Which of the following samples should a phlebotomist present to the laboratory first for processing?
A sodium level from a patient who has a DNR order
A hemoglobin and hematocrit level from a patient who is postoperative
A stat potassium level from a patient in the emergency room
A peak antibiotic level from a patient who is NPO
The Correct Answer is C
Choice A reason:
A sodium level test is important for managing and monitoring a patient's electrolyte balance, particularly in critical care settings. However, a DNR order indicates that the patient has chosen not to undergo CPR, not necessarily that their condition is the most critical at the moment. Therefore, while important, it may not be the most urgent sample to process.
Choice B reason:
Postoperative monitoring of hemoglobin and hematocrit levels is crucial for detecting possible hemorrhage and ensuring proper recovery. However, unless there is an immediate concern for acute blood loss or other complications, these tests may not be as urgent as a stat test from the emergency room.
Choice C reason:
A stat potassium level is typically ordered when there is an urgent need to assess a patient's potassium due to conditions that can rapidly affect heart rhythm and muscle function. In the emergency room setting, where patients often present with acute and life-threatening conditions, stat tests are prioritized to provide rapid results that can influence immediate clinical decisions.
Choice D reason:
Peak antibiotic levels are measured to ensure therapeutic efficacy and to avoid toxicity. While important for managing a patient's treatment, especially for those who are NPO (nothing by mouth), it may not be as time-sensitive as a stat test required for an acute emergency.
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Correct Answer is D
Explanation
Choice A reason:
While maintaining compliance with Clinical Laboratory Improvement Amendments (CLIA) standards is important, it is not the primary reason for explaining the venipuncture procedure to the patient. CLIA standards primarily deal with laboratory testing and do not specifically require the explanation of procedures to patients.
Choice B reason:
Evaluating the patient's understanding is a beneficial practice as it ensures that the patient is informed and can participate in their own care. However, it is not the primary legal or ethical requirement for explaining the procedure.
Choice C reason:
Maintaining compliance with Occupational Safety and Health Administration (OSHA) standards is crucial for ensuring the safety of both the healthcare provider and the patient. OSHA standards require that certain safety protocols be followed, but they do not specifically mandate that the procedure be explained to the patient for the purpose of obtaining consent.
Choice D reason:
Obtaining the patient's consent is the primary reason a phlebotomist should explain the procedure prior to venipuncture. Informed consent is a fundamental ethical and legal principle in healthcare. It involves informing the patient about the procedure, its risks, benefits, and alternatives, and ensuring that the patient understands this information before agreeing to proceed. This process respects the patient's autonomy and right to make decisions about their own healthcare.
Correct Answer is D
Explanation
Choice A Reason:
The age of the newborn is important for certain metabolic screenings, as some metabolites may not be present or at measurable levels immediately after birth. However, the requirement for the newborn to be at least 3 days old is not a standard for all blood spot collections for inborn errors of metabolism (IEM). Some screenings are performed within 24 to 48 hours after birth.
Choice B Reason:
While it is important that the circles on the filter paper are adequately filled to ensure there is enough blood for the test, the requirement for them to be at least half filled is not specified in the guidelines. The focus is usually on ensuring the blood spot is of the right size and properly saturated through the filter paper.
Choice C Reason:
The inclusion of the first drop of blood is not typically a requirement. In fact, the first drop is often wiped away to avoid contamination with tissue fluids that could affect the test results. Subsequent drops are used to fill the circles on the filter paper.
Choice D Reason:
The specimen must be completely dried before the test can be processed to prevent degradation or hemolysis of the blood sample. This is a critical step in the preparation of the sample for accurate testing of IEM. The drying process helps preserve the integrity of the metabolites to be analyzed.
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