NCCT Certification Exam

Which of the following statements made by a phlebotomist indicates understanding of proper specimen processing? (Select the two (2) correct answers.) A. "I must pre-label aliquot tubes one patient at a time." B. "I must centrifuge a gray top tube for whole blood testing." C. "I must label aliquot tubes one patient at a time immediately after aliquoting." D. "I must aliquot a K level into an amber tube." E. "I must remove stoppers from tubes using a face shield."

"I must pre-label aliquot tubes one patient at a time.", "I must remove stoppers from tubes using a face shield." Rationale Aliquoting is the process of transferring a portion of the original specimen to another container for testing. The secondary tubes must have the exact same information as the primary container. Tubes are prelabeled one at a time before the transfer to prevent picking up the wrong tube. Stoppers should be removed using a face shield to protect the processor from aerosols or splashes of fluid. If a tube is centrifuged, it would no longer be useful for whole blood testing. Potassium (K) levels do not need protection from light.

The physician has ordered a sputum collection. Which of the following patient instructions must be given before collection of the sputum? A. "Breathe deeply in and out." B. "Rinse the mouth with warm water." C. "Cough several times." D. "Brush your teeth and use mouthwash."

"Rinse the mouth with warm water." Rationale Before collection of a sputum specimen, the patient is asked to rinse the mouth with warm water. This helps minimize contamination with saliva. Brushing the teeth and using mouthwash might contaminate the sample with those chemicals. Deep breathing has no affect on the collection and coughing is the way in which the sample is collected.

A phlebotomist is tasked with drawing a STAT CBC and a CMP. After palpation, no veins can be felt and there are no visible veins on the back of the hand. The phlebotomist decides to perform a capillary stick. Which of the following microtainers should the phlebotomist choose? A. 1 polymer gel and 1 without an additive. B. 1 EDTA and 1 heparin. C. 1 polymer gel and 1 EDTA. D. 1 heparin and 1 without an additive.

1 EDTA and 1 heparin. Rationale If there are no veins available for venipuncture and a smaller amount of blood can be used for the tests requested, a capillary collection may be appropriate. A lavender (EDTA) microtainer would be used for the CBC and drawn first. Since the request is STAT, the CMP would be drawn in heparin as this tube could be immediately centrifuged and resulted quickly. The polymer gel or non additive tube would have to be allowed to clot, adding to the result turn around time.

A new bariatric patient has come to the lab for CMP and CBC. Inspection of both arms did not reveal any veins. The patient tells the phlebotomist that blood is usually drawn from her hand. Which of the following should the phlebotomist use to draw blood from this patient's hand? A. 21g needle at a 40 to 45 degree angle B. 21g needle at a 10 to 15 degree angle C. 23g needle at a 40 to 45 degree angle D. 23g needle at a 10 to 15 degree angle

23g needle at a 10 to 15 degree angle Rationale Hand veins are close to the surface and tend to "roll". A smaller (23g) needle and lower angle (10-15 degrees) may help the phlebotomist be successful. Any size needle inserted at a steep angle of 40-45 degrees would likely go through the vein and may cause the patient injury. A 21g needle is too large for a hand vein and might cause a hematoma.

Which of the following urine samples should be used for a cortisol level? A. timed B. 24 hour C. random D. clean catch

24 hour Rationale Cortisol is a hormone produced in the adrenal glands that helps to regulate glucose, blood pressure and other metabolic processes. It exhibits diurnal variation - meaning the results are affected by the time of day the specimen is collected. By collecting all urine for 24 hours, a more comprehensive result is obtained. A timed or random specimen would only give a snapshot of cortisol level at the time it was collected. Clean catch specimens are used for urine cultures to help diagnose the cause of a UTI (urinary tract infection).

A patient is receiving therapeutic medication. Which of the following is the correct way to draw trough levels? A. 60 minutes prior to medication administration B. 30 minutes after medication administration C. 30 minutes prior to medication administration D. 10 minutes after medication administration

30 minutes prior to medication administration Rationale It is crucial to accurately monitor the levels of therapeutic medications as many of these drugs have harmful side effects. The physician needs to know that the dose of a particular medication is at the appropriate level to assure it's effectiveness. If the level is too low, no medical benefit will be produced. If too high, there may be toxic consequences. This is called a therapeutic window. A trough (lowest) level is drawn immediately prior to administration and serves as a baseline. A peak (highest) level is drawn at a prescribed time after the drug has been administered. Drawing a trough at any time after the medication has been started is contraindicated as it would not provide the lowest level of the drug.

A pregnant woman presents with orders for an oral glucose gestational challenge test. After the patient finishes the drink, how long does the phlebotomist need to wait before drawing the specimen? A. 180 min B. 60 min C. 90 min D. 120 min

60 min Rationale The prenatal oral glucose challenge is performed to identify the likelihood for gestational diabetes - a condition that can present health risks for the mother and baby. The fasting patient is given 50 to 75 mg of an oral glucose drink and a blood specimen is collected 60 minutes after the drink is finished. A value of 140 mg/dl is considered normal. If the test is positive, then a full oral glucose tolerance test may be ordered.

If alcohol is used to decontaminate the capillary puncture site, which of the following should the phlebotomist do? A. Use two alcohol pads for cleaning. B. Dilute the strength of the alcohol. C. Wipe away the 2nd drop after the puncture. D. Allow the site to air dry before the puncture.

Allow the site to air dry before the puncture. Rationale When performing a capillary (dermal) blood collection, it is necessary to allow the alcohol used for cleansing the site to completely dry before making the puncture. If the area is wet, it will be more painful to the patient, contaminate the blood sample, and cause hemolysis of the red blood cells. A wet site also prevents the formation of a rounded drop because blood will mix with the alcohol, running down the finger and making it harder to collect. The first drop of blood is wiped away as it would be contaminated with tissue fluid. Diluting the strength of the alcohol will make it less effective. Two alcohol pads are not required.

The doctor has ordered a fecal occult blood specimen to be collected by the patient. Which of the following preparatory instructions should the phlebotomist give the patient? A. Consume 8 ounces of fiber before collection. B. Avoid taking vitamin C prior to collection. C. Stop taking prescription medication 12 hours prior to collection. D. Fast for eight hours before collection.

Avoid taking vitamin C prior to collection. Rationale Many laboratory tests have special instructions to be followed by the patient in order to help produce accurate results. For fecal occult blood (FOB) tests it is necessary to avoid ingesting vitamin C for 72 hours as this may cause a false positive test. Fasting, consuming 8 oz of fiber or stopping prescription medications do not affect the test and may be contraindicated.

Which department within the lab should a BMP be delivered to? A. Serology Department B. Chemistry Department C. Blood Bank Department D. Coagulation Department

Chemistry Department Rationale A BMP is a panel of tests (glucose, calcium, BUN, creatinine, sodium, chloride, potassium, CO2) performed in the Chemistry department. The Serology department tests for antibody levels, the Blood Bank does blood types and transfusions and the Coagulation department tests for clotting factors.

A phlebotomist collects citrate, EDTA, and oxalate tubes in that order. Which of the following is the correct lab department for each tube? A. Citrate to coagulation, EDTA to hematology, and oxalate to chemistry. B. Citrate to hematology, EDTA to hematology, and oxalate to immunology. C. Citrate to coagulation, EDTA to immunology, and oxalate to chemistry. D. Citrate to hematology, EDTA to immunology, and oxalate to chemistry.

