NHA Phlebotomy PT #2

A risk of drawing blood from the basilic vein is possible damage to the:

ulnar artery
subclavian artery
superficial radial nerve
medial cutaneous nerve

Which of the following conditions can be diagnosed by a timed urine test?

bladder cancer
pregnancy
asthma
kidney stones

How long should a patient fast before a 2-hour postprandial glucose test?

6 – 8 hours
10 – 12 hours
14 – 16 hours
Fasting is not required.

What is the purpose of CLIA regulations?

to expand medical services to the underinsured
to improve the quality of laboratory testing
to decrease the number of cesarean sections
to standardize laparoscopic procedures

What must happen before a serum test can be centrifuged?

The sample must be frozen.
The clotting process must be completed.
The plasma must separate from the cells.
The top of the specimen tube must be removed.

Which of the following tests does NOT usually require fasting?

lipid panel
vitamin B-12
HCG
iron

What precaution ensures the accuracy of a fecal test for occult blood (guaiac)?

The patient must stop taking NSAIDs for 7 days before the test.
The patient must fast for 12 hours before the test.
The patient must consume minimal carbohydrates for 24 hours before the test.
The patient must stop taking vitamin C and iron for 7 days before the test.

What is in the buffy coat?

white blood cells and platelets
red blood cells and hemoglobin
plasma and platelets
serum and plasma

What should a phlebotomist use to cleanse a venipuncture site before drawing an ethanol level (ETOH)?

isopropyl alcohol
iodine
benzalkonium chloride (BZK)
hand sanitizer

What duties does a phlebotomist who works in central processing have?

perform all the ordered tests
assign other phlebotomists to requisitions
sort specimens by department and processing requirements
deliver all the test results to each department

What determines whether a test is waived?

The facility where the testing takes place has a quality assurance plan.
The test is easy to perform and has a low risk of error.
The specimen being tested does not need to be centrifuged.
The patient has signed a waiver allowing the test.

Before having blood drawn for a fasting test, a patient informs the phlebotomist that they drank water 2 hours ago. What should the phlebotomist do?

proceed with the ordered lab work
reschedule the testing for a different date
draw the labs but make a note in the patient’s chart
have the patient wait an additional 6 hours

Why are double-voided urine collections done?

Double voiding ensures that the urine is not concentrated.
There are no substances in the first urine to test.
Two different samples are needed.
The patient has trouble emptying their bladder.

At most, how long can blood culture collection bottles be held at room temperature?

1 hour
4 hours
12 hours
24 hours

The prothrombin time (PT) test monitors which medication’s therapeutic level?

heparin
clopidogrel (Plavix)
aspirin
warfarin (Coumadin)

Who is the ADA meant to protect?

people who donate blood
people who visit the dentist
people who work as drivers
people who have disabilities

How often should a centrifuge be balanced?

once a shift
before each use
when it is full
once a day

How long should the skin be scrubbed with a cleanser prior to drawing blood cultures?

15 – 20 seconds
30 – 60 seconds
60 – 90 seconds
2 – 3 minutes

The first morning urine is frequently used for what test?

hemoglobin
cytology
HCG
culture and sensitivity

A patient had a right-sided mastectomy with right axillary lymph node removal during breast cancer treatment 10 years ago. Which arm should the phlebotomist use to draw blood?

use the patient’s right arm
use the patient’s left arm
use either arm
consult the patient’s physician

What can cause a blood sample to hemolyze?

centrifuging the sample before it clots
using improper technique when drawing the specimen
leaving the sample at room temperature for more than 2 hours
freezing the sample before it clots

What must happen for patients’ information to be shared?

The patient must sign a release of information.
A staff person must ask for the information.
A doctor must write an order to allow the information to be shared.
The patient must be discharged.

What is the inner layer of the heart called?

endocardium
myocardium
epicardium
pericardium

Which of the following conditions can be treated with therapeutic phlebotomy?

anemia
polycythemia vera
von Willebrand disease
leukemia

Vein viewers use transillumination to project light onto the skin to identify veins. What component of the blood absorbs the light and makes the veins appear dark?

plasma
platelets
white blood cells
hemoglobin

How long can most plasma and serum in gel tubes be refrigerated?

until the cells clot
up to 48 hours
30 minutes to 1 hour
as long as needed

Where in the body is synovial fluid found?

pleural spaces
lymph nodes
joints
peritoneal spaces

A patient’s blood pressure is 120/80. Which of the following numbers represents the arterial pressure when the ventricles are contracting?

