NHA phlebotomy practice for everyone

Which of the following tubes should be collected first for a dermal sample?

lavender top

During a routine venipuncture, a patient becomes pale and diaphoretic. What condition is most likely to occur with this patient?

shock

You are drawing blood from a patient and notice red spots. Which of the following action is appropriate for you to take?

apply pressure after collecting the specimen

The phlebotomist must perform a blood draw on a patient with an IV on the right side, and there has been a mastectomy on the left side. Where should the phlebotomist perform the blood draw?

below the IV

Which of the following is the best method to prevent internal or external bleeding from the venipuncture site once the needle is removed?

apply pressure to prevent leakage of blood into the tissues

According to CLSI guidelines, which of the following samples should the phlebotomist draw first?

blood cultures

Blood cultures have been ordered on a patient in the intensive care. Which materials should the phlebotomist bring?

two aeorbic bottles

After placing the tourniquet on a patient's arm, the phlebotomist notices small red spots below the tourniquet. Which of the following is the correct term for these spots?

petechiae

A phlebotomist receives orders to draw an infant screening card, O2 levels, bilirubin and DNA. Which of these should be drawn first?

O2 level

A physician ordered a tobramycin level to be drawn one hour after dose. The tobramycin has been ordered for 1100. Which of the following actions should the phlebotomist take?

check with the nurse

Which of the following is an example of the acceptable reporting of routine lab results?

send the results to the physician in marked envelope

Why should a phlebotomist avoid drawing blood from the leg or foot of a diabetic?

these areas are more susceptible to infection

Which of the following is the best method to collect a blood specimen from an older adult patient who has fragile, easy to collapse veins?

choose a syringe and butterfly assembly and use a pediatric tube

After performing a heel puncture for neonatal screening, which of the following is the correct procedure for collecting blood?

saturate each circle

Which of the following is the proper procedure after collecting an ammonia sample?

place the specimen tube in an ice water slurry

For which of the following must a phlebotomist follow the chain of custody guidelines?

paternity testing

WBC, RBC, glucose and electrolyte tests are ordered for a patient. The phlebotomist is unable to find accessible veins and has determined that it is acceptable to perform a skin puncture. What color tube should be drawn?

lavender and red

Which of the following provides you the best protection when drawing blood on a patient with active TB?

N-95 respirator

Which of the following test results are affected when povidone iodine is used to cleanse the site for a dermal puncture?

potassium, phosphorus or uric acids

A phlebotomist must centrifuge a serum specimen before shipment to an outside reference laboratory because

cells must be separated from the serum

Performing a venipuncture for blood cultures differs from other venipuncture procedures in that

the site is cleaned more stringently

Which of the following could result in a grossly hemolyzed specimen?

an incorrect needle gauge

Before collecting blood on an inpatient, the phlebotomist notices that the patient does not have a wristband on his wrist, but there is one attached to the patient's IV stand. Which of the following is the proper action?

ask the patient to confirm his identity

Upon entering a patient's room for a routine blood draw, a phlebotomist notices a clergy member is with the patient. The phlebotomist should

return after drawing other patients

Which of the following potential outcomes is the most dangerous if data is entered incorrectly into the automated Laboratory Information System?

the incorrect data may be reported to a health care provider

Which of the following does emergency first aid treatment include maintaining an open airway, controlling bleeding, and keeping the victim warm until help arrives?

shock

Why should the phlebotomist document the total volume of blood drawn from a patient?

to determine if the patient is at risk for developing iatrogenic anemia

A patient states that she is a difficult draw and requests a skin puncture. The test ordered is a PTT. Which of the following should the phlebotomist perform?

a syringe draw into a light blue vacutainer

Which of the following is the first step in the blood collection process?

test requisition

When should a phlebotomist perform external liquid controls for quality control on a CLIA-waived point of care test?

when a new lot number or kit is opened

A phlebotomist is collecting a urine specimen from a patient for a pre-employment drug test. Which of the following actions should the phlebotomist take?

verify that the specimen contains at least 45 mL of urine

How frequently should a phlebotomy technician perform a quality control test on a glucometer in the laboratory?

every day that the meter is used

A phlebotomy technician receives a chemical splash to the arm. After removing his contaminated clothing, which of the following is the minimum amount of time the technician should rinse the affected area?

