Preliminary sample quiz
The phlebotomist was stuck by a contaminated needle while changing out an overflowing sharps container. The phlebotomist should immediately A. report the incident to a supervisor. B. wash the exposed area with soap and water. C. soak the puncture site in BetadineTM. D. milk the puncture site and clean with alcohol.
B. wash the exposed area with soap and water. Rationale: All heathcare facilities are required by OSHA to have a Bloodborne Pathogen exposure control plan. Part of this plan includes the steps to follow if a sharps injury occurs. The first step is to remove the sharp from the wound and wash the site with soap and water for at least 30 seconds. Antiseptics such as Betadine are not necessary. Then inform the immediate supervisor and report to a licensed healthcare provider for evaluation and treatment. It is very important to also document the event on an incident report form. The practice of "milking the site" or making the site bleed is not encouraged.
While performing a venipuncture on an obese patient, the appropriate angle of insertion is A. 30-45 degrees. B. 20-35 degrees. C. 15-30 degrees. D. 10-25 degrees.
C. 15-30 degrees. Rationale: The correct angle of insertion for venipuncture is 15 to 30 degrees regardless of the size of the patient. 10 degrees is too low and risks missing the vein, while 45 degrees is too high and might allow the needle to go through the vein. If the vein is very deep, as is often the case in obese patients, the phlebotomist might have to go farther into the arm but the angle remains the same.
How often should QC be run on a blood glucose meter? A. every 30 days B. every 10 days C. every 5 days D. per manufacturer's instructions
D. per manufacturer's instructions Rationale: Quality control (QC) on a glucometer should be performed and documented per manufacturer's instructions (which is likely every day) and after any maintenance, such as a battery change. In addition, QC solutions should be at room temperature and used before the expiration date. If the QC results are not within the acceptable range, the meter can not be used for patient testing. Always follow the manufacturers instructions and your facility's procedures and policies. Running QC every 5, 10 or 15 days is not recommended and will not validate the patient results.
Place the options below in the correct sequence for applying PPE. (Click and drag the options in the left column to the correct position in the right column.) mask face shield gloves gown
gown, mask, face shield, gloves Rationale: When donning (putting on) PPE, the gown is put on first and fastened in the back. Next, the mask (covering nose & mouth) or face shield, if using. Gloves are put on last and pulled over the cuffs of the gown. To remove PPE, the gloves are taken off first, then the gown and finally the mask.
Which of the following should the phlebotomist do when collecting blood from a fingertip using a blade-type device? A. Make the puncture perpendicular to the fingerprint whorls. B. Ensure all alcohol is wiped off the finger before the puncture is made. C. Milk the finger during the blood collection. D. Turn the patient's hand palm side up.
A. Make the puncture perpendicular to the fingerprint whorls. Rationale: Capillary puncture can be performed on the palmar surface of the distal segment of the 3rd digit (middle finger) or 4th digit (ring finger). Lancet must be placed across (perpendicular) to the fingerprint whorls in order to allow blood to form round drops as it is collected. Placing the lancet along (parallel to) the fingerprint whorls will allow the blood to channel away from the puncture site into the grooves and make collection very difficult. Never wipe, fan or blow at a site that has been cleansed. Alcohol must air dry to allow time for it to work and inhibit bacteria. Wiping can prevents alcohol from work properly and can introduce more microbes. Fanning creates air turbulence and can introduce more microbes. Blowing introduces microbes from the mouth into the cleansed site. Capillary puncture does not require higher degree of antisepsis such as iodine. Iodine should not be used for capillary puncture as it can affect BURPP—bilirubin, uric acid, phosphorus and potassium tests. Milking is contraindicated during capillary puncture as it will increase specimen hemolysis and tissue fluid contamination.
Which of the following is the most common light sensitive analyte specimen? A. bilirubin B. folic acid C. potassium D. calcium
A. bilirubin Rationale: Analyte is any substance being tested in the liquid portion of the blood, except for formed elements (red blood cells, white blood cells, platelets). The most common light sensitive analyte is bilirubin. Bilirubin and vitamins are the most common light sensitive specimens protected from being broken down by ultraviolet light using the amber tube or wrapping the specimen in aluminum foil. Folic acid must be immersed in slurry of ice and water. Chilling helps slow down metabolism and prevent evaporation by keeping volatile substances dissolved in the liquid portion of the blood. Potassium and calcium do not require special handling.