120
80
240
40

Which of the following is the responsibility of OSHA?

to provide health care quality accreditation
to set standards of practice for health care assistants
to provide access to current research in phlebotomy practices
to regulate workplace safety

Which of the following actions will minimize the risk of creating an aerosol?

tipping the tube sideways before pulling off the top
opening the specimen tube top with a forceful tug
holding the tube firmly and twisting the top off
not tightening the top

Which of the following is FALSE regarding blood donation?

If a bag of donor blood only partially fills, a second venipuncture attempt can be performed to fill the bag completely.
Donors must weigh at least 110 lbs and have a hemoglobin level lower than 20.0g/dL.
Citrate phosphate dextrose (CPD) is the additive used in donated blood to prevent clotting and preserve RBCs.
Before an elective surgery that has a risk of blood loss, a patient can donate their own blood in a process called autologous donation.

If blood is pulsing rhythmically into the syringe during a blood draw, what has been punctured?

a vein
an artery
a nerve
a lymphatic duct

Which urine collection technique is done by a physician?

catheterization
clean catch
suprapubic aspiration
random

What law mandates that health insurance providers cover 11 essential health benefits?

the Americans with Disabilities Act
the Health Insurance Portability and Accountability Act
the Patient Protection and Affordable Care Act
the Clinical Laboratory Improvement Amendments

Which skin puncture test should be stored in an amber container?

hemoglobin A1C
bilirubin
CBC
capillary blood gas

Heparin inhibits the action of:

calcium
creatinine
thrombin
glucose

A blood sample is tested for sodium, and a value of 120 mEq/L is returned. What should the phlebotomist do?

send the results to a supervisor
report the finding as normal
manage other tasks already assigned before addressing it
recognize it as dangerously low and report it immediately

T cells and B cells are which type of blood cell?

erythrocytes
platelets
lymphocytes
neutrophils

What does preparation for a hydrogen breath test include?

waiting for 2 hours after the last meal
performing a control test 1 hour before the test
drinking an antibiotic solution
fasting for 8 – 12 hours

What is the Needlestick Safety and Prevention Act?

a law that mandated the use of personal protective equipment
a law that required OSHA to update needlestick safety standards
a law that mandated systems of blood collection that do not use needles
a law that made it the responsibility of health care workers to prevent needlesticks

What component of blood do EDTA and sodium citrate act on to prevent coagulation?

calcium
fibrin
potassium
factor X

The purpose of order of draw is to:

arrange the tubes from smallest to largest volume
prevent additive cross-contamination between tubes
schedule the timing of specific fasting tests
prevent infection

What is a dipstick used for?

collecting urine
chemical testing of urine
measuring the amount of urine in a specimen
transporting urine

How many days is the average life span of red blood cells?

30
60
100
120

Which of the following is the responsibility of the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS)?

to accredit the use of experimental lab testing
to accredit medical laboratories
to accredit medical schools
to accredit educational programs for phlebotomists

A nasopharyngeal specimen is obtained from the:

nose
ear
cheek
back of the throat

During phlebotomy, the phlebotomist realizes they have drawn a tube out of order from the recommended order of draw. What should they do next?

withdraw the needle and tell the patient they will need to come back in 24 hours
discard all tubes and restart the draw
discard the out-of-order tube and draw a discard tube before resuming order of draw
keep the out-of-order tube but label it as “out of order”

What is The Joint Commission?

a private agency that provides accreditation services for many health care organizations in the US
a legal entity that governs standards of care for medical agencies
a government agency that provides accreditation services for many health care organizations in the US
a private agency that develops and implements quality-of-care measures

The specific gravity of a urine sample is 1.045. What can the phlebotomist conclude from this result?

The urine sample is concentrated.
The test is invalid.
The urine sample is diluted.
This result is within a normal range.

Which venous order of draw is correct?

serum, heparin, blood culture, sodium citrate, EDTA
heparin, blood culture, serum, EDTA, sodium citrate
EDTA, heparin, sodium citrate, blood culture, serum
blood culture, sodium citrate, serum, heparin, EDTA

How long should a patient fast before having a fasting urinalysis?

