Exam Study Flashcards
(234 cards)
1
Q
What is the most common complication associated with phlebotomy?
a) Hematoma
b) Infection
c) Hemorrhage
d) Thrombosis
A
a) Hematoma
2
Q
Which vein is most commonly used for venipuncture?
a) Basilic vein
b) Cephalic vein
c) Median cubital vein
d) Dorsal metacarpal vein
A
c) Median cubital vein
3
Q
What is the appropriate angle for needle insertion during venipuncture?
a) 15 - 30 degrees
b) 30 - 45 degrees
c) 45 - 60 degrees
d) 60 - 75 degrees
A
a) 15 - 30 degrees
4
Q
Which of the following tubes should be filled first when drawing multiple specimens?
a) Lavender top (EDTA)
b) Green top (Heparin)
c) Blue top (Sodium Citrate)
d) Red top (Serum)
A
c) Blue top (Sodium Citrate)
5
Q
What additive is in a lavender top tube?
a) Sodium citrate
b) EDTA
c) Heparin
d) Sodium fluoride
A
b) EDTA
6
Q
Which of the following is the correct order of draw for venipuncture?
a) light blue, red, green, lavender, gray
b) red, light blue, lavender, green, gray
c) light blue, red, lavender, green, gray
d) red, light blue, green, lavender, gray
A
a) light blue, red, green, lavender, gray
7
Q
What is the primary purpose of using an anticoagulant in blood collection tube?
a) to preserve the shape of cells
b) to prevent blood from clotting
c) to separate plasma from serum
d) to enhance clotting
A
b) to prevent blood from clotting
8
Q
Which of the following sites is typically used for a capillary puncture in adults?
a) heel
b) earlobe
c) finger
d) forearm
A
c) finger
9
Q
What is the proper procedure if a patient feels faint during a blood draw?
a) continue the draw but work quickly
b) stop the draw and lay the patient down
c) call for help and continue the draw
d) ignore the symptoms and complete the draw
A
b) stop the draw and lay the patient down
10
Q
Which blood component is responsible for clotting?
a) red blood cells
b) white blood cells
c) platelets
d) plasma
A
c) platelets
11
Q
What is the first step in the blood collection process?
a) insert the needle
b) select and prepare the puncture site
c) apply the tourniquet
d) identify the patient
A
d) identify the patient
12
Q
What should be done immediately after removing the needle from the patient’s vein?
a) apply a bandage
b) label the specimen tube
c) apply pressure to the puncture site
d) dispose of the needle
A
c) apply pressure to the puncture site
13
Q
How long should a tourniquet be left on a patient’s arm during venipuncture?
a) no more than 1 minute
b) no more than 2 minutes
c) no more than 3 minutes
d) no more than 4 minutes
A
a) no more than 1 minute
14
Q
Which of the following is a common cause of hemolysis in a blood sample?
a) slow collection of the blood
b) vigorous mixing of the blood
c) properly filling the collection tube
d) using a small gauge needle
A
b) vigorously mixing of the blood
15
Q
Which organization is responsible for regulating laboratory testing and phlebotomy standards?
a) OSHA
b) CLIA
c) CDC
d) FDA
A
b) CLIA
16
Q
What is the minimum time required for a site dry after applying an antiseptic before performing a venipuncture?
a) 5 seconds
b) 10 seconds
c) 15 seconds
d) 30 seconds
A
d) 30 seconds
17
Q
What is the purpose of using a butterfly needle for venipuncture?
a) to collect larger volumes of blood
b) to improve patient comfort during collection
c) to reduce the risk of hemolysis
d) to ensure proper clot formation
A
b) to improve patient comfort during collection
18
Q
Which of the following is considered a pre-analytical error in phlebotomy?
a) mislabeling a specimen
b) incorrect needle gauge
c) using expired tubes
d) both a and c
A
a) mislabeling a specimen
19
Q
Which of the following personal protective equipment (PPE) should be worn during venipuncture?
a) gloves
b) mask
c) goggles
d) all of the above
A
a) gloves
20
Q
What should be done if blood stops flowing into the tube during a draw?
a) remove the needle and start over
b) slightly reposition the needle
c) increase the vacuum in the tube
d) apply more pressure to the site
A
b) slightly reposition the needle
21
Q
What is the correct procedure for collecting a blood culture?
a) clean the site with alcohol only
b) use a single antiseptic swab
c) clean the site with alcohol and then iodine
d) use a sterile water rinse
A
a) clean the site with alcohol and then iodine
22
Q
What is a key characteristic of a basal state?
a) patient has been fasting for at least 12 hours
b) patient has recently exercised
c) patient is dehydrated
d) patient is experiencing acute stress
A
a) patient has been fasting for at least 12 hours
23
Q
Which vein is the least likely to be used for venipuncture due to its location near major arteries?
a) median cubital vein
b) cephalic vein
c) basilic vein
d) dorsal metacarpal vein
A
c) basilic vein
24
Q
Which of the following factors can cause a vein to collapse during venipuncture?
a) using a large gauge needle
b) applying too much suction with the syringe
c) inserting the needle at a steep angle
d) all of the above
A
b) applying too much suction with the syringe
25
What is the main purpose of inverting tubes after collection?
a) to mix the blood with additives
b) to prevent clotting
c) to ensure proper labeling
d) to measure blood volume
a) to mix the blood with additives
26
How should a phlebotomist handle a needle-stick injury?
a) dispose of the needle and continue working
b) wash the site with soap and water and report the incident
c) ignore the injury if it doesn’t bleed
d) apply a bandage and continue working
b) wash he site with soap and water and report the incident
27
Which of the following blood tests requires fasting?
a) complete blood count (CBC)
b) blood glucose
c) electrolyte panel
d) blood urea nitrogen (BUN)
b) blood glucose
28
What is the function of the tourniquet in venipuncture?
a) to stop blood flow
b) to increase blood flow to he area
c) to make veins more visible
d) both b and c
c) to make veins more visible
29
Which of the following tubes contains sodium fluoride?
a) lavender top
b) gray top
c) green top
d) blue top
b) gray top
30
What is the maximum acceptable depth for a heel stick in infants?
a) 1.0 mm
b) 1.5 mm
c) 2.0 mm
d) 2.5 mm
c) 2.0 mm
31
What is the most appropriate action if a phlebotomist cannot locate a vein?
a) apply a warm compress to the area
b) use a smaller gauge needle
c) switch to a butterfly needle
d) attempt the draw in the same spot
a) apply a warm compress to the area
32
What is the role of a centrifuge in a clinical laboratory?
a) to separate blood components
b) to measure blood pressure
c) to mix blood samples
d) to store blood samples
a) to separate blood components
33
Which of the following is NOT a part of the venipuncture process?
a) applying a tourniquet
b) inserting the needle
c) labeling the tube
d) measuring blood pressure
d) measuring blood pressure
34
What is the most common gauge size used for routine adult venipuncture?
a) 16 gauge
b) 18 gauge
c) 21 gauge
d) 25 gauge
c) 21 gauge
35
Which of the following steps is essential before performing venipuncture on a patient with a latex allergy?
a) use latex gloves
b) use a tourniquet made of latex
c) use non-latex equipment
d) avoid using a tourniquet
c) use non-latex equipment
36
What is the purpose of a requisition form in phlebotomy?
a) to identify the patient
b) to list the tests ordered
c) to provide patient history
d) all of the above
b) to list the tests ordered
37
What is the recommended antiseptic for routine venipuncture?
a) iodine
b) alcohol
c) chlorhexidine
d) hydrogen peroxide
b) alcohol
38
Which of the following is NOT a function of the plasma in blood?
a) transporting nutrients
b) carrying oxygen
c) removing waste products
d) regulating body temperature
b) carrying oxygen
39
What should be done if a patient has a seizure during venipuncture?
Remove the needle and protect the patient from injury
40
What is the term for blood collected and returned to the patient during surgery?
Autologous donation
41
Which component of blood contains hemoglobin?
Red blood cells
42
What is the primary function of white blood cells?
To fight infections
43
What is a hematoma?
A localized collection of blood outside the blood vessels
44
What is the proper way to dispose of a used needle?
Place it in a sharps container
45
What does the acronym PPE stand for?
Personal Protective Equipment
46
What is the purpose of a blood culture test?
To detect infections in the blood
47
What is the function of platelets in the blood?
To help with clotting
48
Which organization sets guidelines for the prevention of healthcare-associated infections?
CDC
49
What should be done if a patient refuses a blood draw?
Respect the patient’s decision and notify the supervisor
50
What is the recommended site for venipuncture in pediatric patients?
