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- What temperature should a semen sample be transported?
36-38 degrees C - Which of the following would result in a grossly hemolyzed specimen?
a. Incorrect order of draw
b. Incorrect needle gauge
c. Applying tourniquet too close to the draw site
d. Failure to invert tube
b. Incorrect needle gauge - Which of the following is proper procedure after collecting ammonia specimen?
a. Protect from light
b. Keep specimen warm
c. Keep specimen at body temp
d. Place specimen in icewater slurry (or a cup of ice)
d. Place specimen in icewater slurry (or a cup of ice) - The phlebotomist has a request to collect a CBC from a healthy 10 month old. Which is appropriate?
a. Either heel - A phlebotomist is preparing to draw blood from a patient in hospital/ The patient extends his arm and turns head away. Which consent does this indicate?
a. Implied consent - Why should phlebotomist document volume of blood drawn from a patient?
a. Iatrogenic anemia could be a result fo too much taken - A phlebotomist has a requisition to draw blood on a patient with severe Down’s syndrome. What steps would you take?
a. Speak with the patient guardian before performing venipuncture to enmsure the patient understands - A 69 year old unconscious patient is brought ot the ER. Several blood tests are ordered. The phlebotomist collects blood under
a. Implied consent - Which of the following actions is appropriate when labeling specimens?
a. Label specimens at the time of collection in front of the patient - Before collecting blood on an inpatient, the phlebotomist notices there’s no wristband on wrist. There is one on the IV pole. What do you do?
a. Don’t draw until nurse puts an armband on patient - Which is appropriate form of identification in inpatient setting?
a. Verbal and wrist band - WBC, RBC, Electrolytes are ordered. Which tubes are used for capillary?
a. Lavender and red - A blood specimen is rejected by lab with QNS as the reason? Why?
a. The specimen was insufficient-not enough blood - Which of the following is best method to prevent internal or external bleeding from venipuncture site after needle is removed?
a. Apply pressure to prevent leakage of blood into the tissues - A physician orders a STAT but phlebotomist forgets to fill out patient ID number. What is appropriate procedure for an improperly labeled specimen when received in lab?
a. Lab rejects the mislabeled specimen - Phlebotomist is performing venipuncture and patient begins to seize. What is correct action?
a. Discontinue the draw - Phlebotomist receives orders to draw an infant screening card, O2 levels, bilirubin, and DNA. Which is to be drawn first?
a. O2 levels - When performing a venipuncture on a patient of average weight, which is the correct technique for needle insertion?
a. Insert until a change in resistance - Which is the best method to collect a blood specimen from an older adult patient who has fragile, easy to collapse veins?
a. Choose a syringe and butterfly assembly - Which of the following is the term for donation of a patient’s own blood for an upcoming surgery?
a. Autologous donation - The order of draw for capillary collections is different than venipuncture because
a. Increased risk of coagulation (remember platelets start to form) - Upon entering a patient’s room for routine blood draw, phlebotomist notices clergy member is with the patient. What should you do?
a. Return later after drawing other patients - A phlebotomist notices a hematoma developing at the site of venipuncture. The phlebotomist should
a. Release the tourniquet and stop the draw - Know ORDER of DRAW!!
- A phlebotomist working in an infertility clinic and the patient is to submit a semen specimen. The phlebotomist would tell the patient:
a. As soon as you collect the specimen, keep it next to your body and bring it in right away. (the reason is it needs to stay at body temp and delivered in lab within 2 hours) - After placing tourniquet on a patients arm, the phlebotomist notices small red spots below the tourniquet.
a. Petechiae - The phlebotomist should examine the antecubital veins of both arms because:
a. The median cubital might be more accessible on one side than the other - What is the appropriate cleanser to clean the meatus for a clean catch urine specimen?
a. Benzalkonium chloride - When should the code on glucose cuvettes or strips be compared to the code on the glucose meter?
a. When the patient is tested - Which of the following is appropriate to use when collecting for a chemistry test that requires serum?
a. SST (this is the red gel tube) - A patient state she is a difficult draw and requests a skin puncture. The test is a PTT. Which should you do?
a. Use a syringe and transfer to a light blue tube - Industry standard states needle insertion in the antecubital area should be:
a. 15-30 degree angle - Tubes with which additive should be used for CBC?
a. EDTA (purple tube) - When preparing for transport, which specimen must be placed on ice within 30 minutes after collection?
a. Arterial Blood Gases - Which provides the phlebotomist the best protection when drawing blood from a patient with active TB?
a. N-95 respirator mask - During a draw, the patient becomes unresponsive. What should you do?
a. Check for breathing - Why should a phlebotomist avoid drawing blood from a leg or foot of a diabetic patient?
a. These areas are more susceptible to infection - Why is it important to place a specimen in a biohazard specimen bag outside the laboratory?
a. The biohazard bag prevents a possible exposure incident - As a student. Proper introduction
a. Hi, my name is Sally Smith. I am a student phlebotomist and I’m here to collect blood specimen - When using evacuated tube system (EVS).
a. Position the needle in the same direction as the vein at 30 degree angle - What is additive for a PT/PTT?
a. Sodium Citrate (Blue top) - Blood cultures have been ordered on ICU patient. You would use:
a. Aerobic and anaerobic bottles - A phlebotomist is required to obtain what from a potential donor?
a. Complete medical history - Phlebotomist needs to draw a glucose tolerance test on a patient and notices an empty breakfast plate at bedside. What should you do?
a. Ask the patient when he or she ate last - Which vein should you attempt first?
a. Median cubital - If a phlebotomist is stuck with a used needle, first action is:
a. Flush the area with running water - correct specimen handling, what should you put on collection tubes?
Before leaving a patient room, make sure the date, time and initials are on the tubes. - When removing the needle from the arm, engage the safety device immediately
- What can cause hemolysis?
a. Vigorously shaking the tube - A phlebotomist must centrifuge a serum separator tube before shipment:
a. Cells must be separated from the serum - The phlebotomist draws a CBC at 1800. Lab closed at 1730 and will not process until 500. What temp should the CBC be stored
a. 2-10 degrees C (EDTA tubes may be processed at 12 hours if refrigerated) - What test results can be affected if iodine is used to clean the site?
a. Potassium - According to CLSI, what is collected first?
a. Blood cultures - KNOW ORDER OF DRAW
- KNOW ADDITIVES
- KNOW ORDER OF VENIPUNTURE PROCEDURE
- A physician ordered a Tobramycin level to be drawn one hour after dose. The Tobramycin has been ordered for 11am. What should you do
a. Check with the nurse to make sure meds were given (or not given) - phlebotomist notices red spots. What is appropriate action?
a. Apply pressure after collecting During the draw, the the sample - What is a potential consequence of mislabeling a blood bank specimen?
a. A Transfusion reaction - When should a phlebotomist perform external liquid controls for quality control on CLIA waived point of care test?
a. When a new lot number or kit is opened - A 3.3 kg infant has a total blood volume of 240-330ml
- Cleanse in an outward spiral
- What would you use for a hand draw?
a. Butterfly or winged infusion set - Invert anticoagulant tubes to :prevent coagulation
Name the 3 types of blood samples
whole blood/ plasma/ serum
What two States require licensure
Louisiana & California
When the Phlebotomist collects blood, in which of the patient’s zones of interpersonal space is he/she operating?
The patient’s Intimate Zone or Space
Define Phlebotomy
An incision into the vein
What is the meaning of these acronyms: ASPT, ASCP, and NHA?
ASPT = American Society of Phlebotomy Technicians
ASCP = American Society for Clinical Pathology
NHA = National Healthcareer Association
Define Reference Laboratory:
A reference laboratory is one that specializes in one test or one group of tests, or where more unusual or obscure tests are performed.
. Number the following items to reflect the correct blood flow through the heart and lungs:
1_ Vena Cave (superior/inferior) 7_ Lungs
5_ Pulmonary Valve 6_ Pulmonary Artery
13_ Aorta 9_ Left Atrium
2_ Right Atrium 8_ Pulmonary Veins
4_ Right Ventricle 11_ Left Ventricle
3_ Tricuspid Valve 12_ Aortic Valve
10_ Mitral Valve (aka, Bi-Cuspid)
To whom does the phlebotomist report?
A technical phlebotomy supervisor
What two government agencies administer CLIA?
Center for Medicare/Medicaid Services (CMS)__
FDA
. Is the Joint Commission a non-profit organization?
No, it’s a not for profit organization
In what year and by what organization was The Patient’s Bill of Rights initiated?
1973 by the American Hospital Association.
. What is Informed Consent?
When you explain the procedure to the patient and they give you verbal or written permission to proceed.
What is Implied Consent?
When you explain the procedure to the patient and they make a gesture that implies their permission to proceed, such as extending their arm, rolling up their sleeve or nodding their head.
What is required to obtain Informed Consent for a child?
You explain the procedure to the parent or legal guardian and obtain their informed consent for the child.
What is the difference between a Criminal Lawsuit and a Civil Lawsuit?
A criminal lawsuit is initiated by the government, a civil lawsuit is between private parties.
What is Assault?
The threat of touching another person without his or her consent and with the intention of causing fear of harm
What is Battery?
Actual harmful touching of another person without his or her consent.
What is Libel?
False defamatory writing that is published.
What is a Sentinel Event?
An unanticipated death or permanent loss of function not related to a patient’s illness or underlying condition.
. What does PPE stand for?
Personal Protective Equipment
. How full should you fill the Sharps Container before using a new container?
¾ full
. What is the name of the multi-purpose fire extinguisher?
ABC
To what does the term “aseptic techniques” refer?
Techniques that provide a degree of cleanliness that prevents infection and keeps the phlebotomy environment free of contamination by microorganisms.
. A nosocomial infection is:
a. Something acquired by healthcare workers.
b. Something acquired by visitors to a hospital.
c. Something acquired by patients.
d. A Hospital Acquired Infection.
e. Caused by antibiotic resistant bacteria.
f. Both c and d.
g. Both a and c.
f. Both c and d.
c. Something acquired by patients.
d. A Hospital Acquired Infection
When is hand hygiene performed?
a. When gloves are visibly soiled.
b. Before putting on gloves
c. After removing gloves
d. All of the above
e. Both a and b
d. All of the above
a. When gloves are visibly soiled.
b. Before putting on gloves
c. After removing gloves
Before entering an isolation room, what is the first thing the phlebotomist should do?
a. Wash hands
b. Put on a gown, mask and gloves
c. Read the posted instructions
d. Obtain permission
c. Read the posted instructions
What does the acronym PASS describe and stand for?
It describes the use of a fire extinguisher and stands for: Pull pin, Aim nozzle, Squeeze handle, Sweep from side to side.
What does the acronym RACE stand for?
It stands for what a healthcare worker should do if a fire or explosion occurs in the workplace:
Rescue, Alarm, Contain, Exit
. Before placing a call on hold, a phlebotomist should:
a. record the caller’s name.
b. check to see if it is an emergency.
c. transfer the call to the phlebotomy supervisor.
d. tell the caller his or her name.
b. check to see if it is an emergency.
A competent professional demeanor is shown by:
a. neatness and cleanliness.
b. courtesy and cheerfulness.
c. pleasantness.
d. all of the above.
d. all of the above.
Traditional duties of the phlebotomist include all of the following except:
a. correct labeling of all specimens with the required information.
b. selection of the appropriate specimen containers for the specified tests.
c. performance of tests on patient samples in the laboratory.
d. collection of the appropriate amount of blood by venipuncture or dermal puncture.
c. performance of tests on patient samples in the laboratory
. The two major areas of the clinical laboratory are:
a. chemistry and hematology.
b. cytology and histology.
c. anatomical and clinical.
d. urinalysis and microbiology.
c. anatomical and clinical.
The difference between plasma and serum is that:
a. serum contains fibrinogen.
b. serum is obtained from a non-clotted specimen.
c. plasma is obtained from a clotted specimen.
d. plasma contains fibrinogen.
d. plasma contains fibrinogen.
Specimens collected in serum separator tubes are most frequently delivered to:
a. blood bank.
b. serology.
c. hematology.
d. chemistry
d. chemistry.
To prevent blood from clotting the specimen must be:
d. both A and B
c. centrifuged right after collection.
d. both A and B
d. both A and B
d. both A and B
Which of the following pairings is wrong?
a. icteric and yellow.
b. lipemic and cloudy.
c. hemolyzed and red.
d. fasting and cloudy.
The main anticoagulant for coagulation studies is:
a. ethylenediaminetetraacetic acid (EDTA).
b. sodium citrate.
c. heparin.
d. oxalate.
b. sodium citrate.
. ABO and Rh typing are performed in which laboratory section?
a. Hematology
b. Blood bank
c. Chemistry
d. Cytology
b. Blood bank
The activated partial thromboplastin time (APTT) or partial thromboplastin time (PTT) test is performed in:
a. coagulation.
b. chemistry.
c. urinalysis.
d. histology.
a. coagulation.
. Which test would a physician order on a patient with a suspected infection?
a. Glucose
b. Complete blood count (CBC)
c. Cholesterol
d. Antinuclear antibody (ANA)
b. Complete blood count (CBC)
An anemia would be detected by a:
a. glucose test.
b. blood culture.
c. urinalysis.
d. complete blood count.
d. complete blood count.
. An agency that assures quality care by hospitals is the:
a. Joint Commission.
b. Centers for Disease Control and Prevention.
c. Occupational Safety and Health Administration.
d. College of American Pathologists.
a. Joint Commission.
. The most serious error a phlebotomist can make is:
a. causing a hematoma.
b. failure to correctly identify a patient.
c. drawing a specimen in the wrong tube.
d. collecting a hemolyzed dermal puncture specimen.
b. failure to correctly identify a patient.
. A puncture device with a broken seal should not be used because:
a. it is no longer sterile.
b. the needle may contain a barb.
c. there may be a manufacturing defect.
d. the color coding will not match the size.
a. it is no longer sterile.
Using an evacuated tube after its expiration date can result in all of the following except:
a. a short draw.
b. a clotted specimen.
c. a lipemic specimen.
d. a contaminated specimen
a. a short draw.
