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Phlebotomy Practrice

Helps Study for Phelbotomy Certifications

Arterial blood leaves the heart through the: Aorta
The liquid portion of the blood within the body is: Plasma
The laboratory receives a STAT request for blood glucose level on a patient in the emergency room department. It is appropriate to: Treat the request as a medical emergency: collecting and processing the blood immediately
The best location to preform a dermal puncture for point-of-care glucose test on an adult is the tip of the palmar surface of the: Third or Fourth Finger
Low and High controls are required for a glucose meter. These are run: Exactly the same as the patient samples are run
A patient has recently had a radical mastectomy of the right beast. The best site for venipuncture in the patient is the: Left Arm
Urine begins forming in the ___ where the blood is _____. Kidneys; filter
The length and width of the lancet blades are important for assuring an adequate flow of blood and to: Prevent injury to the bone
Blood Culture collection sites are prepared by swabbing the venipuncture site with iodine, which is left on for at least: 20 seconds
A tourniquet is applied to the arm above a venipuncture site to: Slow the venous blood to the heart
Arterial walls have thick layers of ___ to withstand increased blood pressure during the contraction phase of the heart and to maintain blood flow during the resting phase. Muscle
What color is normal in a plasma specimen? Light Yellow Color
A blood specimen for a 2-hour postprandial glucose test is collected: After the patient eats a meal
A patient's lab req requests the specimen collected by finger-stick. The phlebotomist notices patient's hands feel cold. What should the phelbotomist do? Warm the patient's skin prior to performing the puncture.
A patient has a cast on the left arm and an IV on the right forearm. A venipuncture in the patient's right arm must be done: Below the IV in a different vein
Skin puncture for neonatal screening specifies that: The first drop of blood is wiped away
To prevent tampering and miss-identification of samples for legal purposes, everyone who handles the specimen must provide: Documentation of their identity and the data and time the sample is handled
A neonatal bilirubin specimen should be collected in a: Amber microcollection tube and protected from the light.
A trough specimen for TDM is typically collected: 30 min. before a dose
A specimen for a blood ammonia test is to be preserved from the time of collection until it is tested in the laboratory. The best course of action is to keep the tube: In a cup of ice water
How often should the performance speed on a centrifuge be checked: Every 3 months
What is the proper way to introduce yourself to the patient? Good evening, Ms.____, I'm from the laboratory, and I'm going to be taking your blood today.
Described how to safely operate a centrifuge Tube stoppers are left on, centrifuge is balanced by similar tubes across from each other, and the lid is left closed during centrifugation
The preferred depth of incision for a skin puncture of an premature infant is: 0.85mm
The arteries used for arterial punctures, listed in order of preference, are: Radial, Brachial, Femoral
The transportation of blood and body fluid specimens by pneumatic tubes system: Not recommended
What item is used for venipuncture but NOT used for arterial puncture? Tourniquet
How many mL should be discard in order to collect a patient with a Venous Access Device (VAD)? 5mL
The industry-wide stopper color for tubes chemically clean enough to be used for collecting blood specimens for determination of trace elements is: Royal Blue
After centrifuging a green-stopper tube, phelbotomist notes that the serum is pink, indicating: Hemolysis and an unacceptable specimen
A phelbotomist must collect from a patient in isolation with contact precautions. The appropriate PPE is: Gloves and Gown
An outpatient is scheduled for a GTT and arrives at clinic at 0715. The patient starts drinking glucose beverage at 0725 and finished at 0730. The first specimen should be collected at: 0755
When a lipid panel is ordered the patient should be: Fasting for at least 12hrs; water ONLY and no nicotine
Patient is given a urine collection materials and told to collect a urine sample by cleaning the urethral meatus, starting to void without collection, and collecting the remainder of the void in specimen cup. This urine sample is: Clean-Catch, Midstream Urine
The container for a 24-hour urine collection should be: Labeled and stored in refrigerator
During the collection of a 24 hour urine, it is important to: Avoid contamination of the urine specimen with feces
Which tube would be rejected as unsatisfactory if it was not completely full? Light blue
A phlebotomist is waiting while an elderly patient slowly gets back into bed. The phlebotomist shows appropriate nonverbal communication skills by: By being thoughtful, considerate, and offering to assist
After completing venipuncture by evacuation tube, it is appropriate to: Dispose of the needle in a nearby sharps container
When collecting blood in a syringe, pulling back quickly and hard on the plunger can Collapse the vein and hemolyze the blood
A skin puncture for a CBC is ordered on a newborn. The phlebotomist finds the infant crying violently. The phlebotomist should: If possible wait until the infant has stopped crying for 1 hr.
