Phlebotomy 4th Edition

Massage arm or dangle arm downward Apply dry heat to the collection site Use blood pressure cuff as tourniquet

For a patient with difficult veins, which of the following techniques can be used to enhance prominence of the vein? Reason: To enhance vein prominence, any of the following may be successful: massage the arm upward from the wrist, have the patient dangle arm downward, apply dry heat to the area of the draw or use a blood pressure cuff as a tourniquet.

9 ml

For an infant that weighs 3 kg, which represents the preferred total blood that can be drawn in a 24-hour period? Reason: The preferred maximum total blood to be drawn in a 24-hour period for an infant is 3% of total blood volume; use the formula, 3 x 100 = 300 (total blood volume) x 0.03 = 9 mL.

False

HIPAA is the Hospital Inpatient Protection Administration Act Reason: HIPAA is the Health Insurance Portability and Accountability Act requiring the privacy of all patient's protected health information, or PHI.

False

HIPAA is the Hospital Inpatient Protection Administration Act. Reason: HIPAA is the Health Insurance Portability and Accountability Act requiring the privacy of all patient's protected health information, or PHI.

True

Hand hygiene using proper hand washing or an alcohol-based agent is the most effective means of preventing infection. Reason: The most effective means of preventing spread of infection and antibiotic-resistant microorganisms is hand hygiene.

Shielding the blood sample from the light

If a phlebotomist is required to complete a heel stick to collect a specimen for bilirubin testing on an infant who is under the Bili-light, which of the following is required? Reason: A bilirubin is light sensitive, so it is necessary to shield the specimen from the Bili-light by turning it off while collecting blood; a heel stick is performed rather than using a scalp vein, and filter paper is not required.

True

If a physician arrives when the phlebotomist is in the middle of a blood draw on an inpatient, ask respectfully for a few minutes to complete the test. Reason: When in the middle of completing a blood draw and a physician arrives in the patient's room, ask for a few minutes to complete the collection.

Wash the area with soap and water or a disinfectant Report injury immediately to employer Seek medical attention

If an accidental needle stick does occur, what steps should be taken after flooding the area with water? Reason: The protocol for an accidental needle stick and exposure to blood includes: flooding the area with water followed by washing with soap and water or a disinfectant, immediately reporting the incident to employer, and seeking medical attention.

Keep the specimen warm

If an agglutinin level is ordered, which special handling should the phlebotomist complete? Reason: Agglutinin level specimens must be kept warm until the serum is separated from the RBCs to avoid inaccurate results.

400-450 mL

If an infant weighs 4.2 kg, which of the following ranges represent their total blood volume? Reason: Total blood volume is calculated by multiplying weight in kilograms by 100; in this case, 4.2 x 100 = 420, falling in the range of 400-450.

Use a new tube Retract the needle Advance the needle

If no blood flow is obtained with venipuncture, what is the next step taken by the phlebotomist? Reason: Lack of blood flow with venipuncture can be caused by a defective tube or improper needle position; using a new tube, retracting or advancing the needle are possible solutions

Light Blue

If the only test ordered is coagulation studies, which tube will be used for blood collection? Reason: Coagulation studies are drawn using a light blue topped tube.

Have the patient lie down

If the patient indicates that they always feel faint when having their blood drawn, what approach should be taken by the phlebotomist? Reason: When a patient has a history of feeling faint with a blood draw, have the patient lie down for the blood collection procedure.

Inform the nurse and reapply the ID band, and then draw the patients blood

If the phlebotomist encounters an inpatient that is not wearing a hospital ID band, what is the most appropriate next step? Reason: An inpatient's blood is never drawn without wearing an ID band; if this occurs, inform the patient's nurse to identify the patient and reapply the ID band.

15 Minutes

If the phlebotomist is exposed to a chemical spill, how long should the affected area be flushed following exposure? Reason: If a chemical is spilled on the phlebotomist, the affected area should be flushed with water for a minimum of 15 minutes.

Notify the Physician immediately

If the phlebotomist performs point-of-care testing and notes an elevated test result, what should he or she do? Reason: The phlebotomist must learn to recognize abnormal values for POCT in order to immediately inform the physician for an abnormal result so that treatment can begin, or further testing can be ordered.

