NHA Exam Three Practice C

Squeezing or milking the capillary puncture site during the collection process:

-helps form the round drop of blood
-increases blood flow to the site
-contaminates the specimen with tissue fluid and hemolyzed cells
-increases efficiency of the collection process

Contaminates the specimen with tissue fluid and hemolyzed cells

Pulmonary circulation carries blood between the:

-heart and body tissues
-heart and lungs
-heart and visceral organs
-heart and venue cavae

Heart and lungs

Performing an arterial puncture on geriatric patients poses increased risk for:

-air bubbles in the syringe
-formation of a hematoma
-hemolysis of the sample
-puncturing a vein not an artery

Formation of a hematoma

Which of the following specimens requires special handling?

-BUN
-Pro time
-Ammonia
-Cholesterol

Ammonia

The phlebotomist is called to the ED to pick up forensic specimens for a sexual assault. The most important concept the phlebotomist must adhere to in handling forensic specimens is proper:

-specimen volume
-specimen transportation
-chain of custody
-temperature of specimen

Chain of custody

Blood borne pathogen standards policies are designed for the protection of health care workers and include free immunizations for:

-HIV
-HBV
-HCV
-both A and B

HBV

A throat swab may be used for which of the following tests?

-strep culture
-whooping cough
-RSV
-influenza

Strep culture

What is the maximum amount of time that should elapse before cells should be separated form plasma or serum?

-3 hours -2 hours -1 hour -30 minutes

2 hours

Capillaries are located in which layer of tissue?

-epidermis
-subcutaneous
-dermis
-cutaneous

Dermis

Upon entering a patient's room, the phlebotomist should first:

-ask the patient his name
-check the patient's armband
-greet the patient and identify self
-state the purpose of the visit

Greet the patient and identify self

All of the following prefixes refer to position or location, except:

-ambi
-exo
-intra
-inter

Ambi

Capillary blood gas testing is most commonly performed on what type of patient?

-geriatric patient
-cardiac patient
-pediatric patient
-diabetic patient

Pediatric patient

Restraining a child during a blood collection procedure may be necessary. Which of the following is acceptable?

-lay the child down and lean over the child
-seat the child on a parent's lap and have the parent hug the child's body
-hold the child's unused arm securely in either position
-All of the above
-None of the above, because restraint nullifies a child's consent

All of the above

Which of the following is considered an example of damages?

-injury a patient suffers because of negligence
-jail or prison time served by the defendant for negligent action
-monetary compensation to the plaintiff for injury
-breach of contract between the plaintiff and defendant

Monetary compensation to the plaintiff for injury

Which of the following tubes require a full draw?

-Purple
-Blue
-Gray
-Green
-Both B and C

Both B and C

The word roots pneu and plea refer to:

-veins
-lungs
-GI tract
-breath

Breath

Which of the following is not considered a newborn screening test?

-homocysteine
-galactose
-alkaline phosphatase
-PKU

Alkaline phosphatase

When drawing a blood culture, CBC, and electrolyte with a syringe, the phlebotomist would fill which of the following first?

-aerobic bottle
-anaerobic bottle
-lavender top tube
-green top tube

Anaerobic bottle

Use of a blood pressure cuff in lieu of a tourniquet requires all of the following parameters, except:

-pressure above diastolic pressure
-pressure below systolic pressure
-referencing the patient's blood pressure from the chart
-blood pressure training

Referencing the patient's blood pressure from the chart

Pushing the evacuated tube beyond the tube advancement mark:

-secures the tube in the Vacutainer adapter
-makes it easier for the phlebotomist to hold
-releases the vacuum from the tube
-shields the tube from the patient's view

Releases the vacuum from the tube

Why would a phlebotomist want to avoid using the basilic vein whenever possible?

-using this site may increase risk of infection
-there is increased risk of damaging a nerve or hitting the brachial artery
-specimens drawn from this vein are often hemolyzed
-only a small-gauge needle can be used to access this vein

There is increased risk of damaging a nerve or hitting the brachial artery

On completion of the venipuncture procedure, the phlebotomist discards the needle by:

-activating needle safety device and placing needle/tube holder unit in a biohazard bag
-recapping and placing needle/tube holder unit in an approved biohazard bag
-activating needle safety device and placing needle/tube holder unit in an approved sharps container
-recapping the needle and placing needle/tube holder unit in an approved sharps container

Activating needle safety device and placing needle/tube holder unit in an approved sharps container

Which of the following exhibits a pulsation on palpation?

