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Phlebotomy Practice

QuestionAnswer
A phlebotomy technician is performing for a patient who has a wound infected with MRSA and has been placed in isolation. Which one of these actions should the technician take once the procedure is complete? The technician should remove and dispose of the gown BEFORE leaving the room.
A phlebotomy technician is preparing to glucose monitor quality control record. Which of the following information should the technician include in the quality control record? Date of battery change.
A phlebotomy technician is performing a blood alcohol test. Which of the following antiseptics should the phlebotomist use? Chlorehexdine gluconate
While a technician is using a centrifuge, the device catches on fire. The fire is identified as a? Class C. Class C involves electrical fires from appliances, wiring and electronics.
Which of the of following is the current procedure for medical professionals performing CPR on an infant? MP should use two fingers to compress and deliver 30 rapid compressions at a rate of 100-120 compressions per minute. (1.5 inches deep) followed by two rescue breaths.
A technician finishes performing a blood draw in an isolated room. Which of the following PPE should the technician remove first? Gloves. They are the most contaminated piece of equipment. Remove the most contaminated pieces first.
A technician observes a glucometer reading of 250 mg/dL. A second test returns a reading within the expected reference range. Which of the following circumstances could have caused the first result to be inaccurate? Too much blood was used. Too much blood can cause high glucose levels readings.
A technician experiences a needlestick injury while performing a draw. They are at greater risk of which blood borne pathogen? Hepatitis B. The risk of infection is between 6%-30% according to the CDC.
Which of the following actions should a CPT take when performing a blood culture collection? Scrub the site with isopropyl alcohol for 30 secs. using a back and forth method/
A CPT is preparing to perform a venipuncture for a patient who has pneumonia. Besides gloves, which of the following PPE should the technician use? Face Mask. Wear a PPE for droplet precaution, such as pneumonia.
When testing a pt for STREP. A CPT should implement which of the following types of transmission-based precaution? Droplet. The CPT should use the appropriate PPE for aliments that are spread by large droplets. Such as a face mask.
A technician is educating a pt about a 24-hr urine collection. Which of the following instructions should the technician give to the pt? The pt should use the second void of the day to begin a 24 hr. urine collection. The exact time should be labeled on the container label.
A CPT is preparing to collect specimens to determine a pt's peak and trough levels of a medication. Which of the following actions should the technician take? The technician should verify the time of drug administration with the charge nurse,
A CPT is preparing to draw a pt's blood when the pt informs them that they are taking warfarin. The technician should identify the results of which of the following tests is affected by this medication PT/INR. Take a drug such as warfarin can effect PT/INR levels.
Which of the following types of urine specimen should a pharmacy tech instruct a pt to collect for a pregnancy test? First-morning. This is because the first morning void is the most concentrated. This is good for detecting hCG
A CPT is positioning a pt for a venipuncture. To prevent reflux or back-flow, the tech should instruct the pt to move their arm into what position? Fully extended in a downward position.
Within what amount of time should a CPT collect a newborn blood-spot test screening card? Within 72 hrs.
A phlebotomy technician should invert anticoagulant tubes to prevent the following complication? Hemolysis
What is a potential consequence of a phlebotomy technician mislabeling a blood bank specimen? Transfusion reaction.
What is an additive used to prevent the breakdown of glucose? Sodium fluoride
According to OSHA standards, how often should a CPT wash their hands with soap and water? After every third use of hand sanitizer.
A CPT is using an evacuated needle holder and blood collection tubes to collect blood from a patient. What action should the technician take? Push the first collection tube gently into the holder.
What tubes are the correct draw order? Green Lavender and Grey
What procedures should a CPT follow COC guidelines? Paternity testing Blood alcohol Medilegal matters
How often should a technician run quality control tests on POC testing instruments. Daily
A tourniquet should be left on a PT's arm for how long? No longer than 60 seconds
What regulations ensure that a CPT is proficient to preform job duties and responsibilities? CLIA
A CPT is selecting a site to collect a blood specimen from a PT. After applying a tourniquet, the tech sees no apparent veins to use. What should the tech do? Have the pt dangle their arm for 1 to 2 mins.
