A phlebotomist enters a patient's room and observes the patient to be motionless and cyanotic. Which of the following actions should the phlebotomist take first?

Choice A Reason:
Using only one patient identifier is not sufficient to ensure patient safety and accuracy in healthcare settings. It increases the risk of misidentification, which can lead to serious medical errors. Therefore, one identifier is not the standard practice for patient verification before a blood draw.

Choice B Reason:
While two identifiers are commonly used in many healthcare settings as a minimum requirement, they may not always provide enough differentiation, especially in larger facilities where patient names may be similar. Two identifiers are often the minimum standard, but they are not the most comprehensive approach.

Choice C Reason:
Three unique patient identifiers provide a more robust method for verifying a patient's identity, significantly reducing the likelihood of errors. According to the Clinical and Laboratory Standards Institute (CLSI), three identifiers are recommended to ensure the correct patient is being collected. This may include the patient's full name, date of birth, and medical record number or another unique identifier.

Choice D Reason:
While using four unique identifiers could further reduce the risk of patient misidentification, it is not typically required as the standard minimum. Three identifiers are generally considered adequate for most healthcare settings to ensure patient safety and proper identification.

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.