A phlebotomist spills a reactive agent in the lab. Which of the following should be referenced for clean up? A. Material Safety Data Sheet B. product inserts C. site supervisor D. OSHA guidelines
A. Material Safety Data Sheet Rationale: All chemicals must have a Material Safety Data Sheet (MSDS) or since the implementation of GHS, now called Safety Data Sheets. Information provided must include: product identification, hazard(s) identification, composition (ingredients), first aid measures, firefighting measures, accidental release (spill) measures and handling and storage. Recently MSDS have been changed to Safety Data Sheets (SDS) in an effort to align with the Globally Harmonized System (GHS) that is now being used worldwide. These documents contain all the information on how to safely handle each chemical including how to contain and clean up a spill. Product inserts detail how the chemical is to be used in a test system. A site supervisor may be responsible for assuring the training and competence of employees in handling chemicals. OSHA guidelines provide an outline for workplace safety - which includes proper handling of chemicals.
The patient reports feeling faint and slumps forward as soon as the needle is inserted into the arm during a venipuncture. Which of the following actions should the phlebotomist take next? A. Remove the needle and tourniquet. B. Continue obtaining the specimen as quickly as possible. C. Use smelling salts to revive the patient. D. Apply a cold compress to the back of the patient's neck.
A. Remove the needle and tourniquet. Rationale: The procedure should be discontinued immediately, with the initial step of releasing the tourniquet. The needle would also need to be removed, but the tourniquet should be removed first because it is causing pressure to the vein. Since the needle is being removed, activating the needle safety mechanism before removing the tourniquet would not be appropriate. The phlebotomist should not continue obtaining the specimen, because the patient is clearly not tolerating the procedure.
A lactic acid specimen should be delivered to the lab as A. STAT and on ice slurry. B. routine and on ice slurry. C. STAT and protected from light. D. routine and protected from light.
A. STAT and on ice slurry Rationale: Some blood specimens require special treatment and handling to preserve the analyte while being transported to the lab for testing. Lactic acid and ammonia are chilled in ice slurry and delivered STAT as they deteriorate very quickly at room temperature. It is not necessary to protect them from light.
After performing a venipuncture in a hospital setting and activating the safety device on the needle, which of the following is the correct method of disposing of the used needles, syringe, and ETS? A. Throw the entire assembly into a sharps container. B. Throw the used needle into a sharps container and the syringe and ETS into a biohazard bin. C. Throw the entire assembly into a biohazard bin. D. Throw the entire assembly into the bedside trash.
A. Throw the entire assembly into a sharps container. Rationale: The evacuated tube system (ETS) or syringe system with attached needle and safety device are designed for a single use and are to be placed as a unit into a sharps container upon the completion of the venipuncture procedure. Needles should not be removed from ETS holders. The needle may be removed from the syringe only after the needle safety device has been activated to allow for the attachment of a transfer device. None of this equipment is to be placed into a biohazard bin or bedside trash.
Which of the following quality control measures is a phlebotomist responsible for? (Select the three (3) correct answers.) A. checking expiration dates B. recording refrigerator temperatures C. running controls on POC testing D. recording abnormal test results E. calibrating lab equipment
A. checking expiration dates B. recording refrigerator temperatures C. running controls on POC testing Rationale: Quality control procedures are used to verify that equipment is within certain criteria to ensure accurate specimen collection, testing and patient results. If expiration dates on ETS tubes are exceeded, adequate vacuum and viable contents cannot be guaranteed. Refrigerator temperatures must be within range to keep reagents and specimens at correct temperatures. Controls must be run in the same manner as patient tests on POC test processes to ensure these systems are performing correctly. All QC results must be clearly documented and any outliers investigated and corrective action taken. Calibration of lab equipment and recording abnormal patient results is the job of technologists.
Which of the following items should be used to prepare the site for a blood alcohol collection? (Select the two (2) correct answers.) A. green surgical soap B. iodine swabs C. hydrogen peroxide D. Purell wipes E. Chloraprep
A. green surgical soap C. hydrogen peroxide Rationale: When drawing blood for an alcohol level, it is crucial to avoid cleaning the venipuncture site with any solution containing alcohol. Doing so might contaminate the specimen and invalidate the results, especially in a court of law. Therefore isopropyl alcohol, tincture of iodine, Purell wipes and solutions of chlorhexidine and alcohol (Chloraprep) should not be used. Green surgical soap or hydrogen peroxide would be acceptable.
Capillary blood specimen collection is contraindicated in patients that A. have edema of the hands and feet. B. are severely burned over the torso. C. are extremely obese. D. have very difficult veins.
A. have edema of the hands and feet. Rationale: Patients with peripheral edema have a great deal of fluid in their tissue. Collection of capillary blood would provide a sample that is likely to be highly diluted with tissue fluid, affecting laboratory test results. Capillary testing would be a choice for the other patient conditions.
