Phlebotomy Final Exam: Multiple Choice Questions and Answers, Exams of Medicine

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Phlebotomy Final Exam

Why do pregnant patients have lower reference ranges for red blood cell counts? · Blood fluid increases in pregnancy, having a diluting effect on red blood cells · Poor appetite leads to transient anemia · Constant nausea leads to hemoconcentration of red blood cells. · The growing fetus uses up the mother's iron reserves - ANS · Blood fluid increases in pregnancy, having a diluting effect on red blood cells It is necessary to control depth of lancet insertion during skin puncture to avoid · Bone injury · Bacterial infection · Puncturing an artery · Excessive bleeding - ANS · Bone injury What is an example of a lab test that a Thick Blood smear preparation test would be used? (Thick blood smear is a drop of blood on slide as big as nickel or quarter) · CBC · Malaria · Fat content · Hepatitis - ANS · Malaria Which color top microcollection container would be used to collect a specimen for a CBC?

· Gray top · Green top · Red top · Lavender top - ANS · Lavender top A blood smear made from an EDTA (Lavender top) should be made · Anytime after collection · Within 4 hours of collection · Within 1 hour of collection · Within 12 hours of collection - ANS · Within 1 hour of collection If blood is drawn too quickly from a small vein, the vein will have a tendency to · Collapse · Disintegrate · Bruise · Roll - ANS · Collapse How long before obtaining blood for testing should drugs known to interfere with blood tests be discontinued? · 1 to 4 hours · 24 to 36 hours · 48 to 72 hours

· 4 to 24 hours - ANS · 4 to 24 hours The following are lab test that cannot be collected using a capillary puncture except? · Erythrocyte sedimentation rate (ESR) · PT or APTT specimens · Blood cultures · Hematocrit (Hct) - ANS · Hematocrit (Hct) Which instance most closely resembles basal state? A patient who has · worked all night but did not eat at work · Been lying down for an hour · Just arrived for a fasting blood test · Just awakened at 0600 after fasting all night - ANS · Just awakened at 0600 after fasting all night Most tests are performed to confirm health or to screen for, diagnose, or monitor disease. To be properly evaluated, test results typically need to be compared with results expected of healthy individuals. Consequently, results values for most tests are established using specimens from normal, healthy individuals. Because results vary somewhat from person to person, the results used for comparison become a range of values with high and low limits, commonly called? · Reference range · Normal range · Basal range · Patient range - ANS · Reference range

Why are capillary blood gases less desirable than arterial blood gases (ABGs)? · Skin puncture blood is only partly arterial in composition · All of the options are correct · skin puncture blood contains tissue fluid. · the blood is exposed to air during collection - ANS · All of the options are correct Which of the following tests is most often a timed test? · Rapid plasma regain (RPR) · Blood urea nitrogen (BUN) · Complete blood count (CBC) · Therapeutic drug monitoring (TDM) - ANS · Therapeutic drug monitoring (TDM) What is the Clinical and Laboratory Standards Institute (CLSI) recommended maximum depth of heel puncture? · 2.0 mm · 2.4 mm · 1.4 mm · mm - ANS · 2.0 mm A fistula is a(n): · Special winged infusion set left in a patient's arm · Permanent fusion of an artery and a vein

· An A-line placed in an artery · Implanted port attached to an indwelling line - ANS · Permanent fusion of an artery and a vein Why is EDTA (lavender) specimens obtained before other specimens when collected by skin puncture · To reduce effects of hemolysis · To minimize tissue fluid contamination · Collection order does not matter · To minimize effects of platelet clumping - ANS · To minimize effects of platelet clumping What type of tube is typically used to collect a baby Bilirubin specimen? · royal blue-color microcollection tube · amber-color microcollection tube · lavender-color microcollection tube · clear-color microcollection tube - ANS · amber-color microcollection tube Which of the following situations can result in hemoconcentration? · Partially filling a normal-draw tube · Mixing the specimen too vigorously · Drawing a large tube with a small needle · Leaving the tourniquet on over 1 minute - ANS · Leaving the tourniquet on over 1 minute When a fasting specimen is need for a lipid test, what is the typically time for fasting?

