Phlebotomy Techniques and Procedures, Exams of Clinical chemistry

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NHA Phlebotomy final Exam Prep

Questions and Answers

Order of Draw - \1. Yellow (SPS)

2. Light Blue (sodium citrate)
3. Red, Red/Grey, Gold (none and SST)
4. Green (heparin)
5. Lavender (EDTA)
6. Grey (sodium fluoride, potassium oxalate, lithium iodoacetate) Tube colour departments & inversions - \1. yellow- microbiology (8-10x)
7. light blue- coagulation (3-4x)
8. red, red/grey, gold- chemistry (none, 5x)
9. green- chemistry (8-10x)
10. lavender- haematology (8-10x)
11. grey-chemistry (8-10x) A phlebotomy tech is working with a pt who has TB. Which of the following transmission precautions should the tech use? - \airborne precautions For which of the following conditions does emergency first aid treatment include maintaining an open airway, controlling bleeding, and keeping the pt warm until help arrives? - \shock A phlebotomy tech should identify that HIPAA protects which of the following rights as part of the Patient Care Partnership? - \patient information A phlebotomy tech is collecting capillary blood drops on a filter paper card to screen a newborn for PKU. Which of the following actions should the tech take? - \apply blood to the printed side of the filter paper paediatric needle gauge - \23g (over 1 year) lancet (under 12 months)

Which tube is needed for a sickle cell screening? - \lavender A phlebotomy tech is required to obtain which of the following from a potential blood donor? - \complete medical history A phlebotomy tech has a requisition for collecting a fasting blood glucose and albumin specimens from a patient. Which of the following actions should the tech take before collecting blood? - \make sure the patient has fasted for the past 8-12 hours A phlebotomy tech is performing a heel stick to obtain capillary blood for testing a newborn's bilirubin. Which of the following should actions the tech take? - \use an amber coloured microcontainer paediatric heel puncture area - \medial and lateral portions of the plantar surface Which of the following is a potential consequence of mislabeling a blood bank specimen? - \a transfusion reaction A phlebotomy tech is preparing to use an ETS to obtain a venous blood specimen from a patient. The tourniquet is in place and the site has been cleansed. Which of the following procedural steps should the tech perform next? - \uncap and inspect the needle A phlebotomy tech is performing a brief physical examination on prospective blood donors. Which of the following measurements would indicate the donor's eligibility to donate blood? - \hematocrit level 42% Which of the following actions by a phlebotomy tech can result in a grossly hemolyzed specimen? - \using an incorrect needle gauge A tech should identify which of the following is one of the Joint Commission's National Patient Safety Goals? - \identify patients correctly A provider orders a stat specimen, but a phlebotomy tech forgets to fill out the patient ID number on the collection tube. Which of the following should the tech expect from the lab? -

\reject the specimen For which of the following reasons should a phlebotomy tech avoid drawing blood from the leg or foot of a patient who has diabetes? - \these are more susceptible to infection Which of the following regulations ensures that phlebotomy tech is proficient to perform job duties and responsibilities? - \CLIA Which of the following actions should a phlebotomy tech take when performing a venipuncture using an ETS? - \position the needle at a 30 degree angle in the same direction as the vein and with the bevel up A phlebotomy tech is instructing a patent to collect a clean-catch urine specimen. Which of the following cleansers should the tech instruct the patient to use when cleansing her urinary meatus? - \mild antiseptic soap A phlebotomy tech should identify which of the following phrases is represented by the abbreviation "SD"? - \standard deviation For which of the following reasons should a phlebotomy tech document the total volume of blood drawn from a patient? - \to determine if the patient is at risk for developing iatrogenic anaemia A phlebotomy tech should invert anticoagulant tubes to prevent which of the following complications? - \hemolysis A phlebotomy tech is collecting a unit of blood from a donor. Which of the following actions should the tech take? - \have the donor open and close her fist throughout the collection Within which of the following time periods should a phlebotomy tech collect a newborn blood-spot test screening card? - \within 72 hours A phlebotomy tech is collecting a blood specimen from an adolescent patient who weighs 42.6kg (94lb). Which of the following amounts is appropriate to collect if the maximum allowable volume of blood is 1%? - \40 mL