The Patient’s Bill of Rights guarantees the patient all of the following except:
a. a private room.
b. informed consent.
c. confidentiality.
d. treatment refusal.
a. a private room.
To complete the chain of infection, all of the following are required except a:
a. source.
b. contaminated surface.
c. mode of transmission.
d. host.
b. contaminated surface.
An infection contracted by a patient while in the hospital is termed:
a. antibiotic-resistant.
b. staphylococcal.
c. nosocomial.
d. unfortunate
c. nosocomial.
The recommended disinfectant for blood and body fluid contamination is:
a. sodium hydroxide.
b. antimicrobial soap.
c. hydrogen peroxide.
d. sodium hypochlorite.
d. sodium hypochlorite.
. The term universal precautions refers to:
a. universal blood donors.
b. mixing organic chemicals under a hood.
c. wellness clinics available to everyone.
d. treating all specimens as infectious.
d. treating all specimens as infectious.
In addition to changing gloves between every patient, phlebotomists should also:
a. change their lab coats.
b. disinfect the phlebotomy tray.
c. double-bag the specimens.
d. wash their hands.
d. wash their hands.
To comply with the current Bloodborne Pathogens Standard, phlebotomists must:
a. discard sharps only into containers attached to the wall.
b. activate the needle protection device before removing the needle from the adapter.
c. decontaminate needle adapters between each patient.
d. activate the needle protective device and discard the needle and the adapter.
d. activate the needle protective device and discard the needle and the adapter.
The code word PASS refers to:
a. storage of volatile chemicals.
b. operation of a fire extinguisher.
c. labeling of hazardous material.
d. the presence of radioactive material
b. operation of a fire extinguisher.
Alcohol-based hand sanitizers may be used as a substitute for handwashing:
a. only in a blood donation center.
b. only in certain patient care areas such as oncology or obstetrics and gynecology.
c. at any time.
d. when the hands are not visibly contaminated with blood or other body fluid.
d. when the hands are not visibly contaminated with blood or other body fluid
The prefix that means decreased is:
a. hypo-
b. hyper-
c. hetero-
d. haplo-
a. hypo-
Which of the following abbreviations on a patient’s chart, test requisition, or bedside notice would be most important if a patient asked a phlebotomist for a drink of water?
a. TPR
b. PRN
c. OP
d. NPO
d. NPO
The ability to keep body systems functioning in a steady state is called:
a. coagulation.
b. articulation.
c. metabolism.
d. homeostasis.
d. homeostasis.
The layer of skin that contains the blood vessels is the:
a. epidermis.
b. dermis.
c. keratinized epithelium.
d. root shaft.
b. dermis.
The artery of choice for measuring the pulse rate in an adult is the:
a. carotid.
b. radial.
c. brachial.
d. temporal.
b. radial.
The blood vessels that carry deoxygenated blood to the heart are:
a. arteries.
b. alveoli.
c. capillaries.
d. veins.
d. veins.
All of the following are formed elements found in the blood except:
a. erythrocytes.
b. platelets.
c. macrophages.
d. leukocytes.
c. macrophages
. The primary role of the thrombocyte is to:
a. transport nutrients.
b. promote blood clotting.
c. phagocytize bacteria.
d. produce antibodies.
b. promote blood clotting.
. Functions of the blood include all of the following except:
a. transport oxygen.
b. regulate pulse rate.
c. deliver nutrients.
d. transport waste products.
b. regulate pulse rate.
The fluid that comprises approximately 55% of the total blood volume is made up of:
a. hematocrit.
b. plasma.
c. tissue fluid.
d. serum.
b. plasma.
The primary antiseptic for routine venipuncture is:
a. iodine.
b. chlorhexidine.
c. isopropyl alcohol.
d. Betadine.
c. isopropyl alcohol.
A properly tied tourniquet:
a. permits arterial flow and blocks venous flow.
b. blocks arterial and venous flow.
c. prevents backflow.
d. permits venous flow and blocks arterial flow.
a. permits arterial flow and blocks venous flow.
The color coding of evacuated tubes provides information about all of the following except the:
a. volume of specimen collected.
b. type of specimen collected.
c. need to invert the tube.
d. presence of an anticoagulant.
c. need to invert the tube.
. Which of the following tubes must always be completely filled?
a. Gray
b. Light blue
c. Red
d. Pink
b. Light blue
The ratio of blood to anticoagulant in a light blue stopper tube is:
a. 2:l
b. 5:l
c. 9:l
d. 10:1
c. 9:l
Most anticoagulants in blood collection tubes prevent clotting by:
a. binding calcium.
b. acting as an antithrombin agent.
c. binding fibrinogen.
d. releasing heparin.
a. binding calcium.
Which of the following is the most acceptable order of tube draw?
a. Yellow, red glass, and light blue
b. Lavender, red plastic, and yellow
c. Red plastic, light blue, and lavender
d. Yellow, green, and light blue
a. Yellow, red glass, and light blue
Failing to adequately invert a lavender stopper tube after collection will:
a. cause hemolysis.
b. falsely elevate calcium results.
c. destroy coagulation factors.
d. produce a clotted specimen.
d. produce a clotted specimen
. The presence of a clot is acceptable in:
a. red stopper tubes.
b. lavender stopper tubes.
c. green stopper tubes.
d. light blue stopper tubes.
a. red stopper tubes.
. Which of the following needles has the largest diameter?
a. 16 gauge
b. 18 gauge
c. 20 gauge
d. 22 gauge
a. 16 gauge
Collecting a large evacuated tube using a 23-gauge needle:
a. is recommended for geriatric patients.
b. is required for certain automated tests.
c. may cause a hemolyzed sample.
d. may cause a loss of vacuum in the tube.
c. may cause a hemolyzed sample.
Forcing blood from a syringe into an evacuated tube:
a. prevents the blood from clotting.
b. can only be done when using a small syringe.
c. may hemolyze the specimen.
d. is required when using a transfer device.
c. may hemolyze the specimen
The needle holder that is part of the evacuated tube collection system is:
a. disposed of in the general trash after removing the collection needle.
b. disposed of as a unit with the collection needle into a red bag.
c. disposed of as a unit with the collection needle into a sharps container.
d. made of a grade of plastic that does not require disposal in a sharps container.
c. disposed of as a unit with the collection needle into a sharps container.
All of the following are used to identify a patient except the:
a. bed sign.
b. requisition form.
c. identification band.
d. bar codes.
a. bed sign.
The most important purpose of a requisition form is:
a. authorization to perform the procedure.a. authorization to perform the procedure.
b. providing a system to report results.
c. location of the patient.
d. monitoring test result turnaround time.
a. authorization to perform the procedure.a. authorization to perform the procedure.
Blood should not be drawn from a patient who is:
a. standing.
b. nervous.
c. unable to make a fist.
d. not fasting.
a. standing.
The maximum time a tourniquet should remain on the patient’s arm is:
a. 1 minute.
b. 2 minutes.
c. 3 minutes.
d. 5 minutes.
a. 1 minute.
The vein of choice for routine venipuncture is the:
a. median cubital.
b. radial.
c. cephalic.
d.baslic
a. median cubital.
The vein located on the thumb side of the arm is the:
a. brachial.
b. median cubital.
c. basilic.
d. cephalic.
c. basilic.
Palpate means to:
a. perform a venipuncture.
b. examine by touch.
c. examine by sound.
d. obtain a specimen from an intravenous line.
b. examine by touch.
Prolonged application of a tourniquet will cause:
a. excessive bleeding.
b. difficulty locating a vein.
c. hemolysis.
d. both A and C
d. both A and C
a. excessive bleeding
c. hemolysis.
Failure to allow the alcohol to dry on the patient’s arm after site cleansing can cause all of the following except:
a. increased bacteriostatic action.
b. a stinging sensation for the patient.
c. a possible unsterile site.
d. specimen hemolysis.
a. increased bacteriostatic action.
Correct palpation of a vein includes all of the following except:
a. determining the depth of the vein.
b. detecting a pulse using the thumb.
c. determining the direction of the vein.
d. probing with the index finger.
b. detecting a pulse using the thumb.
Hemoconcentration can be caused by:
a. prolonged tourniquet application.
b. intravenous therapy.
c. excessive probing.
d. failure to clench the fist.
a. prolonged tourniquet application.
. Firmly anchoring the vein prior to needle insertion is necessary to prevent:
a. specimen hemolysis.
b. incompletely filled tubes.
c. an accidental needlestick.
d. the vein from rolling.
d. the vein from rolling.
. During the venipuncture, the phlebotomist should do all of the following except:
a. anchor the vein above and below the puncture site.
b. insert the needle with the bevel up.
c. insert the needle at a 15- to 30-degree angle.
d. brace the hand holding the adapter on the patient’s arm.
a. anchor the vein above and below the puncture site.
A properly labeled tube must have all of the following information except the:
a. patient location.
b. patient identification number.
c. date of collection.
d. phlebotomist’s initials.
a. patient location.
Two identifiers for patient identification before specimen collection are routinely secured by all the following means except:
a. verifying the patient’s identification number on the wrist or ankle identification band.
b. asking the patient to state his or her first name and last name.
c. asking the patient “Are you John Doe?” or “Are you Mary Doe?”.
d. comparing information obtained verbally and from the patient’s identification band with the information on the test requisition.
d. comparing information obtained verbally and from the patient’s identification band with the information on the test requisition
When encountering a patient who is sleeping, the phlebotornist should:
a. return at another time.
b. try to collect the specimen without waking the patient.
c. notify the nursing station.
d. awaken the patient before collecting the specimen
d. awaken the patient before collecting the specimen
The best way to prevent fainting in a patient during blood collection is to:
a. have the patient stand during the phlebotomy.
b. have the patient lie down during the phlebotomy.
c. have the patient pump the fist three times.
d. place a pillow under the patient’s head.
b. have the patient lie down during the phlebotomy
Patients are most likely to be in a basal state at:
a. 6:00 a.m.
b. 10:00 a.m.
c. 2:00 p.m.
d. 6:00 p.m.
a. 6:00 a.m
. A patient who appears pale and has cold, damp skin may develop:
a. coagulation problems.
b. septicemia.
c. sclerosis.
d. syncope.
d. syncope.
When encountering a patient with a fistula, the phlebotornist 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.
b. use the other arm.
When collecting blood from a patient with a very edematous right arm and a large hematoma in the antecubital area of the left arm, the phlebotornist should collect the specimen from:
a. below the hematoma.
b. above the hematoma.
c. the antecubital area of the right arm.
d. the antecubital area of the left arm.
a. below the hematoma
The maximum number of attempts that a phlebotomist should make to collect a specimen is:
a. one.
b. two.
c. three.
d. four.
b. two.
. Prolonged tourniquet application will cause:
a. edema.
b. hemolysis.
c. hemoconcentration.
d. both B and C
d. both B and C
b. hemolysis.
c. hemoconcentration.
. Specimens are rejected by the laboratory for all of the following reasons except:
a. clots in a lavender stopper tube.
b. collection in the wrong tube.
c. incompletely filled light-blue stopper tubes.
d. clots in a red stopper tube.
d. clots in a red stopper tube.
. Allowing blood to leak from a vein into the surrounding tissue will cause:
a. hematoma.
b. hemolysis.
c. nerve damage.
d. syncope.
a. hematoma.
Hematomas can be caused by all of the following except:
a. having the patient bend the elbow.
b. inserting the needle partially into the vein.
c. drawing below an intravenous line.
d. removing the tourniquet after removing the needle.
c. drawing below an intravenous line.
The best reason why the majority of patient samples are drawn in the early moming hours is because:
a. the patient will not be in the basal state early in the rnorning because this requires several hours of normal physical activity by the patient.
b. patients should have consumed a meal no less than three hours prior to the time of collection.
c. the patient will be in the basal state, having restrained from strenuous exercise and having fasted for approximately 12 hours.
d. patients are generally more agreeable with collection times scheduled early in the morning.
c. the patient will be in the basal state, having restrained from strenuous exercise and having fasted for approximately 12 hours.
. Plasma differs from Serum in that:
a. Serum contains fibrinogen
b. Serum is obtained by centrifugation
c. Plasma contains fibrinogen
d. Plasma is obtained by centrifugation
c. Plasma contains fibrinogen
A sentinel event would be most likely caused by delivery of a mislabeled tube to which lab department:
a. Coagulation
b. Hematology
c. Immunology
d. Blood bank
d. Blood bank
. Which of the following tests is not part of the CBC:
a. Red blood cell count
b. Platelet count
c. Sedimentation rate
d. Differential
c. Sedimentation rate
. Testing of a fecal stool for parasites is performed in:
a. Hematology
b. Microbiology
c. Immunology
d. Urinalysis
b. Microbiology
A prothrombin test is performed in:
a. Coagulation
b. Immunology
c. Microbiology
d. Chemistry
a. Coagulation
True/False
Indicate whether the following statements are true or false.
The liquid portion of a specimen collected in a tube containing ethylenediaminetetraacetic acid (EDTA) is serum.
False
True/False
Indicate whether the following statements are true or false.
If a needle has not been used it can be recapped?
False
True/False
Indicate whether the following statements are true or false.
When using a butterfly, a light blue stopper tube should be collected first.
/False
. What zone does a phlebotomist work in, according to the American zone of comfort guide lines?
A. Intimate zone 18-24 inches
B. Intimate zone 24-36 inches
C. Personal zone 18-24 inches
D. None of the above
A. Intimate zone 18-24 inches
. In what department of the lab is a complete blood count performed?
A. Hematology
B. Microbiology
C. Chemistry
D. Blood bank
A. Hematology
Which of the following would not be needed when collecting a throat culture?
a. Flashlight
b. Blood agar culture plate
c. Tongue depressor
d. Sterile swab
b. Blood agar culture plate
What type of tube is used for a complete blood count?
A. Purple with clot activator
B. Lavender with EDTA
C. Lavender with EDTA
D. Lavender with NaK
C. Lavender with EDTA
. What chemical or additive is needed for performing an activated partial thromboplastin time?
