NHA CPT Exam Study Tool

KNOW IT

What is the standard venipuncture order of draw?

1. Blood cultures

2. Light Blue

3. Red

4. Tiger/Gold SST tubes

5. Light Green

6. Lavender/Pink

7. Gray

The purpose of the order is to reduce additive carryover between tubes

KEY CONCEPT

Why are blood cultures collected before most other tubes?

Blood cultures are collected first to reduce the chance of microbial contamination of the specimen (blood cultures are used to detect microorganisms in the bloodstream)

NAME THAT TUBE

Light Blue

Name:

1. Tube/additive

2. Use

1. Sodium citrate

2. Coagulation Testing; PT, INR, aPPT

NAME THAT TUBE

Lavender

Name:

1. Tube/additive

2. Use

1. EDTA (prevents coagulation by binding calcium and helps preserve blood cell morphology)

2. Hematology; CBC

WHAT WOULD YOU DO?

Patient needs:

Lipid Panel

CBC

What tubes and order should you collect them?

Green- heparin

Lavender- EDTA

FIND THE MISTAKE

A phlebotomist draws lavender, light blue, then gold

What is wrong?

Tubes collected in wrong order; light blue coagulation tube should be collected BEFORE serum and EDTA tubes.

KEY CONCEPT

What is additive carryover?

Additive carryover occurs when an additive from one tube is unintentionally transferred into the next specimen during collection. This interferes with testing and can produce incorrect results

WHAT WOULD YOU DO?

You need to collect only: Gray, Green, Lavender

Which goes first?

Green (heparin)

Lavender, (EDTA)

Gray (glucose)

NAME THAT TUBE

GOLD/ SST

Name:

1. Tube/additive

2. Use

1. Clot activator + serum separator gel

2. Chemistry; TSH, vitamins, STI/STD panel

NAME THAT TUBE

Light Green

Name:

1. Tube/additive

2. Use

1. Lithium heparin PST (plasma separator tube)

2. Chemistry; lipid panel

NAME THAT TUBE

Gray

Name:

1. Tube/additive

2. Use

1. Sodium fluoride (inhibits glycolysis) + potassium oxalate (anticoagulant)

2. Glucose testing and blood alcohol tests

NAME THAT TUBE

PINK

Name:

1. Tube/additive

2. Use

1. EDTA

2. Blood bank/ cross match

NAME THAT TUBE

Red

1. Tube/ additive

2. Use

1. Non additive; used to obtain serum no anticoagulant

2. Chemistry; discard tube

WHAT WOULD YOU DO?

You need to collect:

CBC, Glucose, & PT/INR

Put them in order

Light blue (citrate)

Lavender (EDTA)

Gray

FIND THE MISTAKE

A phlebotomist collects:

Gold

Green

Lavender

Light blue

What is the major problem?

The light blue was collected too late; they should come before serum, heparin, and EDTA. Contamination from additives in previously collected tubes could interfere with coagulation testing

KEY CONCEPT

Why is the light blue especially sensitive to being underfilled?

The tube contains a specific amount of sodium citrate designed for a specific volume of blood. If there is too little blood, the blood to anticoagulant ratio becomes incorrect which can affect coagulation incorrect

WHAT WOULD YOU DO?

You are collecting a CBC and a glucose test

You accidentally draw the gray tube before the lavender tube

What should have been the correct order of draw?

Lavender then gray. EDTA comes before gray

FIND THE MISTAKE

A student says the green tube and lavender tube are basically the same because they both keep blood from clotting.

What is wrong with this statement?

They are both anticoagulant tubes, but they contain different additives. Green= heparin

Lavender= EDTA

KNOW IT

Match the additive with its tube

EDTA

Sodium citrate

Heparin

Sodium fluoride/potassium oxalate

Light blue= sodium citrate

Green= heparin

Lavender/Pink = EDTA

Gray= sodium fluoride + potassium oxalate

KEY CONCEPT

Which common tubes produce serum, and which produce plasma/anticoagulated blood?

Serum= red and tiger/gold SST; blood is allowed to clot first

Plasma/ anticoagulated blood= light blue, green, lavender, pink, & gray; if an anticoagulant is present the blood doesn’t clot which means no serum

WHAT WOULD YOU DO?

Patient needs:

PT/INR

Glucose

TSH

CBC

Put them in correct order

Light blue (PT/INR)

Gold SST (TSH)

Lavender (CBC)

Gray (Glucose)

FIND THE MISTAKE

A student draws:

Light blue

Lavender

Green

Gray

What is wrong?

The green should come before the lavender tube. Correct sequence is light blue, green, lavender, gray

KNOW IT

Which tube/additive pair is correct?

A. Lavender- heparin

B. Green- EDTA

C. Light Blue- sodium citrate

D. Gray- sodium citrate

C. Light Blue- sodium citrate

NAME THAT TUBE

I contain EDTA

I am commonly used for a CBC

What tube am I?

