Phlebotomy Procedures and Techniques, Exams of Nursing

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CPT (Certified Phlebotomy Tech) National

Exam Practice Questions & Answers.

A phlebotomist must choose the right tube color and additive for the corresponding _______? - Answer: Laboratory test When a new lot # or kit is opened - Answer: When should a phlebotomist perform external liquid controls for quality control on a CLIA-waived point of care test? 1 to 2 minutes - Answer: A phlebotomist is drawing 5 blood collection tubes. When should the tourniquet be released? Providone Iodine" - Answer: What agent should a phlebotomist cleanse the skin with before drawing blood cultures? Blood cultures - Answer: According to the CLSI order of draw guidelines, which of the following samples should the phlebotomist collect first?

Blood cultures coagulation electrolytes glucose levels SST (serum separator tube) - Answer: Which of the following is appropriate to use when collecting for a chemistry test that requires serum? SST SPS EDTA PST saturate each circle - Answer: After performing a heel puncture for neonatal screening, which of the following is the correct procedure for collecting the blood? Smear the blood on the circle saturate each circle touch the heel to the center of the circle drop the blood on the circle Release the tourniquet and stop the draw - Answer: A phlebotomist observes a hematoma developing at the site of a venous blood draw. The phlebotomist should?? When a patient is tested - Answer: When should the code on glucose cuvettes or strips be compared to the code on the glucose meter?

Ask the patient when she last ate or drank - Answer: The phlebotomist needs to draw a glucose tolerance test (GTT) on a patient and notices an empty breakfast plate on the bedside table. Which of the following actions should the phlebotomist take? EDTA - Answer: Tubes with what additive should be used when collecting a sample for CBC Arterial blood gases - Answer: When preparing for transport, what specimens must be placed into an ice bath within 30 minutes after collection? An incorrect needle gauge - Answer: Which of the following actions would result in a grossly hemolyzed specimen? An incorrect order of draw applying the tourniquet too close to the draw site failure to invert the tube an incorrect needle gauge Below the IV - Answer: The phlebotomist must perform a blood draw on a patient with an IV on the right side, and there has been a mastectomy on the left side. Where should the phlebotomist perform the venipuncture? Don't draw until the nurse has attached a wristband to the patient - Answer: Before collecting blood on an inpatient, the phlebotomist notices that the patient does not have a wristband on his wrist, but there is one attached to the patient's IV stand. Which of the following is the proper action? O2 levels - Answer: A phlebotomist receives orders to draw an infant screening card, O2 levels, bilirubin and DNA. Which of the following should be drawn first?

Bilirubin O2 levels DNA Screening card The biohazard bag prevents a possible exposure incident - Answer: Why is it important to place a specimen in a biohazard specimen bag when transporting to an outside laboratory? 15 to 30 degree angle - Answer: Industry standard states that needle insertion in the antecubital area should be at?? Dorsal veins - Answer: Some older adults or obese patients may not have accessible antecubital veins. In this situation, the phlebotomist may use which of the following? Initial and mark date/time on each tube - Answer: Before leaving the patient's room, which of the following actions is required for the phlebotomist to take? Check for breathing - Answer: During a draw, the patient becomes unresponsive What is the next action the phlebotomist should take? Inspect the integrity of the needle's seal - Answer: What action should a phlebotomist take to verify the quality of veinpuncture supplies before beginning a blood draw on an adult patient? Engage the needle safety device - Answer: Which of the following is the next step after removing the needle from the patient's arm? Ask the patient to open his fist remove the tourniquet engage the needle safety device

invert all tubes To determine if the patient is at risk for developing iatrogenic anemia - Answer: Why should the phlebotomist document the total volume of blood drawn from a patient? Wear gloves when contact with blood is anticipated - Answer: Phlebotomists should comply with which of the following OSHA requirements specific to the venipuncture procedure? Wear gloves when contact with blood is anticipated wear safety glasses if spashes, spray, splatter or droplets of blood may be generated Recap contaminated venipuncture devices to reduce exposure incidents Green, lavender, gray (G,P,G) - Answer: Which of the following indicates the correct order of draw? Lavender, green, gray Gray, green, lavender Green, gray, lavender Green, lavender, gray Inform the patient to contact the ordering physician to get the results - Answer: A patient comes in to find out his test results. The phlebotomist notices the results are ready and verifies the patient's identity. Which of the following action is most appropriate? 2-10 degrees C - Answer: The phlebotomist draws a CBC at the physician's office at 1800. The laboratory closed at 1730 and will not process specimens again until 0500. Which of the following is the proper temperature for preserving the specimen?

