Hartman Phlebotomy Practice Exam 150 Questions

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If a patient asks a phlebotomy technician for her opinion about the doctor who ordered his tests, the phlebotomy technician should (A) Offer her opinion after clarifying that it is only her personal opinion and not a professional assessment (B) Politely decline to offer any opinion (C) Say that all of the doctors who refer patients to the laboratory are excellent (D) Recommend that if the patient is uncertain he should get a second opinion

(B) Politely decline to offer any opinion

The Needlestick Safety and Prevention Act requires that employers (A) Provide biohazard suits for phlebotomy technicians (B) Involve staff in the selection of safer medical devices (C) Provide appropriate PPE at a reasonable cost to the employee (D) Make payments to employees who are victims of accidental needlesticks

(B) Involve staff in the selection of safer medical devices

99. Accidental artery puncture should be avoided for the following reason: (A) It can be more difficult to get an adequate amount of blood for testing (B) It can be more difficult to stop arterial bleeding (C) Diagnostic tests cannot be run on arterial blood (D) Arteries are more likely to collapse than veins

(B) It can be more difficult to stop arterial bleeding

Using liquid controls to test point-of-care devices is effective because (A) It provides the phlebotomy technician practice using the device (B) It tests the device using analytes of known composition (C) It lubricates the device (D) It provides a contrast to actual specimens from patients

(B) It tests the device using analytes of known composition

131. The area of the foot used for infant heel stick is known as the (A) Calcaneus (B) Lateral or medial plantar surface (C) Dorsal surface (D) Arcus pedis

(B) Lateral or medial plantar surface

An emergency room physician directs a phlebotomist to draw blood from an unconscious patient of unknown identity. This is (A) Illegal and the phlebotomist should refuse (B) Legal under the concept of implied consent (C) Legal under the concept of informed consent (D) Illegal unless the patient becomes responsive and agrees to the draw

(B) Legal under the concept of implied consent

141. Blood for newborn metabolic screening is collected (A) In heparinized capillary tubes (B) On filter paper printed with circles for each blood drop (C) On a test strip inserted into a point-ofcare device (D) In EDTA tubes

(B) On filter paper printed with circles for each blood drop

Which of these patient reactions should be documented, but is not a cause for discontinuing a draw or likely to affect analytes? (A) Syncope in a seated patient (B) Petechiae (C) Hematoma (D) Nerve involvement

(B) Petechiae

114. Which of the following tasks related to pointof- care testing devices may be performed by a phlebotomy technician? (A) Opening the machine to perform simple repairs (B) Recording quality control measurements in a daily log (C) Deciding when a test result was inaccurate (D) Instructing a patient on medication dosage based on test results

(B) Recording quality control measurements in a daily log

113. When should a phlebotomy technician label and initial tubes drawn from patients in hospital rooms? (A) After completing all draws in a single hospital department (B) Right after completing the draw and in the presence of the patient (C) After exiting the patient's room, before moving to the next room (D) Before entering each patient's room

(B) Right after completing the draw and in the presence of the patient

In which of the following situations should a phlebotomy technician consult a Safety Data Sheet? (A) She notices a burning smell when operating a centrifuge. (B) She splashes a disinfecting solution on her skin. (C) She receives an accidental needlestick as a venipuncture needle is removed. (D) She drops a glass collection tube and it breaks, spilling blood on the floor of her drawing station.

(B) She splashes a disinfecting solution on her skin.

What action should be taken immediately after a phlebotomy needle has been removed? (A) The patient should bend his arm upwards. (B) The phlebotomist should apply pressure to a gauze square over the venipuncture site. (C) The venipuncture site should be bandaged. (D) A cotton ball should be placed on the venipuncture site.

(B) The phlebotomist should apply pressure to a gauze square over the venipuncture site.

Scars cover the arms and hands of a patient whose requisition requires CBC and electrolytes. After finding no acceptable venipuncture site on either arm or hand, the phlebotomy technician sees that the scarring does not extend to the fingertips. Which of the following is true? (A) The phlebotomy technician can do a capillary draw and submit specimens without additional comment. (B) The phlebotomy technician can do a capillary draw and document that where the blood was collected and why. (C) The phlebotomy technician can draw blood from a vein in the foot or ankle. (D) The phlebotomy technician can dismiss the patient and report that the draw could not be completed.

(B) The phlebotomy technician can do a capillary draw and document that where the blood was collected and why.

148. Which fingers are best suited for capillary blood collection? (Choose two.) (A) The pinky (B) The ring finger (C) The middle finger (D) The index finger (E) The thumb

(B) The ring finger (C) The middle finger

Two sets of blood culture bottles are to be filled for a patient. Which of the following is true? (A) Both sets must be filled from the same venipuncture site. (B) The sets must be filled from two different venipuncture sites. (C) The sets are filled from the same venipuncture site if possible, and from two sites only if the blood flow stops before all bottles are filled. (D) One set is filled from a venipuncture site and the second set is filled from a capillary puncture site.

(B) The sets must be filled from two different venipuncture sites.

