Which of the following accommodations should a phlebotomist make to increase a patient's comfort for venipuncture?

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.

Choice A reason:
The date of birth is a common identifier, but it is not unique to an individual, as multiple patients may share the same birth date. While it is useful in conjunction with other identifiers, on its own, it does not provide a definitive identification.

Choice B reason:
The record number, often referred to as the medical record number, is a unique identifier assigned to each patient within a healthcare system. It is used to track patient information across different visits and services, making it the most reliable standalone identifier if the patient's name is not available.

Choice C reason:
An address can change over time and may not be unique, especially in large apartment buildings or for patients who are homeless or transient. It is also not specific enough to reliably identify a patient, as multiple individuals can reside at the same address.

Choice D reason:
The social security number is a unique identifier, but due to privacy concerns and the risk of identity theft, it is not the preferred method for patient identification in healthcare settings. Additionally, not all patients may have a social security number, such as non-residents or newborns.