A CPT is assembling the equipment they will need for collecting donor units of blood. What needle size should the tech collect? 18-gauge
To prevent hospital-acquired infections, a technician should clean items that have been contaminated with what? 1:10 parts water and Sodium Hypochlorite.
A CPT should transport a semen sample at what temperture? 36-38 degrees Celsius 96.8-100.4 degrees fahrenheit
A tech is using a syringe method to collect a blood culture set, a PTT and a CBC test. What is the proper draw order? Anaerobic bottle, aerobic bottle , light blue top and EDTA (usually lavender)
A tech is preparing to process a WBC differential test, testosterone test and a glucose test. What action should the tech take? Prepare a slide from a lavender top tube and centrifuge a red top tube and a grey top tube.
A tech is performing a two sets of blood cultures for a patient. What action should the tech take? Collect one set from the pt's left arm and one set from a different site on the same arm. This will provide the most accurate result.
A CPT tech is collecting a sample for cholesterol, troponin and HDL blood results. What department does it go to? Chemistry.
A CPT is preparing to perform a venipuncture for a pt who has pneumonia. Besides gloves, what PPE should the tech use? Face mask. Droplet precaution.
A CPT is preparing to collect blood from a pt who has experienced syncope during previous draws. What action should the tech take? Have the pt lay in a supine position.
A CPT is preforming a venipuncture for on a pt who has an IV in both arms. What action should the tech take? Ask the nurse to turn off the IV for 2 mins.
A CPT is informing a pt about the procedure for collecting blood cultures. What information should the tech include? "I will swab the area twice to make sure it's sterile." The area should be swabbed twice, once with isopropyl alcohol and once with chlorohexidine gluconate.
A CPT accidentally punctures a pt's artery during a venipuncture procedure. What action should the tech take? Apply pressure to the site for 5 mins or until the bleeding stops.
A technician is using povidon-iodine during a capillary specimen collection. What is the outcome of this? Increased potassium level. The use of povidon-iodine can contaminate the site, can also cause falsely elevated potassium levels.
A tech is performing a venipuncture for a lipid profile, WBC and a clotting time test. Which tube should the tech use? Light blue =clotting time test SST = Lipid profile Lavemder= WBC
A pt sits down for a venipuncture in an outpt setting. They roll up their sleeve and extends their arm. The pt turns their head away and says, "I don't want my blood drawn." What is a good response for this statement? "May I please draw your blood?" If the pt is implying consent, the tech should confirm it.
A tech is performing a venipuncture for a potassium test, CBC and glucose test. The tech has left the tourniquet on for 3 mins. What is the outcome of this? High potassium levels. Leaving the tourniquet on for longer than 1 min causes hemolysis.
A CPT is performing a hand venipuncture on a pt who has small veins that are difficult to access. What equipment should the tech use? 23 gauge winged infusion set.
A tech is using performing a venipuncture on a pt. When the tech inserts the needle, the vein collapses. What caused this to occur? Applying the tourniquet on too tightly. Having the tourniquet on too tightly can decrease blood flow thus causing a vein collapse.
What action should the CPT take when locating a vein using the warming technique? Encase the warm towel in a plastic bag. This is to maintain the towel's temperature.
A CPT is collecting a peripheral blood smear from a pt. The tech should identify that this collection technique is used for what test. WBC differential. This is the prefered collection
For what reason should a CPT examine the AC in both of a pt's arms? The median cubital could be more accessible in one arm than the other.
A CPT is educating a pt about the at-home collection of a semen specimen. What statement indicates the pt's understanding of the procedure? "I will collect the specimen in a sterile container and return it to the lab within 1 hr."
A CPT is collecting a blood specimen from a pt. What is a good technique to anchor the vein before insert the needle? Use the thumb to anchor the vein 5 cm (2 in) below the puncture.
A CPT should identify that what color signifies a health hazard in the National Fire Protection Association 704 marking system? Blue.
A CPT is collecting a blood specimen from a pt to measure the trough level of a medicine. The tech should collect the specimen at what time? Within 15 mins before the next scheduled dose. The trough level is the lowest concentration of medicine in the pt's blood.
