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  Medical Assistant-øveprøve (USA)

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  Flashcards i medicinsk terminologi

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1. 1. Following the standard order of draw, which tube is collected immediately after the light blue sodium citrate tube?

   • A. The lavender EDTA tube
   • B. The gray sodium fluoride tube
   • C. The red or gold serum tube
   • D. The green heparin tube
   Vis svar og forklaring

   Svar: C. The red or gold serum tube

   The standard sequence is blood cultures first, then the light blue citrate tube, then serum tubes with or without a gel separator, then heparin, then EDTA, then the glycolytic inhibitor tube. The citrate tube comes early because coagulation testing depends on an exact ratio of blood to additive, and it must be filled to the mark for that ratio to hold.

2. 2. Why does the order of draw exist?

   • A. To keep additive from one tube from carrying over into the next through the needle
   • B. To keep the total time of the draw under a fixed limit
   • C. To fill the largest tubes while the vein is still full
   • D. To match the order in which the laboratory runs the tests
   Vis svar og forklaring

   Svar: A. To keep additive from one tube from carrying over into the next through the needle

   Blood in the needle and the holder can carry a trace of additive backward into the following tube, and a trace is enough to ruin a result. EDTA carried into a chemistry tube is the classic example, because the potassium in the salt makes potassium read falsely high and the chelated calcium makes calcium read falsely low.

3. 3. Complete the sentence.

   The lavender top tube contains _____, which stops the specimen from clotting by binding _____.

   Muligheder for felt 1: sodium citrate, EDTA, lithium heparin, sodium fluoride

   Muligheder for felt 2: calcium, potassium, sodium, iron

   Vis svar og forklaring

   Svar: EDTA, calcium

   EDTA binds calcium, and the clotting cascade cannot run without it. It also preserves cell shape better than the other anticoagulants, which is why it is the tube for a complete blood count and a blood smear. The tube has to be filled to the marked volume, because leftover EDTA in an underfilled tube shrinks the red cells and skews the count.

4. 4. In the antecubital fossa, which vein is usually the first choice for venipuncture?

   • A. The cephalic vein
   • B. The median cubital vein
   • C. The basilic vein
   • D. The brachial artery
   Vis svar og forklaring

   Svar: B. The median cubital vein

   The median cubital vein sits toward the middle of the antecubital fossa, is generally large and well anchored so it rolls less, and lies farthest from the major nerve and artery. The cephalic vein on the thumb side is the usual second choice. Vein patterns differ from person to person, so palpate first rather than assuming a textbook layout.

5. 5. Why is the basilic vein the last choice among the antecubital veins?

   • A. It is too small to accept a standard needle
   • B. It collapses as soon as the tourniquet is released
   • C. It carries arterial blood rather than venous blood
   • D. It lies close to the brachial artery and the median nerve
   Vis svar og forklaring

   Svar: D. It lies close to the brachial artery and the median nerve

   The basilic vein runs on the little finger side of the arm, and the brachial artery and the median nerve sit just under it. Puncturing either is the reason this vein is used only when the others are unavailable. It is also less anchored in the tissue, so it tends to roll away from the needle.

6. 6. Which of the following make hemolysis more likely?

   Vælg alle, der passer.

   • A. Drawing through a needle that is too small for the vacuum of the tube
   • B. Pushing blood from a syringe through the tube stopper under pressure
   • C. Shaking the tubes hard instead of inverting them gently
   • D. Letting the alcohol dry fully before the puncture
   • E. Filling each tube to the volume the vacuum draws
   Vis svar og forklaring

   Svar: A. Drawing through a needle that is too small for the vacuum of the tube, B. Pushing blood from a syringe through the tube stopper under pressure, C. Shaking the tubes hard instead of inverting them gently

   Hemolysis is red cells breaking open, and it happens when the cells are forced through too narrow an opening, pushed under pressure, or shaken. It matters because the contents of the cells spill into the plasma, so potassium, LDH, magnesium and phosphate all read falsely high, and a visibly pink or red sample is usually rejected. Letting alcohol dry and filling tubes properly both reduce the risk rather than raise it.

7. 7. An inpatient is scheduled for a draw. Which identification step meets the standard?

   • A. Ask the patient whether they are Mrs. Alvarez and draw if they say yes
   • B. Match the name posted on the door of the room to the requisition
   • C. Ask the patient to state their full name and date of birth, then compare both with the armband and the requisition
   • D. Confirm the patient's name with the nurse assigned to the room
   Vis svar og forklaring

   Svar: C. Ask the patient to state their full name and date of birth, then compare both with the armband and the requisition

   Identification has to be active, using two identifiers the patient supplies rather than ones you offer. A yes or no question invites the wrong answer from someone who is drowsy, hard of hearing or confused. Room numbers and bed numbers are never identifiers, because patients get moved.

8. 8. Complete the sentence.

   The gray top tube contains _____, which slows glycolysis so that the _____ result does not drift downward while the specimen waits to be tested.

   Muligheder for felt 1: EDTA, sodium citrate, sodium fluoride, a clot activator

   Muligheder for felt 2: potassium, glucose, hemoglobin, albumin

   Vis svar og forklaring

   Svar: sodium fluoride, glucose

   Red cells keep consuming glucose after the blood leaves the arm, so an untreated sample reads lower the longer it sits. Sodium fluoride blocks an enzyme in the glycolytic pathway and holds the value steady, which is why this tube is used for glucose and for alcohol testing. It is usually paired with potassium oxalate, which handles the anticoagulation.

9. 9. Which anticoagulant prevents clotting by blocking thrombin rather than by binding calcium?

   • A. Sodium citrate
   • B. EDTA
   • C. Potassium oxalate
   • D. Heparin
   Vis svar og forklaring

   Svar: D. Heparin

   Heparin works further along the cascade. It boosts antithrombin, which shuts down thrombin and factor Xa, so fibrin never forms. Citrate, EDTA and oxalate all work the other way, by tying up the calcium the cascade needs. Because heparin leaves the sample's chemistry closest to untouched, heparin tubes are common for chemistry panels.

10. 10. During a draw the patient reports a sharp, shooting, electric pain running down the forearm. What should the phlebotomist do?

    • A. Release the tourniquet, withdraw the needle right away, and stop the draw
    • B. Continue, since brief pain is expected during venipuncture
    • C. Rotate the needle to a shallower angle and continue
    • D. Loosen the tourniquet and collect the remaining tubes quickly
    Vis svar og forklaring

    Svar: A. Release the tourniquet, withdraw the needle right away, and stop the draw

    Shooting or electric pain, tingling or numbness suggests the needle is near or in a nerve, and that is one of the few injuries from a blood draw that can last. The response is to stop rather than to reposition. Ordinary venipuncture stings briefly at the puncture and then settles, which is different from pain that travels down the limb.

11. 11. Which of these are correct sharps and infection control practices during venipuncture?

    Vælg alle, der passer.

    • A. Activate the needle safety device as soon as the needle leaves the arm
    • B. Discard the needle and the tube holder together as a single unit
    • C. Recap the needle with two hands before disposing of it
    • D. Perform hand hygiene and put on clean gloves before every patient
    • E. Fill the sharps container to the very top before it is replaced
    Vis svar og forklaring

    Svar: A. Activate the needle safety device as soon as the needle leaves the arm, B. Discard the needle and the tube holder together as a single unit, D. Perform hand hygiene and put on clean gloves before every patient

    Most needlestick injuries happen between the arm and the container, so the safety device goes on immediately and the needle is not handled again. Recapping with two hands points a contaminated needle at your own fingers. An overfilled sharps container is a puncture hazard on its own, which is why containers are replaced at the marked fill line rather than when they stop closing.

12. 12. A swelling appears at the site during a draw and the blood flow slows. What is the most likely cause?

    • A. The tourniquet was applied too loosely
    • B. The needle went through the far wall of the vein
    • C. The additive in the tube had expired
    • D. The patient's arm was held above the level of the heart
    Vis svar og forklaring

    Svar: B. The needle went through the far wall of the vein

    That swelling is a hematoma, blood leaking out of the vessel into the surrounding tissue. It usually means the needle passed through the back wall, or that the bevel is only partly in the vein, or that a nearby vessel was nicked. Release the tourniquet, remove the needle and hold firm pressure, and do not try to save the draw by pushing the needle deeper.

13. 13. Which statements about capillary, or dermal, collection are correct?

    Vælg alle, der passer.

    • A. The first drop is wiped away because it is diluted with tissue fluid
    • B. The EDTA tube is filled before the other additive tubes
    • C. On an infant, the puncture is made on the medial or lateral plantar surface of the heel
    • D. Repeated hard squeezing of the site is used to speed up the flow
    • E. A capillary sample is the preferred specimen for blood cultures
    Vis svar og forklaring

    Svar: A. The first drop is wiped away because it is diluted with tissue fluid, B. The EDTA tube is filled before the other additive tubes, C. On an infant, the puncture is made on the medial or lateral plantar surface of the heel

    Capillary collection reverses the venipuncture order because platelets start clumping at the puncture within seconds, so the hematology tube is filled first. Hard squeezing, sometimes called milking, forces tissue fluid into the sample and breaks red cells. On an infant the puncture stays on the sides of the plantar surface to keep away from the heel bone. Blood cultures need a larger sterile volume than a fingerstick can give.

14. 14. Complete the sentence.

    A specimen collected for _____ is wrapped in foil or collected in an amber tube, because that substance breaks down when the sample sits in the light.

    Muligheder for felt 1: potassium, glucose, bilirubin, hemoglobin

    Vis svar og forklaring

    Svar: bilirubin

    Bilirubin is light sensitive, so even a short spell on a sunny counter can drop the value and make a jaundiced newborn look better than they are. Light protection is one of three special handling rules worth knowing together. Some specimens travel chilled, some have to stay near body temperature until they are processed, and the requisition or the laboratory manual says which.

15. 15. When should a blood collection tube be labeled?

    • A. Back in the laboratory, once the specimen has been checked in
    • B. Before the draw, so the tube is ready when it fills
    • C. At the end of the round, together with the rest of the batch
    • D. At the patient's side, right after the tubes are filled and before leaving
    Vis svar og forklaring

    Svar: D. At the patient's side, right after the tubes are filled and before leaving

    Labeling at the bedside, with the patient still in front of you, is what keeps a tube tied to the right person. Prelabeled tubes can end up on the wrong patient, and labeling later relies on memory. The label carries the patient's full name, a second unique identifier, and the date and time of collection, plus whatever else your facility requires, such as the collector's initials.

Hvad en prøve i blodprøvetagning faktisk dækker

Der findes ingen enkelt national prøve i blodprøvetagning i USA. Flere organisationer certificerer folk til at tage blodprøver, blandt andre National Healthcareer Association, American Society for Clinical Pathology, American Medical Technologists og National Center for Competency Testing. Hver af dem fastsætter sit eget antal spørgsmål, sin egen tidsgrænse, beståelsesgrænse, adgangsveje og regler for recertificering, og de detaljer bliver revideret, så den eneste pålidelige kilde til dem er den aktuelle kandidathåndbog fra det organ, du går op hos. Nogle delstater stiller også deres eget krav om autorisation eller certificering for at tage blodprøver, oven i et eventuelt nationalt bevis. De regler fastsættes delstat for delstat, ikke nationalt, så tjek også din egen delstats sundhedsmyndighed.

Det, indholdsoversigterne har til fælles, er selve arbejdet. Næsten alle forventer, at du kender rækkefølgen, glassene tages i, og grunden bag den, hvilket tilsætningsstof der sidder i hvilket glas og hvordan det virker, venerne i albuebøjningen og hvordan du vælger stiksted, hvordan du identificerer en patient og mærker en prøve, de almindelige komplikationer og hvad der forårsager hver enkelt, kapillær prøvetagning og hvordan den adskiller sig fra venepunktur, særlig håndtering som køling og beskyttelse mod lys, og infektionshygiejne og sikkerhed omkring kanyler. De fleste tester også lidt prøvehåndtering, professionel adfærd og patienters ret til privatliv.

To ting vejer tungere, end nye i faget regner med. Den første er rækkefølge. Prøverne spørger, hvad du gør først, hvad der kommer derefter, og hvad du gør i det øjeblik noget går galt, for i det her job er rækkefølgen selve færdigheden. Den anden er sikkerhed, både din egen og patientens, så forvent spørgsmål om kanyleudstyr, bortskaffelse af skarpe genstande og de situationer, hvor du stopper en prøvetagning frem for at gøre den færdig.

Sådan bruger du smagsprøven

De her 15 spørgsmål lægger vægt på hvorfor frem for på navnene. De spørger, hvad et tilsætningsstof faktisk gør ved blodet, hvorfor glassene sættes på kanylen i en fast rækkefølge, hvorfor vena mediana cubiti vælges frem for vena basilica, og hvad en hævelse eller en jagende smerte under en prøvetagning fortæller dig. Det ræsonnement er det, der får de udenadlærte lister til at sidde fast, for en regel du kan forklare, er en du ikke roder rundt i under tidspres.

Tag den i ét stræk uden noter, og læs derefter forklaringen til hvert spørgsmål, også dem du svarede rigtigt på. Behandl et forkert svar som et emne frem for et faktum. Missede du spørgsmålet om rækkefølgen og spørgsmålet om tilsætningsstoffet, så læs glas og tilsætningsstoffer sammen som én tabel, for det er den samme viden spurgt om fra to sider.

En ting skal være klar. Det her er eksamenstræning, ikke medicinsk rådgivning. Intet på denne side fortæller dig, hvordan du plejer en patient. Når du tager prøver i virkeligheden, så følg din arbejdsgivers skriftlige procedure, din underviser eller vejleder, og producentens anvisninger for de glas og det sikkerhedsudstyr, du faktisk bruger.

Sådan bygger StudyPDF fulde øveprøver ud fra dit eget materiale

Femten spørgsmål kan vise dig, hvor du vakler. De kan ikke gøre dig klar alene, og en generisk spørgsmålsbank matcher sjældent det, dit eget uddannelsesforløb eller din arbejdsgivers kompetencetjekliste lægger vægt på.

StudyPDF arbejder ud fra dit eget materiale i stedet. Du uploader din lærebog i blodprøvetagning, din laboratoriemanual eller materialerne fra dit forløb, så bygger Bo, studieagenten, fuldlange øveprøver ud fra præcis de sider. Hvert spørgsmål bygger på dit materiale, og hver forklaring henviser til, hvor svaret kommer fra, så du kan gå direkte til kilden, når noget ser forkert ud. Du kan lave nye prøver så tit du vil, snævre dem ind til ét område som rækkefølgen for glassene eller komplikationer, og følge med i hvilke begreber du bliver ved med at ramme forkert.

Du behøver ikke uploade noget for at komme i gang. Har du ingen fil ved hånden, så nævn et emne i stedet, for eksempel tilsætningsstoffer i glassene eller kapillær prøvetagning, så skriver Bo en øveprøve ud fra det. Gratis at komme i gang.