Gently wake the patient before drawing blood

If upon entering the patient's room, the patient is sleeping, what is the best course of action for the phlebotomist? Reason: Never draw blood from a sleeping patient; first gently wake the patient and allow a moment to become oriented before getting consent and drawing the patient's blood.

All newborns and infants

In which situation is capillary puncture the best method to obtain a specimen? Reason: Since newborns and infants have smaller veins and a smaller volume of blood, making venipuncture more difficult and possibly dangerous, capillary puncture is the preferred method to obtain a specimen.

True

Patient wait time, accurate identification, technical proficiency and post collection specimen handling are all under the control of the phlebotomist who performs the collection procedure. Reason: Pre-analytic variables include patient wait time, accurate identification, technical proficiency and post collection specimen handling, which are all under the control of the phlebotomist performing the collection.

True

Some lancet safety devices are contact activated, and some require the Phlebotomist to depress a trigger to release the blade, delivering a swift puncture to a predetermined depth. Reason: Safety lancets are used to perform capillary puncture with some being activated upon contact and some requiring pressing of a trigger to deliver the puncture to a predetermined length.

Aerosol spray forming when the stopper is removed

Tubes with rubber stoppers and plastic tops, minimize which of the following? Reason: Collection tubes with a rubber stopper and plastic top minimize aerosol spray forming when the stopper is removed by the laboratory technician.

Fingerstick

Upon entering the patient's room, the phlebotomist encounters a very elderly woman who requires a glucose level test; which of the following methods is the best choice to obtain the specimen? Reason: Geriatric patients may have small and fragile veins; and if only a small amount of blood is required, capillary puncture by fingerstick is favored.

"Excuse me doctor, I apologize for the interruption; I am here from the lab to draw the patients STAT blood test"

Upon entering the patient's room, the physician is present; which of the following is the most appropriate response by the phlebotomist for a STAT blood test? Reason: If a STAT blood test is ordered and the physician is in the room upon arrival, respectfully introduce yourself and explain the reason for the interruption.

Plastic

What are most blood collection tubes made of today? Reason: The clear tubes are either plastic or glass, but today most tubes are shatter-proof plastic.

False

When completing an evacuated tube blood collection, a blood transfer device must be used. Reason: The blood transfer device is used with the syringe method to transfer the blood from the barrel of the syringe to the correct collection tube.

Immediately after drawing arterial blood for ammonia testing

When is an ice slurry used? Reason: Collection of an arterial blood specimen for ammonia testing requires that it sit in an ice slurry immediately following the draw.

Early in the morning

When is the best time to collect a sputum culture? Reason: Since sputum is most abundant in the morning after accumulation during the night, a first morning specimen before eating or drinking is best.

Immediately after the needle is removed from the site

When is the needle safety device activated? Reason: The safety needle feature is activated immediately after removal from the collection site.

Performance of CLIA-waived testing

When might the phlebotomy technician have an impact on analytic variables? Reason: Specimen transportation, specimen handling and use of the centrifuge are all part of pre-analysis; since the phlebotomist can perform CLIA-waived testing, he or she has an impact on the analysis of the specimen.

True

When one specimen needs to be centrifuged, the phlebotomist will place a water-filled tube across from the sample in the centrifuge to prevent imbalance and breakage. Reason: A centrifuge can become imbalanced and a tube can break if centrifuged as a single specimen; instead, the phlebotomist places a water-filled tube across from the single specimen.

15-30 degrees

When performing venipuncture, at what angle should the needle be inserted? Reason: Hold the needle assembly with your dominant hand, with the tube inserted up to the line on the adapter. Angle the needle 15 to 30 degrees above the skin.

In an infant

When should a capillary arterial blood gas be performed instead of an arterial blood gas? Reason: It is most common in an infant to collect blood gases using heel stick for capillary puncture and taking added precautions to protect the specimen, including the use of a heparinized pipet.

Standard of care

When the phlebotomist asks for assistance from another phlebotomist working in the lab after two unsuccessful blood draw attempts on a patient, what is being practiced? Reason: A phlebotomist is practicing a high standard of care, which is the consensus of medical care on a patient in the same situation, to include never performing more than two unsuccessful blood draw attempts.

