Collections

Which of the following statements made by a phlebotomist indicates understanding of proper specimen processing? (Select the two (2) correct answers.)

"I must pre-label aliquot tubes one patient at a time.", "I must remove stoppers from tubes using a face shield."

The physician has ordered a sputum collection. Which of the following patient instructions must be given before collection of the sputum?

"Rinse the mouth with warm water."

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?

1 EDTA and 1 heparin. CMP would be drawn in heparin as this tube could be immediately centrifuged and resulted quickly.

A phlebotomist is assigned to manage an outpatient draw station. Prioritize the following patients in the correct order. (Click and drag the options in the left column to their correct position in the right column.)

1 STAT troponin level on a patient sent over from a doctor's office 2 type and screen on a pre-operative patient due for surgery that day 3 2-hour post-prandial glucose level due in 40 minutes 4 weekly PT/INR

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?

23g needle at a 10 to 15 degree angle

Which of the following urine samples should be used for a cortisol level?

24 hour

A patient is receiving therapeutic medication. Which of the following is the correct way to draw trough levels?

30 minutes prior to medication administration

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?

60 min

If alcohol is used to decontaminate the capillary puncture site, which of the following should the phlebotomist do?

Allow the site to air dry before the puncture.

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?

Avoid taking vitamin C prior to collection.

Which of the following should the phlebotomist do with a patient known to have a fainting problem?

C. Position the patient supine.

Which department within the lab should a BMP be delivered to?

Chemistry Department A BMP is a panel of tests (glucose, calcium, BUN, creatinine, sodium, chloride, potassium, CO2) performed in the Chemistry department.

A phlebotomist collects citrate, EDTA, and oxalate tubes in that order. Which of the following is the correct lab department for each tube?

Citrate to coagulation, EDTA to hematology, and oxalate to chemistry. 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

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.)

Collect a first morning specimen., Collect the specimen 1 hour after eating a meal.

A patient arrives at an outpatient draw station for a glucose tolerance test collection. The phlebotomist has verified that the patient has been fasting for 10 hours. Place the steps below in the correct order for performing the test. (Click and drag the options in the left column to their correct position in the right column.)

Collect the initial blood specimens for glucose and insulin levels., Instruct the patient to drink the predetermined dose of the glucose beverage., Start the timing for the glucose tolerance test., Collect blood specimens at physician prescribed intervals.

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?

Continue to draw using a gray top.

Which of the following laboratory departments should a Pap smear be delivered to?

Cytology

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?

D-dimer, RPR, ESR, lactic acid

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?

Draw a new chemistry tube on the patient.

Place the options below in the correct order of draw for micro containers. (Click and drag the options in the left column to their correct position in the right column.)

EDTA, heparin, sodium fluoride, no additive The order of drawn for dermal punctures is different than for venipuncture. Since there is no risk of "carryover" of additives to be concerned with, 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 the correct order for filling micro collection tubes when multiple tests are ordered?

EDTA, other additive tubes, non-additive tubes 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?

FOB Fecal occult blood (FOB) is a waived test used to screen for gastrointestinal bleeding.

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?

Hold pressure on the site for a minimum of five full minutes until the bleeding stops.

Which of the following is a coagulation test that can be performed with a POC machine or instrument?

INR INR which monitors coumadin levels.

Which of the following laboratory departments should a rapid plasma reagin (RPR) be delivered to?

Immunology The specimen collected for an RPR should be delivered to the immunology department The RPR is a screening test for syphilis

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.)

Keep at room temperature., Develop with hydrogen peroxide.

Which of the following is a phlebotomist required to do when preparing to aliquot a specimen? (Select the three (3) correct answers.)

Match the labels on the tubes., Prepare under a bench top splash shield., Use a disposable transfer pipette.

A requisition order requires a phlebotomist to draw a BMP, CBC, PTT, and lactic acid. Place the options below in the correct order of draw. (Click and drag the options in the left column to their correct position in the right column.)

PTT, BMP, CBC, lactic acid light blue (sodium citrate for PTT) is drawn first, then a red, gold or green for the BMP (basic metabolic panel), then a lavender (EDTA) for the CBC and a gray (fluoride / oxalate) for the lactic acid last.

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?

Perform the blood draw in the presence of the physician.

Which of the following is the best way to properly anchor the vein?

Place the thumb 1 to 2 inches below the site.

Which of the following should the phlebotomist do if urine testing will be delayed more than an hour?

Place the urine specimen in the refrigerator

Place the tubes below in the correct order of draw. (Click and drag the options in the left column to their correct position in the right column.)

SPS, SST, heparin, EDTA 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).

Which clinical laboratory department do ANA, HIV, and HCG specimens go to?

Serology/Immunology

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?

The doctor who ordered the test.

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?

The first drop of blood may contain fluid from the tissues.

Which of the following is the reason a phlebotomist should avoid milking a finger during a capillary puncture?

The specimen may be contaminated with interstitial fluid.

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?