· 6-8 hours · 8-12 hours · 4-6 hours · 8-10 hours - ANS · 8-12 hours What type of tube might you use if you know the patient is a hard stick with veins that might collapse for a PTT test? · Grey top tube · ETS purple top tube · Normal draw light blue top tube · Short draw light blue top tube - ANS · Short draw light blue top tube Skin puncture blood most closely resembles · Arterial blood · Intracellular blood · Tissue fluid · Venous blood - ANS · Arterial blood Failure to draw blood during a venipuncture attempt can be caused by a number of procedural errors. Being aware of these errors and knowing how to correct them may determine whether you obtain blood on the first try. All the following are procedural errors that can occur except? · The needle being seated into the vein · Tube being cracked releasing the vacuum

· Tube with expired date · The needle penetrating through the vein - ANS · The needle being seated into the vein Why should a laboratory report form indicate the fact that a specimen has been collected using skin puncture? · So that the patient's nurse can check the site for signs of infection · So that subsequent specimens will be collected by skin puncture also · Because test results may vary depending on the method of collection · For liability insurance and billing purposes - ANS · Because test results may vary depending on the method of collection All of the following are procedures in collection of a microcollection container while doing skin puncture except? · Touch the tip of the tube's "scoop" to the drop of blood · Mix additive microtubes by gently inverting them. · Use a scooping motion against the surface of the skin · Allow the blood to run down the inside of the wall of the tube - ANS · Use a scooping motion against the surface of the skin It is not a good idea to collect a CBC specimen from a screaming infant because the · Platelets are more likely to clump · White blood count may be falsely elevated · Specimen will be hemoconcentrated · Specimen will be more likely to hemolyze - ANS · White blood count may be falsely elevated

Do not perform a skin puncture parallel to the grooves or lines of the fingerprint. A parallel puncture will allow the blood to flow __________________. · None of the above · In a circular pattern forming a rounded drop. · Down the finger preventing the formation of a rounded drop · Across the finger forming a rounded drop. - ANS · Down the finger preventing the formation of a rounded drop When the arm of the patient is swollen with excess fluid, the condition is called · Syncope · Icterus · Hemoconcentration · Edema - ANS · Edema Which of the following vascular access devices is inserted in the peripheral venous system for the purpose of blood collection and administration of medication? · Fistula · Implanted port · PICC · Heparin lock - ANS · Heparin lock The purpose of wiping away the first drop of blood during skin puncture is

· To minimize effects of hemolysis · To minimize effects of platelet aggregation · To avoid bacterial contamination · To eliminate tissue fluid contamination - ANS · To eliminate tissue fluid contamination What is Phenylketonuria (PKU) lab test? · A contagious condition caused by lack of phenylalanine · An acquired condition caused by lack of phenylalanine · An inherited condition caused by lack of thyroid hormone · A genetic disorder characterized by the inability to metabolize phenylalanine - ANS · A genetic disorder characterized by the inability to metabolize phenylalanine Which instance may lead you to suspect that you have accidentally punctured an artery? · There is no way to tell · The blood pulses into the tube · A patient may develop a hematoma over time · The blood obtained is dark red - ANS · The blood pulses into the tube What are special small plastic tubes used to collect the tiny amounts of blood obtained from skin puncture, often referred to as "bullet" tubes? · Baby tubes · Microcollection tubes · ETS tube

· Heel tubes - ANS · Microcollection tubes What is the purpose of warming the site before skin puncture? · It increases blood flow up to seven times · It prevents hemolysis of the sample · It makes the veins more visible · It comforts the patient - ANS · It increases blood flow up to seven times Skin puncture blood reference values (normal) are higher for · Glucose · Calcium · Phosphorus · Total protein - ANS · Glucose Tiny red spots (Petechiae) that appear on a patient's arm when the tourniquet is applied are a sign that the · Tourniquet is too light · Patient is anemic · Site may bleed excessively · Patient is allergic to latex - ANS · Site may bleed excessively What is the term that means related to or marked by jaundice and is used to describe serum, plasma, or urine specimens that have an abnormal deep yellow-brown color due to high bilirubin levels?

· Hemolyzed · Cloudy · Icteric · Lipemic - ANS · Icteric The following area/s should not be punctured during a heel puncture? · Arch · All of the above · Posterior curvature of the heel · Bruised areas - ANS · All of the above You must draw a protime specimen from a patient with IVs in both arms. Which of the following is the best thing to do? Draw the specimen · Distal to an IV · From an IV · Proximal to an IV · From an ankle vein - ANS · Distal to an IV Some patients become faint at just the thought or sight of the blood being drawn. There are many other contributing factors that can cause a patient to faint. What should a phlebotomist due in case his/her patient faints? · Talk to the patient and reassure them · Protect patient from injury by physically supporting them

· Apply a cold compress to forehead or back of neck · All of the above - ANS · All of the above Which of the following is the safest area for infant heel puncture? · The lateral or medial plantar surface · The area of the arch · The central area · The posterior curvature - ANS · The lateral or medial plantar surface A phlebotomist has attempted twice to draw a partial thromboplastin time (PTT) specimen from a patient with difficult veins. Both times the phlebotomist has been able to draw only a partial tube. What should the phlebotomist do? · Send the tube with the most blood to the laboratory with a note that it was a difficult draw. · Pour the two tubes together and mix well · Collect the specimen by skin puncture · Have another phlebotomist attempt to draw the specimen - ANS · Have another phlebotomist attempt to draw the specimen The National Cholesterol Education Program recommends that lipid profiles be collected in a consistent manner after the patient has been either lying down or sitting quietly for a minimum of how many minutes? · 5 minutes · 10 minutes · 20 minutes