85. A patient begins to experience a seizure during a blood draw. What should be the phlebotomist's first response? (A) To ask the patient if he is OK (B) To remove and sheathe the needle (C) To steady the patient's arm so the tube currently inserted can be filled completely (D) To lower the patient to the ground

(B) To remove and sheathe the needle

143. If a tourniquet has been left on the arm for more than one minute, how long should it remain off the arm before it is reapplied? (A) One minute (B) Two minutes (C) Three minutes (D) Five minutes

(B) Two minutes

Microclotting of an anticoagulated specimen may occur if the phlebotomy technician does not (A) Vigorously mix the specimen with the tube additive immediately after it is collected (B) Use gentle inversions to mix the specimen with the tube additive immediately after it is collected (C) Centrifuge the specimen within an hour of collection (D) Place the specimen in a heating block immediately after collection

(B) Use gentle inversions to mix the specimen with the tube additive immediately after it is collected

82. A patient's chart indicates that her veins are thin, fragile, and frequently collapse. A total of 5 mL of blood needs to be drawn for various tests. Which of the following techniques would be best for drawing blood from this patient? (A) Capillary puncture of the third or fourth finger (B) Venipuncture using a 23-gauge butterfly needle and syringe/transfer device (C) Venipuncture using a 21-gauge straight multisample needle (D) Venipuncture using a 23-gauge butterfly needle and a 5 mL evacuated tube

(B) Venipuncture using a 23-gauge butterfly needle and syringe/transfer device

When a blood culture is ordered along with other tests, which tube is filled first? (A) Yellow ACD (B) Yellow SPS (C) Lavender EDTA (D) Light blue sodium citrate

(B) Yellow SPS

Which of the following is instruction that should be given to a patient who will be collecting a 24-hour urine specimen? (A) "Include the urine collected both at the very beginning and very end of the 24-hour cycle." (B) "Deliver the completed specimen within three days of collecting it." (C) "Collect the urine in the 'hat' and then transfer it carefully to the specimen container." (D) "After completing the specimen, put the lid firmly in place and then shake the container to thoroughly mix the chemical additives."

Which of the following tubes contains an anticoagulant that acts by inhibiting thrombin? (A) An EDTA tube (B) A heparin tube (C) A sodium citrate tube (D) A clot activator tube

(B) A heparin tube

110. Which of the following are effects of warming a capillary puncture site? (Choose two.) (A) Decreased pain for the patient (B) Improved blood flow (C) Arterialization of the blood (D) Decreased blood oxygen at the site (E) Increased platelet activation at the site

(B) Improved blood flow (C) Arterialization of the blood

_________________________ is an illness spread by droplets. (A) MRSA (B) Influenza (C) Measles (D) C. diff

(B) Influenza

If blood is taken from a collection tube to perform a peripheral blood smear, what type of tube should be used? (A) Red top (B) Green top (C) Lavender top (D) Light blue top

121. Which of the following equipment has an expiration date that must be checked prior to use? (A) Tube holders (B) Needles (C) Point-of-care test strips (D) Pipettes

101. Which of the following is permitted during blood donation collections but should not be done during routine venipuncture collections? (A) Opening and closing the hand during collection (B) Palpating for a vein (C) Applying a tourniquet during site selection (D) Applying pressure to the puncture site after needle removal

(A) Opening and closing the hand during collection

95. ________________________ patients and patients in ____________________ are at the highest risk for iatrogenic anemia. (A) Pediatric, intensive care (B) Geriatric, emergency departments (C) Middle aged, maternity wards (D) Iron-deficient, cardiac units

(A) Pediatric, intensive care

A CLIA waived test may not be performed by the following laboratory personnel: (A) Personnel who are not trained in its use (B) Phlebotomy technicians (C) Medical technicians (D) Supervising nurses

(A) Personnel who are not trained in its use

Which of the following is within the range of common microcollection tube volumes? (A) 0.5 mL (B) 5 mL (C) 5000 μ (D) 2 mL

(A) 0.5 mL

104. Coagulation studies are ordered for a patient whose veins require use of a butterfly assembly. Which of the following is true? (A) A discard tube should be started first, then a light blue tube filled completely (B) A discard tube should be started first, then a light green tube filled completely (C) A light blue tube should be filled at least halfway (D) A lavender tube should be filled completely

(A) A discard tube should be started first, then a light blue tube filled completely

When a phlebotomy technician begins work at a facility, the employer must offer this protection against bloodborne pathogens: (A) A low-cost hepatitis B vaccine (B) A free hepatitis B vaccine (C) Instruction on how to recap needles effectively (D) Free antiviral medications to take on an ongoing basis

(B) A free hepatitis B vaccine

In which of the following situations must a phlebotomy technician ask nursing staff to complete a blood draw? (A) A hospitalized patient's chart indicates blood should only be taken from a central port. (B) A hospitalized patient has an IV in one forearm and a cast on the other arm. (C) A patient's chart indicates she has had a double mastectomy. (D) An elderly patient reports that his veins frequently collapse during blood draws.

(A) A hospitalized patient's chart indicates blood should only be taken from a central port.

For which of the following tests commonly performed on newborns should an amber microcollection tube be used? (A) Bilirubin (B) Capillary blood gas (C) Newborn metabolic screening (D) Complete blood count

(A) Bilirubin

124. __________________________________ is an organization that develops standards of practice for laboratories worldwide. (A) CLSI (B) CDC (C) CLIA (D) NCCT

(A) CLSI

Which of these statements is true? (A) Citrate tubes must be filled to at least 90% capacity. (B) Citrate tubes must be filled at least 75% full. (C) Citrate tubes must be filled at least 50% full. (D) Citrate tubes are filled to varying capacities, depending on the test ordered.

(A) Citrate tubes must be filled to at least 90% capacity.

