Exam Questions

1. What are the duties of the phlebotomist? What is the main duty?

  • The primary duty of a phlebotomist is to collect blood samples from patients for laboratory testing. This includes ensuring proper patient identification, selecting the correct equipment, preparing the site for venipuncture or capillary puncture, and ensuring proper labeling and transport of specimens.

2. Name the different departments and the corresponding tube colors with the corresponding tests.

  • Hematology: Lavender Tube (Anticoagulant: EDTA) – CBC (Complete Blood Count).

  • Coagulation Studies: Light Blue Tube (Anticoagulant: Sodium Citrate) – PT, aPTT (Prothrombin Time, Activated Partial Thromboplastin Time).

  • Chemistry: Gold/SST Tube – Glucose, Electrolytes, Liver Function Tests.

  • Microbiology: Blood Culture Bottles (No tube color) – C&S (Culture and Sensitivity).

  • Serology/Immunology: Red or Gold Tube – Antibodies, Antigens.

3. What is the C&S test and its purpose?

  • C&S stands for Culture and Sensitivity. It’s used to identify microorganisms (like bacteria or fungi) in the specimen and determine which antibiotics are effective in treating the infection. Writing the type and source of the specimen helps the lab staff properly interpret the test results and determine the correct treatment.

4. What tube color is used for coagulation studies?

  • Light Blue Tube (contains Sodium Citrate as the anticoagulant).

5. What are the tests for coagulation studies?

  • PT (Prothrombin Time), aPTT (Activated Partial Thromboplastin Time), and INR (International Normalized Ratio).

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

  • Yes, the light blue tube must be filled completely to maintain the correct ratio of blood to anticoagulant.

7. Does it make a difference if we underfill the light blue tube?

  • Yes, underfilling can lead to inaccurate test results because the ratio of blood to anticoagulant will be incorrect.

8. What is the ratio of light blue tube?

  • The ratio of blood to anticoagulant is 9:1.

9. What tube do we use for STAT testing?

  • STAT testing is usually done using Plasma and is often collected in a light green tube (Lithium Heparin with Gel) or orange tube (for rapid serum separation).

10. Why do we do STAT testing on plasma and not serum?

  • Plasma is preferred for STAT testing because it can be processed faster, providing quicker results than serum.

11. Do you find an anticoagulant in an SST tube?

  • No, an SST (Serum Separator Tube) does not contain an anticoagulant. It has a gel that separates the serum from blood cells after centrifugation.

12. What does SST stand for?

  • SST stands for Serum Separator Tube.

13. What does PST stand for?

  • PST stands for Plasma Separator Tube.

14. What are the different types of royal blue tubes?

  • Royal blue tubes come with either no additive (for trace metal analysis) or with an EDTA anticoagulant.

15. What does a royal blue with a green color code represent?

  • This tube contains Lithium Heparin as the anticoagulant, used for trace metal analysis.

16. What are three types of needles we learned?

  • Vacutainer Needles, Butterfly Needles, and Syringe Needles.

17. What are the parts of the needle?

  • The hub, shaft, bevel, and lumen.

18. What are the parts of the holder?

  • The flanges, needle adapter, and tube holder.

19. What are the flanges for?

  • Flanges are for gripping and stabilizing the needle holder.

20. If we are collecting blood from a WIS (butterfly), where can we use it?

  • A butterfly needle is typically used for smaller veins, such as those in the hand or for pediatric venipuncture.

21. What is gauge?

  • Gauge refers to the diameter of the needle. The smaller the gauge number, the larger the diameter.

22. What is the gauge size for the green needle and the black needle?

  • The green needle is typically 21 gauge, and the black needle (also called the 22 gauge) is used for smaller veins.

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

  • Vacuum.

24. What is serum?

  • Serum is the liquid portion of the blood after the blood has clotted and the cells have been removed.

25. Does serum have fibrinogen?

  • No, serum does not contain fibrinogen because it is used up in the clotting process.

26. What is plasma?

  • Plasma is the liquid portion of the blood that is anticoagulated (not clotted).

27. Can you perform PT and aPTT tests on plasma?

  • Yes, both PT and aPTT tests are performed on plasma.

28. What is whole blood?

  • Whole blood is blood that has not been separated into its components (plasma, serum, etc.) and contains all blood components, including red and white blood cells, platelets, and plasma.

29. What tests can you perform on whole blood?

  • Tests like CBC (Complete Blood Count) are commonly performed on whole blood.

30. What is an icteric specimen? What color is an icteric specimen?

  • An icteric specimen is a sample that has jaundice, which causes the serum to appear yellow.

31. What is a lipemic specimen? What color is a lipemic specimen?

  • A lipemic specimen has high lipid levels, causing the serum to appear milky or cloudy.

32. How long can we leave the tourniquet on for?

  • The tourniquet should be left on no longer than 1 minute to avoid hemoconcentration.

33. What is the routine venipuncture procedure?

  • The routine venipuncture procedure includes identifying the patient, selecting the correct site, preparing the site with antiseptic, inserting the needle, and collecting the sample while ensuring proper tube inversion and labeling.

34. What is the best angle for needle insertion during venipuncture?

  • The needle should be inserted at a 15-30 degree angle.

35. When should we invert the tubes?

  • Immediately after collection to ensure proper mixing of the blood with the additive or anticoagulant.

