Phlebotomy National Exam Practice
How long should to tourniquet be left on the arm during venipuncture procedure?
No more than one minute
Wh
Not
Which of the following cleansing errors will result in the microbial contamination of the specimen? · Allowing 70% alcohol to air- dry after cleansing the site · Using povidone- iodine-based cleansing solutions · Patient washing his/her hands if a finger-stick is performed · Not properly cleansing the site before the incision is made with 70% alcohol
Not properly cleansing the site before the incision is made with 70% alcohol
What section of the SDS would provide information about whether a chemical is carcinogenic?
Health hazard data
Which of the following hematology tests is used to indicate anemic conditions? · Platelet count · White blood cell count · White blood cell differential · Hemoglobin
Hemoglobin
What type of anticoagulant is generally suitable for TDM analysis?
Heparin
What is the structure F from the figure below?
Median Vein
Which of the following clinical laboratory departments cultures and identifies the presence of microorganisms from body fluids and tissues? · Clinical chemistry · Urinalysis · Hematology · Microbiology
Microbiology
If a phlebotomist is failing to invert whole blood specimen 5-10 times immediately after filling the tube, which of the following pre-analytic errors can occur? · Microclots · Hemoconcentration · Hemolysis · Lipemia
Microclots
A phlebotomist needs to collect the following microcollection tubes during a capillary blood collection: · Lavender top (EDTA) · Red top (no additive) · Blood gas specimen · Gray top (sodium fluoride) What is the correct order of draw?
Blood gas→ EDTA→ Other additives→ Serum
Hemogentisic acid in urine will cause urine to be which of the following colors? · Green · Pink · Port-wine · Brown/black
Brown/black
Which of the following blood test can be collected in a serum separation tube (SST)? · CBC · Hepatitis B surface antigen (HBsAg) · PT · ABO group and Rh typing
Hepatitis B surface antigen (HBsAg)
Which of the following laboratories DO NOT belong to the Clinical Pathology Laboratory? · Histology and cytology · Hematology and Coagulation · Urinalysis and Flow Cytometry · Immunology and Immunohematology
Histology and Cytology
What is at the end of the needle that attaches to the syringe or tube holder?
Hub
To assess drug concentration during the trough phase, blood should be drawn:
Immediately before the next dose is given
All of the following are examples of efforts taken to maintain sample integrity during transportation to the laboratory EXCEPT: · Control shipping temperature · Protect from direct exposure to light · Minimize the transport time · Tubes kept in a horizontal(flat) position while being taken to the lab
Tubes kept in a horizontal(flat) position while being taken to the lab
What is the name of the outer layer of the walls of veins and arteries?
Tunica adventitia
Which of the following would ensure positive patient identification prior to specimen collection? · Patient's full name and mother's maiden name · Patient's full name and room number · Patient's full name and hospital or medical record number · Patient's full name and age
Patient's full name and hospital or medical record number
Correct identification of a patient is crucial before collecting a laboratory specimen. A properly labeled patient specimen requires at least two patient identifiers. Which of the following examples is NOT an acceptable patient identifier used before a specimen is collected? · Patient's date of birth · Patient's room number · Patient's medical record number · Patient's full name
Patient's room number
Regarding therapeutic drug monitoring, which of the following statements is correct when collecting a specimen for a peak level · Peak level is the point at which the drug is lowest in the patient's body · Peak level is the point at which the drug is highest in the patient's body · Peak level is tested on a blood sample that is collected immediately prior to when the next dose of the drug is given · None of the above choices are correct
Peak level is the point at which the drug is highest in the patient's body
Which type of healthcare occupational exposure has the greatest risk of HIV transmission? · Percutaneous injury · Mucous membrane exposure · Abraded skin exposure · Inhalation of droplets
Percutaneous injury
All of the following will interfere with blood test results, EXCEPT? · Hemolysis · Icterus · Lipemia · Tube gel barrier
Tube gel barrier
A phlebotomist is required to draw the following evacuated tubes by using the winged infusion needle: · Gray top · Light blue top · Aerobic blood culture bottle · Anaerobic blood culture bottle Which tube/bottle should be collected first?
Aerobic blood culture bottle
What would be the order of draw for the following tubes: · Gray top · Light blue top · Aerobic blood culture bottle · Anaerobic blood culture bottle
Aerobic blood culture bottle Anaerobic blood culture bottle Light blue top Gray top
A phlebotomist is required to draw the following evacuated tubes by using the winged infusion needle: · Gray top · Light blue top · Aerobic blood culture bottle · Anaerobic blood culture bottle What is the correct order of draw?