False

When using filter paper to perform testing for neonatal screen for inborn metabolic disorders, touch the circle to smear the blood and completely fill each circle. Reason: When using filter paper to collect a specimen, a drop of blood is applied directly on each circle to completely fill the circle without touching it.

CLIA

Which is a law that mandates the regulations on all facilities who perform patient testing? Reason: The Clinical Laboratory Improvement Act, or CLIA, mandated regulations on all facilities that perform patient testing beginning in 1988.

Informatics

Which is a term for electronic methods of processing specimens? Reason: Specimen processing is completed using electronic methods in some facilities, which is called informatics

Lancet

Which is an example of sharps? Reason: Items that are used to puncture the skin are sharps, including lancets and needles.

Reference Laboratory

Which is an independent laboratory facility that analyzes specimens sent from other healthcare facilities? Reason: An independent reference, or referral, laboratory analyzes specimens sent from other healthcare facilities or laboratories.

Confidentiality

Which is being followed when a patient is only discussed with healthcare personnel directly involved in the patient's care? Reason: Confidentiality requires that patient information is not discussed in public and is never discussed with anyone not directly involved in the patient's care.

3 mm

Which is the appropriate maximum depth for a fingerstick puncture? Reason: A fingerstick puncture should never exceed a depth of 3 mm.

Third and fourth finger

Which is the most appropriate finger for a fingerstick? Reason: A fingerstick should be performed on the nondominant hand using the distal.

Sharps

Which is the most common hazard for the phlebotomy technician? Reason: The phlebotomy technician can be exposed to a variety of hazards in the healthcare setting; however, sharps hazards are the most common.

Midstream Catch

Which is the most common method of obtaining the urine sample? Reason: Timed, random and first-morning specimens are types of urine; midstream clean catch is the most common method of obtaining a urine sample.

Median Cubital

Which is the most preferred vein in the antecubital space for a blood draw? Reason: The most preferred vein for blood draw is the median cubital followed by the median cephalic and then median basilic as second and third choices.

POCT CLIA-waived tests Kit testing

Which of the following are approved for in home use and are simple to perform? Reason: Point-of-care testing can be performed in the home with CLIA-waived test kits approved by the FDA for in-home use as they are simple to perform.

HDL LDL Total cholesterol

Which of the following are cholesterol tests that can be performed at point-of-care? Reason: Cholesterol testing done at point-of-care includes HDL, LDL and total cholesterol

Technical knowledge Organizational skills Interpersonal skills

Which of the following are phlebotomy job skills? Reason: A phlebotomist's job skills include having technical knowledge, organization skills with attention to detail, good interpersonal skills and the ability to handle stress.

Using improper labeling

Which of the following are reasons for arterial specimen rejection by the laboratory? Reason: Arterial collection requires a syringe pretreated with heparin to prevent coagulation and a needle with a Luer tip to keep air from reaching the specimen; the laboratory will reject the specimen without proper labeling.

Obtain authorized signature of every person who handles the specimens Proper identification of the patient Indirect observation of specimen collection

Which of the following describes chain of custody? Reason: A chain of custody is required for drug screening, which requires identification of the patient, indirect observation of specimen collection with date and time recorded as well as an authorized signature from everyone who handles the specimen.

Nonsocomial

Which of the following is referring to a healthcare-associated infection? Reason: Infections contracted by patients during a hospital stay are called healthcare-associated infections or nosocomial infections.

CEU

Which of the following is required to maintain certification or license and demonstrates the phlebotomist is staying current in the field? Reason: To maintain a credential or license, continuing education units, or CEUs, are required by the credentialing organization.

The needle and the evacuated tube system are disposed of in the biohazard container

Which of the following is the correct procedure for disposal of the needle after a blood draw? Reason: The evacuated tube system with needle are disposed of in the biohazard container.

It will hurt just a little

Which of the following is the most appropriate to tell a child prior to drawing blood? Reason: When drawing blood on a pediatric patient, it is important to use a soothing tone of voice with an empathetic manner, never telling the child that it will not hurt but rather being honest and saying it will hurt just a little bit.

Certification and Licensure

Which of the following may be required of a phlebotomist? Reason: Even though certification is commonly voluntary, some states or regions may require either certification or licensures

Loose skin Less skin elasticity Displaced veins

Which of the following might be found in the geriatric patient when selecting a collection site? Reason: Skin changes are common in the aging patient including less elasticity, loose skin and loss of muscle tissue that can displace veins.

