A phlebotomist is planning to collect a specimen to measure a patient's serum cortisol level. Which of the following factors should the phlebotomist consider?
Body temperature
Time of day
Alcohol consumption
Prandial status
The Correct Answer is B
Choice A Reason:
Body temperature does not significantly affect serum cortisol levels and is not a factor that needs to be considered when planning to collect a cortisol specimen. Cortisol levels are regulated by the hypothalamic-pituitary-adrenal axis and not by body temperature.
Choice B Reason:
Time of day is a critical factor to consider when collecting a specimen for serum cortisol level measurement. Cortisol levels follow a diurnal pattern, peaking in the early morning hours and declining throughout the day, with the lowest levels typically occurring around midnight¹². This variation is known as the cortisol awakening response (CAR) and is important for accurately interpreting the results of the test.
Choice C Reason:
Alcohol consumption can affect cortisol levels; however, it is not typically a factor that a phlebotomist needs to consider immediately before specimen collection unless the patient is under the influence at the time of the test. Chronic alcohol use can lead to alterations in cortisol levels, but this is more of a consideration for the healthcare provider interpreting the results rather than the phlebotomist collecting the specimen.
Choice D Reason:
Prandial status, or the fed or fasting state of the patient, can influence cortisol levels, but it is not as significant a factor as the time of day. Cortisol levels can be slightly higher after eating, but this effect is generally considered minimal. The primary concern for prandial status would be if the cortisol test is being conducted alongside other tests that require fasting.
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Related Questions
Correct Answer is D
Explanation
Choice A reason:
While maintaining compliance with Clinical Laboratory Improvement Amendments (CLIA) standards is important, it is not the primary reason for explaining the venipuncture procedure to the patient. CLIA standards primarily deal with laboratory testing and do not specifically require the explanation of procedures to patients.
Choice B reason:
Evaluating the patient's understanding is a beneficial practice as it ensures that the patient is informed and can participate in their own care. However, it is not the primary legal or ethical requirement for explaining the procedure.
Choice C reason:
Maintaining compliance with Occupational Safety and Health Administration (OSHA) standards is crucial for ensuring the safety of both the healthcare provider and the patient. OSHA standards require that certain safety protocols be followed, but they do not specifically mandate that the procedure be explained to the patient for the purpose of obtaining consent.
Choice D reason:
Obtaining the patient's consent is the primary reason a phlebotomist should explain the procedure prior to venipuncture. Informed consent is a fundamental ethical and legal principle in healthcare. It involves informing the patient about the procedure, its risks, benefits, and alternatives, and ensuring that the patient understands this information before agreeing to proceed. This process respects the patient's autonomy and right to make decisions about their own healthcare.
Correct Answer is B
Explanation
Choice A reason:
Cleaning the site is a step that should be completed before anchoring the vein. The site should be cleaned with an antiseptic to reduce the risk of infection. Once the vein is anchored, cleaning the site again could displace the vein and compromise the anchoring.
Choice B reason:
After anchoring the vein, the phlebotomist should perform the procedure, which involves inserting the needle into the vein at the appropriate angle. Once the needle is in place and blood is seen in the tubing, the phlebotomist can proceed to collect the necessary amount of blood into the vacutainers or syringe.
Choice C reason:
Examining the needle is not the next step after anchoring the vein. The needle should be examined before the procedure begins to ensure it is the correct size and gauge for the venipuncture and that there are no defects.
Choice D reason:
Reapplying the tourniquet is not necessary at this point in the procedure. The tourniquet should already be in place to engorge the vein, making it easier to anchor and access. Reapplying it could cause discomfort or even disrupt the already anchored vein.
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