Citrate to coagulation, EDTA to hematology, and oxalate to chemistry. Rationale Clinical laboratories are divided into several departments by the type of testing that each performs. Citrate tubes (light blue) go to the Coagulation area. EDTA tubes (lavender) are processed in Hematology. An oxalate tube (gray) would go to the Chemistry department.

A phlebotomist is preparing to draw an 85-year-old patient whose skin is thin and paper like. Which of the following should the phlebotomist use to secure the gauze? A. paper tape B. bandage C. Micropore D. Coban

Coban Rationale Geriatric patients tend to have thin skin that can tear when an adhesive bandage is removed. Coban is used in these cases as it sticks to itself and not to the skin. Paper tape, Band-Aids, and micropore tape are all adhesive bandages.

Which of the following should the phlebotomist tell the patient when giving instructions to a patient for sputum collection? (Select the two (2) correct answers.) A. Collect a first morning specimen. B. Collect the specimen 1 hour after eating a meal. C. Gargle with mouthwash before collection .D. Consume only clear liquids prior to collection. E. Rinse the mouth with sterile water prior to collection.

Collect a first morning specimen., Collect the specimen 1 hour after eating a meal. Rationale First morning specimens are preferred for sputum collections as secretions tend to collect in the lungs overnight and a larger volume of specimen can be produced. It is advisable to wait at least an hour after the patient has eaten to minimize the risk the patient will gag or vomit. Rinsing the mouth with water before the collection will reduce the risk of contaminating the sample with normal mouth flora. Mouthwash may contain antiseptics which could contaminate the sample. Sterile water is not necessary. A normal diet may be followed before the procedure.

A phlebotomist is drawing a sample for glucose testing and realizes she is using a pink top sample tube. Which of the following should the phlebotomist do? A. Quarantine the sample. B. Discontinue the draw and reschedule the patient. C. Continue the draw using a black top. D. Continue to draw using a gray top.

Continue to draw using a gray top. Rationale A blood sample for glucose testing may be drawn in a gray top tube (sodium fluoride and potassium oxalate) so the phlebotomist should change from a pink top (EDTA) to a gray. If not needed for other tests, the pink top may be discarded. If the draw is proceeding well there is no need to discontinue or reschedule it. A black top (EDTA) is used for ESR (erythrocyte sedimentation rate) tests and not for glucose.

Which of the following laboratory departments should a Pap smear be delivered to? A. Hematology B. Immunology C. Microbiology D. Cytology

Cytology Rationale Pap smears sent to the lab for cancer screening are delivered to the Cytology department. Hematology counts levels of blood cells, Immunology checks for levels of antibodies and Microbiology assesses specimens for pathogenic bacteria.

A phlebotomist has just gathered her supplies for an out-patient procedure and has selected grey, red, light blue, and lavender tubes. Which of the following is the appropriate order of draw? A. lactic acid, ESR, D-dimer, RPR B. D-dimer, RPR, ESR, lactic acid C. HIV, CTGC, D-dimer, RPR D. D-dimer, RPR, CTGC, HIV

D-dimer, RPR, ESR, lactic acid 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 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). In this case, the light blue would be drawn first for the D-dimer, the non-additive (serum) tube second (RPR), lavender (ESR) third and gray (lactic acid) last. The grey top should be transported in an ice slurry.

A phlebotomist has just drawn a chemistry tube on an inpatient at the hospital. The tube has been spun down and opened so that an aliquot could be taken from the sample. A request for a blood alcohol level has been ordered on the same patient. Which of the following should the phlebotomist do? A. Add the test to the aliquot. B. Draw a new chemistry tube on the patient C. Call for permission to add the test to the aliquot. D. Allow the patient sufficient time before drawing a new tube.

Draw a new chemistry tube on the patient. Rationale It is not uncommon for additional testing to be requested on blood specimens that have already been drawn. However, if alcohol had been used to clean the venipuncture site, an alcohol level should not be run on this specimen. Since the tube's cap had already been removed, the alcohol level would not be accurate because this analyte is a volatile substance and subject to evaporation. The proper step to take is redraw the patient for the alcohol level.

Which of the following is the correct order for filling micro collection tubes when multiple tests are ordered? A. EDTA, non-additive tubes, other additive tubes B. non-additive tubes, EDTA, other additive tubes C. EDTA, other additive tubes, non-additive tubes D. non-additive tubes, other additive tubes, EDTA

EDTA, other additive tubes, non-additive tubes Rationale The order of drawn for dermal punctures is different than for venipuncture. Since there is no risk of "carryover" of additives with which to be concerned , the CBC (EDTA) tube should be collected first as it presents the most likely to form clots. Then other additive tubes such as heparin and sodium fluoride. It is important to continually mix the additive tubes while performing the procedure. Serum tubes (red or gold with no anticoagulant) are collected last as clots forming in these will not matter.

Which of the following is a POCT? A. cortisol B. FOB C. iron D. T4

FOB Rationale Although more and more laboratory tests are available as POCT (point of care testing), cortisol, iron and T4 are still performed in the main lab. Fecal occult blood (FOB) is a waived test used to screen for gastrointestinal bleeding. This may be done as POCT.

During a venipuncture the patient has excessive bleeding and then states she forgot to mention her anticoagulant (Coumadin) therapy. Which of the following should the phlebotomist do immediately after removing the needle? A. Immediately apply a pressure bandage. B. Ask the patient to hold pressure on the site and then look for a physician. C. Hold pressure on the site for a minimum of five full minutes until the bleeding stops. D. Hold pressure on the site until the bleeding begins to stop and apply a bandage.

Hold pressure on the site for a minimum of five full minutes until the bleeding stops. Rationale The phlebotomist is responsible for post venipuncture wound care which includes confirming that the site has stopped bleeding. If the patient is on coumadin or other anticoagulant therapy, this may require applying pressure for five minutes or longer and the application of a pressure bandage before releasing the patient. Immediately applying a pressure bandage does not assure the wound will close and bleeding will stop. Leaving the patient to apply pressure while going to find a physician may result in patient injury. A patient should never be left alone.

Which of the following is a coagulation test that can be performed with a POC machine or instrument? A. HCT B. BUN C. D-dimer D. INR

INR Rationale Currently, the only coagulation test available as a POC (point of care) is the INR which monitors coumadin levels. The D-dimer must be performed in the lab. Hct ( a hematology test) and Bun (a chemistry analysis) can be done as POC but are not coagulation tests.

Which of the following laboratory departments should a rapid plasma reagin (RPR) be delivered to? A. Hematology B. Microbiology C. Immunology D. Histology

Immunology Rationale The specimen collected for an RPR should be delivered to the immunology department. This area of the lab performs testing for antibodies to antigens (bacteria, viruses and other organisms) found in the blood. The RPR is a screening test for syphilis. Hematology counts blood cells, microbiology performs cultures and histology prepares thin sections of tissues for diagnosis of disease.

A phlebotomist working in an outpatient setting has just received a set of guaiac smears from a patient that must be processed. How should the phlebotomist process the specimen? (Select the two (2) correct answers.) A. Develop with 70% isopropyl alcohol. B. Keep at room temperature. C. Develop with hydrogen peroxide. D. Keep chilled. E. Develop with normal saline.

