NCCT- Phlebotomy
The appropriate needle gauge to use for most venipuncture collections is
21
The medical assistant is educating the patient on fasting diet requirements prior to a glucose tolerance test. Which of the following is the minimum time frame the patient must remain NPO before the start of the test?
8-12 hours
Which patient description is correctly matched with the appropriate site selection?
A 53-year old male with a central line has a specimen collected from the dorsal side of the hand.
EDTA is an
Anticoagulant
An infant is brought to the clinic for a CBC. After performing a heelstick, not enough blood is collected to perform the test. Which of the following actions should the medical assistant take?
Apply a warm compress
Which of the following actions should the medical assistant take to make a vein more prominent when attempting to select a venipuncture site?
Apply a warm compress to the area for 5 minutes.
Which of the following actions by the medical assistant demonstrates safe use of a centrifuge?
Balance the tube load to prevent breakage
Which of the following forms is the medical assistant responsible for having the patient sign when a specimen is being collected for substance abuse screening for employment?
Chain-of-custody
The phlebotomist needs to draw routine labs. The skin preparation for this procedure would be.
Cleanse the site by using a circular motion from center to periphery
The medical assistant is collecting a sample on a 2 year old outpatient by finger stick. Following the collection, the medical assistant holds firm pressure on the site until bleeding has stopped. How should the medical assistant proceed?
Do not bandage the site
Patient has a DVT in left arm and the patient is also on blood thinners, where would be the best site for drawing blood?
Draw right arm and hold for 5 minutes
Identify the CLSI recommended micro-collection order of draw for a BMP, CBC & Bilirubin.
EDTA, Heparin, serum seperater
When performing a CBC on a six year old, the parent insists upon using an anesthetic at the venipuncture site. Which would be correct?
EMLA Cream (lidocaine 2.5% and prilocaine 2.5%) is an emulsion, with a mixture of lidocaine and prilocaine.
The physician orders a sedimentation rate for a patient recovering from an infection. This is indicated on the lab requisition as which of the following?
ESR-Erythrocyte Sedimentation Rate
Since special precautions are needed for patients with Vascular Access Devices, which of the following devices are contraindicated for any type of blood draws?
Fistula
Which of the following actions should the medical assistant take to prevent hemolysis of a blood specimen in an EDTA tube?
Gently invert specimen
Which of the following tests is drawn in an EDTA tube for the hematology department of the laboratory?
HGB
A patient's past history indicates episodes of syncope. Which of the following would be the best course of action the phlebotomist would perform to prevent complications of syncope?
Have the patient lie down on a hospital bed or exam table.
The physician orders a hemoglobin level to be checked on a 2-month-old patient. Which of the following sites should the medical assistant use to obtain the specimen?
Heel of the foot
After a phlebotomy draw, the phlebotomist realizes the tourniquet was on the patient's arm for an extensive length of time. Which of these is the most common complication?
Hemoconcentration
The medical assistant completes a venipuncture in the antecubital area without complications. Pressure is placed on the site following the collection. The patient is still bleeding after five minutes of continuous pressure by the medical assistant and there is bruising at the site. The medical assistant asks the patient if she is on anticoagulants. The patient indicates that she is, and states that this is normal for her. How should the medical assistant proceed?
Hold direct pressure until bleeding stops, apply a bandage, and notify nurse.
During a venipuncture the patient has excessive bleeding and then states she forgot to mention her anticoagulant (Coumadin) therapy. Which of the following should the medical assistant do?
Hold pressure on the site for a minimum of five full minutes until bleeding stops.
Which of the following tubes should the medical assistant select in collecting a blood sample for a Complete Blood Count (CBC)?
Lavender Tube
A phlebotomist is staffing the outpatient clinic at a remote site. There is a centrifuge at the site, but it is not functional. The courier will be arriving to pick-up all samples collected at 1300, and will deliver to the testing laboratory at 1500. A patient arrives at 1200 with orders for Complete Blood Count, Prothrombin Time, and Basic Metabolic Panel. Which tubes should the phlebotomist use for blood collection?
Lavender, Blue, Green, Gray
Which of the following Vacutainer tubes is routinely used for hematology testing?
Lavender-topped
A physician asked you to draw a INR on Mr. Jones which tube and additive would you choose
Light Blue, Sodium Citrate
A patient is at the lab for their weekly PT/INR. Which of the following tubes should the medical assistant collect for this test?
