Which of the following actions is required immediately after a phlebotomist experiences an accidental needlestick injury when drawing blood from a patient who has HIV?
Report the exposure to the supervisor.
Report the exposure to the CDC.
Send the patient for further STI testing.
Save the collection device for future evaluation.
The Correct Answer is A
Choice A reason:
Reporting the exposure to the supervisor is the immediate and required action after experiencing a needlestick injury. The supervisor will then guide the phlebotomist through the institution's post-exposure protocol, which includes immediate care of the wound, evaluation of the exposure, and initiation of post-exposure prophylaxis (PEP) if necessary. This step is crucial to ensure that the risk of HIV transmission is minimized and that the phlebotomist receives appropriate medical attention and follow-up.
Choice B reason:
Reporting the exposure to the Centers for Disease Control and Prevention (CDC) is not the immediate action required. The CDC provides guidelines and recommendations for handling such incidents, but the initial report and response are managed at the healthcare facility level. The CDC may be involved in the tracking of such incidents on a larger scale or providing statistical data, but they are not the first point of contact.
Choice C reason:
Sending the patient for further sexually transmitted infection (STI) testing is not an immediate action required following a needlestick injury. The patient's HIV status is already known, and the focus should be on the treatment and protection of the healthcare worker who experienced the needlestick. Any additional testing of the patient would be unrelated to the immediate management of the injury.
Choice D reason:
Saving the collection device for future evaluation is not a standard procedure. While the device may be retained as part of the incident investigation to determine how the injury occurred and to improve safety measures, the immediate concern is the treatment of the injured healthcare worker. The device itself does not play a role in the post-exposure management of the worker.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason:
When encountering a patient who appears motionless and cyanotic, the first action should be to assess their level of consciousness. Asking loudly if they are okay can help determine if the patient is responsive or unresponsive. If there is no response, this indicates that the patient may be unconscious and requires further immediate assessment and potential intervention.
Choice B reason:
The head-tilt-chin-lift maneuver is used to open the airway of an unresponsive patient who is not suspected of having a spinal injury. However, this is not the first step. Before performing any maneuvers, it is essential to determine the patient's level of consciousness and whether they are breathing.
Choice C reason:
Administering rescue breaths is part of the process of cardiopulmonary resuscitation (CPR), which is only initiated after confirming that the patient is unresponsive and not breathing normally. This step comes after checking for responsiveness and breathing.
Choice D reason:
Looking, listening, and feeling for breathing movements is part of the assessment to determine if the patient is breathing normally. This is done after establishing unresponsiveness but before initiating CPR. It is a critical step, but it follows after confirming that the patient does not respond to verbal stimuli.
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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