Keep at room temperature., Develop with hydrogen peroxide. Rationale Guaiac smears are a waived point of care method of screening for fecal occult blood. After the patient collects these, they are returned to the lab or physician's office for testing. The test consists of developing the area with hydrogen peroxide. A blue color around the specimen on the card indicates the presence of blood. Each card has a quality control (QC) area which is developed first. Should the QC does not perform correctly, the patient results are invalid. These specimens are kept at room temperature. Normal saline or 70% alcohol is not used in this test.

Which of the following is a phlebotomist required to do when preparing to aliquot a specimen? (Select the three (3) correct answers.) A. Match the labels on the tubes. B. Invert the tubes 8 to 10 times before centrifuging. C. Prepare under a bench top splash shield. D. Pour the specimen directly into the aliquot container. E. Use a disposable transfer pipette.

Match the labels on the tubes., Prepare under a bench top splash shield., Use a disposable transfer pipette. Rationale An aliquot is a portion of a specimen taken from the original sample to have further testing done in a different area of the lab. It is crucial to have the exact same information on the aliquot container as the original tube. When separating specimens, a bench top splash shield should be used to prevent splashes of blood or body fluids from coming into contact with the processor. Specimens are not poured directly into aliquot containers. Disposable transfer pipettes are used in moving portions of the sample to the aliquot tube.

A phlebotomist is to draw blood from a psychiatric patient. The patient does not understand what is being done. Which of the following is the appropriate action the phlebotomist should take to ensure the safety of all? A. Perform the blood draw in the presence of the physician. B. Explain the procedure to the patient thoroughly. C. Confirm the patient's identity and perform the draw. D. Take patient restraints into the room.

Perform the blood draw in the presence of the physician. Rationale If the patient is not mentally competent enough to understand and consent to a medical procedure, the caregiver or physician must be present. Performing a draw without positive identification from the patient can be seen as malpractice and without consent is considered assault and battery. Patients can only be restrained on orders from a physician and after all other measures have been exhausted. Phlebotomists do not place patients in restraints.

Which of the following is the best way to properly anchor the vein? A. Use the thumb and index finger to stretch the skin. B. Place the thumb 1 to 2 inches below the site .C. Use two fingers and stretch the skin toward the forearm. D. Hold skin with thumb tightly and pull forward toward forearm.

Place the thumb 1 to 2 inches below the site. Rationale Using the thumb of the non-dominant hand to anchor the vein 1 to 2 inches below the site before inserting the needle for venipuncture not only keeps the vein from rolling but stretches the skin and helps make the puncture less painful. Using the thumb and the index finger (C or window hold) leaves the index finger in line for a possible needlestick injury. Just enough pressure should be applied to keep the vein still.

Which of the following should the phlebotomist do if urine testing will be delayed more than an hour? A. Place the urine on ice, then in the refrigerator. B. Protect the specimen from light. C. Place the urine specimen in the refrigerator. D. Store the urine at room temperature.

Place the urine specimen in the refrigerator. Rationale For accurate test results, a urine specimen should be refrigerated if testing is delayed more than one hour. Chemical and cellular contents will deteriorate at room temperature. Bacteria will multiply and change test results. However, the specimen should be brought to room temperature before testing. Unless the test requested is susceptible to light, there is no need for light protection. It is not necessary to use ice, refrigeration at 2 - 8 oC is sufficient.

Which of the following should the phlebotomist do with a patient known to have a fainting problem? A. Inform the physician that the patient cannot be drawn. B. Give the patient orange juice. C. Position the patient supine. D. Ask a co-worker to assist.

Position the patient supine. Rationale If a patient is known to have a history of syncope (fainting) during blood draws, it is best to perform the procedure in a supine position. This minimizes the chance of patient injury. Asking a co-worker to assist might help distract the patient and provide help if it is needed. It is not necessary to inform the ordering physician unless there is an untoward event. Giving the patient orange juice might induce vomiting or affect the test results.

SPS, SST, heparin, EDTA Rationale The order of draw is designed to prevent carryover of additives from one tube to the next thereby affecting patient results. CLSI states the order of draw for ETS tubes to be: SPS (sterile), sodium citrate (blue), serum (red or gold), heparin (green), purple (EDTA), oxalate / fluoride (gray). In this case the order would be SPS blood cultures, SST (serum separator), Heparin (green), EDTA (purple).

SPS, SST, heparin, EDTA Rationale The order of draw is designed to prevent carryover of additives from one tube to the next thereby affecting patient results. CLSI states the order of draw for ETS tubes to be: SPS (sterile), sodium citrate (blue), serum (red or gold), heparin (green), purple (EDTA), oxalate / fluoride (gray). In this case the order would be SPS blood cultures, SST (serum separator), Heparin (green), EDTA (purple).

A phlebotomist is assigned to manage an outpatient draw station. Prioritize the following patients in the correct order. A. 2-hour post-prandial glucose level due in 40 minutes B. type and screen on a pre-operative patient due for surgery that day C.weekly PT/INR D.STAT troponin level on a patient sent over from a doctor's office

STAT troponin level on a patient sent over from a doctor's office, type and screen on a pre-operative patient due for surgery that day, 2-hour post-prandial glucose level due in 40 minutes, weekly PT/INR Rationale It is important that a phlebotomist be able to prioritize blood draw orders. This assures that patients get correct and timely medical treatment. A STAT troponin level is used to triage the possibility of heart attack. The type and screen for surgery the same day is needed so the Blood Bank staff can assure blood components can be ready if necessary. For accurate results, timed tests need to be drawn within a certain window. The weekly PT/INR can be done anytime.

Which clinical laboratory department do ANA, HIV, and HCG specimens go to? A. Microbiology B. Biochemistry C. Serology/Immunology D. Hematology

Serology/Immunology Rationale There are many departments within a clinical laboratory and each is responsible for a certain discipline of testing. The serology / immunology area tests for antibodies to viruses such as HIV (Human Immunodeficiency Virus), levels of hormones like HCG (Human chorionic gonadotropin) and autoimmune antibodies such as ANA (Anti-nuclear Antibodies). Microbiology tests blood, other body fluids and tissues for the presence of bacteria, viruses, and parasites. The biochemistry department measures levels of glucose and other nutrients, enzymes, hormones, lipids and proteins, vitamins, therapeutic drugs, drugs of abuse, minerals and trace elements. Hematology describes and measures levels of red blood cells, white blood cells and platelets.

The phlebotomist notices that the patient's INR is in the critical value range. Which of the following should the phlebotomist contact regarding the critical result? A. The doctor who ordered the test. B. The doctor's nurse. C. The doctor's medical assistant. D. The lab manager.

The doctor who ordered the test. Rationale A critical result should be reported to the ordering physician so that immediate follow up action can be taken to prevent harm to the patient. It may be acceptable to report these results to the doctor's nurse or medical assistant but the phlebotomist should document the date, time and to whom the information was given. The lab manager is not usually involved in result reporting except to create and enforce the policies that govern the task.

