Question 1

Which of the following terms refers to improper or unskillful care of a patient by a health care worker, any unreasonable lack of skill, and/or professional misconduct?
A)Assault.
B)Slander
C)Malpractice
D)Battery

Accepted Answer

Malpractice is defined as improper or unskillful care of a patient by a health care worker. An accusation of malpractice is considered by comparing the actions of the accused health care worker against the accepted standard of care for that field. Malpractice is a type of negligence; negligence is defined as a violation of duty to exercise reasonable skill and care while performing a task.

Question 2

What is the disadvantage of using the radial artery for arterial puncture?
A)There is not a disadvantage; it is the first choice for arterial puncture.
B)It lies close to the medial nerve.
C)It is small.
D)It is not easily palpable.

Accepted Answer

The disadvantage of using the radial artery for arterial puncture is that it is smaller than other arteries. However, while other arteries may be larger, the advantage of the radial artery's accessibility, proximity to skin surface, and lack of nearby nerve structures outweigh the disadvantages. Arterial puncture requires considerable skill and experience.

Question 3

Which is larger, a 22-gauge needle or a 18-gauge needle?
A)The 22-gauge needle is larger.
B)The 18-gauge needle is larger.

Accepted Answer

The needle identified as an 18-gauge needle has a larger bore than a 22-gauge needle. The numbers indicate the width of the bore of the needle. The SMALLER the number, the LARGER the bore of the needle. Generally, a 20-gauge needle is used in venipuncture. During the assessment, the nurse determines what size gauge is most appropriate for performing a successful blood collection on that specific patient. This determination is based on size of the patient's vein, findings gathered from palpitation. It is part of the nurse responsibility to understand the effects of different gauge needles on blood and blood products.

Question 4

Blood-borne pathogens are:
A)Disease-producing organisms.
B)Often found in blood and body fluids of infected patients.
C)Organisms that can be spread by sharps injuries.
D)All of the above

Accepted Answer

Blood-borne pathogens are infectious agents that are found in the blood and body fluids of infected individuals and can be passed by injuries resulting from sharp objects that pierce the skin, such as needles and broken glass. Needle-sticks that occur as a result of a laboratory accident are the most common way that blood-borne pathogens are spread between patients and health care workers.

Question 5

In hypothesis testing, the area of the curve in which it is unlikely a researcher will obtain means is called the rejection region (or region of unlikely values). What conclusions are drawn when obtained values fall in the rejection region?
A)The experiment was unsuccessful and needs to be redesigned
B)Null hypothesis is rejected; there are differences between groups
C)Null hypothesis is rejected; there are no statistically significant differences between groups
D)Null hypothesis is accepted; there are no statistically significant differences between groups

Accepted Answer

When obtained values fall in the rejection region, a researcher concludes that there are differences between groups; null hypothesis is rejected. This outcome provides statistically significant findings.

Question 6

The disintegration or destruction of red blood cells along with subsequent rupture of the cell membrane and release of the cell contents, is the definition of which of the following terms?
A)Homeostasis.
B)Hemolysis.
C)Hemostasis.

Accepted Answer

When red blood cells rupture (due to disintegration or destruction), the cell-contents are released, this is known as hemolysis The presence of the cell contents in plasma blood will alter different laboratory studies. Hemolysis may occur with some disorders or blood diseases. However, it is possible for the nurse to cause hemolysis during the specimen collection process if not careful.

Question 7

A nurse is using a butterfly syringe, tube adaptor, and pediatric tubes to collect blood from an adult patient with very fragile veins. Has the nurse made a mistake by doing this?

Accepted Answer

No, the nurse has not made a mistake by using a butterfly syringe and pediatric collection tubes. Although smaller, the additive- to- blood ratio is the same in pediatric tubes as in adult collection tubes, and will not be rejected by the lab Using a butterfly syringe for people with very fragile veins is preferred.

Question 8

Which of the following situations would be reported as a sentinel event, according to the Joint Commission?
A)A patient who received surgery on the wrong part of the body
B)A patient developing a stage II pressure wound during surgery
C)A patient who received an extra dose of antibiotic before surgery
D)A patient who developed a wound infection postoperatively

Accepted Answer

A patient who received surgery on the wrong part of the body is an example of a sentinel event. According to the Joint Commission, this type of event is unexpected and involves death or serious, permanent physical injury. Surgery on the wrong patient is also classified as a sentinel event under the Joint Commission guidelines.

Question 9

What is glycolysis?
A)The additive used to preserve glucose in blood.
B)The destruction of red blood cells.
C)The process of breaking down glucose for energy.

