Test questions

You observe a new phlebotomist as they finished performing a skin puncture on a baby in the hospital. You ask him why he used iodine and he tells you that he had no more alcohol wipes in his phlebotomy tray but there was plenty of iodine swabs nearby in the baby's room so he just used one of those instead. What should you say? TIP: Which answer would sound the MOST accurate and professional?

"Actually, iodine can elevate some test results. The nurse's supply room just down the hall has plenty of alcohol wipes. We better note on the paperwork that you used iodine so the lab will know."

You are getting ready to insert the needle into a patient's arm and then the patient wants to pump their fist. Since they want to be helpful, how would you tell them what to do?

'Just pump your fist once and hold it until I get the needle inside. Then you can relax your fist.' One fist pump is sufficient but more pumps can actually dislodge the needle hemoconcentrate the blood.

What is the maximum depth that a lancet can penetrate for the premature newborn?

.85 mm

What is the maximum depth that a lancet can penetrate for the average newborn HEEL stick?

1 mm

What is the maximum depth that a lancet can penetrate for an ADULT finger stick?

2 mm

This needle is the standard needle for routine venipuncture.

21 gauge

What is the percent of normal total blood volume that are red blood cells (RBCs)?

45%

The average person has about ____ liters of blood.

5

What is the approximate percent of total blood volume that is plasma?

55%

Plasma is...

90% water

Which of the following substances would be the best thing to use to disinfect a blood spill on a lab counter-top prior to cleanup?

A 1:10 dilution of bleach

Which of the following would be the best choice of equipment for drawing a small hand vein?

A 23-gauge butterfly and ETS holder

Which of the following is most likely the policy that hospitals and labs would have regarding asking patients about their medications?

A phlebotomist can ask about medication when it directly relates to the draw such as when drawing for a medication level or if they are taking medication that 'thins' the blood if there is evidence of easy bruising.

What are the two major blood antigen types?

ABO group and Rh group

What can happen if the phlebotomist does not allow the alcohol to dry completely before puncturing the skin?

ALL are correct but concentration of the specimen.

Which of the following work environments might you use butterflies more often?

All answers correct but adult family medicine clinic.

Which of the following additives is an anticoagulant?

All but gel and clot activator

When it is hard to find a vein on a patient, which of the following could help?

Apply heat if possible, retie tourniquet, scrub skin well with alcohol to help pop up veins.

Capillary blood is what component?

Arterial and venous blood

You are a phlebotomy student on rotation at an outpatient site. A patient who seems extremely apprehensive about having her blood drawn tells you that she is afraid of needles. What should you do?

Ask an experienced phlebtomist to perform the draw for you.

You have just made two unsuccessful attempts to collect a fasting blood specimen from an outpatient. The patient rotates his arm, and you note a large vein that you had not seen before. How do you proceed?

Ask another phlebotomist to collect the specimen.

BLRGLDLGY

Blood coagulation. light blue. red.gold. light gren. dark green,lav, gray, yello

What can happen if the tourniquet is left on too long during the draw?

Blood specimen can have too high of a red blood cell count.. Because the pressure causes plasma to leave the veins causing a higher RBC count.

How can you tell that you are in a vein when drawing blood with a butterfly?

Blood usually appears in the tubing

How would you know if you punctured an artery with your needle?

Blood would be a brighter red and enter into the tube rapidly, maybe even in pulses.

Lavender tubes are used for what kind of common lab tests?

CBC

Which AC vein is not very well anchored?

Cephalic

Sodium citrate tubes are used for what purpose?

Coagulation tests

The time is 0750 hours. You have received the following test requests on different patients. Which test specimen should you collect first?

Cortisol ordered for 0800

What is the main reason for using a BLUE tube?

Doctor wants to know if pt's blood clotting ability is functioning properly

You are performing a venipuncture on a difficult vein using a butterfly. You can have an SST and a light-blue-top tube to collect. How do you proceed?

Draw a clear tube, fill and mix the light-blue top, then fill and mix the SST.

What is the additive in the white topped tube ("pearl top")?

EDTA

Which additive preserves the shape of blood cells and stops platelets from clumping?

EDTA

Which of the following is the additive in lavender (purple) topped tubes?

EDTA

The most common, direct, and efficient means of venipuncture is

ETS needle and tube holder.