A hospital phlebotomist is conducting routine glucose monitoring for a patient. Why should the first drop of blood be wiped away prior to applying it to the test strip? A. The 70% isopropyl can contaminate the blood sample and give elevated results. B. The patient may have bacteria on their finger, which can cause abnormal results. C. The first drop is over oxygenated. D. The first drop of blood may contain fluid from the tissues.

The first drop of blood may contain fluid from the tissues. Rationale The first drop of blood obtained after a dermal puncture will contain tissue fluid and should be wiped away for accurate test results. The 70% alcohol used to clean the site should be allowed to dry completely so as not to contaminate the sample or cause pain to the patient. Bacteria on the finger should have been cleaned away during site preparation. The amount of oxygen in the capillary specimen will not affect test results unless arterial blood gases are being measured.

Which of the following is the reason a phlebotomist should avoid milking a finger during a capillary puncture? A. The specimen may be contaminated with interstitial fluid. B. The specimen may be contaminated with staphylococcus aureus. C. The specimen may be contaminated with isopropyl and cause hemolysis. D. The collection site may be contaminated by the phlebotomist's gloves.

The specimen may be contaminated with interstitial fluid. Rationale Milking a capillary puncture, in an effort to obtain more blood, involves excessive squeezing and the possible introduction of tissue fluid into the specimen, thereby diluting or contaminating the result. The phlebotomist needs to assure the area is warm to encourage good blood flow, perform an adequate puncture with the correct device, wipe the first drop of blood away and continue with a "squeeze, collect and release" rhythm to allow blood flow to recover after the squeezing and collection. Contamination with staphylococcus aureus can occur if the puncture area is not adequately cleaned or is retouched after cleaning. Contamination with isopropyl alcohol can occur when the area is not allowed completely dry resulting in the possibility of hemolysis of the specimen.

A glucose specimen collected in a gel barrier tube from a hyperglycemic patient was left in a pneumatic tube system for four hours before being centrifuged. The test results were unusually low. Which of the following specimen handling errors is most likely to have caused the inaccurate results? A. The specimen was not protected from light and cells were not separated from serum or plasma within the time limit. B. The specimen was not protected from light and was not placed on ice. C. The specimen was transported in a pneumatic tube system and was not placed on ice. D. The specimen was transported in a pneumatic tube system and cells were not separated from serum or plasma within the time limit.

The specimen was transported in a pneumatic tube system and cells were not separated from serum or plasma within the time limit. Rationale When a physician orders laboratory testing, he is looking for a "snapshot" of the patient's condition at the time the specimen was collected. If the cells are not separated from the serum/plasma in a timely manner (2 hours), metabolism will continue and the levels of analytes will change. Since this glucose was drawn in a gel barrier tube and left unspun for 4 hours, the results could be lowered by as much a 7% per hour. This could cause inaccurate treatment of the patient. It is not necessary to place this specimen on ice or protect it from light. Timely transport and processing are crucial.

A phlebotomist performs a blood draw testing for CBC, chemistry, and bilirubin. After the draw, the phlebotomist wraps the bilirubin tube in aluminum foil. Which of the following was the reason for the wrapping of the bilirubin tube? A. To cool down the specimen. B. To maintain the specimen at 37 degrees Celsius. C. To protect specimen from light. D. To prevent contamination of the specimen.

To protect specimen from light. Rationale Levels of bilirubin 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. The specimen does not have to be cooled down or maintained at body temperature (37oC). Also, the foil wrapping does not prevent contamination of the specimen.

At what point should specimen labeling occur? A. During assembly of the equipment. B. Upon completion of the blood draw. C. Before approaching the patient's side. D. After the patient is released.

Upon completion of the blood draw. Rationale Specimens should be labeled immediately after drawing at the patient's side. Some facilities require the patient to review the labels on the tubes to assure that they are correct. Labeling tubes after the patient is released omits this step. Applying labels during equipment assembly or before approaching the patient is contraindicated as the phlebotomist may encounter a faulty tube and have to obtain a new set of labels. Also, it is too easy to pick up a pre labeled tube for another patient.

A trough Dilantin (phenytoin) level is ordered to be collected at 12:30 PM. The phlebotomist arrives at 12:20 PM to collect the specimen and notices the patient is receiving an infusion of normal saline in the right arm and Dilantin in the left arm. Which of the following is the appropriate course of action? A. Collect the specimen distal to the normal saline infusion and label it as peak level. B. Verify the time of collection with the patient's nurse or physician. C. Consult the patient's chart to determine appropriate collection time. D. Contact the laboratory supervisor to confirm peak or trough collection.

Verify the time of collection with the patient's nurse or physician. Rationale It is crucial to accurately monitor the levels of therapeutic medications as many of these drugs have harmful side effects. The physician needs to know that the dose of a particular medication is at the appropriate level to assure its effectiveness. If the level is too low, no medical benefit will be produced. If too high, there may be toxic consequences. This is called a therapeutic window. A trough (lowest) level is drawn immediately prior to administration and serves as a baseline. A peak (highest) level is drawn at a prescribed time after the drug has been administered. In this case, the phlebotomist needs to verify the time the dilantin infusion was begun as it appears the opportunity to draw an accurate trough level has been missed. Consulting with the patient's caregiver - not the chart - will determine the course of action. If a sample needs to be collected, a site distal to the saline infusion would be appropriate. The laboratory supervisor would have no accurate information pertaining to this particular case.

Which of the following samples is still acceptable when kept at room temperature for 8 hours after collection? A. a urine sample B. a stool culture C. a glucose test in a gray top tube D. a B12 test in a red top tube

a glucose test in a gray top tube Rationale Glucose levels are stable in a gray top tube at room temperature for up to three days because they contain the glycolytic inhibitor sodium fluoride. A urine or stool sample would need to be refrigerated to prevent overgrowth of bacteria or deterioration of analytes. Red top tubes for B12 levels should be centrifuged and the serum removed from the cells within 2 hours of collection.

The phlebotomist has orders to draw blood cultures on a patient with fragile veins and decides to use a butterfly system. Which of the following should be drawn first? A. anaerobic B. aerobic C. pediatric D. mycobacterium

aerobic Rationale Blood cultures are typically drawn when the patient's physician suspects a bacterial infection in the bloodstream (septicemia). To maximize the chance of harvesting the infectious agent, the cultures are drawn in sets of two bottles, one aerobic (with air) and one anaerobic (without air). A volume of 20 ml is collected aseptically with 10 ml distributed into each bottle. If the collection is performed with a butterfly system, the aerobic bottle is filled first as the tubing of the butterfly set will introduce air into the container. Once the tubing is filled with blood, the anaerobic bottle is attached and filled. The same order is used regardless of the size or draw volume of the bottles. Mycobacterium is the causative agent of tuberculosis and not a collection device

Which of the following blood tests require special handling? (Select the three (3) correct answers.) A. CBC B. ammonia C. cold agglutinin D. blood culture E. bilirubin

ammonia, cold agglutinin, bilirubin Rationale Many types of specimens require special handling for accurate test results to be obtained by the laboratory. Ammonia must be transported in an ice slurry as this analyte deteriorates rapidly. Cold agglutinins must be kept at 37o C (body temperature). Bilirubin requires protection from light. Consult your facility's policies for the correct procedures to follow. CBCs and blood cultures are kept at room temperature.