-arteriole
-venule
-vein
-artery

Artery

First aid for victims who are bleeding include all of the following, except:

-applying direct pressure to the site of bleeding
-elevating limbs above heart level even if broken
-maintaining pressure until medical assistance arrives
-securing a tourniquet if bleeding cannot be stopped by direct pressure

Elevating limbs above heart level even if broken

Guidelines for standard precautions were set by ____, while blood borne pathogen standards were set by ____.

-CDC; OSHA
-CLIA; CDC
-NFPA; OSHA
-OSHA; TJC

CDC; OSHA

Which of the following tubes contains an anticoagulant that inhibits the conversion of prothrombin to thrombin?

-lavender
-SPS
-green
-light blue

Green

The outermost layer of the integumentary system is called the:

-subcutaneous
-epidermis
-keratin
-epithelial

Epidermis

The function of the circulatory system includes transportation of all of the following, except:

-blood throughout the body
-hormones, enzymes, nutrients, clotting factors
-wastes for removal
-lymph fluid

Lymph fluid

An elderly patient comes to the lab to have a test drawn that may not be covered by medicare. The phlebotomist must make sure the at the patient:

-pays for the test before performing the venipuncture
-signs a patient bill of rights and responsibilities
-signs an advanced beneficiary notice
-has supplementary insurance information on file

Signs an advanced beneficiary notice

Features of dermal puncture devices include all of the following, except:

-retractable blade
-single use
-automatic puncture
-uniform depth

Uniform depth

If a patient experiences prolonged bleeding at the puncture site because of aspirin or anticoagulant therapy, the phlebotomist must make sure that bleeding has completely stopped to prevent all of the following complications, except:

-compartment syndrome
-development of hematoma
-excessive bruising of the arm
-formation of sclerotic vessels

Formation of sclerotic vessels

A competent and professional phlebotomist will try to:

-keep small talk to a minimum
-distract a nervous patient with small talk
-keep the conversation focused on the venipuncture process
-remain silent to ease the patient's anxiety

Distract a nervous patient with small talk

The term phlebotomy is derived from the Greek word phlebotomas, which literally means:

-drawing blood from vessels
-cutting a vein
-puncturing an arterial vessel
-removing a portion of the vein

Cutting a vein

Time-sensitive specimens are:

-drawn at a specific time
-peak and trough draws
-tested immediately after collection
-drawn in the AM versus PM

Tested immediately after collection

All of the following are common tests for bone and joint disorders, except:

-calcium
-uric acid
-CK MM
-rheumatoid factor

CK-MM

The classification of fire extinguisher that can be used on electrical fires is:

-type A
-type B
-type C
-type K

Type C

The DOT label for hazardous substances is:

-diamond shape with United Nations hazard class number and identifying number
-diamond shape with four quadrant colors representing hazards in four areas
-center circle with tritons in fuchsia or yellow colorations and identifying number
-center circle with tricycles erased on outer edges, representing hazards in three areas

Diamond shape with United Nations hazard class number and identifying number

Upon withdrawal of the needle from the patient's arm and activation of the needle safety shield, the needle/adapter can then be discarded in (a):

-biohazard labeled bag on the phlebotomy tray
-designated wastebasket in the patient's room
-puncture resistant biohazard-labeled container
-any puncture-resistant container with a lid

Puncture-resistant biohazard-labeled container

If a serum sample is not separated from the formed elements within 2 hours from the time of collection, which of the following may occur?

-the specimen will show a falsely lowered glucose and a falsely elevated potassium
-the specimen will show a falsely elevated glucose and a falsely lowered potassium
-the specimen will show a falsely lowered glucose and a falsely lowered potassium
-the specimen will show a falsely elevated glucose and a falsely elevated potassium

The specimen will show a falsely lowered glucose and a falsely elevated potassium

Who is legally responsible for injuries resulting from a venipuncture?