When properly placing the needle within a vein you should not have: Swelling around the venipuncture site
When labeling blood collection tube you must NEVER: label vacutainer tubes before calling an outpatient into the draw area.
What term is used to indicate a patient has has something to eat? Postprandial
What terms indicate that the patient has had nothing to eat? Fasting, Withhold, NPO
The term for identifying the means of transmission of a contagious disease from its host is: Chain of Infection
The most effective means of preventing the spread of infectious disease is: Observer proper hand washing/hand hygiene
The laboratory receives a request to collect 450mL of blood from a patient with polycythemia. The blood collection would be called a(n): Therapeutic Phlebotomy
Care in centrifuging, such as eliminating splashing or splattering and not "popping" of tube stopper, are designed to prevent the formation of: Aerosols
A phlebotomist performs a venipuncture without disinfecting the site and leaves the tourniquet on longer than indicated. This would be considered: Negligence
To avoid a hematoma the patient must: Apply pressure on the venipuncture site with the arm straight
3 ways to cause a hematoma during venipuncture procedures: (1) Probing/Fishing for a vein (2) Going all the way through vein (3) Bending the elbow with a cotton ball on venipuncture site to apply pressure
The steps to be followed in response to discovering a fire may be remembered by the acronym: RACE
When blood leaves the right ventricle, it enters the: Right and Left Pulmonary Arteries
A blood sample collected in a tube without anticoagulant would contain: Serum
A STAT specimen Must be collected and tested immediately
When collecting blood specimen from an infant or neonate, the best site for a skin puncture is: The medial or lateral section of the foot
What g value and minimum time are used in a centrifuge to effect good separation of clotted blood from serum? 1000 rpm for 10 minutes
Obese patient may be difficult to draw because their veins can be more difficult to palpate. Excessive probing by the phlebotomist may: Release some tissue clotting factors
What percentage of water in a human is found within the cells? 60%
What is the guideline for the use of gloves when performing a skin puncture? Gloves must be changed between patients
What make veins different that arteries? Veins have one-way valves
True or False: Arteries carry blood to the heart? True
True of False: Plasma does not carry fibrinogen False
True or False: If a timed glucose is collected too early; the results could be falsely elevated. True
If a phelbotomist notices a patient eating during a Glucose Tolerance Test the correct procedure would be to: Contact the physician to determine if the test should be continued
True or False: During phenylketonuria (PKU) screening you should touch the filter paper directly to the puncture site. False
When using Gel Separator, Red, Light Blue and Green vacuum tubes, the proper order of draw would be: Red, Light Blue, Gel Separator, Green
When performing capillary puncture on neonates, the following orders of the collection is mandated, when dealing with Chemistry, Blood Bank, Microbiology, and Hematology: Hematology, Chemistry, Blood Bank.
When dealing with forensic samples, the "Chain-of-Custody" would include: Documentation of each person who handles the specimen
True/False: Bilirubin and Carotene must be protected from the light, immediately after collection? True
A phlebotomist was scheduled to collect 2-hour GTT at exactly 9AM. At 9:15AM the phlebotomist realizes that the specimen has not yet been collected. What is the appropriate course of action? Collect the sample as soon as possible as note the collection time on the tube and laboratory slip.