Which of the following types of medication work to inhibit blood from clotting? A. antihypertensives B. anticoagulants C. antiglycolytics D. antihistamines

anticoagulants Rationale Medications such as coumadin and heparin are given to patients whose disease process leads to intravascular clotting such as heart attacks (myocardial infarction) and DVTs (deep vein thrombosis). Also called blood thinners, these drugs work by lengthening the time that blood takes to clot. Antihypertensives are used to lower blood pressure. Antiglycolytics lower blood glucose and antihistamines offer allergy relief.

A patient who received a vasectomy 90 days ago reports to the lab for a semen analysis. The patient will be collecting the sample at home. To avoid sample rejection the phlebotomist should instruct the patient to keep the specimen A. at body temperature and return it to the lab within 30 minutes. B. at room temperature and return it to the lab within 30 minutes. C. in a zip locked bag over ice and return it to the lab within 30 minutes. D. in a zip lock bag over ice and return it to the lab within 8 hours.

at body temperature and return it to the lab within 30 minutes. Rationale Semen is analyzed for fertility testing and effectiveness of post vasectomy procedures. It is vital that after the sample is collected in a sterile container, it be kept at body temperature and returned to the lab within 30 minutes. Fertility testing includes measurements of macroscopic, microscopic and physiologic elements. Sperm motility can decrease significantly within 2 hours. Placing the container in ice is contraindicated.

A phlebotomist is asked to process a bilirubin level collected in a red top tube. The phlebotomist should centrifuge the specimen A. at least 20 minutes after collection and aliquot into an amber tube. B. at least 20 minutes after collection and aliquot into a plain tube. C. 60 minutes after collection and aliquot into an amber tube. D. 60 minutes after collection and aliquot into a plain tube.

at least 20 minutes after collection and aliquot into an amber tube. Rationale The specimen should be allowed to completely clot for at least 20 minutes and the serum aliquoted into an amber tube. Levels of bilirubin are susceptible to deterioration if exposed to light. Bilirubin may drop in concentration as much as 50% in one hour if not protected from light.

The phlebotomist draws blood from a patient in an isolation room. The specimen should be properly taken to the lab in a A. red biohazard bag B. yellow bag C. biohazard transport bag D. brown paper bag

biohazard transport bag Rationale Biohazard transport bags are used to transfer specimens to the lab in an effort to prevent the spread on infection. There are two pockets. The inside one holds the specimen and the outside pocket is for any labels or paperwork. Red biohazard bags are used for disposal of medical waste such as used gloves or objects contaminated with blood or body fluids. Yellow bags are used for containing contaminated linens or PPE. Brown paper bags are not used for specimen transport.

Which of the following specimens is most susceptible to contamination and should always be drawn first? A. hematocrit B. serum cholesterol C. complete blood count D. blood culture

blood culture Rationale If the intended site of venipuncture for blood culture collection is not cleaned properly or is recontaminated by touching, skin bacteria can be introduced into the specimen and produce false positive results. This is why these tests are drawn first while the skin is as clean and free of bacteria as possible. The special skin cleansing is not required for hematocrit, cholesterol and complete blood count (CBC).

Which of the following tests can be collected by capillary puncture? (Select the two (2) correct answers.) A. blood cultures B. blood gas C. bilirubin D. erythrocyte sedimentation rate E. PTT

blood gas, bilirubin Rationale Collecting blood samples by capillary (dermal) puncture is an alternative to venipuncture when a small amount of blood is needed and the procedure is appropriate for the test requested. Blood gasses and bilirubin determinations may be done with this method. Blood cultures and erythrocyte sedimentation rates (ESR) require a larger amount of blood. Coagulation tests that require plasma specimens such as the PTT are not done by dermal puncture.

After a course of antibiotics for a UTI a patient returns for a follow up urinalysis. The order calls for a midstream clean catch specimen. In order to prevent contamination, the phlebotomist should provide the patient with which of the following antiseptics? A. iodine wipes B. castile soap wipes C. betadine wipes D. alcohol wipes

castile soap wipes Rationale It is important not to contaminate the urine sample with normal skin flora, therefore the genital area is cleansed with castile soap wipes just prior to collecting the sample. Alcohol, iodine and betadine are not used for this purpose as they would be too harsh for the skin.

Which of the following is the appropriate antiseptic to use in order to achieve a high degree of antisepsis prior to blood culture collection on a 6-month-old infant? A. benzalkonium chloride B. povidone-iodine (PVP) C. betadine D. chlorhexidine gluconate

chlorhexidine gluconate Rationale CLSI recommends chlorhexidene gluconate to prepare a venipuncture site for blood culture collection on infants older than 2 months. Iodine preparations or benzalkonium chloride are not typically used as they may be too harsh for sensitive skin.

A patient with Pseudmonas aeruginosa is receiving gentamicin antibiotic for therapy. In order to appropriately monitor this drug for patient safety the phlebotomist must A. stay with the patient the initial two hours to monitor status. B. collect two trough samples. C. collect the blood sample before the drug is administered. D. label all tubes simultaneously before drug monitoring starts.

collect the blood sample before the drug is administered. Rationale It is crucial to accurately monitor the levels of therapeutic medications as many of these drugs have harmful side effects. The physician needs to know that the dose of a particular medication is at the appropriate level to assure its effectiveness. If the level is too low, no medical benefit will be produced. If too high, there may be toxic consequences. This is called a therapeutic window. A trough (lowest) level is drawn immediately prior to administration and serves as a baseline. A peak (highest) level is drawn at a prescribed time after the drug has been administered. It is not the responsibility of the phlebotomist to stay with or monitor the patient. Collecting two trough samples or prelabeling tubes is not good laboratory practice.

A three-month-old patient was sent to the lab for an H&H. How should the phlebotomist collect the sample? A. venipuncture, antecubital fossa B. dermal puncture, great toe C. dermal puncture, middle finger D. dermal puncture, heel stick

dermal puncture, heel stick Rationale Capillary blood samples may be taken from the lateral side heel of children until they begin to walk at which time the heel becomes tougher and more difficult to penetrate. In this case, as the patient is 3 months old, a heel stick would be the best choice. The middle finger or great toe are not used. Since a very small amount of blood is needed, a venipuncture in the antecubital area is not necessary.

The doctor has ordered occult blood test and sent the patient to the lab to pick up the testing materials. After instructing the patient how to collect the specimen, it is very important to tell him to A. follow dietary guidelines specifically for the test. B. inform the doctor about any gastric ulcers he may have. C. clean the area thoroughly. D. stop taking medications during the collection period.

follow dietary guidelines specifically for the test. Rationale Many laboratory tests have special instructions to be followed by the patient in order to help produce accurate results. Fecal occult blood (FOB) tests are done on special collection cards supplied to the patient by the ordering doctor's office or lab to assess the presence of intestinal bleeding. It is necessary to avoid ingesting vitamin C or red meat for 72 hours as this may produce false test results. Gastric ulcers would cause a positive result. Thoroughly cleaning the anal area or discontinuing medications (other than aspirin or NSAIDS) is not necessary.

Which of the following sites is contraindicated for a patient with diabetes? A. antecubital area B. foot/ankle C. hand D. lower forearm

foot/ankle Rationale The most often used site for venipuncture is the antecubital fossa. The veins in this area of the arm are easily felt and accessed. The hand or the top of the wrist may also be selected. The underside of the wrist is never used as the nerves and tendons present would make the draw too dangerous. A draw in the foot or ankle requires a physician's written permission and is contraindicated in diabetic patients because of their predilection to tissue necrosis and thrombosis formation.

