Phlebotomy Final

When drawing blood on an outpatient, what is the next positive identification to ask for after obtaining DOB ?

Correct spelling of name

A patient has a requisition for a urine test. The patient asks to have their blood drawn. They intend to call the Physician's office when they leave to fax the orders. What should the phleb technician do ?

Call the physician before the draw to request and obtain orders for additional

A requisition form requires a phlebotomy technician to draw blood for an hgA1C and lipid panel. How should the phlebotomy tech draw blood from the patient to meet this requirement ?

Draw the SST/gold top tube Draw the lavender top tube.

The phlebotomy technician initiates a blood draw after receiving verbal consent from the patient. What type of consent has been given ?

Informed Consent

The physician orders an Erythrocyte sedimentation rate (ESR) lab test. Which tube should the phlebotomy technician use ?

Lavender

Patient A is in the waiting room and has been waiting for a phlebotomy technician for 15 mins. Patient B is in the waiting room and has been waiting for a phlebotomy technician for 5 mins. Both patients require a CBC with differential. The STAT box on patient B's requisition is checked. What should the phlebotomy technician do first ?

Draw blood from Patient B using a lavender top tube

A phlebotomy technician is ready to perform a venipuncture on a patient for labs the physician has ordered. What should the phlebotomy technician do first.

Identify the patient

A phlebotomy technician enters a patient's room to draw blood and notices the patient's date of birth on the ID band is different from the date of birth on the requisition . How should the phleb technician handle this situation ?

Delay drawing the blood until the tissue with the ID hand is resolved

A phleb technician receives an impatient lab order. Upton entering room, the technician observes an unconsicous with the family present.

What should the phleb tech do to verify the patient to the order, prior to the blood draw ?

Use the patient ID band

Patient A is drawn by the phlebotomy technician for a Type and Cross Blood that mistakenly labeled on patient B. The tubes are processed Patient A's blood is entered into Patient's B chart. Later that day, Patient B has surgery, is given the wrong blood type, and dies during surgery.

What should the phlebotomy technician have done differently?

Properly identify the patient

The lab receives three specimens labeled Maria Sanchez, 4/1/56. The name on the requisition reads as Maria Sanches, 4/1165. The error is discovered during the ordering process.

What should the phleb tech do ?

Call the physician's office to verify the name and DOB

A phlebotomy technician draws blood from a patient whose name is James Davis. The patient states that the prefers to be called Jim.

How should the phlebotomy technician label the collection tube ?

James Davis

In which format should informed consent be written ?

Layperson's terms

What type of consent is required for a patient who is injured and unable to respond ?

Implied consent

Which of the following does a requisition form include ?

ICD 10 code

Which form of consent should be obtained when providing venipuncture services to a conscious patient ?

Informed consent

Which of the following should be used when a patient presents with latex allergy ?

Nitrile or Vinyl

A phlebotomy technician is entering a patient's room to draw blood after just drawing blood from a patient with a cold.

What should the phlebotomy technician do before coming in contact with a new patient ?

Wash hands with soap and water

The phlebotomy technician is drawing a patient that has tested positive for tuberculosis.

What PPE protocol should the phlebotomy technician do next ?

Put on an N95 respirator mask and gloves

A phlebotomy technician completes a draw inside a patient's room. As the technician is walking out, the technician notices a stop sign on the door that reads "isolation".

What should the phlebotomy technician do ?

Notify the supervisor and follow exposure protocol

A phlebotomy technician needs to perform a STAT draw on the floor. The patient is on contact and airborne precautions.

How should the phlebotomy technician dress for this procedure ?

N95 respirator mask, gown, gloves

When a patient is sneezing and coughing, PPE is worn to prevent which mode of transmission ?

Droplet

A phlebotomy technician puts on gloves to begin preparation for a venipuncture draw, but has to step away for a moment.

What should the phlebotomy technician do before drawing blood from this patient ?

Remove gloves, resanitize hands, apply fresh gloves and continue the procedure

How often should a phlebotomy technician wash hands to prevent the spread of infection ?

Before and after every draw

The phlebotomist enters the room wearing a gown and gloves.