Which of the following information on a requisition form is essential for a phlebotomy technician to match exactly with information provided by the patient? (A) Complete date of birth (B) Insurance account number (C) Diagnosis code(s) (D) Address/facility room number

(A) Complete date of birth

76. Which of these tasks is typically considered within a phlebotomy technician's scope of practice? (Choose three.) (A) Creating peripheral blood smear slides (B) Drawing blood from an indwelling port (C) Performing a throat culture (D) Drawing blood from the dorsal aspect of the hand using a syringe and transfer device (E) Using a microscope to examine blood smears

(A) Creating peripheral blood smear slides (C) Performing a throat culture (D) Drawing blood from the dorsal aspect of the hand using a syringe and transfer device

147. Hemolysis can occur when the phlebotomist (A) Draws a syringe plunger back forcefully (B) Uses a low-gauge needle (C) Mixes specimens by inversion (D) Removes a tourniquet immediately after blood flow is established

(A) Draws a syringe plunger back forcefully

140. Electrolytes and complete blood count are ordered for a patient who must have blood collected by capillary puncture. The correct tubes to use, in the correct order, would be (A) EDTA, serum (B) Serum, EDTA (C) Heparin only (D) Oxalate, EDTA

(A) EDTA, serum

129. Which of the following is true of labeling aliquot tubes? (A) Each one should be labeled with the patient's identifying information (B) A single label can be wrapped around several tubes (C) The tubes can be placed, unlabeled, in a labeled transport bag (D) They do not need to be labeled if they will be delivered by hand to the testing area along with the requisition

(A) Each one should be labeled with the patient's identifying information

Which of the following tests cannot be performed on capillary blood? (A) Erythrocyte sedimentation rate (B) Complete blood count (C) Hemoglobin/hematocrit (D) Prothrombin time/international normalized ratio

(A) Erythrocyte sedimentation rate

Which of the following is a HIPAA violation? (A) Failing to log out of a patient record on a visible screen before calling the next patient in (B) Discussing which tests were ordered for a patient with the patient's physician (C) Asking a fellow phlebotomist for help finding a good venipuncture site on a patient the colleague has worked with previously (D) Calling a patient's first name to summon her to a drawing station

(A) Failing to log out of a patient record on a visible screen before calling the next patient in

A phlebotomy technician at a primary care clinic is performing venipuncture on a patient with suspected influenza. The patient is wearing a mask. What PPE should the technician wear? (A) Gloves and a mask (B) Gloves, gown, and a mask (C) Gloves only (D) Gloves, gown, mask, and goggles

(A) Gloves and a mask

78. A phlebotomist needs to collect gold, pink, and green-topped tubes by venipuncture. Which order is correct? (A) Gold, green, pink (B) Green, gold, pink (C) Pink, green, gold (D) Gold, pink, green

(A) Gold, green, pink

If, after centrifuging a specimen, a phlebotomist notices a pink or red tint to the serum, the specimen is likely ________________ . (A) Hemolyzed (B) Glycolyzed (C) Lipemic (D) Icteric

(A) Hemolyzed

116. After centrifuging a specimen that does not have a separator gel, when should the liquid portion of the specimen be removed from the solid portion? (A) Immediately (B) Within 15 minutes (C) Within 30 minutes (D) Within 60 minutes

(A) Immediately

How is a five-year-old child most likely to be positioned for venipuncture? (A) In a parent or guardian's lap (B) In a booster seat with straps to secure the arm (C) In an adult phlebotomy chair adjusted to its highest setting (D) Sitting on his knees in a bariatric phlebotomy chair

(A) In a parent or guardian's lap

112. When a patient is in an isolation room, where should the phlebotomy technician doff any required PPE? (A) Inside the patient's room right before exiting (B) Just outside the patient's room (C) At the nurses' station (D) At the patient's bedside after the procedure is complete

(A) Inside the patient's room right before exiting

Orders indicate a patient needs coagulation studies, a lipid panel, and a complete blood count. Which of these tubes will be needed? (Choose three.) (A) Lavender top (B) Yellow top (C) Tiger top (D) Royal blue top (E) Light blue top

(A) Lavender top, (C) Tiger top, (E) Light blue top

84. Hemoconcentration may be caused by (A) Leaving a tourniquet in place for too long (B) A patient eating a breakfast rich in fatty foods (C) Using too narrow a needle (D) Probing with the venipuncture needle

(A) Leaving a tourniquet in place for too long

106. Sharp, shooting pain during venipuncture is a possible sign of what complication? (A) Nerve involvement (B) Hematoma (C) Vein collapse (D) Artery involvement

(A) Nerve involvement

Disposable tourniquets are intended to be used (A) On one patient only (B) During one shift only (C) Until used on a patient with broken skin (D) Until they lose elasticity

(A) On one patient only

The veins in both arms of a patient who is obese are difficult for a phlebotomy technician to palpate and the patient is complaining of pain from the standard disposable tourniquet applied to her arm. Which steps might help the phlebotomy technician locate a vein and improve comfort for the patient? (A) Remove the tourniquet, ask the patient to dangle her arms for several minutes, and then use a blood pressure cuff inflated to just below the patient's diastolic blood pressure in place of a standard tourniquet (B) Remove the tourniquet, ask the patient to dangle her arms for several minutes, and then use a blood pressure cuff inflated to just below the patient's systolic blood pressure in place of a standard tourniquet (C) Leave the tourniquet in place, ask the patient to dangle her arms for several minutes, and then try again to palpate a vein (D) Remove the tourniquet, wait two minutes, apply a blood pressure cuff inflated to just below the patient's diastolic blood pressure, then ask the patient to pump her fist rapidly while the phlebotomist attempts to palpate a vein

(A) Remove the tourniquet, ask the patient to dangle her arms for several minutes, and then use a blood pressure cuff inflated to just below the patient's diastolic blood

79. Collection tubes with ___________________ _____________ should not be used for therapeutic drug testing. (A) Separator gel (B) Clot activator (C) Red tops (D) Internal vacuum

(A) Separator gel

Most blood chemistry tests are performed on specimens collected in either (A) Serum tubes or heparin tubes (B) Heparin tubes or EDTA tubes (C) Sodium citrate tubes or heparin tubes (D) Serum tubes or sodium fluoride tubes