The phlebotomist obtains 70% isopropyl wipe, a 25g butterfly needle, and two evacuated tubes to collect CBC and ethanol levels. Which of the following pre-analytical sources of error are likely results of this collection? (Select the two (2) correct answers.) A. hemolysis B. microclots C. infection D. specimen contamination E. hemoconcentration
A. hemolysis D. specimen contamination Rationale: If the phlebotomist uses a 25 g needle with evacuated tubes, hemolysis of the blood sample is likely to occur as the needle is too small for the vacuum in the tubes. Cleaning the site with 70% isopropyl alcohol is contraindicated when drawing an alcohol level as the specimen might become contaminated with the antiseptic and affect the results. Infection could occur from improper cleaning, but has nothing to do with the needle gauge or use of the wipe. Microclots result from inadequate mixing of evacuated tubes with their additive contents. Hemoconcentration is caused by leaving a tourniquet on too long which alters the ratio of cells and other constituents to the plasma in the blood.
The phlebotomist received an order for a neonatal screen for PKU. Which of the following equipment will be necessary? (Select the two (2) correct answers.) A. lancet (depth 2.0mm) B. filter paper collection card C. microtainer (green top) D. 23g vacutainer needle and syringe E. 23g butterfly needle and adapter
A. lancet (depth 2.0mm) B. filter paper collection card Rationale: Neonatal screening for metabolic disorders is done with a dermal puncture to the medial or lateral plantar surface of the heel using a special lancet that penetrates no more than 2.0 mm. The blood collected is transferred directly to a special filter paper card. A green top microtainer is not used as the heparin anticoagulant would interfere with testing. A 23g needle, syringe, butterfly and adapter are all venipuncture equipment and not used for this dermal procedure.
According to the CLSI recommended order of draw for capillary puncture, which of the following microcollection tubes must be collected first? A. potassium EDTA B. no additive C. potassium oxalate D. sodium heparin
A. potassium EDTA Rationale: The potassium EDTA microcollection tube should be collected first because it is used for whole blood tests and microclots easily in these containers from inadequate mixing. Next should be the other additive tubes, sodium heparin and potassium oxalate. Last would be the non additive tube. There is no concern about carryover of additives with dermal collection as there would be with venipuncture.
Blood cultures need to be drawn from a patient who is sensitive to iodine. Which of the following antiseptics should be used to cleanse the collection site? A. 70% isopropyl alcohol B. 0.5% chlorhexidine C. 2% hydrogen peroxide D. 2% povidone
B. 0.5% chlorhexidine Rationale: To minimize the risk of contamination by normal skin flora, sites for blood culture collection require a 30 - 60 second scrub to access the bacteria beneath the dead skin cells in the area. Although not appropriate for infants under 2 months of age, chlorhexidene gluconate has become the antiseptic of choice. Isopropyl alcohol may be used but requires a longer scrub with at least two pads. Isopropyl alcohol is used to clean the tops of the cultures bottles before inoculation with blood. Preparations of iodine such as 2% povidone should not be used on those sensitive to iodine as they may provoke allergic reactions. Hydrogen peroxide is not considered effective for blood culture site cleansing. Whichever antiseptic is used, it is important to allow the area to air dry and not to retouch the site before performing the venipuncture.
When selecting a lancet for collecting blood from the heel of a newborn, the length should be A. 2.4 mm or greater B. 2.0 mm or less C. 2.4 cm or greater D. 2.0 cm or less
B. 2.0 mm or less Rationale: CLSI recommends that capillary blood collection on infants less than one year of age be performed on medial or lateral plantar surface of the heel and that the puncture must not exceed 2.0 mm. WHO Guidelines on Drawing Blood: Best Practices in Phlebotomy recommends that the depth of heel punctures not exceed 2.4 mm as pain fibers/receptors significantly increase in abundance and the potential for bone injury also increases. Given the CLSI and WHO recommendations, 2.4 mm or less is the most appropriate response. 2.5 cm and 2.4 cm are equal to 25 mm and 24 mm, respectively, which is wider than the thickness of an average adult finger. It is important to note that units are very important (1.0 cm equals 10mm). Deeper puncture may only be appropriate in performing capillary puncture on adults with excessive scarring and callouses on the fingers. Callouses are often the result of manual work and is also seen in musicians who play certain string instruments. In these situations, it is warranted to perform a deeper puncture in order to penetrate the callous and obtain blood from the capillary bed in the dermis, middle vascular layer of the skin located just deep to the epidermis.