36. Why do we invert the tubes and mix the anticoagulant?

  • To prevent clot formation and ensure uniform mixing of blood with the additive.

37. What is the antiseptic used to clean the site for venipuncture?

  • 70% Isopropyl Alcohol is commonly used to clean the venipuncture site.

38. What is a capillary puncture?

  • A capillary puncture involves collecting blood from the fingertip or heel for small volume tests.

39. What is a heel puncture?

  • A heel puncture is performed on infants, usually on the lateral or medial part of the heel.

40. What does plantar mean?

  • Plantar refers to the bottom of the foot.

41. What is a lancet?

  • A lancet is a small, sharp instrument used to make an incision in the skin during capillary puncture.

42. What are the tests you cannot do a capillary puncture for?

  • Tests like blood cultures, coagulation studies (PT, aPTT), and blood gases should not be performed on capillary samples.

43. What are the 2 newborn tests typically collected via capillary blood?

  • New born screening and Blood Glucose Level Testing

44. What analyte is light sensitive?

  • Bilirubin is light-sensitive and must be protected from light.

45. What tests are light-sensitive, need to be warmed, or chilled?

  • Light-sensitive tests include bilirubin. Tests like cold agglutinins need to be warmed, and tests like ammonia need to be chilled.

46. What is a random sample for urine?

  • A random urine sample is collected at any time, not necessarily in the morning.

47. What is a timed sample?

  • A timed urine sample is collected at specific intervals, such as for a 24-hour urine collection.

48. What is a 24-hour urine sample?

  • A 24-hour urine sample is collected over a 24-hour period to measure substances in the urine.

49. Why do we collect the morning sample at the end of 24 hours?

  • The first morning urine is often more concentrated and contains higher levels of certain analytes.

50. What is MSU?

  • MSU stands for Midstream Sample of Urine.

51. What is CCMUS? Where do we cleanse?

  • CCMUS stands for Clean Catch Midstream Urine Sample, and cleansing is done around the urinary meatus.

52. What is the best preferred urine sample for pregnancy testing?

  • The first morning urine is preferred for pregnancy testing.

53. What is FOBT?

  • FOBT stands for Fecal Occult Blood Test, used to check for hidden blood in stool.

54. What are all the non-blood specimens?

  • Non-blood specimens include urine, saliva, sputum, stool, semen, cerebrospinal fluid (CSF), and pleural fluid.

55. What is pleural fluid, pericardial, peritoneal, synovial?

  • Pleural fluid surrounds the lungs, pericardial fluid surrounds the heart, peritoneal fluid surrounds abdominal organs, and synovial fluid lubricates joints.

56. Where can we collect a synovial fluid specimen?

  • Synovial fluid is collected from the joint cavity.

57. What is CSF? Where do you find it?

  • CSF (Cerebrospinal Fluid) is found in the spinal cord and brain.

58. What are the causes for hematoma formation?

  • Causes include poor needle placement, excessive pressure on the vein, or repeated punctures.

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

  • Lymphostasis (reduced lymph flow) can occur after a mastectomy, increasing the risk of lymphoedema and infection.

60. Define lymphostasis.

  • Lymphostasis is the impaired flow of lymphatic fluid, often caused by surgery like mastectomy.

61. What does hemoconcentration mean?

  • Hemoconcentration refers to increased concentration of blood components due to reduced blood volume (like from prolonged tourniquet application).

62. What does hemolysis mean?

  • Hemolysis is the destruction of red blood cells, releasing their contents into the plasma.

63. What are the causes of hemolysis?

  • Causes include excessive force during collection, improper storage, or freezing of specimens.

64. What are venipuncture troubleshooting examples?

  • If blood is flowing slowly, the needle may be partially inserted, or the vein may be collapsed. Hematoma formation could result from poor needle insertion or excessive movement.

65. What should you do if a patient doesn’t have an armband for verification?

  • Verify patient identity by asking for personal details and cross-checking with medical records.

66. What should you do if a patient feels like fainting?

  • Have the patient lie down and apply pressure to prevent injury.

67. What is blood culture? When should you draw it?

  • Blood cultures are drawn when a bacterial infection is suspected. Two bottles (aerobic and anaerobic) should be collected from different sites.

68. What is the order of draw?

  • 1. Blood cultures, 2. Light blue (Coagulation), 3. Red (Serum), 4. Gold/SST, 5. Green (Heparin), 6. Lavender (EDTA), 7. Gray (Glucose).

69. What if someone is bleeding for more than 5 minutes?

  • Apply pressure, elevate the site, and check if the needle or tourniquet is applied properly.

70. What is ethics?

  • Ethics refers to the moral principles governing behavior and decision-making.

71. What is professionalism?

  • Professionalism involves maintaining respect, integrity, and competence in patient interactions and following ethical guidelines.

  1. PKU and TSH are related: PKU can affect thyroid hormone levels, specifically TSH. Phenylalanine, which accumulates in PKU, can interfere with thyroid hormone production and metabolism, often resulting in lower TSH levels.

  2. PT (Prothrombin Time): Measures the time it takes for blood to clot, used to monitor warfarin therapy.

  3. aPTT (Activated Partial Thromboplastin Time): Measures the time it takes for blood to clot, used to monitor heparin therapy.

  4. INR (International Normalized Ratio): Standardized ratio of PT, used to ensure consistency in results across different laboratories and to monitor warfarin therapy effectively.