Aerobic blood culture bottle→ Anaerobic blood culture bottle→ Light blue top→ Gray top tube
A Comprehensive Metabolic Panel (CMP) consists of which group of tests?
Albumin, Glucose, BUN, Creatinine, Sodium, Potassium, Chloride, CO2, AST, ALT, Alkaline Phosphatase, Total Protein, Total Bilirubin, Calcium
Which of the following blood tests is used to determine acute pancreatitis? · Acid phosphatase · Uric acid · Amylase · Alkaline Phosphatase (ALP)
Amylase
Which of the listed fingers should be used for dermal puncture to obtain capillary blood specimens? · #1 Thumb · #2 Index finger · #3 Middle finger · #5 Little finger
#3 Middle finger
Which of the following needle gauges has the smallest lumen or bore? · 18 · 20 · 21 · 22
22
Which of the following tests are affected by the pneumatic tube system transport? · Albumin · Chloride · Acid phosphatase · Creatinine
Acid phosphatase
As a phlebotomist in an outpatient clinic you encounter many different types of patients. One day, due to weather conditions, there is a shortage of phlebotomist at your clinic. The waiting room is getting full and wait times are getting longer. As you call in the next patient, she is starting to complain loudly and make rude comments about the long wait time and the incompetence of the staff. Which of the following scenarios is the most appropriate course of action? · Agree with the patient and proceed with the phlebotomy procedure · Apologize to the patient for the long wait, acknowledge that you understand her frustration and explain that this is an unusual situation due to unforeseen weather conditions, then proceed with the phlebotomy procedure. · Tel the patient that if she does not stop complaining and making rude comments, you would refuse to perform the phlebotomy procedure and have her escorted out · Say nothing about her complaints and comments and continue with the phlebotomy procedure
Apologize to the patient for the long wait, acknowledge that you understand her frustration and explain that this is an unusual situation due to unforeseen weather conditions, then proceed with the phlebotomy procedure.
All of the following circumstances are acceptable when identifying a patient, EXCEPT? · Asking the patient to state his/ her full name · Asking the patient to state his/ her date of birth · Asking the patient "are you Mr. Smith?" · Asking the patient to show his/her patient identification band
Asking the patient "are you Mr. Smith?"
Which of the following veins is the last choice for venipuncture? · Median cubital · Cephalic · Basilic · Any of the listed veins can be accessed for venipuncture, there is no specific choice order
Basilic
When collecting a specimen for a blood alcohol test, why should tincture of iodine NOT be used to cleanse the venipuncture site?
Because it contain alcohol
What is the slanted tip of the phlebotomy needle called?
Bevel
Guidelines recommend that laboratory specimens that can produce infectious aerosols must be processed using which of the following safety precautions? · Lab coat and safety goggles only · Biological safety cabinet, lab coat, and gloves · Lab coat only · Lab coat and gloves only
Biological safety cabinet, lab coat, and gloves
A phlebotomist needs to collect the following tubes during a routine venipuncture: · Gray (sodium fluoride) · Green (heparin) · Lavender (EDTA) · Blood culture bottles
Blood culture bottles→Green→Lavender→Gray
What is the correct order of draw for the following tubes when blood is collected by routine venipuncture? · Blood Cultures · Green · Gray · Red
Blood culture→ Red→ Green→ Gray
Which of the following terms refers to a slow heart rate? · Tachycardia · Bradycardia · Arrhythmia · Systole
Bradycardia
The artery is found on the side of the neck which brings oxygenated blood to the head and brain area is called?
Carotid
Which of the following specimen processing examples is considered a processing error and can have a negative impact on the test results? · Aliquoting serum to a transfer tube after centrifugation is complete · Centrifuging a plasma specimen 4 hours after collection · Allowing a red top blood tube to fully clot before centrifugation · Transporting an ammonia specimen to the laboratory in an ice slurry
Centrifuging a plasma specimen 4 hours after collection
Materials such as strong acids and bases are classified as
Chemical irritants
Which of the following conditions is associated with a positive ketone test on the urine test strip? · Renal calculi · Diabetes mellitus · Hepatitis/ Cirrhosis · Urinary tract infection
Diabetes mellitus
What are function(s) of the platelet?