37-39 degrees C 15-30 degrees C 2-10 degrees C -20 to -10 degrees C Verbal, wrist band - Answer: which of the following are appropriate forms of ID in the inpatient setting? Verbal, wrist band Medical chart, nurse Family member, driver's license Clergy person, physician Test requisition - Answer: What is the first step in the blood collection procedure? (have to have orders before anything can be drawn obviously) Median cubital - Answer: When collecting a routine blood sample, which of the following vessels should the phlebotomist attempt to draw from first? A transfusion reaction - Answer: What is a potential consequence of mislabeling a blood bank specimen? benzalkonium chloride (BZK) - Answer: What is an appropriate cleanser for cleansing around the urinary meatus in a clean-catch urine collection? Veins are inaccessible - Answer: Capillary specimen collection is preferred over venipuncture when?

Perform the venipuncture - Answer: Before a phlebotomist performs a venipuncture, the patient warns that he is HIV positive. According to OSHA regulations, after donning gloves, the phlebotomist should? The incorrect data may be reported to the healthcare provider - Answer: Which of the following outcomes is the most damaging if data is entered incorrectly into the automated laboratory information system? Implied consent - Answer: A phlebotomist is preparing to draw blood from a patient in the hospital. The patient extends his arm and turns his head away. What type of consent does this indicate? The lab rejects the mislabeled specimen - Answer: A physician orders a STAT specimen but the phlebotomist forgets to fill out the patient ID number. What is the appropriate procedure for an improper labeled specimen once the outside lab receives it? Send the results to the physician in a marked envelope - Answer: What is an example of the acceptable reporting of routine lab results? The median cubital vein could be more accessible on one side then the other - Answer: The phlebotomist should examine the antecubital veins of both arms for which of the following reasons? Shock - Answer: For which of the following does emergency first-aid treatment include maintaining an open airway, controlling bleeding, and keeping the victim warm until help arrives? Either heel - Answer: The phlebotomist has a request to collect a routine CBC From a healthy 10 month old infant. Which of the following is the most appropriate collection site?

36-38 degree C - Answer: At what temp should a semen sample be transported by the phlebotomist? Flush the injured area with running water (said "soap & water" on prior exams) - Answer: During venipunture the phlebotomist is stuck with a used needle. What is the first action the phlebotomist should take? Petechiae - Answer: After placing the tourniquet on the patient's arm, the phlebotomist notices small red spots below the tourniquet. Which of the following is the correct term for these spots? Patient's information - Answer: A phlebotomist should comply with HIPAA to protect which of the following? For no longer than 60 seconds - Answer: How long should a tourniquet be left on a patient's arm? Release the tourniquet and remove the needle. - Answer: During a venipuncture, the patient reports a sharp pain radiating down his arm. What action should the phlebotomist take? These areas are more prone to infection - Answer: Why should a phlebotomist avoid drawing blood from the leg or foot of a diabetic? Complete medical history - Answer: a phlebotomist is required to obtain which of the following from a potential blood donor? Clotting (coagulation) - Answer: A phlebotomist must invert anticoagulant tubes to prevent which of the following?