A. EDTA
B. SPS
C. Clot activator
D. Sodium citrate
D. Sodium citrate
What color of tube is used for activated partial thromboplastin time?
A. Light blue
B. Light green
C. Purple
D. Yellow
B. Light green
What is the abbreviation for activated partial thromboplastin time?
A. PT
B. CBC
C. PTT
D. CHEM-7
C. PTT
Which of the following is not one of the three types of blood samples?
A. Whole blood
B. Plasma
C. Serum
D. Iron
D. Iron
In which part of the lab is a CMP performed?
A. Microbiology
B. Chemistry
C. Hematology
D. Blood bank
B. Chemistry
What does CMP stand for?
A. Comprehensive Metabolic Panel
B. Choke Mary Partially
C. Chemistry Metabolic Panel
D. Chloride Metabolic Panel
A. Comprehensive Metabolic Panel
. What color of tube does the phlebotomist use for blood bank testing?
A. Red plastic
B. Red glass
C. Yellow
D. Pink
D. Pink
Traditional duties of the phlebotomist include all of the following except:
A. Correctly label all specimens with required information
B. Select the appropriate specimen containers for the specified test
C. Perform test on patient samples in the lab
D. Collect the appropriate amount of blood by venipuncture or dermal puncture
C. Perform test on patient samples in the lab
. To prevent blood from clotting, the specimen must be:
A. Collected in a tube containing an anticoagulant
B. Inverted right after collection
C. Centrifuged right after collection
D. Both a and b
D. Both a and b
A. Collected in a tube containing an anticoagulant
B. Inverted right after collection
The primary antiseptic for venipuncture is:
A. 70% isopropyl alcohol
B. 80% isopropyl alcohol
C. 90% isopropyl alcohol
A. 70% isopropyl alcohol
. Most anticoagulants in blood collection tubes prevent clotting by:
A. Binding calcium
B. Acting as an antithrombin agent
C. Binding fibrinogen
D. Releasing heparin
A. Binding calcium
. List five (5) physical and/or emotional changes associated with the aging process that could impact phlebotomy procedures
Any 5 of the following:
- Hearing loss leading to embarrassment and frustration
- Impaired verbal communication
- Failing eyesight
- Loss of taste, smell and/or feeling
- Memory loss
- Thinner skin tissue
- Smaller muscles
- Increased susceptibility to accidental hypothermia
- Increased sensitivities and allergies
- Anxiety related to becoming older and less capable
List two other terms used to refer to point-of-care testing:
Any two of the following:
- Decentralized laboratory testing
- On-site testing
- Bedside testing
- Near-patient testing
- Patient-focused testing
The nervous system that is made up of the brain and spinal cord is the:
a. central nervous system.
b. peripheral nervous system.
c. autonomic nervous system.
d. voluntary nervous system
a. central nervous system
Application of the tourniquet on the patient’s arm for longer than one minute may cause:
a. an increase in contaminated blood cultures.
b. a clotted sample in the red top tubes collected.
c. an increase in concentration of large molecules.
d. decreased pain and discomfort in the arm.
c. an increase in concentration of large molecules
The anterior portion of the body is the:
a. right side.
b. front side.
c. back side.
d. left side.
b. front side.
When a central venous access device (CVAD) is present:
a. blood is drawn from the line using a 30-mL syringe.
b. laboratory specimens should not be collected from the catheter.
c. blood is drawn and discarded before the specimen is collected.
d. an evacuated tube is attached to the line for specimen collection.
c. blood is drawn and discarded before the specimen is collected.
A phlebotomist may be requested not to transport a specimen through the pneumatic tube system if it is to be tested for:
a. glucose.
b. cholesterol.
c. creatinine.
d. potassium.
d. potassium.
Inflammation of the meninges caused by a bacterial or viral infection is called:
a. poliomyelitis.
b. chondrosarcoma.
c. meningitis.
d. cerebral palsy
c. meningitis.
Accessioning refers to:
a. a test performed in the chemistry section.
b. organization of requisition slips for morning sweeps.
c. assigning of identification numbers and distribution of specimens.
d. processing of specimens requiring special handling.
c. assigning of identification numbers and distribution of specimens.
Errors in prioritizing specimens appropriately (routine versus stat) for processing are classified as:
a. post-examination variables.
b. different types of variables depending on the type of laboratory.
c. pre-examination variables.
d. examination variables.
c. pre-examination variables.
Alcohol-based hand sanitizers may be used as a substitute for handwashing:
a. only in a blood donation center.
b. only in certain patient care areas such as oncology or obstetrics and gynecology
c. at any time.
d. when the hands are not visibly contaminated with blood or other body fluid.
d. when the hands are not visibly contaminated with blood or other body fluid.
The physical examination of urine includes reports on:
a. odor and turbidity.
b. color and appearance.
c. clarity and foam color.
d. color and blood.
b. color and appearance.
Which of the following pairings is wrong?
a. icteric and yellow.
b. lipemic and cloudy.
c. hemolyzed and red.
d. fasting and cloudy.
d. fasting and cloudy.
Phlebotomists may be required to classify tests using a:
a. current procedural technology (CPT) code.
b. bar code.
c. International Classification of Diseases, 9th Revision (ICD-9) code.
d. Centers for Disease Control and Prevention (CDC) code.
a. current procedural technology (CPT) code.
The sweat electrolyte test is used in the diagnosis of;
a. multiple sclerosis.
b. cystic fibrosis.
c. muscular dystrophy.
d. electrolyte imbalance.
b. cystic fibrosis.
The puncture site may require additional pressure to stop bleeding when the patient:
a. has low blood pressure.
b. is taking anticoagulants.
c. frequently takes aspirin.
d. both B and C
d. both B and C
b. is taking anticoagulants.
c. frequently takes aspirin
. Which of the following pairings is incorrect?
a. Thumb and calluses
b. Index finger and increased nerve endings
c. Third finger and increased possibility of bone puncture
d. Fifth finger and decreased tissue mass
c. Third finger and increased possibility of bone puncture
. Lavender stopper tubes can be used for all of the following except:
a. coagulation tests.
b. platelet counts.
c. differential counts.
d. hematocrits.
a. coagulation tests.
The most economical and safest method for performing routine venipuncture is the use of:
a. butterflies.
b. plastic syringes.
c. glass syringes.
d. evacuated tubes
d. evacuated tubes.
. An elevated bilirubin might indicate a disorder of the:
a. heart.
b. kidney.
c. brain.
d. liver.
d. liver.
Areas that should be avoided for venipuncture include all of the following except:
a. hematomas.
b. deep cephalic veins.
c. sclerosed veins.
d. tattoos.
b. deep cephalic veins.
. To produce a rounded drop of blood, finger punctures should be made:
a. on the index finger.
b. on the fingerprint.
c. before the alcohol is dry.
d. across the fingerprint.
d. across the fingerprint.
Using a small-gauge needle with a large evacuated tube can cause:
a. a hematoma.
b. petechiae.
c. hemolysis.
d. patient discomfort.
c. hemolysis
An unexpected patient death that is not related to the patient’s illness is termed a:
a. root cause.
b. human error.
c. sentinel event.
d. professional liability.
c. sentinel event.
The maximum safe length of lancets used for heel puncture is:
a. 1.5 mm.
b. 2.0 mm.
c. 2.75 mm.
d. 3.4 mm.
b. 2.0 mm.
The main organ(s) of the integumentary system is (are) the:
a. nails.
b. hair.
c. skin.
d. sweat glands.
c. skin.
. If a patient refuses to have blood drawn, the phlebotomist should:
a. send another phlebotomist to collect the specimen.
b. report the situation to the nursing station.
c. return the requisition form to the laboratory.
d. ask someone to hold the patient and collect the specimen.
b. report the situation to the nursing station.
What is the most preferred site for venipuncture?
Median Cubital
Prior to preforming the capillary (dermal) puncture the PT should select the
Lancet size
When collecting blood cultures from an adult patient it is recommended to collect
8-10 mL per bottle
Feather edge reflects the correct results for a
Peripheral Blood Smear
What tests require fasting
Glucose, triglycerides, cholesterol, vitamin & mineral problems and pregnancy
When entering a patients room you should
introduce yourself and explain procedure
What two factors that determine weather a child should have capillary collection by heel or stick?
Age & developmental factors
What is used to collect cerebrospinal fluid, which is a non blood specimen?
Lumbar tap
What type of alcohol compound is appropriate for a routine skin puncture?
70% isopropyl alcohol
When running an IV what is the preferred site for drawing blood specimen?
Going Distal
If during a venipunture the patient moves needle and needle comes out PT should
Release tourniquet
If patient notifies PT of fainting during blood collection you should
Position in supine
OSHA guidelines are standards for
Reduction of risks and injuries to employee
The lavender evacuated tube contains
EDTA
Stool specimen should be refrigerated for 24 hours when conducting what test
Ova and parasite test
If a PT needs to collect a prothrombin time from a patient with difficult veins
A light blue tube is best
According to CISI order of draw guidelines, the following samples should be collected first
Cultures
What is the most important info included on MSDS (material safety data sheet)
The composition of compounds
In order for blood alcohol level to be admitted by evidence in court of law what must be done
PT must document the process of cleansing the site with chlohexadine prep
What is needed for proper out patient ID
Name and DOB
If a patient is a contact isolation
Precaution gown and gloves must be worn
If a female refuses to get blood drawn from a male for religious purposes
A female PT should collect the specimen
A PT should explain the procedure prior to the venipuncture in order to
Obtain patient consent
According to CISI the standard depth of dermal puncture for infants is
2mm
What are one of the complications associated with dermal puncture?
Osteomyelitis
What is the most common reason for glucose monitoring through point of care testing
To monitor glucose levels
If a patient had a mastectomy when preforming a venipuncture you should
Draw from opposite arm
When is it appropriate to place specimen in ice when transporting
For ABG analysis
The timing for a GTT begins when
Patient finishes drinking glucose solution
The proper order of draw of capillary specimen is
Lavender, green, gray, SST
An alcohol level test is ordered
The sodium fluoride tube should be used
After collecting a billirubin test the specimen should
Be kept away from direct light to ensure accurate results
Using antimicrobial sanitizers is a way of preventing
Nosocomial infections
The proper way a Pt should instruct their patient to collect a C&S stool specimen is to tell them to
Chill stool specimen in a container
Which veins should be avoided by PT unless otherwise instructed by Physician
Dorsalis Pedis
When receiving a specimen collected by a patient PT shoudl
Compare the lab requisition form to patient photo ID
After cleansing a site PT should
Always let the spot dry
What is the most important to verify prior to obtaining specimen
Patient identity
When performing a capillary collection serum tubes sample should be drawn when?
Last
What is a complication that could happen is the needle is too small?
Hemolysis
Which veins should be used by a PT at first choice by a venipuncture on a 3 yr old?
Dorsal veins of the hand
What does warming the site do?
Increases blood flow
When collecting a bilirubin specimen from a newborn it must?
Be protected from the light
If PT is inserting needle and patient complains of sharp radiating pain down his arm you should?
Release tourniquet, remove needle and apply pressure and cover
What is needed for homeostasis to take place?
Thrombocytes
When collecting a capillary specimen after the site is punctured you should?
Wipe the first draw
When is the winged infusion needle used?
With patients who have fragile veins
If the PT observes a hematoma forming at the site of draw the PT should?
Release tourniquet and stop draw
When a PT enters room without introducing or asking permission to enter its considered
Invasion of privacy
The duties of a PT are to
Instruct and greet patients
When drawing blood on a small child the PT should explain procedure to
Parents and child
When performing a dermal puncture on patients 1 year or older they should perform it on which finger?
Middle finger
A PT has orders to draw blood cultures, CBC, PTT, and iron panels but forgets to draw PTT what should you do?
Draw a discard tube and redraw blood cultures
Quality control testing of glucometer is important to
Promote accurate test results
What are additives sodium citrate and EDTA used to prevent?
Hemostais
While on flood a PT is paged for a STAT which is the most useful to PT?
Room location
During venipuncture the needle in the vein and bloodflow is established when the second tube is attached blood flow stops the PT should
Rotate the bevel of needle
While the PT is drawing and patient reports feeling lightheaded and faints PT should
Remove tourniquet
All test results of hospital patients are available to physicians and nursing staff in house via
Internet
While preforming donor phlebotomy for blood bank PT should use what size needle?
18-16 gauge
Vein located laterally on arm is called
Cephalic
Hemoconcentration of a venous blood sample is most often caused when
The tourniquet is in place for more than 2 mins
When performing a draw on a diabetic patient with small fragile veins and PT misses twice the PT should
Ask another PT to obtain
Utilizing tubes that have expired may result in
Loss of vacuum
What causes hemolysis
Vigorously inverting tubes
Dermal puncture performed on an infant are routinely collected from
Lateral plantar surface
After introducing yourself you should
Correctly identify patient
What is negligence
Failure to demonstrate proper care that results in an injury to another person
Heel sticks are done for which neonatal screening
PKU
For patient compliance with GTT test PT should
Confirm patient has been fasting
Sclerosed vein
Hardening of vein
Hemoconcentration
Concentration of blood
Hematoma
Accumulation of blood under skin
Phlebitis
Inflammation of the vein
Thrombus
Blood clot
Petechaie
Tiny hemorrhage
Thrombophlebitis
Infected clot in vein
Spticemia
Infection in the blood
Trauma
Bruses
When is povidone iodine solution used?
For collections that require more stringent infection control ex blood cultures and arterial punctures
When is chlorhexidine gluconate used?
For those allergic to iodine and tests for alcohol
What should you do when antibodies are produced in response to an infection?
The specimen must be kept warm until the serum is separated from the cells
What specimens must be chilled immediately after collection?
ABG blood gases, ammonia, latic acid, pyruvate, ACTH, gastrin and parathyroid hormone
Which specimens must be protected from light after collection?
Bilirubin, beta carotene, vitamin A & B6 and prophyrins
Where should dermal puncture be preformed for adult?
Distal segment of third or fourth finger of non dominant hand
Where should dermal puncture be preformed for infant less than 1 year?
The heel cant go deeper than 2 mm
What is order of draw for capillary punctures?