Light blue tube
The laboratory requisition indicates that you are to collect a venous blood specimen for hematology CBC testing, serum chemistry testing, and coagulation studies. What is the proper order of collection for these tubes?
Light blue, red, lavender
Which of the following tube tops contain silica particles to enhance clotting and a thixotropic gel to assist in the separation of serum and blood cells?
Marbled red and grey
For which of the following patients is the use of an adhesive bandage contraindicated?
New born with hyperbilirubinemia
Which of the following tests is required in all 50 states to screen newborns for metabolic disease?
PKU
Which of the following tests monitor anticoagulation therapy?
PT and PTT
When performing a venipuncture, sudden swelling is observed at the insertion site. Which of the following actions should the medical assistant take?
Release the tourniquet, remove the needle, and immediately apply pressure at the site.
During a blood draw, a patient begins complaining of discomfort and tingling, at which time the phlebotomist notices bruising and discoloration at the site. How should the phlebotomist proceed?
Release the tourniquet, withdraw the needle, and apply pressure.
After the phlebotomist puts on latex gloves and ties a non-latex tourniquet on the patient's arm, the patient indicates that he is highly allergic to latex. Which of the following is the phlebotomist's best course of action?
Remove the tourniquet, wash hands, change to non-latex gloves and use a new tourniquet.
tubes can contain ethylenediamine tetraacetic acid?
Royal blue/ Lavender
The phlebotomist is drawing plain red, lavender, and blue top tubes. Upon completion of the blood draw, the phlebotomist noticed that an order that requires a SST has been missed. What would be the next action?
Share the plain red top specimen for the SST test.
The medical assistant is collecting four tubes of blood on a patient who begins wheezing. She asks the patient if he is okay, he states that he has asthma. The medical assistant is in the process of switching to the fourth tube when the patient faints in the phlebotomy chair. Which of the following steps should the medical assistant take?
Stop the collection, apply pressure to site, call for help, and assist the patient.
When performing a skin puncture on an infant what is the preferred site?
The plantar surface of the heel
After centrifuging a blood specimen, the medical assistant notes the serum has a reddish appearance. Which of the following has occurred?
The specimen is hemolyzed
When a complete metabolic profile (CMP) and complete blood count (CBC) are ordered at the same time, why should the CMP be drawn first?
Tubes without additives should be drawn before tubes with additives.
A phlebotomist is asked to collect a CBC, PT and Chem 7 on a patient that requires a hand stick with a butterfly needle into evacuated tubes. The correct order of draw for this collection would be
Two Light Blue Top Tubes, Green Top Tube, Lavender Top Tube
When inserting a needle during venipuncture, the bevel should be in which of the following positions in relation to the vein?
Up
After several minutes of searching the medical assistant can only palpate a small vein. The patient is prepared and the venipuncture is performed. The blood is filling the tube, but slows and then stops even though the patient and medical assistant remained still. Which of the following actions should the medical assistant take?
Use a smaller tube because the vein has collapsed.
Filling evacuated tubes to the indicated level results in the correct ratio of
additive to blood
When performing a venipuncture on an infant, the amount of blood taken from the infant should be monitored to avoid
anemia
To help prevent a hematoma at the site after drawing blood, which of the following actions does the medical assistant take?
apply direct pressure with cotton gauze
Capillary blood specimens are typically collected on patients that
are extremely obese
An entry level medical assistant goes to collect blood from a 70-year-old woman with diabetes who had a mastectomy of the left breast. The medical assistant notices a PICC line in the patient's right arm. For this specimen collection, the medical assistant should
ask a nurse to collect the specimen.
At what time should a test tube be labeled with the patient's identification?
before leaving the patient's room, after drawing the blood
Which of the following specimens is most susceptible to cross contamination and should always be drawn first?
blood culture
The medical assistant has an order to collect a CBC with diff, PT, a basic metabolic panel (BMP), and blood cultures. Place the collection tubes in the correct order of draw. (Click and drag the options in the left column to their correct order in the right column).
blood culture bottles, light blue, red, lavender
While performing a venipuncture in the antecubital space, the patient verbalizes an extreme amount of pain and the blood in the collection tube is noted to be bright red. Which of the following sites is most likely to have been inadvertently punctured?
brachial artery
A 2 week old infant has been brought to the lab for a repeat PKU/neonatal screening. Which of the following collection procedures is appropriate to collect the specimens?
capillary using heel puncture lancet
When performing a fingerstick on a patient, the phlebotomist must pay close attention to the extremity that has been compromised by
circulation, swelling, and infection.