Which of the following applies to every United States clinical laboratory that tests human specimens? A. Commission on Office Laboratory Accreditation (COLA) B. Clinical Laboratory Improvement Amendments (CLIA) C. College of American Pathologists (CAP) D. Joint Commission on the Accreditation of Health Care Organizations (JCAHO)
B. Clinical Laboratory Improvement Amendments (CLIA) Rationale: The Clinical Laboratory Improvement Amendments (CLIA) became law in 1988 and was implemented for all labs testing human specimens in 1992. It is an effort to standardize policies, procedures and personnel criteria to provide better patient outcomes. The law is administered by CMS and the FDA and defines four categories of testing: waived, provider performed, moderate and high complexity according to the training and degree of judgement required to perform the test. Each laboratory must have a license to operate under the appropriate category and be periodically inspected. COLA, CAP, and JCAHO are accrediting agencies that inspect laboratories to assure the CLIA law, good laboratory practices and the highest standards of patient care are being employed.
The right side of a patient's body is severely burned, including the right arm and hand. The patient has an IV in the antecubital area of the left arm. The physician orders labs that require venous blood. Which of the following should the phlebotomist do? A. Turn off the IV for 2 minutes and collect the specimen distal to the IV in the antecubital area of the left arm. B. Collect distal to the IV in antecubital area of left arm after the nurse has turned off the IV for 2 minutes. C. Collect distal to the IV in antecubital area of left arm after the nurse has disconnected the IV. D. Disconnect the IV and collect the specimen distal to the IV in the antecubital area of the left arm.
B. Collect distal to the IV in antecubital area of left arm after the nurse has turned off the IV for 2 minutes. Rationale: A blood test can be considered a "snapshot" of the patient's condition at the time it was drawn. Contaminating this specimen with IV fluid will give false results and cause the patient to be incorrectly treated. If a collection must be made in an arm with an IV, the nurse must turn off the infusion for 2 minutes and the tourniquet place distal to the IV site. The phlebotomist does not tamper with any medical equipment attached to a patient. It is not necessary to disconnect or remove the IV for a blood draw.
A phlebotomist is working at a cardiology office where the majority of the patients are on either aspirin or anticoagulant therapy. Upon retracting the needle from the patient's arm the patient begins to bleed profusely. Which of the following should the phlebotomist do next? A. Apply a pressure bandage. B. Hold direct pressure for up to 5 minutes. C. Leave the patient and immediately notify the doctor. D. Have patient hold direct pressure for up to 5 minutes.
B. Hold direct pressure for up to 5 minutes. Rationale: Patients on anticoagulant therapy tend to bleed longer from the site of a venipuncture. The patient can assist but it is the responsibility of the phlebotomist to assure that bleeding has completely stopped before bandaging and releasing the patient. This may take direct pressure for 5 minutes or longer. The patient is never left alone and the doctor relies on the phlebotomist to resolve this situation.
Which of the following should the phlebotomist do after drawing blood from a patient on anticoagulant therapy? (Select the three (3) correct answers.) A. Call the nurse for instructions. B. Hold pressure and elevate the patients arm. C. Wait for bleeding to stop. D. Have the patient bend the arm and hold pressure. E. Apply a pressure dressing over the site.
B. Hold pressure and elevate the patients arm. C. Wait for bleeding to stop. E. Apply a pressure dressing over the site. Rationale: Complications can arise with any medical procedure. A phlebotomist should confirm hemostasis before leaving a venipuncture patient or allowing the patient to leave. If a patient continues to bleed after a reasonable amount of time, further intervention is required. Another medical professional (like a nurse) may be needed to help stop the bleeding. This is common in patients on anticoagulants.
A phlebotomist completed venipuncture on a patient for bilirubin and carotene. Which of the following must the phlebotomist do with these lab tests to prevent altering the chemical composition? A. Invert the test tube 10 times and set it on the testing rack. B. Keep the test tube away from direct light by wrapping it in foil. C. Place the test tube in an ice slurry. D. Invert the test tube 10 times and take it directly to the lab.
B. Keep the test tube away from direct light by wrapping it in foil. Rationale: Levels of both bilirubin and carotene are susceptible to deterioration if exposed to light. Bilirubin is the most sensitive - it may drop in concentration as much as 50% in one hour. Therefore these tests are protected from light by either wrapping the specimen in aluminum foil or transferring the spun serum or plasma to a brown aliquot tube. Other light sensitive analytes include RBC folate and vitamin B12. The number of inversions has no effect on light sensitivity and as long as the specimens light protected, it doesn't have to taken immediately to the lab. Analytes that need to be placed on an ice slurry include lactic acid, ammonia and some coagulation factors.