Dorsal hand veins
51
Which of the following is the best indication that a patient might be at risk of syncope?
a) involuntary movement
b) lightheadedness and shallow breath
c) small red spots appearing on skin
d) paleness and sweating
d) paleness and sweating
52
Why is it important for a phlebotomist to invert anticoagulant tubes?
a) to prevent a pH imbalance
b) to prevent hemolysis
c) to ensure proper mixing of blood and additive
d) to prevent hemoconcentration
c) to ensure proper mixing of blood and additive
53
Which of the following protects a patient’s information?
a) OSHA
b) HIPAA
c) The Joint Commission
d) AAHSA
b) HIPAA
54
Which of the following needle sizes is NOT used for laboratory assays but for collection of donor units of blood?
a) 18-gauge
b) 23-gauge
c) 21-gauge
d) 22-gauge
a) 18-gauge
55
How many minutes within collection of a urine sample should the phlebotomist take the temperature of the specimen?
a) within 10 minutes
b) within 45 minutes
c) within 30 minutes
d) within 4 minutes
d) within 4 minutes
56
Quality control checklists ensures machines are inspected for compliance at time intervals specific to the equipment and ____________.
a) clinical application
b) chemical measurement
c) expiration date
d) stock rotation
a) clinical application
57
Which of the following actions will most likely prevent a needle stick injury?
a) having a nurse or other healthcare team member dispose of used needles for the phlebotomist
b) replacing sharps containers when they have reached their fill line
c) recapping every needle prior to discarding it in the sharps container
d) wearing rubber gloves during venipuncture
b) replacing sharps containers when they have reached their fill line
58
Which of the following pieces of information need to be on a laboratory requisition from before a phlebotomist should proceed with obtaining a blood specimen?
a) the patient’s status as an organ donor
b) a specimen identification code
c) a laboratory’s CLIA number
d) the patient’s emergency contact
b) a specimen identification code
59
A patient is listening to a phlebotomist explain the venipuncture process before initiating the blood draw. The patient communicates their understanding but seems hesitant and confused. How should the phlebotomist handle the situation?
a) the phlebotomist should surmise that the patient has heard enough information and get ready to draw the patient’s blood
b) the phlebotomist should leave the room and ask for another doctor or nurse to explain the procedure
c) the phlebotomist should repeat the same explanation in a slower voice
d) the phlebotomist should find another way to phrase the explanation and invite the patient to ask any clarifying questions.
d) the phlebotomist should find another way to phrase the explanation and invite the patient to ask any clarifying questions
60
The additive in a Pink Top Tube used in blood banking is which of the following?
a) sodium polyanethole sulfonate (SPS)
b) sodium heparin
c) potassium ethylenediamineteraacetic acid (EDTA)
d) acid citrate dextrose (ACD)
c) potassium ethylenediamineteraacetic acid (EDTA)
61
If a patient verbally or physically refuses a venipuncture procedure, the phlebotomist should do which of the following?
a) the phlebotomist should inform the patient that they will still be responsible to pay for the procedure
b) the phlebotomist should re-explain the procedure in case the patient did not understand
c) the phlebotomist should inform the patient that they will need to reschedule their appointment
d) the phlebotomist should immediately report the refusal and actions taken to their supervisor
d) the phlebotomist should immediately report the refusal and actions taken to their supervisor
62
What is the recommended allowance for a total volume of blood drawn from a patient within a 24-hour period?
a) .05% - 1%
b) 1% - 5%
c) 5% - 7%
d) 10%
b) 1% - 5%
63
Which of the following is the proper way a phlebotomist should dispose of a needle?
a) the phlebotomist should recap it with the original white lid with the opposite hand and put it in a sharps container
b) the phlebotomist should throw it, recapped, into a biohazard bag
c) the phlebotomist should put it into a sharps container, SAFETY CAPPED, after withdrawing it from the patient’s arm
d) the phlebotomist should collect them in a cup for disposal at the end of the day
c) the phlebotomist should put it into a sharps container, SAFETY CAPPED, after withdrawing it from the patient’s arm
64
When drawing blood from a patient who has a contagious pathogen, like COVID-19, which PPE provides the best protection for a phlebotomist?
a) surgical mask
b) gown
c) double gloves
d) respirator
a) surgical mask
65
How should vitamin B6 be transported in order to protect its photosensitive nature?
a) it should be transported on ice
b) it should be transported at room temperature, no additional precaution needed
c) it should be transported in an air-tight container, no additional precaution needed
d) it should be transported in an amber or brown-colored biohazard bag.
d) it should be transported in an amber or brown-colored biohazard bag.
66
Before asking permission to obtain a specimen from a patient, a phlebotomist should:
a) the phlebotomist should introduce themselves to the patient and any healthcare team members in the room
b) the phlebotomist should ask the patient to extend their arm
c) the phlebotomist should locate the sharps container
d) the phlebotomist should begin to explain the phlebotomy procedure
a) the phlebotomist should introduce themselves to the patient and any healthcare team members in the room
67
What is an ICD-10 Code?
a) ICD-10 codes classify diagnoses and diseases
b) ICD-10 codes identify specimens
c) ICD-10 codes dictate patient care and privacy
d) ICD-10 codes organize the medical record number
a) ICD-10 codes classify diagnoses and diseases
68
If a patient expresses that they often faint when getting their blood drawn, a phlebotomist should do which of the following?
a) the phlebotomist should tell a nurse to supervise the patient while the phlebotomist proceeds with the blood draw
b) the phlebotomist should ask the patient to keep them updated on how they are feeling, have smelling salts ready, then proceed with the blood draw
c) the phlebotomist should perform the blood draw while the patient lies down
d) the phlebotomist should reassure the patient that they are in a safe place and keep close watch while they perform the blood draw
c) the phlebotomist should perform the blood draw while the patient lies down
69
How many inversions of a Lavender Top Tube should be done before placing it in the specimen collection tray?
a) 8 to 10 times
b) 2 to 6 times
c) 3 to 4 times
d) 6 to 8 times
a) 8 to 10 times
70
Which step of the blood draw should be done right before removing the needle from a patient’s arm?
a) inverting all the tubes used in the procedure
b) getting a bandage ready for the patient
c) re-anchoring of the skin below the draw site
d) asking the patient to open their fist
b) getting a bandage ready for the patient
71
A phlebotomist witnesses a nurse receive a major electric shock from an instrument and immediately calls 911. What action should the phlebotomist have taken before calling 911?
a) the phlebotomist should have first removed the nurse from the instrument and the scene of the incident
b) the phlebotomist should have first notified the supervisor that was on staff of the emergency
c) the phlebotomist should have first found another nurse to take over the injured nurse’s duties
d) the phlebotomist should have first shut off the instrument to cut off the source of the shock
d) the phlebotomist should have first shut off the instrument to cut off the source of the shock
72
The type of microorganism that causes disease is which of the following?
a) normal flora
b) nonpathogenic
c) pathogenic
d) hereditary
c) pathogenic
73
Which interfacility conditions would require a phlebotomist to transport specimens in a closed container with ice packs?
a) none as this is never necessary and will damage any specimen
b) if the specimens are hot to the touch and need to be cooled before testing
c) if it is hot weather
d) if the transported arrives and is missing a biohazard label
c) if it is hot weather
74
Which color signifies “instability” in the National Fire Protection Association marking system?
a) yellow
b) white
c) red
d) orange
a) yellow
75
If a patient decided to go on a morning jog on their way to the facility, which precautions should a phlebotomist take before proceeding with venipuncture?
a) the phlebotomist should ask the patient to raise their feet above their heart for 20 minutes
b) the phlebotomist should provide the patient with a glass of ice water
c) the phlebotomist should reschedule the appointment for another day
d) the phlebotomist should have the patient rest for 15 minutes
c) the phlebotomist should reschedule the appointment for another day
76
An obese patient was sent to the laboratory for a complete blood count. Which of the following veins is most likely to be the only one that the phlebotomist can palpate?
a) median cubital vein
b) cephalic vein
c) basilic vein
d) antecubital vein
b) cephalic vein
77
Which of the following steps should a phlebotomist take if blood was drawn from the wrong patient?
a) the phlebotomist should re-label the tubes with the correct patient’s name and move on
b) the phlebotomist should immediately report the incident to the supervisor for corrective action
c) the phlebotomist should redraw the specimen immediately and discard the wrong tubes
d) the phlebotomist should throw away and have a nurse do the draw again
b) the phlebotomist should immediately report the incident to the supervisor for corrective action
78
Which of the following is the additive in the Red-Gray Speckled Top Tube, also known as a Gold Top tube or SST Tube?
a) sodium heparin
b) thixotropic gel for serum separation
c) ethylenediamineteraacetic acid (EDTA)
d) no additive
b) thixotropic gel for serum separation
79
Where is the best draw site on a 9-month-old infant?