An increase rate of coagulation - Answer: The order of draw for capillary collections is different than venipuncture because of? "As soon as you collect the specimen, keep it next to your body (to keep it closer to normal body temp). We will need to submit it right away for testing" - Answer: A phlebotomist working in a fertility clinic draws blood from a patient who also must submit a semen sample for analysis. Which of the following should the phlebotomist tell the patient? Apply pressure to prevent leakage of blood into the tissues. - Answer: What is the best method to prevent internal or external bleeding from the venipuncture site after the needle is removed? Choose a syringe and butterfly assembly and transfer to an ETS tube - Answer: What is the best method to collect a blood specimen from an older adult patient who has fragile, easy to collapse veins? Apply direct pressure to the wound - Answer: A phlebotomist working in an outpatient facility finds an unconscious patient in the waiting room bleeding profusely from the leg. What action should the phlebotomist take first? The ordered test can be performed on a capillary specimen - Answer: A patient asks a phlebotomist to please use her finger for the blood work. The phlebotomist can do this if....? "When was the last time you ate?" - Answer: What question is the most important to ask the patient prior to collecting a metabolic panel? Paternity testing - Answer: What circumstance would you need to abide by chain of custody guidelines?

Report the results to the patient's physician - Answer: A phlebotomist performs a point-of-care glucose test on an outpatient. The results are in the critical value range. What is the appropriate action? Return after drawing other patients - Answer: Upon entering a patient's room, a phlebotomist notices a clergy member is with the patient. The phlebotomist should.... Describe the procedure - Answer: A patient states that this is his first blood draw. Which of the following actions is appropriate? Lavender top - Answer: Which of the following tubes should be collected first for dermal samples? Shut off power to the instrument - Answer: A phlebotomist sees a coworker receive a major electrical shock from an instrument. What is the first thing the phlebotomist should do? Assess the site, cleanse the site, insert the needle - Answer: Which of the following venipuncture steps are in the appropriate order? Insert the needle, place the tourniquet, label the tube Assess the site, cleanse the site, insert the needle Identify the patient, cleans the site, assess the site the site is cleaned more stringently - Answer: performing a venipuncture for blood cultures differs from other venipuncture procedures in that... Iatrogenic anemia - Answer: A phlebotomist collects multiple specimens on a premature infant. What is a possible result (complication) of the procedure?

Accession number - Answer: Which of the following identifies a specimen as long as it remains in the laboratory? ICD-10 code accession number CPT code medical record number Presurgical - Answer: When a phlebotomist is distributing lab results to ordering physicians, which results have priority? lead basal metabolic panel presurgical ferritin Speak with the patient's guardian before performing the blood draw to ensure the explanation is understood. - Answer: A phlebotomist has a requisition to draw blood on a patient who has severe Down syndrome. Which of the following steps should he take? Explain the procedure to the patient in simple terms, then proceed with the venipuncture. Speak with the patient's guardian before performing the blood draw to ensure the explanation is understood. Draw the patient's blood without trying to explain the procedure. Check with the nurse (you need to know the actual time the patient took the medication) - Answer: A physician ordered a Tobramycin level to be drawn one hour after dose. The

tobramycin has been ordered for 1100. Which of the following actions should the phlebotomist take? Confirm the correct identify of the patient - Answer: Which of the following procedural steps for a finger stick should the phlebotomist do first? Cleanse the site with an antiseptic wipe Position the blade of the lancet across the line of the fingertip Confirm the correct identify of the patient Apply ice to the site - Answer: A phlebotomist is drawing blood and observes red spots. What is the appropriate action? Discontinue the draw - Answer: You are performing a blood draw and the patient begins to have a seizure. What is the appropriate action? "Hi, I am Sally Smith. I am a student phlebotomist and I am here to collect a blood specimen." (name, that you're a student, and that you are here to do a blood draw) - Answer: Which of the following statement is an appropriate introduction for a student phlebotomist? Lavender and red - Answer: WBC, RBC, glucose and electrolyte tests are ordered for a patient. The phlebotomist is unable to find an accessible vein and has determined that it is acceptable to perform a skin puncture. What color tubes should be drawn? Cleanse the site in an outward spiral - Answer: Which is the proper cleansing procedure for routine venipuncture?