Which of the following is the reason blood cultures are typically drawn first? A. They take more time to collect. B. They can easily be contaminated. C. A greater quantity of blood is required. D. The blood needs to be in contact with the additive longer.
B. They can easily be contaminated. Rationale: When sepsis is suspected, the physician orders blood cultures. Specimen collection for blood cultures is more detailed than for routine venipuncture, thus adding collection time. Blood cultures are always drawn first to avoid contamination from drawing additional tubes. It is necessary to disinfect the draw site before collecting blood cultures so they are not contaminated with normal skin flora. Contamination can result in unreliable test results, which in turn can lead to incorrect diagnosis and treatment of the patient. Blood culture bottles are sterile and the different colored tops indicate different additives.
Evacuated tubes must be filled to the level indicated. This will result in the correct ratio of A. liquid to additive. B. additive to blood. C. blood to air. D. air to liquid.
B. additive to blood. Rationale: The manufacturers of evacuated tubes adjust the amount of additive contained in each tube in order to preserve the analytes to be tested. It is imperative to fill these tubes to the correct level for accurate patient results. This is especially true of the sodium citrate (blue) tube which must have a ratio of 1 part sodium citrate to 9 parts of blood in order to correctly measure coagulation factors. Other than blood and additives, there are no other liquids in these tubes. The amount of air within the tube does not affect patient results other than having them insufficiently filled.
A patient arrives with a family member for a blood draw. The phlebotomist notices the patient speaking in another language, but the family member was responding to her intermittently in English. The phlebotomist should A. inform the supervisor. B. call for a professional interpreter. C. use non-verbal cues to accomplish the task. D. allow the family member to serve as an interpreter.
B. call for a professional interpreter. Rationale: It is imperative that the patient understand the procedure being performed and that a professional medical interpreter be present. Recent changes in medical law require a professional medical interpreter. The use of non-verbal cues or allowing a family member who might not understand medical terms to interpret may cause miscommunication and incorrect medical treatment. Informing a supervisor would just waste time in getting the patient the correct care.
Which of the following forms is the phlebotomist responsible for having the patient sign when a specimen is being collected for substance abuse screening for employment? A. advance directive B. chain-of-custody C. informed consent D. release of medical Information
B. chain-of-custody Rationale: A Chain-of-custody form is used to maintain a legal record of individuals who have had physical possession of the specimen. It prevents the possiblity of tampering. An Advance Directive is a legal document that allow someone to spell out medical decisions about end-of-life care ahead of time. Informed Constent recognizes the need of a patient to know about a procedure, surgery, or treatment, before deciding whether to have it. No medical information may be released without proper authorization (Medical Release form) from the patient or legal guardian, currently dated and signed.
A phlebotomist is tasked with drawing routine bloodwork on a patient, but upon entering the room the phlebotomist notices a sign that states "No Bloodwork From Right Arm". After reading the sign the phlebotomist notices an IV in the patient's left arm. Under normal circumstances which of the following is the best site for the phlebotomist to choose? A. proximal to the IV site B. distal to the IV site C. the back of the right hand D. the foot
B. distal to the IV site Rationale: It is not uncommon for the patient's physician to restrict blood draws from certain areas of the body on which mastectomy, AV fistulas, surgeries or other treatments may have been performed. In this case, a site for venipuncture should be selected distal to (away from) the IV in the left arm. A site proximal (close to) the IV might contaminate the blood sample with the contents of the fluid being administered. The exclusion of the right arm includes the hand. Blood draws from a foot require a doctor's written permission. If a small amount of blood is needed for the tests requested, the phlebotomist might consider a dermal puncture of a finger.
The phlebotomist enters a non-English speaking patient's room with her supplies. The patient extends his arm. In this case the patient has A. not legally granted consent. B. granted implied consent. C. granted informed consent. D. granted expressed consent.
B. granted implied consent. Rationale: Informed consent is the agreement of the patient to a medical procedure after having the procedure explained and being given the chance to ask questions. The patient must be competent and consent voluntarily. Implied consent is given by a patient's actions - such as extending the arm, or if the situation is an emergency. In the above case, the patient has legally granted implied consent. However, if further explanation or questions arise, a trained medical interpreter must be found. Expressed consent is permission for something that is given specifically, either verbally or in writing and would be documented in the chart or medical record.