Lavender, tubes with additives, tubes with no additives
Pre analytical errors
Patient misidentification, inadequate fast, patient posture, poor coordination with other treatment
Post analytical erros
Processing delays, failure to separate serum from cells, rimming clots
Intra/ Co analytical errors
Under filling tubes
After draw the patient begins to twitch and shake and her eyes roll back what should PT do
Observe patient and help protect against injury
If before draw pattient was very talkative and after draw becomes quiet and stares blankly you should?
Ask if he or she is okay and feels faint
When collecting blood in an evacuated tube hemolysis would occur with which gauge needle>
25′
What are signs PT should recognize on patient during venipuncture?
Cold, calmmy, and diaphoretic skin
If a patient turns pale and complains of nausea when PT is about to collect these are signs of what
Syncope
Where should a PT document test preformed with regent products as part of protocol
On a quality control log
To ensure safety of PT and psychiatric patients and others a PT should
Bring all necessary equipment to patients room
What does SST in a collection tube indicate
To indicate if plasma is used and distinguish weather a collection tube contains serum or plasma
Because of time between collection and plasma separation the PT should
Centrifuge specimen
If a PT is ordered to draw blood from a 6lb newborn from the NICU and the order states blood draw for HCT, HGB and potassium every 24 hours what is a complication for patient?
Hemolytic anemia
What is the percent of body weight is the volume of blood that can be drawn at one time or short period of time before patient faces the risk of latrogenic anemia?
10-20%
What must be followed exactly whenever a PT draws patient test samples that may be used in a legal proceeding?
Chain of custody
For inpatient in addition to patients complete name and DOB, medical record # what else must be included in the physicians requisition form
Test to be preformed
A positive HIV test results are an example of
Point of care testing
When labeling a non blood specimen where must the label be put
On the container
Quality assurance standards include
Procedure manuals, instrument maintenance, quality control and proficiency testing
A STAT electrolyte panels was reported to have critically high sodium levels
Use gold tube explains pre analytic error
What would exclude a patient from donating blood?
Obesity
The emergency dept sends 2 swabs from 2 year old child for influenza and strep only one swab has patients label PT should
Run test on labeled swab
Which is a likely result of filling a light blue tube with a ratio 1:6
False elevation of international normalized ratio
When drawing blood PT should instruct patient to
Make a fist do not pump
While transferring serum into an isolator tube, some blood splashes into your eyes. What must you do?
Rinse your eyes with water for 15 minutes
You are conducting a streptococcal pharyngitis test on a pa-tient. What transmission-based precaution should you take?
Droplet
You observe a glucometer reading of 250 mL/dL. You get a reading in the average range when you do a second test. What may have caused the first result?
You used too much blood
You are to perform a glucometer reading for a young adult while the patient’s parent is in the room. The parent asks what the patient’s glucose level is. What should you do?
Ask the patient for permission to provide the results to the parent
You are about to collect a blood sample when you find a cracked glass collection tube. What must you do?
Dispose of the tube in a sharps container
What information must be included when filling out a glucose monitor quality control record?
The date that battery is changed
Other than gloves, what PPE should you wear when performing venipuncture for a patient with pneumonia?
Face mask
After completing a venipunc-ture in an isolation room, what personal protective equipment should you remove first?
Gloves
If you receive a needlestick injury, for what bloodborne pathogen are you at most significant risk?
Hepatitis B virus (HBV)
What of the following actions must you do when collecting a blood culture?
Rub the site with isopropyl alcohol for 30 seconds
What solution should be used to clean a spill of cerebral spinal fluid?
Chlorine-bleach
After receiving a needlestick in-jury, what information must you input in the online sharps injury log?
The department where the injury happened
What antiseptic should you use during a blood alcohol test?
Chlorhexidine gluconate
At a minimum, what personal protective equipment do you need to prepare to aliquot a blood specimen?
Face shield and gloves
A centrifuge catches on fire. In what class of fire should this situation be identified?
Class C
When collecting a sample for cholesterol, troponin, and HDL blood results, in which department should these tests be pro-cessed?
Chemistry
You collect a blood collection in a micro collection container after two failed venipuncture at-tempts. Why should you write on the medical requisition form that you collected the
To alert the lab of the presence of capillary blood
What is the correct way to perform CPR on an infant as a medical professional?
30 compressions, 5.08 cm
(2 in) deep
A patient has a wound infected with MRSA (methicillin-resist-ant Staphylococcus aureus). You are tasked with performing venipuncture for this patient.
What must you do once you complete the procedure?
Dispose of gloves upon leaving the room
You are about to perform the third set of blood draws for a glucose tolerance test (GTT)
when the patient starts to cry and does not want to extend her arm. What is the best thing to say?
“May I come back in an hour to perform the draw?”
Which of the following statements regarding standard precautions for infection control is false?
Use both hands to recap needles
Antisepsis is a technique that is used on which of the following?
skin
How often should latex gloves be changed?
Between patient contacts
Once you have stopped excessive bleeding, what should you apply over the site?
Pressure bandage
The patient may leave when the bleeding has stopped com-pletely, and there are no signs of
Syncope
What is the difference between syncope and hypovolemic shock?
Fainting may be caused by pain or emotions
You are performing venipuncture, and a hemorrhage occurs in a limb. What must you do?
Elevate the extremity and continue applying pressure until more medical assistance arrives
How long should you scrub hands when washing according to CDC?
30 seconds
Where should you dispose of all contaminated material?
A biohazard bag
What is the best way to prevent infection and transmission?
Handwashing
When disinfecting a venipunc-ture site, why should you not use cotton balls?
Cotton balls leave behind small fibers
Alcohol that has not fully dried on the venipuncture site can lead to
Hemolysis of the specimen
What is alcohol’s purpose in bacterial testing?
Remove oil
What is the purpose of povi-done-iodine in bacterial testing?
Kill bacteria
What should you use at the venipuncture site if the patient is allergic to alcohol?
Chlorhexidine gluconate
What form must you and the patient sign to permit blood tests to determine exposure?
HIV
What is required following accidental exposure to body fluids?
Documentation of the accidental exposure
What is the first priority after accidental exposure?
First aid
What is the term for the following equipment: gloves, masks, gowns, face shields, and gog-gles?
Personal Protective
Equipment
What PPE should be worn for venipuncture?
Gloves
When should you wash your hands?
before and after every patient
What should be done if your gloves are punctured or torn?
Replace the gloves
Where should you dispose of used needles and lancets?
Sharps container
According to the Bloodborne Pathogen Standard, what two guidelines must all at-risk employees adhere to?
Personal protective equipment ment and HBV immunization
What organization establishes regulations for phlebotomists to work as effectively and safely as possible?
OSHA
What guidelines protect healthcare professionals from exposure to body fluids, prevent ex-posure, and train for handling situations of body fluid exposure?
Bloodborne Pathogen
Standard
All phlebotomists and healthcare professionals must deem body fluids as..
Potentially infectious
What information must the sharps injury log include?
Date, time, type of sharps used, staff or patient involved (without names), location, description
In the case of a splash risk, what can you use instead of a full-face shield?
Goggles and face mask
What independent, non-govern-mental, nonprofit organization accredits and certifies healthcare facilities to focus on the continual importance of quality of care and patient safety?
The Toint Commission
(TIC)
What organization established the proper order of draw for venipuncture?
Clinical and Laboratory
Standards Institute (CLSI)
What should you first use to disinfect a needlestick injury?
Hydrogen peroxide
Starting a procedure without consent is considered
Assault
What should you do if a patient refuses care?
Notify a nurse and the ordering physician
How should you obtain patient identification from a conscious patient prior to venipuncture?
Ask the patient, “What is your name?”
How often should laboratory equipment be cleaned?
Several times a day
What lab test is the least complicated to perform, with results that are as accurate as possible and a low risk of error?
CLIA-waived tests
What is not considered a sharp?
Glucometer
What are the three types of transmission included in trans-mission-based precautions?
Contact, droplet, airborne
What types of transmission do mumps, rubella, meningi-tis, diphtheria, and influenza fall under?
Droplet
What types of transmission do tuberculosis, rubeola (measles), and varicella (chickenpox) fall under?
Airborne
What type of precaution is required for scabies and wound/ skin infections?
Contact
What PPE should you use for contact-based transmissions?
Gloves and grown
What PPE should you use for droplet-based transmissions?
Mask
What PPE should you use for air-borne-based transmissions?
N95 mask
When performing CPR, what results in a higher survival rate?
Faster compressions
What is the adult compression rate during CPR?
100-12o compressions per minute
Before administering CPR in an emergency, what should you do first?
Call 911
When can you use hand sanitizer instead of handwashing?
When hands are not visibly soiled
What PPE gear should you use when dealing with and processing blood samples and specimen containers (i.e., vacuum tubes, urine collections), like loading and unloading the centrifuge and carrying out diagnostic tests?
Gown
What items are disposed of in a biohazard bag?
Used glucose test strips
What is the normal range for glucose levels?
60-180 mg/dL
On what document should you record equipment maintenance and quality control testing?
Equipment log
What happens if the centrifuge is not balanced?
It vibrates more than usual, with more noise
How should glucometers be cleaned after each use?
Wiped with an alcohol wipe
When obtaining patient identi-fication, which of the following information do you need?
Patient number, full name, date of birth
When drawing blood from a patient admitted for cardiac symp-toms, what action should you take when drawing blood?
Collect the patient’s blood
Which information is required on the requisition form for an outpatient blood collection?
Patient’s billing information and test status
A patient has a history of syncope in previous blood collec-tions. What should you do to avoid this happening?
Place the patient in a su-
pine position
What should the patient do before their blood is taken for a cholesterol test?
Sit for about 5 minutes before test
What should you use when taking a sample for a coagulation test from a three-year-old patient?
Winged safety butterfly
What should you do if an inpatient has an IV in both arms?
Ask the nurse to turn off IVs for two minutes
In what position should a patient’s arm be during venipuncture?
Extended fully downward
A blood sample of a patient who ate a fatty meal before blood collection is processing. What should you expect to find about the specimen after centrifugation?
The specimen is lipemic.
Before blood collection, a patient tells you he is taking warfarin (anticoagulant meds). What type of test will be affected by this medication?
PT/INR
You are taking a patient’s blood sample to check for lithium level after a dose of medication. At which level should you collect the sample?
Peak
How should you answer if a patient asks you why his blood is to be collected?
You should ask your provider about the test.
When collecting a urine sample for a culture and sensitivity test, how should you direct your patient to do so?
“You must collect a midstream clean catch specimen.”
What information should you provide to the patient about the venipuncture procedure?
“I will swab the area twice to ensure it is sterile.”
What should you do when preparing to collect blood samples to track a patient’s medication levels?
Ask the nurse when the medication was last administered
What type of urine sample should a patient collect for a pregnancy test?
First morning void
How should you interact with a patient wearing hearing aids to ensure he understands the pro-cedure?
“Would you like me to repeat the directions?”
How should you check an ID if a patient is unconscious?
Use the ID bracelet only if attached to the wrist
What makes an ID bracelet an acceptable form of ID?
Worn around patient’s wrist only
When can you ask the family to identify the patient?
When the patient is alert but unable to communicate
What is a requisition form?
Identification form with last name, birth date, and other information
All patients are subject to protection under the
Patients bill of rights
The patient does not have the right to
Access the health information of family members
What is explicit consent required for?
Only larger, invasive treatments
What should a requisition form include?
the patient’s full name, sex, birth date, ID number, lab test ordered by the patient’s doctor, the full name of the doctor, date and time of the lab test, and your initials as the phlebotomist.
What is informed consent?
Clear consent from a patient after hearing a detailed explanation from the phlebotomist
The only time you should get consent from anyone else is
From the parent/guardian if the patient is a minor
What is medical malpractice?
When you continue with treatment without obtaining patient consent
Patients cannot take consent back once they have given it.
False
What is the most commonly selected vein for venipuncture?
Cephalic and median cubital veins
What must you do to find the right vein?
Always palpate the site first
What is the first thing you must do if you struggle to see a vein?
Palpate or massage from the patient’s wrist up to the elbow
How many times should you mix tubes with an anticoagulant addi-tive?
Eight times
A patient must remain calm because high stress can cause the blood sample to have
High adrenal hormone
value
What is it called when you assign a unique number for patient iden-tification?
Accessioning
Which of the following is not one of the three primary goals of the Patient’s Bill of Rights?
Promise affordable care
To deliver quality patient care, which actions should be avoided?
-Too many blood draw attempts
-Too many punctures
- Asking the patient for more details about their medical condition
Which of the following duties is outside the scope of the phlebotomist’s practice?
Collecting a tissue sample.
What organization gives out phlebotomy certifications?
-National Institutes of
Health
- Center for Disease Control
-Health and Human
Services
None of the above
Implied consent to draw blood from a patient can be obtained by which action?
The patient extends their arm
A patient’s name is spelled differently on the wristband than on the requisition form. What should you do?
Verify the information with your supervisor or attending nurse
Which of the following options is one way phlebotomists uphold their ethical obligations?
Respect for patient’s privacy
Cleanliness and personal hygiene are important for
Personal and patient safety
The term right to know refers to:
The patient’s legal right to know about the medical treatments and procedures they will receive
What is a characteristic of geriatric patients that may make venipuncture challenging?
The veins move more quickly if not anchored well enough
What is a characteristic of pediatric patients that may make venipuncture challenging?
They have a lower blood volume than adults
How must you approach drawing blood from a pediatric patient?
You must monitor and document the amount of blood drawn
Why do newborns need more blood?
They have a higher ratio of red blood cells to plasma than adults do
If a patient has an IV in both arms, how long before veni-puncture should the nurse turn both IVs off?
2-15 minutes before drawing
How should consent be obtained in emergency blood collections?
Patient consent is assumed
A timed specimen is used to measure how the body’s metab-olization of a substance, monitor anticoagulant therapy, and
Monitor changes in a patient’s condition
What tests can be inaccurate if the patient is not fasting?
