A phlebotomist should recognize that the Clinical and Laboratory Standards Institute (CLSI) recommends that a heel stick depth should not penetrate deeper than which of the following depths for an infant patient?
2.0 mm
2.5 mm
3.0 mm
3.5 mm
The Correct Answer is A
Choice A Reason:
The recommended heel stick depth of 2.0 mm is based on the need to minimize the risk of injury to the infant. Penetrating deeper than this can increase the likelihood of hitting bone, which in infants can be as close as 2.0 mm under the skin of the plantar surface of the heel. This depth is sufficient to obtain a blood sample without risking injury to deeper tissues or bone.
Choice B Reason:
A depth of 2.5 mm may be too deep for some infants, especially preterm or very small infants, where the calcaneus (heel bone) is closer to the surface. While this depth might still be safe for some infants, it does not provide the same margin of safety as the 2.0 mm recommendation and could potentially lead to bone puncture or other injuries.
Choice C Reason:
A depth of 3.0 mm significantly increases the risk of bone puncture, especially in infants with less subcutaneous fat or in those who are preterm. This depth could easily breach the protective layer of skin and subcutaneous tissue, leading to a higher risk of osteomyelitis, an infection of the bone, which can be a serious complication in infants.
Choice D Reason:
A depth of 3.5 mm is considered too deep for a heel stick procedure and is likely to cause injury to the infant. This depth would almost certainly penetrate the bone in most infants, leading to severe pain, potential for infection, and other complications. It is well beyond the safe range recommended by CLSI and should be avoided.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A Reason:
The chain of custody form is crucial in the context of a toxicology drug screen for legal purposes. It is a document that records the sequence of custody, control, transfer, analysis, and disposition of physical and electronic evidence. It is particularly important in legal cases where the results of the toxicology screen can be used as evidence in court. The chain of custody ensures that the sample has been handled properly and that the integrity of the sample has been maintained throughout the testing process.
Choice B Reason:
A requisition form is used to request a specific test or service. While it is an essential document in the process of ordering a toxicology drug screen, it does not serve the same purpose as the chain of custody in terms of legal proceedings. The requisition form typically includes patient information, the tests ordered, and the reason for the test, but it does not track the handling of the sample.
Choice C Reason:
An encounter form, also known as a superbill, is used in medical billing to capture the services provided during a patient's visit. It includes information about the patient's diagnosis, the procedures performed, and the codes for billing purposes. However, it is not specifically related to the legal aspects of a toxicology drug screen.
Choice D Reason:
The CMS 1500 form is the standard claim form used by healthcare providers to bill Medicare and Medicaid services. It is also used by some private insurers and managed care plans. Like the encounter form, it is related to billing and not to the legal chain of custody required for a toxicology drug screen.
Correct Answer is B
Explanation
Choice A Reason:
The timeline of the individual prior to specimen collection is important for context but is not typically part of the chain of custody documentation. The chain of custody focuses on the handling of the specimen rather than the activities of the individual before the collection.
Choice B Reason:
The identity of each person who handles the specimen is a critical element of the chain of custody. This information ensures that the specimen can be tracked at every stage from collection to analysis, and any potential tampering can be identified and addressed.
Choice C Reason:
While the physical and mental status of the individual may be noted in medical records or police reports, it is not a standard part of the chain of custody for a blood alcohol test. The chain of custody's purpose is to track the specimen, not the condition of the individual.
Choice D Reason:
The condition of the specimen every hour is not required in the chain of custody documentation. What is necessary is the documentation of any changes in the condition of the specimen that could affect the integrity of the results, such as temperature excursions or signs of tampering.
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