True/False: Cold agglutinins and cyrofibrinogen are not to be collected at 37 degrees Celsius? False
Centrifuges should be checked on a regular maintenance schedule using a tachometer that registers Revolutions per minute(RPM)
_____ is not an acceptable form of identification with the exception of a patient with severe burns or patient in isolation? Patient name card on bed or door
When filling glass capillary tubes, follow the OSHA recommendation: TO use glass capillary tubes wrapped in puncture-resistant film
True/False: The best way to assure a good blood flow with less injury to the tissue is to perform the heelstick at the same site as previous heelstick False
Which artery should be used when performing an arterial puncture? Radial
True/False: Amylase need not be transported in a mixture of ice and water? True
What is not standard equipment when performing an arterial puncture for blood glass? Tourniquet
If no other site is available it is permissible to collect from an arm with and IV line provided that: The sample is collected below the IV line
When collecting blood for trace metal analysis, which of the following must be observed Avoid the use of an anticoagulant that binds metals
A hemolyzed blood sample would have the greatest impact and cause elevated levels in: Potassium, Iron, and Magnesium
True/False: Articles removed from patient in reverse isolation room need not be double bagged? True
Patient scheduled for 3-hour GTT wants to know when his final specimen is collected. Fasting specimen was collected at 0700, a patient finished glucose solution at 0710. Finally specimen would be collected at: 1000
When preparing a patient for a glucose tolerance test, the patient should not: Fast for more than 14-hours before the test
True/False: Is it mandated that the urine sample should always be the second voided of the day in order to reduce contamination, when properly instructing the the patient to collect a mid-stream urine? False
A preservative used in 24-hour urine collection that will interfere at least with the dipstick analysis and other urine chemical tests is Boric Acid
Instructions for a 24-hour urine collection would indicate the starting time of collection and ending time. This means that: The patient voids into the toilet and starts the timing with an empty bladder collecting all subsequent samples
A blood sample tested for liver enzymes showed an elevation of all liver enzymes except lactated dehydrogenase (LDH). This lower result may have been the result of: Refrigeration of the blood sample
If the phelbotomist were unsuccessful upon a first attempt to collect a blood specimen, the next step would be: To ask the patient if the are willing to allow the phelbotomist to perform a second attempt
What is the appropriate procedure for tourniquet use? Tourniquet must be wiped with 70% alcohol between patients
The action of Sodium Polyanethole Sulfate (SPS) as an additive to blood culture containers includes: Complement inhibition
The best marker to insure the completeness of a 24-hour urine collection would be: 4-aminobenzoic acid levels
of the following anticoagulant, Heparin, EDTA, Sodium Citrate, and Potassium Oxalate, which does not bind calcium? Heparin
True/False: The antiglycolytic agents, Sodium iodoacetate is preferred because it does not interfere with urease and allows the same blood sample to be tested for Blood Urea Nitrogen (BUN)as well as glucose True
True/False: From the standpoint of patient safety, is per-labeling the vacutainer tubes before collection a dangerous practice? True
Out of Sodium Fluoride, Potassium Oxalate, Thrombin, and Sodium Citrate, which additive is a true anticoagulant? Sodium Citrate
When preparing a patient's arm for a blood culture collection: Use iodine first ONLY if the patient is not allergic to it
When preforming a capillary puncture on the fingertips the phelbotomist must insert the lancet _______ to the the fingerprint Perpendicular
What type of bandage is part of the standard protocol when doing a bleed time? Butterfly
When collecting blood using a syringe,samples should be placed into the Blue, Lavender, and Red tube in the which order? Blue, Red, Lavender
The outer layer of the heart is the: Epicardium
A platelet count of 650,000 per cubic millimeter is termed Thrombocytosis
A phelbotomist with 6 collections orders for patient in the hospital receives handwritten laboratory order for a STAT glucose after only completing the fourth phlebotomy. The phlebotomist should: Collect STAT glucose, deliver it to the laboratory, then return to perform the other 2 collections.