-Glucose
-Cholesterol
-Iron
A phlebotomy technician is preparing to perform a neonatal screening test. The technician should identify which of the following is the optimal time to perform the test?
Between 24 and 72 hours after birth
What information is needed for the requisition form?
Patient billing information and test status
When should a patient begin the collection of their 24-hour urine collection?
At the second void of the
day
What test is used to screen for diabetes?
2-hour postprandial specimens
What is the name for the daily fluctuations in body hormonal levels and chemistry?
Diurnal variation
What is the first thing to do when collecting blood using a central venous access device?
Discard 5 mL of blood
How much blood should be flushed or discarded for coagulation tests?
20 mL
What do the following tests have in common: ammonia, lactic acid, acetone, PTH, homo-cysteine, ABG?
They all must be chilled right after collection
What do the following tests have in common: Bilirubin, Vitamin A, folate, vitamins A, B6, and B12?
They are all tests that are affected by light exposure
What do the following tests have in common: molecular diagnostic specimens, drug screening, and blood alcohol specimens?
All are used for forensic studies
What is the first course of action if a patient has an IV?
the other arm
Where should you select the site if drawing from the same arm as the IV?
Below the IV site
What should you document in the case of venipuncture on the same arm of an IV?
Document that the draw was distal to the IV and the type of solution
What should you not do after disinfecting the venipuncture site?
Wipe the skin dry with a cotton ball
What should you do during venipuncture if the patient has many severe burns?
Avoid the burned areas
How long should a tourniquet remain on the patient?
1 minute
What does not have a risk of hemolysis?
Using a huge needle
When collecting a sample to determine blood alcohol levels, what color tube should be used?
Gray tube
What do you add to a sample if it needs to be diluted?
Diluent
Potassium EDTA binds to what element in the blood?
Calcium
A failure to fast when ordered can impact a blood sample in the following ways?
Increasing its turbidity
How must you anchor a vein?
Place the thumb of the non-dominant hand below the vein and stretch the skin tightly
What is the most common cause of blood culture contamination?
Not preparing the selected venipuncture site properly
What is another name for a thrombocyte?
platelet
What is a common complication in capillary sampling?
-Vein collapsing
-Hitting a nerve
-Scarring
How many liters of blood does the average human adult body have?
5
What can cause the rejection of a blood sample?
-Vein collapsing
-Hitting a nerve
-Scarring
How many liters of blood does the average human adult body have?
5
What can cause the rejection of a blood sample?
-Not enough quantity
-Incomplete chain of custody
-Improper specimen (serum/blood/plasma)
What can happen if you do not allow the alcohol to dry completely after disinfecting the venipuncture site?
Hemolysis
What is the nerve most susceptible to injury during venipuncture?
Median
What do you do if you have attempted blood draw twice without success?
Call for a more experienced phlebotomist or nurse
Which of the following additive should be used for a CBC test?
EDTA
The patient becomes pale and diaphoretic during venipunc-ture? What is going on?
The patient has syncope
What happens if you have collected a STAT specimen but forget to label it with the patient ID number?
The lab will reject the specimen
What can be used as patient identification for inpatients?
Verbal patient identification
-Intact, attached ID bracelet
-Driver’s license
What should you do if the patient says they feel a sharp pain down the arm?
Remove tourniquet and needle ASAP
What does the word phlebotomy mean?
Red, blood
What is a venesection?
Another word for phlebotomy
An emergency lab test request occurs in which phase of lab testing?
Preanalytical
During which phase is a blood specimen tested?
Analytical
What is the best way to apply antiseptic agents to the site?
Use friction in a back-and-forth motion
What should you say to a patient to know if they have ever fainted before during a blood draw?
“Have you ever experienced difficulty in previous blood draws?”
If a patient faints, how long should you stay with them?
15 minutes
What if the patient does not regain consciousness?
Call a nurse or a physician
What should you do if a patient’s artery is accidentally punctured?
Remove the needle and apply firm pressure for 5 minutes
What colors are blood culture tube caps?
Blue and purple tube
What is the recommended blood-to-anticoagulation ratio of a tube?
9:1
What if it takes longer than 1 minute to find the vein?
Remove the tourniquet,wait 2 minutes, put it back on, and try again
What makes some veins harder to find or more collapsable?
Dehydration
What is a complication caused by blood leaking into the tissues?
Hematoma
You can only draw from the IV if
you
Have a nurse or doctor’s permission
What two things can help dilate veins and make them easier to
find?
Heat and exercise
This feature is a shield that covers the needle and retracts the needle back into the needle cap.
Re-sheathing device
What is a slowly performed blood draw called?
Incorrect blood draw
What can probing or too much needle repositioning within the vein do?
Hemolysis
What should you do when conducting a second venipuncture?
Always use a new tube when conducting a second blood draw
What can occur if you combine two partially filled tubes with the same additive?
-The blood to additive ratio will be affected
-Inaccurate test results
How many times should you invert blue top tubes (sodium citrate)?
3-4 times
How many times should you invert gold top tubes (SST)?
5 times
How many times should you invert green (PST) tubes?
8-10 times
How many times should you invert lavender EDTA?
8-10 minutes
What should you use to transfer a blood sample from a syringe to a vacutainer tube?
Blood transfer device
What can lead to a change in the blood-to-additive ratio?
Both underfilling and overfilling overfilling tubes can change the blood-additive ratio.
Massaging the site of a capillary blood collection can lead to
Hemolysis
The results show false high po-tassium, indicating
Hemoconcentration
What bandages are recommended for most venipunc-tures?
Latex
When a patient’s lab test must be redone for emergency reasons, what is necessary if there is a missing/inaccurate label?
Emergency release form
What type of reaction can lead to fainting or hypotension?
Vasovagal reaction
What tubes are used for serum tubes with gel separator?
Red and gold cap
How should the blood culture be taken if a patient has an unexplained fever?
2-3 blood culture samples must be taken simultaneously via two separate venipunctures
What additive do light blue topped tubes have?
Sodium citrate
For how long do gray tubes for glucose preserve blood specimens?
24 hours
What needle gauge is not for routine blood draws, therapeutic phlebotomy, or drawing a higher volume of blood from donors?
18 gauge
What type of needle system prevents the risk of needlesticks and collecting inappropriate specimens?
Evacuated tube system
What are Microtainer tubes used for?
Collecting blood from finger or heel
Where is the basilic vein located?
The medial side of the arm
Why should you not tap the site when palpating?
It can lead to hematoma
What do you do if you accidentally probe a nerve with the nee-dle?
Move the needle away and reposition to find the vein
When should you label a patient’s specimen?
After collecting the blood
Can you disclose a patient’s lab result to a nurse?
No
You apply the tourniquet on a patient, and small reddish brown spots appear below. What are these called?
Petechiae
What can cause hemolysis?
Shaking the collection tube too hard
How do you correctly insert a needle?
Insert until you feel a change in resistance (be-comes easier to slip inside)
What are areas of a diabetic patient more susceptible to infection?
Leg or foot
What is the best equipment to use for collecting from an older patient with collapsable veins?
Butterfly collection system with an ETS tube
From where should you collect blood from a ten-month-old infant for a routine CBC?
Either heel
When doing a skin puncture,
what color tubes should be used for WBC, RBC, glucose, and electrolyte tests?
Lavender and red
What should you ask your patient before collecting blood for a metabolite pane?
“When was the last time you ate?”
What is the name for a protein that prompts the creation of antibodies?
Antigen
What is the purpose of the CDC’s
Contact Precautions?
To reduce the risk of spreading bacteria via direct or indirect contact
What protein is essential to the formation of blood clots?
Fibrin
Where are blood cells and platelets created in the body?
Bone narrow
What type of lymphocyte is in charge of creating antibodies to protect against foreign pathogens.
lymphocytes
What occurs during the diastole phase of the cardiovascular cycle?
Blood from the body fills the ventricles
A pediatric patient weighs 15.4 kg. What is the maximum volume of blood to draw during a venipuncture session?
10 mL
What must you do when preparing a peripheral blood slide from a capillary puncture?
Touch the slide to the second drop of blood
What should you do when carrying out two blood culture collections for a patient?
Collect one culture from the patient’s left arm and the other from a different site on the same arm
How should you verify if a forensic specimen matches the requisition form?
Case number
Which of the following tests can be used when collecting a peripheral blood smear from a pa-tient?
WBC differential test
How should you complete the screening card when collecting capillary blood for neonatal ana-lysis?
Touch the paper to a drop of blood to saturate each printed circle of the card
Which of the following patients can donate blood?
A 65-year-old patient weighing 54.4 kg
Which of the following blood types is a universal recipient?
AB
What blood collection amounts are recommended for a 3-year-old child weighing 15.9 kg?
40 mL
How much blood volume does an infant weighing 3 kg have?
240-330 mL
Which statements should you say when instructing a patient about performing a pregnancy test?
Collect first urine sample of the morning
When instructing a patient about collecting a sputum spe-cimen, what statement should vou say?
Provide the specimen in the morning before eating and drinking.
What additive should be used for peripheral blood smear for
WBC count?
EDTA
What blood type should a patient with type O receive for a blood transfusion?
Type O
You are going to collect blood cultures, PTT, and testosterone levels. In what order should the following collection tubes be used?
Yellow topped tube, blue topped tube, red topped tube
What should you say when explaining to a patient how to collect an at-home fecal specimen?
Do not mix urine with the fecal sample
Where should the neonatal screening card be dried after blood spot collection?
Place the card on a flat dry surface
Which of the following measurements shows that a donor can provide blood?
Hematocrit level 42%
A phlebotomy technician uses a syringe to collect a blood culture set, a PTT, and a CBC test. Which of the following should the technician identify as the proper draw order?
Anaerobic bottle, aerobic bottle, light-blue-topped tube, EDTA.
Which type of collection is a priority?
STAT collection
By what order should patient blood specimens be collected?
Drug level, fasting, glucose tolerance testing
What is the lowest a drug gets in the bloodstream before the next dose?
Half-time
When does peak level occur in therapeutic drug monitoring?
30-60 minutes after the patient takes the drug
What must the patient do before an oral glucose tolerance test?
Fast for 12 hours before the test
What should be used to clean the tops of blood collection tubes?
Alcohol
PKU tests are performed using
?
Skin puncture blood
What information can a blood smear provide?
Shape and amount of all blood cells
The following conditions are related to which blood cell: HIV, leukemia, lymphoma?
White blood cells
The following conditions are related to what blood cells: thrombocytopenia and myeloprolif-erative disorders.
Platelets
The following conditions are related to which blood cell: Sick cell anemia, polycythemia rubra vera, iron deficiency?
Red blood cells
Before collecting a blood smear, check if the patient takes any medications. Which medication can affect a blood smear’s results?
-Antibiotics
-Warfarin
-NSAIDs
What word refers to the total red blood cells in proportion to the total blood volume?
Hemocrit
What is the process of stopping bleeding through constricting the blood vessels and blood clotting at a site of injury?
Hemostasis
What are blood clots made up of?
Platelets
What is it called when blood capillaries rupture?
Contusion
What is it called when a vein connects to an artery-changing blood course?
Fistula
What happens during the first phase of hemostasis?
Platelets begin blood clotting
What happens during the second stage of hemostasis?
Coagulation cascade
What happens during the final stage of hemostasis?
Fibrin clot remodeling
What is it called when there is excessive blood clotting?
Hypercoagulability
What is it called when there is too little clotting?
Hypocoagulablity
What can hypercoagulability lead to?
Thrombophilia
What can hypercoagulability lead to?
Thrombocytopenia
Which additive is most recommended for plasma testing?
lithium heparin
What is a necessary responsibility of phlebotomists under the Needlestick Safety and Prevention Act?
Document information in a sharps injury log
What is a requirement for documentation when it comes to a physician ordering a lab test?
It must include a purpose and have medical necessity
Sodium fluoride is used to pre-
serve _ for three days.
Glucose
HIV stands for:
human immunodeficiency virus
What purpose does the multi-draw needle serve?
To draw multiple tubes of blood from the same patient during venipuncture
.In what order should you remove PPE?
Gloves, gown, mask
What makes up 55% of blood
content?
Plasma
How many types of white blood cells are there?
5 types
What color tube should be used to obtain an electrolyte panel specimen?
Green
What is a pathogen?
A non-infectious organism
What is a BBP?
Blood-Borne Pathogen
How should the needle bevel be facing when inserted into the arm?
Upwards
What is it called when a group of blood tests must be performed?
Both A and B
What percentage of blood volume comprises red blood cells, white blood cells, and platelets?
55%
Infections that originate in hospitals are known as
Nosocomial infections
What tube contains the reversible anticoagulant citrate?
Light blue
Serum is
Neither a red or white blood cell
B. Plasma with the clotting proteins removed
C. A liquid that separates when blood coagulates
What tubes contain no addi-tives?
Red(glass) tube
What is septicemia?
blood poisoning caused by bacteria
What is the difference between plasma and serum?
Plasma contains fibrinogen
Serum is used more frequently for testing than plasma because
It has more antigens
After centrifugation, what is the liquid component of a sample in an anticoagulation collection tube?
Plasma
After centrifugation, what is the liquid component of a sample that has clotted?
Serum
What is the purpose of centrifuging samples?
To separate plasma and serum
What layers are separated during centrifugation?
Serum, gel, cells
What are the un-clearly defined layers after centrifugation?
Serum with fibrin, gel, cells
What body system notices any internal or external changes and reacts accordingly?
Endocrine system
What type of blood cell fights against viruses, parasites, aller-gens, and other pathogens?
Basophils
Where is the antecubital fossa located?
The bend of the elbow, front of the arm
What blood vessels flow from the heart to the body tissues and only have smooth muscle lining its vessel walls?
Capillary blood vessels
99.A winged infusion set is also known as a?
Butterfly needle
What does hemolysis mean?
Hemolysis is the breakdown of red blood cells.
OSHA
Establishes regulations and guidelines to direct phlebotomists to work at the highest level of safety possible when handling bio hazards and chemicals.
The blood borne pathogens standard (OSHA)
- addresses use of PPE
- availability to the Hep B immunization
- Each workplace must have a exposure control plan
- has guidelines to ensure safety
- provides standard plans for after an exposure.