Cleanse the site in an outward spiral Cleanse the site in an overlapping circle Cleanse the site in an inward spiral Place the specimen tube in an ice water slurry - Answer: Which of the following is the proper procedure after collecting an ammonia specimen? Protect the specimen tube from light Keep the specimen tube warm Keep the specimen at body temp Place the specimen in an ice water slurry Position the needle in the same direction as the vein and at a 30 degree angle with the bevel up

• Answer: When performing an evacuated tube system (ETS) venipuncture, a phlebotomist should? Position the needle in the same direction as the vein and at a 30-degree angle with bevel up Position the needle near the vein and at a 15-degree angle bevel up Position the needle near the vein and at a 15-degree angle with bevel down Attempt to draw from the antecubital region - Answer: A diabetic patient states she prefers to be drawn on the inside of her wrist. Which of the following actions should the phlebotomist take? Drawn from the inside of the patient's wrist Attempt to draw from the antecubital region Warm the ventral side of the hand to enhance vein location prior to draw

Place a 1-mm drop of blood a half-inch from the edge of the slide - Answer: Which of the following actions is appropriate for preparing a peripheral blood smear? Place a drop of blood the size of a dime on the center of the slide Place a 1-mm drop of blood a half-inch from the edge of the slide Place a 1-mm drop of blood on the center of the slide Requires time for antiseptic action - Answer: When alcohol is used to cleanse the venipuncture site, it must be allowed to air dry prior to the venipuncture because alcohol....? Requires time for antiseptic action destroys WBCs Compromises the additives in the tubes Winged infusion set (butterfly) and adapter - Answer: A phlebotomist is preparing to perform a hand draw. which of the following should he assemble? Winged infusion set (butterfly) and adapter Syringe and vacutainer ETS needle and transfer device

Sodium citrate - Answer: You should use which of the following anticoagulants to collect a PT/PTT test? Ethylenediaminetetraacetic acid (ETA) Sodium citrate Potassium oxalate Heparin Potassium - Answer: Which of the following test results are affected when providone iodine is used to cleanse the site for a dermal puncture? glucose blood urea nitrogen (BUN) potassium coagulant studies Labeling specimens at the time of collection in front of the patient - Answer: what is the appropriate action when labeling specimens? A syringe draw transferred into a light blue vacutainer - Answer: A patient states that she is a difficult draw and requests a skin puncture. The test ordered is a PTT. Which should a phlebotomist perform? A capillary draw into a light blue microtainer A capillary draw into a lavender microtainer A syringe draw transferred into a lavender vacutainer A syringe draw transferred into a light blue vacutainer

An aerobic and anaerobic bottle - Answer: Blood cultures have been ordered on a patient in the ICU. Which containers should the phlebotomist bring for the blood draw? Syncope - Answer: During a routine blood draw the patient becomes pale and diaphoretic. What condition is most likely about to occur? "I will collect the specimen in a sterile container and return within 1 hour" - Answer: A phlebotomist is educating a patient about the proper at home collection procedure for a semen specimen. Which of the following statements indicates the patient understands the teaching? "I will collect the specimen in a sterile container and refrigerate" "I will collect the specimen in a sterile container and return within 1 hour" "I will abstain from ejaculation for three days prior to the test" 240-330 ml (easier to remember 3.3) - Answer: Which of the following is the total blood volume of a 3.3 kg infant? 350-390 ml 125-230 ml 240-330 ml 405-450 ml Shaking the tube vigorously - Answer: Which of the following can cause a hemolyzed specimen? Inverting the specimen four times partially filling the collection tube shaking the tube vigorously

allowing the specimen to clot N-95 respirator - Answer: What provides the phlebotomist the best protection when drawing blood from a patient with active TB? The specimen was insufficient ("quantity insufficient") - Answer: A blood specimen was rejected by the lab with the abbreviation of "QNS". What does this mean? Insert until a change in resistance - Answer: when performing a venipuncture on a patient of average weight, which of the following is a correct technique for needle insertion? Insert half an inch Insert 1.5" Insert until a change in resistance Insert until it meets resistance Cells must be separated from the serum - Answer: A phlebotomist must centrifuge a serum specimen before shipment to an outside lab because...? Cells will hemolyze cells must be separated from the serum platelets must be separated from the serum WBC will be elevated Insert a new tube to see if it will fill - Answer: While forming a venipuncture, the first tube fills, but the second tube slows and does not fill completely. The phlebotomist needs to draw 2 additional tubes. Which of the following steps should the phlebotomist take? Tell the patient she will need to perform another venipuncture

