Preventing Preanalytical Errors, 3rd Edition
P.A.C.E.® Continuing Education Exam

Choose the one best answer to the questions or statements below

1. According to the standards, which of the scenarios below is an acceptable method of inpatient identification?
1. ask the patient to affirm his/her name and compare it with the requisition and identification bracelet
2. compare the requisition with the patient’s identification bracelet
3. ask the patient to state his/her full name and birth date, spell the first and last names, then compare it with the requisition and identification bracelet, which must be attached to the patient
4. compare the room number, identification bracelet, and requisition to see that they match
2. According to the standards, the proper order of draw for tube holder, butterfly & syringe draws is:
1. blood culture tubes or vials, serum tube (with or without gel or clot activator), sodium citrate tube, EDTA tube, heparin tube, oxalate tube
2. blood culture tubes or vials, heparin tube, sodium citrate tube, serum tube (with or without gel or clot activator), EDTA tube, exalate tube
3. blood culture tubes or vials, EDTA tube, serum tube (with or without gel or clot activator), sodium citrate tube, heparin tube, oxalate tube
4. blood culture, sodium citrate, serum tubes (with or without gel or clot activator), heparin, EDTA, oxalate
3. According to the standards, the proper order of draw for capillary draws is:
1. EDTA, other additive tubes, non-additive tubes
2. non-additive tubes, other additive tubes, EDTA
3. non-additive tubes, EDTA, other additive tubes
4. additive tubes other than EDTA, EDTA tubes, non-EDTA tubes
4. If the only available vein for a venipuncture is below an infusing IV, the proper procedure is to:
1. have the nurse shut off the IV, apply the tourniquet above the IV, draw the specimen discarding the first 5cc of blood, and notify the nurse the IV may be restarted
2. have the nurse shut off the IV for two minutes, apply the tourniquet below the IV, draw the blood specimen, and document the circumstances of the draw
3. have the nurse shut off the IV for five minutes, tighten the tourniquet below the IV, draw the specimen discarding the first 5cc of blood, and notify the nurse the IV may be restarted
4. apply the tourniquet below the IV, draw the specimen, and document it was drawn below an active IV
5. Timed draws are important for:
1. therapeutic drug monitoring (TDM)
2. dietary considerations
3. tests affected by chronobiology (“body clock”)
4. all of the above
6. What is hemolysis?
1. red blood cells rupture, releasing their hemoglobin into the serum or plasma
2. water and small components in the blood efflux from the capillaries into the tissues, temporarily altering the cell counts and analytes remaining in the blood
3. blood leaks from the vein into the surrounding tissues, causing the area to discolor and mound
4. clotting of blood in the tube as a result of inadequate mixing
7. According to CLSI standards, tourniquet application should not exceed:
1. 5 minutes
2. 90 seconds
3. 2 minutes
4. 1 minute
8. What is hemoconcentration?
1. clotting of blood in the tube as a result of inadequate mixing
2. water and small components in the blood efflux from the capillaries into the tissues, temporarily altering the cell counts and analytes remaining in the blood
3. blood leaks from the vein into the surrounding tissues, causing the area to discolor and mound
4. red blood cells rupture, releasing their hemoglobin into the serum or plasma
9. What might happen if a blood culture is improperly collected and a false-positive result is reported?
1. the patient may be treated for an infection he/she does not have
2. the patient may be hospitalized for a longer period of time
3. hospital and patient expenses are significantly increased
4. all of the above
10. To minimize the risk of blood culture contamination, a phlebotomist should:
1. avoid repalpating the site after cleansing
2. cleanse the site thoroughly with friction and allow the antiseptic to dry on the skin for at least 30 seconds
3. clean the gloved finger with the same antiseptic solution prior to repalpating the site to affirm vein location
4. A & B
11. Tests affected when heparin tubes are underfilled include:
1. potassium, CK, troponin, lipase, amylase, ALT, AST, and GGT
2. sodium, glucose, and LDH
3. no significant changes in analyte concentration would be expected
4. A & B
12. If a phlebotomist anticipates that he/she will only be able to obtain a small amount of blood from a patient during a venipuncture, how might the phlebotomist assure an accurate test result?
1. distribute the entire collection equally among all tubes
2. do multiple sticks on the patient so that standard tubes can be used for testing
3. stock trays and draw stations with low-volume tubes so they can be fully filled when the volume of blood collected would otherwise lead to underfilled tubes
4. A & B
13. What, if any, special procedure is necessary when drawing a single specimen in a sodium citrate tube to be used for coagulation studies if a butterfly device is used to collect the blood sample?
1. an appropriate discard tube must be used first to remove the air from the device tubing, thus assuring a proper blood to anticoagulant ratio
2. the patient or phlebotomist must hold pressure on the site for an additional minute to prevent hematoma
3. the sample must be vigorously mixed after collection
4. no special procedure is necessary
14. With regard to clot-activator tubes, which statement(s) below are correct?
1. 20-30 minutes are still required for clotting
2. clot-activators tubes facilitate more complete clotting, not faster clotting
3. clot-activator tubes should be centrifuged with the stoppers removed
4. A & B
15. Who has the greatest responsibility in preventing the preanalytical errors thay may occur during blood collection procedures that could alter test results?
1. the patient’s physician
2. the laboratory supervisor or manager
3. the phlebotomist or other health care personnel who collects blood specimens
4. the patient