A phlebotomy tech is performing venipuncture for a patient who suddenly reports feeling faint. After removing the tourniquet and needle, which of the following actions should the tech take? - \have the patient put her head between her legs A phlebotomy tech should identify which of the following additives is used to break down glucose? - \sodium fluoride For an older adult patient who has difficult to access veins, a tech should select which of the following veins for venipuncture? - \dorsal veins A phlebotomy tech is collecting a urine specimen from a patient for a pre-employment drug screen. Which of the following findings should indicate to the tech that tampering possibly occurred? - \the temperature of the specimen is 30 degrees celsius (86 degrees F) A phlebotomy tech is explaining the venipuncture procedure to an adult patient. The patient nods frequently but appears confused. Which of the following actions should the tech take? - \rephrase the information for the patient A patient asks the phlebotomist to use her finger for the blood work. The phlebotomist can do this if - \the ordered tests can be performed on a capillary specimen Which of the following venipuncture steps is in the correct order? - \assess the site, cleanse the site, insert the needle According to the CLSI order of draw guidelines, which of the following samples should be drawn first? - \blood cultures A phlebotomy tech is preparing to draw a blood specimen from a patient who has a C Diff infection. Which of the following precautions should the tech take? - \contact precautions Industry standards state that needle insertion in the antecubital area should be at a?

\15 to 30 degree angle

If a phlebotomist notices a hematoma forming during blood draw, what should they do? - \release the tourniquet and stop the draw A phlebotomy tech should ensure that which of the following specimens is protected from light? - \bilirubin A phlebotomy tech is performing a heel stick to obtain capillary blood from a newborn for bilirubin testing. Which of the following actions should the tech take? - \use an amber-coloured micro-container A blood specimen was rejected by the lab with the abbreviation QNS. Why was the specimen rejected? - \the specimen was insufficient Routine phlebotomy collection needle gauge - \20g, 21g, 22g *21g most common Blood donor collection needle gauge - \16g, 18g A phlebotomy tech is collecting a venipuncture blood specimen from a patient for a blood assay. The tech should fill which of the following tubes first? - \yellow top (to decrease the probability of bacterial contamination) What is the term for a patient donating their own blood for an upcoming surgery? - \autologous donation After performing a heel puncture for a newborn screening, what is the correct procedure for collecting the blood? - \saturate each circle During venipuncture, the patient becomes pale and diaphoretic. What condition is most likely occurring? - \syncope Which tube must be prepped with chlorhexidine? - \yellow tube w/ SPS Maximum depth for infant heel puncture? - \2.0 mm

Which of the following is true about microcapillary collection - \the first drop of blood must be wiped away Which of the following precautions should be used for a patient with pulmonary TB? - \airborne and standard The physician orders the following blood work to evaluate a patient for sepsis: CBC, Blood culture, and BMP. When using the evacuated tube method for venipuncture, in which of the following orders should the tubes be drawn? - \blood culture, red top, lavender top Which of the following is a CLIA waived test that can be performed by the phlebotomist - \chemical urinalysis A phlebotomist must invert anticoagulant tubes to prevent which of the following? - \clotting A phlebotomy tech is exposed to blood via a needle stick injury. Within how many hours should the tech initiate post exposure prophylaxis (PEP)? - \24 hours All blood specimens transported by a courier must be - \protected from direct sun exposure Which of the following is used by the lab to identify a specimen throughout the testing process? - \accession number When performing a OGTT, the timing should begin - \as soon as the patient finishes the drink Which of the following tubes should a phlebotomy tech collect first when obtaining a dermal (capillary) sample? - \lavender A phlebotomy tech is preparing to draw a peak level for a medication that was administered orally to a patient. After verifying when the patient received the medication, how long should the tech wait prior to attempting the draw? - \2 hours after administration Which of the following is the phlebotomy tech required to do before leaving the patient's room? -