a) dorsal vein
b) thumb finger on either hand
c) cephalic vein
d) either heel
d) either heel
80
When removing gloves after a procedure, which action best prevents contact with blood?
a) the phlebotomist should discard the first glove before touching the other glove
b) the phlebotomist should ask another healthcare team member to assist them in taking off their gloves
c) the phlebotomist should pinch the fingers of one glove and tug quickly
d) the phlebotomist should remove the first glove so that it turns inside out
d) the phlebotomist should remove the first glove so that it turns inside out
81
Serum is the LIQUID portion of ________ blood.
a) hemolyzed
b) anticoagulated
c) hemostasis
d) coagulated
d) coagulated
82
Which of the following is true about OSHA standards and the hepatitis B vaccine?
a) employers must offer the hepatitis B vaccine to their phlebotomist at no cost
b) patients are unable to receive the hepatitis B vaccine unless they have also received the hepatitis E vaccine
c) employers must require that every employee receive the hepatitis B vaccine within 90 days of beginning employment
d) phlebotomists cannot receive the hepatitis B at their place of employment if they have had symptoms in the last 90 days
a) employers must offer the hepatitis B vaccine to their phlebotomist at no cost
83
When teaching a patient to collect a sputum sample at home, the MOST important direction to include would be which of the following?
a) the patient should be directed to take the sample immediately after eating
b) the patient should be directed to rinse out their mouth before spitting into the container
c) the patient should be directed to spit into the container after taking a deep breath and coughing
d) the patient should be directed to keep the specimen in a room-temperature area, preferably in the dark
c) the patient should be directed to spit into the container after taking a deep breath and coughing
84
Which of the following examples of questions is most appropriate to use when identifying a patient?
a) “Are you Ms. Smith?”
b) “Is your name Jane Smith?”
c) “Would you please state and spell your full name and provide your date of birth?”
d) “Would you please provide me with your last name and your billing address?”
c) “Would you please state and spell your full name and provide your date of birth?”
85
Why should a phlebotomist use an amber-colored microcontainer when obtaining a bilirubin level from a newborn?
a) this reduces the risk of penetrating bone during the heel stick
b) bilirubin is photosensitive, and this tube protects the specimen from light exposure
c) this tube prevents the risk of cross-contamination
d) bilirubin needs to be in a microcontainer in order to test properly
b) bilirubin is photosensitive, and this tube protects the specimen from light exposure
86
Hemolyzation occurs when a phlebotomist:
a) uses an incorrect needle gauge
b) transports a specimen incorrectly
c) follows an incorrect order of draw
d) fails to invert the tube
a) uses an incorrect needle gauge
87
How many minutes should a phlebotomist rinse with water after receiving a chemical spill to exposed skin?
a) 10 minutes
b) 15 minutes
c) 12 minutes
d) 7 minutes
b) 15 minutes
88
When the tourniquet is tied too tight, the capillaries in the area may rupture causing which of the following?
a) rashes
b) pain
c) urticaria
d) petechiae
d) petechiae
89
When explaining an at-home collection of a semen specimen to a patient, the phlebotomist should tell the patient to return within ________ to deliver the specimen to the lab?
a) 24 hours
b) 1 hour
c) 3 hours
d) 12 hours
b) 1 hour
90
Where should the phlebotomist send a patient’s laboratory results?
a) the phlebotomist should send the results to the patient’s net of kin
b) the phlebotomist should send the results to the patient’s ordering provider
c) the phlebotomist should send the results to the patient directed y through mail
d) the phlebotomist should send the results to the patient’s insurance
b) the phlebotomist should send the results to the patient’s ordering provider
91
Which of the following actions should a phlebotomist advise a blood donor patient to take to ensure a quality of collection?
a) to stand upright during collection
b) to open and close their hand gently throughout the collection
c) to uncross their legs before the procedure
d) to label the collection tube with their name and mailing address
b) to open and close their hand gently throughout the collection
92
What is the LIQUID portion of anticoagualted blood?
a) serum
b) plasma
c) hematocrit
d) leukocytes
b) plasma
93
After setting up for a blood draw, a phlebotomist notices raised, red welts on a patient’s arm. Which of the following describes these welts?
a) edema
b) petechiae
c) psoriasis
d) urticaria
d) urticaria
94
Which three additives are ALL used to prevent coagulation?
a) sodium fluoride, EDTA, heparin
b) EDTA, sodium citrate, and heparin
c) heparin, sodium chloride, EDTA
d) sodium citrate, sodium fluoride, heparin
b) EDTA, sodium citrate, and heparin
95
When using an evacuated tube system to obtain a blood specimen, what step should the phlebotomist perform after tying the tourniquet and cleaning the site?
a) the phlebotomist should now uncap the needle and inspect it
b) the phlebotomist should now begin to explain the procedure to the patient
c) the phlebotomist should now make sure the sharps container is nearby for needle disposal
d) the phlebotomist should now anchor the skin below the puncture site
a) the phlebotomist should now uncap the needle and inspect it
96
What actions should a phlebotomist take if they have an allergy to latex?
a) the phlebotomist should wear nitrile gloves
b) the phlebotomist should still wear the latex gloves but be sure to keep them on for less than a 5-minute period
c) the phlebotomist should wear the latex gloves inside-out to not get the powder on their hands
d) the phlebotomist should proceed with the procedure without gloves, but ensure they wash their hands with hot, soapy, water.
a) the phlebotomist should wear nitrile gloves
97
Which of the following ensure that a phlebotomist is able to perform their job duties?
a) OSHA
b) HIPAA
c) ICD-10 Codes
d) CLIA
d) CLIA
98
A patient has signed a general consent from upon arriving at a clinic. The patient rolls up their sleeve and holds out their arm as the phlebotomist explains the procedure. What should the phlebotomist assume from this action?
a) the phlebotomist should not assume and should verify verbally with the patient that they are ready to proceed, as well as check the patient’s general consent form
b) the phlebotomist should assume the patient wants them to stop explaining the procedure
c) the phlebotomist should recognize this as a sign of implied consent from the patient
d) the phlebotomist should assume the patient is apprehensive about the procedure and start their explanation over
c) the phlebotomist should recognize this as a sign of implied consent from the patient
99
Who should a phlebotomist refer to when checking on medication peak levels for patient to see when their last dose was taken, and to verify that the medication schedule is accurate before blood collection?
a) the phlebotomist should ask the patient’s emergency contact
b) the phlebotomist should ask the attending nurse
c) the phlebotomist should ask the patient directly
d) the phlebotomist should ask the provider
b) the phlebotomist should ask the attending nurse
100
Blood is classified based on the presence or absence of antigens on the surface of what?
a) thrombocytes
b) erythrocytes
c) leucocytes
d) basophils
b) erythrocytes
101
How much blood is found in the average adult body?
a) 0.5 L
b) 5.0 - 7.0 L
c) 10.0 L
d) 90.0 gallons
b) 5.0 - 7.0 L
102
In what order should a phlebotomist take the below steps when they are accidentally stuck with a used needle?
a) contact their supervisor, report for a medical evaluation, rinse the injured area with water, then report for the HIV evaluation
b) report for HIV evaluation first, then do the other steps in any order
c) contact their supervisor, rinse the injured area with water, report for HIV evaluation, then report for a medical evaluation
d) rinse the infused area with water first, then do the other steps in any order
d) rinse the infused area with water first, then do the other steps in any order
103
When taking a blood sample to measure the trough level of a medication, a phlebotomist should:
a) wait 24 hours after the last dose to take the sample
b) take the sample immediately after the patient takes the medication
c) take the sample about 15 minutes before the patient receives the next dose of medication
d) wait 20 - 30 minutes after the last dose to take the sample
c) take the sample about 15 minutes before the patient receives the next dose of medication
104
When a phlebotomist centrifuges blood in a Gray Top Tube containing an anticoagulant, which is the resulting fluid portion?
a) plasma
b) serum
c) nosocomial
d) dehydration
a) plasma
105
To avoid damaging test results, a tourniquet should not be left on the patient’s arm longer than:
a) 30 seconds
b) 180 seconds
c) 60 seconds
d) 90 seconds
c) 60 seconds
106
According to OSHA requirements, a phlebotomist must replace a sharps container:
a) when the container has an uncapped needle inside
b) when it is too full to add other contaminated needles
c) when the container is two-thirds full
d) when the technician has discarded all lancets into metal trash bins
c) when the container is two-thirds full
107
The needle should be inserted into the arm with the bevel facing in which direction?
a) downward
b) towards either side
c) upwards
d) it makes no difference which direction the bevel is facing
c) upwards
108
Why should a phlebotomist not transfer a specimen to a different labeled tube if they accidentally mislabeled the first collection tube?
