Exam Questions

Phlebotomist

A healthcare professional responsible for collecting blood samples from patients for laboratory testing.

Culture and Sensitivity (C&S)

Test used to identify microorganisms in a specimen and determine effective antibiotics for treatment.

Light Blue Tube

Used for coagulation studies; contains Sodium Citrate as the anticoagulant.

SST (Serum Separator Tube)

A tube without anticoagulant that separates serum from blood cells after centrifugation.

Gauge

Refers to the diameter of a needle; smaller gauge numbers indicate larger diameters.

Hemoconcentration

Increased concentration of blood components due to reduced blood volume.

Lymphostasis

Impaired flow of lymphatic fluid, often occurring after a mastectomy.

PT (Prothrombin Time)

Measures the time it takes for blood to clot, used to monitor warfarin therapy.

aPTT (Activated Partial Thromboplastin Time)

Measures the time it takes for blood to clot, used to monitor heparin therapy.

INR (International Normalized Ratio)

Standardized ratio of PT used to ensure consistency in results across laboratories.

Morning Urine Sample

Preferred sample type for tests like pregnancy testing; collected as the first urine of the day.

What is serum?

The liquid portion of the blood after clotting, which does not contain fibrinogen.

What is plasma?

The liquid portion of the blood that is anticoagulated and includes clotting factors.

What does hemolysis mean?

Destruction of red blood cells leading to the release of their contents into the plasma.

Vacutainer

A type of needle used for drawing blood and collecting samples in vacuum tubes.

What are the flanges on a needle holder for?

Flanges are used for gripping and stabilizing the needle holder during sample collection.

What tests require capillary puncture?

Tests such as blood glucose level testing and newborn screening.

What is an icteric specimen?

A specimen that appears yellow due to jaundice.

What is a lipemic specimen?

A specimen that appears milky or cloudy due to high lipid levels.

What is an example of a non-blood specimen?

Non-blood specimens include urine, saliva, sputum, stool, and cerebrospinal fluid.

What does FOBT stand for?

Fecal Occult Blood Test; used to check for hidden blood in stool.

What is the primary duty of a phlebotomist?

Collect blood samples for lab testing.

Name tube colors, anticoagulants, and tests for Hematology, Coagulation, Chemistry, Microbiology, and Serology/Immunology.

Hematology: 

• Tube: Lavender/Purple top

• Anticoagulant: EDTA (Ethylenediaminetetraacetic acid)

• Tests: Complete Blood Count (CBC), Blood Smear, Hemoglobin, Hematocrit, WBC, RBC, Platelet counts, etc.

Coagulation: 

• Tube: Light Blue top

• Anticoagulant: Sodium Citrate

• Tests: Prothrombin Time (PT), Activated Partial Thromboplastin Time (aPTT), INR, D-dimer, Fibrinogen, etc.

Chemistry: 

• Tube: Red top (no additive or with clot activator) or Gold/ speckled (SST)

• Tests: Comprehensive Metabolic Panel (CMP), Electrolytes, Liver Function Tests (LFTs), Renal Function Tests (RFTs), Lipid Panel, Cardiac Enzymes, Thyroid tests, etc.

• Anticoagulant (if applicable): Green top (Heparin) for plasma-based chemistry tests.

Microbiology: 

• Tube: Yellow top (for blood cultures) or Sterile bottles

• Tests: Blood cultures, Aerobic and Anaerobic, Gram stain, Cultures, etc.

• Anticoagulant (if applicable): Some microbiology tests may require EDTA for specific assays.

Serology/Immunology: 

• Tube: Red top (no additive or with clot activator) or Gold/ speckled (SST)

• Tests: Antibody titers (e.g., HIV, Hepatitis), Autoimmune markers, Infectious disease testing, etc.

• • Anticoagulant (if applicable): Some immunology tests may require EDTA or Heparin for specific assays

What is a C&S test?

Culture and Sensitivity: Identifies microorganisms and effective antibiotics.

What tube color is used for coagulation studies?

Light Blue Tube

What are the tests for coagulation studies?

PT, aPTT, INR

Do we have to fill up the light blue tube completely?

Yes, to maintain the correct blood to anticoagulant ratio.

What is the ratio of blood to anticoagulant in a light blue tube?

The ratio of blood to anticoagulant is 9:1.

What tube is used for STAT testing and why?

Green tube, because plasma can be processed faster than serum.

Does an SST tube contain an anticoagulant?

No, it contains a gel separator.

What does SST stand for?

Serum Separator Tube

What does PST stand for?

Plasma Separator Tube

What additives do royal blue tubes contain?

No additive or EDTA

What anticoagulant is in a royal blue tube with a green color code?

Lithium Heparin

Name three types of needles.

Vacutainer, Butterfly, Syringe

What are the parts of the needle?

