A phlebotomist is preparing to collect a blood specimen from a patient who has self-reported needle phobia. Which of the following actions should the phlebotomist take?
Encourage the patient to chew gum during the procedure.
Instruct the patient to lie supine during the procedure.
Place the patient's elbow joint at 90 degrees of flexion.
Warm the site for 10 minutes before venipuncture.
The Correct Answer is D
Choice A Reason:
Encouraging the patient to chew gum during the procedure may serve as a distraction, which can be helpful for some patients. However, this is not a widely recommended practice for reducing needle phobia. Distraction techniques can be beneficial, but they should be tailored to the individual patient's preferences and should not interfere with the procedure.
Choice B Reason:
Instructing the patient to lie supine during the procedure can help prevent fainting and reduce anxiety for some patients. This position is often used for patients who have a history of fainting or feel dizzy during blood draws. However, it is not specifically targeted at managing needle phobia.
Choice C Reason:
Placing the patient's elbow joint at 90 degrees of flexion is a standard practice to stabilize the arm and provide an optimal angle for venipuncture. While this is a necessary step in the procedure, it does not directly address the patient's needle phobia.
Choice D Reason:
Warming the site for 10 minutes before venipuncture is a technique used to enhance vein visibility and elasticity, making the venipuncture easier and potentially less painful. This can be particularly helpful for patients with needle phobia, as a smoother and quicker procedure may reduce anxiety and discomfort.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A Reason:
Warfarin does not typically require a fasting state before blood is drawn for testing. The medication's effect on clotting factors is independent of food intake. Therefore, a fasting requirement is not anticipated for patients taking warfarin unless specified for other concurrent tests.
Choice B Reason:
There is no need for an alternate antiseptic due to warfarin use. Standard antiseptic procedures are sufficient when drawing blood from patients on warfarin. The choice of antiseptic would be more influenced by patient allergies or specific institutional protocols.
Choice C Reason:
Patients on warfarin have an increased bleeding time because the medication is an anticoagulant, which means it works to prevent blood clots by thinning the blood. This can lead to prolonged bleeding after a venipuncture, and phlebotomists should be prepared to apply pressure for a longer time to ensure hemostasis.
Choice D Reason:
Placing a specimen on ice is not a standard procedure for blood samples taken for warfarin monitoring, which is typically done through a PT/INR test. This test measures the time it takes for blood to clot and is not affected by temperature in the same way that tests for certain enzymes or gases might be.
Correct Answer is B
Explanation
Choice A reason:
The order of citrate, heparin, EDTA, and fluoride is not the correct sequence for blood collection. The correct order is essential to prevent cross-contamination of additives between tubes, which could interfere with test results. Citrate tubes should be drawn first to ensure that the blood does not clot prematurely, but heparin should not follow immediately after citrate.
Choice B reason:
Citrate tubes, which contain sodium citrate, are used for coagulation tests and must be drawn first to ensure the proper blood-to-additive ratio. EDTA tubes are drawn next because EDTA binds calcium and prevents clotting, making it ideal for complete blood counts and other hematology studies. Heparin tubes, which prevent clotting by inhibiting thrombin and thromboplastin, are drawn after EDTA. Lastly, fluoride tubes, which contain a glycolysis inhibitor, are drawn to preserve glucose levels and are typically used for glucose and lactate testing.
Choice C reason:
Starting with fluoride is not recommended as it could lead to contamination of the EDTA and heparin tubes with fluoride, which could affect the results of certain tests, such as calcium determinations in heparin tubes. The order of draw is designed to minimize such risks.
Choice D reason:
This sequence is incorrect because fluoride tubes are not drawn before EDTA and heparin tubes. The presence of fluoride could potentially contaminate the subsequent tubes and alter the results of the tests that require heparin or EDTA as an anticoagulant.
In phlebotomy, following the correct order of draw is crucial. The order is established based on the type of additive in each tube and its potential to interfere with tests conducted in subsequent tubes. The standard order is: blood cultures, citrate tubes, serum tubes with or without clot activator and gel, heparin tubes with or without gel, EDTA tubes, and lastly, fluoride tubes. This sequence helps prevent cross-contamination and ensures the accuracy of laboratory results, which are critical for patient diagnosis and treatment.
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