After a phlebotomy draw, the phlebotomist realizes that the tourniquet was on for an extensive length of time. Which of the following is the most likely resulting complication? A. hemolysis B. hemoconcentration C. hematoma D. excessive bleeding
B. hemoconcentration Rationale: Hemoconcentration is decrease in the volume of plasma in relation to the number of red blood cells. Prolonged tourniquet use impedes circulation and will cause this to happen, but will likely not cause hemolysis or a hematoma. Hematocrit is a measure of the volume of red blood cells in a whole blood sample, and is not a physiological complication at all.
Which of the following additives prevents glycolysis? A. sodium citrate B. sodium fluoride C. potassium oxalate D. EDTA
B. sodium fluoride Rationale: Blood cells will continue to metabolize glucose in the collection tube which will decrease the result. Sodium fluoride is added to a gray top tube to prevent glycolysis and stabilize the glucose result. It acts on the enzyme enolase and interrupts the glycolytic pathway. Glucose in a gray top tube can remain stable for up to three days. Sodium citrate (light blue top), potassium oxalate (gray top) and EDTA (lavender top) are all anticoagulants that prevent blood samples from clotting in the tubes.
When preparing to do a urine drug test, which of the following should the phlebotomist ask the patient? A. "Do you have any diet restrictions?" B. "Have you been standing for 30 minutes?" C. "Are you taking any medications?" D. "What time was your last meal?"
C. "Are you taking any medications?" Rationale: It is important to know what medications the patient is taking prior to performing a drug screen as those prescriptions and supplements might cause false positive or negative results. The typical urine drug screen tests for drug abuse involving amphetamines, barbiturates, benzodiazepines, cocaine, ethanol, marijuana, opiates, and phencyclidine. Diet restrictions, timing of meals or positions issues such as standing, sitting or lying down will not affect the results of a drug screen.
The phlebotomist is given an order for a blood draw. How high above the venipuncture site should the phlebotomist wrap the tourniquet around the arm? A. 1-2 inches B. 1-2 cm C. 3-4 inches D. 3-4 cm
C. 3-4 inches Rationale: The tourniquet should be applied 3-4 inches above the intended venipuncture site. Too close to the site may cause the vein to collapse and too far away might not be effective in distension of the veins. 1-2 or 3-4 cm would be too close.
During a phlebotomy collection, the needle came out of patient's arm and the phlebotomist's gloves were spattered with blood. Which of the following statements correctly describes the disposal of the waste? A. First dispose of the contaminated gloves in a biohazard bag; second dispose of the sharps in puncture-proof biohazard sharps container. B. First dispose of the contaminated gloves in the trashcan; second dispose of the sharps in puncture-proof biohazard sharps container. C. First dispose of the sharps in puncture-proof biohazard sharps container, second dispose of the contaminated gloves in a biohazard bag. D. First dispose of the sharps in puncture-proof biohazard sharps container, second dispose of the contaminated gloves in the trashcan.
C. First dispose of the sharps in puncture-proof biohazard sharps container, second dispose of the contaminated gloves in a biohazard bag. Rationale: It is always important to immediately activate the needle safety device after removing the needle from the venipuncture site. The needle and holder are then disposed of as a unit in a puncture proof sharps container. Gloves visibly contaminated with blood must be placed in a biohazard bag.
Which of the following additional PPE should the phlebotomist wear when entering a room marked for airborne precautions? A. mask B. face shield C. N95 Respirator D. non-latex gloves
C. N95 Respirator Rationale: Airborne infections are carried by droplet nuclei particles smaller than 5 um and include tuberculosis, measles, chickenpox and mumps. Protection from these microbes requires an N95 respirator. Gloves are worn as part of PPE under standard precautions. A face shield is typically used to protect the wearer from splashes of blood or other body fluids that might enter the eyes or mucous membranes of the face.
During a blood draw, a patient begins complaining of discomfort and tingling, at which time the phlebotomist notices bruising and discoloration at the site. How should the phlebotomist proceed? A. Release the tourniquet and complete the draw. B. Withdraw the needle immediately, apply pressure, and apply ice. C. Release the tourniquet, withdraw the needle, and apply pressure. D. Complete the draw, release the tourniquet, and apply pressure.
C. Release the tourniquet, withdraw the needle, and apply pressure. Rationale: The correct response is to release the tourniquet, withdraw the needle, and apply pressure to avoid any further damage or pain at the venipuncture site. The tourniquet MUST be released before the needle is withdrawn. The application of pressure by the phlebotomist is meant to stop any bleeding. The use of ice and bending of the arm are not typically recommended after any phlebotomy procedures.
