismol for at least one week prior to specimen collection. Bismuth is an antidiarrheal, antiulcer and anti-inflammatory drug, and it is excreted mainly through urine. For measuring the amount of bismuth in the urine, the patient should not take any mineral supplements and preparations that contain bismuth for at least one week before the test. This helps to get exact value of bismuth in the urine. 7) Setup: Days: Tuesday, Thursday, & Saturday The laboratory testing days for the Bismuth, urine random specimen is done on Tuesday, Thursday, and Saturday in a week. The test is not done on other days BISMUTH, URINE, 24 HOUR 8) Reports: 2-4Days. BISMUTH, URINE, 24 HOUR (24-hour urine sample collected for testing the amount of bismuth) takes 2-4 days for getting the report, Or the report will be available 2-4 days after giving the sample. Chapter Review Questions

8.Which national organization develops guidelines and sets standards for laboratory procedures? a) CAP b) CLIAC c) CLSI d) NAACLS 9.A phlebotomist hired by a hospital as a temporary employee commits a negligent act for which the hospital is liable. This is an example of a) assault and battery. b) res ipsa loquitur. c) respondent superior. d) standard of care. 10.A phlebotomist collects a sample from a 16-year-old patient without obtaining parental or guardian consent. The phlebotomist could be charged with which of the following? a) Assault and battery b) Invasion of privacy c) Statute of limitations d) Vicarious liability 11.National Patient Safety Goals (NPSGs) are a) rules set by CDC and overseen by OSHA. b) standards set by NAACLS for educational programs. c) The Joint Commission’s specific safety requirements. d) voluntary guidelines and protocol written by CLSI. 12.A comparison of current test results with previous results for the same test on the same patient is called a a) delta check. b) quality indicator. c) risk control. d) sentinel event. 13.Which of the following forms states the concern and describes the corrective action when a problem occurs? a) Equipment check form b) Delta review form c) Internal report d) Quality control check 14.A type of negligence committed by a professional is called a) assault. b) battery. c) invasion of privacy. d) malpractice.

15.Failure to keep privileged medical information private is called a) breach of confidentiality. b) invasion of privacy. c) res ipsa loquitur. d) vicarious liability. 16.Risk factors in phlebotomy can be identified by a) adhering to national standards of good practice. b) consistently following OSHA guidelines. c) looking at trends in internal reporting forms. d) managing patient safety and sentinel events. 17.One of TJC’s safety goals for the clinical laboratory includes a) standardizing all outpatient phlebotomy practices. b) improving the turnaround time for test results. c) sanitizing collection carts and equipment daily. d) labeling all specimens before leaving the patient. 18.EMR stands for a) electronic medical record. b) emergency medical radiofrequency. c) employee medical restrictions. d) equipment manufacturer’s rating. 19.A phlebotomist using an armband for patient ID must also a) check the room number for additional verification. b) have the patient state his or her full name and DOB. c) match the order date with the date on the wristband. d) write down location of the patient on the requisition. 20.Which are the initials for the type of plan established when data identify a problem? a) CAPA b) FMEA c) IQCP d) NPS CASE STUDY 2-2: BLOOD DRAW FAILS DELTA CHECK It was a busy day in the hospital laboratory since two phlebotomists were out for medical reasons. An order came from the fourth floor for a timed draw. Joe, a phlebotomist from a temporary agency, was still there, even though he was supposed to have gotten off 2 hours earlier. No one was there to collect the specimen except Joe. Knowing how important it was, he decided to go ahead and collect it. When he arrived in the room, the patient was seated in a chair between the beds. Joe asked the patient his name and in which bed he belonged. When the seated patient answered with the right last name and pointed to the correct bed, Joe proceeded to collect the specimen from him while he sat in the chair. Joe labeled the specimen tubes at the nursing

MED158 Phlebotomy Workbook Chapter 3 MATCHING 3-1: KEY TERMS AND DESCRIPTIONS Match each key term with the best description. Key Terms 1._U _ Airborne precautions 2._C _ Asepsis 3._G __ Aseptic technique 4._S _ BBP 5._A _ Biohazard 6._R _ Biosafety 7._ B _ Clostridium difficile 8.__E _ CDC 9.__P _ Chain of infection 10._T _ Contact precautions 11._V _ Droplet precautions 12._D _ Engineering controls 13._F _ EPA 14._J _ Fomites 15._K _ HAI 16._H _ HBV 17._L _ HCS 18._I _ HCV 19._W _ HIV 20._O _ Immune 21._M _ Infectious/causative agent 22._N _ Isolation procedures 23._Q _ Microbe Descriptions A. Anything harmful to health B. Common cause of diarrhea in healthcare settings C. Condition of being free of pathogenic microbes D. Devices that isolate a workplace BBP hazard E. Federal agency charged with the investigation and control of various diseases F. Federal agency that regulates the disposal of hazardous waste G. Healthcare practice used to reduce the chance of microbial contamination H. Hepatitis B virus I. Hepatitis C virus J. Inanimate objects that can harbor material containing infectious agents K. Infection acquired in any healthcare setting L. OSHA standard regarding hazardous chemicals M. Pathogen responsible for causing an infection N. Procedures that separate patients with certain transmissible infections from others O. Protected from a specific disease by antibodies P. Series of events that lead to infection Q. Short for microorganism R. Taking precautions when handling biological substances that pose health risks S. Term applied to infectious microorganisms in blood and other body fluids T. Used to reduce the risk of infection from direct contact with