-the physician
-the laboratory
-the phlebotomist
-the health care institution

The phlebotomist

A patient in need of supportive oxygen therapy would require the services of:

-occupational therapy
-respiratory therapy
-pharmacy
-physical therapy

Respiratory therapy

Why must a phlebotomist discard the first sample drawn from a heparin or saline lock?

-risk of sample clotting in line
-presence of antibodies in tubing
-potential dilution of the specimen
-reduce risk of infection in the catheter

Potential dilution of the specimen

Proper collection of microcollection tubes includes all of the following, except:

-touching the scoop to the drop of blood
-allowing blood to run freely into the tube
-squeezing as you scrape upward to capture drop
-tapping lightly to move blood into the tube

Squeezing as you scrape upward to capture drop

Application of a tourniquet too tightly can cause which of the following?

-decreased arterial blood flow
-numbing of the arm
-nerve damage
-all of the above

All of the above

Which of the following tests is used to test for diabetes mellitus?

-2 hour postprandial test
-epinephrine tolerance test
-lactose tolerance test
-glucagon tolerance test

2 hour postprandial test

The phlebotomist was having difficulty getting a nice round drop of blood at the dermal puncture site and had a very messy stick. The most likely cause is the puncture:

-was too deep and hit a small venule
-did not cut across the capillary bed
-was parallel to the fingerprint ridges
-was made with the wrong depth of blade

Was parallel to the fingerprint ridges

All of the following prefixes refer to a color, except:

-albi
-lute
-nigr
-bili

Bili

The phlebotomist is documenting lab receipt of a fecal specimen from a patient. What condition(s) would indicate that the fecal specimen is unacceptable?

-does not contain any urine
-not at room temperature
-collected from the toilet
-refrigerated

Collected from the toilet

During venipuncture selection, which of the following would not preclude selection of a particular site?

-slight edema of an arm
-new sleeve tattoo on entire arm
-veins feel cordlike and hard
-appearance of petechiae on tourniquet application

Application of petechiae on tourniquet application

Which of the following is not appropriate personal protective equipment for laboratory specimen processing?

-gloves
-scrub jacket
-goggles
-face shield

Scrub jacket

Which gland regulates carbohydrate metabolism through secretion of insulin and glucagon, which serve to maintain normal blood glucose level?

-pituitary
-liver
-pancreas
-thyroid

Pancreas

The level of a drug that is drawn 30 minutes before the administration of the next dose is known as the:

-peak level
-trough level
-therapeutic level
-none of the above

Trough level

Monitoring the amount of blood drawn from patients who require repeated blood draws is important for all patients but is even more important for children, because:

-children have a lower blood volume than adults
-you may be able to use previously drawn specimens
-children are more difficult to draw than adults
-parents may object to their child's having numerous draws

Children have a lower blood volume than adults

The class of fire encompassing wood, paper, or cloth is:

-class A
-class B
-class C
-class D

Class A

All of the following statements are true about arterial blood collection and testing, except:

-is more dangerous than venous blood collection
-requires additional, specialized training
-can be performed by an MLS or MLT
-requires use of EDTA-coated syringe

Requires use of EDTA-coated syringe

Which of the following point-of-care tests could be performed on whole blood?

-cholesterol
-glucose
-prothrombin time
-all of the above

All of the above

A health maintenance organization (HMO):

-does not employ phlebotomists
-functions as a full-service outpatient clinic
-provides walk-in services, taking no appointments
-functions as an independent laboratory analyzing samples from other labs

Functions as a full-service outpatient clinic

The appropriate tube for a STAT sodium level is:

-sodium heparin
-lithium heparin
-SST
-red glass

Lithium heparin

Blood should not be drawn from the arm on the side of a mastectomy because of:

-lymphostasis due to lymph node removal
-edematous fluids that may hemolyze the blood
-hemoconcentration of analyses in the arm
-veins that are sclerosed or occluded in the arm

Lymphostasis due to lymph node removal

A patient is admitted to the hospital with a diagnosis of influenza. The patient is admitted under tier 2 isolation precautions that include the use of which of the following precautions?

-airborne
-expanded
-isolation
-protective environment

Expanded

The phlebotomist must instruct the patient on collection of a specimen for occult blood and tells the patient to collect a ____ specimen, because it is the specimen of choice for occult.