8 hours
10 hours
4 hours
12 hours

Which of the following terms describes the position of the palm relative to the elbow?

distal
posterior
superior
medial

The additive in a tube with a light blue top is:

sodium citrate
silica
heparin
EDTA

What is it called when a patient is injured by the failure of a medical professional to act?

harm
felony
misdemeanor
negligence

How is blood glucose tested outside the lab?

A reagent is added to blood from a capillary stick.
A glucometer is placed on the patient’s finger.
A drop of blood is placed on a test strip in a glucometer.
Blood glucose cannot be tested outside a lab.

The additive in blood culture bottles is:

sodium citrate
potassium oxalate
acid citrate dextrose (ACD)
sodium polyanethol sulfonate (SPS)

What should a patient do before providing a sample of saliva?

avoid NSAIDs
avoid eating, drinking, and brushing their teeth for 2 hours
apply anti-aging cream to their skin
rinse their mouth with antiseptic mouthwash

Which of the following conditions is characterized by a low number of platelets?

anemia
thrombocytopenia
thrombocytosis
hemophilia

Where is a near miss documented?

in the patient’s chart
on an occurrence report
on the staff communication log
in a staff email

The correct order of draw for capillary specimens is:

EDTA/anticoagulant, other additives, serum, blood gas
blood gas, EDTA/anticoagulant, other additives, serum
serum, blood gas, EDTA/anticoagulant, other additives
serum, EDTA/anticoagulant, other additives, blood gas

Which of the following is a quality control measure for a glucometer?

testing its temperature against a control glucometer
changing its batteries weekly to ensure its ongoing operation
changing its sensor monthly to ensure its accuracy
testing it with high and low solutions to ensure it reads within an appropriate range

Which of the following blood components is responsible for fighting infection?

red blood cells
white blood cells
plasma
hemoglobin

A patient informs the phlebotomist that they have a history of syncope with blood draws. What position should the patient be placed in for phlebotomy?

sitting upright
reclined
prone
standing

During a lab draw, a patient begins to have a seizure. What should the phlebotomist NOT do?

Stop the blood draw immediately.
Slowly lower the patient to the floor and turn them on their side.
Hold pressure on the site without restraining the patient.
Place a tongue blade in the patient’s mouth.

What is an example of nonverbal communication?

facial expression
tone
language
volume

When is the best time to collect a sputum sample?

after using mouthwash
after eating a light meal
after vigorous exercise
after waking in the morning

What does an ACT test measure?

blood glucose
clotting time
hemoglobin
blood pressure

The purpose of recommended fill lines on evacuated tubes is to:

ensure proper additive-to-blood ratio
instruct the phlebotomist on when to release the vacuum
collect extra blood to avoid a redraw
be used as a guideline, but underfilling or overfilling is acceptable

A hematoma rapidly develops in a patient’s antecubital space after phlebotomy. What complication should be suspected?

nerve injury
acute arterial occlusion
accidental arterial puncture
deep vein thrombosis

Which of the following directional terms means “closest to the point of attachment”?

distal
proximal
lateral
medial

Which of the following actions is within a phlebotomist’s scope of practice?

administration of medication
obtaining a blood specimen from an IV
performing waived tests
diagnosing a medical condition

Too-frequent blood draws can put NICU infants at risk for _______________.

vitamin B-12 deficiency anemia
iron deficiency anemia
iatrogenic anemia
hemolytic anemia

After a lab draw, a patient continues to bleed from the venipuncture site despite pressure being applied for 5 minutes. What should the phlebotomist do next?

notify a supervisor or the patient’s provider
apply a pressure dressing and discharge the patient
tell the patient this is a normal side effect of phlebotomy
apply a skin adhesive over the wound

Which of the following is a preservative used in specimen collection?

hydrochloric acid
boric acid
citric acid
nucleic acid

Which vitamin is important in blood clotting?

vitamin A
vitamin K
vitamin B
vitamin C

Tiny, flat, red or purple spots less than 3 mm in diameter caused by blood leaking from capillaries into the skin surface are known as:

urticaria
hematomas
petechiae
papules

A phlebotomist maintains eye contact and waits for a patient to finish talking before speaking. What communication technique is the phlebotomist practicing?