- engineering controls and record keeping protocols
PPE for venipuncture and capillary (OSHA)
well fitting gloves
Airborne infection PPE (OSHA)
N99 or N95 mask
What do you do when you have an accidental needle stick? (OSHA)
First you wash the area with soap and water (basic first aid), then undergo medical examination that includes you and the patient get tested for HIV, HBV and HCV. Then document the exposure in sharps injury log.
What do you include in a sharps injury log? (OSHA)
date and time of incident, type of sharps used, who was involved (patient or staff w/o names), location and a detailed description of how it occurred.
What is the joint commission?
- accredits and certifies healthcare organizations
- independent, nongovernmental, and nonprofit
- focuses on continual improvement of patient safety and quality of care through regulations and standards
The national patient safety goals program (JC)
sets requirements for issues including training of health care professionals, communication of test results, and accurate IDs (2-factor method)
Clinical and Laboratory Standards Institute (CLSI)
-develops standards and guidelines in order for a laboratory to be accredited
- provides guidelines for phlebotomists for better accuracy and patient care (like for the use of tubes and needles). standards include level of additives and their use for which tests, order of draw, processing and handling, depth of needle and location needed for capillary collection
- provides guidelines for quality control, patient care, risk reductions, and time saving and cost cutting measures.
Centers for Disease Control and Prevention (CDC)
- helps ID and and educate about infections, illnesses and disease preventions.
- IDs new disease and works to prevent spreads
- Provides guidelines for PPE sharps handling and hand hygiene
- recommends standard precautions when handling body fluids
HIPPA
- Protects every patients PHI (protected health info) which is any and all info that relates to the patients medical record or electronic health record.
- details what info is confidential and any authorized release of that info
Info protected under HIPPA
demographic info, treatment, meds, diagnostic testing. Any info w/o a way to ID the patient is not protected
When is the phlebotomist responsible for the patient?
Before, during and immediately after venipuncture
What happens if you go through with the venipuncture without consent?
It would be considered assult
Techniques to find a vein
warming the area, wiping it with an alcohol wipe, and lowering the limb below the level of the patients heart
Why do phlebotomists avoid the wrist?
potential ulnar nerve damage or inadvertent arterial access
Why is the basilic vein the least desirable for venipuncture?
it is close to the brachial artery and it is most painful
Why would a phlebotomist avoid the legs and feet of a patient who has diabetes mellitus?
To prevent possible infection
What do you do if a hematoma develops?
Stop the procedure
What do you do if the patient shows early signs of a seizure or syncope?
You immediately stop the procedure and lie them on the floor or in their bed. Give them a cold compress and stay with them until they recover
Quality control
a measure of precision or of how well an instrument is functioning over time
Quality assurance
ensuring a test is as accurate as possible
What do you write in the equipment log
The time and date you ran a quality control test and the results of the test
How often should you clean lab equipment?
several times per day
Why would a centrifuge be shaking excessively?
The tubes need to be about the same size and volume. The tubes also have to be placed directly across from each other
What could happen if the centrifuge shakes too much
tube breakage or improper centrifuging
What do you do if a piece of equipment is not working correctly or at all?
Make a repair report (state the date, description of issue, and the steps you took to try to fix the problem)
How can you ensure quality control when using glucometers?
Use of external controls, matching test strip codes and reviewing expiration dates
When do you use external controls when using a glucometer?
- when opening a new package of strips and each day you preform a test
- drastically out of range readings
- use at room temp and not past expiration date
What step should the phlebotomist take after seeing 2 widely divergent test results in a glucometer?
Preform liquid controls (running controls will help to troubleshoot the problem)
What should the phlebotomist do about the defective glucometer strips?
Contact the manufacturer and follow instructions for sending back the strips
While collecting a blood specimen, a phlebotomist notices the glass collection tube is cracked. What would be the correct action?
dispose of the tube in a sharps container
A phlebotomist is taking blood from a patient with a MRSA infected wound, what should they do once once the procedure is done?
Dispose of their gown before leaving the room
A phlebotomist is performing a blood alcohol test. What antiseptic should they use?
Chlorhexidine gluconate (ethanol, iodine tincture and isopropyl alcohol all has alcohol in it and would skew the results)
If a centrifuge where to catch on fire, which class of fire would it be?
Class C (it involves electrical equipment)
What is the current procedure for CPR on an infant?
30 compressions, 1.5 in deep (using 2 fingers)
What piece of PPE should a phlebotomist remove first after a draw in an isolation room?
gloves (the most contaminated piece of PPE first)
A phlebotomist gets a very large glucometer reading the first try and then is back in the normal range the second reading. What could have caused the first inaccurate reading?
too much blood was used
A phlebotomist comes in the get another set of blood for a GTT (glucose tolerance test) and the patient starts to cry and doesn’t comply. What statement should you say?
May I please perform the draw? A GTT requires multiple timed draws at set intervals.
What department is responsible for processing cholesterol, troponin, and HDL tests?
Chemistry (body chemistry)
What substance is used to clean a cerebral spinal specimen spill?
Chlorine bleach (1:10 bleach to water)
What pieces of PPE are minimum requirements to wear for aliquoting a blood specimen?
face shield and gloves
What pathogen is the phlebotomist at most risk for in the case of an accidental needle stick?
Hepatitis B virus (HBV)
Who can order lab tests?
Physicians, physician assistants, and nurse practitioners
What info is on the requisition form?
- Patients name, DOB, sex, and ID number
- It can also have allergies, tendency to faint, excessive bleeding, and sites to avoid
- it has space for date and time of collection, billing info and diagnostic coding
What would you review the req form for?
duplicate test orders or missing info
What info needs to be on the tube label if there is no bar code?
date and time of collection, your initials, the patients full name, DOB and other identifiers.
What are two identifiers that you can use when IDing the patient?
patients name, DOB, home address, phone number, or social (if available)
- compare what they say with the req form
How can you cross check patient identifiers
you can cross check the patients drivers license with the req form, or their hospital band. Never use a patients room or bed number
Exceptions for teenage consent
married, in the military, emancipated, or otherwise self supporting
Most common pretesting preparations
- fasting (8-12 hours not eating or drinking other than water)
- Medications
- basal state (first thing in the morning or after sleeping)
before the blood collection make sure they completed the requirements
Things to ask the patent before continuing
allergies, fainting tendencies, blood thinners, what arm they wish for you the use, current medications, drug and alcohol use
How long after a fainting spell should you stay with them?
at least 15 minutes
Complications that can occur with venipuncture
Excessive bleeding or bruising, severe pain or lack of sensation, and infections
What to do in the case of excessive bleeding
apply pressure and ice to the site and call for
What to do in the case of excessive bruising
apply pressure and ice to the site and call for
What to do in the case of severe pain or lack of sensation?
It can indicate nerve damage. stop the procedure and use ice if available
What to do in the case of infection?
If the site becomes red, swollen and painful, they may have infection. Alert the patient to sign of infection and to contact a physician if they appear
What are acceptable ways to position your patient while taking blood
- On a bed (increases comfort and safety if they fall)
- chair with arm rests and adjustable heights
What are some examples of unacceptable ways to potion your patient while taking blood?
- standing
- sitting on a high stool
- edge of an examination table
When would you not use a finger for dermal puncture?
If the finger is:
- cold
- cyanotic (blue)
- scarred
- swollen
- covered in a rash
Where do you collect capillary blood from an infant?
On the sides of their heel
What places can you get blood from if the antecubital fossa is not available?
- Hand veins (next choice after AF)
- ankle and foot veins (last choice)
What are characteristics of hand veins?
- more fragile
- often roll
- often small
- more painful than antecubital fossa
- short and thin
- best to use a butterfly needle
(never draw from the wrist)
What are characteristics of ankle and foot veins?
- last choice
- difficult to access
- easy to injure
- often painful
- usually needs physician approval
(never collect from a diabetes or peripheral vascular disease patient due to poor circulation)
Why do you palpate for a vein?
- to insure it is a vein and not an artery (arteries have a pulse)
- ensure the vein is subtable for collection (soft, bouncy, flexible)
- determine depth, direction and dimension of the vein
What sites should not be used for venipuncture?
- above an IV (IV fluids can mix w/ sample)
- an arm with a shunt for hemodialysis (could damage the shunt)
- central venous access device (could damage it)
- side of a mastectomy
- site w/ an edema
- site w/ scarring
- site w/ hematoma
What are types of veins that should not be used for venipuncture?
- Sclerotic veins: hard, inflexible, narrow
- Tortuous veins: twisted, dilated, lack elasticity
- Fragile: thin, weak, difficult to puncture (common in elderly, newborns, pediatric patients)
- phlebitic veins: tender and warm w/ a red area around them (painful for patients)
- Thrombotic veins: veins w/ a clot (can feel hard and inflexible). Patients report tenderness when touched
What are the common non blood specimens will need to be collected?
urine, stool, sputum, and semen
What factors are examined in urine?
appearance, color, odor, pH, specific gravity, cultures, and presence or absence of many other components (protein, glucose, hemoglobin)
Steps to instructing someone to take a urine sample
- give patient a clean, disposable container and a label w/ their info
- fill between 30-60 mL
- make sure to be refrigerated if not immediately taken to the lab
- after the cup is filled and cleaned from debris, but the label on the cup
Clean catch urine specimen
the sample has to be without any other contact except the urine.
- no contact with body parts
- men and women must clean the area around the urination opening before filling the cup
- women must separate the labia while the sample is being collected
- first start to urinate and then collect the urine
- be very careful not to touch the inside of the container
What is the normal range of pH for urine?
5.5 – 8.0 (bacteria grow easily in an alkaline environment)
What does white blood cells or nitrites in urine mean?
infection
What is the normal range for specific gravity for urine?
1.003 – 1.030 (but is usually 1.010 – 1.025)
specific gravity is concentration.
- below 1.010 = diluted urine
-above 1.010 = concentrated urine (dehydration)
What does hemoglobin in urine mean?
bleeding, infection, cancer, kidney disease, chemical poisoning, and other pathology
What does ketones in urine mean?
possibly diabetes, starvation or vomiting
What does bilirubin in urine mean?
possibly liver disease or red blood cell destruction
What does protein in urine mean?
inflammation, infection, kidney disease, or chemical poisoning
What does glucose in urine mean?
possibly diabetes
What test can provide information on pH, specific gravity, white blood cells, hemoglobin, ketones, bilirubin, nitrites, and glucose?
Urine reagent testing (test strips)
What is the most common point of care test on stool?
fecal occult blood test
What does a fecal occult blood test test for?
presence of blood in the stool that is not visible. It helps diagnose gastrointestinal lesions and colon cancer
What else can be tested for on stool samples?
bacteria, viruses, fungi, and parasites
steps in collecting a stool sample
- give the patient a sterile container (wide-mouth container w/ tight lid)
- usually defecate directly into the specimen container
- avoid getting urine in with the sample
- avoid getting water into the sample
(if given an FOBT, give the patient the kit w/ instructions and advice to not eat red meat, citrus fruit and raw veggies as well as take vitamin c subs or aspirin 3 days before collection)
Why is sputum testing usually ordered?
- for people w/ respiratory infection such as tuberculosis and pneumonia to confirm micro-organisms
- to confirm treatment effectiveness
(it likely contains infectious material)
When should sputum be collected?
first thing in the morning before eating or drinking
what is sputum?
material coughed from the lungs
sputum testing instructions
- provide a sterile container
- instruct them to get sample before eating or drinking
- breath deep, cough forcefully and deeply, and expectorate into the container
- do not put saliva into the container
- 1 or 2 teaspoons of sample is enough
- close the lid, clean container, affix the label, and deliver to the lab
A phlebotomist is preparing to collect a specimen from a 3-year old for a coagulation test. What method should the technician use?
Winged butterfly needle, it is best for patients w/ small veins
A phlebotomist is prepared to draw blood for a patient with life-threatening cardiac symptoms. How should the phlebotomist approach consent?
An emergency situation removes the need for consent and the phlebotomist should proceed with the collection
A phlebotomist is about to draw a patient with a history of syncope with previous draws. Should the technician:
a. draw from the patients hand
b. place the patient in a supine position
c. place the patient in a prone position
d. perform a capillary draw
b. place the patient in a supine position
A phlebotomist is instructing the patient about a 24 hour urine collection. Which of the following instructions should the technician give the patient?
a. “avoid mixing or inverting the container after collection”
b. “start collecting at the second void of the day”
c. “reduce the fluid intake during the 24 hr period”
d. “store the specimen at room temp.”
b. start collecting at the second void of the day and the exact time should be written on the container label
What type of urine specimen technique should a technician instruct a patient to collect for a pregnancy test?
first morning, it is the most concentrated specimen of the day
What level should the technician collect when trying to test a patients lithium level following a dose of meds?
Peak, which is 15 – 30 mins after they take the med and should be during the peak levels in the patients body
A phlebotomist should ID that which of the following info is required for a positive ID of a patient in an outpatient setting:
a. attached ID band, full name and accession number
b. picture ID, full name, date of birth
c. accession number, full name and date of birth
d. medical req number, full name, date of draw
b. picture ID, full name, DOB
A phlebotomist is informing the patient about a blood culture collection. Which of the following info should the technician include?
a. “I will swab the area twice to make sure it is sterile”
b. “I am going to use an evacuated tube system to perform the draw”
c. “I am going to wait 15 seconds to let the antiseptic dry before I draw your blood”
d. “I will leave the tourniquet on longer, so we can collect enough blood for testing”
a. “I will swab the area twice to make sure it is sterile”. you first sob with isopropyl alcohol and then with a chlorhexidine gluconate swab
If a patient ate a meal of meat and cheese prior to the draw, what should the phlebotomist expect?
That the specimen is lipemic. It indicates that the patient has eaten fatty foods and will appear cloudy.
A phlebotomist is preparing to collect blood for a cholesterol test. Which statement should they make?
a. “sit for at least 5 minutes before the test”
b. “take an meds after the test”
c. “avoid eating red meat the day before the test”
d. “avoid any caffeine on the day of the test”
a. “sit for 5 minutes before the test”. Doing that will help lower the results
The phlebotomist enters a room and sees the patients ID band is on the table, they say that they took it off. What should you respond with?