(A) Serum tubes or heparin tubes

93. The anticoagulant action of this tube additive can be reversed with the addition of calcium: (A) Sodium citrate (B) Sodium fluoride (C) EDTA (D) Sodium heparin

(A) Sodium citrate

86. Which of these tests is an entry-level phlebotomy technician most likely to be trained to perform in its entirety? (A) Testing urine with a dipstick (B) Arterial blood gas (C) Urine culture and sensitivity (D) Complete blood count with differential

(A) Testing urine with a dipstick

136. After completing a blood draw the phlebotomy technician should always (A) Thank the patient (B) Reassure the patient that everything will be OK (C) Make suggestions regarding the patient's health (D) Immediately call the next patient

(A) Thank the patient

83. Which of the following is a significant difference between midstream and routine urine specimens? (A) The area around the urethra is cleaned before collecting a midstream specimen (B) A routine urine specimen is collected first thing in the morning (C) A midstream urine specimen is collected at a patient's home (D) A routine urine specimen is collected in a sterile container

(A) The area around the urethra is cleaned before collecting a midstream specimen

Where is venipuncture most commonly performed if no suitable site can be found in the antecubital area of either of the patient's arms? (A) The dorsal aspect of one of the patient's hands (B) The dorsal aspect of one of the patient's forearms (C) The lateral aspect of one of the patient's wrists (D) One of the patient's feet or ankles

(A) The dorsal aspect of one of the patient's hands

What part of the evacuated tube system allows multiple collection tubes to be filled with one puncture? (A) The interior needle/tube holder (B) The syringe barrel (C) The bevel (D) The lumen

(A) The interior needle/tube holder

144. A patient is being tested for various vitamin levels. Which of the following is true? (A) The tubes should be protected from light. (B) The tubes should be held at body temperature. (C) The tubes should be held in an ice slurry. (D) The specimen will be drawn in a citrate tube.

(A) The tubes should be protected from light.

Veins carry blood _______________ the heart and arteries carry blood ________________ the heart. (A) Toward, away from (B) Away from, toward (C) Around, through (D) Through, around

(A) Toward, away from

During a blood draw on an elderly patient the patient's vein collapses when the first tube is inserted. Which of the following is the best option for completing the draw? (A) Try a tube with a smaller volume (B) Try a new tube of the same size at the same venipuncture site (C) Try a new tube of the same size using a new venipuncture site in the other arm (D) Try a needle with a lower gauge

(A) Try a tube with a smaller volume

126. A patient who uses a cane or walker is at a higher risk for this type of hazard: (A) Uneven walkways and tripping hazards (B) Chemical spills or splashes (C) Radiation exposure (D) Burns from hot equipment

(A) Uneven walkways and tripping hazards

123. Which set of adaptations is appropriate when drawing blood from a pediatric patient? (A) Use of a higher gauge needle, removing any sharp or potentially dangerous objects from within the patient's reach, and never leaving the patient alone at the drawing station (B) Use of a lower gauge needle, removing any sharp or potentially dangerous objects from within the patient's reach, and never leaving the patient alone at the drawing station (C) Use of a higher gauge needle, reminding the patient not to touch anything sharp or dangerous, and only leaving the patient alone briefly (D) Use of a higher gauge needle, talking to the patient's parent or guardian instead of to the patient, and performing the venipuncture when the patient does not expect it to decrease anxiety

(A) Use of a higher gauge needle, removing any sharp or potentially dangerous objects from within the patient's reach, and never leaving the patient alone at the drawing station

108. Hemolysis of a capillary specimen is most likely to have resulted from (A) Warming the collection site for too long (B) "Milking" the finger during collection (C) Using incorrect order of draw (D) Creating too deep a puncture with the lancet

(B) "Milking" the finger during collection

81. Facility policy states that no more than 5% of a patient's blood may be drawn in 30 days. What is the maximum amount of blood than can be drawn from an 9-pound infant in a month? (A) 12 mL (B) 16 mL (C) 20 mL (D) 24 mL

(B) 16 mL

What is the maximum angle at which a venipuncture needle should be inserted when drawing blood from a patient who is obese? (A) 15 degrees (B) 30 degrees (C) 45 degrees (D) 90 degrees

(B) 30 degrees

138. A blade-style lancet should be held at a _______ angle to a patient's fingerprint whorls when performing capillary collection. (A) 45° (B) 90° (C) 180° (D) 360°

(B) 90°

In which of the following cases should a phlebotomy technician seek out interpretation services? (A) A patient whose first language is not English indicates that she is comfortable communicating in English and seems to understand well. (B) A patient does not speak English and is accompanied by her 10-year-old grandson who speaks fluent English. (C) A patient does not speak English, but the PBT speaks the patient's language and has been trained in interpretation by her facility. (D) A patient speaks moderately fluent English and communicates that she understands the procedure, rolling up her sleeve and nodding.

(B) A patient does not speak English and is accompanied by her 10-year-old grandson who speaks fluent English.