a) because the laboratory will process it either way; it is a waste of time and resources
b) because the phlebotomist should just notify a supervisor and they will take care of the mislabel
c) because the laboratory personnel will change the information on the label
d) because the collection tube already has a specific measure of additive that could be altered if the specimen was transferred into another tube
d) because the collection tube already has a specific measure of added in that could be altered if the specimen was transferred into another tube
109
Which piece of information is critical for a phlebotomist to document when following a chain of custody guideline?
a) identify the patient’s next of kin
b) identify everyone who had possession of the specimen
c) identify the CLIA protocol that was breached
d) identified the lawyers involved
b) identify everyone who had possession of the specimen
110
What is the process by which blood vessels repair after injury?
a) hemodialysis
b) hemodynamics
c) hemolysis
d) hemostasis
d) hemostasis
111
Which of the following examples would be best for the determination of blood acidity and blood gases?
a) capillary blood
b) arterial blood
c) venous blood
d) cerebrospinal fluid?
b) arterial blood
112
The most frequently occurring nosocomial (clinical setting acquired) infection for laboratory employees in which of the following?
a) human immunodeficiency virus
b) hepatitis A virus
c) hepatitis C virus
d) hepatitis B virus
d) hepatitis B virus
113
When drawing blood from a patient who has pneumonia, which PPE provides the BEST protection for a phlebotomist?
a) mask
b) gown
c) double gloves
d) goggles
a) mask
114
What term best describes a red blood cell that burst because the plasma that attached to it was not a match?
a) rhesus
b) fibrinolysis
c) agglutination
d) prothrombin
c) agglutination
115
When drawing blood from a patient who has active tuberculosis, which PPE provides the best protection for phlebotomist?
a) double gloves
b) gown
c) N95 respirator
d) surgical mass
c) N95 respirator
116
Which of the following is the total blood volume of an infant who weighs 3.3 kg (7.3 lb)? (Refer to latrogenic anemia in the glossary for conversion information).
1kg = 2.2lbs multiply kg x 100 to get amount in microLiter
a) 300 - 350 mL
b) 400 - 450 mL
c) 240 - 300 mL
d) 115 - 225 mL
a) 300 - 350 mL
117
Which of the following is the most critical mistake a phlebotomist can make?
a) failing to properly identify the patient
b) failing to collect a specimen
c) collecting a time specimen late
d) a hematoma
a) failing to properly identify the patient
118
Which of the following additives is required in the tube when collecting specimen for a blood culture test?
a) sodium polyanethol sulfonate
b) EDTA
c) sodium fluoride
d) gel serum separator
a) sodium polyanethol sulfonate
119
What order should a phlebotomist remove their PPE after finishing a procedure?
a) mask, goggles, gown, gloves
b) down, mask, gloves, goggles
c) gloves, mask, goggles, gown
d) gloves, goggles, gown, mask
d) gloves, goggles, gown, mask
120
If a patient has recently had a mastectomy on their right side, the phlebotomist should draw blood from the:
a) left thumb finger
b) right thumb finger
c) left arm
d) right arm
c) left arm
121
If a patient were to complain of a sharp pain running up and down their arm during a blood draw, which of the following is the best action for a phlebotomist to take?
a) the phlebotomist should ask the patient to take some deep breaths
b) the phlebotomist should slowly re-angle the needle
c) the phlebotomist should quickly finish the blood draw, then ask the patient to lie down
d) the phlebotomist should release the tourniquet and remove the needle
d) the phlebotomist should release the tourniquet and remove the needle
122
Postprandial means which of the following?
a) fasting
b) before a meal
c) after a meal
d) after a procedure
c) after a meal
123
When a phlebotomist is washing their hands, they should make sure to:
a) dry off with a microfiber towel
b) use hot water for at least 5 seconds
c) turn on the faucet with soapy hands
d) use enough soap to form a lather
d) use enough soap to form a lather
124
When blood is found in the urine of a patient, it is defined as which of the following?
a) hematuria
b) phenylketonuria (PKU)
c) proteinuria
d) bacteriuria
a) hematuria
125
A new phlebotomist is inserting a needle into a patient’s arm to draw a blood sample when the patient suddenly jerks. The needle comes out of the vein and pierces the phlebotomist’s index finger. Which of the following is the appropriate reaction?
a) the phlebotomist should start the blood draw over with the patient lying down
b) the phlebotomist should wash the wound with soapy water as soon as possible and report the injury to their supervisor
c) the phlebotomist should wash their wound after rescheduling the appointment with the patient
d) the phlebotomist should ask a nurse to finish the blood draw
b) the phlebotomist should wash the wound with soapy water as soon as possible and report the injury to their supervisor
126
The additive in a Light Blue Top Tube is which of the following?
a) sodium heparin
b) sodium citrate
c) sodium fluoride
d) sodium polyanethole sulfonate
b) sodium citrate
127
The most important means of preventing the spread of infection is which of the following?
a) personal protective equipment
b) hand washing
c) disinfection
d) sterilization
b) hand washing
128
During a routine blood draw, which of the following veins should a phlebotomist attempt to draw from first?
a) dorsal
b) radial
c) median cubital
d) ulnar
c) median cubital
129
Which is the most important piece of personal protective equipment for a phlebotomist to have on in an outpatient setting?
a) gloves
b) mask
c) gown
d) show cover
a) gloves
130
Which of the following is a right under the patient’s bill of rights?
a) the right to decline medical treatment
b) the right to know the medical status of family members in the hospital
c) the right to refuse to pay for medical treatment
d) the right to escort their specimens to and from the laboratory
a) the right to decline medical treatment
131
CDC is the abbreviation for which of the following?
a) Centers for Disease Connection
b) Centers for Disease Control and Prevention
c) Civil Disease Control
d) Civil Damage Center
b) Centers for Disease Control and Prevention
132
The vascular phase of hemostatsis is characterized by which of the following reactions?
a) platelets aggregate at the injured site forming a temporary platelet plug
b) the temporary platelet plug is converted to a stable fibrin clot
c) the blood vessels constrict in response to injury
d) there is breakdown and removal of the clot
c) the blood vessels constrict in response to injury
133
When blood cultures are ordered on an adult patient, which of the following material should the phlebotomist bring?
a) the phlebotomist should bring an aerobic bottle and an anaerobic bottle
b) the phlebotomist should bring three anaerobic bottles
c) the phlebotomist should bring three aerobic bottles and one SPS tube
d) the phlebotomist should bring one aerobic bottle
a) the phlebotomist should bring an aerobic bottle and an anaerobic bottle
134
A phlebotomist is asked to collect a specimen from a patient in the Oncology department. A patient in this department is most likely being treated for which of the following?
a) diabetes
b) cancer
c) vascular disorders
d) pregnancy
b) cancer
135
If a patient has a syncopal episode during a blood draw, what should the phlebotomist do first?
a) the phlebotomist should use an ammonia inhalant to wake them up
b) the phlebotomist should remove the needle, and then remove the tourniquet
c) the phlebotomist should remove the tourniquet, and then remove the needle
d) the phlebotomist should call for help
c) the phlebotomist should remove the tourniquet, and then remove the needle
136
Which of the following is incorrect about the Lavender Top Tube?
a) it contains an anticoagulant which binds to calcium
b) it is used to collect a specimen for a complete blood count
c) it must be inverted several times immediately after drawing to ensure uniform mixing of blood and anticoagulant
d) it is used to collect specimens for coagulation studies
d) it is used to collect specimens for coagulation studies
137
The boundaries for the approved area in performing heel punctures are which of the following?
a) the medial line extending from the great toe and lateral line extending from the fourth and fifth digit
b) the lateral line extending from the third toe and the medial line extending from the second toe
c) the line extending from the third toe, dividing the plantar surface into medial and lateral aspects
d) the line extending from the third and fourth toe, dividing the plantar surface
a) the medial line extending from the great toe and lateral line extending from the fourth and fifth digit
138
The Joint Commission created patient safety goals to direct healthcare workers and facilities in:
a) identifying the correct order of draw with every individual test
b) identifying patient safety risks
c) using sharp containers correctly
d) using appropriate needle gauges
b) identifying patient safety risks
139
Which of the following actions should a phlebotomist take if they are with a patient when they notice the patient’s laboratory results are ready?
a) the phlebotomist should notify the supervisor on site and have them communicate the results to the patient
b) the phlebotomist should read the results after verification from the patient
c) the phlebotomist should send the results to the patient’s provider
d) the phlebotomist should mail the results to the patient’s home address
c) the phlebotomist should send the results to the patient’s provider
140
Blood cultures, also known as culture and sensitivity (C&S) testing, are taken to determine which of the following?