What place of required PPE is the phlebotomist missing for "droplet precautions" ?

Face shield

A phlebotomy technician was drawing blood from a young child when the child jerked and the phlebotomy technician was poked. Because the child was young, the phlebotomy technician disregarded exposure protocol and continued on with their work day.

What important assumption did the phlebotomy technician ignore?

All patients are unhealthy and may be infected with blood borne pathogens

A phlebotomy technician recognizes a patient they are about to draw. After leaving the room, the phlebotomy tech posts on facebook searching for anyone who can bring the patient's family dinner while the patient is in the hospital. The phlebotomy technician's manager overhears the tech sharing what happened with a co-worker and cites the phleb tec for a regulatory violation.

What regulation has been violated?

HIPPA

A phleb tech was drawing blood from a young child when the child jerked and the phleb tech was poked. The phleb tech continued with their work day.

What standard procedure should the phlebotomy tech have followed ?

Wash the exposed area then report exposure to their supervisor

A laboratory clerk receives a call requesting labs to be faxed from wellness center. The wellness center has yet to obtain patient record consent. The clerk sends the fax.

What protocol has been violated ?

HIPAA

A patient comes in for routine blood work and is drawn by the same phlebotomy tech as their last visit. Two other people in the lab are having their blood drawn at the same time. The patient asks the phleb tech to give them results of their blood test from 2 weeks ago.

What response should the phlebotomy technician give the patient?

Tell the patient you CANNOT give the results and refer them to the physician

A law enforcement officer comes to the lab to collect blood on a patient that had been seen in the ER a few days before. The officer asks the phleb tech to release all related specimens on the patient.

What should the phleb tech do?

DO NOT give the officer the specimens samples without a warrant to protect the patient's information under HIPAA

A phleb tech has a computer screen open that displays personal information about a patient. The phleb tech walks away without securing the screen.

What has been violated ?

HIPAA

A phelb tech is inoculating blood cultures but fails to use the shield. As the needle is being pushed into the bottle, a spray of blood catches the phelb tech in the eyes.

What should the phleb tech do next ?

Flush eyes for 15 mins at the eyewash station.

The phleb tech is drawing blood from a patient who is very different to stick. While trying to dispose of the butterfly, the safety is unsecured. The needle sticks the phleb tech.

What should the phelb tech do next ?

Immediately wash the area with soap and water

A phleb tech who is working inpatient notices that the sharps container in the patient's room is 90% full. The phleb tech has just performed a draw and needs to dispose of the needle. The container is filled beyond capacity. The flap used to secure the sharps is unable to perform its function.

What should the phleb tech do?

Inform the nurse and request a new sharps

A phleb tech is caught eating lunch at their drawing station for the second time in a week. The phleb tech is reprimanded and explained the safety rules.

Which safety is rule is the phleb tech breaking ?

Occupational safety

While preparing to draw blood, the phleb tech touches the patient's bed with the tip of the needle before insertion.

Which measure should the phleb tech take next ?

Change only the needle that touched the bed.

During a blood draw, a drop of blood falls into the lab chair. The phlebotomy tech quickly wipes the blood with an alcohol wipe and continues to take in patients for blood draws.

What should the phlebotomy tech have done differently ?

Cleanse the area with bleach (1:10)

A phlebotomy tech draws a patient and removes one glove to assist with applying the bandage.

What compliance rule has been broken ?

OSHA's blood borne pathogen standards

A phleb tech introduces themselves to a patient and explains the testing procedure. The phleb tech fails to look at the patient for non-verbal cues or listen to a verbal refusal before touching the patient.

How were the patient's rights violated ?

Batter

A phleb tech is certified in Minnesota. The phleb tech wants to travel and work in California.

Which governing body will oversee this process ?

State government

Company X provides goggles, lab coats and gloves for all phleb techs. This personal protective equipment is provided in compliance with which entity ?

Centers of Disease Control

A lab manager is trying to reduce costs and has instructed all phleb techs to start disinfecting the adapters and tourniquets so they can be reused. A phleb tech states to their supervisor several times that they are uncomfortable with this practice. The tech calls to have the facility inspected.