The specimen was transported in a pneumatic tube system and cells were not separated from serum or plasma within the time limit.

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?

To protect specimen from light.

At what point should specimen labeling occur?

Upon completion of the blood draw.

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?

Verify the time of collection with the patient's nurse or physician.

Which of the following samples is still acceptable when kept at room temperature for 8 hours after collection?

a glucose test in a gray top tube 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?

aerobic

Which of the following blood tests require special handling? (Select the three (3) correct answers.)

ammonia, cold agglutinin, bilirubin

Which of the following types of medication work to inhibit blood from clotting?

anticoagulants

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

at body temperature and return it to the lab within 30 minutes.

A phlebotomist is asked to process a bilirubin level collected in a red top tube. The phlebotomist should centrifuge the specimen

at least 20 minutes after collection and aliquot into an amber tube.

The phlebotomist draws blood from a patient in an isolation room. The specimen should be properly taken to the lab in a

biohazard transport bag

Which of the following specimens is most susceptible to contamination and should always be drawn first?

blood culture

Which of the following tests can be collected by capillary puncture? (Select the two (2) correct answers.)

blood gas, bilirubin

. 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?

castile soap wipes

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

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?

coban

A patient with Pseudmonas aeruginosa is receiving gentamicin antibiotic for therapy. In order to appropriately monitor this drug for patient safety the phlebotomist must

collect the blood sample before the drug is administered.

A three-month-old patient was sent to the lab for an H&H. How should the phlebotomist collect the sample?

dermal puncture, heel stick

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

follow dietary guidelines specifically for the test.

Which of the following sites is contraindicated for a patient with diabetes?

foot/ankle

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

gauze and instruct the patient not to bend the arm.

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?

glucose and electrolytes 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?

gray top

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 The liver enzyme AST can be collected into a green (heparin) tube

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?

hand vein

After drawing a patient with hemophilia the phlebotomist should

hold pressure for 5-10 minutes.

Which of the following specimens is likely to be considered STAT?

lactic acid 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.

Which of the following correctly matches the test with the appropriate special handling instructions?

lactic acid chilled in slurry of ice 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.e and water

Which of the following tubes contains an anticoagulant that prevents platelets from clumping and preserves the appearance of blood cells for microscopic prep?

lavender 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.

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?

left arm

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?

light blue, gold, lavender, grey

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?

light blue, gold, lavender, pink, gray.

A phlebotomist is asked to collect a CBC, PT, electrolytes and BUN. The correct order of draw for this collection is

light blue, green, lavender.

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.)

light blue, lavender, gold gel barrier A gold gel barrier tube can be used for the Prostate-specific antigen (PSA) as this test requires serum

The phlebotomist has orders for an FBS, INR, and CBC Stat. Which of the following is the correct tube selection and order of draw?

light blue, lavender, gray the light blue would be drawn first for the INR (international normalized ratio), lavender second for the CBC and gray last for the FBS (fasting blood sugar).

Which of the following is the correct order of draw when one or more tubes containing anticoagulant are collected?

light blue, red, green

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?

light blue, red, green, lavender

Test ordered are for hematology, serum chemistry, and coagulation studies. Which of the following is the correct order of draw?

light blue, red, lavender

After a tiger top tube was centrifuged the phlebotomist noticed that the serum was milky white. Which of the following conditions does this indicate?

lipemia

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

not transported at the correct temperature.

A 76-year-old patient has fragile skin with little elasticity. The best choice to ensure his skin doesn't tear should be

paper tape.

The phlebotomist must label blood bank specimens with which of the following information? (Select the three (3) correct answers.)

patient's date of birth, patient's first and last name, date and time of collection

When anchoring a vein the phlebotomist should (Select the two (2) correct answers.)

place the thumb 1-2 inches below venipuncture site., draw the skin away from the site.

The phlebotomist has to draw lavender, gold, light blue and gray top tubes for the following tests. Place the tests listed below in the correct order of draw. (Click and drag the options in the left column to their correct position in the right column.)

prothrombin, cholesterol, CBC, glucose

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

read the temperature strip.

Which of the following tubes needs time to clot before being centrifuged?

red

When processing a specimen in a centrifuge the phlebotomist should ensure that all the

samples are balanced in the centrifuge.

Which of the following is the CLSI recommended order of draw for a BMP, CBC & PTT?

sodium citrate, heparin, EDTA

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?

source of specimen 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.

Which of the following are required for a sputum collection?

sterile cup, immediate delivery to lab

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

they run a risk of choking.

Which of the following tubes is most likely to be centrifuged?

tiger top SST

While providing patient education on 24-hour urine collection for creatinine clearance, it is imperative to tell the patient

to keep the specimen refrigerated at all times.

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

transfer the specimen to the centrifuge to be spun down.

When collecting blood for a neonatal screening, the phlebotomist should

use a capillary collection procedure.

When performing a blood draw on a 75-year-old patient with thin, papery skin, the phlebotomist should

wrap the arm in gauze and apply the tourniquet