A CPT is transporting a blood specimen to a lab. What action should the tech take? Place the specimen in a lockable container to avoid spills during transport.
After verifying a pt's identity , the tech sees that the pt's lab results are ready. What action should the tech take? Inform the pt to contact the ordering provider to obtain the results.
What tube should a tech use first when collecting from a dermal sample? Lavender top. This is because it minimizes platelet clumping and microclot formation.
What is the best method for a tech to collect a blood specimen from an older adult pt who has fragile, easy to collapse veins? A syringe and butterfly assembly and transfer to an ETS tube/
A tech is preparing to draw a peak level for a medication that was administered orally to a pt. After verifying when the pt received the medication, how long should the tech wait prior to collecting the draw? 2 hrs after administration. This is to ensure that the medication is not at a toxic level.
A tech has a requisition form to perform a chromosome analysis for a pt. The tech should use what tube that contains what additive? Heparin. Heparin is an anticoagulant that produces a plasma specimen for chromosome analysis. Think of the chromosomes themselves and what they look like.
A tech is preparing to obtain a blood specimen to determine a pt's sodium level. What colored tube should the tech use? Green. Green tubes contain heparin, which aids in determining sodium levels.
A tech is preparing several specimens for transport to the facility's lab. What specimen should the tech protect from bright light by placing it in an amber or brown bio-hazard bag? Vitamin B6. B6 and Bilirubin is photosensitive.
A tech is collecting blood from a pt for donation. The collection bag only fills halfway and the vein collapses. What action should the tech take? Use a new collection bag to draw a new unit of blood. This is because collection bags have a specific amount of the additive citrate phosphate dextrose to prevent coagulation.
A tech is obtaining a blood culture specimen from an adult pt. What action should the tech take? Withdraw the blood into a sterile safety syringe. This is after obtaining a blood culture specimen.
A tech has a requisition form for a series of tests on a pt's serum. The tech should use what tube that contains what additive? Thrombin. This additive aids in accelerating the clotting process for serum specimen. Thrombosis = Clotting.
According to standard precautions, a tech should take which of the following actions when shipping specimens to a reference lab in hot weather? Place the specimen in a box with cold packs and a biohazard label.
A tech is reviewing a lab test requisition form before obtaining blood specimens for a pt. What action should the tech take prior to the venipuncture? Check the requisition form for duplicate test order.
An unconscious pt is brought to the emergency room and several blood tests are ordered. A tech should collect blood because what type of consent has been given? Implied consent. Implied consent is given even when the pt is unconscious.
A tech is performing a total cholesterol POC test for a pt. What finding should the tech immediately report to the provider? 300 mg/dL. This is higher the cholesterol reference range which is 140 mg/dL to 200 mg/dL
When should a tech perform external lipid controls for quality control on a CLIA-waived glucose POC test? When a new lot number or kit is opened.
A tech is using a glucose monitor for POC testing of a pt who has been fasting for 12 hrs. What result should the tech notify to the provider? 130 mg/dL This is above the normal reference range which is 70 mg/dL to 110 mg/dL
A tech is reviewing a lab requisition before obtaining a blood specimen from a pt. The tech should verify that the tech includes what? A specimen identification code.. This includes the pt's full name and DOB.
What action should the tech take after collecting an ammonia specimen? Place it in an ice slurry. Chilling the specimen slows down metabolic processes and protects the analytes.
A tech should identify that the order of draw for capillary collections is different from venipuncture because? An increased rate of coagulation. Thromboplastin is released when the skin is punctured causing blood to clot more quickly.
A tech is preparing to enter into a pt's room to collect a blood specimen. What action should the tech plan to take? Communicate name and department affiliation to the pt.
Prior to transport, what specimen should a tech place in an ice bath within 30 mins of collection? Arterial blood gas, This is to stop metabolic activity of the blood cells.
A tech is preparing a peripheral blood slide from a capillary puncture. What action should the tech take? Touch the slide to the second drop of blood.
For an older adult pt who has difficult to access veins, what veins should the tech select for venipuncture? Dorsal (hand) veins.