CLSI

Which of the following organizations is responsible for the standards for laboratory procedures? Reason: The Clinical and Laboratory Standards Institute, or CLSI, sets standards and guidelines for laboratory procedures.

Pathologists

Which of the following personnel has specialized training and will supervise the laboratory? Reason: A pathologist is usually the lab supervisor with specialized training in laboratory analysis of tissues and fluids.

Safety Data Sheets

Which of the following provides information about the chemical, its hazards and its cleanup and first aid for exposure? Reason: OSHA requires safety data sheets, or SDS, are provided with each chemical to provide information about the chemical and its hazards, cleanup and first aid for exposure.

Standard Precautions

Which of the following refers to infection control with use of barrier protection and work practice controls? Reason: Standard precautions refer to infection control with the use of barrier protection and work practice controls per the guidelines set by the CDC.

Soap and water

Which of the following should be used to clean the site when obtaining a specimen for an alcohol level? Reason: For an alcohol level, a nonalcoholic solution must be used to clean the site so that the test results are not altered.

Semen

Which of the following specimens must be kept warm and away from light? Reason: Semen specimens are collected in a sterile container and must be warm, away from light and delivered to the laboratory within one hour.

False

phlebotomist trained to draw blood is personally liable for their own actions Reason: The personal liability of a phlebotomist is responsibility for their own actions

True

A specimen that is thermolabile must be kept warm at 98.6 F or 37⁰C. Reason: A sample that must be kept warm, such as cold agglutinin, is kept at body temperature, or 98.6 F or 37⁰C.

False

Since a caregiver will be in attendance, it is not necessary to check the ID band of a pediatric inpatient. Reason: For all inpatients, pediatric or otherwise, the ID band is used as one of the two identifiers; and the pediatric patient must also be wearing the ID band.

True

Since access to veins may be difficult for obese patients, a dermal puncture is preferred. Reason: If a blood test can be performed on a capillary specimen, a dermal puncture is performed for the obese patient where there may be difficult access to veins.

Shortly after the medication has been administered

If a peak level is ordered for a medication monitoring, when should the phlebotomist collect the specimen? Reason: Peak level is the highest concentration of medication after the drug is given and takes effect, so a peak level specimen is obtained shortly after the medication has been administered.

Use the opposite arm

If a phlebotomist arrives in the patient's room and finds the patient has an IV in the left arm, how should blood be drawn? Reason: If a patient has an IV in one arm, the opposite arm should be used as a site for blood collection.

Syringe Method

If a phlebotomist determines that the patient has been returning each day for the last week for consecutive blood testing, which of the following should be completed? Reason: The timing of tests is determined by the physician, and the phlebotomist should choose the syringe method as best for the patient's fragile veins.

The left hand

If a phlebotomist is required to complete a capillary puncture on a patient with a right sided mastectomy, which hand is chosen for the fingerstick? Reason: Capillary puncture is performed on the nondominant hand in most situations; however, if a patient has a mastectomy, the opposite hand is chosen for the puncture; in this case the left hand.

True

A vascular access device is common for a patient in the ICU or ER, and collection from this device is only performed by specially trained personnel sometimes with the assistance of the phlebotomist. Reason: A vascular access device is a tube inserted into a vein or artery, and the phlebotomist may assist in this type of collection that is only performed by specially trained personnel with a physician's order.

False

Patient instructions provided for obtaining a 24-hour urine specimen include beginning collection with the very first morning specimen. Reason: N/A

False

For a patient with a right mastectomy, the right arm would be used for the blood collection site. Reason: If a patient has had a mastectomy on the right, drawing blood on this side may cause the patient discomfort; so, the opposite side is used as the blood collection site.

Mask

If a patient is in isolation with droplet precautions for pneumonia, what PPE must be worn if there is contact within three feet of the patient? Reason: In addition to Standard Precautions including hand hygiene, droplet precautions require the use of a mask by people who will be within three feet of the patient.