Key Terms 24._B _ MRSA 25._I _ Neutropenic 26._M _ Normal flora 27._K _ Nosocomial infection 28._H _ OSHA 29._C _ Parenteral 30._D _ Pathogenic 31._L _ Pathogens 32._U _ Percutaneous 33._T _ Per mucosal 34._Q _ PPE 35._R _ Protective/reverse isolation 36._S _ Reservoir 37._E _ SDS 38._P _ Standard precautions 39._J _ Susceptible host 40._O _ Transmission-based precautions 41._V _ Vector transmission 42._W _ Vehicle transmission 43._A _ Viability 44._F _ Virulence 45._G _ VRE 46._N _ Work practice controls Descriptions A. Ability of a microbe to survive B. Acronym for one type of bacteria that is resistant to methicillin C. Any route other than the digestive tract D. Capable of causing disease E. Contains hazardous chemical information F. Degree to which a microbe is capable of causing disease G. Enterococcus bacteria that are resistant to vancomycin H. Federal agency that mandates and enforces safe working conditions for employees I. Having an abnormally low neutrophil count J. Individual with little resistance to an infectious agent K. Infection acquired in a hospital L. Microorganisms capable of causing disease M. Nonpathogenic microbes normally on skin and other areas of the body N. Practices that reduce the likelihood of BBP exposure O. Precautions that reduce the risk of airborne, droplet, or contact transmission P. Precautions to be used in caring for all patients Q. Protective items worn by an individual R. Protects a patient who is highly susceptible to infection S. Source of an infectious microorganism T. Through mucous membranes U. Through the skin V. Transmission of an infectious agent by an insect, arthropod, or animal W. Transmission of an infectious agent through contaminated food, water, drugs, or blood

LABELING EXERCISE 3-1: NFPA 704 MARKING SYSTEM Label the quadrants in the NFPA marking system diagram according to the type of hazard they identify. You can cut and paste or type your answer on the correct line. 1. Material that on short exposure could cause serious temporary injury even with prompt medical attention 2. Material that would have to be preheated before ignition could occur 3. Material that is capable of detonating or exploding at normal temperature and pressure 4. Material that is radioactive SKILLS DRILL 3-1: REQUISITION ACTIVITY Fire Hazard 4 Health Hazard Instability Hazard 3 2 Specific Hazard

A phlebotomist is sent to collect the specimens identified on the requisition. Upon arrival at the patient’s room, he finds airborne precautions sign on the door.

1. What precautions, if any, must the phlebotomist take before entering the room? The phlebotomist must wear an N95 respirator in addition to following standard precautions. 2. Which test requested might be a clue as to why the patient has airborne precautions? ABF culture 3. What is the full name of the correct answer to 2, and why is it a clue to required precautions? 3. Acid-fast bacillus culture: TB is caused by an acid-fast bacillus and TB in the pneumonic phase requires airborne precautions. 4. Name the disease the patient has or is suspected of having. Tuberculosis Chapter 3 Review Questions 1. Terms used to identify components of the chain of infection include a) infectious agent. b) susceptible host. c) reservoir. d) all of the above. 2. Which of the following is an example of employee screening for infection control? a) HBV vaccination b) TB testing c) MMR vaccination d) All of the above 3. CDC and HICPAC recommendations allow the use of alcohol based antiseptic hand cleaners in place of handwashing if a) gloves were worn during the prior activity. b) hands are first cleaned with detergent wipes. c) hands have no visible dirt or organic material. d) all of the above conditions are met.

4. Standard precautions a) apply only to secretions and excretions that contain blood. b) are to be used when caring for all patients at all times. c) never supersede other CDC isolation recommendations. d) should not be combined with other precautions. 5. Which actions would violate a laboratory safety rule? a) Chewing gum while processing specimens b) Keeping food in a laboratory reagent refrigerator c) Wearing artificial nails d) All of the above 6. Which is an example of a bloodborne pathogen? a) Cytomegalovirus b) M. tuberculosis c) Group A strep d) Varicella virus 7. Which meets the OSHA BBP standard definition of an engineering control? a) Self-sheathing needle b) Sharps container c) Splash shield d) All of the above 8. The best defense against HBV infection is a) HBV vaccination. b) proper hand hygiene. c) using safety needles. d) wearing gloves. 9.Which involves the possibility of a permucosal BBP exposure? a) Failing to cover broken skin with a bandage b) Getting stuck with a used phlebotomy needle c) Licking the fingers to turn laboratory manual pages d) Opening blood tubes without a safety shield 10.Proper procedure for cleaning the site of an injury from a contaminated needle includes a) cleaning it with povidone–iodine or another antiseptic. b) squeezing the injured area hard until it bleeds freely. c) washing it with soap and water for at least 30 seconds. d) all of the above.