A transfer device allows blood to be safely transferred from _____________ to _____________. (A) Evacuated tubes, aliquot tubes (B) A syringe, evacuated tubes (C) A patient's vein, evacuated tubes (D) A syringe, microcollection tubes

(B) A syringe, evacuated tubes

150. The number associated with all documents and specimens connected to a particular requisition is known as the (A) Member record number (B) Accession number (C) Testing number (D) Patient ID number

(B) Accession number

128. What step immediately follows removing the needle from a venipuncture site? (A) Thanking the patient (B) Activating the needle's safety mechanism (C) Discarding the needle (D) Bandaging the site

(B) Activating the needle's safety mechanism

134. When is a bandage applied to a venipuncture site? (A) Immediately after the needle is withdrawn (B) After bleeding has stopped (C) After 3 minutes (D) After 5 minutes

(B) After bleeding has stopped

102. When should gloves be removed and replaced? (A) Only if they become visibly soiled (B) Always between patients (C) Only if they are punctured or torn (D) After every three patients

(B) Always between patients

120. Some swabs are transported in a tube with a(n) _________________ that must be ______________ to release liquid. (A) Bulb, squeezed lightly (B) Ampule, crushed (C) Sticker, peeled off (D) Attachment, screwed on

(B) Ampule, crushed

A patient with measles is in an airborne infection isolation room. When drawing blood from this patient, a phlebotomy technician will need to wear (A) A surgical mask (B) An N95 respirator (C) A biohazard suit (D) A face shield

(B) An N95 respirator

4. Blood exits the heart through the body's largest artery, the ________________. (A) Atrium (B) Aorta (C) Vena cava (D) Carotid artery

(B) Aorta

A patient has orders for a fasting blood glucose test. What should the phlebotomy technician do before inspecting the patient's arms for an acceptable venipuncture site? (A) Ask if the patient has had this test performed before (B) Ask the patient when she last had anything to eat or drink other than water (C) Ask the patient when she last consumed any sugary foods or beverages (D) Ask the patient if she has been formally diagnosed with diabetes

(B) Ask the patient when she last had anything to eat or drink other than water

118. Drawing a patient's blood for routine testing after she has expressed that she does not wish to have the procedure performed may be considered (A) Assault (B) Battery (C) Slander (D) Libel

(B) Battery

A patient whose veins must be preserved for medical interventions such as chemotherapy may have blood tests conducted on (A) Blood taken from arteries (B) Blood taken from capillaries (C) Blood taken from veins in the legs or feet (D) Blood taken from the back of the hand

(B) Blood taken from capillaries

133. In which of the following ways can a phlebotomy technician help to prevent iatrogenic anemia? (A) By choosing not to draw blood for certain tests (B) By performing draws carefully and avoiding the need for redraws (C) By only performing capillary puncture any time tests are ordered (D) By performing a point-of-care hematocrit/ hemoglobin test before performing venipuncture

(B) By performing draws carefully and avoiding the need for redraws

117. How should a vein be anchored before venipuncture? (A) By placing the thumb of the dominant hand 1-2 inches below the venipuncture site and pulling firmly but gently toward the wrist (B) By placing the thumb of the nondominant hand 1-2 inches below the venipuncture site and pulling firmly but gently toward the wrist (C) By placing the thumb of the nondominant hand just below and the index finger of the nondominant hand just above the venipuncture site and pulling firmly and gently outward (D) By placing the thumb of the nondominant hand 1-2 inches above the venipuncture site and pulling firmly but gently toward the upper arm

(B) By placing the thumb of the nondominant hand 1-2 inches below the venipuncture site and pulling firmly but gently toward the wrist

109. A patient indicates that phlebotomy technicians have always had the best luck drawing blood from his right arm, but no suitable site can be found in the right arm after visual inspection and palpation. What should the phlebotomy technician do next? (A) Draw from the patient's hand (B) Check the left arm (C) Attempt to draw from the right arm (D) Perform capillary puncture

(B) Check the left arm

A requisition calls for the following tests: CBC, CMP, and PTT. Which of the following reflects the proper order of draw? (A) EDTA, SST, citrate (B) Citrate, SST, EDTA (C) SST, citrate, EDTA (D) EDTA, citrate, SST

(B) Citrate, SST, EDTA

94. Which of the following situations always requires written permission from a physician? (Choose two.) (A) Drawing blood from the basilic vein in either arm (B) Drawing blood from either arm or hand of a patient who has had a double mastectomy (C) Drawing blood from the dorsal aspect of a patient's hand (D) Drawing blood from a site distal to an IV (E) Drawing blood from an ankle or foot

(B) Drawing blood from either arm or hand of a patient who has had a double mastectomy (E) Drawing blood from an ankle or foot

91. During centrifugation of a specimen the centrifuge becomes very hot and then bursts into flames. The power cord is plugged in behind the centrifuge. How should the phlebotomy technician operating the centrifuge respond? (A) He should reach around carefully and unplug the centrifuge, then activate the fire alarm. (B) He should leave the area and immediately activate the fire alarm. (C) He should attempt to smother the flames with his lab coat, then activate the fire alarm. (D) He should douse the centrifuge with water, then activate the fire alarm.

(B) He should leave the area and immediately activate the fire alarm.

92. Which of the following is the best response to a patient who is afraid of needles? (A) "The sooner we do this, the sooner you can leave." (B) "My last patient was ten years old and he said it didn't even hurt." (C) "You might find it easiest to look away while I get the equipment ready. I'll tell you before I actually perform the procedure." (D) "Just close your eyes. It's probably easier if you just don't know when it's coming."

(C) "You might find it easiest to look away while I get the equipment ready. I'll tell you before I actually perform the procedure."

A lancet designed for heel stick on a full-term infant usually punctures at a depth of (A) 2.2 mm (B) 2.0 mm (C) 1.0 mm (D) 0.85 mm

At what temperature should a specimen drawn to for cryofibrinogen testing be held? (A) 0°C (B) 5°C (C) 37°C (D) 100°C

Which set of differences is true of collection of donor blood as compared to routine venipuncture for diagnostic testing? (A) A smaller needle is used and the patient is first given a brief medical exam. (B) A larger needle is used and the patient is not required to provide consent. (C) A larger needle is used and the patient is first given a brief medical exam. (D) A smaller needle is used and the patient is first tested for anemia.