Most of the venous system flows with the pull of gravity.

FALSE

Which of the following statements describes proper venipuncture technique?

Fill additive tubes until the vacuum is exhausted.

Which fingers is best for the average skin puncture on an adult?

Fourth finger (ring finger) middle finger

Which of the following is an inert, synthetic substance that is put into some tubes to help form a barrier?

Gel

What do the gold and tiger red tubes have in common?

Gel and extra clot activator

What does the gold and tiger red tubes have in common?

Gel and extra clot activator

A patient in a hospital has refused their blood draw from an inexperienced phlebotomist. The phlebotomist did not even get to try one time to draw blood and only asked the patient once. You are nearby and overhear the patient refuse. You are also more experienced. The inexperienced phlebotomist comes out of the room and asks you what to do next. What do you think is best to do under these circumstances?

Go in and ask the patient one time yourself, in case the patient is detecting inexperience from the phlebotomist and is reluctant. If patient still refuses, go inform the patient's nurse and let them know that the patient refused twice

Serum tubes are...

Gold, Red, Tiger Red

Which tube is typically used for testing for antibodies?

Gold. Antibody testing is often performed on serum. Antibody tests are tests like HIV antibody, hepatitis B antibody, and hepatitis C antibody.

Phil Phlebotomist is performing a draw on his patient. He takes his eyes off the needle to pull the tourniquet early and hears a hissing sound. What most likely happened?

He took his eyes off the needle and the bevel became exposed, which caused the tube to suck in air.

Which anticoagulant prevents coagulation by inhibiting thrombin formation?

Heparin

Blood flow during a draw can be affected by several things. How does needle gauge affect the flow of blood?

If affects the flow of blood by the size of the lumen space within the needle. The larger the space, the faster the flow of blood. The smaller the space, the slower the flow.

Why is the non-dominate fingertip used for palpating (feeling) veins? Select the BEST answer.

It has both the advantage of having thinner skin as well as availability of use, since the dominate hand holds needle.

What are the properties of blood when it is collected by dermal puncture?

It is a mixture of venous and arterial blood. It is capillary blood. There is a higher concentration of arterial blood and a lower concentration of venous blood

What are the properties of blood when it is collected by dermal puncture? There may be more than one answer...

It is capillary blood. It is a mixture of venous and arterial blood.

What is the advantage to using a butterfly?

It is easy to get a low angle with butterflies, therefore making hard veins easier.

What is the purpose of a royal-blue topped tube?

Minimize trace element contamination

Which of the following tubes would most typically be used for a stat chemistry test such as a potassium test (K) or a basic metabolic panel (BMP)?

Mint green. Using a mint green (sometimes referred to as a light green) allows the lab to immediately process the tube. They do not have to wait for blood to clot like the red or gold tubes.

What is the most critical error a phlebotomist can make?

Misidentifying a patient specimen

Another term for sodium is...

Na

Which hand and part of hand is used by the phlebotomist for selecting the vein and for anchoring the vein before the draw?

Non-dominate hand index finger - finding vein. Non-dominate hand thumb - anchoring vein.

Where are infants' heel sticks performed on the heel?

On the inside and outside borders of the heel.

Which of the following patients is NOT a good candidate for dermal puncture?

Patient with arms with edema (mastectomy patient for example)

You are watching a new phlebotomist perform their first fingerstick and they become real excited when seeing the blood rise further and further up into the capillary tube. Suddenly, they say, "What do I do? What do I do? I can't stop it! It's going to go out the other end!" What do you tell them to do?

Place their index finger on the opposite end (top) of the capillary tube than the finger end.

Which tube needs to sit for at least 50 to 60 minutes before processing?

Plain red (plastic or glass)

Review each situation below and select the BEST example of a 'reflexive' test.

Pt has a syphilis test (RPR) that was reactive. Lab immediately performs additional test (VDRL) to determine level of infection. Both results are sent to MD.

Which of the following tests is most affected by altitude?

RBC count

Lime green tubes are often used for what kind of common lab tests?

STAT chemistry

What is the additive in gray topped tubes?

Sodium fluoride and potassium oxalate

Which needle can be removed from the blood collection unit before disposal?

Syringe needle

There is more than one type of heparin additive.

TRUE: there are 3 types - sodium, lithium, or ammonium.

The difference between a SST tube and a PST tube is that...

