AMCA PHLEB

A phlebotomy technician arrives for a shift wearing clean scrubs, closed-toe shoes, and a name badge. The technician is also wearing long artificial nails. What is the most appropriate action to maintain a professional appearance and follow safety standards?

Remove or shorten the artificial nails before performing patient care

Define ethics

Principles of right and wrong

Empathy

To care for and and respect the health and welfare of your patients

A phlebotomy technician prepares for a blood draw and realizes they set up the wrong additive tube for the ordered test. The patient has not been stuck yet. What should the technician do next?

Stop, replace the tube with the correct one, and follow facility policy before proceeding

A very busy phlebotomist misidentifies the patient when collecting a specimen for transfusion preparation. The possible misdiagnosis of blood type could cause the patient's death. If the phlebotomist's action results in injury, this wrongful act is known as…

Negligence

Deceitful practice or false portrayal of facts either by words or conduct is the definition of….

Fraud

Performing one's duties in the same manner as any other reasonable and prudent person with the same experience and training is referred to as…

Standard of care

"People like that always get ringworm." What is this statement an example of?

Stereotyping

What is not a phlebotomist’s duty?

Starting IV lines

A patient appears anxious and says, "I hate needles —please don't embarrass me about this." Which response best supports the patient's right to dignity and respect?

"I understand — many people feel nervous. I'll explain each step and we'll take it at your pace”

After a blood draw, a patient tells the phlebotomy technician, "My rights were violated and I want to file a complaint." What is the phlebotomy technician's best response?

Provide the patient with the facility's complaint process or appropriate contact (e.g., supervisor/patient relations) and report the concern per policy

Before performing a venipuncture, which information must the phlebotomy technician explain to obtain informed consent?

The purpose of the blood draw and what the patient should expect during the procedure

What is most important for phlebotomists to keep in mind during their daily routine in medical settings?

Confidentiality

Which government agency regulates the quality of gloves worn when performing phlebotomy procedures?

FDA

• The FDA regulates medical device manufacturing. Gloves are classified as medical devices and must meet FDA quality standards.

What is the national organization that sets standards for phlebotomy procedures?

CLSI

During a venipuncture, a patient suddenly becomes dizzy and faints, sliding partway off the chair before the phlebotomy technician and a coworker assists the patient safely to the floor. What action is most appropriate regarding documentation and reporting?

Complete an incident report according to facility policy and document relevant facts in the patient's medical record

Critical values (test values that are considered life threatening) are also known as what?

Panic values

What is the primary purpose of continuing education for a phlebotomy technician?

To maintain an update, knowledge and skills to remain competent and follow current standards

What is the most important step in achieving medical sepsis?

Washing hands

A patient coughs into a tissue and then touches the armrest while waiting for a blood draw. What should the phlebotomy technician do next to follow proper respiratory hygiene and cough etiquette?

Perform hand hygiene before patient contact and offer the patient hand hygiene supplies (e.g. sanitizer)

According to OSHA's Bloodborne Pathogen Standard, medical personnel must wear personal protective equipment (PPE) when they may come into contact with what?

Blood

While preparing a patient for an examination, the patient states that she is nauseous. She begins to vomit bright, red blood. Which PPE would be the most appropriate to wear in this situation?

Gloves, face shield, and gown

What is an example of a disease requiring droplet isolation?

Pertussis

• Pertussis (whipping cough) is a respiratory disease transmitted by droplets.

Which type of contact infection transmission involves transfer of an infecting microbe to the mucous membranes of a susceptible individual by means of a cough or sneeze?

Droplet

Which type of precautions would be used for a patient who has pulmonary tuberculosis?

Airborne

• anyone entering the patient's room is required to wear a mask (respirator). In addition to standard precautions, airborne isolation is required for pulmonary tuberculosis

What is the physical removal of blood, mucus, and other debris from instruments using brushes and detergent called?

Cleaning

which disinfectant are commonly used in the medical field and found to be effective against the blood-borne pathogens?

Bleach

What solution will help prevent the transmission of hepatitis?

Household bleach

What is the most appropriate method for disposing of a contaminated needle?