What agency did the phleb tech call ?

OSHA

A phleb tech successfully draws blood from a difficult patient. The nurse requests that the phleb tech start an IV because the tech has been so successful with the difficult draw.

What should the phelb tech do next ?

Explain to the nurse that the IVs are out of the scope of practice.

A phelb tech approaches an inpatient room with an irate patient. The patient immediately starts screaming, "I don't know you" and demands to see the phleb tech that the patient had yesterday. The patient refuses testing.

How should the phleb tech handle this situation ?

Leave the room and explain to the patient that a nurse will be notified of the refusal.

A phleb tech is called to collect blood cultures in the emergency room.

What special handling should the phleb tech perform with sterile bottles?

Clean bottle tops for 30 secs and let dry completely before transfer

A patient enters the lab to have blood drawn. A phleb tech calls the patient back to the draw stations and then rushes out of the station to answer a phone call. A different phleb tech steps in to perform the venipuncture.

What is the first step the new phleb tech takes when initially coming into contact with this patient ?

Verify the patient name and DOB

In an outpatient setting, a patient requests the best phleb tech. The patient is told that all of the phleb techs are highly skilled. One of the phleb techs is new and has only worked for 2 days.

How should the phleb tech greet the patient ?

Acknowledge the patient concerns and introduce themselves.

A phleb tech enters a patient's room. The patient asks the phleb tech what tests are being performed on their blood.

What response should the phleb tech provide to the patient ?

Give the patient the names of the tests that have been ordered.

A patient exhibits nervousness before a venipuncture and states they have NEVEr had their blood drawn before. Which action should the phleb tech to help calm the patient ?

Explain the whole procedure to easy to understand terms

A patient is scheduled for a 3-hour glucose test. The patient states they are unsure about what the test entails and are anxious about having it performed.

How should the phleb tech communicate with the patient ?

Tell the patient that their physician will explain the procedure.

What is the order of the last four steps to end a venipuncture ?

Tourniquet, tube, safety cap, cotton ball

A patient receives a stool for guaic card during a visit to the physician. The patient brings the card to the lab because they felt rushed and misunderstood what must be done.

What should the phleb tech do to educate the patient ?

Send the patient back to the physician's office

A physician orders the following tabs on a patient: CBC, APTT, CMP, D-Dimer.

In which order should the draw be completed ?

Blue, Blue, SST/Gold, Lab

When a patient is in a "basal state", what have they refrained from an extended period of time ?

Calories

A phleb tech arrives at an inpatient room to draw a timed sample. A CBC test is ordered. The patient explains that they take chemotherapy intravenously and want to reserve their veins for treatment. A sign above the patient's bed indicates that the total daily blood volume is 10 mL.

How should the phleb tech obtain the blood ?

Fingerstick

A patient on anticoagulant therapy reports excessive bruising. The doctor sends the patient to the outpatient lab for a PT/NR and APTT to be drawn. The patient states they started bleeding after leaving the lab on their previous visit.

What precaution should be used to prevent such an occurrence ?

Apply pressure until bleeding stops and uses an adhesive pressure wrap

The physician on call has ordered a quantitative HCG and progesterone.

What tube needs to be drawn ?

A SST/Gold tube

A phleb tech needs to redraw blood from a patient because one the was missing from the order. The phleb tech noticies the unfilled tube under the patient's leg on the bed.

What action will prevent the error in the future ?

Place supplies on the patient's bed closer to the draw site.

After identifying the patient, which action should the phleb tech perform to ensure a successful venipuncture ?

Ask patient where is the best place to draw

A phleb tech needs to perform a venipuncture on a child who is less than 2 years old. The phleb tech must use a butterfly needle to collect the sample.

What is the suggested vein for the phleb tech to collect the sample ?

Median cubital

A patient who is ready for a blood draw informs the phleb tech that they have tough skin.

How should the phleb tech draw the blood from the patient ?

Check both arms and feel for an adequate site

The phleb tech notices a large scar on the patient's antecubital area on the same side the nurse has requested to draw the blood to be performed.