During processing, the centrifuge rotor lid should be kept
closed to maintain an airtight seal
The medical assistant collects blood for a test that requires a blood smear. What is the terminology that would indicate that the sample clumped (therefore requiring a redraw)?
coagulation
While performing a venipuncture using an evacuated tube, a small amount of blood enters the tube and then stops. Which of the following conditions is likely to lead to this?
collapsing vein
A medical assistant needs to draw a bilirubin on a jaundiced infant. The medical assistant should
collect the specimen in an amber tube to protect from light.
After a phlebotomist has successfully followed all the steps for blood collection, the patient informs the phlebotomist that he tends to bleed longer than the average person. What would be the next course of action for the phlebotomist?
confirm hemostasis and apply paper tape
After performing a venipuncture on a patient the medical assistant notices the patient is bending his elbow to hold the gauze in place. This action is contraindicated because bending the elbow is likely to
create a hematoma
When collecting specimens for alanine aminotransferase (ALT) or aspartate aminotransferase (AST), avoid gray-topped sodium fluoride tubes because the anticoagulant
destroys many enzymes
Venipuncture on the foot is performed in which of the following locations?
dorsal pedis
Which of the following arteries provides direct blood flow to the foot?
dorsalis pedis
The medical assistant is asked to draw blood from a patient with an I.V. whose opposite, left arm is inaccessible. Drawing blood from which of the following sites would be appropriate without a physician's approval?
draw from the right arm distal to the I.V. site
Which of the following additives protects serum from interacting with red blood cells after a specimen has been centrifuged?
gel separators
A test tube with which of the following colored stoppers has a glycolytic inhibitor?
gray
The medical assistant is instructed to perform a capillary stick for newborn screening. Which of the following collection devices should the medical assistant use?
heel stick lancet
Forceful shaking of blood in an evacuated collection tube will cause which of the following complications?
hemolysis
A phlebotomist has received a requisition for a PT/aPTT to evaluate the patient for Von Willebrand's disease. Because of the patient's potential diagnosis, the phlebotomist should be sure to
hold pressure on the draw site until bleeding has stopped.
Which of the following steps is completed first in performing venipuncture?
identify the patient
The physician orders a prothrombin time. Which of the following tubes should be used to collect the specimen?
light blue
Which of the following evacuated tubes should the medical assistant draw first?
light blue top
The patient was sent to the lab to have CBC (lavender), PT/PTT (light blue), CMP (green), and glucose (grey). Place the evacuated tubes in the correct order of draw.
light blue, green, lavender, gray
The phlebotomist should send a specimen collected in a yellow stopper tube with SPS additive to which of the following laboratory departments?
microbiology
A patient with an order for a blood draw presents with burns covering both arms. Which of the following is the medical assistant's best option for collecting the largest amount of blood for this patient?
microtainer tube
Which of the following items is more commonly found on a phlebotomy tray?
multi-sample needle
Capillary blood specimen collections are contraindicated in patients with
peripheral edema
A phlebotomist has received a requisition to collect a blood culture. Using a butterfly, three milliliters of blood is collected. Into which of the following bottles is the proper dispensation of the specimen?
place all three mLs in the aerobic bottle
Which of the following sites should the medical assistant use for newborn screening blood collection?
plantar surface of the heel
The patient reports feeling faint, and slumps forward during a venipuncture. After calling for assistance, which of the following actions should the medical assistant take next?
remove the tourniquet
When performing venipuncture on a patient with a left mastectomy, which site should the medical assistant use?
right antecubital fossa
A centrifuge functions in which of the following ways?
rotates to separate components of a patient's blood
Which of the following is a likely complication from repeated phlebotomy procedures in the same area?
sclerosed veins
additive in the light blue top tube?
sodium citrate
A syringe is preferred over a vacuum collection device when
the patient's veins are fragile
Blood cultures are always drawn first because?
to avoid contamination of the cultures.
Which of the following actions is appropriate for the medical assistant to take if an evacuated tube does not even begin to fill during a specimen draw?
try another evacuated tube prior to withdrawing from the vein