During an evacuated tube system draw, the phlebotomy technician properly positions the needle in the vein and inserts the blood tube into the tube holder to collect a blood sample, but there is no blood return. Which of the following should the phlebotomy technician do next to obtain the specimen? A. Remove the needle and start the procedure again. B. Adjust the needle to gain blood flow. C. Replace the initial tube with another tube to check vacuum. D. Use a different blood collection system to collect the blood.
C. Replace the initial tube with another tube to check vacuum. Rationale: Evacuated tubes are manufactured items and have expiration dates to assure the viability of their contents, their sterility and the strength of the vacuum. However, even with good quality control procedures, the tubes may become defective during transport, handling or storage. As decreased vacuum may not allow the tube to fill properly, it is wise to keep an extra set of tubes at hand so an exchange can verify that the tube, not the draw, is causing the problem. If the second tube does not fill, the needle may be repositioned slightly to recover the draw. The venipuncture may have to be discontinued and another collection system, such as a syringe, used on the next attempt.
Which of the following is the proper draw site for an infant less than one year of age? A. plantar surface of heel B. palmar surface of hand C. lateral surface of heel D. 4th distal phalanx
C. lateral surface of heel Rationale: For infants less than one year of age, the heel is typically used for a dermal puncture. Capillary blood samples may be taken from the heel of children until they begin to walk at which time the heel becomes tougher and more difficult to penetrate. The site chosen should be the lateral or medial side and not the plantar surface as it is too close to the bone. Fingers are too small and there is not enough tissue surrounding the bone.
Which of the following should a phlebotomist do when testing glucometers for quality assurance? A. train patients B. compare policy and procedures C. maintain records D. record patient results
C. maintain records Rationale: The documented maintenance of an instrument, such as a glucometer, is necessary to prove that it is performing correctly before being used to provide patient results. If records are not kept it will be assumed maintenance and quality control (QC) have not been performed and patient results will be invalid. Patients are not trained to do this - it is the responsibility of the laboratory, as is comparing policies and procedures to assure they are in accord. Patient results are run and recorded after the instrument has been validated with the performance of quality control.
To anchor the vein a phlebotomist should use the A. index finger above and thumb below the site. B. index finger and pull the skin taunt. C. thumb 1-2 inches below the site. D. thumb 1-2 inches above the site.
C. thumb 1-2 inches below the site. Rationale: Anchoring a vein prior to venipuncture serves two purposes - to keep the vein from rolling away when the needle is inserted and to pull the skin taut which makes the procedure less painful for the patient. The proper way to do this is to place the thumb of the non-drawing hand 1 - 2 inches below the intended site while grasping the patient's arm. Placing the thumb below and the index finger above the site ("C" or window hold) leaves the index finger exposed to a possible needlestick injury. Using only the index finger would not allow the hand to steady the arm. Placing the thumb 1-2 inches above the site would not help to anchor the vein.
Cryoglobulin specimens must be transported to the laboratory A. at room temperature. B. immersed in ice. C. with a 37 degree Celsius heat block. D. protected from light.
C. with a 37 degree Celsius heat block. Rationale: Many types of specimens are required to be kept at certain temperatures in order for accurate test results to be obtained by the laboratory. Cryofibrinogen, cryoglobulin and cold agglutinins must be kept at 37o C (body temperature). Tests requiring protection from light include: bilirubin, carotene, porphyrins and vitamins A, B2, and C. Specimens that require chilling on an ice slurry are ammonia, lactic acid, pH & blood gases among others. Consult your facility's policies for the correct procedures to follow. Aliquoting of the specimen (dividing it into parts) is done during or after processing in the laboratory.
Which of the following is the correct order of draw for a STAT lactic acid, lead level, and calcium? A. royal blue, gray, SST B. gray, royal blue, SST C. royal blue, SST, gray D. SST, royal blue, gray
D. SST, royal blue, gray Rationale: Blood collection tubes are color coded to indicate their chemical contents. The Clinical Laboratory Standards Institute (CLSI) defines the order of drawing these tubes to prevent carryover of the contents from one tube to the next. A small amount of the chemical may be retained on the inner needle or rubber sleeve of the ETS system and contaminate the next tube thereby affecting patient results. The order is (for the most commonly used tubes): sterile (blood cultures), sodium citrate (blue), serum ( red or gold with or without clot activator or gel separator), heparin (green), EDTA (purple), sodium fluoride & potassium oxalate (gray). It is also important to know the order of draw by the contents of the tubes as there are many infrequently used colors that may use the same anticoagulants as more common ones. As an example, pink, tan and royal blue tubes contain EDTA. In this case, the phlebotomist should draw an SST (serum separator) for the calcium, royal blue (EDTA) for the lead and gray (sodium fluoride & potassium oxalate) last. Lead levels can also be drawn in a tan top tube. Lead levels can also be drawn in a tan top tube (use royal blue or tan in accordance with the testing laboratory requirements).