Place it directly into a sharps container without recapping in the room where it was used

What is the first method used to control severe bleeding?

Direct pressure

What is the abbreviation for the virus that causes acquired immunity deficiency syndrome (AIDS)?

HIV

What is true when using a phlebotomy needle that does not have a safety feature?

It must be used with a holder that has a safety feature

Which organization originally developed the guidelines for universal precautions?

CDC

A phlebotomy technician reviews a requisition that lists the patient as “Maria Lopez,” DOB 04/12/1985. At the bedside, the patient's wristband reads “Maria Lopes,” DOB 04/12/1985. What should the technician do next?

Stop the collection and resolve the discrepancy according to facility policy before drawing blood

A hospitalized patient may not be identified by what means?

Patient’s chart

• A patient armband and verbal confirmation are acceptable ways of patient ID according to the joint commission

After you have washed your hands, put on PPE, and assembled the equipment and supplies, what is your next step in obtaining a capillary blood sample?

Identify the patient

What is the difference between NPO and fasting?

Fasting allows the patient to drink water, whereas NPO does not

What are the best specimens to use for establishing inpatient reference ranges for blood tests?

Basal state specimens

What is lymphostasis

Obstruction/stoppage of the flow of lymph

A patient tells the phlebotomy technician, “I have a latex allergy.” What action is most appropriate before beginning specimen collection?

Select non-latex gloves and non-latex equipment as needed before contacting the patient

A patient tells the phlebotomy technician, “I fainted the last time I had blood drawn.” What is the best position for this patient during venipuncture to ensure safety?

Seated in a chair with arm support or lying down per facility policy

The most common sites for venipuncture are in what area?

The antecubital area of the arm

What site is most commonly used in venipuncture to withdraw blood?

Median cubital vein

Which of the following veins is not an antecubital vein?

A) median cubital

B) basilic

C) femoral

D) cephalic

C) femoral

What must the clinical medical assistant do in preparation for a venipuncture or capillary stick?

A) allow the alcohol to air dry

B) blow on the alcohol for quicker drying time

C) wipe the alcohol off with dry gauze

D) fan the alcohol with your hand

A) allow the alcohol to air dry

A phlebotomy tourniquet should never be left on for more than how long?

1 minute

Hemoconcentration from prolonged tourniquet application increases what?

Non-filterable analytes

If the tourniquet is applied for longer than three minutes, which of the analytes will most likely become falsely evaluated?

Potassium

• plasma, cholesterol, iron, lipid protein, and potassium levels will be falsely elevated if tourniquet is too tight or prolonged

What effect does warming the site have on venipuncture?

Increases localized blood flow

What is venous stasis?

Stoppage of the normal venous blood flow

How does heparin prevent blood from clotting?

Buy inactivating thrombin

• heparin prevents coagulation by enhancing anti-throbbing III, which inactivates thrombin during the coagulation process

What is the purpose of an anti-glycolytic agent?

It preserves glucose

Blood would be used for what kind of testing if it was collected in a vacuum tube containing EDTA?

Hematology tests

What stopper color identifies a tube used for coagulation testing?

Light blue

What would result in lipemia?

High fat content from the blood

When would using a butterfly needle be beneficial?

When handling geriatric patients

Which needle gauge has the largest lumen?

A) 18

B) 21

C) 22

D) 20

A) 18

Where is the most common vocabulary puncture site on an adult?

Ring finger

Guides used to monitor all aspects of patient care are known as what?

QA indicators

• QA indicators are specific markers that can measure quality, adequacy, accuracy, timeliness, and customer satisfaction

How often should quality control tests be done for procedures performed in the office?

Daily

A phlebotomy technician is about to perform of any puncture on an anxious patient. What statement best uses patient centered language to promote understanding?

“I’m going to clean your arm and then you'll feel a quick stick while I collect the blood sample”

A tube containing heparin is collected between which two other tubes listed below?

A) an EDTA tube and a glycolytic inhibitor tube

B) A serum tube and an EDTA tube

C) A blood culture and before a serum tube

D) A citrate additive tube and a serum tube

B) A serum tube and an EDTA tube

Which tubes must be first in the order of draw?