Clotting, plug formation, release of serotonin, and repair of the injured tissues
What can a phlebotomist do when preparing a patient to help minimize pre-analytical variability.
Confirm that the patient fasted for at least 8 hours prior to collecting blood for a lipid profile
You need to perform a veni-puncture on three-year-old. Which of the following should be avoided when collecting the blood specimen? · Do not allow the parent to be in the room when the specimen is being obtained. · Have a trained staff member hold the arm of the child · Attempt to explain to the child what you will be doing before proceeding · Treat children with the same honesty and respect as all patients
Do not allow the parent to be in the room when the specimen is being obtained
Which of the following blood tests is used to evaluate kidney function? · Alkaline Phosphatase (ALP) · Creatinine · Amylase · Uric acid
Creatinine
What is the correct procedure when using a winged collection device (butterfly) to draw a light blue top tube intended for a coagulation test if this is the first tube that will be collected in the draw?
Draw and discard a waster light-blue top tube before the tube that will be used for coagulation studies.
The accumulation of interstitial fluid under the skin causing swelling is called:
Edema
Before disposing of a needle in the sharps containers, what should you do?
Engage the needle safety device
Which of the following terms specifically refers to the production of red blood cells? · Thrombopoiesis · Leukopoiesis · Erythropoiesis · Hematopoiesis
Erythropoisesis
On each blood collection tube the manufacturer places a label with information useful to the phlebotomist. Which of the following label information determines time frame of tube use? · Additive · Expiration date · Volume · Lot number
Expiration date
Significantly increased levels of ketones are typically detected in the urine with all of the following conditions, EXCEPT? · Diabetic acidosis · Excessive carbohydrate loss · Starvation · Following a low-impact exercise routine
Following a low-impact exercise routine
Which of the following analytes would be decreased due to delay in centrifugation? · Potassium · Creatinine · Glucose · AST
Glucose
A Renal Function Panel consists of which tests?
Glucose, BUN, Creatinine, Sodium, Potassium, Chloride, CO2, Calcium, Albumin, Phosphorus
You need to collect a routine CBC specimen from an inpatient. When you arrive to collect the specimen, the curtain is pulled around the patient's bed and the physician and nurse with the patient. Which of these actions would be in the best interest of the patient and the most professional way to handle the situation? · Pull back the curtain and proceed with the blood collection · From outside the curtained area, inform the physician that you are here to collect a blood specimen that has to be collected at this time. Request permission to proceed. · Go on and proceed with other duties you may have and return as soon as the physician/patient consultation is over. · Wait outside the patient's room until physician and nurse leave the room
Go on and proceed with other duties you may have and return as soon as the physician/patient consultation is over.
Which of the following errors could most likely occur in the preanalytical phase? · Incorrectly collected sample · Wrong test method used · Incorrectly performed instrument calibration · Inaccurately handled critical test value
Incorrectly collected sample
Wh
It m
When a laboratory test is ordered as "fasting" what is meant by it?
It means no food or drink (except water) for the 8-12 hours prior collection
What additive is found in a green top collection tube?
Lithium or sodium heparin
What is the inside portion of the needle tube called?
Lumen
Which of the following conditions would make a sample unsuitable for lactic acid testing · Movement of hand or arm during specimen collection · Received in the laboratory on ice · Centrifuged in a refrigerated centrifuge · Specimen centrifuged and plasma separated from cells less than 15 minutes after collection
Movement of hand or arm during specimen collection
A phlebotomist enters a blood draw to perform a routine venipuncture procedure. The phlebotomist notices a vein that appears to be a good choice for venipuncture and inserts a needle. There is no blood return; therefore, the phlebotomist has to perform a second venipuncture in the opposite arm. All of the following information would have been obtained by the phlebotomist from palpation of the vein EXCEPT: · The size of the vein · The health or resiliency of the vein · The direction and depth of the vein · Observation of hematoma formation
Observation of hematoma formation
A semen sample for semen analysis should generally be recieved at the testing site within what period of time?
One hour
Which of the following blood tube storage practices is considered acceptable and will NOT impact the quality of the specimen? · Overnight room temperature storage of serum or plasma specimens intended for chemistry testing · Repeatedly freezing and thawing stored specimens intended for chemistry testing · Overnight room temperature storage of EDTA whole blood specimens intended for CBC testing · None of the above
Overnight room temperature storage of EDTA whole blood specimens intended for CBC testing
How should healthcare computer passwords be managed?