What should the phleb tech do ?

Perform a dorsal hand draw

A neonate needs to have a bilirubin and a BMP drawn. The heels have been stuck multiple times to prevent injury to the calcaneus bone. The parents are irate with the multiple heel sticks.

Where should the phleb tech obtain the specimen ?

Perform a fingerstick

A plheb tech receives an order for lab work on a patient. The phleb tech enteres the room and thepatient tells the phleb technician that she has had a left mastectomy.

What is the proper protocol for the drawn ?

Performs the draw on the right hand.

What special handling is required during a 24-hour creatine collection performed at homes by a patient to ensure test validity ?

Refrigerate sample

A phleb tech receives an order in the neonatal until to draw a PKU sample. The parents are nervous about their baby being poked by a needle. The phleb tech explains the proedure and demonstrates where the test will be performed.

Which area of the body should the phleb tech indicate as the site for the blood draw ?

Plantar surfaces of the heel

An elderly patient has an order for labs. The patient advises the phleb tech that she has had a right mastectomy. The phleb tech warms the antecubital fossa on the left arm and attempts to draw, but is unsuccessful.

Which site should the tech select next ?

The left hand

A geriatric patient has large bruises on their arms due to several blood draws over a period of 3 days in the hospital. A new phleb tech enters the room to perform a venipuncture and has a difficult time finding a suitable vein. The tech identifies a vein above the IV in the hand.

What is the appropriate action for the phleb tech to take ?

Ask a nurse to pause the IV and draw the blood after 15 mins

A patient who is an active IV drug user comes into the lab for an HIV screening. The patient has extensive scar tissue and collapsed veins. The phleb tech visually notices track marks and vein damage on both arms.

What technique should the phleb tech use to obtain the draw ?

Ask the patient where they usually have blood drawn.

A 6-week old baby is brought in for lab work. The order is for a bilirubin, BMP and CBC.

What site should be used for the draw ?

Heel (use microtainer to collect sample)

A newborn baby comes into an outpatient clinic and needs a blood draw. The physician has ordered NO heel pokes due to the birth defects on the baby"s feet.

Which location and equipment is appropriate for this blood draw ?

Finger dermal puncture with lancet

A patient is ready for a draw and states that they are difficult and will only allow one stick.

How should the phleb tech enhance the vein process to choose the best vein ?

Lower the patient's arm and swing back and forth

A phleb tech is preparing to draw a geriatric patient. The tourniquet becomes loose on the patient's arm.

What should the phleb tech do to ensure a successful draw ?

Re-apply the tourniquet and reassess the site

A phleb technician receives an order to draw a Lactic acid on a patient. When the draw is complete, the phleb tech wraps the specimen in foil. The lab results back as inconclusive and need to be redrawn.

What should have been done to the specimen ?

It should have been chilled on ice and delivered to the lab.

A phleb tech prepares to draw a patient when they notice bruising on the right upper arm.

What should the phleb tech do?

Evaluate both arms to select the best site

An ABG was ordered on a patient in the ER. The phlebotomist was asked to deliver the specimen to the lab. On the way to the lab, the phleb drew another patient and set the specimen down the counter.

What should the phleb have done ?

Immediately delivered the sample on ice

A patient comes in for an H. pylori test and is provided instructions on how to take the test. The patient blows into the blue breath bag and drinks the H.pylori test drink. After consuming the drink, the patient washes the taste out of their mouth with a Gatorade. After waiting for 15 mins, the patient returns to the lab to blow into the pink bag. The test results come back inconclusive.

What is a reason for the inconclusive test results ?

The patient consumed the Gatorade

A phleb tech is in the NICU to draw blood from a baby diagnosed with jaundice. The blood sample must be protected from light.

What test is the phleb tech drawing ?

Bilirubin

A pregnant woman has been admitted into Labor and Delivery. The patient's doctor orders a 24-hour urine sample. During the collection, the nurse uses a variety of urine cups and leaves them in the patient's room. When the phleb tech collects the urine sample, the tech sees that the urine was improperly stored.

How should the phleb tech handle this situation ?