87. Which of these items may be reused between patients with proper cleaning? (A) A tube holder if there is no blood visible (B) A specimen tube that was inserted but never received blood flow (C) A phlebotomy wedge (D) A retractable lancet

When can a phlebotomy technician puncture the patient's skin for either venipuncture or capillary puncture? (A) Right after locating a suitable site (B) Right after cleaning the site with a facility- approved antiseptic (C) After the site has been cleaned and has dried (D) One minute after site cleaning is performed

When drawing a specimen for an ammonia test, what should a phlebotomy technician have ready for specimen transportation? (A) A heating block (B) An amber transport tube (C) An ice slurry (D) Ice cubes

80. Which of the following will help a phlebotomy technician avoid having a patient's vein roll away when the needle is inserted? (A) Selecting a vein in the hand (B) Forming an anchoring "window" around the puncture site with the thumb below and the index finger above (C) Anchoring the site from below, using the thumb to pull toward the wrist (D) Warming the site for 3-5 minutes prior to venipuncture

111. Gray-topped tubes typically have two additives. What are the actions of these two additives? (A) Anticoagulant and clot activation (B) Antihemolytic and antiglycolytic (C) Anticoagulant and antiglycolytic (D) Antiglycolytic and antithrombolytic

125. Drawing blood from _____________ is usually considered to be beyond the scope of practice for entry-level phlebotomy technicians. (A) The hand (B) A site below an IV (C) Arteries (D) The antecubital fossa

96. If a patient's veins seem difficult to access, one appropriate adaptation is to (A) Slightly bend the venipuncture needle to allow a low angle of insertion while still maintaining control of the needle (B) Ask the patient to dangle his arms for 3 minutes with the tourniquet in place (C) Ask the patient to dangle his arms for 3 minutes without the tourniquet in place (D) Attempt a "blind stick"

When a patient enters a phlebotomist's drawing station, how can the phlebotomist best communicate a positive, professional attitude? (A) By having all equipment preassembled and immediately beginning the procedure (B) By facing away from the phlebotomy chair to allow the patient time to be seated without any pressure to communicate (C) By greeting the patient, introducing himself by name and title, and inviting the patient to be seated (D) By greeting the patient and then asking the patient to confirm the tests ordered

105. If a phlebotomy technician is not able to read a note made on a manual requisition form, she should (A) Perform the draw as long as she can read which tests are ordered (B) Ask the patient if she knows what the doctor wrote at the top of her requisition (C) Contact the ordering provider for clarification (D) Send the patient back to the ordering provider for a new requisition

115. A split specimen is often created for purposes of _____________ testing. (A) 24-hour urine (B) Glucose (C) Drug (D) Pregnancy

A new patient is seated at the drawing station before the phlebotomist realizes he forgot to label and initial the collection tubes from the last patient. What would be his best course of action? (A) Ask the new patient to wait while he labels and initials the tubes immediately (B) Set the tubes aside where they are unlikely to be confused with the new patient's tubes, then label them before calling the next patient (C) Excuse himself and try to catch the last patient before she leaves the facility, then label and initial the tubes in her presence (D) Discard the tubes and schedule a redraw for the previous patient

(C) Excuse himself and try to catch the last patient before she leaves the facility, then label and initial the tubes in her presence

After introducing herself, confirming the patient's identity and matching it to the requisition, what should a phlebotomy technician do? (A) Ask the patient what symptoms he has been experiencing (B) Apply a tourniquet and look for a suitable vein (C) Explain the procedure to the patient (D) Call the patient's doctor to confirm that the tests on the requisition are correct

103. The bloodborne illness that has most commonly affected healthcare workers is (A) HIV (B) AIDS (C) Hepatitis B (D) Hepatitis C

146. Which of the following is true of patient fasting? (A) If it is marked on the requisition, it is recommended but not required. (B) It applies only to food; any liquid is allowed. (C) If it extends beyond 14 hours it may produce inaccurate test results. (D) It is only required for tests related to blood sugar.

When passing another phlebotomy technician's drawing station a PBT overhears him telling the patient that if she does not extend her arm, he will have to extend it for her and strap it down for the draw. What is the passing PBT's best course of action? (A) Keep walking and tell a supervisor about the situation later (B) Immediately call facility security (C) Politely ask a coworker to pause for a moment, then immediately find a supervisor to intervene (D) Confront the coworker, informing him that his behavior is abusive, and perform the draw in his place

Glucose challenge tests are routinely performed on what patient population? (A) Newborn infants (B) Children entering school (C) Pregnant women (D) Elderly patients

127. The following tests may be related to assessing kidney health: (A) Lipid panel, blood culture (B) Hepatic panel, erythrocyte sedimentation rate (C) Renal panel, 24-hour urine collection (D) Thyroid panel, fecal occult blood testing

130. An endocrinologist has ordered a thyroid panel and fasting blood glucose tests for a patient. Which of these choices represents a possible tube choice? (A) SST only (B) EDTA tube only (C) SST tube and sodium fluoride/oxalate tube (D) Citrate tube and sodium fluoride/oxalate tube

Of the three veins commonly assessed for venipuncture, which is considered the least favorable? (A) The median cubital vein (B) The cephalic vein (C) The basilic vein (D) The radial vein

142. This venipuncture site poses the lowest risk for nerve or artery involvement, and is generally well anchored: (A) The fleshy part to the side of the third finger (B) The cephalic vein (C) The median cubital vein (D) The basilic vein

Why is it especially important that a phlebotomy technician take care when drawing from a patient who is quadriplegic? (A) The patient is likely to be more sensitive to pain (B) The patient's veins are likely to collapse (C) The patient is unable to alert the phlebotomy technician to pain that might signal nerve involvement (D) The patient is at elevated risk for iatrogenic anemia

A phlebotomy technician is performing a venipuncture collection on a young adult and needs to draw a citrate tube, a serum separator tube, and an EDTA tube. The citrate tube and SST fill quickly. The EDTA tube fills partway and then blood flow stops. What is the most likely explanation? (A) The patient's vein has collapsed. (B) A clot has formed in the needle. (C) The tube's vacuum is compromised. (D) The patient's vein is empty.