“I will ask a nurse to replace the ID band” it has to be on their body to validly ID them
A phlebotomist is position a patient for venipuncture. To prevent back flow or reflux, what position should they put the patients arm in?
Full extended in a downward position
A phlebotomist is taking blood from a patient with IVs in both arms, what should they do?
ask the nurse to turn the IVs off for 2 minutes
A phlebotomist is about to take blood when the patient says they are taking warfarin. The phlebotomist should ID that what test results may be affected?
PT/INR (an anticoagulant like warfarin can affect these results)
A phlebotomist is preparing to collect specimens to determine peak and trough levels of a med. What action should the phlebotomist take?
They would ask the nurse when the med was administered
a phlebotomist is taking blood from a patient with hearing aids and seem distracted. What question should the phlebotomist ask to ensure understanding?
“would you like me to repeat the directions?” asking them if they need the phlebotomist to talk slower, if they understand or if they heard what was said could be taken as offensive.
A phlebotomist is preparing for blood collection in an outpatient setting. What info is required on the req form?
patients billing info and test status
What should you say if the patient asks why their blood is being drawn?
“you should ask your provider about the test”
The phlebotomist is instructing the patient on how to collect a urine specimen for a culture and sensitivity test. Which statement should be included?
a. “you will need to collect a midstream clean catch specimen”
b. “you will need to collect your first void of the morning”
c. “you will need to fast for 12 hours prior”
d. “you will need to collect the specimen 2 hours after eating”
a. “you will need to collect a midstream clean catch specimen” to avoid cross contamination with other microbes.
A phlebotomist is seeking consent from an older adult patient who was accompanied by a younger adult. Which action should the technician take?
a. speak to the patient in a loud voice
b. give the consent form to the accompanying adult
c. speak to the patient in a normal tone
d. stand close to the patient while speaking
c. speak in a normal tone. always treat the patient with respect and not assume they are heard of hearing due to age
What test results are affected when a phlebotomist uses providone-iodine to cleanse a site for dermal puncture?
Potassium (it can cause a false elevation)
Which of the following actions should a phlebotomist take to locate a vein using the warming technique?
a. heat a clean bowl to 45*C
b. wrap the warm towel around the site for 1 or 2 minutes
c. encase the warm towel in a plastic bag
d. ask the patient to rinse her hands in warm water for 2 minutes
c. encase the warm towel in a plastic bag (it maintains the towels temp. and keeps the patients skin dry)
How high above the antecubital area should the tourniquet be?
3 or 4 in above
What should the phlebotomist do when applying the tourniquet?
Tuck a partial loop of tourniquet underneath the tourniquet so it can be easily undone
What temperature should a semen sample be transported in?
36 to 38 C (98.6*F)
Which color signifies a health hazard in the National Fire Protection Association 704 Marking System?
Blue
A phlebotomist is using a point of care test system for a WBC count. Which results should the technician immediately notify the provider?
1.8/mm^3 (4.4-11 is the expected range)
How should the phlebotomist transport blood to the lab?
a. in a specimen collection tray
b. in the trunk of a car
c. in a lockable container
d. near an air conditioning vent in a car
c. in a lockable container to avoid spills
Which tube should be collected first during a dermal sample?
a. lavender
b. green
c. red
d. light blue
a. lavender (it minimizes platelet clumping and micro-clot formation)
When preparing for a peak level draw, how long should the phlebotomist wait prior to drawing (after verifying when the meds are administered)
2 hr after administration
What additive is used when the phlebotomist is to perform a chromosome analysis for a patient?
Heparin
The phlebotomist is using filter paper for a newborn capillary draw for phenylketonuria. What should the phlebotomist do?
a. apply the blood to the printed side of the filter paper
b. add a second drop of blood if a circle is not full
c. touch the puncture site to the filter paper
d. allow the blood spots to dry for a min. of 2 hours
a. apply the blood to the printed side of the filter paper.
While drawing a patient for donation, the collection bag fills half way and the vein collapses. What should they do?
use a new collection bag
Do not:
- mark the collection bag as half full
- continue filling the bag from an alternate site
- combine the 2 separate bags to make whole
How long do you rub the site with isopropyl alcohol for a blood culture?
60 seconds
When obtaining a blood culture specimen from an adult patient, what action should you take?
Withdraw the blood into a sterile safety syringe
Which blood culture bottle get filled first?
anaerobic and then aerobic
The phlebotomist has a req form for a series of tests on a patients serum. Which additive should be in the tube for the collection?
Thrombin (it accelerates clotting for serum)
When performing a cholesterol point of care test, what findings should the tech immediately report?
300 mg/dL (the usual range is 140 – 200)
What type of consent does a patient give when they’re brought into the emergency department?
implied consent
What is an accession number for?
It IDs a specimen as long as it remains in the lab
What PPE provides the best protection from a tuberculosis patient?
N95 respirator (for airborne pathogens)
What needle size should a phlebotomist use for a blood donation?
18-gauge
To prevent hospital-acquired infections, a phlebotomist should clean blood contaminated items with a 1:10 dilution of what substance?
sodium hypochlorite (or chlorine bleach)
Which piece of PPE should a phlebotomist take off last?
a. gown
b. gloves
c. mask
d. protective eyewear
c. mask (the order of removing PPE is gloves, goggles, gown, mask)
What specimen should a phlebotomist place in an ice bath within 30 minutes after collection?
arterial blood gas
Why should the phlebotomist allow the site to dry from an alcohol cleanse before venipuncture?
alcohol requires time for the antiseptic action to take effect
What is the usual range of troponin T levels?
0 – 0.2
What action should a phlebotomist take as part of the post-examination phase of the process?
enter critical lab data
What device should a phlebotomist use if the hand of a patient is difficult to access?
Hand immobilizer (it uses straps to keep the hand still during the procedure)
What outcome is to be expected if the phlebotomist keeps the tourniquet on for 3 minutes?
high potassium levels (keeping the tourniquet on for more then 1 minute causes hemolysis, which creates a falsely high K level)
What is the proper collection order when obtaining a CBC, FSH and electrolyte test via capillary collection?
Lavender, green, and then red
which additives would be used while collecting for the following tests: coagulation, WBC, pregnancy and random glucose?
Sodium citrate, SST and EDTA (EDTA for WBC, sodium citrate for coag. and SST for pregnancy and glucose)
If the phlebotomist were to use povidone-iodine for a capillary specimen collection, what outcome should they expect?
Increase potassium levels
A phlebotomist is performing a dorsal venipuncture w/ the needle at a 15* angle, resulting in slow blood flow and the development of a hematoma. What was a cause of the hematoma?
The needle went completely through the vein
What can cause a vein to collapse?
tying the tourniquet on too tightly
Should you collect blood above or below an IV?
Below
What area is best for a dermal puncture?
The middle and ring fingers of the non dominant hand
Which vein is more pronounced in obese patients?
Cephalic
What can be used if a tourniquet is not available?
a blood pressure cuff pumped to 40 mm/Hg
What are some replacements for 70% alcohol if none is available?
providone-iodine or chlorhexidine gluconate
What is the lumen of the vein?
the middle
order of draw
blood culture (yellow SPS), light blue (sodium citrate), red (none), SST (t-gel), orange (thrombin), green (sodium or lithium heparin), green pst (t-gel + lithium heparin), lavender (EDTA), pink (EDTA), grey (NaFL + K oxalate), light yellow (ACD), dark blue (Na2 EDTA), brown (sodium heparin)
Which tube needs to be filled 100%?
light blue
Which tube needs a red throw away tube when using a butterfly needle?
light blue
how long do specimens need to clot?
30 minutes
What does the blood need to do in order to produce serum?
clot
What does the blood need to do in order to produce plasma?
not clot
What are all the common anti-coagulants?
EDTA, heparin, sodium citrate, NaFL + K oxalate
Why should the phlebotomist warn the patient when the needle is coming?
So they don’t jerk when it happens
What are some things you can do if someone faints?
discontinue the draw, lay them down in a safe area, make sure that their airway is clear and apply a cold compress to their neck or forehead
How long after someone becomes unconscious should the phlebotomist call for help?
2 minutes
What are the common complications that can happen during a venipuncture?
- nerve damage (severe pain, pins and needles, or numbness. They may need medical attention if it continues)
- hematoma
- phlebitis
- thrombosis (blood clot)
- petechiae
- hemoconcentration
- collection/processing errors (misID, wrong tube, mislabel, etc)
- syncope
- seizure
- shock (cold, clammy and pale skin, rapid pulse, shallow breathing, blank stare.
- nausea (bring them a bag/bucket
- diaphoresis (severe sweating
What should you do if someone is in shock?
call for help, ensure they have an open airway, lower their head below the body if possible, and keep them safe and warm until help arrives
What should you do if someone has a seizure?
stop procedure, call 911, document event, remove anything to cause injury, do not restrain or put anything in their mouth, do not bring additional attention to them, stay with them until help arrives
How many times do you invert each tube?
- blood culture: 8-10
- light blue: 3-4
- SST: 5
- green top: 8-10
- lavender: 8-10
- grey: 8-10
What common point of care tests are used with a dermal puncture?
glucose, cholesterol, hematocrit
Dermal puncture do’s and dont’s
do: provide pressure to the joint in a press and release motion
don’t: take longer than 2 minutes to fill each tube, scoop the blood to get it into the container, milk the finger for blood
What is the capillary order of draw?
blood gas collection, purple, lavender, pink or pearl tops, green, any other additive specimens, serum (red)
A phlebotomist is collecting a peripheral blood smear from a patient. Which of the following tests is this collection technique used for?
a. (ESR) sed rate
b. WBC differential test
c. blood culture
d. arterial blood gas
b. WBC differential test
What collection method is preferred for an erythrocyte sedimentation red (ESR) test?
blood collection for plasma
What collection method is preferred for arterial blood gas?
blood collection for plasma
what is the acceptable pulse rate range in order to donate blood?
50 – 100 bpm
what is the acceptable diastolic blood pressure range in order to donate blood?
no higher than 100 mm Hg
what is the acceptable temperature range in order to donate blood?
no higher than 99.5*F
what is the acceptable hematocrit range in order to donate blood?
38% or higher
a phlebotomist is collecting a blood culture from an infant that weights 3 kg (6.6 Lbs). What is the total blood volume for this patient?
240 – 330 mL (the total blood volume can be calculated by multiplying the infants weight in kg by 100 and changing the units to mL)
The phlebotomist is preparing for a WBC differential test, testosterone test and a glucose test. what actions should they take to process the tests?
Prepare a slide from a lavender top tube (for WBC) and centrifuge a red top (for testosterone) and a gray (glucose)
What additive should be used for a peripheral blood smear for a WBC count?
EDTA
what additive is used when performing a glucose test?
sodium floride (grey top)
what additive is used when performing a coagulation test?
sodium citrate (light blue)
what additive is used when performing a plasma test?
heparin (green)
A phlebotomist is performing 2 sets of blood cultures for a patient. Which of the following actions should the technician take?
a. collect both sets from the same site after waiting 4 hrs.
b. collect one set from the antecubital region and one from the ventral part of the patients hand
c. collect one set from the patients left arm and one from a different site on the same arm
d. collect one set from the capillary region and one from the antecubital region
c. collect one set from the left arm and one set from a different site on the same arm
A phlebotomist is taking blood from a 3 year old child who weighs 15.9 kg (35 lbs), what blood collection amount is within total volume guidelines for a 1 month period for this patient?
100 mL or less
When a phlebotomist receives a forensic specimen, what info should they verify matches the req form?
Case number (along with type of specimen and name, age and sex of the specimen donor)
What type of test is usually ordered to help diagnose someone with a fever of unknown origin?
Blood cultures
Should/can you ask a patient to clench their fist right before the venipuncture for a blood culture?
yes (and unclench after blood enters the tube or bottle)
When are screenings for newborns performed?
before 72 hrs old
Which conditions can be detected with screenings of newborns?
- cystic fibrosis
- hypothyroidism
- phenylketonuria (PKU)
- galactosemia
- biotinidase deficiency
- sickle cell disease
- HIV
- toxoplasmosis
How are newborn screenings collected?
with a heel stick and a newborn screening card where you fill circles with capillary blood
How long should the lancet be for a newborn capillary stick?
2 mm
How long should a newborn screen dry?
at least 3 hours at room temp.
What would make a newborn screening unusable and rejected?
- oversaturation
- circles are not completely filled
- expired form
- form is not received within 14 days of collection
- contamination w/ foreign substance (avoid touching skin to filter paper)
- it does not dry throughly
- circles have serum rings
what is an autologous transfusion?
when a patient donates their own blood to use for a transfusion or upcoming surgery
What is therapeutic phlebotomy?
the intentional removal of blood to lower red blood cells or lower iron levels
What are some general requirements for blood donation?
- 17 or older (16 in some states)
- at least 110 pounds)
- donations at least 56 days apart
what is apheresis?
techniques that allow the removal of one or more blood products during blood collection via special equipment
What are the requirements for donation via apheresis?
Males:
- 17 or older
- 130 lbs or greater
- 61 inches or taller
Females: - 17 or older
- 150 lbs or greater
- 65 inches or greater
What conditions must be tests for before being able to donate blood?
HIV, AIDS, and hepatitis
what is iatrogenic anemia?
it is caused by blood loss due to repeated venipuncture in a short period of time
who are most susceptible to iatrogenic anemia?
- older adults (medications can suppress bone marrow production)
- pediatric patients (lower volume of blood)
- underweight patients (decrease in nutritional intake)
what percentage of blood volume can be collected from infants?
10%
How much blood can be collected from an adult?
no more than 100 mL
What is a random urine collection?
- no prep or time restriction is needed
- time of collection must be recorded
What is a glucose tolerance test? (gtt)
- 12 hr fasting required
- blood and urine tests should be performed at the same time
- collections must occur every 1 or 2 hours at the same time
What is a postprandial test?