Instruct the nurse to recollect using a urine collection jug and store on ice during 24-hour collection.

Which cleaning technique should be used on the skin before venipuncture when collecting blood culture samples ?

70% isopropyl alcohol

Which antiseptic should be used to draw an ETOH test for a patient ?

Soap and water

What antiseptic on the skin destroys or inhibits the growth of disease causing bacteria and other microorganisms and minimizes allergies ?

Chorhexidine

A phleb tech is beginning to draw a patient who is obese and diabetic. The phleb tech places the tourniquet on the arm and palpated for the veins and is unsuccessful in finding a vein.

What is another appropriate place to draw from this patient ?

Hand

After doing rounds in the nursery, a physician notices a newborn is missing a state-mandated lab test that should be done within 24 to 48 hours after delivery. The nurse asks the phleb tech if a special paper with circles on it was used to perform one of the post partum tests.

What blood test must be performed on the newborn ?

PKU

A lab requisition slip indicates the need to draw an ESR, Electrolytes panel, type and screen, and HCG.

What is the correct order of the draw for these tests ?

SST/Gold, Green (Lithium Heparin), Lavender, Pink

A phleb tech performs a blood draw in the right hand of a patient. After the blood draw, the phleb tech notices that the light blue top tube is under filled.

Why is the blue tube under filled ?

A discard was not drawn

A patient comes in for labs and states they are a very hard stick. The phleb tech takes the patient back and is unsuccessful after two sticks. The patient insists on another attempt.

What should the phleb tech do ?

Stop after the second attempt and find a more experienced phleb

A doctor orders blood cultures, CBC, CMP, and PT.

In what order should each sterile bottle be drawn?

Blood culture, BLUE, SST/Gold, Lav

A patient comes to the lab to get supplies needed to collect stool for testing after seeing their physician for chronic diarrhea and possible infection.

What supplies should the phleb tech give to the patient ?

Sterile urine cup

What documentation must accompany each sample when they are sent to specialty laboratories ?

Matching requisition form

A phleb tech is drawing a patient in the hand with a butterfly needle at a 50 degree angle. The patient screams out in pain and draw must be stopped.

What degree angle should the phleb tech have inserted the needle at to avoid this problem ?

5-10

A phleb tech has an order to draw a lavender top for platelets and a light blue for an INR. The phleb tech draws the lavender top first and then the light blue top.

What potential issues could develop secondary to this order of draw?

Cross contamination of additives in test tubes that could skew test results

A phleb tech has an order to draw labs. Four tubes need to be drawn. Upon completion of the lab draw, the technician notices that there is a Light blue tube left.

What action should the tech complete?

Acknowledge their mistake and perform additional draw

A physician orders two sets of blood cultures on a patient with a FUO. The phleb tech gathers the following equipment: 2 anaerobic bottles, 2 aerobic bottles, 2 winged infusion sets, a tourniquet, a tape, a transfer device, a bandage and alcohol pads.

What item did the phleb tech forget ?

Chlorhexidine

A phleb tech performed a point of care pregnancy test on a 16-year old minor in the emergency room. The parents of the patient are present and request to know the result of the test.

What should the technician do ?

Refer the parents to the treating physician

A phleb tech receives an order to collect a CBC, APTT and CMP. The phleb tech draws a Light blue, SST/Gold, and Lavender, fills all tubes 12 full, and inverts the tubes 10 times. The APTT is rejected by the lab and needs to be be redrawn.

What is the cause of this rejection ?

Insufficient blood was collected

What is the correct way to dispose of a dirty needle after a venipuncture ?

Safety cap needle and then place it in the sharps container

In which container should used needles be disposed ?

Biohazard sharps

A phleb tech is drawing an SST/Gold tube for a blood draw. When the phleb tech inserts the tube into the hub, the phleb tech fails to get blood flow. The phleb tech adjusts the needle using proper techniques and still receives NO blood. The phleb tech changes out the SST/Gold tube for another tube and gets blood flow.

What should the phleb tech do with the un-obtained blood tube ?

Dispose the tube in a biohazard sharps container