Do not draw the patient's blood and notify the physician

If a patient refuses having their blood drawn, what is the next step by the phlebotomist? Reason: Patient's always have the right to refuse any medical treatments, including phlebotomy; if this occurs, do not draw the patient's blood and notify the physician

True

Arterial blood gas specimens can be kept at room temperature for 15 to 20 minutes. Reason: Arterial blood gases can be kept at room temperature after collection for 15 to 20 minutes; if the specimen is not delivered to the laboratory within that time, it is placed in an ice slurry for up to one hour.

True

An ABG is performed after the site is cleaned with an antiseptic using both alcohol and povidone-iodine. Reason: Since the risk of infection is higher with arterial puncture, both alcohol and povidone iodine are used as an antiseptic.

False

An aerobic sample is one that has not been exposed to oxygen. Reason: An anaerobic sample is without oxygen, and an aerobic sample is one with oxygen

True

Any higher than normal results are reported immediately to the ordering physician. Reason: Critical test values, those higher or lower than normal, are immediately reported to the ordering physician.

False

A bilirubin sample must be kept warm. Reason: Bilirubin samples are sensitive to light and must be protected from light by wrapping the specimen in aluminum foil after collection.

False

A buccal swab and throat swab are both obtained from the back of the throat. Reason: A throat swab is obtained from the back of the throat and tonsils, and a buccal swab is obtained from inside the cheek.

True

A fasting specimen that requires a basal state should be scheduled in in the early morning. Reason: A basal state is the body's state after fasting for 8 to 12 hours, so tests requiring this state, should be scheduled in the early morning before breakfast.

True

A fecal specimen can be obtained for infection, parasites or occult blood. Reason:Fecal samples can be obtained to check for infection, parasites, colon cancer and occult blood.

False

A fingerstick puncture should be made near the fleshy center of the chosen finger, in the same line as the fingerprint lines. Reason: A fingerstick puncture is made near the fleshy center of the chosen finger, perpendicular to the ridges of the fingerprint, meaning across the fingerprint lines.

Metabolic

A random urine specimen is used to measure the presence of protein, glucose and other significant elements to detect which of the following abnormalities? Reason: An abnormal amount of protein, glucose and other significant element can detect metabolic abnormalities.

True

Calibration of a glucometer determines the accuracy of the device. Reason: Directions are provided by the glucometer manufacturer to calibrate the device to determine its accuracy before testing.

True

Compartment syndrome can occur in patients with coagulation disorders, such as hemophilia. Reason: Compartment syndrome is bleeding into surrounding tissues that can occur in patients with hemophilia or coagulation disorders.

False

Contact precautions only require Standard Precautions, hand hygiene and gloves. Reason: In addition to Standard Precautions including hand hygiene, contact precautions require the use of gloves and a gown by people entering the patient's room

Indirect Contact

Contact with a contaminated surface represents which type of transmission? Reason: Contact transmission of infection can occur from direct contact with a patient's infection or when touching a contaminated surface, which is indirect contact.

True

Hematology tests that can be completed as CLIA-waived, point-of-care testing include hemoglobin, hematocrit, RBCs and WBCS. Reason: Hemoglobin, hematocrit, RBCs and WBCs are all CLIA-waived, point-of-care hematology tests that can be performed by capillary puncture.

Anemia

Hemoglobin is a POCT that is conducted using a handheld hemoglobin analyzer to diagnose which type of condition? Reason: Hemoglobin is a POCT using capillary puncture to diagnosis or monitor anemia.

20-30 Minutes

How long should bleach remain in contact with a contaminated area after a biohazardous spill? Reason: To ensure complete disinfection, bleach should remain in contact with the contaminated area for 20 to 30 minutes.

Two hours after the last consumption of glucose or a meal

If a 2-hour postprandial specimen is required, when should the phlebotomist complete the collection? Reason: Postprandial is after consumption of glucose or a meal, so a 2-hour postprandial specimen is collected two hours after the patient consumes glucose or a meal.

Yellow, Red, Lavender

If a blood collection requires the phlebotomist to draw a red tube, a lavender tube and a yellow tube for blood cultures, which is the correct order of draw? Reason: Yellow tubes for blood cultures are always drawn first followed by red tubes for chemistry tests followed by lavender for hematology tests.