In order to prevent post-puncture hematoma formation at the antecubital fossa after a successful venipuncture, the phlebotomist must apply firm and direct pressure with cotton A. gauze and instruct the patient to bend the arm. B. gauze and instruct the patient not to bend the arm. C. balls and instruct the patient to bend the arm. D. balls and instruct the patient not to bend the arm.

gauze and instruct the patient not to bend the arm. Rationale It is the responsibility of the phlebotomist to assure that bleeding has stopped after completing a venipuncture procedure. This is accomplished by applying direct pressure to the wound site with a gauze pad. If the patient is capable, they may be enlisted to apply the pressure and allow the phlebotomist to complete other tasks. Cotton balls are not used because the fibers may stick to and dislodge the platelet plug when the bandage is removed and bleeding may resume. Bending the arm up will encourage bleeding under the skin at the site and a hematoma may form.

A specimen processor receives a lipemic glucose specimen, a clotted HCG, a moderately hemolyzed electrolyte panel specimen, and an icteric bilirubin specimen. Which of the following is likely to be rejected for analysis? A. glucose and bilirubin B. glucose and electrolytes C. HCG and bilirubin D. HCG and electrolytes

glucose and electrolytes Rationale Specimens are rejected when they are deemed unsuitable for accurate analysis by laboratory personnel. In this case, a lipemic sample for glucose measurement cannot be used because the cloudiness of the serum or plasma interferes with the instrument's test method. Electrolytes consist of sodium, potassium, chloride and bicarbonate. Hemolysis in these samples will cause a false elevation of potassium and possible mistreatment of the patient. Serum from a clotted blood sample is used for the HCG and the level of bilirubin in an icteric sample is an indication of liver disease.

The doctor has ordered a CBC, Cholesterol, and PT on a fasting patient. The phlebotomist is in the process of collecting the last tube when the nurse walks in with an add-on for a glucose test. Which of the following tubes should the phlebotomist use to collect the glucose test? A. light green top B. SST C. lavender top D. gray top

gray top Rationale It is not uncommon for test requests to be added onto a patient's orders. In this case, a gray top would suffice for the glucose level. Blue tops (sodium citrate) are used for coagulation testing. Lavender tops (EDTA) are used for Hematology tests. A tan top also contains EDTA but is used for lead tests.

Which of the following is the correct pairing of tube and test for a chemistry specimen collection? A. gold and blood type B. tiger top and lactic acid C. green and AST D. yellow and D-dimer

green and AST Rationale Blood is drawn into tubes containing additives that preserve the analyte being tested for. The colors of the tube caps indicate the contents. The liver enzyme AST can be collected into a green (heparin) tube. A gold serum tube with gel cannot be used for blood types as the gel creates a barrier over the red cells. Lactic acid must be drawn into a gray top (sodium fluoride, potassium oxalate) and delivered STAT on ice. A blue top (sodium citrate) is used for D-dimer which is a coagulation factor test.

The phlebotomist has orders to draw blood on a patient with edema in the left arm and burns on the upper right arm. Which of the following is the preferred draw site? A. foot vein B. antecubital vein C. hand vein D. femoral vein

hand vein Rationale Edematous areas should be avoided because the blood sample will be contaminated with tissue fluid and give false test results. A tourniquet cannot be placed of the right arm due to burns. A hand vein on the right arm may be the best choice. The femoral veins and arteries are only accessed by a physician. Written permission from the patient's doctor must be obtained before drawing from a foot.

After drawing a patient with hemophilia the phlebotomist should A. bandage the patient as normal. B. apply an extra layer of gauze. C. hold pressure for 5-10 minutes. D. lower the patient's head.

hold pressure for 5-10 minutes. Rationale It is the responsibility of the phlebotomist to assure bleeding from the venipuncture site has completely stopped before applying a bandage and releasing the patient. As those with hemophilia tend to bleed longer, direct pressure to the wound site for 5-10 minutes may be required. The patient may be enlisted to assist if able. Bandaging the patient as normal or applying an extra layer of gauze will not aid in cessation of bleeding in this case. Lowering the patient's head will only help to prevent syncope (fainting).

Which of the following specimens is likely to be considered STAT? A. therapeutic drug levels B. lactic acid C. electrolytes D. blood smears

lactic acid Rationale A lactic acid level is likely to be a STAT order as this analyte deteriorates very quickly after being drawn and is usually associated with emergency situations. Therapeutic drug levels, electrolytes and blood smears are much more stable analytes.

Which of the following correctly matches the test with the appropriate special handling instructions? A. vitamin A specimen kept warm using a heating pack B. cryoglobulin level protected from light with aluminum foil C. ammonia level kept warm using a heating pack D. lactic acid chilled in slurry of ice and water

lactic acid chilled in slurry of ice and water 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 slurries as they deteriorate very quickly at room temperature. Cryoglobulin must be kept at body temperature (in a 37 degree C heat block) until analysis can begin. Vitamin A samples need to be protected from light and may be wrapped with aluminum foil.

Which of the following tubes contains an anticoagulant that prevents platelets from clumping and preserves the appearance of blood cells for microscopic prep? A. light green B. dark green C. light blue D. lavender

lavender Rationale Many evacuated blood collection tubes contain additives that stop blood samples from clotting to preserve the analytes to be measured. Lavender tubes contain EDTA which prevents platelets from clumping and preserves the appearance of red and white cells for microscopic examination. Light and dark green tubes contain heparin and are used for many chemistry tests. Light blue tubes use sodium citrate and are used to assess coagulation factors.

A patient visits the lab for a routine venipuncture collection and informs the phlebotomist that she recently had a mastectomy of the right breast. Which of the following is the appropriate draw site? A. right arm B. left arm C. either arm D. either hand

left arm Rationale When a patient has a mastectomy, often lymph nodes are removed with the breast tissue. This leaves the patient predisposed to lymphostasis and possible infection on that side of the body. Therefore, another site must be chosen for venipuncture unless the doctor has given written permission for a draw in that area.

A phlebotomist is tasked with drawing an ESR, CMP, PT/INR, and an lactic acid level. Which of the following is the correct order of draw? A. gold, lavender, pink, grey B. grey, lavender, gold, light blue C. pink, light blue, grey, gold D. light blue, gold, lavender, grey

light blue, gold, lavender, grey 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). In this case, the order would be light blue (PT/INR), gold (CMP), lavender (ESR), and grey (lactic acid). Pink tubes also contain EDTA but are typically used for Blood Bank tests.

The doctor ordered the following lab tests: CBC, calcium, glucose, ABO Group, Rh typing, aPTT. Which of the following is the correct order of draw for these tests? A. gold, lavender, pink, gray, light blue. B. lavender, gray, gold, light blue, pink. C. light blue, gold, lavender, pink, gray. D. light blue, lavender, gold, pink, gray.

light blue, gold, lavender, pink, 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 sterile (blood cultures), sodium citrate (blue), serum (red or gold with or without clot activator or gel separator), heparin (green), EDTA (purple or pink), sodium fluoride & potassium oxalate (gray). In this case, the order would be light blue (APTT), gold (calcium), lavender (CBC), pink (ABO group and Rh type), and gray (glucose).