· 15 minutes - ANS · 5 minutes You have no choice but to draw a specimen from a site with a hematoma. Where should you obtain the specimen? · In the area of the hematoma · None of the options is correct · Distal to the hematoma · Proximal to the hematoma - ANS · Distal to the hematoma What is the most common complication of venipuncture? · Pain · Hematoma · Petechiae · Syncope - ANS · Hematoma A skin puncture should be done rather than a venipuncture in all of the following situations except · When a small volume of blood is adequate · When a light blue stopper tube is needed · A child younger that 1 year of age · A patient with difficult veins - ANS · When a light blue stopper tube is needed Why would a phlebotomist resist drawing blood from an area that has become endemic because of an IV infiltrating surrounding tissues with fluid?

· Veins are harder to locate · All of the above · Inaccurate results because contamination with tissue fluid · Easily injured by tourniquet, delay healing - ANS · All of the above What does the term "calcaneus" mean? · Bone infection · Calcium containing · Venous blood · Heel bone - ANS · Heel bone When doing a skin puncture on a young child how might you hold their hand? · Have the parent hold the hand of the child · Hold onto three to four fingers to prevent child from moving · Do heel puncture on child that cannot hold still · Hold the finger being puncture tightly so will not move - ANS · Hold onto three to four fingers to prevent child from moving The following blood component can be elevated with moderate exercise? · Total Protein · All of the above · Creatinine

· Glucose - ANS · All of the above When a test requires a fasting specimen, but the serum is _______________, it is a clue that the patient was not fasting. · Hemoconcentrated · Hemolyzed · Jaundiced · Lipemic - ANS · Lipemic Prolonged tourniquet application may cause a change in blood composition primarily because of · Hemoconcentration · Hemoglobin · Hemolysis · Homeostasis - ANS · Hemoconcentration What does a person need to be able to do to be considered computer literate? · Know basic computer terminology · Understand the computer and the functions it performs · Perform basic operations using computers · All of the above - ANS · All of the above Which of the following tubes can be used to collect blood for a type and crossmatch?

· Gray top · Non-additive red top · Royal blue top · Serum separator tube - ANS · Non-additive red top This test requires a specimen with a 9:1 ratio of blood to anticoagulant. · Ethanol (ETOH) · Glycohemoglobin (HgbA1C) · Prothrombin time (PTT) · Zinc - ANS · Prothrombin time (PTT) Which test requires strict skin antisepsis procedures before specimen is collected? · Blood culture · Blood urea nitrogen (BUN) · Compete blood count (CBC) · Type and crossmatch - ANS · Blood culture A 2-hour postprandial specimen should be drawn · 2 hours before patient arrives for the test · 2 hours after the patient arrives for the test · 2 hours before the patient has a meal · 2 hours after the patient has a meal - ANS · 2 hours after the patient has a meal

When performing a GTT (glucose tolerance test), the timing should begin · When the patient arrives · When the fasting specimen is drawn · When the patient finishes the glucose drink (glucola) · One-half hour after the drink is finished. - ANS · When the patient finishes the glucose drink (glucola) What type of additive is recommended for collecting an ethanol test specimen (ETOH)? · EDTA · No additive · Sodium citrate · Sodium fluoride - ANS · Sodium fluoride The physician has ordered two sets of blood cultures, how do you collect these specimens and what is important? · Follow strict septic procedure and collect blood as usual venipuncture procedure · Follow strict septic procedure and collect each set from a different location · If at all possible, draw each set at least 30 minutes apart. · Both B and C are correct - ANS · Both B and C are correct Which of the following tests may require special "chain of custody" documentation when collected? · Blood culture

· Crossmatch · Drug Screen · TDM - ANS · Drug Screen Tests performed using special POCT instruments or test kits include · Arterial blood gases · Glucose · Occult blood · All of the answers are correct - ANS · All of the answers are correct At what intervals is the blood blotted during a bleeding time test? · 15 seconds · 20 seconds · 30 seconds · 45 seconds - ANS · 30 seconds What is the common lab test used to detect blood in the feces? · Occult blood · Hemoglobin · Lactate · Glycemic index - ANS · Occult blood

