NCCT Phlebotomy

The patient was sent to the lab to have CBC (lavendar), PT/PTT (light blue), CMP (green), and glucose (grey). Place the evacuated tubes in the correct order of draw.

1. Light blue 2.Green 3.Lavendar Purple 4. Gray

The appropriate needle gauge to use for most venipuncture collections is

21

After selecting the appropriate location to collect a blood sample, how many inches above that location should the phlebotomist fasten the tourniquet?

3 to 4 inches

The medical assistant is educating the patient on fasting diet requirements prior to a glucose tolerance test. Which of the following is the minimum time frame the patient must remain NPO before the start of the test?

8-12 hours

Which patient description is correctly matched with the appropriate site selection

A 53-year old male with a central line has a specimen collected from the dorsal side of the hand.

An infant is brought to the clinic for a CBC. After performing a heelstick, not enough blood is collecting to perform the test. Which of the following actions should the medical assistant take?

Apply a warm compress

Which of the following actions should the medical assistant take to make a vein more prominent whem attempting to select a venipuncture site?

Apply a warm compress to the area for 5 minutes

Which of the following is the proper way to identify a patient prior to performing a venipuncture?

Ask the patient to state his/her full name and DOB and compare to the chart.

Which of the following actions by the medical assistant demonstrates safe use of a centrifuge?

Balance the tube load to prevent breakage

The medical assistant has an order to collect a CBC with diff, PT, a basic metabolic panel (BMP) and blood culture. Place the collection tubes in the correct order of draw.

Blood cultures, PT, BMP, CBC with diff Blood cultures, light blue, red, lavender

The physician has ordered a prothrombin time (PT) and complete blood count (CBC) for an adult patient with a diagnosis of thrombophlebitis. The medical assistant should collect the evacuated tubes in which of the following orders?

Blue, lavender top

A CMP is ordered for an older adult patient whose veins continue to collapse despite drinking water. Which of the following is the best collection method for this patient?

Butterfly needle

Prior to any type of inpatient specimen collection, a phlebotomist must correctly verify their patient's identify by using which two-step procedure?

Check ID bracelet, and ask patient to verbally confirm their identity

The medical assistant is collecting a sample on a 2 year old outpatient by finger stick. Following collection, the medical assistant holds firm pressure on the site until bleeding has stopped. How should the medical assistant proceed?

Do not bandage the site.

Patient has a DVT in left arm and the patient is also on blood thinners, where would be the best site for drawing blood?

Draw right arm and hold for 5 minutes

Identify the CLSI recommended micro-collection order of draw for a BMP, CBC, & Bilirubin.

EDTA (lavender), Herparin(green), Serum Separator(SST)

When performing a CBC on a six year old, the parent insists upon using an anesthetic at the venipuncture site. Which would be correct?

EMLA

Since special precautions are needed for patients with Vascular Access Device, which of the following devices are contraindicated for any type of blood draws?

Fistula

Which of the following additives protects serum from interacting with red blood cells after a specimen has been centrifuged?

Gel separators

Which of the following actions should the medical assistant take to prevent hemolysis of a blood specimen in an EDTA tube?

Gently invert the tube after collecting the specimen.

Which of the following evacuated tubes should the medical assistant select for collection of electrolytes?

Green-top

The medical assistant is instructed to perform a capillary stick for newborn screening. Which of the following collection devices should the medical assistant use?

Heel stick lancet

While performing a venipuncture, the medical assistant removes the filled tubes, but forgets to remove the tourniquet prior to needle withdrawal. Which of the following is the most likely results?

Hemoatoma

After a phlebotomy draw, the phlebotomist realizes the tourniquet was on the patient's arm for an extensive length of time. Which of these is the most common complication?

Hemoconcentration

The medical assistant completes a venipuncture in the antecubital area without complications. Pressure is placed on the site following the collection. The patient is still bleeding after five minutes of continuous pressure by the medical assistant and there is bruising at the site. The medical assistant asks the patient if she is on anticoagulants. The patient indicates that she is, and states that this is normal for her. How should the medical assistant proceed?

Hold direct pressure until bleeding stops, apply bandage, and notify nurse.

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 medical assistant do?

Hold pressure on the site for a minimum of five full minutes

A phlebotomist draws a patient that is on anticoagulant therapy and bleeds excessively after the venipuncture. What is the proper course of action in this situation?

Hold pressure over the site and call the nurse

Place the following steps in the correct sequence when preparing to perform a venipuncture.

