Phlebotomy Venipuncture Procedures Questions and Answers 1 — Questions and Answers
Question 1: A phlebotomist is preparing for a routine venipuncture on an adult patient. Which of the following is the most critical first step in this procedure?
- Selecting the appropriate gauge needle
- Applying the tourniquet
- Positively identifying the patient (Correct answer)
- Palpating for a suitable vein
Correct answer: Positively identifying the patient
The most critical initial step in any patient procedure, including venipuncture, is to ensure the correct patient is being treated. The Joint Commission mandates using at least two patient identifiers to prevent errors. All other steps follow after the patient's identity has been confirmed.
Question 2: During a venipuncture, the patient complains of a sharp, radiating pain down their arm. The phlebotomist should immediately:
- Continue the draw but pull back on the needle slightly
- Ask the patient to make a fist to improve blood flow
- Re-angle the needle to find a better position
- Release the tourniquet, remove the needle, and apply pressure (Correct answer)
Correct answer: Release the tourniquet, remove the needle, and apply pressure
A sharp, radiating pain is a primary indicator of possible nerve injury. The procedure must be stopped immediately to prevent further damage. The tourniquet should be released, the needle withdrawn, and pressure applied to the site.
Question 3: What is the proper angle for needle insertion during a routine venipuncture in the antecubital fossa?
- 5 to 10 degrees
- 15 to 30 degrees (Correct answer)
- 45 to 60 degrees
- 90 degrees
Correct answer: 15 to 30 degrees
The recommended angle of needle insertion for a standard venipuncture is between 15 and 30 degrees. This angle allows the needle to enter the vein smoothly without passing through it. A lower angle risks being too shallow, while a higher angle increases the risk of puncturing the back wall of the vein or injuring underlying structures.
Question 4: A phlebotomist must draw blood for a coagulation test, a complete blood count (CBC), and a serum chemistry panel. Which is the correct order of draw using the evacuated tube system?
- Red top (serum), Lavender top (EDTA), Light Blue top (sodium citrate)
- Lavender top (EDTA), Light Blue top (sodium citrate), Red top (serum)
- Light Blue top (sodium citrate), Red top (serum), Lavender top (EDTA) (Correct answer)
- Red top (serum), Light Blue top (sodium citrate), Lavender top (EDTA)
Correct answer: Light Blue top (sodium citrate), Red top (serum), Lavender top (EDTA)
The correct order of draw is critical to prevent cross-contamination of additives between tubes. For these tests, the Light Blue top (sodium citrate for coagulation) must be drawn first. The Red top (serum tube, which may have a clot activator but no anticoagulant) comes next. Finally, the Lavender top (EDTA) is drawn for the CBC.
Question 5: Which of the following veins is the last choice for venipuncture due to its proximity to the brachial artery and median nerve?
- Median cubital vein
- Cephalic vein
- Dorsal metacarpal veins
- Basilic vein (Correct answer)
Correct answer: Basilic vein
The basilic vein, located on the inner side of the antecubital fossa, is considered the last choice for venipuncture. It is close to the brachial artery and the median nerve, increasing the risk of accidental puncture of these structures. The median cubital vein is the first choice, followed by the cephalic vein.
Question 6: After removing the needle from the patient's arm, what is the correct immediate post-venipuncture instruction for the patient?
- Bend the arm at the elbow to hold the gauze in place.
- Apply firm pressure to the gauze over the site without bending the arm. (Correct answer)
- Remove the gauze immediately to check if bleeding has stopped.
- Pump their fist several times to restore circulation.
Correct answer: Apply firm pressure to the gauze over the site without bending the arm.
Immediately after needle withdrawal, the patient should be instructed to apply firm pressure with gauze over the puncture site while keeping the arm extended. Bending the arm at the elbow can cause a hematoma by pushing the vein against the puncture site in the skin, allowing blood to leak into the tissue.
Phlebotomy Venipuncture Procedures Questions and Answers 1
A phlebotomist is preparing for a routine venipuncture on an adult patient.
Which of the following is the most critical first step in this procedure?