Which of the following processes is part of appropriate medical asepsis in a laboratory? (A) Using sterile gloves during venipuncture procedures (B) Placing used needles in an autoclave before disposal (C) Thoroughly cleaning a venipuncture site with 70% isopropyl alcohol (D) Performing hand hygiene after every third patient

98. When a patient's veins are difficult to access, how many attempts at venipuncture should a phlebotomy technician make before seeking help from other qualified personnel? (A) Four (B) Three (C) Two (D) One

119. Most collection tubes should be centrifuged within ______________ of collection. (A) 30 minutes (B) One hour (C) Two hours (D) Three hours

When is a sharps receptacle considered to be overfilled according to OSHA standards? (A) When it is more than 1/2 full (B) When it is more than 2/3 full (C) When it is more than 3/4 full (D) When it is filled to a point one inch below the opening

145. When an order is marked STAT it should be collected (A) Within an hour (B) Within 30 minutes (C) Within 10 minutes (D) When the phlebotomy technician has a break in her schedule

135. If a patient has orders for therapeutic drug monitoring and must have blood drawn at trough medication levels, when should her blood be drawn? (A) Within an hour before her next dose (B) An hour after her last dose (C) Within 10 minutes before her next dose (D) Within 10 minutes after her last dose

When performing venipuncture on a schoolaged child, which needle gauge is the best choice? (A) 16 (B) 18 (C) 21 (D) 23

(D) 23

When performing a draw on an inpatient with a recent mastectomy, the phlebotomy technician finds that an IV is running in the arm on the non-mastectomy side. Which site should the phlebotomy technician use? (A) The dorsal aspect of the hand on the mastectomy side (B) The third or fourth finger of the hand on the mastectomy side, documenting that capillary blood was drawn (C) A site proximal to the IV on the non-mastectomy side (D) A site distal to the IV on the non-mastectomy side

(D) A site distal to the IV on the non-mastectomy side

107. Which of the following patients is most likely to require use of a syringe and transfer device? (A) A 10-month-old infant (B) A 12-year-old child (C) A 40-year-old woman (D) An 80-year old man

(D) An 80-year old man

In which of the following situations should a phlebotomy technician report a point-ofcare testing result that is in the critical value range? (A) When the patient appears unwell (B) When the patient complains of specific symptoms (C) Any time a repeated test is also in the critical value range (D) Any time a result is in critical value range, even if the repeated test is normal

(D) Any time a result is in critical value range, even if the repeated test is normal

97. Which set of regulations deals with how laboratories are staffed and what tests they can perform? (A) HITECH (B) HIPAA (C) CLSI (D) CLIA

(D) CLIA

A phlebotomy technician asks a patient to state and spell his name. He says, "Chris Morgan, C-H-R-I-S M-O-R-G-A-N." The name listed on the requisition is "Criss Morgan." What should the phlebotomy technician do? (A) Assume the requisition has a typographical error and complete the blood draw (B) Ask the patient if he minds that his name is misspelled on the requisition, then complete the blood draw if the patient agrees (C) Cross out "Criss" on the requisition and write "Chris" (D) Call the ordering provider to resolve the issue and get a new requisition with the correct spelling if the spelling was an error

(D) Call the ordering provider to resolve the issue and get a new requisition with the correct spelling if the spelling was an error

90. Which of the following is one acceptable way of confirming a patient's identity? (A) Asking the patient to confirm his name and date of birth (B) Checking the name and date of birth on a wristband sitting on the patient's bedside table against his stated name and date of birth (C) Matching a patient's hospital room number to the room number on the requisition (D) Checking the name and date of birth on a wristband on the patient's wrist against his stated name and date of birth

(D) Checking the name and date of birth on a wristband on the patient's wrist against his stated name and date of birth

A patient with a DNR order in place becomes unresponsive during the course of a blood draw. The phlebotomy technician should (A) Discontinue the blood draw and immediately start CPR if trained to do so (B) Discontinue the blood draw, document the time at which the patient became unresponsive, and move on to the next patient (C) Complete the blood draw and then call for help (D) Discontinue the blood draw and immediately call for help

(D) Discontinue the blood draw and immediately call for help

Specimens drawn for testing cold agglutinins must be (A) Kept on an ice slurry (B) Frozen immediately (C) Drawn in chilled tubes (D) Drawn in warmed tubes and kept at body temperature

(D) Drawn in warmed tubes and kept at body temperature

Capillary blood gas testing is ordered on a newborn infant. Where and how should the specimen be drawn? (A) From the scalp by venipuncture (B) From the antecubital fossa by venipuncture (C) From the third or fourth finger by capillary puncture (D) From the lateral or medial plantar surface of the foot by capillary puncture

(D) From the lateral or medial plantar surface of the foot by capillary puncture

A phlebotomist is drawing blood for a glucose tolerance test. What process is avoided by using gray-topped collection tubes? (A) Hemolysis (B) Hemoconcentration (C) Lipemia (D) Glycolysis

(D) Glycolysis

100. In addition to causing pain for the patient, probing for a vein can result in ____________, which may affect analytes in a specimen. (A) Hemostasis (B) Hemoconcentration (C) Homeostasis (D) Hematoma