A tech is collecting a urine specimen from a pt from a pre-employment drug test. What action should the tech take? Make sure the container has at least 45 mL of urine
What action should the tech take when performing a venipuncture using a Evacuated Tube System? Position the needle at a 30 degree angle in the same direction of the vein with the bevel up.
A tech enters a pt's room to obtain a stat specimen. The pt's provider and nurse is speaking with the pt. What action should the tech take? Introduce self to the pt and the health team members.
How many inversions does a lavender tube need Eight
A tech is collecting blood specimen for a blood assay. What tube should the tech fill first? Yellow-topped tube. This is to decrease the probability of a bacterial contamination.
A tech enters a pt's room to perform a venipuncture and notices that the pt is asleep. What should the tech do? Wake the pt to perform the draw. This is verify the pt's identity and obtain consent.
A tech is collecting a urine specimen for a pre-employment drug screening. What finding should indicate that possible tampering has occured? The temperature of the specimen is 30 degrees C. (86 degrees) It is below the expected range of 32 degrees to 38 degrees. (90-100 degrees F)
What action can result in a grossly hemolyzed specimen? Using an incorrect needle gauge. If the tech uses a large gauge needle to draw from a vein with a small lumen, it can result in a hemolyzed specimen.
A tech has a requisition for collecting fasting blood glucose albumin specimens from a pt. What action should the tech take before collecting the pt's blood? Make sure the pt fasted for 8 to 12 hrs.
A tech should identify that what is one of the Joint Commission's National Patient Safety Goals? Identify pts correctly. Techs should use at least two IDs when verifying pt identity.
Why should a tech document the total volume of blood drawn from a pt? To determine if the pt is at risk for iatrogenic anemia.
What does "SD" mean? Standard Deviation.
A tech is collecting a unit of blood from a donor. What action should the tech take? Instruct the donor to open and close their fist during the procedure.
What condition does emergency first aid treatment include maintaining an open airway, controlling bleeding and keeping the pt warm until help arrives? Shock.
A tech is working with a pt who has Mycobacterium tuberculosis. What transmission precaution should the tech use for this pt? Airborne. The tech should follow airborne precautions to prevent the transmission of small particle residue. Conditions that require this precaution include: Tuberculosis, Varicella and Measles.
A tech is preparing to collect a blood sample from a pt who states that they are HIV positive. What action should the tech take? Perform the venipuncture. Standard precaution should be followed for all specimen collected.
A tech is removing a bag of contaminated items from a collection area. What action should the tech take to properly dispose of the items? Place the bag inside of another biohazard waste bag outside of the room. This technique is called double-bagging.
What action should the tech take BEFORE leaving the pt's room? Initial and mark the date and time the draw was completed.
A tech is preparing to obtain a blood specimen from a pt for thyroid studies. What colored tube should the tech use? Speckled. (T3, T4, and TSH)
A tech is preparing to perform a venipuncture on a pt who has small, rolling veins. What equipment should the tech use? Winged infusion set. It is designed for pts with small, rolling veins.
Why should a tech centrifuge a serum specimen before transporting it to an reference lab? Cells must be separated from the serum. If it is not separated, the cells will continue to metabolize into the serum.
After a tech performs a heel puncture for a neonatal screening, what is the correct procedure for collecting the blood? Saturate each circle with one drop of blood. The tech should wipe away the first drop of blood and use the drops onward to saturate the circles.
What action should a tech take when preparing peripheral blood smear? Place a 1 mm drop of blood one-half inch away from the edge of the slide.
A tech should identify that what is first step in the blood collection procedure? Test requisition, The tech must ensure that the provider has ordered a test to be done.
A tech obtains two readings 17 mg/dL when performing a glucometer test for a pt. What action should the tech take? Perform a set of liquid controls. The tech should preform quality control testing to verify that the glucometer is working properly
What action should the tech take to verify the quality of venipuncture supplies before beginning a blood draw on an adult pt. Inspect the integrity of the needle's seal to ensure the sterility of the needle.
The Joint Commission recommends using the pt's full name and what other piece of information to ensure accurate inpt identification? Medical record number.
A tech is instructing a pt about how to collect a fecal occult specimen. What instruction should the tech include? Avoid taking ibuprofen. Ibuprofen can cause a false-positive result.
