CNA CNA Medical Lab and Specimen Collection Skills 2 — Questions and Answers
Question 1: When performing blood glucose monitoring with a glucometer, what is the preferred site for obtaining a finger-stick blood sample?
- The side of the fingertip (lateral aspect) (Correct answer)
- The center of the fingertip pad
- The heel of the hand
- The earlobe
Correct answer: The side of the fingertip (lateral aspect)
The lateral (side) aspect of the fingertip is preferred for glucose monitoring because it has fewer nerve endings than the center, causing less pain, while still providing adequate blood flow. The center pad has more nerves, making it more painful.
Finger-stick technique for blood glucose: (1) Wash hands with soap and warm water (or use gloves). (2) Allow blood to flow to the fingertip by holding the hand down or gently massaging toward the fingertip. (3) Clean the site with an alcohol wipe and allow to fully dry — wet alcohol can dilute the sample and give false readings. (4) Use a lancet on the lateral aspect of a non-dominant finger, avoiding the thumb and index finger (used most for daily tasks). (5) Gently squeeze or allow blood to form a drop — do not milk aggressively as tissue fluid dilutes the sample. (6) Apply blood to the glucometer strip per manufacturer instructions. (7) Apply gentle pressure to the puncture site after collection. Alternate sites (palm, forearm) may be used per facility policy.
Question 2: After performing a blood glucose check with a glucometer, what should the CNA do with the lancet?
- Place it immediately into the sharps container without recapping (Correct answer)
- Recap it and dispose of in regular trash
- Recap it and place in the sharps container
- Bend it before disposal to prevent reuse
Correct answer: Place it immediately into the sharps container without recapping
Lancets must be placed directly into an approved sharps container immediately after use, without recapping. Recapping is a leading cause of needle-stick injuries. Bending needles is also prohibited. Sharps containers prevent injuries to healthcare workers and housekeeping staff.
Safe sharps handling is critical to prevent bloodborne pathogen exposure. Key rules: (1) Never recap needles or lancets — one-handed scoop technique is the only exception if a cap must be replaced. (2) Never bend or break sharps — this is prohibited by OSHA. (3) Never place sharps in regular trash, linen bags, or on bedside tables. (4) Dispose of sharps immediately after use, while still at the bedside. (5) Never overfill sharps containers — dispose of when 3/4 full. (6) Never reach into a sharps container. (7) If a needle-stick injury occurs: wash with soap and water, report immediately to supervisor, follow facility bloodborne pathogen exposure protocol. These rules apply to all sharps: lancets, needles, syringes, broken glass.
Question 3: A CNA records a blood glucose reading of 48 mg/dL. What action should be taken FIRST?
- Report the value to the nurse immediately (Correct answer)
- Document the result in the chart
- Administer orange juice to the patient
- Recheck the blood glucose with a new strip
Correct answer: Report the value to the nurse immediately
A blood glucose of 48 mg/dL is critically low (hypoglycemia — normal fasting is 70-100 mg/dL). The CNA must immediately report this critical value to the nurse, who will then determine the appropriate intervention. A CNA does not independently administer treatments for critical values.
Blood glucose critical values that require immediate nurse notification: Hypoglycemia: below 70 mg/dL (critical below 50 mg/dL); Hyperglycemia: above 400 mg/dL (critical above 500 mg/dL). At 48 mg/dL, the patient may be experiencing: shakiness, diaphoresis (sweating), confusion, pallor, rapid heartbeat, or loss of consciousness. The CNA's role: (1) Report immediately to the nurse — do not wait. (2) Stay with the patient. (3) Keep the patient safe (lower bed, raise rails). (4) Follow nurse's orders for intervention. The nurse (not the CNA) will order/administer 4 oz juice, glucose gel, or IV dextrose as appropriate. Document per nurse instruction after the emergency is addressed.
Question 4: Which of the following is correct regarding proper labeling of a specimen?
- Label the specimen container at the patient's bedside immediately after collection (Correct answer)
- Label the specimen container before going into the patient's room
- Ask another CNA to label the specimen after collection
- Label the specimen in the hallway outside the patient's room
Correct answer: Label the specimen container at the patient's bedside immediately after collection
Specimens must be labeled immediately after collection, in the patient's presence and at the bedside. Pre-labeling before collection risks mix-ups. Post-labeling away from the patient risks errors in identification. Bedside labeling ensures the right specimen goes with the right label.