Point-of-care testing (POCT) occurs: (A) At the patient's bedside (B) In the Emergency Department (C) In patient's home
Quality control for POCT must be performed: Each day of use
Special considerations for phlebotomy on an elderly person would most likely include: Decrease the angle of penetration of the venipuncture needle
A body fluid that should be protected from light before analysis for bilirubin is: Amniotic Fluid
Skin puncture on an infant should done on the medial and lateral plantar surface of the heel to avoid injury to the: Bone
Veins Carry ___ to the heart Deoxygenated blood
When collecting blood from an arterial blood gases (ABGs), it is not necessary to pull back on the plunger of the syringe because: Arterial blood is under pressure from the contraction of the ventricles
A plasma protein that is not present in serum is: Fibrinogen
A specimen for a peak Gentamicin level should be collected: 30 to 60 minutes after administration of the drug.
If a patient indicates that he/she is not fasting, the phlebotomist should: Ask the patient's nurse if the sample should be collected at this time
When collecting a specimen for slides for a CBC, EDTA, Heparin, and Sodium Citrate Microcolletion tube. Which specimen should be collected last? Heparin microcollection tube
During a venipuncture procedure, place the phlebotomy tray: Within easy reach on the bedside table
Blood samples collected on filter paper for newborn screening test should be hung to dry to avoid: Concentration of the blood towards one end of the filter paper
Chain of Custody protocol must be followed when collecting a forensic sample to ensure that: The integrity of the specimen is accounted for
Blood specimens collected for carotene analysis should be: Protected from the light
Blood specimens collected for Prothrombin Time testing must be analyzed within: Within 24 hours of collection
When collecting blood for plasma renin activity testing, the blood must be transported: In ice water
The right ventricle of the heart pumps blood into the: Lungs (Pulmonary Veins and Arteries)
Leukocytes are responsible for: Defending the body against bacteria and viruses
The appropriate course of action for a STAT order is: To send the tubes to the laboratory immediately upon collection
A fingerstick sample for hemoglobin must be collected from a patient whose middle finger is broken and bandaged. The next best choice for fingerstick is the : Ring Finger
When testing for PT with a point of care instrument, the on-board control (OBC) will: Be accepted by a bar code range
A patient who has had a mastectomy cannot have blood collected from the arm on the same side as the mastectomy due to: Lymphedoma - Swelling lymph nodes causing infection
All the testing on cerebral spinal fluid (CSF)sample should be performed within 1 hour of collection because cytolysis is dependent on: Temperature
A phlebotomist used a vacutainer system to collect blood specimen for the following test: CBC, PT, APTT. OSHA blood-borne pathogens standards state that: Both the needle and holder must be discarded together
Collecting blood from a vascular access device can result in: Colonized bacteria that accumulate around the line can be pulled into the line when used for a blood collection
A patient has an unsuitable antecubital vein. The next best choice to use for phlebotomy would be the: Dorsal side of the hand
The left ventricle pumps blood into the heart itself and into the circulation via the: Aortic Artery
The principal component of plasma is: Water
A patient seeks care at the ER with a temp of 101. A thorough history and physical exam revealed no cause for patient increase temp. Blood culture specimens should be collected: 2 Blood Cultures at intervals of 45-60min, 2 more at 24-48 hours.
Fasting Urine Specimen is: The second voided urine specimen of the day
An activated partial thromboplastin time (APTT) and factor VIII assay are requested on a patient with hemophilia. The appropriate course of action is to: Hold pressure on the collection site for 15-20 minutes.
When obtaining a routine blood sample and a vein is not evident, a blood pressure cuff may be used at the following level: 60-80
Removal of more than 10% of an infant's blood volume at one time may cause: Cardiac Arrest
During a trail in which forensic samples were used as evidence, it was noted that method validation for linearity limits were not performed for the drug-base testing. The evidence is: Unacceptable due to questionable linearity limits.