\initial and mark the date and time on each tube drawn How frequently should the phlebotomy tech perform a quality control test on a glucometer in the lab? - \every day the metre is used A phlebotomy tech is preparing to dispose of contaminated sharps. According to OSHA, which of the following actions should the tech take? - \Empty the sharps container when it is two-thirds full When reviewing a requisition before obtaining a blood specimen, the tech should verify that the requisition includes which of the following? - \a specimen identification code A phlebotomy tech is selecting a site to collect a blood specimen from a patient. After applying the tourniquet, the tech sees no apparent vein to use. Which of the following actions should the tech take? - \Have the patient dangle their arm for 1-2 minutes A phlebotomy tech is collecting a urine specimen for a routine pre-employment drug test. Which of the following actions should the tech take? - \verify the specimen contains at least 45 mL of urine Which of the following pieces of PPE should the tech remove first after being in an isolation room? - \gloves A phlebotomy tech notices a sore at the site where the tourniquet is to be placed. Which of the following actions should the tech take? - \tie the tourniquet over the patient's sleeve A phlebotomy tech is collecting blood from a patient for donation. The collection bag only fills halfway and the vein collapses. What should the tech do? - \use a new collection bag to draw a new unit of blood A phlebotomy tech is preparing to collect a blood specimen from a patient who signed a general informed consent form upon admission. Which of the following actions by the patient indicates implied consent? - \rolling up her shirt sleeve A phlebotomy tech is using a POCT system to determine a patient's WBC count. Which of the following results should the tech immediately notify the provider? - \1.8/mm (range is 4.4 to 11/mm)

A phlebotomy tech is preparing to store a blood specimen. At which of the following temperatures should the tech store the specimen? - \2 to 8 degrees C (35.6-46.4 degrees F) When should a phlebotomy technician perform external liquid controls for quality control on a CLIA-waived glucose point-of-care test? - \when a new lot number or kit is opened A phlebotomy tech should identify which of the following is an identifier to a specimen as long as it remains in the lab? - \accession number A phlebotomy tech is preparing to collect a vancomycin peak level for a patient in an inpatient setting. Which of the following actions should the tech take? - \Ask the attending nurse if the patient's vancomycin dose schedule is accurate Last piece of PPE to remove after leaving a patient's room - \mask Why should a phlebotomy tech centrifuge a serum specimen before transport to an outside lab? - \cells must be separated from the serum A phlebotomy tech has a requisition for a series of tests on a patient's serum. The tech should select a collection tube that has which of the following additives? - \thrombin A phlebotomy tech is preparing to perform a lactic acid test. Which of the following actions should the tech take? - \collect the specimen in a grey top tube Which tube do you use to draw for a thyroid studies test? - \speckled (red/grey) (thyroid stimulating hormone:chemistry dept) Which colour tube for a collection of sodium? - \green (heparin aids in determining sodium levels) A phlebotomy tech is reviewing a lab test requisition form before obtaining a blood specimen. Which of the following actions should the tech take prior to drawing blood? - \check the requisition form for duplicate test orders A provider has an order for a urine culture and sensitivity test. Which of the following types of urine collection should the tech take? -

\clean-catch midstream Which of the following specimens should be protected from bright light by placing it in an amber/brown biohazard bag for transport? - \vitamin B Which of the following test results is affected when a tech uses povidone-iodine to cleanse the site? - \potassium A phlebotomy tech receives a chemical splash to his forearm. Which is the minimum amount of time the tech should rinse the affected area? - \15 min Chromosome analysis needs a collection tube with which additive? - \heparin (green) Cholesterol POCT test result that requires immediate notification of the provider? - \300 mg/dL When transporting blood specimens to a lab, which action should the tech take? - \place the specimens in a lockable container When collecting blood from a patient with cutaneous diphtheria, which PPE do you need aside from gloves? - \gown- cutaneous diphtheria is spread through contact A phlebotomy tech is following the CLSI's clinical lab workflow pathway. As part of the post-examination phase, the tech should? - \enter critical laboratory data A phlebotomy tech is collecting a specimen to measure the trough level of a medication. The tech should collect at which of the following times? - \Within 15 minutes before the pt receives the next dose of medication According to OSHA, which of the following vaccines should a company offer to its phlebotomist at no cost? - \Hep B Why does alcohol need time to dry before a venipuncture is performed? - \it needs time to dry for antiseptic action to take effect According to standard precautions, what actions should be taken when shipping specimens to a lab in hot weather? -