questioning
active listening
de-escalation
placating

Why is a blood smear spread thinly on a microscope slide?

to allow the number, type, and characteristics of blood cells to be examined
to detect malaria
to prevent the blood from clotting
to allow the Giemsa stain to be more effective

When is a sealed biohazard bag used?

when a specimen needs to be transported
before a sample has been centrifuged
when a sample needs to be frozen
when multiple tests are to be performed on one sample

Which of the following is a symptom of a nerve injury caused by venipuncture?

muscle twitch
extreme pain or tingling up and down the arm
seizure
shortness of breath

What is collected through a lumbar puncture?

synovial fluid
serous fluid
cerebrospinal fluid
amniotic fluid

If a patient contracts an infection from an inorganic object, what is the mode of transmission called?

biological
direct
physical
indirect

Keeping the contents of an evacuated tube from contacting the needle helps prevent:

an air embolism
an infection
the formation of a hematoma
the reflux of additive into the vein

If a hematoma develops after venipuncture, the phlebotomist should advise the patient to do all of the following EXCEPT:

fold the arm at the elbow
hold pressure for 3 – 5 minutes until bleeding stops
elevate their arm over their head
apply ice to the puncture site

A patient is in the hospital for a large burn covering most of their left arm and hand and has an IV in their right antecubital space. Where should the phlebotomist draw labs from?

proximal to the IV on the right arm
distal to the IV in the right arm
the left antecubital space
from the IV

What type of swab is used for a rapid strep test?

throat
buccal
oral
nasopharyngeal

Which of the following risks should the phlebotomist be aware of when drawing blood from a paralyzed limb?

increased clotting time
increased sensitivity in underlying nerves
decreased blood flow
presence of spasms or tremors

When a phlebotomist inserts the needle for a draw, a hissing sound is noted and no blood flows into the tube. What is most likely the problem?

The needle is too deep.
The bevel is against a vein wall.
The bevel is partially out of the skin.
The bevel is partially out of the vein.

What type of infection control technique is being used when wearing gloves to perform a venipuncture?

disinfected
aseptic
sterile
clean

During phlebotomy, a patient’s vein unexpectedly becomes invisible once the tube vacuum engages, and blood flow stops. All of the following are troubleshooting actions the phlebotomist can take EXCEPT:

using a larger-volume tube
adjusting or reapplying the tourniquet to increase vein pressure
applying pressure to the vein with a finger several inches proximal to the needle site
removing the tube and returning it for a second attempt once blood flow resumes

What condition can be detected with an acid-fast bacillus test?

hormone imbalance
tuberculosis
diabetes
occult blood

Which of the following is an example of ensuring electrical safety?

nailing cords to the floor
discarding cords that are damaged or frayed
covering table lamps with lampshades
unplugging any equipment not in use

A tourniquet is used to:

anchor veins
prevent excessive blood loss during venipuncture
slow the return of venous blood to the heart
mark the chosen venipuncture site

Which size needle would be best for phlebotomy from the scalp veins of a premature infant?

15-gauge
21-gauge
22-gauge
25-gauge

What is the appropriate first action for a membrane exposure?

alert the physician
dispose of the sample
call 911
flush the area for 10 minutes using water or saline

Which additive is correctly paired with its purpose?

anticoagulants: prevent breakdown of blood glucose
dextrose: nourishes and preserves cells
clot activators: prevent blood from clotting
antiglycolytic: separates cells and plasma during centrifugation

What is the first thing to do if a patient has a seizure?

place something in the patient’s mouth for them to bite
restrain the patient
remove anything in the area that might injure the patient
ask the patient in an outpatient facility if they would like to go to the hospital

Blood collected in a syringe can be transferred to an evacuated tube system with a:

syringe transfer device
barrel
collection bottle
winged infusion set

When using a butterfly system, which of the following is FALSE?

Smaller needles can cause hemolysis.
The last tube collected should be discarded.
The needle length is 0.5 – 0.75 inches.
The tubing can be connected to a syringe or evacuated tube holder.

Which of the following is TRUE of capillary blood gases?

They are not affected by air exposure.
They are performed because arterial punctures are too dangerous for infants.
They are collected in an additive-free tube.
They are collected in a microtube labeled with a blue band.

NHA Phlebotomy PT #2

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