Lavender tube; EDTA preserves blood cells well making it useful for hematology testing

NAME THAT TUBE

I contain sodium citrate

I am commonly used for PT, INR, and aPPT

What tube am I?

Light blue; sodium citrate bind calcium and prevents clotting

KEY CONCEPT

Why does the tube sequence place EDTA tubes toward the end?

EDTA strongly binds calcium so if it contaminates another specimen it can interfere with testing

KNOW IT

Which of these would not be appropriate?

A. Red

B. Gold/Tiger

C. Green

C. Green; heparin prevents blood from clotting and produces plasma instead of serum. Serum requires blood to clot first

KNOW IT

Which statement is correct?

A. Plasma is obtained after blood clots

B. Serum contains fibrinogen

C. Anticoagulant tubes can produce plasma

D. Serum tubes must contain EDTA

C. Anticoagulant tubes can produce plasma

FILL IN THE BLANK

If EDTA from a lavender tube contaminates the next specimen, it may falsely decrease ____ because EDTA ____ calcium.

Calcium; binds

FILL IN THE BLANK

In the standard order of draw, a serum tube must be collected before a ____ tube to reduce the risk of ___ carryover.

Heparin; additive

KNOW IT

What are the Five Points of Standard Precautions?

1. Wash hands when changing gloves and between patients

2. Wear gloves when touching body substances, mucous membranes, non intact skin, and during all blood draws

3. Wear protective covering if clothing may be soiled

4. Wear mask and eye protection plus body covering when splashing is possible

5. Dispose of intact needles/sharps in designated containers

KNOW IT

What is the difference between a local infection and a systemic infection?

Local infection: Affects only one area of the body

Systemic infection: Affects the whole body

KNOW IT

What is the difference between nosocomial infection and community acquired infection?

Nosocomial infection develops 48 hours after a patient is admitted to the hospital that wasn’t present upon admission.

Community acquired infection acquired before admission or before 48 hours after admission

KNOW IT

What is the difference between engineering controls and work practice controls?

Engineering controls: Physical or mechanical devices that isolate or remove bloodborne pathogen hazards.

Example: Self-sheathing needles, autoclaves, sharps container

Work practice controls: Practices incorporated into healthcare workers daily habits to prevent the spread of infection

Example: handwashing, wear gloves/PPE, proper sharps disposal

KNOW IT

What is Other Potentially Infectious Material (OPIM)?

Human body fluids, unfixed tissue or blood, and organ or other tissues from experimental animals infected with HIV or HBV. Examples include semen, vaginal secretions, cerebrospinal fluid, pleural fluid, and amniotic fluid

KEY CONCEPT

What is the difference between Universal Precautions, Body Substance Isolation, and Standard Precautions?

Universal precautions- assumes any patient may be infected with a blood-borne pathogen

BSI- Assumes each patient may spread disease through body substances and expanded glove use for contact with body substances'

Standard precautions- an enhancement of universal precautions that incorporates techniques from BSI. Under standard precautions PPE is used when contact with body fluids is expected, whether blood is visible or not.

KEY CONCEPT

What factors can make a person more susceptible to infection?

Age

Disease

Medication

Immunosuppression

KEY CONCEPT

What is the single most important way to prevent the spread of infection?

Handwashing (work practice control)

KEY CONCEPT

What are the six major tactics used to reduce the risk of exposure to bloodborne pathogens?

1. Engineering controls

2. Work practices

3. Housekeeping

4. HBV vaccination

5. Private rooms

6. PPE

KEY CONCEPT

What are OSHA’s major responsibilities in healthcare safety?

Investigates unsafe work practices

Develops and promotes occupational standards

Develops and issues regulations

Determines compliance with health and safety regulations

Issues fines for noncompliance

FILL IN THE BLANK

The transfer of infectious material by an object, such as contaminated bed linens, is called ____ contact transmission.

Indirect

FILL IN THE BLANK

An infection that comes from a person’s own normal flora is called an ____ infection.

Autogenous

FILL IN THE BLANK

Droplets that travel through air currents, such as those associated with tuberculosis, are considered ____.

Airborne

FILL IN THE BLANK

For fire safety, the acronym RACE stands for ____, ____, ____, and ____.

Rescue, Alarm, Contain, Extinguish/Evacuate

KNOW IT

What laboratory activities can create potentially infectious aerosols?

Centrifuging open serum tubes

Popping open blood containers

Pouring off serum

FIND THE MISTAKE

A phlebotomist finishes drawing one patient, removes their gloves, puts on a clean pair, and immediately beings drawing the next patient.

What is wrong?

Handwashing was skipped. Standard precautions require healthcare workers to wash their hands when changing gloves and between patients. Gloves do not replace handwashing.

FIND THE MISTAKE

After a blood draw, a phlebotomist bends the used needle before placing it into the sharps container.

What is the mistake?

Used needles should be discarded intact and not be bent, broken, cut, or recapped.

What disinfecting solution is an example for cleaning hard surfaces such as countertops?