Accepted Answer

Glycolysis is the action of breaking down glucose for energy. In blood, RBC's and WBC's use glucose for energy. This natural occurring action can cause inaccurately lowered blood glucose and pH levels. Blood glucose levels are collected in specimen containers that contain an additive meant to prevent the breakdown of glucose (antiglycolytics). Specimens drawn for blood gas studies are transported to the laboratory immediately immersed in ice water, to slow the process.

Question 10

An amendment created to ensure accurate laboratory results was passed in 1988 and enacted in 1992; it applies to every American clinical laboratory. What is the name of this amendment?
A)Patient Bill of Rights
B)Clinical Laboratory Improvement Amendment
C)HIPPA

Accepted Answer

The Clinical Laboratory Improvement Amendment, CLIA88, requires every American clinical laboratory to document the education and the continuing education of each of its employees. In addition, CLIA 88 requires documentation of all procedural steps of all lab testing conducted in that clinical laboratory. If the laboratory is conducting moderate to complex testing, the facility must also undergo biannual inspections. The nurse should have a basic understanding of CLIA88 and its impact on the facility in which s/he is employed. CLIA88 also establishes what tests the nurse is permitted to perform.

Question 11

Why is careful documentation and monitoring of the amount of draws and total volume of blood drawn, from a premature infant necessary?
A)It is not necessary.
B)To prevent unnecessary pain and testing.
C)It is not the nurse's responsibility.
D)To prevent complications related to blood volume depletion.

Accepted Answer

Careful documentation and monitoring of the total amount of blood drawn from a premature infant is critical. Since 10 ml of blood is equivalent to about 10% of a premature infants' total blood volume, complications such as anemia, dehydration or hypovolemic shock can easily occur if total amount of blood draws exceed more than 10 ml.

Question 12

What is the difference between the effects of asking a patient to hold a fist while applying a tourniquet, and the effects of applying warmth to a potential puncture site? Choose all that apply.
A)Application of heat engorges venous blood vessels, making palpitation easier
B)Application of heat causes dilation of blood vessels, allowing veins to fill with more blood
C)Holding a fist while a tourniquet is applied engorges venous blood vessels, making palpitation easier
D)Holding a fist while a tourniquet is applied causes dilation of blood vessels, allowing veins to fill with more blood
E)None of the above

Accepted Answer

Requesting the patient to hold a fist while applying a tourniquet is a standard procedure at the start of all venipuncture procedures. The effect is venous engorgement; this allows easier identification of potential venipuncture sites by palpitation. The technique of applying warmth to a site is used for dilating blood vessels. This action will have the effect of increasing circulating blood to that area. Applying warmth to a newborn's heel prior to a heel puncture is an example of this.

Question 13

Where is the cephalic vein located?
A)In the antecubital area, on the outside of the arm.
B)In the antecubital area, on the inner side of the arm.
C)In the antecubital area, near the center of the arm.
D)On the hand.

Accepted Answer

The cephalic vein is located in the antecubital area of the arm, on the outside of the arm. The cephalic vein is considered the second choice for venipuncture if the median cubital vein (the first choice) is not a suitable choice. The cephalic vein is fairly well anchored and may be the only palpable vein in obese patients.

Question 14

Where is a bevel of the needle located?
A)The point of the needle.
B)The inside of the needle.
C)The end of the needle that attaches to the hub of a syringe.

Accepted Answer

The bevel is located at the end of the needle. It is the slant at the tip. The bevel tip should always be inspected for possible manufacturer defects before use. Do not use if defects are found. The bevel is always inserted into the body with bevel facing upward.

Question 15

A nurse is changing a client's abdominal dressing. A nursing assistant enters the room and informs the nurse that the IV fluid ordered for another client, who is experiencing difficulty breathing, has just arrived from the pharmacy. The nurse's most appropriate action is to:
A)Drape the client's abdomen, administer the IV fluid to the dyspneic client, and finish the treatment.
B)Ask the nursing assistant to find another nurse to administer the IV fluid, finish the treatment, and check on the respiratory rate of the dyspneic client.
C)Ask the nursing assistant to teach deep breathing exercises to dyspneic client until she's free to administer the IV.
D)Finish cleansing the wound, apply the sterile dressing, and administer IV fluid to the dyspneic client.

Accepted Answer

The nurse's most appropriate action is to finish the immediate task and swiftly move to the other client. Option A would compromise the sterility of the wound, increasing the client's risk for infection.

Question 16

A nurse notes that the site of the client's intravenous catheter is edematous and cool. Which of the following nursing actions is not appropriate for this client?
A)Removing the intravenous catheter immediately
B)Rubbing or massaging the infiltrated area
C)Elevating the affected extremity
D)Application of warm or cool compresses over the site

Accepted Answer

An infiltrated site is not rubbed or massaged, as it can cause the development of hematoma. The other options are appropriate.