Correct specimen labeling is essential to prevent medical errors. Required label information typically includes: (1) Patient full name (first and last). (2) Patient date of birth or medical record number. (3) Date and time of collection. (4) Type of specimen (urine, stool, etc.). (5) Collecting person's name or initials. (6) Test ordered. Labeling rules: Always label at bedside immediately after collection while the patient can verify identity. Use two patient identifiers before collection (name + DOB or MRN). Never prelabel containers. Never leave unlabeled specimens. In many facilities, nurses use wristband scanners to print labels at the bedside — the CNA's role is to follow facility protocol and never skip the identification step.
Question 5: What personal protective equipment (PPE) is required when handling any patient specimen?
- Gloves at minimum; mask and eye protection if splashing is possible (Correct answer)
- Gloves only — other PPE is optional
- A gown and mask regardless of splash risk
- No PPE is needed for routine urine specimens
Correct answer: Gloves at minimum; mask and eye protection if splashing is possible
Standard precautions require gloves as the minimum PPE when handling any body fluid or specimen. If splashing or aerosolization is possible (sputum collection, large volumes), a mask and eye/face protection should be added. A gown is added if clothing contamination is likely.
PPE for specimen collection follows Standard Precautions (treat all specimens as potentially infectious): (1) GLOVES: Always required for any specimen handling. Change gloves between patients. Remove properly to avoid self-contamination. (2) MASK and EYE PROTECTION: Required when splashing is possible — sputum induction, large volume urine or stool collection, wound cultures with irrigation. (3) GOWN: Add when clothing contamination is likely (patient with uncontrolled diarrhea, large wound). (4) HAND HYGIENE: Perform before donning gloves and after removing gloves — PPE does not replace hand washing. (5) Additional precautions (droplet/contact/airborne) may apply for specific organisms like MRSA, C. diff, or TB. The CNA should assess each situation and select appropriate PPE before beginning.
Question 6: A specimen must be transported to the lab. Which statement about specimen transport is correct?
- Specimens should be placed in a sealed biohazard bag for transport (Correct answer)
- Specimens can be carried loosely to the lab to save time
- Specimens should be left at the nursing station until the lab calls for them
- Transport containers are optional if the lab is nearby
Correct answer: Specimens should be placed in a sealed biohazard bag for transport
All specimens must be placed in a sealed, leak-proof biohazard bag for transport to the lab. This protects lab personnel, transport staff, and others from exposure to potentially infectious material. The biohazard bag is required regardless of how far the lab is.
Proper specimen transport requirements: (1) CONTAINER: Place specimen in a sealed, leak-proof primary container (the specimen cup with a tight lid). (2) BIOHAZARD BAG: Place the sealed container inside a biohazard-labeled, zip-lock secondary bag. The lab requisition form goes in the outside pocket — not inside with the specimen. (3) TEMPERATURE: Some specimens require specific temperatures — refrigerate urine and cultures if not immediately transported, keep blood glucose samples at room temp, some specimens need ice. (4) TIMING: Time-sensitive specimens should be transported promptly — sputum within 2 hours, stool cultures per lab policy. (5) LABELING: Verify label matches requisition before transport. (6) SAFETY: Never carry specimens in open hands or pockets. These requirements apply whether sending via pneumatic tube, carrier, or hand delivery.
Question 7: When is hand hygiene required during specimen collection procedures?
- Before and after the procedure, and after removing gloves (Correct answer)
- Only after the procedure is complete
- Only before the procedure begins
- Only when the specimen is visibly contaminated
Correct answer: Before and after the procedure, and after removing gloves
Hand hygiene is required before AND after specimen collection procedures, and specifically after removing gloves. Gloves are not a substitute for handwashing — microscopic tears in gloves and contamination during removal mean hands must be washed regardless.
Hand hygiene moments during specimen collection: (1) BEFORE: Clean hands before entering the patient's room and before donning gloves. This protects the patient from organisms on the CNA's hands. (2) DURING: If hands become contaminated (glove tears, splash), remove soiled gloves, perform hand hygiene, and don new gloves. (3) AFTER GLOVE REMOVAL: Always perform hand hygiene after removing gloves — the outer surface of gloves is contaminated, and gloves may have microscopic holes. (4) AFTER leaving the patient's room: Perform hand hygiene when exiting. Alcohol-based hand sanitizer is acceptable when hands are not visibly soiled. Soap and water is required when hands are visibly dirty or after contact with C. difficile (spores resist alcohol). The CDC's 5 Moments for Hand Hygiene guide all patient contact.
CNA CNA Medical Lab and Specimen Collection Skills 2
When performing blood glucose monitoring with a glucometer, what is the preferred site for obtaining a finger-stick blood sample?