The SST tube can be a gold or red tiger and the PST is often mint green.

Why should threading of the needle up into the lumen of the vein be avoided in most blood draw situations? (Threading is when the needle enters the vein and the drawer lowers the angle of the needle and moves the needle up the vein about an additional inch, or so.)

The needle shaft at point of entry could create too much pressure on the vein causing a pulling effect and even allow blood to leak from top side of vein. It can often be uncomfortable for the patient due to the extra tension. There is a greater chance the bevel could go through the back wall of the vein. The bevel could slice the vein

If a blood tube is left standing, the red cells, white cells, platelets, and liquid (plasma or serum) will separate because of what reason?

They separate because of their different densities.

Which of the following equipment is required when collecting blood by syringe?

Transfer device

Which of the following is true for laboratory testing with serum tubes?

Used for over half of all blood tests since it is for chemistry tests

Veins that 'roll' mean what?

Veins that are less well anchored with connective tissue.

Why is venous blood darker than arterial blood?

Venous blood is oxygen poor

It is not a good idea to collect a CBC from a screaming infant because the

WBCs may be temporarily elevated

When is the tourniquet typically released on a one-tube draw?

When the tube is about half-way full. Most phlebotomist will delay even longer if the tube is a blue tube.

IF an outpatient tells you before a blood draw that she is feeling nauseated, you should

advise her to begin slow, deep breathing

How should a PKU card be dried?

airdry away from heat or sunlight

Which test below needs to be put immediately on ice after the draw?

ammonia

Blind or deep probing for a vein can result in

an arterial puncture

Skin changes in elderly patients can make it harder to...

anchor vein

16 gauge butterfly

anetecube draw for donating blood

21 gauge butterfly

antecube draw for average size healthy vein

EDTA is a(n)

anticoagulant

Which type of test requisition has been shown to decrease laboratory errors?

bar coded

The best specimens to use for establishing inpatient reference ranges for blood tests are

basal state specimens

What vein lies superficial to a nerve?

basilic

Match the following terms that are common for skin puncture situations with the one-word descriptor. Glucose. Bleeding time. PKU. Scars. Calcaneous

bedside. coagulation. newborn screening. avoid. heel

Which tube must have a 9 to 1 ratio of blood to additive?

blue

Which tube is a plasma tube and allows the lab to perform a test on plasma?

blue. blood does not clot in a blue tube

The narrow white band that lies above the RBCs in a tube that has been spun down is called the ______ coat. Type in only ONE word!

buffy

Serum is the remaining fluid portion of

clotted blood

Platelets help with what bodily process?

clotting process

A light-blue topped tube is most often associated with tests in this department.

coagulation

A patient experiences a momentary loss of consciousness or a mini-seizure while you are drawing his blood. The last tube has just started to fill. Which of the following is the wrong thing to do?

complete the draw as quickly as you can

If a test is ordered STAT, it may mean that the patient is in

critical condition

ou are a new phlebotomist at a large urban hospital. It is your turn to go to the mother/baby unit for morning draw. As you look over the paperwork for the unit, you notice that you have five mothers to draw and two infants. The One infant is 2 days old; requisition is ordering a HCT The other infant 8 days old; requisition is ordering a WBC with (PLTCNT) platelet count and a potassium level. What equipment would you use, and what type of collection would you perform for each infant?

day old infant - use a lavender pediatric tube from the heel 8 day old infant - use a lavender microtainer first and then a gold microtainer from the heel

What does serum from an icteric sample look like?

deep yellow to yellow-brown color

Which tube is used to draw a little blood into it so as to clear the line of a butterfly from the air inside it?

discard tube

You need to draw an inpatient in the hand for a stat potassium, a protime, and a CBC. What are your tubes and what is the order of draw?

discard, blue, mint green, purple

The reason a test is ordered "timed" is to

draw blood at the best time for accurate results.

A patient's arm is swollen. The term used to describe this condition is

edematous

Which additive preserves the shape of blood cells and stops platelet clumping?

edta

A test is ordered "fasting" to

eliminate the effect of diet on test results.