A phlebotomist is asked to collect a CBC, PT, electrolytes and BUN. The correct order of draw for this collection is A. light blue, green, lavender. B. green, lavender, light blue. C. lavender, light blue, green. D. green, light blue, lavender.

light blue, green, lavender. Rationale The correct order of draw would be light blue for the PT, green for the BUN and electrolytes and lavender for the CBC.

When ordering a PT, PSA and CBC, which of the following tubes are needed to effectively draw these labs? (Select the three (3) correct answers.) A. light blue B. gray C. lavender D. gold gel barrier E. yellow ACD

light blue, lavender, gold gel barrier Rationale A Prothrombin Time (PT) is drawn in a light blue top tube which contains sodium citrate. A gold gel barrier tube can be used for the Prostate-specific antigen (PSA) as this test requires serum. The lavender tube (K EDTA) would be used for the complete blood count (CBC) because this test must be done on whole blood. The gray top ( sodium fluoride and potassium oxalate) is reserved for glucoses, lactic acids and alcohol levels. Yellow ACD (acid, citrate, dextrose) tubes are used for special tests such as cellular studies, HLA typing and paternity testing.

The phlebotomist has orders for an FBS, INR, and CBC Stat. Which of the following is the correct tube selection and order of draw? A. red, lavender, light blue B. red, light blue, lavender C. lavender, light blue, gray D. light blue, lavender, gray

light blue, lavender, 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 sterile (blood cultures), sodium citrate (blue), serum (red or gold with or without clot activator or gel separator), heparin (green), EDTA (purple or pink), sodium fluoride & potassium oxalate (gray). In this case, the light blue would be drawn first for the INR, lavender second for the CBC and gray last for the FBS.

Which of the following is the correct order of draw when one or more tubes containing anticoagulant are collected? A. green, red, light blue B. red, green, light blue C. light blue, red, green D. green, light blue, red

light blue, red, green 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 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). In this case, the order would be: light blue drawn first, the non-additive (serum) tube second and the green last

A phlebotomist must collect ESR, STAT electrolytes, D-Dimer and estrogen. Which of the following correctly lists the appropriate tubes in the CLSI recommended order of draw? A. red, light blue, green, lavender B. light blue, red, green, lavender C. light blue, red, lavender, green D. red, light blue, lavender, green

light blue, red, green, lavender Rationale Blood collection tubes are color coded to indicate their chemical contents. The Clinical Laboratory Standards Institute (CLSI) defines the order in which these tubes should be drawn 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 recommended order is sterile (blood cultures), sodium citrate (blue), serum (red or gold with or without clot activator or gel separator), heparin (green), EDTA (purple or pink), sodium fluoride & potassium oxalate (gray). In this case, the order would be light blue (D-Dimer), red (estrogen), green (STAT electrolytes), lavender (ESR).

Test ordered are for hematology, serum chemistry, and coagulation studies. Which of the following is the correct order of draw? A. red, light blue, lavender B. yellow, lavender, light blue C. light blue, red, lavender D. lavender, yellow, light blue

light blue, red, lavender 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 sterile (blood cultures), sodium citrate (blue), serum (red or gold with or without clot activator or gel separator), heparin (green), EDTA (purple or pink), sodium fluoride & potassium oxalate (gray). In this case, the light blue (sodium citrate for coagulation studies) is drawn first, then the red (no additive for serum chemistry) and the lavender (EDTA) for hematology last.

After a tiger top tube was centrifuged the phlebotomist noticed that the serum was milky white. Which of the following conditions does this indicate? A. diabetes B. anemia C. icterus D. lipemia

lipemia Rationale A milky appearance of serum or plasma indicates lipemia. This condition may result after ingestion of a fatty diet. Lipids are not water soluble and can remain in the blood stream for 12 hours. This is why patients are asked to fast for a period of time before having a lipid panel drawn. In addition, many other laboratory tests cannot be accurately measured until the lipid is cleared for the plasma. Although diabetic patients may experience lipemia, the condition is not usually associated with the disease. Icteric samples have an excess of bilirubin, an indication of liver disease. Anemia is the abnormal reduction of red blood cells in the circulating blood.

The phlebotomist collects electrolytes and ammonia specimens from the same patient in lithium heparin tubes, and places them in ice slurry while collecting other specimens before transporting them to the lab 15 minutes later. The results for electrolytes were incorrect, most likely because the specimen was A. collected in the wrong tube. B. not processed in a timely manner. C. not transported at the correct temperature. D. not protected from light.

not transported at the correct temperature. Rationale A blood specimen for ammonia testing should be placed in a ice slurry as this analyte deteriorates rapidly. However, electrolytes should be kept at room temperature. Lithium heparin is the correct anticoagulant for both tests. Neither analyte needs protection from light. Fifteen minutes for draw to lab transport time is acceptable.

A 76-year-old patient has fragile skin with little elasticity. The best choice to ensure his skin doesn't tear should be A. silk tape. B. paper tape. C. surgical tape. D. a Band-aid.

paper tape. Rationale Paper tape is best choice to prevent tearing of fragile skin during the removal of a bandage after performing a venipuncture. Bandaids, silk or surgical tape are harder to remove and could damage the skin leaving it open to infection.

The phlebotomist must label blood bank specimens with which of the following information? (Select the three (3) correct answers.) A. patient's date of birth B. patient's room number C. patient's first and last name D. date and time of collection E. physician's name

patient's date of birth, patient's first and last name, date and time of collection Rationale It is especially crucial that patients having any Blood Bank testing, particularly transfusions, be properly identified. Failing to correctly perform this step can be fatal. At a minimum, the patient's full name, date of birth and date and time of collection must appear on the tube label. In addition, the blood bank specimens must include the initials (or unique id ) of the phlebotomist and the medical record number. Also, if the patient is to be transfused, they are given a special armband with a unique number from a specially labeled identification card that has multiple stickers with this number. When blood products are selected and crossmatched for this patient, one of the numbered stickers is placed on each of the product labels. The numbers from this band and card must match with those on the blood product before the transfusion can take place. Room numbers and physician's names may appear on pre-printed labels, but are not necessary for proper identification.

When anchoring a vein the phlebotomist should (Select the two (2) correct answers.) A. place the thumb 1-2 inches below venipuncture site. B. apply direct downward pressure. C. draw the skin away from the site. D. place the pointer finger 1-2 inches below the venipuncture site. E. place the thumb below and the index finger above the site.

place the thumb 1-2 inches below venipuncture site., draw the skin away from the site. Rationale Using the thumb of the non-dominant hand to anchor the vein 1 to 2 inches below the site before inserting the needle for venipuncture not only keeps the vein from rolling but stretches the skin and helps make the puncture less painful. Using the thumb and the forefinger (C or window hold) leaves the forefinger in line for a possible needlestick injury. Just enough pressure should be applied to keep the vein still.