A tech is preparing to obtain a blood specimen from a pt for an ESR test. What color top should the tech use? Lavender
A tech is preparing to store a blood specimen. What temperature should it be stored at? 2-8 degrees C. or 35.6-46.4 F
A tech is preparing to draw a blood sample from a pt for a Glucose Tolerance Test and notices an empty breakfast plate on a bedside table. What action should the tech take? Ask the pt when they last ate or drank/.
A tech is informing a pt about how to enter a basal state for a blood collection. The tech should inform the pt to not consume food for how long prior to blood collection? 12 hrs.
A tech collects multiple specimens from a premature infant. The infant is at risk for? Iatrogenic Anemia
A pt states that they are a "difficult draw" and requests a skin puncture. The test order is a PTT. What should the tech perform? A syringe draw is transferred into a light blue vacuum tube .
A tech is instructing a pt about proper semen specimen collection for determining fertility potential. What instructions should the tech include? Protect the specimen from exposure to bright light.
A tech is collecting capillary blood drops on a filter paper card to screen a newborn for phenylketouria. What action should the tech take? Apply blood to the printed side of the filter paper
A tech is using a POC test system to determine a pt's WBC. What result should the tech immediately report to the provider? 1.8 mm3. It is outside the norm range for WBC which is 4.4 to 11 mm3.
A tech is performing a heelstick to obtain capillary blood for testing a newborn''s bilirubin level. What action should the tech take? Use an amber colored microcontainer. Bilirubin + Jaundice.
A tech is preparing to use an ETS to obtain a venous blood specimen from a pt. The tourniquet is in place and the tech has cleansed the site. What should the tech do next? Ask the pt to make a fist. This is to make the vein more prominent.
A tech is preforming a venipuncture for a bilirubin test, a cold agglutinin titer, a CBC and PTT test. What tubes should the tech use? One light blue tube = PTT Two serum tubes = bilirubin (must be protected from light) and CA. Lavender tube = CBC
A tech is performing a venipuncture on a pt's deep MC vein. What is the correct method of withdraw? Withdraw with the bevel up at 25 -30 degrees. The deeper the vein, the higher the angle.
A tech is preforming a capillary collection for CBC, FSH and electrolyte tests. Which tubes should the tech use? Lavender microcontainer, green microcontainer the red microcotainer.
What do you do if a pt shows signs of syncope? Stop the draw, apply pressure to the puncture site and get the pt laying down or in an reclining position.
What do you do if a pt looses consciousness before, during or after a venipuncture? Stop the draw and monitor the pt's breathing. Do not leave the pt until they have fully recovered.
How to perform CPR on an adult. Give 100 chest compressions per minute at the sternum. 1.5-2 inches in depth.
Techniques to find a vein. Applying a tourniquet. warming the area, wiping it with an alcohol wipe or lowering the limb below the level of the pt's heart.
A tech has received a needlestick injury while performing a venipuncture. What information should they include in online sharps injury log? The department where the injury occurred.
How long should a tube be pre-warmed in an incubator prior to collecting a warmed specimen, such as Cold Agglutinins? 30 mins
Which cleansing agent is typically not used on venipuncture for the collection of blood cultures or blood alcohol specimens? Isopropyl alcohol
What are the smallest veins in the human body? Venules
What is the smallest gauge needle used for venipuncture? 18 gauge
What is not a standard vacuum tube size? 20 mL
When performing quality control checks, tubes should be discarded under which circumstances? The stopper has small cracks.
How long should you observe the site prior to bandaging? For 5 secs
When washing your hands, why is it important to stand back from the sink? Because the sink might be contaminated.
Which antiseptic should not be used on pre-term infants or those under 2 months of age? Chlorhexidine gluconate. This is because this can lead to chemical burns on the infant.
What field is unnecessary on an infant's blood sample label? Infant's first name. On an infant sample, the infant's last name is included and the mother's name is also included; this is also true for gender. Phlebotomist identification is always required.
Which test requires the collection of both blood and urine at specific intervals? Glucose Tolerance Testing. This is to test for Gestational Diabetes
For adult patients, what is the maximum length lancet that should be used for a fingerstick? 2.2mm
If you experience a patient pumping their fists during a blood draw, what can you do? Politely explain to them that this can elevate ionized calcium and potassium levels and request that they stop.