Which of the following precautions should be used when drawing blood on patients diagnosed with tuberculosis? A. Standard and Contact Precautions B. Standard Precautions C. Universal Precautions D. Standard and Airborne Precautions
D. Standard and Airborne Precautions Rationale: Universal precautions (1980s) were introduced to protect health care workers from bloodborne pathogens. These rules were updated to Standard precautions (1996) to combine the use of PPE with hand hygiene and apply to blood, all body fluids, non-intact skin or mucous membranes. Transmission based isolation precautions are a subset of Standard Precautions designed by how infectious agents are spread. There are three categories. Contact requires gloves and gown, droplet requires a mask and eye protection (goggles), and airborne requires an N95 respirator with the patient placed in a negative airflow environment.
A 2-week-old infant has been brought in the lab for a repeat PKU/neonatal screening. Which of the following collection procedures is appropriate to collect the specimens? A. venipuncture using evacuated tube system B. venipuncture using winged infusion set C. capillary using dermal puncture lancet D. capillary using heel puncture lancet
D. capillary using heel puncture lancet Rationale: PKU is a neonatal screening test collected on a blot card. The recommended method of blood collection on infants less than a year old is via capillary (thus eliminating the venipuncture choices). A capillary collection using heel puncture lancet would be the correct choice in this situation. The heel puncture lancet would go the proper depth on an infant (there are even different sizes of lancets available for premature vs. term infants).
When preparing a site with alcohol for venipuncture, the phlebotomist should cleanse in which of the following motions? A. horizontally back and forth B. vertically up and down C. concentric from the periphery to the center D. concentric from the center to the periphery
D. concentric from the center to the periphery Rationale: Proper concentric cleansing (from the targeted venipuncture site outward) is necessary to prevent contamination. Cleanser should be allowed to air dry before sticking the patient.
When leaving a droplet isolation room, which of the following is the correct order for removing PPE? A. mask, gloves, gown B. mask, gown, gloves C. gown, mask, gloves D. gloves, gown, mask
D. gloves, gown, mask Rationale: To remove PPE (personal protective equipment), the gloves are removed first as these are considered likely to be most contaminated. Using a gloved hand, grasp the palm area of the other gloved hand and peel off first glove. Hold removed glove in gloved hand. Slide fingers of ungloved hand under remaining glove at wrist and peel off second glove over first glove. Discard gloves in a waste container. The gown is then removed by pulling it from the shoulders, turning it inside out and then rolling it into a bundle before disposal. The mask is removed last by touching only the ties.
A test tube with which of the following stopper colors prevents the conversion from prothrombin to thrombin? A. red B. lavender C. yellow D. green
D. green Rationale: Green tube contains anticoagulant heparin in the form or lithium heparin or sodium heparin. Heparin inhibits thrombin to prevent fibrin formation from fibrinogen. Red tube contains clot activator silica. Silica enhances clotting by providing increased surface area for platelets. Lavender tubes contain EDTA which works by inactivating calcium. Yellow tube contains anticoagulant sodium polyanethol sulfonate (SPS). SPS chelates calcium to prevent fibrin formation from fibrinogen.
Which of the following information will a phlebotomist need to add onto the computer generated label? A. patient's date of birth B. patient's first and last name C. identification number D. initials of the person collecting the sample
D. initials of the person collecting the sample Rationale: When labeling a tube after collection, the phlebotomist should add her initials, the time of draw and any special comments such as "line draw". The patient's first and last name, date of birth and identification number should be preprinted of the label.
Which of the following tube stopper colors is used to collect blood cell counts? A. green B. red/grey speckled top C. red D. lavender
D. lavender Rationale: The lavender top (EDTA) tube is used in the Hematology department for blood cell counts. It has been found to best preserve the size and morphology of red cells, white cells and platelets. Adequate filling of the tube is required as too much EDTA will shrink the red cells, causing inaccurate results. Green tops (heparin) and red or red/grey speckled (tiger tops). Serum tubes contain no anticoagulant and are typically used by the Chemistry and Serology departments.
The physician orders a prothrombin time. Which of the following evacuated tubes should the phlebotomist select for collecting the specimen? A. light green B. red C. grey D. light blue
D. light blue Rationale: A light blue top tube contains buffered sodium citrate, an additive that removes calcium to prevent blood from clotting.