(D) Hematoma

If a facility's policy is to collect tan-topped tubes along with tubes with the same additive, they should be collected in the same order as (A) Yellow-topped tubes (B) Gray-topped tubes (C) Green-topped tubes (D) Lavender-topped tubes

(D) Lavender-topped tubes

Chain of custody documentation is required when a test (A) Relates to genetics in any way (B) May result in a diagnosis of terminal illness (C) Is ordered at a very busy facility (D) May be used in legal proceedings

(D) May be used in legal proceedings

137. Death is a possible consequence of (A) Touching a nerve during venipuncture (B) Using the incorrect tubes to draw a specimen (C) Inserting a phlebotomy needle at too high an angle (D) Misidentifying a patient

(D) Misidentifying a patient

122. Adhesive bandages are never placed on (A) Capillary puncture sites (B) Venipuncture sites (C) Geriatric patients (D) Patients under 2 years of age

(D) Patients under 2 years of age

A patient reports that during a previous blood draw he felt lightheaded and almost passed out. What should the phlebotomy technician do? (A) Call the patient's doctor to verify that the draw should be performed (B) Give the patient a cup of juice or light snack before the draw (C) Perform the draw according to standard procedures, but make sure a trained first aid provider is nearby (D) Perform the draw with the patient reclined or in a supine position

(D) Perform the draw with the patient reclined or in a supine position

139. Which of the following techniques is an acceptable way to make a patient's veins appear more prominently? (A) Lightly flicking or slapping the skin in the antecubital area (B) Placing an icepack over the antecubital area for 3-5 minutes (C) Asking the patient to pump his fist rapidly (D) Placing a warm pack over the antecubital area for 3-5 minutes

(D) Placing a warm pack over the antecubital area for 3-5 minutes

149. Patients who are performing stool guaiac testing at home should be instructed not to eat _____________________ in the days leading up to and during the test. (A) Fish (B) Cooked vegetables (C) Sweets (D) Red meat

(D) Red meat

How should a phlebotomy technician respond if, after a site is selected and cleaned and equipment prepared, the patient pushes down his sleeve and clutches his arm to his chest? (A) She should gently pull his arm back into the proper position for venipuncture. (B) She should call another lab employee to hold the patient's arm in place during the procedure. (C) She should tell the patient she will have to report him to the doctor if he does not extend his arm and let her complete the procedure. (D) She should ask the patient if he has concerns she can address or if he would like to talk to his doctor.

(D) She should ask the patient if he has concerns she can address or if he would like to talk to his doctor.

132. CLSI standards for patient identification include asking a patient to _______________ her full name. (A) Confirm (B) Read out (C) Sign (D) State and spell

(D) State and spell

77. Blood pulsing into collection tubes is an indication that (A) The needle is placed in the exact center of the vein (B) The needle has struck a nerve (C) The needle has passed entirely through the vein (D) The needle has struck an artery

(D) The needle has struck an artery

Capillary blood will flow more easily when this is done prior to capillary puncture: (A) The patient drinks a tall glass of water (B) The patient raises her hands above her head for 3-5 minutes (C) The patient breathes deeply just before the puncture is performed (D) The site is warmed for 3-5 minutes

(D) The site is warmed for 3-5 minutes

After assembling the ETS and double-checking that he has the correct tubes gathered for a venipuncture draw, a phlebotomy technician realizes that he forgot to remove the tourniquet after site selection. He knows that it has been in place for more than one minute. If he continues with the draw, what is one possible consequence? (A) The procedure will be more painful for the patient. (B) There will not be sufficient blood flow to fill the necessary tubes. (C) The selected site will be difficult to find. (D) The specimens collected will not produce accurate test results.

(D) The specimens collected will not produce accurate test results.

Which of these choices lists lab tests in the order in which tubes would be drawn to conduct the tests? (A) Glucose, thyroid panel, complete blood count (B) Thyroid panel, glucose, complete blood count (C) Complete blood count, thyroid panel, glucose (D) Thyroid panel, complete blood count, glucose

(D) Thyroid panel, complete blood count, glucose

Blood flow slows and then stops while a phlebotomy technician is halfway through drawing a citrate tube. After adjusting the needle gently forward and backward, the technician is not able to restore the flow. What should he do? (A) Label and submit the tube for testing halfway full (B) Label and submit the tube for testing halfway full only if a second tube is inserted and also does not fill (C) Discontinue the draw and reschedule the patient (D) Try a second citrate tube; if the second tube does not fill, perform a second venipuncture at a new site

(D) Try a second citrate tube; if the second tube does not fill, perform a second venipuncture at a new site

88. One effective method to help control healthcare associated infections is (A) Wiping down surfaces in a drawing station between patients using a damp, soapy cloth (B) Performing hand hygiene after every other patient (C) Washing hands for at least 15 seconds (D) Using facility-approved disinfectants to clean reusable items like point-of-care testing devices

(D) Using facility-approved disinfectants to clean reusable items like point-of-care testing devices

89. Just as a needle is removed from a patient's arm, the patient has a coughing fit and the phlebotomy technician is accidentally stuck with the needle. What should the phlebotomy technician do after placing the needle in the sharps container? (A) Call her supervisor (B) Ask the patient if he has any known bloodborne illnesses (C) Complete an incident report (D) Wash the injury with soap under running water for 15 minutes

(D) Wash the injury with soap under running water for 15 minutes

An infant's blood volume may be approximated by multiplying the child's ___________________ by ________. (A) Weight in pounds, 65 (B) Weight in kilograms, 65 (C) Weight in pounds, 80 (D) Weight in kilograms, 80

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