During blood coagulation, what is formed? A fibrin clot. Hemostasis is comprised of 3 steps: vasoconstriction, platelet plug formation and blood coagulation. During blood coagulation a fibrin clot is formed to function as a "plug," which prevents the further release of blood.
The veins of patients undergoing chemotherapy are especially challenging for venipuncture due to what characteristics? They are smaller, rolling and often time sclerosed
Under what circumstances should a tube be pre-labeled? Never. Pre-labeling should never be done. CLSI standards indicate that pre-labeling is not acceptable and labeling should always be done at the point of the draw in the presence of the patient.
After what action is it acceptable to not wash your hands?aat Infection control requires proper hand hygiene, which outlines hand washing before and after patient contact, before and after putting on or taking off gloves, before leaving the laboratory and before going to the restroom.
How many unsuccessful attempts at venipuncte are allowed before seeking additional assistance is required? Two.
For elderly patients, in what circumstances would a capillary puncture be performed rather than venipuncture? The patient has a tendency to form clots.
What test requires that it be chilled in ice right after collection? Tests that require immediate chilling in crushed ice or an ice water mixture include arterial gases, ammonia, lactic acid, pyruvate, and ACTH.
What may occur if a trniquet is left on too long? When a tourniquet is left on longer than recommended, it generally leaves no lasting physical damage, redness and skin indentation at the tourniquet site. Sometimes, it can result in pain and discomfort, extremity edema, extremity color or numbness
What is the maximum depth a heel stick should penetrate? 2.0mm. An infant's capillary bed is located 0.35 to 1.6 mm beneath skin surface. It's heel bone may begin as early as 2.6 mm below skin surface. For this reason, the maximum depth of a heel stick should be 2.0 mm.
In what location are nutrients and gasses exchanged in the body? In the capillaries
Which color tube needs to be filled completely? Blue. Blue, black and green tubes should be filled completely to the fill line. Red and yellow/gold must hold enough for the test required and mint green, lavender, and gray tubes must be at least half full.
What can be done to make drawing easier on a patient with rolling veins? One can anchor the veins
If an intoxicated person refuses a blood sample to determine the presence of alcohol or drugs at the request of a police officer, what is the best course of action? Request that the officer get a warrant.
Where do red blood cells originate? Bone marrow
An NP culture swab is collected to help diagnose Whooping Cough
The first stage of homeostasis Vascular stage
The pulmonic valve is situated between what? Right ventricle and pulmonary artery
What is the oxygen carrying protein in erythrocytes? Hemoglobin
To measure diurnal variation of cotisol hormone what kind of specimen would be required? Timed
The heart disorder characterized by fluid buildup in the lungs Congestive Heart Failure
What causes vacuum tubes to fill with blood? Tube vacuum.
What WBC comprises 40%-60% of the white blood cells? Neutrophils
What needle has the largest gauge? 16-Gauge
Collecting urine by aspiration through the bladder wall Suprapubic
The proper order for doning PPE Gown, mask and gloves
Which test requires a 24 hour urine specimen? Creatnine Clearance
The internal space of a blood vessel is called Lumen
How many inches above the site should the tourniquet be tied? 3-4in
Which body plane divides the body in equal portions? Midsagittal
What organ would a doctor be intested in if he ordered an ALP, AST, ALT, GTT and bilirubin? Liver
Capillary puncture blood most closely resembles what? Arterial Blood
A pad used to correct the patient's clothing is called? Chux
Fluid aspirated from the peritoneal cavity. Ascites
What is the first link in the chain of infection? Agent
How many hours before a blood test should a patient discontinue the use of medications known to interfere with blood tests? 4-24 hrs
How many times should a light-blue tube be inverted? Three or Four.
Hemostasis is defined as _______________. Stoppage of blood
Which blood vessel is NOT part of systemic circulation? Pulmonary artery
A tech is processing a semen specimen. What action should the tech take? Deliver the specimen to the lab within 2 hrs. for optimal results.
Created by: starrytabby