Passwords should be memorized
Acceptable patient identifiers include:
Patient's full name Patient's date of birth Medical record number Social Security Number Accession Number Hospital Number
For an inpatient, which of the following examples will be acceptable patient identifiers? · Patient's full name and room number · Patient's medical record number and age · Patient's age and room number · Patient's full name and hospital or medical record number
Patient's full name and hospital or medical record number
The centrifuge in the image is not properly balanced. What is the correct positioning of tube A so the centrifuge is balanced?
Position #2
Which of the following electrolytes is most likely to be spuriously elevated in a hemolyzed specimen? · Sodium · Potassium · Chloride · BUN
Potassium
The greatest source of error in point of care testing is:
Preanalytical error
A phlebotomist arrives in the blood draw area where a mother and her 3 year old toddler have been seated. Prior to performing the capillary blood collection on the child, the phlebotomist asks the mother "Is this amanda?" The mother says yes. The phlebotomist then proceeds to cleanse the child's middle finger with alcohol and allows the site to air dry before performing the finger puncture. The phlebotomist punctures the side of the fleshy pad of the finger, wipe away the first drop, fills a lavender top microcollection container, caps it, inverts its several times and lays it on the the table. She makes sure that the child's finger has stopped bleeding and then tells the mother that they can go. She then labels the specimen
Puncture site preparation
All of the following are primary functions of the kidney, EXCEPT? · Acid-base balance · Retention of essential nutrients and water · Reabsorption of waste products · Blood filtration
Reabsorption of waste products
What is the purpose of the BNP test?
Rules out acute heart failure in the emergency setting
Which of the following statements about butterfly needles is incorrect? · When collecting a blood culture set, the aerobic bottle should be collected first · Butterfly needles are also known as a winged infusion set · Butterfly needles are required to have safety devices to reduce the chance of accidental needle sticks · Safety butterflies activate themselves after blood collection is completed, without you doing anything at all
Safety butterflies activate themselves after blood collection is completed, without you doing anything at all
Which of the following refers to the liquid portion of blood that is collected into a evacuated tube that contains no anticoagulant? · Serum · Plasma · Effusion · Fluid
Serum
What is the tube body of the needle called?
Shaft
When collecting a urine specimen for workplace drug testing, all of the following are included on the chain-of-custody, EXCEPT? · Name and address of the employer · Test price · Reason for the test · Donor's first and last name
Test price
What does the anatomic term "Distal" refer to?
The area farthest from the center of the body
What does the anatomic term "Promixal" refer to?
The area nearest to the center of the body
What does the anatomic term "Palmar" refer to?
The palm of the hand
What is the main function of leukocytes?
To fight off infection
What is the purpose of the sweat chloride test?
To help diagnose cystic fibrosis
All of the following statements are true regarding the reagent strip test procedure, EXCEPT? · Urine should be centrifuged prior to dipping the reagent strip · Urine should be well mixed prior to dipping the reagent strip · When visually reading the reagent strip, the results should be read at the prescribed time suggested by the manufacturer after dipping the strip in the urine specimen · Prolonged immersion may was out test reagents
Urine should be centrifuged prior to dipping the reagent strip
Which one of the following statements about fingersticks is correct? · Use the pointer finger to the right hand · Choose a site in the middle of the fingertip · Use the index finger or the small (fifth) finger of the patient's nondominant hand · Use the middle or fourth finger
Use the middle or fourth finger
An investigation into a pre-analytical cause for an unanticipated laboratory finding should START with which of the following actions?
Verification of the sample identity, which includes at least two unique identifiers, such as the patient name, medical record number, and date of birth
The recommended storage temperature for the preservation of activity for MOST enzymes is:
4 degrees Celsius
All of the following tests does require protection from the light after collection, EXCEPT? · Bilirubin · Beta Carotene · CBC · Vitamin B12 and folate
CBC
Which anticoagulant is commonly added to tubes containing antiglycolytic agents, such as sodium fluoride, to provide plasma for glucose analysis? · EDTA · Sodium citrate · Lithium or sodium heparin · Potassium oxalate
Potassium oxalate
All of the following scenarios of concern for a phlebotomist when collecting a bilirubin specimen from a neonate, EXCEPT? · Collecting the specimen in a clear tube · Forgetting to turn off the ultraviolet (UV) light while collecting the specimen · Properly inverting the blood tube after collection · Prolonged collection time due to slow blood flow
Properly inverting the blood tube after collection
While performing a point-of-care blood glucose testing, the instrument becomes contaminated with the patient's blood. How should the instrument be cleaned?