Identify the patient and explain the procedure Wash hands and put on gloves Apply Tourniquet Palpate the antecubital space of the arm Locate an acceptable vein

A phlebotomist is staffing the outpatient clinic at a remote site. There is a centrifuge at the site, but it is not functional. The courier will be arriving to pick-up all samples collected at 1300, and will deliver to the testing laboratory at 1500. A patient arrives at 1200 with orders for Complete Blood Count, Prothrombin Time, and Basic Metabolic Panel. Which tubes should the phlebotomist use for blood collection?

Lavender, Blue, Green, Gray

A physician asked you to draw a INR on Mr. Jones which tube and additive would you choose

Light blue, sodium citrate

Which of the following tests monitor anticoagulation therapy?

PT and PTT

While obtaining blood during a venipuncture, the patient faints. Which of the following actions should the medical assistant take initially?

Pass an alcohol prep pad briefly under the patient's nostrils.

Name the two most used patient identifiers.

Patient's name/ date of birth

Which task should a phlebotomist complete prior to useing a POCT instrument

Perform QA and QC on the instrument

A phlebotomist inserts a needle into a patient's vein and notices there is no blood flow into the tube. The needle is positioned against the wall of the vein. How should the phlebotomist proceed?

Relax the needle;s angle, and insert new tube

When performing a venipuncture, sudden swelling is observed at the insertion site. Which of the following actions should the medical assistant take?

Release the tourniquet, remove the needle, and immediately apply pressure at the site

During a blood draw, a patient begins complaining of discomfort and tingling, at which time the phlebotomist notices bruising and discoloration at the site. How should the phlebotomist proceed?

Release the tourniquet, withdraw the needle, and apply pressure.

After the phlebotomist puts on latex gloves and ties a non-latex tourniquet on the patient's arm, the patient indicates that he is highly allergic to latex. Which of the following is the phlebotomist's best course of action?

Remove the tourniquet, wash hands, change to non-latex gloves, and use a new tourniquet

Using the guidelines for any method of venipuncture, which of the following actions should the medical assistant perform directly after confirming patient identity?

Review the requirements for collecting and handling the blood specimen as ordered by the physician

When performing venipuncture on a patient with a left mastectomy, which site should the medical assistant use?

Right antecubital fossa

Which of the following tubes contains ethylenediamineteractic acid?

Royal blue

The medical assistant is collecting four tubes of blood on a patient who begins wheezing. She asks the patient if he is okay, he states that he has asthma. The medical assistant is in the process os switching to the fourth tube when the patient faints in the phlebotomy chair. Which of the following steps should the medical assistant take?

Stop the collection, apply pressure to site, call for help, and assist the patient

A medical assistant has active symptoms of the common cold. Under which of the following conditions may he perform venipuncture?

The medical assistant may perform venipunture provided he is wearing a mask and afebrile.

When performing a skin puncture on an infant what is the preferred site?

The plantar surface of the heel

After centrifuging a blood specimen, the medical assistant notes the serum has a reddish appearance. Which of the following has occurred?

The specimen is hemolyzed

Which of the following statements best describes the reason antecubital veins are most desirable to use when performing venipuncture?

The tissue surrounding these veins is less sensitive, making the procedure less painful.

Which of the following actions is appropiate for the medical assistant to take if an evacuated tube does not even begin to fill during a specimen draw?

Try another evacuated tube prior to withdrawing from the vein

When a complete metabolic profile (CMP) and complete blood count (CBC) are ordered at the same time, why should the CMP be drawn first?

Tubes without additives should be drawn before tubes with additives.

A phlebotomist is asked to collect a CBC, PT, and Chem 7 on a patient that requires a handstick with a butterfly needle into evacuated tubes. The correct order of draw for this collection would be

Two light blue tube tops, Green top tube, Lavender top tube

When inserting a needle during venipuncture, the bevel should be in which of the following positions in relation to the vein?

Up

After several minutes of searching the medical assistant can only palpate a small vein. The patient is prepared and the venipuncture is performed. The blood is filling the tube, but slows and then stops even though the patient and medical assistant remained still. Which of the following actions should the medical assistant take?

Use a smaller tube because the vein has collapsed.

insurance number

Which of the following should be avoided as a form of patient identification?

Filling evacuated tubes to the indicated level results in the correct ratio of

additive to blood

When performing a venipuncture on an infant, the amount of blood taken from the infant should be monitored to avoid

anemia

EDTA is an

anticoagulant

Which of the following types of additives is present in an EDTA tube?

anticoagulant

To help prevent a hematoma at the site after drawing blood, which of the following actions does the medical assistant take?

appply direct pressure with cotton gauze

Capillary blood specimens are typically collected on patients that

are extremely obese.