a) hormone levels in the blood
b) presence of microorganisms in the blood
c) lactose intolerance
d) drug dosing
b) presence of microorganisms in the blood
141
Every time a phlebotomist clocks in for their shift, they notice that the sharps container on the phlebotomy tray is overflowing. Which of the following is the appropriate reaction to the situation?
a) the phlebotomist should pick out and discard the excess needles by hand until the unit can be sealed and replaced
b) the phlebotomist should throw it in the biohazard waste
c) the phlebotomist should remove the overflowing sharps container from the tray; replace it with an empty one for the shift, then return the overflowing container to the tray for the next shift
d) the phlebotomist should report the safety violation to the supervisor
d) the phlebotomist should report the safety violation to the supervisor
142
Informed consent is defined as which of the following?
a) the patient consents for any doctor to perform a procedure
b) a patient gives voluntary permission for a medical procedure after receiving adequate information
c) a medical assistant consents to assist in performance reviews
d) all of the above
b) a patient gives voluntary permission for a medical procedure after receiving adequate information
143
Which of the following tests may be performed from capillary blood collection?
a) complete blood count
b) blood culture
c) coagulation studies
d) strep test
a) complete blood count
144
Why should a phlebotomist avoid using earlobes as a site for capillary blood collection?
a) this site does not have any blood
b) this site lacks skin tissue and has a risk of damaging the surrounding cartilage
c) this site can cause patients to feel nervous and their head may move around too much
d) this site is too far away from the heart
c) this site can cause patients to feel nervous and their head may move around too much
145
Within which time period should a phlebotomist collect a newborn PKU blood-spot test?
a) within 30 minutes
b) within 72 hours
c) within 3 months
d) within 96 hours
b) within 72 hours
146
Where is the tourniquet generally tied on a patient?
a) 3-4” above the draw site
b) 2-4” above the draw site
c) 4-6” above the draw site
d) 2-5” above the draw site
a) 3-4” above the draw site
147
Red blood cells are also called which of the following?
a) erythrocytes
b) thrombocytes
c) leukocytes
d) phagocytes
a) erythrocytes
148
Which of the following antiseptics are the most appropriate if a phlebotomist has a patient who is allergic to alcohol?
a) hexachlorophene
b) chlorhexidine
c) tincture of iodine
d) chloroxylenol
b) chlorhexidine
149
The function of thrombocytes is which of the following?
a) transportation of oxygen to the tissues
b) engulfing bacteria (phagocytes)
c) clotting or repairing of blood vessels
d) producing antibodies
c) clotting or repairing of blood vessels
150
List the correct order of the venipuncture steps.
a) cleanse the site, palpate, apply tourniquet, collect the specimen, identify the patient
b) identify the patient, apply the tourniquet, palpate, cleanse the site, collect the specimen
c) identify the patients, gather the equipment, palpate, apply the tourniquet, collect the sample
d) gather equipment, cleanse the site, apply the tourniquet, palpate, collect the sample
b) identify the patient, apply the tourniquet, palpate, cleanse the site, collect the specimen
151
Plasma is the liquid portion of the unclotted blood and still contains clotting factors.
Tubes with anticoagulants: Lavender, Green (light or dark), Pink, Royal blue with a lavender strip, Light blue, and Gray.
Will produce plasma when separated in a centrifuge.
152
Serum is the liquid portion of blood that has been allowed to clot (coagulate). (Clotting factors are no longer present as they have been used to clot the blood).
Tubes without anticoagulants: Clear- used as a discard tube, Red- glass, Red- plastic (will have clot activator), Tiger Top / Gold Top / Marble Top, Royal blue with a red stripe
Will produce serum when separated in a centrifuge.
153
The approved order of draw is as follows:
1) Blood Culture Bottles (Broth)
2) Discard Tube (Clear or Red)
3) Light Blue Top (Sodium Citrate)
4) Royal Blue with Red Stripe
5) Red Top (Clot Activator if Plastic)
6) Gold / Tiger / Marble Top (Silica / Gel)
7) Light Green Top (Lithium Heparin / Gel)
8) Dark Green Top (Sodium Heparin)
9) Pink Top (Potassium EDTA)
10) Lavender Top (EDTA)
11) Royal Blue with Lavender Stripe
12) Gray Top (Sodium Fluoride / Potassium Oxalate)
13) Dark Blue (As called for in draw order)
154
Bottle Cultures
Additive: Nutrient Broth
Laboratory responsible for specimen testing: Microbiology
When a patient shows symptoms of a systemic infection or has a fever of unknown origin (FUO), a blood culture is performed to determine the presence of pathogenic or infectious microorganisms in the bloodstream. If infectious microorganisms are present, the nutrient broth will promote the rapid growth of microorganisms. Once assessed and positively identified, the infection can be controlled and treated with antibiotics.
155
Sterile Bottles (BCX)
Blood culture bottles contain SPS (sodium polyanethol sulfonate). In certain situations, a Yellow Top Tube (containing SPS) may be used for bacterial and fungal blood culture.
Blood culture collection requires a strict aseptic technique. The most common cause of blood culture contamination is improper site preparation.
The venipuncture site is cleansed with ChloraPrep to minimize the risk of contamination.
the top of the collection bottles should be cleaned. Let the ChloraPrep solution dray, then draw the blood.
156
Common tests: Blood cultures x 2
Collection Method: Blood cultures are ordered in sets of two (BC x2), each set consisting of two bottles:
aerobic (with oxygen)
anaerobic (without oxygen)
These blood draws and lab tests are usually ordered STAT or as timed specimens.
157
Clear Top Tube = Discard
A Clear Top Tube is used as a discard tube. A sample is drawn into this tube and then discarded to avoid the thrombin and other cells polluting the samples drawn into different tubes. In some clinical settings, a Red Top Tube will take the place of a Clear Top Tube as the discard tube.
158
Light Blue Top Tube
Additive: Sodium Citrate - an Anticoagulant
Yields: Plasma
Laboratory responsible for specimen testing: Coagulation
Common Tests: PT, PTT, aPTT
Sodium citrate prevents coagulation by binding to the calcium specimen. This additive is used for coagulation studies because it preserves the coagulation factors in the specimen.
Sodium citrate is a liquid additive that requires a specific blood-to-additive ratio.
-The ratio is 9 parts blood to 1 part additive.
-The Light Blue Top Tube must be filled completely to avoid an inadequate blood-to-additive ratio. There is a line marked on the tube to ensure the proper amount.
-The sample is collected and inverted 3-4 times to mix the blood and additive properly.
159
Light Blue Top Tube and Platelet-Rich Plasma (PRP)
-Platelet-rich plasma (PRP) therapy is a process where a patient’s platelets are harvested from their blood. Those platelets are then injected back into their body to accelerate healing in a particular area of concern.
-To process platelet-rich plasma (PRP) from a blood draw, the Light Blue Top Tube is used. This tube is used instead of other tubes because it contains the anticoagulant sodium citrate. Other anticoagulants do not work as well for obtaining the end process.
-Blood is usually drawn into two Light Blue Top Tubes to provide the required amount necessary for PRP therapy.
-The blood is centrifuged for 12 minutes. The horizontal spinning centrifuge creates the best results for harvesting PRP.
-After the blood is centrifuged, plasma is withdrawn from the Buffy coat layer via a 2-inch, 18-gauge needle and a 30 mL syringe. The buffy coat layer is the white separating layer between the red blood cells and the plasma layers.
-The harvested sample is rich with platelets, hence the name platelet-rich plasma. This specimen is then injected into an area requiring expedient healing.
-The PRP can also be mixed with freeze-dried bone to create sticky bone material that is packed into hard tissues (bone) to accelerate healing.
160
Red Top Tube
Additive: None - Glass; Clot Activator - Plastic (silica)
Yields: Serum
Laboratory responsible for specimen testing: Chemistry
Common Tests: This tube is also known as a “plain vacuum tube.” It contains no additive or anticoagulant. In this tube, blood will clot naturally within 30 - 60 minutes. With clotting factors left in the blood, a Red Top Tube can be used for a serum pregnancy test.
A Red Top / Plain Tube is frequently used as a”discard” tube to prevent sample contamination. It is sometimes used to “clear the line” to obtain a purer sample.
-There is no need to invert this tube after sample collection.
The exception to the rule is: If the Red Top Tube is made of plastic, a clotting agent is added as plastic tubes’ sides are too slick for natural clotting to form.
-Alcohol (Ethanol or ETOH) levels can also be drawn in a Red Top Tube when testing serum.