Question 17

Where is the antecubital fossa located?
A)The bend of the elbow, front of the arm.
B)The bend of the elbow, back of the arm.
C)The bend of the elbow, outer side of arm.
D)The bend of the elbow, inner side of arm.

Accepted Answer

The antecubital fossa is located at the bend of the elbow, on the front side of the arm. There are three superficial veins crossing this area, cephalic vein, median cubital, and basilic, primarily used for venipuncture procedures.

Question 18

Generally, where and how is a tourniquet applied for a venipuncture procedure?
A)Midway between the shoulder and bend of elbow. Applied with enough pressure to compress and engorge the vein.
B)Three inches above venipuncture site. Applied with enough pressure to slow or stop blood flow.
C)Two inches above venipuncture site. Applied with enough pressure to compress and engorge the vein.
D)Midway between the shoulder and bend of elbow. Applied with enough pressure to slow or stop blood flow.

Accepted Answer

A tourniquet should be applied approximately midway between the shoulder and bend of elbow (about 3 inches above the elbow). A properly applied tourniquet will compress the vein only. A tourniquet should never be applied with enough tension to slow or stop arterial blood flow.

Question 19

A hospital supervisor is preparing for an evaluation of health care service quality on the surgical and medical wards of the hospital. The evaluators inspected the nursing staff's compliance with the standards and criteria provided by the hospital and accrediting agency. This method of quality assurance is called:
A)Retrospective
B)Concurrent
C)Introspective
D)Perspective

Accepted Answer

There are two methods of quality assurance: retrospective and concurrent. Concurrent audit occurs when the performance and compliance with the standards and criteria in providing care are evaluated. On the other hand, in a retrospective audit, medical records are inspected for compliance in standards of documentation.

Question 20

An elderly client admitted in the intensive care unit suddenly experienced acute respiratory distress. This occurred while the nurse was infusing the IV meds via central line. Before placing the client on 100% oxygen, the nurse should first:
A)Discontinue the IV infusion.
B)Place the client in a left lateral position.
C)Place the client in a Trendelenburg's position.
D)Ask permission from the physician to remove the catheter.

Accepted Answer

The initial action is to discontinue the infusion, clamp the IV tubing and place the client in a left lateral position or Trendelenburg's position. This allows the air to float towards the upper part of the atria which relieves obstruction in the blood vessels and the lungs. The catheter should not be removed. Start 100 % oxygen to remove the nitrogen in the blood.

Quiz 2: Vascular Access

Which of the following terms refers to improper or unskillful care of a patient by a health care worker, any unreasonable lack of skill, and/or professional misconduct?

What is the disadvantage of using the radial artery for arterial puncture?

Which is larger, a 22-gauge needle or a 18-gauge needle?

Blood-borne pathogens are:

In hypothesis testing, the area of the curve in which it is unlikely a researcher will obtain means is called the rejection region (or region of unlikely values) . What conclusions are drawn when obtained values fall in the rejection region?

The disintegration or destruction of red blood cells along with subsequent rupture of the cell membrane and release of the cell contents, is the definition of which of the following terms?

A nurse is using a butterfly syringe, tube adaptor, and pediatric tubes to collect blood from an adult patient with very fragile veins. Has the nurse made a mistake by doing this?

Which of the following situations would be reported as a sentinel event, according to the Joint Commission?

What is glycolysis?

An amendment created to ensure accurate laboratory results was passed in 1988 and enacted in 1992; it applies to every American clinical laboratory. What is the name of this amendment?

Why is careful documentation and monitoring of the amount of draws and total volume of blood drawn, from a premature infant necessary?

What is the difference between the effects of asking a patient to hold a fist while applying a tourniquet, and the effects of applying warmth to a potential puncture site? Choose all that apply.

Where is the cephalic vein located?

Where is a bevel of the needle located?

A nurse is changing a client's abdominal dressing. A nursing assistant enters the room and informs the nurse that the IV fluid ordered for another client, who is experiencing difficulty breathing, has just arrived from the pharmacy. The nurse's most appropriate action is to:

A nurse notes that the site of the client's intravenous catheter is edematous and cool. Which of the following nursing actions is not appropriate for this client?

Where is the antecubital fossa located?

Generally, where and how is a tourniquet applied for a venipuncture procedure?

An elderly client admitted in the intensive care unit suddenly experienced acute respiratory distress. This occurred while the nurse was infusing the IV meds via central line. Before placing the client on 100% oxygen, the nurse should first: