Med Lab Summative #15: Q&A + Answers

MEDICAL LABORATORY SCIENCE SUMMATIVE EXAM REVIEW QUESTIONS #15 + ANSWERS & RATIONALIZATIONS 1. 2. 3. 4. 5. 6. 7. 8. 9. A decreased leukocyte alkaline phosphatase (LAP) score is seen in: a. Polycythemia vera b. Chronic myelogenous leukemia c. Leukemoid reactions d. Acute myelogenous leukemia The result for a leukocyte alkaline phosphatase stain (LAP) stain is: a. Normal if the result is 32 to 182 with fast blue RR dye b. Positive, if 10 to 50% hemolysis present c. Normal, if <10% of cells exhibit hemoglobin F in adults d. Normal in newborns if the result is 70 to 90% → Normal range depends on the type of azo dye used. ▪ If fast blue RR is used, normal range is 32 to 182. ▪ If fast violet B is used, normal range is 12 to180. The Philadelphia chromosome is formed by a translocation between: a. Chromosome 22 and chromosome 9 b. Chromosome 21 and chromosome 9 c. Chromosome 21 and chromosome 6 d. Chromosome 22 and chromosome 6 Molecular techniques are being used to detect abnormalities of: a. Erythrocytes b. Leukocytes c. Some coagulation factors d. All of the above The first inherited hematologic disorder to be diagnosed using molecular biologic assay was: a. Hemophilia A b. Factor V Leiden c. Sickle cell anemia d. CML PCR testing is useful in: a. Forensic testing b. Genetic testing c. Disease diagnosis d. All of the above The method considered to be the “gold standard” of molecular methods is: a. DNA sequencing b. Southern blot c. Northern blot d. Dot blot The major intended purpose of the laboratory safety manual is to: a. Protect the patient and laboratory personnel b. Protect laboratory and other hospital personnel c. Comply with local health and state regulatory requirements d. Comply with OSHA regulations The most important step in phlebotomy is: a. Cleansing the site b. Identifying the patient c. Selecting the proper needle length d. Using the correct evacuated tube 10. Which of the following skin puncture areas is (are) acceptable for the collection of capillary blood from an infant? a. Previous puncture site b. Posterior curve of the heel c. The arch d. Medial or lateral plantar surface 11. Vein of choice for performing a venipuncture is the: a. Basilic, because it is the most prominent vein in the antecubital fossa b. Cephalic or accessory cephalic, because it is the least painful site c. Median or median cubital, because it has the lowest risk of damaging nerves in the arm d. One of the hand veins, because they are most superficial and easily accessed 12. The venipuncture needle should be inserted into the arm with the bevel facing: a. Down and an angle of insertion between 15 and 30 degrees b. Up and an angle of insertion less than 30 degrees c. Down and an angle of insertion greater than 45 degrees d. Up and an angle of insertion between 30 and 45 degrees 13. A blood sample is needed from a patient with IV fluids running in both arms. Which of the following is an acceptable procedure? a. Any obtainable vein is satisfactory. b. Obtain sample from above the IV site. c. Obtain sample from below the IV site with special restrictions. d. Disconnect the IV line. e. Do not draw a blood specimen. 14. When encountering a patient with a fistula, the phlebotomist should: a. Apply the tourniquet below the fistula b. Use the other arm c. Collect the blood from the fistula d. Attach a syringe to the T-tube connector 15. An unconscious inpatient does not have an ID band. The name on an envelope on the patient’s nightstand matches with the requisition. What should you do? a. Ask the nurse to verify the patient’s ID and collect the specimen. b. Complete the required procedure and then file an incident report. c. Do not start any procedure until the nurse attaches an ID bracelet. d. Make a computer entry to will alert other phlebotomists of the issue. 16. If a blood specimen is spilled on a laboratory bench or floor area, the first step in cleanup should be: a. Wear gloves and a lab coat b. Absorb blood with disposable towels c. Clean with freshly prepared 1% chlorine solution d. Wash with water 1 17. What is the best way to clean up blood that has dripped on the arm of a phlebotomy chair? a. Absorb it with a gauze pad and clean the area with disinfectant. b. Rub it with a damp cloth and wash the area with soap and water. c. Wait for it to dry and then scrape it into a biohazard container. d. Wipe it with an alcohol pad using an outward circular motion 18. Which characteristic is inaccurate with respect to the anticoagulant K3 EDTA? a. Removes ionized calcium (Ca2+) from fresh whole blood by the process of chelation b. Is used for most routine coagulation studies c. Is the most commonly used anticoagulant in hematology d. Is conventionally placed in lavender-stoppered evacuated tubes 19. In which of the following laboratory situations is a verbal report permissible? a. When the patient is going directly to the physician’s office and wants to have the report available b. When the report cannot be found at the nurse’s station c. When preoperative test results are needed by the anesthesiologist d. None of the above 20. If a blood smear is too long, the problem can be resolved by: a. Decreasing the angle of the pusher slide b. Increasing the angle of the pusher slide c. Using a larger drop of blood d. Pushing the slide slower in smearing out the blood → Improper angle of the pusher slide. ▪ The more the angle of the pusher slide is decreased, the longer the smear. ▪ The greater the angle, the thicker the smear. 21. If a blood smear stains too red on microscopic examination of a Wright-stained preparation, possible causes include that: a. The staining time was too long b. The stain was too basic c. The buffer was too acidic and the exposure time was too short d. The buffer was too basic and the exposure time was too long 22. Hematology and hemostasis laboratory quality assurance relies on basic statistics describing: 1. Measures of central tendency 2. Measures of dispersion 3. Measures of probability a. b. c. d. → 1 and 2 1 and 3 2 and 3 1, 2 and 3 Hematology and hemostasis laboratory quality assurance relies on basic statistics describing measures of central tendency, measures of dispersion, and significance 23. Acceptable limits of a control value must fall: a. Within ±1 standard deviation of the mean b. Between 1 and 2 standard deviations of the mean c. Within ±2 standard deviations of the mean d. Within ±3 standard deviations of the mean → For biological studies, control confidence limits are usually established at ±2 SD. When values fall outside these limits, the procedure is considered out of control. 24. Delta checks identify: a. Random error b. Shift c. Trend d. Gross error 25. The laboratory procedure manual does not need to include: a. Test method, principle of the test, and clinical applications b. Specimen collection and storage procedures c. The name of the supplier of common laboratory chemicals d. QC techniques, procedures, normal values, and technical sources of error 26. The most important practice in preventing the spread of disease is: a. Wearing masks during patient contact b. Proper hand washing c. Wearing disposable laboratory coats d. Identifying specimens from known or suspected HIVand HBV-infected patients with a red label 27. Where should alcohol and other flammable chemicals be stored? a. In an approved safety can or storage cabinet away from heat sources b. Under a hood and arranged alphabetically for ease of identification in an emergency c. In a refrigerator at 28 C to 88 C to reduce volatilization d. On a low shelf in an area protected from light 28. A cloudy and turbid CSF specimen is most commonly caused by: a. Increased fibrinogen b. Subarachnoid hemorrhage c. Subarachnoid hemorrhage, more than 12 hours after the bleed d. Increased number of leukocytes 29. A grossly bloody CSF specimen is most commonly caused by: a. Increased fibrinogen b. Subarachnoid hemorrhage c. Subarachnoid hemorrhage, more than 12 hours after the bleed d. Increased number of leukocytes 30. A xanthochromic (yellow color) CSF specimen is most commonly caused by: a. Increased fibrinogen b. Subarachnoid hemorrhage c. Subarachnoid hemorrhage, more than 12 hours after the bleed d. Increased number of leukocytes 31. An indicator of pre-eclampsia: a. Cylindruria b. Ketonuria c. Hematuria d. Proteinuria 2 32. A "Maltese cross" configuration is produced in tissue by polarization of: a. Calcium oxalate b. Uric acid c. Talcum powder d. Lipofuscin 33. In obese patients, veins may be neither readily visible nor easy to palpate. Sometimes the use of a blood pressure cuff can aid in locating a vein. The cuff should: a. Inflated higher than 40 mm Hg and should be left on the arm for longer than 1 minute b. Inflated higher than 40 mmHg and should not be left on the arm for longer than 1 minute c. Not be inflated any higher than 40 mm Hg and should be left on the arm for longer than 1 minute d. Not be inflated any higher than 40 mm Hg and should not be left on the arm for longer than 1 minute 34. RBC with membrane folded over: a. Aplastic anemia b. Iron deficiency anemia c. Hemoglobin C, hemoglobin SC disease d. Sickle cell anemia, thalassemia 35. Gaucher disease: a. Monocyte-macrophage series b. Neutrophilic series c. Lymphocytic series d. Erythrocytic series 36. Niemann-Pick disease: a. Monocyte-macrophage series b. Neutrophilic series c. Lymphocytic series d. Erythrocytic series 37. Chédiak-Higashi syndrome: a. Monocyte-macrophage series b. Neutrophilic series c. Lymphocytic series d. Erythrocytic series 38. Chronic granulomatous disease: a. Monocyte-macrophage series b. Neutrophilic series c. Lymphocytic series d. Erythrocytic series 39. Lazy leukocyte syndrome: a. Monocyte-macrophage series b. Neutrophilic series c. Lymphocytic series d. Erythrocytic series 40. The newer clinical instruments for measuring blood clotting are based on: a. Clot elasticity b. Fibrin adhesion c. Conduction of impedance of an electrical current by fibrin d. Changes in optical density 41. A patient’s serum IgA as measured by radial immunodiffusion (RID) was 40 mg/dL. Another laboratory reported IgA absent. A possible explanation for this discrepancy is that the: a. Rabbit antiserum was used in the RID plates and rabbit antisera should not be utilized in RID assays b. IgA has an Fc deletion that cause complex formation in vivo c. IgA antiserum has kappa specificity d. Patient serum has antibodies against a protein in the antiserum in the agarose of the RID utilized by the first lab 42. All of the following are reasons for performing an adsorption, EXCEPT: a. Separation of mixtures of antibodies b. Removal of interfering substances c. Confirmation of weak antigens on red cells d. Identification of antibodies causing a positive DAT 43. How is an individual with genotype Dce/dce classified? a. Rh positive b. Rh negative c. Rh null d. Total Rh 44. Testing reveals a weak D that reacts 1+ after indirect antiglobulin testing (IAT). How is this result classified? a. Rh-positive b. Rh-negative, Du positive c. Rh-negative d. Rh-positive, Du positive 45. How often can a blood donor donate whole blood? a. Every 24 hours b. Once a month c. Every 8 weeks d. Twice a year 46. Following plasmapheresis, how long must a person wait before being eligible to donate a unit of whole blood? a. 8 weeks b. 2 weeks c. 48 hours d. 24 hours 47. What is the safest blood that patient can receive? a. Autologous blood b. Blood from directed donor c. Blood that was crossmatched d. Blood that was crossmatched and screened for transfusion-transmitted infections 48. A cause for permanent deferral of blood donation is: a. Diabetes b. Residence in an endemic malaria region c. History of jaundice of uncertain cause d. History of therapeutic rabies vaccine → Jaundice is a sign of liver impairment, which might be due to HBV or HCV. Infection with HBV or HCV is a cause of indefinite deferral. 3 49. Which physical examination result is cause for rejecting a whole-blood donor? a. Weight of 105 lb b. Pulse of 75 c. Temperature of 99.3°F d. Diastolic pressure of 110 mm Hg 50. An 18-year-old female with a hematocrit of 38%, temperature of 37 °C, and blood pressure of 175/ 90 mm Hg presents for whole blood donation. Based on this information, would you accept, permanently defer (PD), or temporarily defer (TD) the donor? a. Accept b. TD, blood pressure is too high for a person of her age c. TD, temperature is too high d. PD, for all values listed 4