161
Tiger Top, Marble Top, Red-Gray Speckled Top, or Gold Top Tubes
Additive: Silica (clot activator) and Thixotropic Gel (serum separator)
Yields: Serum
Laboratory responsible for specimen testing: Chemistry
Common Tests: BMP, CMP, Serum Pregnancy Test, Lipids and Cholesterol
Most commonly, this tube is referred to as “SST,” which stands for a serum separation tube.
-Silica promotes rapid clot formation of the blood (30 minutes).
-This tube also contains thixotropic gel, a separator that creates a barrier between the serum and formed cellular elements when centrifuged. This barrier prevents contamination of the serum.
-After the sample is collected, it must be inverted 8 times to mix the blood and additive properly.
-A C-reactive protein test can be drawn in a serum separator tube when serum is required.
162
Light Green Top Tube (Lithium)
Additive: Lithium Heparin, an Anticoagulant, and Thixotropic Gel, a Plasma Separator
Yields: Plasma
Laboratory responsible for specimen testing: Chemistry
Common Tests: STAT Electrolytes “LYTES”, hcG, hcG qualitative, hcG quantitative
The Light Green Top tube is also called a “PST,” which stands for “plasma separation tube.”
-Heparin, the anticoagulation in plasma separation tubes, works by inhibiting thrombin in the coagulation cascade.
-A PST is not used for hematology because heparin interferes with Wright’s stained blood smear.
-This tube contains thixotropic gel, a separator that creates a barrier between the plasma and formed cellular elements when centrifuged and prevents the plasma’s contamination.
-After the sample is collected, it must be inverted 8 times to mix the blood and anticoagulant properly.
163
Dark Green Top Tube
Additive: Sodium Heparin, and Anticoagulant
Yields: Plasma
Laboratory responsible for specimen testing: Chemistry
Common Test: Ammonia
Heparin, the anticoagulant in Green Top Tubes, works by inhibiting thrombin in the coagulation cascade.
-This tube does not have a gel additive.
-After the sample is collected, it must be inverted 8 times to mix blood and additive properly.
164
Pink Top Tube - (P) in (K2)
Additive: Potassium EDTA
Yields: Plasma
Laboratory responsible for testing sample: Blood Bank
Common Tests: Type and Screen Ratio (TSR) and Cross match
Like the Lavender Purple Top Tubes, a Pink Top Tube contains the anticoagulant EDTA. The blood sample must fill the tube to 2/3 or more full.
-Blood banks use this for molecular diagnostics and testing of viral loads.
-After the sample is collected, it must be inverted 8 times to mix blood and additive properly.
165
Lavender or Light / Dark Purple Top Tubes
Additive: Ethylenediaminetetraacetic Acid (EDTA)
Yields: Plasma
Laboratory responsible for testing sample: Hematology
Common Tests: Erythrocytes Sedimentation (ESR), Sickle Cell, Complete Blood Count (CBC), Hematocrit, Hemoglobin, Platelets
This tube contains the anticoagulant EDTA. EDTA inhibits coagulation by binding to calcium that is present in the specimen.
-This tube is not used for coagulation studies.
-This tube is used to collect a specimen for complete blood punt (CBC).
-Lavender / Purple Top Tubes must be filled at least 2/3 full.
-After the sample is collected, it must be inverted at least 8 times to mix the blood and the anticoagulant properly.
-C-reactive protein can be drawn in a Lavender Top Tube if plasma is required for the test.
-Complete blood count (CBC) cannot be performed on hemolyzed samples. Hemolyzation happens when the membranes of red blood cells break releasing free hemoglobin into the circulating blood. If the specimen is hemolyzed or damaged, the laboratory will reject it. A CBC should NEVER be centrifuged.
166
Gray Top Tube
Additive: Sodium Fluoride, an Antiglycolytic Agent (glucose preservative), and Potassium Oxalate, an Anticoagualnt
Yields: Plasma
Laboratory responsible for testing sample: Chemistry
Common Tests: Oral Glucose Tolerance Test (OGTT), Lactic Acid, Alcohol (Ethanol or ETOH) levels
The Gray Top Tube tests glucose levels in plasma. Some glucose testing requires serum. If this is the case, use an SST (serum separation tube).
-Sodium fluoride is a preservative that prevents the breakdown of sugar. It will preserve the integrity of glucose in the sample for 3 days.
-Potassium Oxalate is anticoagulant that prevents clotting by binding to calcium in the sample. To ensure proper mixing of additive, anticoagulant, and blood, invert the sample 8 times after collection.
167
Royal Blue Top Tube
Additive: None (red stripe) / EDTA (blue / lavender stripe)
Yields: Serum (red stripe) / Plasma (blue / lavender stripe)
Laboratory responsible for testing sample: Toxicology
Common Tests: Lead (Pb) Poisoning, Heavy Metal Toxicology
Royal blue is NOT actually drawn last in the order of draw. It is drawn in the order of the additive.
-A Royal Blue Top Tube with a red stripe does not have an additive and will yield serum. It is drawn after the Light Blue Top Tube and before other serum tubes.
-A Royal Blue Top Tube with. A blue or lavender line has the anticoagulant EDTA and will yield plasma. It is drawn after the Lavender / Purple Top Tubes.
-To ensure proper mixing of additive, anticoagulant, and blood, invert sample 8 times after collection.
168
Tubes that produce Plasma
1) Clear Top Tube = Discard
2) Light Blue Top Tube
3) Light (Lithium) Green Top Tube
4) Dark Green Top Tube
5) Pink Top Tube
6) Lavender Top Tube
7) Gray Top Tube
8) Royal Blue Top (with blue / lavender stripe)
Tubes that produce Serum
1) Red Top Tube
2) Tiger Top, Marble Top, Red-Gray Speckled Top, or Gold Top Tubes
3) Royal Blue Top (with red stripe)
169
Light Blue Top Tube: Common Tests
PT
PTT
aPTT
Prothrombin Time (PT)- evaluates the extrinsic system of the coagulation cascade. Therapeutic monitoring requires prothrombin time to be drawn when a patient is on a Coumadin regimen.
Partial Thromboplastin Time (PTT)- evaluates the intrinsic system of the coagulation cascade. Therapeutic drug monitoring requires partial thromboplastin time to be drawn when a patient is on a Heparin regimen.
Activated Partial Thromboplastin Time (aPTT)- evaluates how long the patient’s blood takes to form a clot.
-PTT and aPTT are used to test for the same functions. In aPTT, an activator is added that speeds up the clotting time, resulting in a narrower reference range.
170
Red Top Tube: Common Tests
PRP or PRF
-Platelet-Rich Plasma (PRP) blood specimens were drawn using tubes that contained anticoagulants to prevent clotting which allowed the PRP time to be correctly harvested. PRP is harvested from tubes containing the anticoagulant sodium citrate.
-Discovered that a clotted specimen can be used to create PRF blood products which accelerate healing processes. The protocols for creating the PRF clot and for using it in healing practices are quite simple to learn, though kind of messy to perform. PRF is harvested from White Top Plastic Tubes containing zero additive.
171
Tiger Top, Marble Top, Red-Gray Speckled Top, or Gold Top Tubes
Common Tests: Basic Metabolic Panel (BMP), Complete / Comprehensive Metabolic Panel / Profile (CMP), Serum Pregnancy Test, Lipids and Cholesterol
Basic Metabolic Panel (BMP)- this group of tests provides general information about the patient’s metabolism, kidney function, electrolytes, and fluid balance.
Complete / Comprehensive Metabolic Panel / Profiles (CMP)- while a CMP is a similar to a BMO, the CMP group of tests is a more comprehensive (complete) look at the patient’s metabolism of chemicals in their body, including kidney function, electrolytes, and fluid balance. It also provides information about liver function and performance.
Serum Pregnancy Test- with clotting factors left in the blood, a Marble Top Tube can also be used for a serum pregnancy test.
Lipids and Cholesterol- this test is performed to identify possible circulatory system health issues. Testing is done with whole blood or serum.
172
Light (Lithium) Green Top Tube
Common Tests: STAT Electrolytes “LYTES”, hCG, hCG qualitative, hCG quantitative
STAT Electrolytes “LYTES”- the measurement of electrolytes is necessary for diagnosing and treating renal and endocrine conditions. Low electrolyte levels are associated with arrhythmia (irregular heartbeat) and tachycardia (rapid heartbeat). High levels are associated with heart failure.
hCG, (Plasma Pregnancy Test)- this test measures the amount of human chorionic gonadotropin in the body.
hCG qualitative- this test determines if hCG is present in the bloodstream. Qualitative hCG can also be determined using a urine sample.
hCG quantitative- this test measures how much hCG is present in the bloodstream.