\place in a box with cold packs and biohazard label Which fasting blood glucose level should be reported immediately to the provider? - \130 mg/dL (normal is 70-110) To prevent hospital-acquired infections, a phlebotomy technician should clean items that have been contaminated by blood with a 1:10 dilution of which of the following substances and water? - \sodium hypochlorite aka chlorine bleach Which of the following is the best method for collecting a specimen on an older adult with fragile, easy to collapse veins? - \a syringe and butterfly assembly and transfer to ETS tube A phlebotomy tech is performing two sets of blood cultures for a patient. Which of the following actions should the tech take? - \collect one set from the patient's left arm and one set from a different site of the same arm When using the syringe method to collect a blood culture specimen, which of the actions should the tech take? - \withdraw the blood into a sterile safety syringe When drawing blood cultures, which bottle do you fill first? - \anaerobic When drawing blood on a R side mastectomy patient who also has a L arm IV, which location should be used? - \left arm, below the IV What antiseptic do you use when a patient has an alcohol allergy? - \chlorhexidine What antiseptic do you use when a patient has a seafood/shellfish allergy? - \chlorhexidine Prior to transport, which of the following specimens should a phlebotomy technician place in an ice bath within 30 min after collection? - \arterial blood gas Semen should be transported at what temperature? - \36-38 degrees celsius (37 degrees celsius or 98.6F)

A phlebotomy tech is collecting a blood culture from an infant who weighs 3kg (6. lbs). The tech should identify which of the following is the total blood volume for this infant? - \240-330 mL How much blood can you collect from a newborn who weighs 6.6lbs, - \3 mL Order of draw for capillary collections is different from venipuncture for which of the following reasons? - \an increased rate of coagulation To avoid hemolysis, which of the following precautions should the phlebotomist take?

\ensure the alcohol at the insertion site has dried Which of the following troponin T levels should be immediately reported to the provider? - \0.3 ng/mL A phlebotomy tech is instructing a patient about how to collect a faecal occult at home, which of the following instructions should the tech include? - \avoid taking IBuprofen When is use of capillary collection instead of venipuncture acceptable? - \when a patient's veins are inaccessible During venipuncture, a red top tube fills completely, but the light blue top tube slows and does not fill completely. Which action should the tech take? - \insert a new light blue tube to see if it will fill Which of the following colours indicates a health hazard in the national fire protection association marking system? - \blue When performing a blood transfusion on a patient with type O blood, which of the following blood types can they receive? - \type O Blood types - \determined by whichever antigen is present A, B, or O which has neither Rh factor -

\blood is either positive or negative depending on the presence or absence of the D antigen

• contains D antigen

• does not contain D antigen Airborne precautions are for which diseases? - \measles, TB, varicella (chickenpox), zoster (shingles), SARS Droplet precautions are for which diseases? - \Strep, pneumonia, scarlet fever, influenza, mumps, rubella, meningococcal infections, meningitis Contact precautions are for which diseases? - \C-Diff, adenovirus, infectious diarrhoea, MRSA, VRE, lice, scabies, RSV A phlebotomy tech obtains 2 readings of 17 mg/dL when performing a glucometer test. Which of the following actions should the tech take? - \Perform set of liquid controls Which of the following actions should the phlebotomy tech take when preparing a peripheral blood smear? - \Place a 1 mm drop of blood one-half inch from the edge of the slide A patient states he is a difficult draw and requests a skin puncture. The test ordered is a PTT. Which of the following should a phlebotomy tech perform? - \a syringe draw transferred into a light blue vacuum tube A phlebotomy tech is instructing a patient about proper semen specimen collection for determination of fertility potential. Which of the following instructions should the tech include? - \protect the specimen from exposure to bright light When performing a hand draw, which of the following steps should a phlebotomy tech take before removing the needle? - \disengage the tube from the adapter A phlebotomy tech is preparing to perform a blood draw when a patient states that he is severely allergic to latex. Which of the following actions should the tech take? - \Use a BP cuff and inflate it to 40 mmHg A phlebotomy tech is processing a semen specimen. Which of the following actions should the tech take? - \deliver the specimen to the lab within 2 hours