15 min

Which of the following actions should a phlebotomy technician take to locate a vein using the warming technique?

encase the warm towel in a plastic bag

A phlebotomy technician is applying a tourniquet prior to collecting a blood sample from a patient. Which of the following actions should the phlebotomist take?

tuck a loop of partial tourniquet underneath the tourniquet

A phlebotomy technician is collecting a blood sample from a patient. Which of the following techniques should the technician use to anchor the vein just before inserting the needle?

use thumb and forefinger to hold the vein in place

A phlebotomy technician is preparing to draw a peak level for a medication for a medication that was administered orally to a patient. After verifying when the patient received the medication, how long should the technician wait prior to attempting the draw?

2 hours after administration

A provider has ordered a urine culture and sensitivity test. Which of the following types of urine collection should a phlebotomy technician obtain?

clean catch midstream

a thin film of blood that is spread onto a glass slide

blood smear

CLSI order of draw for capillary sticks

Lavender, Green, any other additive specimens, red or gold/tiger tops

Which of the following is an appropriate cleanser for cleansing around the urinary meatus in a clean catch urine collection?

benzalkonium chloride

Which of the following is the total blood volume of a 3.3kg infant?

240 to 330 mL

During a draw, the patient becomes unresponsive. What is the next action the phlebotomist should take?

check for breathing

Why is it important to place a specimen in a biohazard specimen bag when transporting to an outside laboratory?

the biohazrd bag prevents a possible exposure incident

the biohazrd bag prevents a possible exposure incident

clotting

While performing a venipuncture, the first tube fills, but the second tube slows and does not completely fill. The phlebotomist needs to draw 2 additional tubes. Which of the following steps should the phlebotomist take?

insert a new tube to see if it will fill

Values for this test are normally highest in the morning

cortisol

What tests may be affected most if the patient is not fasting?

glucose and triglycerides

According to CAP guidelines, drugs that interfere with blood tests should be stopped

4 to 24 hours before the test

Results of this test have a direct correlation with the patient's age

creatinine clearance

Which of the following specimen conditions would lead you to suspect that the patient was not fasting when it was collected?

cloudy white serum

A failure to fast when ordered can impact a blood sample in which of the following ways?

increasing its turbidity

If you notice that the name of a patient is spelled differently on the requisition and a patient's armband, what it the best course of action?

Visit with your manager to verify the information and have it corrected.

What is another name for a thrombocyte?

platelet

Inserting a needle at the point of divergence between veins can result in what?

An increased chance of a hematoma.

When collecting blood on an infant:

A. The heel should be warmed with a heel warmer

B. The fist drop of blood should be wiped away and not use

C. The heel should be punctured away from the plantar surface of the heel

D. All of the above

D. All of the above

A tourniquet should not be applied when following occurs:

A. Side of body where Mastectomy was

performed

B. Warm bruised area of the skin

C. Dialysis Access

D. Implanted port

all of the above

Why are the tubes drawn in a specific

order:

A. To prevent infection

B. To promote quality control standards

C. Cross contamination

D. Avoid hemolyzing the blood sample

C. Cross contamination

Quality control is part of the:

A. Pre-examination phase

B. Examination phase

C. Post-examination phase

D. Collection phase

B. Examination phase

The two levels of control samples that

are tested to ensure test results

accuracy are:

A. Baseline and elevated

B. Normal and abnormal

C. Acceptable and unacceptable

D. Internal and proficiency

B. Normal and abnormal

Acceptable QC can ensure:

A. Correct functioning of the testing device

B. Integrity of the testing materials

C. Correct performance of the test

D. All of the above

D. All of the above

Why should a dermal collection be

warmed?

A. Prevents hemolysis

B. Increases blood flow

C. Prevents clotting

D. Causes hemoconcentration

B. Increases blood flow

Wiping away the first drop of blood:

A. Increases blood flow

B. Prevents sample contamination

C. Causes air bubbles to enter the tube

D. Stimulates platelets and faster clotting

B. Prevents sample contamination

Failure to allow the alcohol to dry on

the puncture site may cause:

A. Inability to form a rounded drop

B. Sample contamination

C. Red blood cells hemolysis

D. All of the above

D. All of the above

The order of the draw for a Bilirubin,

Blood smear, and CBC by dermal

puncture is:

A. CBC, Blood smear, and Bilirubin

B. Blood smear, CBC, and Bilirubin

C. Bilirubin, Blood smear, and CBC

D. Blood smear, Bilirubin, and CBC

B. Blood smear, Bilirubin, CBC

When blood is drawn into blood

collection bottles using a winged bold

collection set the:

A. Anaerobic bottle is inoculated first

B. Safety device is activated first

C. Aerobic bottle is inoculated first

D. Volume of blood inoculated is

increased

C. Aerobic bottle is inoculated first

The timing for a glucose tolerance test

begins when:

A. The fasting sample is drawn

B. The test results are completed in the

fasting sample

C. The patient finishes drinking the glucose

D. 30 minutes has passed after the patient

finished drinking the glucose

C. The patient finishes drinking the glucose

Selection of an improper heel puncture

site can result in:

A. Puncture of the calcaneous

B. Sample hemolysis

C. The need for vigorous massaging

D. Increased blood flow

A. Puncture of the calcaneous

Capillary punctures on newborns are

outperformed on the:

A. Index finger

B. Plantar area of the heel

C. Back of the heel

D. Earlobe

B. Plantar area of the heel

A test included in a newborn screen is:

A. PKU

B. Electrolytes

C. Bilirubin

D. CBC

A. PKU

What does TTN stand for?

Tourniquet, Tube, Needle

What is the order of draw by the

vacutainer tubes?

sterile, citrate, sst, pst, edta, oxalate

What are the three main veins in order?

median cubital, cephalic, basilic vein

Why is the order of draw so important?

To avoid cross contamination

The most important step in the

venipuncture procedure is?

Identifying the patient.

The needle is inserted into the veins at

what angle degree?

15-30 degree beveled up

The maximum time that a tourniquet

can remain on the patient is?

1 minute

Geriatric patients are more prone to

hematoma formation because?

decreased elasticity.

Upon completion of the blood

collection the vacutainer holder

should be disassembled before

disposed.

True

False

False

Phlebotomy

The incision of the vein for the purpose of drawing blood

Plasma

The liquid portion of the blood

QNS

Quantity Not Sufficient

Venipuncture

The puncture of the vein for any purpose.

Citrate

A compound that is intermediate in the citric acid cycle

Hematoma

A localize collection of blood

Heparin

An anticoagulant that acts to inhibit a number of coagulation factors

Basilic vein

A large vein situated on the inner side of the arm.

Cephalic vein

A large vein in the arm that empties into the auxiliary vein.

Median cubital vein

most commonly used for venipuncture because it is generally the largest and best-anchored vein.

Coagulate

The process of clot formation.

Anticoagulant

Any substance that prevents blood clotting.

Hemolysis

The destruction of red blood cells.

Antecubital fossa

That part of the arm opposing the elbow.

Palpate

To examine by hand

Case Study #1

Mary was having a difficult time collecting blood from the antecubital area of an obese patient. After redirecting the needle three or four times, Mary noticed that blood was pulsating into the evacuated tube.

1.) What would be Mary's first step when

drawing blood on an obese patient?

identifying the pt

Case Study #1

Mary was having a difficult time collecting blood from the antecubital area of an obese patient. After redirecting the needle three or four times, Mary noticed that blood was pulsating into the evacuated tube.

2.) What blood vessel may have been

punctured when Mary was redirecting

the needle ?

Cephalic vein.

Case Study #1

Mary was having a difficult time collecting blood from the antecubital area of an obese patient. After redirecting the needle three or four times, Mary noticed that blood was pulsating into the evacuated tube.

3.) What is the most probable complication

for this patient?

Hematoma

Case Study #1

Mary was having a difficult time collecting blood from the antecubital area of an obese patient. After redirecting the needle three or four times, Mary noticed that blood was pulsating into the evacuated tube.

4.) What additional precautions should

Mary take to protect the patient?

use the correct size tourniquet to ensure the pt is comfortable

Case Study #2

Lisa, the Phlebotomist, collects a lavender top Microtainer and a red top Microtainer by dermal puncture from a newborn's heel in the physician's office. The doctor is concerned because the platelet count is much lower than the previous day's result when the blood was tested before the newborn was released from the hospital. All other CBC parameters match the previous values. The serum in the red top Microtainer appears hemolyzed.

1.) Could the blood collection techniques

have caused this?

Yes.

Case Study #2

Lisa, the Phlebotomist, collects a lavender top Microtainer and a red top Microtainer by dermal puncture from a newborn's heel in the physician's office. The doctor is concerned because the platelet count is much lower than the previous day's result when the blood was tested before the newborn was released from the hospital. All other CBC parameters match the previous values. The serum in the red top Microtainer appears hemolyzed.

2.) Why or why not?

If microtainers were not properly inverted according to order of draw, blood would not have been filled top to bottom in tube to invert with additive in the tube. Not placing a red top in centrifuge after coagulation could affect results. Additionally, underfilling the microtainers could shrink red blood cells.