Arteries carry carbon dioxide and wastes.

false

Fibrinogen is found in serum.

false

If a tube of unclotted blood is left standing for some time, you will find the buffy coat in beween the serum and the RBCs.

false

It is acceptable to collect a PKU by filling the circles with blood using both sides of the paper.

false

Platelets are fully functional cells.

false

Serum can be centrifuged immediately.

false

What does serum lack? (think of what happens during clotting process)

fibringen

The Becton-Dickinson company manufactures a "pink" tube. What is the purpose of this tube?

for blood typing test

Needles are color coded according to

gauge

Virginia is going to draw Jill for a skills test. Virginia has randomly picked K and PLNH3. What tubes does she draw, and what order does she draw them in?

gold. lime

Which of the following tubes would typically be used to collect plasma for a stat chemistry specimen?

green

22 gauge butterfly

hand draw with average size veins

25 gauge butterfly

hand draw with small fragile veins or wrist veins

A vein that has patency...

has a bounce or resilience to it.

An outpatient becomes weak and pale after a blood draw. What should the phlebotomist do?

have the patient lie down until recovered

All of the following are acceptable actions during the vein selection process except

having a patient pump his or her fist repeatedly.

Most reference ranges are based on normal laboratory test values for

healthy people

What molecule exists in high numbers inside a red blood cell that helps with the transporting of oxygen?

hemoglobin

Green tubes have which additive?

heparin

A PST contains

heparin and gel

Lipemia results from

high fat content of the blood

In which instance was the patient closest to basal state?

is awakened for a blood draw at 0600 after fasting since 0800 last night

What is an analyte?

it is a substance undergoing analysis or being measured

If a tube has an additive within it, what must be remembered?

it must be inverted after the draw

What is the other word for icterus?

jaundice

Which tube is mixed (inverted) more times than the other tubes after the tube has been filled with blood?

lav. 8x times

Which tube is used for counting the red blood cells and determining the count and differential of EACH TYPE of white blood cells?

lav. One way to remember is when you see that the word "count" is in the test, there is a high possibility that when referring to the blood cells (RBCs, WBCs, platelets), they are in the lavender tube. Hematology department does many tests that are "counts" of something (like RBCs).

Exsanguination is

life-threatening loss of blood

Which of the following tubes contains an anticoagulant that works by binding calcium?

light blue

Which of the following tubes is a plasma separator tube?

light green (mint)

What does vein patency refer to?

medical condition of not being blocked

A patient who is NPO

no food or water

Lymphostasis is

obstruction of the flow of lymph

During a fingerstick, how should the puncture be aligned with the grooves of the fingerprint?

perpendicular to the grooves

Which tube do some blood banks require to be used for 'typing' a patient's blood

pink

Which tube do some blood banks require to be used for 'typing' a patient's blood?

pink

Thrombocyte is the scientific term for which of the following?

platelet

The answer may not have been provided for you - use your critical thinking skills to consider WHAT occurs when an incision is made in the skin. Which of the two tests below would be FIRST to collect if a skin puncture was performed?

platelet count

Another name for thixotropic gel is...

polymer gel

An antiglycolytic agent

prevents the breakdown of glucose.

Which test below is a coagulation test?

protime

Pain associated with venipuncture can potentially be minimized by

putting the patient at ease with a little small talk

Sharps containers do not have to be

recyclable.

The proper way to transfer blood from a syringe into an ETS tube is to..

safely remove the needle and attach a transfer device to fill the tube.

When performing a finger stick, the puncture site should be located

slightly to the side of the center of the finger

Of the following tubes or containers which is filled first in the ETS (evacuated tube system) order of draw?

sps

Venous stasis is

stoppage of blood flow

When performing a finger stick, you will be most successful if you pick

the non-dominant hand

Which of the following additives provides a physical barrier to prevent glycolysis?

thixtropic gel

Hemoconcentration of the blood specimen is what?

too many RBC

You are performing a multi-tube blood draw with a straight needle. You collect blood into the first tube without a problem. Then second tube fails to fill with blood. You pull the needle back and nothing happens. You push the needle a little deeper and nothing happens.Which of the following actions should you take?

try a new tube in case it is a vacuum issue

Misidentification of a specimen for this test is MOST likely to have fatal consequences.

type and screen

You are collecting a PKU on an infant's heel. Right before you finish, You notice that on the back side of the PKU card, one of the circles is incompletely filled. Does this matter?

yes

A student asks the patient for permission to draw a blood specimen. Which of the following answers implies that the student does NOT really have permission?

yes but i would rather not