- requires patient to void and then eat
- must eat prescribed amount of carbs or glucose solution
- urine collected 2 hours after a patient eats
- monitors effects of a prescribed insulin in diabetes patients
- is a screening took for non-diabetes patients
What is a 24-hour urine collection?
- patient receives a container that can hold 3-4 liters of fluid
- do not collect the first void
- collect all other voids for 24 hours
when is a clean catch midstream method used?
for culture and sensitivity testing (needs to prevent any other contamination other than the urine)
A phlebotomy technician is preparing to perform a venipuncture for a patient who has pneumonia. Besides gloves, which of the following pieces of personal protective equipment should the technician wear?
Face mask
while collecting a blood specimen, a phlebotomy technician notices the glass collection tube is cracked. Which of the following actions should the technician use?
Dispose of the tube in a sharps container
A phlebotomy technician is performing a glucometer reading for a young adult patient. The patients parent id in the room and asks about the patients glucose level. Which of the following actions should the technician take?
Ask the patient for permission to disclose the results with the parent present
A phlebotomy technician is preparing to perform the third set of blood draws for a glucose tolerance test, The patient starts to cry and refuses to extend her arm for the draw. Which of the following statements should the technician make?
“May I please perform the draw?”
phlebotomy Technician is preparing to complete the glucose monitor quality control record. Which information should the technician record in the quality control record?
Date of battery change
A technician observes a glucometer reading of 250 mg/dL. A second test is performed and returns a reading within the expected reference range. What could have been the cause of the first test to be inaccurate?
Too much blood was used
What solution should a technician used to clean a cerebral spinal specimen spill?
Chlorine bleach
A technician experiences a needlestick injury while performing a venipuncture. What should the technician include in the online sharps injury log?
The department where the injury happened
When testing a p.t for streptococcal pharyngitis, a phlebotomist should implement what type of transmission-based precaution?
Droplet
what actions should a phlebotomist take when performing a blood culture collection?
scrub the site with isopropyl alcohol for 1 minute in outward, concentric circles.
Which of the following what is the current procedure for medical professionals performing CPR on an infant?
30 compressions, 3.8 cm (1.5in) deep
A technician collects a specimen in a microcollection container after two failed veni. attempts. What reason should the technician write on the requisition form why the blood was collected in this manner?
To alert the Lab of the presence of capillary blood
while a technician is using a centrifuge,the device catches on fire. The technician should identify a centrifuge fire as what class of fire?
class C
A technician finishes performing a blood draw in an isolation room. What PPE should be removed FIRST?
Gloves
A technician is preparing to aliquot a blood specimen. What PPE are the minimum requirments for the technician to wear?
face shield and gloves
A technician experiences a needlestick injury while performing a draw. They are at greater risk of exposure to what bloodborne pathogens?
Hep. B (HBV)
A tech. receives a splash of blood to the eye while transferring serum into an isolator tube. What action should they take first?
Rinse eye with water
A tech. is collecting a sample for cholesterol, troporin, and HDL blood results. Which department is responsible for processing these tests?
chemistry
A tech. is performing a blood alcohol test which antiseptic should the tech use?
ethanol
a tech. is performing a venipuncture on a pt. who has a wound infected with methicillin-resistant staphylococcus aureus (MRSA) and has been placed in isolation. what action should a tech. take after the procedure?
dispose of the gown before leaving the room
Which type of urine specimen should a tech. Instruct a pt. To collect for a pregnancy test?
First-morning
A tech. Is explaining a phlebotomy procedure to a pt. Who wears hearing aids. The pt. Seems distracted. Which way should the tech. Ask to ensure the pt. Understands the procedure?
“Would you like me to repeat the directions?”
A tech should identify which information is required for positive identification of a pt. In an outpatient facility?
Picture ID, full name, DOB
A tech enters a pts. Room to perform a blood draw and notices that the patient’s ID band is sitting on the bedside table. The pt states “I hate wearing it, so I took it off” what response should the tech make?
“I will ask the nurse to replace the ID band”
A tech is seeking consent to perform veni. On an older adult pt who has been accompanied to the facility by a younger adult. Which action should the tech take?
Speak to the pt in a normal tone.
A tech is preparing to draw blood from a pt who had been admitted for life threatening cardiac symptoms. Which action should the tech take?
Proceed with collecting the patients blood
A tech is collecting a specimen to test a patients lithium level following a recent dose of medication. Which levels should the tech collect?
Peak
A tech is preparing to perform a blood collection in an outpatient setting. Which info is required on the requisition form?
Patients billing info and test status
A tech is preparing to collect specimens to determine a pts peak and trough levels. Which actions should the tech take?
Ask the nurse when the medication was administered.
A tech is processing the blood sample of a pt who ate a meal of meat and cheese prior to draw. Following centrifugation, what should the tech expect to find?
The specimen is lipemic
A tech is preparing to draw a pts blood when the pt informs him that she is taking warfarin. The tech should identify that the results of which of the tests is affected by the medication?
PT/INR
A tech is preparing to collect blood from a pt who has experienced syncope during previous draws. Which action should the tech take?
Place the pt in a supine position
A pts asks a tech why his blood is being drawn. What response should the tech make?
“You should ask your provider about the test”
A tech is informing a pt about the procedure for collecting a blood culture. What should the tech include?
“I will swab the area twice to make sure it is sterile”
A tech is preparing to collect a blood sample from a patient for a cholesterol test. What statement should the tech make?
“Please sit for at least 5 mins before the test”
A tech is positioning a pt for a veni. To prevent reflux or backflow, the tech should instruct the pt to love arm into what position?
Fully extended in a downward position.
A tech is preparing to collect a specimen from a 3-year old pt to perform a coagulation test. What collection method should the tech use?
Winged safety butterfly
A tech is performing a veni. On a pt. Who currently has an IV in both arms. What action should the tech take?
Ask the nurse to turn off the IV for 2 mins
A tech is educating a pt ab a 24-hr urine collection. What instructions should the tech give the pt?
“Start collecting at the second void of the day”
A tech is instructing a pt on how to collect a urine specimen for a culture and sensitivity test. What statement should the tech include?
“You will need to collect a midstream clean-catch specimen”
A tech is performing a veni. For bilirubin test, a cold agglutinin tiger, a CBC, and a PTT test. Which tubes should the tech use?
One light blue, two serum tops, and one lavender tube
A pt sits down for a veni. In an outpatient setting, rolls up her sleeve, and extends arm. The pt turns her head away from the tech and says “I don’t want my blood drawn” which responses should the tech make to the pt?
“May I draw your blood”
A tech is preforming a veni. On a deep median cubical vein. What methods of withdrawal should the tech use?
Withdraw the bevel up a 25 degree – 30 angle
A tech is performing a dorsal veni. With the needle at 15 degrees resulting in slow blood flow and the development of a hematoma. What should the tech identify as the cause of the hematoma?
Needle went through the vein
A tech is preparing to perform a veni. Test for coagulation, WBC, pregnancy, and random glucose. Which of the following tubes should the tech choose?
Sodium citrate, SST and EDTA
A tech is performing a dermal puncture for an adult pt. What location should the tech use for the procedure?
The side of the central of the ring finger
A tech is performing a hand veni. On a 25 year old pt who has small veins that are difficult to access. What equipment should the tech use to perform the procedure?
23 gauge winged collection set
A tech is preparing equipment for a blood draw. The tech notices that one tube on the tray is expired. What action should the tech take to ensure accurate test results?
Use a new tube from the front of the shelf
A tech is preforming a veni. For a potassium test, CBC, and glucose test. The tech has left the tourniquet tied on the pt for 3 Mins. What outcome should the tech expect?
High potassium level
A tech is preforming a blood collection for a pt who has edema in her right arm. What location should the tech identify as the best vein choice for veni?
Left side dorsal hand
A tech is using providone-iodine during a capillary specimen collection. What outcome should the tech expect?
Increased potassium level
A tech is preforming a veni. After removing the needle cap what steps should the tech take?
Anchor the vein 2.5-5 cm (1-2in) below the puncture site
A tech is drawing blood through a hematoma. What errors should the tech expect to see in the specimen?
Hemolysis
A tech is preforming a capillary collection for CBC, FSH, and electrolyte tests. What is the proper collection order?
Lavender microcollection container
Green microcollection container, the red microcollection container
A tech has three bar-coded labels but has to fill four tubes. The tech needs to create one more label for evacuated tubes. What info should the tech include on the label
Tech initials, date, and time of collection
A tech accidentally punctures a patients artery during a veni. Procedure. What actions should the tech take?
Apply pressure on the site for at least 5 mins
A tech is preparing to preform a CBC for a 7 month old infant. What equipment will the tech need?
Lancet with 2mm depth and a EDTA microcollection tube
A tech is preforming a veni. For a lipid profile, WBC, and a clotting time test. What is the correct order of draw?
Light blue, SST, lavender
A tech is performing veni. On a pt. When the tech inserts needle the vein collapses. What is a possible cause?
Applying the tourniquet too tight
A tech is preparing to collect a variety of blood specimens. What should the tech collect first?
Blood cultures
A tech is preparing to process a WBC differential test, testosterone test, and a glucose test. What actions should the tech take to process these tests
Prepare a slide from lavender topped tube and centrifuge a red topped tube and a gray topped tube
A tech is preparing a peripheral blood slide form a capillary puncture. What action should the tech take?
Touch the slide to the second drop of blood
A tech is using a syringe method to collect a blood culture set, a PTT, and a CBC test. What is the proper order of draw?
aerobic bottle
Anaerobic bottle
EDTA
light blue topped tube
A tech is preforming two sets of blood cultures for a pt. What action should the tech take?
Collect one set from the pts left arm and one set from a different site on the same arm.
A tech is collecting a peripheral blood smear from a pt. The tech should identify that this collection technique is used for what test?
WBC differential test
A tech receives a forensic specimen. The tech should verify that what specimen info matches the requisition form?
Case number
A tech is collecting capillary blood from a pt for neonatal screening. What actions should the tech take to complete the newborn screening card?
Touch the paper to a drop of blood and saturate each circle of the card
A tech is preparing to perform a neonatal screening test. The tech should identify what is the optimal time to perform the test?
Between 24-72 hr after birth
A tech is screening potential blood donors. The tech should identify what pt is able to donate blood?
A 65 year old pt who weighs 120lbs
A tech should identify that a pt who has what blood types is a universal recipient?
AB
A tech is caring for a 3 yr old child who weighs 35lbs during 1 month hospital stay, the tech should identify what blood collection amounts is within total volume guidelines for this pt?
95 mL
A tech is collecting ab blood culture from an infant who weighs 6.6lbs. The tech should identify what the total blood volume is for this infant?
240-330 mL
A tech is instructing a pt ab how to perform a pregnancy test. What statement should the tech include?
“Collect your first urine specimen of the morning”
A tech is instructing a pt about how to collect a sputum specimen. What statement should the tech make?
“You should provide the specimen in the morning before eating or drinking”
Which of the following additives should the tech use when performing a peripheral blood smear for a WBC. Count?
EDTA
A tech is preparing to perform blood collection for blood cultures, PTT and testosterone levels. What order should the tech collect these samples?
Yellow top
Blue top
Red top
A tech is performing a blood transfusion for a pt who has type O blood. The tech should identify that the pt should receive what types of blood?
Type O
A tech is instructing a pt about how to collect a fecal specimen at home. What instructions should be included?
“Do not mix urine with the fecal sample”
A tech is performing a brief psychical examination of a prospective blood donor. What measurements would indicate the donors eligibility to donate blood?
Hematocrit level 42%
A tech has collected a neonatal screening card. What actions should the tech take to properly dry the blood spot collection card?
Place card on a flat, dry surface
A tech is preparing to load two tubes into a centrifuge. What actions should the tech take?
Place tubes of equal volume across from each other
A tech is preparing serum samples for the centrifugation. How many minutes should the tech allow the serum samples to stand before loading them into the centrifuge?
30 mins
A tech is preparing to draw a blood specimen that must be protected from light. what lab tests will be performed on this specimen?
Bilirubin
A tech working in a lab has received six filled evacuated tubes, one of whimsy is missing a label. What action should the tech take?
Recollect the unlabeled specimen
What action should a tech take when collecting urine specimen for drug testing?
Seal the specimen in a tamper evident container
A tech is preparing to obtain a forensic specimen to determine a pts blood alcohol level. What info should the tech include on the chain of custody form?
Date and time of specimen collection
A tech has received a urine drug test specimen with a thermometer reading of 29.4 degrees Celsius. What action should the tech take?
Have the pt provide another urine specimen under observation.
A tech has released a specimen to a courier who is transporting it to the lab. What statements should the courier use to instruct the medical specimen accessioner on how to complete the chain of custody form?
“Write your name on the form”
A female pt is being referred to a reproductive specialist. What blood test last would the tech release to the referring personnel?
FSH and LH
A tech calls a medical assistant to inquire about a lab requisition. What info is required on a lab requisition?
Pt ID number
A tech is accessing the lab info system prior to collecting a specimen. What actions should the tech take?
Print the specimen labels
A tech is accessing the lab info system. The tech should identify what info can be found in the system?
Previous lab results
What info should the tech use to access a pts medical record in the lab info system?
Pt ID number
A tech is performing a point of care glucose test for a pt and receives a glucometer reading of 46 mg/dL. What findings should the tech expect the pt to exhibit?
Rapid heartbeat
A tech is performing a point of care hemoglobin test for a pt. What values should the tech report to the provider?
9.2 g/dL
A tech is performing a point of care total cholesterol test for a pt. What values should the tech report to the provider?
250 mg/dL
A tech notices that the volume of blood required to fill the tests ordered by a pts endocrinologist exceeds the recommended draw amount for the day. What action should the tech take?
Contact the pts endocrinologist
A tech has just received several blood test results from different pts. What results should the tech distribute first?
Stat CBC drawn in surgery
A tech should refrigerate what specimens before transportation?
Lactic acid
A tech is transporting a cryoglobulin specimen to the lab. The tech should keep the specimen at what temperature?
37 degrees Celsius (98.6 degrees F)