A urine drug screen has been ordered for the patient and instructions for how to void have been provided. When the phlebotomist is given the specimen, she must immediately A. prepare the specimen for transport. B. read the temperature strip. C. ask patient what medications he is taking. D. wash her hands.

read the temperature strip. Rationale Urine specimens for drug screening are most vulnerable to adulteration during the collection process. The temperature of the sample must be taken within 4 minutes of collection and be within a range of 32.5 oC to 37.7 oC. Also checked are the pH, color and specific gravity for signs that the specimen has been tampered with. The phlebotomist should always wash her hands and put on gloves before beginning the process and document medications being taken by the donor if applicable. Specimens are packaged and prepared for transport under the chain of command protocol.

Which of the following tubes needs time to clot before being centrifuged? A. red B. gray C. green D. light blue

red Rationale Evacuated blood collection tubes are color coded to indicate their contents. The red top is a serum tube that requires 20-30 minutes in an upright position to completely clot before centrifugation. The gray (potassium oxalate), green (heparin) and light blue (sodium citrate) tubes all contain anticoagulants that keep the blood liquid. These specimens may be centrifuged immediately after collection to yield plasma.

When processing a specimen in a centrifuge the phlebotomist should ensure that all the A. samples are centrifuged at 3000 rpm. B. samples are balanced in the centrifuge. C. samples are spun for at least 20-30 minutes. D. tubes are allowed to clot for 10 minutes before spinning.

samples are balanced in the centrifuge. Rationale It is very important to assure that sample tubes are balanced to each other when spinning them in a centrifuge. The speed and timing of the instrument are determined by each laboratory to yield the volume of plasma or serum needed for testing. Serum tubes need to be allowed to completely clot for 20 to 30 minutes to prevent fibrin strands from forming.

Which of the following is the CLSI recommended order of draw for a BMP, CBC & PTT? A. EDTA, heparin, sodium citrate B. heparin, EDTA, serum separator C. serum separator, heparin, EDTA D. sodium citrate, heparin, EDTA

sodium citrate, heparin, EDTA Rationale The order of draw is designed to prevent carryover of additives from one tube to the next thereby affecting patient results. CLSI states the order of draw for ETS tubes to be: SPS (sterile), sodium citrate (blue, serum ( red or gold), heparin (green), purple (EDTA), oxalate / fluoride (gray). In this case the order would be sodium citrate (PTT), heparin (BMP) EDTA (CBC).

The phlebotomist collects a small amount of blood from an elderly patient using a syringe. There is not enough blood to fill all the collection tubes, so the phlebotomist places the blood in the appropriate microcollection containers instead. Which of the following additional information is required on the specimen label? A. date and time of collection B. phlebotomist's initials C. patient's initials D. source of specimen

source of specimen Rationale If using a micro collection tube for other than capillary collection, the phlebotomist needs to add the source of the specimen to the label - such as "venous blood". Reference ranges for many tests are different for capillary, venous and arterial samples. The patient's initials are not used. The date and time of collection and the phlebotomist's initials are always added to the label.

Which of the following are required for a sputum collection? A. sterile cup, 24 hour collection B. plastic transport cup, immediate delivery to lab C. sterile cup, immediate delivery to lab D. plastic transport cup, 24-hour collection

sterile cup, immediate delivery to lab Rationale Sputum specimens are collected into sterile cups and quickly delivered to the lab when a bacterial infection such as bronchitis or pneumonia are suspected. If the container is not sterile, other contaminating organisms may cause a false positive result. Failure to transport to the lab in a timely fashion may cause the loss of bacteria and a false negative culture result. A random sample is usually used, not a 24-hour collection.

A phlebotomist has completed a dermal puncture on a one-year-old patient who is completing an annual physical. Children this age should not have a bandage applied because A. they run a higher risk of contamination. B. they run a risk of choking. C. clotting occurs quickly for children this young. D. they run a higher risk of petechiae.

they run a risk of choking. Rationale Applying a bandage to the site of blood collection for small children leads to the risk of choking if they place it in their mouth. Simply applying pressure and checking the site until assured that bleeding has stopped will usually suffice. There is no risk of contamination and clotting should be complete in the usual time. Petechiae might appear after tourniquet application, but usually resolve after the procedure is ended.

Which of the following tubes is most likely to be centrifuged? A. tiger top SST B. yellow ACD C. royal blue EDTA D. yellow SPS

tiger top SST Rationale The tiger top SST (serum separator tube) would be allowed to clot for at least 20 minutes, then centrifuged and the serum be removed from the cells for testing. The yellow ACD is used for HLA phenotyping, DNA and paternity testing, royal blue (EDTA) is used for heavy metal screening and the yellow SPS is used for blood cultures. All of these tests use whole blood and do not require centrifugation.

While providing patient education on 24-hour urine collection for creatinine clearance, it is imperative to tell the patient A. to keep the specimen refrigerated at all times. B. to maintain particular dietary restrictions. C. start collection 96 hours after any procedure using contrast dye. D. to avoid laxatives during the collection process.

to keep the specimen refrigerated at all times. Rationale For accurate results, a urine specimen for 24 hr analysis should be kept refrigerated during the collection. Refrigeration prevents the analytes in the specimen from deteriorating at room temperature. Maintenance of dietary restrictions and the clearance of contrast dye are important for certain tests. The avoidance of laxatives helps ensure the specimen will not be contaminated with stool.

A phlebotomist in central processing discovers an unspun glucose specimen in a gray top tube kept at room temperature for four hours after it was collected. The phlebotomist should A. transfer the specimen to the chemistry department for testing. B. transfer the specimen to the centrifuge to be spun down. C. reject the specimen due to the delay in processing. D. reject the specimen because the temperature requirement was not met.

transfer the specimen to the centrifuge to be spun down. Rationale Glucose specimens drawn in gray top tubes (sodium fluoride / potassium oxalate) are stable at room temperature for 24 hours. Therefore, the phlebotomist was correct in centrifuging the specimen for testing. If the chemistry department is responsible for processing the blood, it would be accepted and not rejected.

When collecting blood for a neonatal screening, the phlebotomist should A. use a capillary collection procedure. B. use special patient identification banding. C. maintain a warm temperature at the site. D. use a syringe method.

use a capillary collection procedure. Rationale Blood for neonatal screening is typically collected from a dermal puncture to the medial or lateral plantar surface of the heel. The baby must have an identification band attached - usually to a leg. Warming the site will yield a better blood flow as babies have higher red blood cell counts. A syringe would be used on an arm, hand or wrist and are not used for these collections.

When performing a blood draw on a 75-year-old patient with thin, papery skin, the phlebotomist should A. apply the tourniquet directly to the skin above the site B. wrap the arm in gauze and apply the tourniquet C. do not apply a tourniquet D. use a cloth tourniquet

wrap the arm in gauze and apply the tourniquet Rationale If the skin is irritated or very thin, the tourniquet may be applied over clothing, a clean dry washcloth or length of gauze. A tourniquet is used during the venipuncture procedure to distend the vein, making it easier to see and providing adequate pressure to assist in collecting the specimen. The tourniquet should be applied 3 to 4 inches above the intended venipuncture site. If applied too closely, the vein may collapse during the procedure and if too far away, not enough pressure will be generated to distend the vein adequately. Typically, tourniquets are a flat strap made of a latex free elasticized material. The current trend is use them once and discard. This practice aids in preventing transmission of infection. If the tourniquet is reused, it must be disinfected regularly. A cloth tourniquet would be an infection control risk if used repeatedly.