A phlebotomist is preparing to draw blood from a patient for therapeutic drug monitoring. Which of the following questions should the phlebotomist ask?
"When was your last dose of lithium?"
"For how long have you been fasting?"
"When did you have your last alcoholic beverage?"
"Have you finished drinking the glucose solution?"
The Correct Answer is A
Choice A Reason:
Asking "When was your last dose of lithium?" is crucial for therapeutic drug monitoring (TDM). TDM is used to tailor dosages and maintain therapeutic levels in a patient’s bloodstream, especially for drugs with narrow therapeutic indices like lithium. The timing of the last dose can significantly affect blood levels, and knowing this information helps in interpreting the results accurately.
Choice B Reason:
While knowing the fasting status of a patient may be relevant for certain tests, it is not typically critical for TDM unless the medication being monitored is affected by food intake. Lithium levels are not significantly influenced by fasting, so this question is less relevant than knowing the timing of the last dose.
Choice C Reason:
Inquiring about the last alcoholic beverage is important if alcohol could interfere with the medication's metabolism or the test's accuracy. However, for lithium TDM, alcohol consumption is not as directly relevant as the timing of the last dose. Alcohol does not typically alter lithium levels unless it affects the patient's hydration status.
Choice D Reason:
Asking if the patient has finished drinking the glucose solution would be pertinent if conducting a glucose tolerance test. However, this is not relevant for TDM of lithium, as the glucose solution does not interfere with lithium levels or the TDM process.
In conclusion, for therapeutic drug monitoring, particularly for lithium, the most critical question is regarding the timing of the last dose. This information is essential to ensure that the blood levels reflect the peak or trough concentration, depending on what is being measured, and to avoid misinterpretation that could lead to inappropriate dosing adjustments.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A Reason:
A red-top tube is used for serum determinations in chemistry and should be allowed to clot completely, typically for 30 minutes, before centrifugation. Shipping after only 15 minutes may result in incomplete clotting and potentially inaccurate test results.
Choice B Reason:
Serum should not be separated from a lavender-top tube, as this type of tube contains EDTA and is used for whole blood tests, not serum. This indicates a misunderstanding of the tube's purpose and could lead to compromised test results.
Choice C Reason:
A tiger-top tube, also known as a serum separator tube, is used for various chemistry tests. However, bilirubin is light-sensitive, and specimens for bilirubin testing should be protected from light, not shipped in a clear bag. This could lead to degradation of the bilirubin and inaccurate results.
Choice D Reason:
A green-top tube contains heparin and is used for plasma determinations. Ammonia testing requires the plasma to be placed on ice immediately after collection to inhibit the continued production of ammonia from red blood cells. Therefore, shipping in an icy water mixture is the correct procedure to ensure accurate ammonia levels.
In conclusion, the proper preparation and transport of blood specimens are crucial for the accuracy of laboratory tests. The green-top tube for ammonia testing, shipped in an icy water mixture, is the only option that follows the correct protocol for specimen handling and transport.
Correct Answer is B
Explanation
Choice A Reason:
Shoe covers are used to protect the shoes and prevent the spread of contaminants from one area to another. They are not specifically required for droplet precautions during blood glucose monitoring. Droplet precautions typically focus on protecting mucous membranes of the eyes, nose, and mouth from droplet spatter.
Choice B Reason:
Masks are essential when dealing with patients under droplet precautions. Droplets can transmit infections when a person coughs, sneezes, or talks, and a mask provides a barrier that prevents the inhalation of these potentially infectious droplets. For procedures like blood glucose monitoring, where close contact with the patient is necessary, wearing a mask is crucial to protect both the healthcare worker and the patient.
Choice C Reason:
A gown is used to protect the healthcare worker's skin and clothing from contamination with potentially infectious material. While it is an important piece of personal protective equipment, it is not the primary requirement for droplet precautions in the context of blood glucose monitoring, unless there is a risk of substantial splashing or spraying of bodily fluids.
Choice D Reason:
Goggles are used to protect the eyes from splashes of blood or other body fluids. They are important in procedures where there is a risk of splashing, but for blood glucose monitoring, the risk is minimal. Therefore, goggles are not the primary piece of equipment required for droplet precautions in this scenario.
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