Wipe down the instrument with a hospital approved disinfectant and allow to air dry
Which of the following statements is true regarding patients who faint during the phlebotomy procedure? · A patient about to faint can be recognized prior to starting the blood draw because of a fearful look on his/her face · Patients who faint during phlebotomy are children and women · Fainting patients should always be immediately exposed to an ample dose of smelling salts (ammonium salts) · You can't tell who might faint during phlebotomy, so be sure patients are seated appropriately or lie in such a manner so that if they do faint, they won't hurt themselves
You can't tell who might faint during phlebotomy, so be sure patients are seated appropriately or lie in such a manner so that if they do faint, they won't hurt themselves
Which one of the following statements about heelstick is incorrect? · You may collect blood from any part of the heel · Do not milk the heel excessively as this may cause hemolysis · Do not apply an adhesive bandage to a neonate's heel · Wipe away the first drop of blood obtained to eliminate tissue contamination
You may collect blood from any part of the heel
What urine contaminant could cause a falsely elevated level of urinary albumin, thus giving the false interpretation of kidney damage?
Blood from menstruation
A phlebotomist needs to collect the following microcollection tubes during a capillary blood collection: · Lavender top (EDTA) · Red top (no additive) · Blood gas specimen · Gray top (sodium fluoride) Which microcollection tube should be collected first?
Blood gas specimen
According to the OSHA Bloodborne Pathogens Standard, how often should work surfaces in the laboratory by decontaminated with an appropriate disinfectant?
If blood or other potentially infectious material has spilled on the work surface
What are key things to remember when collecting a light-blue top tube for coagulation testing?
If a winged device is used for collection of a light-blue top tube for coagulation testing, always draw a waste tube first
Which of the following substances is a disinfectant commonly used in Clinical laboratory settings? · Insulin · Tincture of iodine · Acid citrate dextrose (ACD) · Hypochlorite solution
Hypochlorite solution
All of the following demonstrate safe work habits that should be utilized when using hazardous processing reagents, EXCEPT? · Wearing personal protective equipment (PPE), such as gloves and safety glasses · Working in a fume hood and having good air quality/ventilation · Being familiar with the safety data sheet (SDS) for each reagent · Recapping a needle
Recapping a needle
Which of the following statements about blood collection tubes is incorrect? · Red-topped tubes are used for electrolytes and contain anticoagulant · Lavender-topped tubes contain EDTA and are routinely used for CBC testing · Light blue-topped tubes are used for coagulation testing and contain sodium citrate · Green-topped tubes are used for assays performed on plasma and contain either sodium or lithium heparin
Red-topped tubes are used for electrolytes and contain anticoagulant
A spill of a chemical listed as a potential carcinogen has occurred in the laboratory. What document should the laboratory personnel use to find information on how to handle the spill?
Safety Manual
When collecting blood from a pediatric patient, which of the following is an example of proper phlebotomist to patient introduction? · Start by telling the patient's parent to leave the room because you are about to draw blood · Come in the room and while you prepare your blood collecting materials ask the child to state their full name · First you need to properly identify the patient, so you can start by grabbing the patient's arm to verify that the information on your laboratory order matches the patient's hospital identification bracelet · Smile, make eye contact, get low to the patient's level if you can, and introduce yourself
Smile, make eye contact, get low to the patient's level if you can, and introduce yourself.
What is the anticoagulant most commonly used for routine coagulation testing?
Sodium citrate
Which of the following anticoagulants is the best choice for coagulation studies? · EDTA · Sodium citrate · Sodium polyanethol sulfonate (SPS) · Acid citrate dextrose (ACD)
Sodium citrate
Jenny works at an outpatient clinic. The clinic stocks purple top, light blue top, red top, green top, and speckled top tubes in the blood drawing stations. Jenny receives a requisition that states, "draw a serum separator tube, a tube for hematology, and a heparin plasma tube and hold for testing". What color tubes should jenny collect
Speckled top, purple top, and green top
All of the following statements are true regarding urinalysis reagent strips EXCEPT? · Prolonged immersion may wash out reagents · Strips should be stored to prevent exposure to moisture · Some tests require specified reading times · The expiration date on the bottle does not matter, as long as the controls are acceptable
The expiration date on the bottle does not matter, as long as the controls are acceptable
What does the anatomic term "Plantar" refer to?
The sole of the foot