-urine
-stool
-sputum
-peritoneal fluid

Stool

A physician calls the laboratory requesting a procedure whereby a patient will donate his or her own blood before his or her surgery. This type of donation is known as:

-heterogeneous donation
-autologous donation
-homogeneous donation
-xenogenous donation

Autologous donation

Which of the following anticoagulants does not alter the pH of the sample collected?

-EDTA
-oxalates
-citrate
-heparin

Heparin

The medical term for nausea and vomiting is _______.

-syncope
-vertigo
-emesis
-petechiae

Emesis

Blood enters the left ventricle from the:

-pulmonary vein
-venae cavae
-left atrium
-systemic circulation

Left atrium

OSHA Hazardous Communication Standard (HAZCOM):

-requires manufacturers to supply MSDS
-displays the type of hazard on a material's label
-warns of the location of hazardous materials
-describes all safety procedures for using chemicals

Requires manufacturers to supply MSDS

Which of the following is not a reason for donor rejection during blood donor collection procedures?

-exposure to HIV
-exposure to hepatitis
-race/ethnicity
-drug consumption

Race/ethnicity

The best choice of needle for a radial arterial blood has draw is:

-22 gauge, 1 inch
-20 gauge, 1 1/2 inch
-18 gauge, 1 inch
-25 gauge, 1 1/2 inch

22 gauge, 1 inch

All of the following can be used to assess whether or not a patient has suffered a heart attack, except:

-creatine kinase
-protein
-troponin
-myoglobin

Protein

For a semen sample to be analyzed before the deterioration of the sperm, the patient must be instructed to deliver the semen sample to the lab within how many minutes of collection?

-10 minutes
-20 minutes
-30 minutes
-45 minutes

30 minutes

The tube attitude that inhibits complement and phagocytosis is:

-SPS
-EDTA
-Silicone
-Thixotropic gel

SPS

Which word part of en/ceph/al/itis is the suffix?

-En
-Ceph
-Alitis
-Itis

Itis

Bile is produced by which organ?

-liver
-pancreas
-Islets of Langerhans
-gallbladder

Liver

How long should you wait to centrifuge thrombin tubes that have been sitting at room temperature to ensure complete clotting of a tube?

-5 to 10 minutes -15 to 20 minutes -30 to 45 minutes -1 hour

5 to 10 minutes

A 4 year old child is screaming and thrashing as the phlebotomist tries to look for a vein. Mom is upset and is not helpful in restraining the child. The best course of action for the phlebotomist to take is to:

-instruct the mom in the importance of restraining the child
-reason with the child about the importance of the blood draw
-offer the child a reward for holding still for the draw
-seek the assistance of another phlebotomist to restrain the child

Seek the assistance of another phlebotomist to restrain the child

Which of the following terms refers to one complete heartbeat consisting of depolarization and depolarization of both the atria and the ventricles?

-sinoatrial node
-cardiac cycle
-stylus
-myocardial event

Cardiac cycle

Sodium citrate functions to:

-promote faster clotting of the specimen
-coat tube walls to prevent RBC adherence
-prevent clotting of the specimen
-provide surface area for platelet activation

Prevent clotting of the specimen

Which of the following contains protocols and other information about tests performed in the lab, the reason for test performance, specimen requirements, collection methods, and required equipment and supplies?

-floor book
-procedure manual
-maintenance logs
-QA manual

Procedure manual

Normal bleeding time results fall within the range of:

-1 to 2 minutes -2 to 10 minutes -6 to 12 minutes -15 to 20 minutes

2 to 10 minutes

Which cell loses its nucleus before release from the bone marrow?

-RBC
-WBC
-Platelet
-Stem cell

RBC

**An RBC initially contain a nucleus, but as the cell matures, the nucleus is expelled, after which the cell is referred to as a reticulocyte. Nucleated RBCs are not normally seen in the peripheral blood of healthy individuals.**

Which of the following potential exposures presents the least risk to the phlebotomist?

-cut on hand from a broken tube of blood while cleaning up
-blood leaks through the glove onto badly chapped hands
-blood sprays onto exposed intact skin during venipuncture
-rub eyes without washing hands while processing specimens

Blood sprays onto exposed intact skin during venipuncture

You are assigned to cover the open-heart recovery unit and will be monitoring heparin therapy on several patients. Which of the following point-of-care tests will you perform to monitor heparin therapy?