173
Dark Green Top Tube
Common Tests: Ammonia
Ammonia- a high volume of ammonia in the blood is an indication that the liver is not functioning correctly. The liver is responsible for converting ammonia into urea to be expelled from the body. Ammonia tests must be placed on ice.
174
Pink Top Tube
Common Tests: Type and Screen Ratio (TSR), Cross Match
Type and Screen Ratio (TSR)- this test provides a basic understanding of patients’ blood types. It screens for antibodies present in plasma and serum. TSR also categorizes the blood into one of the four blood types: A+/-, B+/-, AB +/-, or O+/-
Cross Match- this test is required before blood transfusion, it is used to determine if donor blood is compatible with the recipient.
175
Lavender or Light / Dark Purple Top Tubes
Common Tests: Erythrocytes Sedimentation Rate (ESR), Sickle Cell, Complete Blood Count (CBC), Hematocrit, Hemoglobin, Platelets
Erythrocytes Sedimentation Rate (ESR)- this test requires a full tube for accurate collection.
Sickle Cell- this test screens for a condition where the red blood cells are misshapen.
Complete Blood Count (CBC)- CBC can be tested using blood from a dermal puncture. Complete blood count is an extensive test that evaluates the formed cellular elements of blood including, but not limited to: white blood cell count, white blood cell differential.
Hematocrit- this test measures the volume percentage of red blood cells in the blood. This test is always performed before whole blood donation.
Hemoglobin- this test measures the amount of oxygen-carrying protein in the blood. This test is always performed before whole blood donation.
Platelets- a platelets test establishes the number of platelets in a given volume of blood. Both increases and decreases in platelet count can point to abnormal conditions of excess bleeding or clotting.
Note: the most common bleeding disorders include, hemophilia, Factor II, V, VII, X, or XII, and non Willebrand’s disease
176
Gray Top Tube
Common Tests: Oral Glucose Tolerance Test (OGTT), Lactic Acid, Alcohol (Ethanol or ETOH) levels
Oral Glucose Tolerance Test (OGTT)- blood and urine samples are glucose tolerance tested over a specific time. This test is used to evaluate blood sugar. 3-hour OGTT is used to test hyperglycemia (abnormally high blood sugar level) and diagnose diabetes mellitus. 5-hour OGTT is used to assess hypoglycemia (abnormally low blood sugar level) for carbohydrate metabolism disorders.
Lactic Acid- abnormal lactic acid results are an indication that the body is not receiving proper oxygenation. Lactic acid tests should be drawn without stasis, meaning without a tourniquet applied. If taken with stasis the lactic acid may increase times 100. The sample must be placed on ice.
Alcohol (Ethanol or ETOH) levels- when drawing an alcohol level do NOT clean the site when alcohol as it may cause a false positive.
177
Royal Blue Tube
Common Tests: Lead (Pb) Poisoning, Heavy Metal Toxicology
Lead (Pb) Poisoning
Heavy metal Toxicology
178
Newborns are screened for many things before released to go home from the hospital. Most screenings are done from the heel stick collection including: Cystic Fibrosis, Hypothyroidism, Galactosemia, Bilirubin, PKU, Sickle Cell, Toxoplasmosis, Brotianides Deficiency, HIV
-Bilirubin (light protected) is a standard test performed on babies via heel stick. When bilirubin is overproduced, this is due to the liver not breaking down and excreting red blood cells as it is supposed to do. This causes a baby to become jaundiced or yellow.
-Bilirubin is dangerous in infants since it can accumulate to toxic levels which can cause permanent brain damage and death. High bilirubin, or jaundice, becomes visible about 2-3 days after being born. If the condition is not too severe, it can go away with minimal treatment in about 1-2 weeks. The most common treatment for this is Phototherapy, o “light” therapy.
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Heel Stick
-The heel is used for dermal punctures on infants and toddlers up to two years of age areas recommended for a heel stick are the medial and lateral portions of the plantar surface of the foot.
-By drawing imaginary lines medially extending from the middle of the great toe to the heel, and then laterally from the middle of the fourth and fifth toes to the heel, the phlebotomist will know where to draw the blood.
-The American Academy of Pediatrics, or AAP, recommends that heel punctures not exceed 2.0mm for infants. Preemies should not exceed 0.85mm.
-Before performing a heel stick on an infant, a heel-warmer should be placed on the foot for 2-5 minutes. A heel-warmer dilates the capillaries and vessels and allows increased blood flow to that area.
1) Do not puncture deeper than 2.0mm for full-term infants.
2) Do not perform punctures on previous puncture sites as this poses a threat of infection.
3) Do not use the back of the heel or arch of the foot.
4) Always wipe away the first drop of blood.
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Pediatric Patients - With children, consider using APE - Approach, Positioning, and Equipment
- “Dry run” or “rehearse” with kids. Distractions and the human touch work well.
- Try to reduce procedural cues such as counting down to the needle insertion.
- More than one person may be needed to restrain the child.
- Perform heel sticks on pediatric patients.
- If attempts to obtain a heel stick sample are unsuccessful, the phlebotomist should get the sample from the median cubital vein.
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The Joint Commission (TJC)- The Joint Commission was founded in 1951 and is the oldest watchdog in healthcare facility oversight. The Joint Commission is pivotal in bringing quality assurance reviews to the healthcare market. Independent and not-for-profit, TJC was formed to solely look out for patients and establish standards and practices of operations in all healthcare settings.
Clinical and Laboratory Standards Institute (CLSI)- CLSI is a global, non-profit organization that develops standards using representatives taken directly from the fields they oversee.
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Equipment Check Forms- The equipment check forms, or QC checklists, ensure the machines are inspected for performance and operation compliance at time intervals specific to the equipment and clinical application.
Incident Reports- an incident report form records and tracks internal issues.
Risk Management- risk management can boil down to “loss of property, or injury” in the healthcare industry.
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Informed Consent- a competent person gives voluntary permission for a medical procedure after receiving adequate information about the risk of the procedure’s methods and consequences.
Expressed Consent- permission is given by the patient verbally or in writing for a procedure.
Implied Consent- the patient’s actions permit the procedure without verbal or written consent.
HIV Testing Consent- special permission is needed to administer a test that detects HIV.
Parental Consent for Minors- a parent or a legal guardian must permit procedures administered to underage patients depending on the state law, ranging from 18 to 21 years old.
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Arterial Blood Gas (ABG)- a test that analyzes arterial blood for oxygen, carbon dioxide, bicarbonate content, and blood pH. This test is used to determine the effectiveness of respiration.
Iatrogenic- refers to any effect on a person resulting from any activity of one or more persons acting as healthcare professionals or promoting products or services a beneficial to health that does not support a goal of the person affected.
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Iatrogenic Anemia- anemia is a condition marked by a deficiency of red blood cells or hemoglobin in the blood, resulting in poor skin color weariness. Iatrogenic anemia describes anemia resulting from repeated blood collection for diagnostic testing. The key to preventing iatrogenic anemia is blood conservation. It may be achieved by avoiding taking blood samples from a patient unless absolutely necessary, collecting only the minimum volume required to perform a diagnostic test, reducing blood sampling frequency, and using small blood volume containers. Removal of more than 10% of these patients’ blood can be life-threatening.
Part 1
1) anemia can lead to shortness of breath, fatigue, and a need for blood transfusions.
2) geriatric and underweight pediatric patients are the most vulnerable.
3) understand the implications of drawing too much blood in a short time frame.
4) if requests seem excessive, check with the nurse
Part 2
1) draw no more than 10% of blood volume for infants.
2) convert weight to kilograms (kg) to begin volume calculation.
3) draw no more than 100 mL for adults.
Part 3
1) calculate infant blood volume.
2) multiply kilograms by 100 to get volume in microliters.
3) document the amount of blood collected in each tube.
4) draw minimum requires an amount.
Part 4
1) communicate regularly with supervisor and laboratory manager.
2) discuss concerns with supervisor.
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Point-of-Care Testing (POCT)- diagnostic testing at or near the site of patient care. The driving notion behind POCT is to bring the test conveniently and immediately to the patient. POCT increases the likelihood that the patient will receive the results in a timely manner.
(QNS) Quantity Not Sufficient- occurs when drawing blood and you do not get enough blood for the lab to perform the test or tests indicated on the requisition form.
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Septicemia- a systemic infection associated with pathogenic organisms introduced during venipuncture.
Thrombophlebitis- inflammation of a vein with the formation of a clot.
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Universal Precautions- the name describes a prevention strategy in which all blood and potentially infectious materials are treated as infectious regardless of the sources individual’s perceived status. In other words, whether or not you think the blood or body fluid is infected with bloodborne pathogens, you treat it as if it is. This approach is used in all situations where exposure to blood or potentially infectious materials is possible. Engineering and work practice controls are always used when exposure may occur.
