A phlebotomist has just confirmed critical values on a laboratory test. Which of the following actions should the phlebotomist take when the physician's office is already closed?
Contact the physician by paging or calling right away.
Leave a message at the physician's office number.
Call the physician's office on the next business day.
Fax the results to the physician's office with a stat fax cover.
The Correct Answer is A
Choice A Reason:
Contacting the physician by paging or calling right away is the most appropriate action when critical values are confirmed on a laboratory test. Critical values are defined as those that indicate the patient is in danger of death unless treatment is initiated immediately. Immediate notification of the responsible licensed caregiver is required so that appropriate clinical action can be taken for the patient. This is a standard procedure compliant with CLIA regulation 493.1109(f) and is essential for patient safety.
Choice B Reason:
Leaving a message at the physician's office number is not an adequate response to confirmed critical values. Messages can be overlooked or not checked until the next business day, which could delay necessary urgent medical interventions.
Choice C Reason:
Calling the physician's office on the next business day is not acceptable when dealing with critical values. The urgency of critical results requires immediate action, and waiting until the next business day could result in significant harm or death to the patient.
Choice D Reason:
Faxing the results to the physician's office with a stat fax cover is not sufficient for immediate communication of critical values. While the fax may indicate urgency, there is no guarantee that the fax will be seen immediately by the physician or their staff. Direct communication through paging or calling ensures that the critical information is relayed without delay.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A Reason:
The red top tube is typically used for serum determinations in chemistry, serology, and blood bank. It contains no additive or may contain a clot activator. The red top tube is not the first choice for capillary puncture order of draw because it is designed for tests that require serum and not whole blood.
Choice B Reason:
The lavender top tube is used for whole blood hematology determinations, as it contains EDTA as an anticoagulant. According to the order of draw for capillary punctures, the EDTA tube should be collected first to ensure adequate volume and accurate hematology test results. This makes the lavender top tube the correct choice for the first collection in this scenario.
Choice C Reason:
The light blue top tube contains sodium citrate and is used for coagulation tests. In venipuncture, it is drawn after the blood culture bottle and before other tubes to prevent contamination with additives from other tubes. However, for capillary punctures, it is not the first choice as hematology tests take precedence.
Choice D Reason:
The royal blue top tube is used for trace element, toxicology, and nutrient determinations². While it may be used for lead and toxicology screens mentioned in the question, it is not the first tube to be drawn in a capillary puncture sequence. The EDTA tube (lavender top) is drawn first to prevent clotting and ensure accurate CBC results.
Correct Answer is D
Explanation
Choice A Reason:
Withdrawing the needle completely would be an incorrect action because it would end the procedure prematurely and require a new venipuncture, causing unnecessary discomfort to the patient. It should only be done if the venipuncture has been completed or if there is a need to stop due to a complication.
Choice B Reason:
Rotating the bevel of the needle could potentially reposition the needle for better blood flow if it has become occluded or is not properly aligned with the vein. However, this action should be done with caution to avoid causing injury to the vein or discomfort to the patient.
Choice C Reason:
Increasing tourniquet pressure is not advisable once blood flow has been established, as it could cause damage to the vein or hemolysis of the blood sample. The tourniquet should be released once the blood starts flowing into the first tube to avoid these issues.
Choice D Reason:
Activating a new evacuated tube is the correct action to take when blood flow stops upon attaching a second tube. This could indicate a problem with the vacuum in the tube rather than with the needle or the venipuncture site. Trying a new tube can resolve the issue without needing to adjust the needle or the patient's position.
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