Hub, shaft, bevel, lumen

What are the parts of the holder?

Flanges, needle adapter, tube holder

What are flanges for?

Gripping and stabilizing the needle holder

When collecting blood with a butterfly needle, where can we use it?

Smaller veins (hand) or pediatric venipuncture

What is gauge?

Needle diameter; smaller number = larger diameter

What gauge sizes are green and black needles?

Green = 21 gauge, Black = 22 gauge

What do tubes have pre-measured inside that allows them to fill with blood right away?

Vacuum

What is serum?

Liquid portion of blood after clotting

Does serum have fibrinogen?

No

What is plasma?

Liquid portion of anticoagulated blood

Can you perform PT and aPTT tests on plasma?

Yes, the standard laboratory tests for Prothrombin Time (PT) and Activated Partial Thromboplastin Time (aPTT) are performed on citrated plasma.

What is whole blood?

Blood with all components (cells and plasma)

What tests can you perform on whole blood?

CBC (Complete Blood Count)

What is an icteric specimen and what color is it?

Jaundiced sample; yellow

What is a lipemic specimen and what color is it?

High lipid levels; milky/cloudy

How long can the tourniquet be left on?

1 minute

What is the routine venipuncture procedure?

Identify patient, select site, prepare site, insert needle, collect sample

What is the best angle for needle insertion during venipuncture?

15-30 degrees

When should tubes be inverted?

Immediately after collection

Why do we invert tubes and mix anticoagulant?

Prevent clot formation and ensure uniform mixing

What antiseptic is used to clean the site for venipuncture?

70% Isopropyl Alcohol

What is a capillary puncture?

Blood collection from fingertip or heel.

What is a heel puncture?

a small incision or puncture that is made on a newborn's heel to collect a blood sample

What does plantar mean?

Bottom of the foot

What is a lancet?

Small, sharp instrument for skin incision

What tests cannot be done via capillary puncture?

Blood cultures, coagulation studies (PT, aPTT), blood gases

What newborn tests are typically collected via capillary blood?

Newborn screening and Blood Glucose Level Testing

What analyte is light-sensitive?

Bilirubin

Name some tests that are light-sensitive, need to be warmed, or chilled

Bilirubin (light-sensitive), cold agglutinins (warmed), ammonia (chilled)

What is a random urine sample?

Collected at any time

What is a timed urine sample?

Collected at specific intervals (e.g., 24-hour collection)

What is a 24-hour urine sample?

Collected over 24 hours

Why collect the first morning urine sample at the end of a 24 hour urine sample?

More concentrated, higher analyte levels

What is MSU?

Midstream Specimen of Urine

What is CCMUS?

Clean Catch Midstream Urine Sample; cleanse around urinary meatus

What is the best urine sample for pregnancy testing?

First morning urine

What is FOBT?

Fecal Occult Blood Test: checks for hidden blood in stool

What are non-blood specimens?

Urine, saliva, sputum, stool, semen, CSF, pleural fluid

Where are pleural, pericardial, peritoneal, and synovial fluids found?

Pleural (lungs), pericardial (heart), peritoneal (abdominal organs), synovial (joints)

Where is synovial fluid collected from?

Joint cavity

Where is CSF found?

Spinal cord and brain

What causes hematoma formation?

Poor needle placement, excessive pressure, repeated punctures

Why can’t you collect from an arm with a mastectomy?

Risk of lymphoedema and infection due to lymphostasis

Define lymphostasis.

Impaired flow of lymphatic fluid

What does hemoconcentration mean?

Increased concentration of blood components

What does hemolysis mean?

Destruction of red blood cells

What causes hemolysis?

Excessive force during collection, improper storage, freezing

What are some venipuncture troubleshooting examples?

Needle partially inserted/vein collapsed; poor insertion/movement

What should you do if a patient doesn’t have an armband?

Verify identity with personal details and medical records

What should you do if a patient feels like fainting?

Have patient lie down and apply pressure

What is a blood culture and when do you draw it?

Suspected bacterial infection; collect two bottles (aerobic and anaerobic) from different sites

What is the order of draw?

1. Blood cultures, 2. Light blue, 3. Red, 4. Gold/SST, 5. Green, 6. Lavender, 7. Gray

What if someone is bleeding for more than 5 minutes?

Apply pressure, elevate site, check needle/tourniquet

What is ethics?

Moral principles governing behavior

What is professionalism?

Respect, integrity, competence, following ethical guidelines

PT (Prothrombin Time):

Measures time for blood to clot, monitors warfarin therapy

aPTT (Activated Partial Thromboplastin Time):

Measures time for blood to clot, monitors heparin therapy

INR (International Normalized Ratio):

Standardized PT ratio, ensures consistency across labs, monitors warfarin