Standard Precautions- are the minimum measure taken to prevent direct contact with blood, other bodily fluids, and tissues by using barrier protection and work control practices. These precautions should be used when there is a possibility of contact with any of the following: blood, non-intact skin.
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What was the concept behind bloodletting?
a) to continue with the ancient art behind it
b) for transfusion, donations, and research
c) to rid the body of excess fluids
d) to discontinue the use of leeches
c) to rid the body of excess fluids
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What is the primary role in responsibility of a phlebotomist?
a) the patient, vital signs and bring them to a room
b) interview and screen donors at a blood bank
c) draw specimens from healthy patients only
d) obtain blood specimens by venipuncture or capillary techniques
d) obtain blood specimens by venipuncture or capillary techniques
191
When you participate as both the sender and the receiver, you create an effective _________.
a) communication loop
b) listening circle
c) nonverbal exchange
d) verbal hierarchy
a) communication loop
192
Who overseas and ensures quality and healthcare?
a) CLSI
b) TJC
c) POCT
d) CLIA
b) TJC
193
Ethical behavior entails conforming to a standard of right and wrong to avoid __________?
a) patients bill of rights
b) harming the patient
c) civil court
d) criminal court
b) harming the patient
194
Of the types of OSHA compliance inspections, which one is conducted on randomly chosen workplaces, determined to be engaged in particularly hazardous work types?
a) fatality or accidents inspection
b) eminent danger inspection
c) compliance inspection
d) programmed inspection
d) programmed inspection
195
True or False ?
The lower the gauge, the smaller/thinner the needle is; the larger the gauge, the bigger/thicker the needle is.
False
196
True or False
Duplicate test should be drawn individually because results might be going to different doctors.
False
197
True or False
Verbal verification of ID from the patient is good enough to proceed with the venipuncture.
False
198
Hemostasis is the process by which…..
a) blood takes longer than normal to clot
b) blood vessels repair in three stages
c) blood vessels repair after injury
d) blood clots, faster than normal
c) blood vessels repair after injury
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What determines if the yellow liquid portion of blood is plasma or serum?
a) RBC, WBC, thrombocytes
b) looking at it
c) how hydrated the patient is
d) clotting factors
d) clotting factors
200
What additive is in blood culture bottles?
a) aerobic
b) sodium polyanethol sulfonate
c) anaerobic
d) ChloraPrep
b) sodium polyanethol sulfonate
201
Who defined the order of draw?
a) MSDS
b) CLSI
c) CLIA
d) TJC
b) CLSI
202
AAP states that heel puncture should not exceed _________ for infants.
a) 0.85mm
b) 1.0mm
c) 2.0mm
d) 2.2mm
c) 2.0mm
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True or False
Higher Bilirubin is a result of the liver, not breaking down and exerting red blood cells as it is supposed to do.
True
204
True or False
The venipuncture order of draw is the same as the capillary collection order of draw.
False
205
The CLSI estimates __________ of lab errors result from improper handling of a specimen before being analyzed.
a) 28% to 52%
b) 34% to 57%
c) 46% to 68%
d) 51% to 73%
c) 46% to 68%
206
On challenging draws, what is something that can be done to aid and successfully collecting a sample?
a) telling the patient to exercise vigorously prior to the blood draw
b) the patient drink an energy drink to get their veins to pop
c) telling the patient not to watch the draw as it makes you nervous
d) where other phlebotomist have been successful before
d) asking where other phlebotomist have been successful before
207
True or False
Hematoma is the most common complication of phlebotomy.
True
208
The Occupational Safety and Health Administration is responsible for:
a) blood donation and donor standards
b) national standards for phlebotomy procedures
c) ensuring a safe and healthy work environment
d) hemochron signature elite monitor system
c) ensuring a safe and healthy work environment
209
The 7 environmental hazards include: sharps, physical, biologic, electrical, fire/explosive, allergic reactions, and _________?
a) chemical
b) bloodborne pathogens
c) safety
d) occupational
a) chemical
210
_______ is the most commonly occurring nosocomial infection for lab employees.
a) HIV
b) HCV
c) HBV
d) HAV
c) HBV
211
What precautions does the CDC recommend?
a) exposure
b) universal
c) safety
d) biohazard
b) universal
212
What requirement will the 1:10 cleaning solution need to meet to be used for medical asepsis?
a) MSDS standards
b) NSPA approval
c) POCT regulations
d) EPA registered tuberculocidal
d) EPA registered tuberculocidal
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Basal state refers to:
a) nothing by mouth and restraint from strenuous exercise for 8 to 12 hours
b) measuring blood levels exhibiting diurnal variations
c) tubes pre-warmed in incubator for 30 minutes
d) tubes wrapped in foil immediately after collection
a) nothing by mouth and restraint from strenuous exercise for 8 to 12 hours
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Which 3 specimens are required to be chilled?
a) cryoglobin, bilirubin, gastrin
b) cold agglutinins, folate, vitamin B12
c) ammonia, ABG, lactic acid
d) vitamin B6, ammonia, PT
c) ammonia, ABG, lactic acid
215
What is aliqouting?
a) shaking the tube vigorously
b) dividing the specimen into equal parts
c) refrigerating the tube
d) centrifuging the specimen
b) dividing the specimen into equal parts
216
Which 4 tests are primarily performed on ABG specimens?
a) BPH, CO2, cryoglobulin, CBC
b) bicarb, CO2, lipid, PT
c) CO2, lactic acid, O2, gastrin
d) BPH, CO2, bicarb, O2
d) BPH, CO2, bicarb, O2
217
When should a Phenylketonuria (PKU) be performed?
a) within 96 hours of life
b) after first week of life
c) after two weeks of life
d) within 72 hours of life
d) within 72 hours of life
218
True or False
Diurnal variation first to the daily cyclic variations within the body during a 24 hour.
True
219
True or False
POCT procedures are waived test performed by healthcare staff other than the doctor or RN.
True
220
True or False
Polycythemia vera is when a patient is holding too much iron in their system.
False
221
_________ is a swab specimen collected sublingually.
a) nasal
b) buccal
c) throat
d) sputum
b) buccal
222
What 5 items are required to be on a medical order/requisition?
a) name, and DOB, address, phone number, tests, SS number
b) name, and DOB, ordering physicians name, tests, ICD – 10 code, address
c) name, and DOB, tests, drivers license number, address, physician signature
d) name and DOB, tests, ICD – 10 code, physicians name, physician signature
d) name and DOB, test, ICD – 10 code, physicians name, physician signature
223
The hepatitis B vaccine is given in a series of _____ shots.
a) 2
b) 4
c) 3
d) 5
c) 3
224
What is the proper order of removal of PPE when finished with a procedure?
a) mask, goggles, gown, gloves
b) gloves, goggles, gown, mask
c) goggles, gown, mask, gloves
d) gloves, mask, goggles, gown
b) gloves, goggles, gown, mask
225
Together with the ____________ system, the nervous system regulates and maintains homeostasis.
a) endocrine
b) PNS
c) ganglia
d) CNS
a) endocrine
226
What is the human body’s largest organ system?
a) muscular system
b) renal system
c) central nervous system
d) integumentary system
d) integumentary system
227
Which layer of the skin contains the site of hair follicles, sweat, glands, and dense connective tissue?
a) dermis layer
b) subcutaneous layer
c) epidermis layer
d) all 3 layers
a) dermis layer
228
Which two valves are located on the right side of the heart?
a) pulmonary valve and bicuspid valve
b) tricuspid valve and aortic valve
c) bicuspid valve and aortic valve
d) pulmonary valve and tricuspid valve
d) pulmonary valve and tricuspid valve
229
The circulatory system has which two circulations?
a) arteries and arterioles
b) pulmonary and systemic
c) atrium and ventricle
d) veins and venules
b) pulmonary and systemic
230
What is the plasma percentage of blood versus the formed elements percentage?
a) 35% / 65%
b) 40% / 60%
c) 55% / 45%
d) 62% / 38%
c) 55% / 45%
231
What are the 5 types of Leukocytes?
a) neutrophils, plasma, monocytes, eosinophils, and serum
b) neutrophils, lymphocytes, monocytes, eosinophils, and basophils
c) neutrophils, lymphocytes, monocytes, plasma, and eosinophils
d) neutrophil, lymphocytes, serum, basophils, and monocytes
b) neutrophils, lymphocytes, monocytes, eosinophils , and basophils
232
True or False
Blood has been classified into four groups based on the presence or absence of antigens A and B.
True
233
True or False
As a licensed phlebotomist, you do not need to maintain a CPR/BLS certificate.
False
234
True or False
The globally harmonized system of classification has replaced the pic graphs with four color labels on the chemical container.
False