Laborotory Technician

If a centrifuge is not working properly, who should the phlebotomist inform of the need for repair? Reason: Any need for centrifuge repair or maintenance is reported to the laboratory technician.

True

If a geriatric patient is on anticoagulation therapy, it is important to remember that clotting can take longer, and pressure will need to be placed on the site gently to avoid bruising but for an extended period of time. Reason: It is common that many geriatric patients are on anticoagulation therapy, so be aware of the longer time to apply pressure on the site after a blood draw

True

If a geriatric patient is on anticoagulation therapy, it is important to remember that clotting can take longer; and to avoid bruising, gentle pressure will need to be placed on the site for an extended period of time. Reason: Since it is common that many geriatric patients are on anticoagulation therapy, be aware of the longer time to apply pressure on the site after a blood draw; gentle pressure is required to avoid bruising.

N95 Respirator

If a patient is in isolation with airborne precautions for tuberculosis, what PPE must be worn when entering the room? Reason: In addition to Standard Precautions including hand hygiene, airborne precautions require the use of a N95 Respirator by people entering the patient's room.

Quality-control and pre-analysis

Making sure that a point-of-control instrument is working properly is a part of what process? Reason: Quality control is a process to monitor procedure quality and accuracy of test results to include properly working instruments, which is also a part of the pre-analytic process.

False

Once the tourniquet is placed to determine site selection and the area is cleansed, it can be left in place until after completing the blood draw. Reason: A tourniquet is left in place no longer than one minute and should be removed after selection, reapplied after the area is cleansed and dried and then removed after blood begins to flow with the venipuncture procedure to stay within the one-minute timeframe.

False

Once the venipuncture site has been determined, it is cleansed with an alcohol pad and then the Phlebotomist should blow on the site to dry. Reason: The venipuncture site should be allowed to air dry after cleansing with an alcohol pad in a circular fashion, from the inside and moving outward.

False

Quality assurance is a component of quality control. Reason: Quality control is a component of the facility's quality assurance program standards.

False

Quality control is the process of making sure test results are reported to the physician in a timely manner. Reason: Quality control procedures are performed according to the manufacturer's directions to determine the accuracy of test strips whenever a new package is opened.

Ice slurry and Refrigerator

Samples collected for ammonia and lactic acid levels are thermolabile specimens and must be placed in which of the following immediately after the draw? Reason: Both ammonia and lactic levels are sensitive to temperature and must be kept cold by placing in an ice slurry or refrigerator immediately after collection.

False

The Needle Stick Safety and Prevention Act required employers to prevent bloodborne pathogen exposure. Reason: The use of safety needle devices was required by employers by the Needle Stick Safety and Prevention Act; however, accidental exposure to bloodborne pathogens can still occur.

True

The Phlebotomist must collect blood samples according to established procedures and adhere to all safety and infection regulations. Reason: Established procedures as well as safety and infection regulations require adherence for protection of both the patient and the employee.

Yellow

The Phlebotomy Technician receives an order to collect blood for blood culture and glucose; which tube is drawn first? Reason: Blood cultures are always drawn first using a yellow topped tube followed by a gray tube for glucose for this order.

Do not proceed with blood draw

The Phlebotomy Technician uses the requisition to identify the inpatient, finding that the date of birth and name match, but the hospital ID is incorrect; what happens next? Reason: Any available patient identifiers must match including name, date of birth and hospital ID for an inpatient; do not proceed with the blood draw if they do not match and notify the nurse or a supervisor.

True

The composition of capillary blood containing venous and arterial blood will not produce accurate blood culture results. Reason: Regardless of the times where capillary blood is preferred and appropriate, there are some tests that just cannot be performed with capillary blood due to its composition, which include blood cultures and most routine coagulation tests.

Smaller

The larger the needle gauge, the _____________________ the diameter of the needle opening. Reason: A 23-gauge needle has a smaller diameter opening than a 21-gauge needle, thus, the larger the gauge, the smaller the diameter of the needle opening

True

The microbiology section in the laboratory identifies pathogenic organisms in specimens. Reason: Identification of pathogenic organisms in specimens takes place in the microbiology section of the laboratory.

False

The most common reason for post-procedure complications is due to poor patient preparation. Reason: One of the most significant reasons for post-procedure complications are sampling errors that occur due to improper delivery to the laboratory.