A blood sample for carotene analysis should be labeled and: Placed on ice
When a patient seeks care at the ER because of complaints of chest pain, acute myocardial infarction (AMI) specimens measuring cardiac markers must be collected: When the patient arrives, as well as 2-4, 6-8, and 12 hours later
A specimen for a cold agglutinin analysis was collected and placed in a 37 degrees Celsius incubator. The specimen is unacceptable because: The sample should have been prewarmed for 30 minutes
Specimens for daily chemistry testing were placed into the centrifuge. Upon starting to spin, the centrifuge began to shake. This could be due to: An imbalance of tubes
The best way to prevent mislabeling of tubes is to: Label blood tubes immediately after collecting.
Requirement for personal protective equipment (PPE), chemical hazards, reactivity and health hazards are found in: Material Safety Data Sheets (MSDS)
The phlebotomist must select the appropriate method of obtaining a blood sample after considering the patient's: Age and sample requirements
When preparing to collect a sample for an arterial stick the radial artery can be recognized by: It's Pulse
If a sample is delayed en route to the chemistry laboratory, the glycolytic action of blood cells will primarily affect tests for:` Glucose, Phosphorous and Enzymes
The appropriate anticoagulant used to coat a syringe for collecting an arterial blood gas is: Heparin
A patient in the ICU had indwelling lines for fluid and medication. A chemistry panel was ordered. The correct procedure for collecting blood from an indwelling lines is: To discard the first 5 mL
A sample was collected 24 hours ago in a red-topped tube and sent to the Chemistry Laboratory for testing. This morning the physician requested that a manganese test be added. This trace metal: Is stable at room temperature for 7 days
A specimen that was difficult to collect was sent to lab for APTT and the results were prolonged. The patient was not on medication. A repeat sample was collected and results were normal. A possible explanation for the first abnormal results may be: Under-collection of first tube, which causes excess anticoagulant
A patient in the ICU is infected with methicilin-resistant Staphylococcus aureus (MSRA). The proper PPE to be worn when collecting blood from this patient is: Gown and Gloves
A patient is scheduled for a 2 hr GTT drinks the glucose beverage and complains of feeling nauseated. The patient vomits 75 minutes into the test. The phlebotomist should: Stop the test, it is complete
A patient is being monitored for diabetes. While hypoglycemia is diagnosed with a fasting blood specimen, diabetes is monitored with a: 2 hour Postprandial Blood test
A patient needs a urine test for a routine drug screen but is unable to provide a urine sample. The patient is instructed to drink up to 24 fluid oz of water in 2 hrs. Another sample is obtained but it is insufficient in quantity. The lab should: Discard the urine sample and cancel the test.
To best preserve the urinary sediment in a 24 hr urine specimen the preservative of choice are: Boric acid and Thymol
For 24-hour urine specimen to be handled appropriately it should include: The total volume of urine collected
A sample collected by syringes for coagulation testing should not be placed into a vacutainer by piercing the cap because of: Hemolysis of the RBCs
When collecting blood form adolescents the phlebotomist should: Answer all questions that adolescents might ask
Contaminated sharps must be placed in a puncture resistant container that displays: Bio-hazard symbol
A patient comes to the outpatient phlebotomy area to have blood collected. The patient is on AZT, and the test ordered is a CD4. Then phlebotomist assumes the patient is HIV infected and should: Practice standard procedures routinely used for collecting blood
True/False: Maintaining frozen specimen storage records could be an application of bar code utilization in the post-analytical phase? True
A patient's result were abnormal for the following test: Potassium, Calcium, Uric Acid, and Bilirubin. It was noted that the sample was collected by finger stick. A possible source of error is: Using Betadine to clean the site
NCCLS recommends when performing a heelstick on a newborn, the site be warmed for 42 degrees Celsius for 3 minutes
The best vein for venipuncture is the: Median Cubital
The trough value of a drug is collected: Prior to the patient receiving the drug