Blood culture tubes

To prevent additive, cross-contamination, which tube should be drawn first when collecting multiple blood specimens by venipuncture?

A) gray top (fluoride/oxalate)

B) lavender top (EDTA)

C) light blue top (sodium citrate)

D) green top (heparin)

C) light blue top (sodium citrate)

A patient is scheduled for a fasting blood test. What best describes the correct patient preparation for a fasting specimen?

The patient should not eat or drink anything except water for the required fasting, unless instructed otherwise.

A single order that is administered immediately and usually written for emergencies is known as what?

STAT order

What test may require special “chain of custody” documentation when collected?

Drug screen

What item is unnecessary when performing a routine venipuncture?

Sterile gloves

• routine venipuncture requires clean, non-sterile gloves. Sterile gloves are not necessary or unless performing a sterile procedure or if otherwise indicated.

What angles should your needle position be in to perform a venipuncture?

15° angle with the bevel up

When would a capillary blood sample be diluted with tissue fluid?

If the finger is squeezed excessively

What step is not appropriate when performing a capillary puncture?

Placing a tourniquet around the finger

What is the principle reason for bracing the hand holding the needle assembly against the patient's arm during phlebotomy?

To prevent excess needle movement

What is the primary purpose for anchoring a vein in performing a venipuncture?

To prevent it from rolling

What are the small red spots on a patient's skin due to a blood clotting abnormality?

Petechiae

What term refers to the control of bleeding?

Hemostasis

You must draw a proton specimen from a patient with IVs in both arms. What location is the best place to draw the specimen?

Below an IV

A phlebotomist must collect a blood specimen from a patient who has an active IV line in the left arm, and the right arm is unavailable. What is the appropriate site for venipuncture?

Distal to the IV insertion site

What hormone is detected in positive urine pregnancy tests?

HCG

• human chorionic gonadotropin is produced by the placenta

What step is correct when collecting a capillary blood specimen for point of care (POC) glucose testing?

Wipe away the first drop of blood after the fingerstick, then collect the specimen

What is an abnormal finding in the blood?

Bacteria

What test requires strict skin antisepsis procedures before specimen collection?

Blood culture

A phlebotomy technician collects a light blue top tube for coagulation testing, but noticed it filled only halfway before blood flow stopped. What is the most appropriate action?

Discard the underfilled tube and recollect a properly filled light blue tube per policy

What is a urine C&S typically ordered to detect?

Presence of UTI

What instruction is most appropriate when collecting a sputum specimen?

“Take a deep breath and cough deeply to bring up mucus from your lungs into the container.”

What can you do to lower the risk of bruising after venipuncture?

Apply pressure to the puncture site.

Why should a laboratory report form state that a specimen has been collected by capillary puncture?

Because results can vary by specimen source

What is the range for normal respiratory rates for adults?

12-20 per minute

What word is used to describe the breakdown of red blood cells?

Hemolysis

A decrease in the plasma volume with an increased concentration of cells in larger molecules is referred to as what?

Hemoconcentration

Which type of blood cell is responsible for defense and immunity?

White blood cells

The liquid portion of a blood specimen (without an anticoagulant) is known as what?

Serum

What is the best way to prepare routine blood specimen tubes for transportation to an offsite lab?

Seal the tubes in plastic bags

What fluid is obtained by lumbar puncture?

Cerebrospinal

What specimen is least likely to require special handling?

Cholesterol

What would be a pre-analytical error related to a specimen storage?

Exposure to light

What best describes the type of analysis used when processing blood for transfusions?

Immunohematological

• a Immunohematological process looks for blood that is a non-harmful match to a possible recipient by checking blood type (ABO) and blood antigens (Rh factor)

What test is most likely used to test for inflammation, infectious disease, and malignant neoplasms?

ESR

• ESR is used to test for collagen disease, inflammatory disease, and rheumatoid arthritis

A phlebotomy technician collects a specimen in a light blue topped tube for a PT/INR test. To which laboratory department should the specimen be delivered?

Coagulation