After entering input onto a computer, what must a user do to make the computer process the information? · Log off · Move the cursor · Press the Enter Key · Select an icon - ANS · Press the Enter Key Which of the following would not be considered a preanalytical error? · Failing to mix an additive tube · Mislabeling an aliquot tube · Misreporting patient results Using the wrong order of draw - ANS · Misreporting patient results A glucose specimen drawn in a sodium fluoride tube (Gray top) is stable at room temperature for · 2 hours · 6 hours · 12 hours · 24 hours - ANS · 24 hours Which of the following actions can lead to inaccurate test results? · Collecting a bilirubin specimen in an amber tube · Inadequate mixing of an EDTA tube

· Mixing a serum separator tube · Placing a cold agglutinin specimen in a 37 degree heat block - ANS · Inadequate mixing of an EDTA tube A bleeding time (BT) test assesses the functioning of · Erythrocytes · Leukocytes · Neutrophils · Thrombocytes - ANS · Thrombocytes Identify the condition in which a unit of blood is withdrawn form a patient as treatment? · ABO Rh incompatibility · Autologous donation · Hemochromatosis · Leukemia - ANS · Hemochromatosis Which of the following is used by the laboratory to identify a specimen throughout the testing process? · Accession number · Hospital number · Mnemonic code · Password - ANS · Accession number What POCT is used to monitor heparin therapy?

· ACT

· BT

· PT

· TnT - ANS · ACT Which of the following should be avoided during a glucose tolerance test (GTT)? · Chewing sugarless gum · Drinking sugar-free tea · Smoking low-tar cigarettes · All of the answers are correct - ANS · All of the answers are correct Which of the following is an example of a computer peripheral? · CPU · Keyboard · Memory byte · ROM - ANS · Keyboard Which of the following conditions would cause a specimen to be rejected for testing in the laboratory? · Icteric bilirubin specimen · Partially filled red top tube · Potassium specimen submitted on ice

· All of the above - ANS · Potassium specimen submitted on ice The most critical aspect of the blood culture collection procedure is · Needle gauge · Skin antisepsis · Specimen handling · Volume of blood collected - ANS · Skin antisepsis You have a requisition for a test with which you are unfamiliar. How do you determine what tube to use and how to collect and handle the specimen? · Ask your supervisor · Call the patient's physician · Check with the specimen processing department · Refer to the lab user manual - ANS · Refer to the lab user manual Of the following tests, which is most likely to result in fatal consequences for the patient if the specimen is misidentified? · Blood cultures · Drug screen · 2-hr Postprandial glucose · Type and crossmatch - ANS · Type and crossmatch Which of the following specimens needs to be chilled after drawn?

· Ammonia · Bilirubin · Cold agglutinin · Sodium - ANS · Ammonia Timing of specimen collection in regard to dosage administration in therapeutic drug monitoring (TDM) is critical for safe and beneficial treatment and must be consistent. What are the difference between the peak and trough levels in a patient? · Above Peak can be toxic and below trough will not be therapeutic · Above Peak will be therapeutic and below trough can be toxic · Medication should be both above peak and trough for therapeutic measures · Medication should be both below peak and trough for therapeutic measures - ANS · Above Peak can be toxic and below trough will not be therapeutic What is crucial in the operation of a centrifuge? · Every slot is filled · Tubes be balanced · Each color tube is matched up · Run the centrifuge for 5 minutes - ANS · Tubes be balanced Presence of the antimicrobial agent (antibiotics) in the patient's blood can inhibit the growth of the microorganisms in the blood culture bottle. In such cases, the physician may order blood cultures to be collected in which bottles?

· Fastidious antimicrobial neutralization (FAN) bottles · Antimicrobial removal device (ARD) bottles · regular blood culture bottles · Both A and B are correct - ANS · Both A and B are correct When collecting a blood culture specimen directly from a butterfly needle into the blood culture bottles, which bottle should be collected first? · Either, it does not matter · Aerobic · Anaerobic · A discard tube should be drawn first - ANS · Aerobic Which of the following does not represent proper aliquot preparation? · Removing the stopper behind a splash shield · Carefully pouring the contents into the aliquot tube · Covering or capping the aliquot tube · Properly labeling the aliquot tube - ANS · Carefully pouring the contents into the aliquot tube Which of the following test specimens is collected from patients with fever of unknown origin (FUO) to rule out septicemia? · Blood culture · Nasopharyngeal culture · Urine culture and sensitivity (C & S)

· Wound culture - ANS · Blood culture Which type of specimens may take longer to clot? · Chilled specimens · Specimens from patients on heparin therapy · Specimens from patients with high WBC counts · All of the above - ANS · All of the above How would you transport a cryoglobulin specimen after being drawn? · At room temperature · In a 37 degree heat block · In an ice slurry · With protection from light (amber tube) - ANS · In a 37 degree heat block An autologous blood transfusion is a transfusion of blood · Directly from the donor to the patient · Donated by a patient for his or her own use · Donated by a relative · From an anonymous donor - ANS · Donated by a patient for his or her own use The process of entering a password and gaining access to a computer is called