10% bleach solution (skin=antiseptic technique 70% isopropyl alcohol; hard surfaces=disinfecting technique)

FIND THE MISTAKE

A healthcare worker is handling material that may splash fluids but only wears gloves.

What is missing?

The worker should wear

A mask

Eye protection

Protective body covering

FIND THE MISTAKE

A laboratory employee uses a chemical that produces toxic vapor on an open countertop.

What is wrong?

Chemical that produces a toxic or irritating vapor must be used in an approved chemical hood.

WHAT WOULD YOU DO?

During a blood draw, you accidentally puncture your finger with a contaminated needle.

What should you do?

1. Wash exposed area with soap and water

2. report the exposure to supervisor immediately

3. The exposed employee may be tested for HIV and HBV if consent is given

4. The source individuals’ blood may also be tested if consent is given

5. If the source refuses testing, tests positive, or is high risk, the employee may elect prophylactic treatment

WHAT WOULD YOU DO?

A colleague in the lab just had a chemical splash in their eye. They are panicking and unsure as to what they should do next.

What immediate advice and assistance would you give your colleague in this case?

Remove their contacts, help them to the nearest eye wash station where they would flush their eye for 15 minutes (holding their eye open) then we would notify the supervisor and make sure they get proper medical care and follow facilities protocol like filing an incident report

WHAT WOULD YOU DO?

You need to draw blood from a patient in an isolation room. What should you do?

1. Check the isolation instructions

2. Remove jewelry and watches

3. Bring only essential supplies

4. Perform hand hygiene and put on necessary PPE

5. Take a new tourniquet and needed supplies in

6. Identify patient and collect specimen

7. Dispose of sharps and contaminated materials properly

8. Wipe tubes as directed

9. Move tubes to the anteroom using paper towel method

10. Label tubes and place in a self-sealing bag

11. Remove isolation attire and perform hand hygiene

WHAT SHOULD YOU DO?

You encounter a patient with severe diarrhea caused by a contagious organism such as Salmonella or Shigella.

What type of precautions may be used?

Enteric precautions. These are used for infections transmitted through contact with the infected patients feces

CHAIN SCENARIO

Mucous membranes, the gastrointestinal tract, and broken skin can represent which part of the chain of infection?

Portal of entry- think how is the organism getting INTO the host?

CHAIN SCENARIO

People, equipment, or water can represent which part of the chain of infection?

Source- think where the infectious organism is coming FROM?

CHAIN SCENARIO

An immunosuppressed patient or a patient with severe burns is most likely which part of the chain of infection?

Susceptible host- defenses are weakened making them more vulnerable to infection

CHAIN SCENARIO

Direct contact, ingestion, or air can represent which part of the chain of infection?

Means of transmission- how is the organism traveling?

CHAIN SCENARIO

Excretions, secretions, or droplets leaving an infected person can represent which part of the chain of infection?

Portal of exit- think how is the organism getting OUT of the source?

WHAT WOULD YOU DO?

You are drawing blood from a patient in protective or reverse isolation. Who is considered a potential source of infection?

The phlebotomist is considered a potential source of infection to the patient.

FIND THE MISTAKE

A phlebotomist applies lip balm and drinks coffee at the specimen-processing counter.

What is wrong?

Eating, drinking, handling contact lenses, and applying cosmetics or lip balm should be avoided in contaminated work areas.

WHAT WOULD YOU DO?

Blood spills onto a work surface.

What should you do?

Clean and decontaminate the area immediately using an appropriate disinfectant (10% bleach made fresh daily)

KEY CONCEPT

Hepatitis B vaccination

Must be available free of charge to phlebotomists

Provides long term protection against hepatitis B

It does not protect against every type of hepatitis

FILL IN THE BLANK

After collection, blood tubes should be placed into a ____ plastic bag for transport.

Self-sealing; reduces exposure and contamination risk

KNOW IT

Transmission methods

Match each description to the correct means of transportation

Droplets travel 1 meter or less

Physical transfer directly from source to host

Spread by insects

Transfer through objects such as bed linens

Transfer through contaminated food

Droplets travel on air currents

Droplet- travel 1 meter or less

Direct contact- physical transfer from source to host

Vector- insects, such as mosquitoes

Indirect contact- objects such as bed linens

Vehicle- contaminated items like food

Airborne- droplets carried on air currents like tuberculosis

KNOW IT

What do the hazard identification colors represent?

Red= flammability

Yellow= reactivity

Blue= health hazard

White= specific hazard

KEY CONCEPT

What is the purpose of an Exposure Control Plan?

To identify tasks in which occupational exposure may occur

KNOW IT

What information do Material Safety Data Sheets (MSDSs) provide?

Information about chemical hazards.

KNOW IT

What is the difference between Type 1 and Type IV latex reaction?

Type IV- Irritant/contact dermatitis causing skin irritation and redness

Type 1- A more serious immunologic allergic reaction that can progress to anaphylactic shock