-ACT
-PT
-APTT
-Both A and C

Both A and C

**the activated coagulation time (ACT) and the activated partial thromboplastin time (APTT) can be used to monitor heparin therapy and are available now as point of care tests**

The phlebotomist drew four red glass tubes for a reference lab test. The minimum amount of time she waited before centrifuging the tubes was:

-10 minutes
-15 minutes
-20 minutes
-30 minutes

30 minutes

The phlebotomist forgot to put the bed rail back up after lowering it to perform the venipuncture. The patient later fell out of the bed and broke a hip. This is an example of:

-negligence
-malpractice
-damages
-battery

Negligence

Specimen collection requiring chain of custody protocol:

-HIV
-HBV
-DNA
-MRSA

DNA

All of the following are common lab tests for the digestive system, except:

-occult blood
-ammonia
-bilirubin
-microalbumin

Microalbumin

**microalbumin is a renal test**

The proper instruction for collection of a midstream clean-catch after hand are washed is:

-cleanse; void portion into container; void remainder into the toilet
-cleanse; void portion into toilet; void remainder into container
-void portion into toilet; cleanse; collect remainder into container
-cleanse, void portion into toilet; void portion into container; void remainder into toilet

Cleanse, void portion into toilet; void portion into container; void remainder into toilet

Precautions that can reduce risk of injury in the laboratory include all of the following, except:

-wearing perforated shoes with nonskid soles
-not eating, drinking, smoking, or chewing gum
-tying hair that hangs below collar back from face
-wearing correct PPE when handling specimens

Wearing perforated shoes with nonskid shoes

The purpose of palpating a vein is to determine all of the following characteristics of a suitable vein for venipuncture, except:

-bounciness
-rigidity
-depth
-direction

Rigidity

Which of the following should the phlebotomist avoid when making a site selection?

-veins in the back of the hand
-the median antecubital vein
-the arm nearest a mastectomy
-the brachial antecubital vein

The arm nearest a mastectomy

The phlebotomist has received a specimen for chromosomal studies and delivers it to which laboratory department?

-immunochemistry
-molecular diagnostics
-cytology
-cytogenics

Cytogenics

Warm collection and storage are required for all of the following specimens, except:

-cryoglobulin
-cold agglutinins
-c reactive protein
-cryofibrinogen

C-reactive protein

The phlebotomist is centrifuging and processing the samples collected in the morning sweep. Which of the following tubes does not require the serum to be transferred to another labeled tube within 2 hours to avoid falsely increased or decreased laboratory values?

-sodium citrate tube
-EDTA
-SST
-Red top tube

SST

What is the best way to prove standard of care?

-have another health care worker witness the action
-document any incidents that occur
-have expert witnesses give testimony during trial
-do not do any task outside your scope of practice

Document any incident that occur

The phlebotomist draws a sedimentation rate, PT/PTT, and total protein to be delivered to which of the following departments per the correct order of draw?

-Coagulation, chemistry, hematology
-Chemistry, coagulation, flow cytometry
-Chemistry, hematology, coagulation
-Coagulation, hematology, immunochemistry

Coagulation, chemistry, hematology

Which agency grants certification for phlebotomy upon the passing of a certification exam?

-American Society for Clinical Laboratory Science (ASCLS)
-National Phlebotomy Association
-American Society for Clinical Pathology (ASCP)
-Only B and C
-All of the above

Only B and C

An example of a percutaneous exposure is:

-blood splash in the eye
-blood exposure by needlestick
-blood splashes on the intact skin
-blood exposure on lab coat

Blood exposure by needlestick

Chemistry tests that can be performed as POCT include all of the following, except:

-ABGs
-CBC
-BUN
-Electrolytes

CBC

Potassium levels can be collected by dermal puncture, but it is not the method of choice for all of the following reasons, except:

-there is a greater risk for sample hemolysis
-potassium levels are lower in capillary blood
-a larger sample volume is required for testing
-venous blood reference ranges are higher

A larger sample volume is required for testing

Which of the following terms describes the quantitative methods used to monitor the quality of procedures?

-quality phlebotomy
-quality control
-quality enhancement
-quality assurance

Quality control