True

The phlebotomist would recognize 46 mg/mL as an abnormally low fasting glucose in a patient who is also exhibiting a rapid heartbeat. Reason:Normal fasting glucose is between 70 and 100 mg/mL, so a blood glucose of 46 mg/mL should be recognized as low and can cause a rapid heart rate.

True

The pneumatic tube system is a method of transport that some larger facilities use to transport specimens to the laboratory. Reason: Specimen transport can be accomplished in a variety of ways; however, it is common that a pneumatic tube system is used in larger facilities.

False

The tourniquet should be released as soon the blood draw is complete. Reason: The tourniquet should be released as soon as blood flow begins into the first tube drawn.

True

The trained phlebotomist has employment opportunities in a variety of facilities including nursing homes, physician office laboratories and health fairs. Reason: Potential employment opportunities for phlebotomists are available in many facilities including urgent care centers, physician office laboratories, nursing homes, reference laboratories, health fairs and blood donor services.

True

There is potential for exposure to bloodborne pathogens with a needle stick injury. Reason: Bloodborne pathogen exposure is a potential hazard when drawing blood with a needle.

Hemolysis

What can be prevented with gentle inversion of blood collection tubes? Reason: Blood collection tubes are inverted five to 10 times to mix the sample with the additive; gentle inversion can prevent hemolysis.

Point-of-care-testing

What does POCT represent? Reason: Point-of-care testing, or POCT, is the performance of analytic tests at the point of care, which may include the bedside, the clinic or the patient's home.

Complete the blood test immediately

What does a STAT blood test order mean for the phlebotomist? Reason: An order for a STAT blood test is completed immediately.

Delta Check

What is a method to ensure proper identification by comparing previous and current test results? Reason: Prior to reporting test results, a delta check is a method of comparing the patient's previous results to the current results to identify identification errors

Informed consent

What is being provided when a patient agrees to a procedure after being told about the procedure and risks? Reason: The law requires that a patient is informed of intended treatments and the risks in order to provide informed consent before proceeding with the procedure.

1 : 10

What is the ratio using 10% bleach to water when mixing a solution to clean up a potentially infectious spill? Reason: Bleach solution is made once a week in a 1:10 ratio, meaning 1 part bleach and 9 parts water or 10% bleach and 90% water.

Anaphylaxis

What life-threatening condition can occur with a severe latex allergy. Reason: Anaphylaxis is a life-threatening condition in which the airway can swell shut, blood pressure can drop, and the heart rate can increase in response to a severe allergic reaction to latex.

Jaundice

What might be seen in an infant with a buildup of bilirubin in the blood? Reason: In infants, the liver may not be developed enough to prevent bilirubin from accumulating in the blood, which causes yellow of the skin, or jaundice.

Impermeable gown Gloves Facial mask

What personal protective equipment, or PPE, should be used when obtaining an arterial specimen? Reason: Since arterial blood is under pressure, the chance of spray from blood is higher with arterial collection; and PPE should include an impermeable gown, gloves and facial mask

Coagulation

What section in the laboratory checks blood specimens for clotting factors? Reason: The coagulation section, usually found in hematology, analyzes blood samples for clotting factors.

Wrap the specimen in aluminum foil

What should the phlebotomist do if a specimen is photosensitive? Reason: A photosensitive specimen must be protected from light, such as a bilirubin specimen, which can be wrapped in aluminum foil.

Refrigerate the specimen

What should the phlebotomist do if the urine specimen cannot be delivered to the laboratory within one hour? Reason: If a urine specimen cannot be delivered to the laboratory within one hour, it must be refrigerated and can be delivered within 24 hours.

Betadine and Chlorhexadine gluconate

When a blood culture is being drawn, which of the following antiseptics can be used to clean the site? Reason: Alcohol cannot be used for blood cultures, so Betadine would be used; however, for patients allergic to Betadine, Chlorhexidine gluconate can also be used.

Plantar medial and lateral surfaces

When a heel stick is performed on a patient under one, which is the most preferred surface for the puncture? Reason: Since children under one have too little tissue in the fingers, the plantar surface of the heel is chosen as the most preferred site using the medial and lateral surfaces for the puncture.

