CSC Patient Assessment & Clinical Evaluation 3 — Questions and Answers
Question 1: A patient's requisition indicates they are receiving IV fluids in their left arm. Which site should the collector choose?
- The left arm, proximal to the IV site
- The left arm, distal to the IV site
- The right arm, away from the IV (Correct answer)
- Either arm — IV fluids do not affect results
Correct answer: The right arm, away from the IV
IV fluids dilute blood constituents in that arm; the contralateral arm must be used to ensure accurate, undiluted specimen results.
Question 2: During pre-collection assessment, a patient mentions they have had a mastectomy on the right side. What does this mean for specimen collection?
- Right arm is preferred because veins are more prominent post-surgery
- Right arm should be avoided; collect from the left arm (Correct answer)
- Either arm is acceptable since mastectomy only affects breast tissue
- Consult the patient's surgeon before any collection
Correct answer: Right arm should be avoided; collect from the left arm
Lymph node removal during mastectomy impairs lymphatic drainage, making the ipsilateral arm susceptible to infection and lymphedema from venipuncture.
Question 3: A patient states they have a dialysis fistula in their left arm. The collector should:
- Use the fistula site as it provides easy vascular access
- Avoid the fistula arm entirely and collect from the right arm (Correct answer)
- Draw just below the fistula to minimize disruption
- Check blood pressure in the fistula arm first
Correct answer: Avoid the fistula arm entirely and collect from the right arm
Arteriovenous fistulas used for dialysis must never be punctured for routine blood collection due to risk of infection, hematoma, and fistula damage.
Question 4: Which patient history finding requires the collector to apply pressure for a longer-than-normal time after venipuncture?
- Patient had a large meal two hours prior
- Patient is taking heparin or low-molecular-weight heparin (Correct answer)
- Patient reports mild seasonal allergies
- Patient's veins were difficult to locate
Correct answer: Patient is taking heparin or low-molecular-weight heparin
Heparin and its derivatives are anticoagulants that prolong clotting time, requiring extended pressure at the puncture site to achieve hemostasis.
Question 5: Before collecting a blood culture specimen, the collector's assessment should include confirming that the patient:
- Has been fasting for at least 4 hours
- Has not received antibiotics in the last 24 hours if possible (Correct answer)
- Has no known fear of needles
- Is seated upright rather than supine
Correct answer: Has not received antibiotics in the last 24 hours if possible
Antibiotic therapy can suppress bacterial growth in culture media, ideally specimens should be collected before antibiotics are administered.
Question 6: A patient reports dizziness and feeling faint halfway through a multi-tube collection. What is the FIRST action?
- Quickly finish collecting the remaining tubes before stopping
- Remove the needle immediately and have the patient lower their head (Correct answer)
- Ask the patient to breathe deeply and continue collection
- Call for emergency assistance before removing the needle
Correct answer: Remove the needle immediately and have the patient lower their head
Signs of syncope require immediate needle removal to prevent injury, followed by lowering the patient's head to restore cerebral blood flow.
Question 7: When assessing venous access in an obese patient, the collector should:
- Always use the antecubital fossa without palpation since obesity obscures veins
- Palpate carefully to locate a vein by feel rather than relying on visual inspection (Correct answer)
- Immediately request a phlebotomist supervisor without attempting collection
- Perform a capillary stick on the fingertip as the first choice
Correct answer: Palpate carefully to locate a vein by feel rather than relying on visual inspection
In obese patients, subcutaneous fat may obscure veins visually, but thorough palpation can identify accessible veins by their resilient, bouncy texture.
CSC Patient Assessment & Clinical Evaluation 3
A patient's requisition indicates they are receiving IV fluids in their left arm.
Which site should the collector choose?