At what time should a test tube be labeled with the patient's identification?

before leaving the patient's room, after drawing the blood

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

blood culture

Which of the following is an appropriate alternative to using a rubber tourniquet when attempting a venipuncture on a known patient who is difficult to obtain a sample from?

blood pressure cuff

While performing a venipuncture in the antecubital space, the patient verbalizes an extreme amount of pain and the blood in the collection tube is noted to be bright red. Which of the following sites is most likely to have been inadvertently punctured?

brachial artery

The phlebotomist is responsible for performing which of the following QC measures? (Select All)

checking the expiration dates of venipuncture supplies monitoring temperatures of specimen refrigerators routine cleaning of surfaces where specimens are processed

When performing a fingerstick on a patient, the phlebotomist must pay close attention to the extremity that has been compromised by

circulation, swelling and infection

While performing a venipuncture using an evacuated tube, a small amount of blood enters the tube and then stops. Which of the following conditions is likely to lead to this?

collapsing vein

A medical assistant needs to draw a bilirubin on a jaundiced infant. The medical assistant should

collect the specimen in an amber tube to protect from light

After a phlebotomist has successfully followed all the steps for blood collection, the patient informs the phlebotomist that he tends to bleed longer than the average person. What would be the next course of action for the phlebotmist?

confirm hemostasis and apply paper tape

After performing a venipuncture on a patient the medical assistant notices the patient is bending his elbow to hold the gauze in place. This action is contraindicated because bending the elbow is likely to

create a hematoma

When collecting specimens for alanine aminotransferase (ALT) or aspartate aminotransferase (AST), avoid gray-topped sodium fluoride tubes because the anticoagulant

destroys many enzymes

The phlebotomist is asked to draw blood from a patient with an I.V. whose opposite, left arm is inaccessible. Drawing blood from which pf the following sites would be appropriate without a physician's approval?

draw from the right arm distal to the I.V. site

A test tube with which of the following colored stoppers has a glycolytic inhibitor?

gray

A patient's past history indicates episodes of syncope. Which of the following would be the best course of action the phlebotomist would perform to prevent complications of synocpe?

have the patient lie down on a hospital bed or exam table

The physician orders a hemoglobin level to be checked on a 2-month-old patient. Which of the following sites should the medical assistant use to obtain the specimen?

heel of the foot

Forceful shaking of blood in an evacuated collection tube will cause which of the following complications?

hemolysis

A phlebotomist has received a requisition for a PT/aPTT to evaluate the patient for Von Willebrand's disease. Because of the patient's potential diagnosis, the phlebotomist should be sure to

hold pressure on the draw site until bleeding has stopped.

Which of the following steps is completed first in performing venipuncture?

identify the patient

Which of the following tubes should the medical assistant select in collecting a blood sample for a Complete Blood Count (CBC)?

lavender top ethylenediaminetetracetic acid additive

The physician orders a prothrombin time. Which of the following tubes should be used to collect the specimen?

light blue

A patient is at the lab for their weekly PT/INR. Which of the following tubes should the medical assistant collect for this tube?

light blue top

Which of the following evacuated tubes should the medical assistant draw first?

light blue top

A patient with an order for a blood draw presents with burns covering both arms. Which of the following is the medical assistant's best option for collecting the largest amount of blood for this patient?

microtainer tube

Which of the following items is more commonly found on a phlebotomy tray?

multi-sample needle

For which of the following patients is the use of an adhesive bandage contraindicated?

newborn with hyperbilirubinemia

The phlebotomist is drawing blood from a patient that is taking blood thinners. Which of the following is a necessary piece of additional equipment to have at the drawing station?

non-adhering bandage

Capillary blood specimen collections are contraindicated in patients with

peripheral edema

Which of the following sites should the medical assistant use for newborn screening blood collection

plantar surface of the heel

A phlebotomist has received a requisition to collect a blood specimen on patient in isolation. When entering the patient's room, which should the phlebotomist do first?

put on the gown

While performing a venipuncture, immediately before removing the needle, the medical assistant should

release the tourniquet

A centrifuge functions in which of the following ways?

rotates to separate components of a patient's blood

Which of the following is a likely complication from repeared phlebotomy procedures in the same area

sclerosed veins

Which of the following is the additive in the light blue top tube?

sodium citrate

Blood cultures are always drawn first because

to avoid contamination of the cultures

After a patient's skin is punctured to obtain a blood glucose level, what should be the phlebotomist's next step?

use a sterile gauze pad to remove the first drop

In which of the following time frames should a tourniquet be rountinely released on a patient while performing a blood draw?

within one minute