Mode of Transmission

When a phlebotomist does not wear gloves during contact with a patient, which link in the chain of infection does this represent? Reason: A phlebotomist not wearing gloves can become contaminated from an infectious patient and be the mode of transmission of the infection to his or herself or to another patient.

False

When a specimen first arrives in the laboratory in central processing, it is marked with an aliquot number for cataloging. Reason: When specimens first arrive in the laboratory, they are sorted, and accession numbers are assigned to identify and catalog samples.

Collection of blood samples from inpatients Proper handling and timely delivery of samples Sending specimens to a referral laboratory for testing not performed in the hospital lab

Which of the following tasks may be the responsibility of the phlebotomist in the hospital setting? Reason: The phlebotomist in the hospital setting may have a variety of duties including collecting blood samples, proper handling of samples, timely delivery of samples and sending specimens to a referral laboratory for tests not performed in the hospital laboratory.

Group A streptococcus

Which of the following test is performed with a throat swab specimen? Reason: A urinalysis requires urine; occult blood requires feces, and the Group A Streptococcus test is performed with a kit using a throat swab specimen.

Patient having a STAT test

Which of the following test status should be drawn first? Reason: Every effort is made to draw STAT tests first.

Arterial blood gases

Which of the following tests measures the concentration of oxygen and carbon dioxide in the blood? Reason: The ability of the lungs to perform gas exchange is determined by measuring the concentration of oxygen and carbon dioxide in the blood by measuring arterial blood gases, or ABGs.

Arterial Blood Gases (ABG's)

Which of the following types of specimens are temperature sensitive and should be placed in crushed ice following collection for delivery to the laboratory? Reason: To prevent chemical changes that can alter test results, arterial blood gas specimens must be placed in crushed ice or ice and water after collection.

OSHA

Which organization is a governmental agency responsible for workplace safety Reason: The Occupational Safety and Health Administration, or OSHA, is responsible for workplace safety to protect workers from harm.

Cytogentics

Which section of anatomic and surgical pathology examines specimens for genetic disorders? Reason: Cytogenetics is the laboratory section that examines specimens for evidence of genetic diseases.

Serum and plasma

Which two components of blood are separated during centrifugation? Reason: After clotting, a sample is centrifuged to separate the serum from the plasma.

Triglycerides and glucose

Which two tests are obtained after the patient has fasted? Reason: Triglycerides and glucose both require that the patient fast for 12 hours.

EDTA

Which type of additive is contained in a lavender topped tube as an anticoagulant that needs inversion of 8 to 10 times? Reason: A lavender topped tube contains an anticoagulant called EDTA and must be inverted 8 to 10 times after obtaining the blood specimen.

Pre-analytic

Which variable includes patient identification? Reason: Proper patient identification is under the control of the phlebotomist as a pre-analytic variable

Pre-analytic

Which variable includes quality control of test strips? Reason: The accuracy of testing is impacted by performing quality control on test strips used by the phlebotomist in point-of-care testing prior to performing a test on a patient in the pre-analytic period.

Post-analytic

Which variable includes reporting results to the physician? Reason: The phlebotomist may be responsible to report test results to physicians in a timely manner as part of the post analytic variable.

Aerosol

While in central processing of the laboratory, what is a risk for the phlebotomist for which he or she must wear PPE for protection when removing a stopper from a collection tube? Reason: When aliquot is created by removing a stopper from a collection tube, there is a risk of formation of aerosol, or mist of blood, that can splatter the phlebotomist.

The specimen is altered by lower temperatures

Why is a specimen for a potassium test not placed in an ice slurry? Reason: A potassium specimen is not placed in an ice slurry because the level is altered by lower temperatures, which would be caused by ice

True

With nasal, throat and buccal swabs, the phlebotomy technician needs to wear gloves and a facial mask. Reason: Due to the possibility of airborne contamination, the phlebotomy technician must wear a facial mask as well as gloves.

True

With therapeutic drug monitoring, a trough level is the lowest serum level of the medication that occurs immediately before the next dose. Reason: A trough level is obtained immediately before the next dose of medication when the serum level is lowest.

Nursing

With which of the following hospital services is the phlebotomist most likely to interact? Reason: The phlebotomist's interaction with the nursing staff providing direct patient care will be most common when obtaining specimens from inpatients.