Write "QNS" on teh requisition for the other tests Submit the existing tubes for all the ordered tests Insert a new tube to see if it will fill Implied consent - Answer: A 69-year-old unconscious patient is brought to the ER. Several blood tests are ordered. The phlebotomist collects blood under....? Informed consent active consent implied consent explicit consent place in a box with cold packs and a biohazard label - Answer: According to standard precautions, what is the procedure for shipping specimens to a reference laboratory in hot weather? Place in a box with bubble wrap and a biohazard label place in a box with cold packs and a biohazard label placed in a padded envelope with cold packs and a biohazard label Autologous donation - Answer: Whic of the following is the term for a donation of a patient's own blood for an upcoming surgery? Autonomic donation presurgical donation autologous donation homologous donation

Therapeutic phlebotomy - Answer: intentional removal of a large amount of blood to lower the red blood cell concentration, or to lower iron levels. polycythemia vera - Answer: is a slow-growing blood cancer in which your bone marrow makes too many red blood cells. These excess cells thicken your blood, slowing its flow. They also cause complications, such as blood clots, which can lead to a heart attack or stroke. hemochromatosis - Answer: high iron levels in the blood

1. Wash hands and put on gloves
2. Properly identify the patient with two patient identifiers
3. Perform the venipuncture (often a plain red top tube and an EDTA tube) although sometimes pink top tubes are used.
4. confirm additive on label before use
5. Label the specimens with the specific blood bank labels in the presence of the patient.
6. Deliver the specimens as soon as possible.
7. Gravity helps fill the blood bags. Make sure bags are hung lower than the patient's arm during collection.
8. If a bag only fills partially, then the blood collection may have to start again. Do NOT combine 2 bags.
9. Monitor the patient for any complications during and after the procedure. - Answer: Steps in blood donation collection Iatrogenic anemia - Answer: anemia caused by excessive blood draws. Older patients, pediatric patients, and patients who are underweight. - Answer: Who is at greatest risk for iatrogenic anemia?

No more than 10% of blood volume - Answer: How much blood can be drawn on an infant? No more than 100 mL - Answer: What is the limit for a blood draw on an adult patient? 6.2 lb. x 2.2 = 2.82 kg. - Answer: Convert 6.2 lb. to kg 2.82 x 100 = 282 mL - Answer: Convert 2.82 kg to mL 282 mL /1,000 = 0.28 mL - Answer: Convert blood volume in mL to Liters Shortness of breath, fatigue, and need for blood transfusions. - Answer: What are symptoms/complications of iatrogenic anemia? c) mask - Answer: A patient has pneumonia, before a blood draw, besides gloves, what other PPD should a phlebotomist use? a) Gown b) N95 respirator c) Face mask d) goggles Dispose of the tube in a sharps container - Answer: while collecting a blood specimen, you notice the tube is cracked. What should you do? Ask for the patient's permission to disclose the results with the parent. - Answer: you are performing a glucometer reading for a young adult patient. The patient's parent is in the room and asks about the patient's glucose level. what action should you take?

"May I please perform the draw?" - Answer: You are preparing to perform the third set of blood draws for a glucose tolerance test (GTT). The patient starts to cry and refuses to extend` her arm for the draw. What statement should you make? a) too much blood was used - Answer: A phlebotomy technician observes a glucometer reading of 250 mg/dL. A second test is performed and returns a reading within the expected reference range. Which of the following circumstances could have caused the first result to be inaccurate? a) Too much blood was used b) The first drop of blood was used c) Too little blood was used d) The test strips were left open. a) chlorine bleach - Answer: Which of the following solutions should a phlebotomy technician use to clean a cerebral spinal specimen spill? a) Chlorine bleach b) Hydrogen Peroxide c) Povidone-iodine d) Isopropyl alcohol c) The dept. where the injury occured - Answer: A phlebotomy technician experiences a needle stick injury while performing a venipuncture. Which of the following information should the technician include in the online sharps injury log? a) The tech's name b) The recommended f/up treatment c) The department where the injury occurred d) The patient's name

B) Cleanse the site outward to a diameter of approx. 2.54 cm (1 inch). - Answer: Which of the following actions should a phlebotomy technician take when performing a blood culture collection? a) Scrub the site with isopropyl alcohol for 1 min in outward, concentric circles. b) Cleanse the site outward to a diameter of approx 2.54 cm (1 inch). c) Palpate the vein after cleansing the site d) Remove the tourniquet after 2 mins. a) 30 compressions, 3.8 cm (1.5" deep) - Answer: Which of the following is the current procedure for medical professionals performing CPR on an infant? a) 30 compressions, 3.8 cm (1.5" deep) b) 30 compresions, 5.08 cm (2" deep) c) 100 compressions 5.08 cm (2" deep) d) 100 compressions 3.8 cm (1.5" deep) Identifying the patient - Answer: What is the most important step in any phlebotomy procedure? Vectors - Answer: Which would not be considered a pathogen? a) Bacteria b) Viruses c) Fungi d) Vectors Chickenpox (Varicella) - Answer: varicella-zoster is the cause of:

Insects - Answer: Vectors include: Gown - Answer: What is the first article of PPE you put on? source, means of transmission, and susceptible host - Answer: Name the 3 parts of the chain of infection Ventral - Answer: belly side (underside) Posterior - Answer: toward the back Lateral - Answer: away from the midline; side Medial - Answer: toward the midline; middle Prone - Answer: lying face down Supine - Answer: lying on the back; face up Extension - Answer: Straightening of a joint Inferior - Answer: Away from the head; farther down the body Homeostasis - Answer: The term to define the overall well-being of the body: the flow is more rapid like arterial blood - Answer: Capillary blood is more similar to arterial blood because:

Aneurysm - Answer: A bulge in a vessel, usually an artery caused by weakening of the wall or hypertension; without surgical correction these may burst. Arteriosclerosis - Answer: Accumulation of fatty deposits on the tunica intima of arteries, causing thickening and toughening of the arterial wall; loss of elasticity increases strain on the artery and may lead to myocardial infarction or stroke. Stroke - Answer: A loss of blood flow to the brain as a result of either hemorrhage or more commonly blocked circulation. Hemorrhoids - Answer: Swollen veins in the rectum. Varicose veins - Answer: veins that are tortuous and dilated because of swelling and loss of function of valves often caused by prolonged sitting or standing. 5 to 6 liters of blood - Answer: How many liters of blood does the average adult have? 55% - Answer: What percentage of blood does plasma account for? anticoagulant - Answer: A chemical that keeps blood from clotting is: Eosinophils - Answer: A white blood cell that would be elevated during seasonal allergies: Serum - Answer: plasma without its clotting factors is known as: Leukocyte - Answer: Another term for a white blood cell

1. Vascular phase
2. Platelet phase

3. Coagulation phase
4. Fibrinolysis - Answer: What are the 4 stages of hemostasis? 4) Hemostasis - Answer: The processes by which blood vessels are repaired after injury: Capillaries - Answer: In the circulatory system, gas exchange occurs in the ___________ Three - Answer: Veins and arteries are comprised of how many layers? 9-12 days - Answer: platelet life span Hemoconcentration - Answer: An increase in the ratio of formed elements to plasma caused by leaving the tourniquet on too long or too tight. this can alter some test results. Hemolysis - Answer: Can occur if the tourniquet is too tight or left on too long. petecheia - Answer: Small red spots on the skin caused by a tourniquet that is too tight. Basilic - Answer: Which vein lies close to the brachial artery?

1. Blood cultures
2. Coagulation studies - Answer: What are two tests that cannot be performed using capillary blood? 3.0 mm (average); no more than 2.0 for babies - Answer: Heel puncture depth of a lancet 2.4 mm - Answer: Heel puncture width maximum should not exceed