NCCT Interactive Review 6 MLT 413NC Saddleback College |
UPDATED Questions with 100% Verified Answers
Question:
1. Which of the following specimens is likely to be considered
STAT?
A. therapeutic drug levels
B. lactic acid
C. electrolytes
D. blood smears
Answer:
lactic acid
Rationale
A lactic acid level is likely to be a STAT order as this analyte deteriorates very quickly after
being drawn and is usually associated with emergency situations. Therapeutic drug levels,
electrolytes and blood smears are much more stable analytes.
Question:
A phlebotomist is assigned to manage an outpatient draw
station. Prioritize the following patients in the correct order.
(Click and drag the options in the left column to their correct
position in the right column.)
2-hour post-prandial glucose level due in 40 minutes
type and screen on a pre-operative patient due for surgery
that day
weekly PT/INR
STAT troponin level on a patient sent over from a doctor's
office
Answer:
STAT troponin level on a patient sent over from a doctor's office, type and screen on a
pre-operative patient due for surgery that day, 2-hour post-prandial glucose level due in
40 minutes, weekly PT/INR
Rationale
It is important that a phlebotomist be able to prioritize blood draw orders. This assures
,that patients get correct and timely medical treatment. A STAT troponin level is used to
triage the possibility of heart attack. The type and screen for surgery the same day is
needed so the Blood Bank staff can assure blood components can be ready if necessary.
For accurate results, timed tests need to be drawn within a certain window. The weekly
PT/INR can be done anytime.
Question:
3. Which of the following is the appropriate antiseptic to use in
order to achieve a high degree of antisepsis prior to blood
culture collection on a 6-month-old infant?
A. benzalkonium chloride
B. povidone-iodine (PVP)
C. betadine
D. chlorhexidine gluconate
Answer:
chlorhexidine gluconate
Rationale
CLSI recommends chlorhexidene gluconate to prepare a venipuncture site for blood
culture collection on infants older than 2 months. Iodine preparations or benzalkonium
chloride are not typically used as they may be too harsh for sensitive skin.
Question:
4. The phlebotomist has orders to draw blood cultures on a
patient with fragile veins and decides to use a butterfly
system. Which of the following should be drawn first?
A. anaerobic
B. aerobic
C. pediatric
D. mycobacterium
Answer:
aerobic
Rationale
Blood cultures are typically drawn when the patient's physician suspects a bacterial
,infection in the bloodstream (septicemia). To maximize the chance of harvesting the
infectious agent, the cultures are drawn in sets of two bottles, one aerobic (with air) and
one anaerobic (without air). A volume of 20 ml is collected aseptically with 10 ml
distributed into each bottle. If the collection is performed with a butterfly system, the
aerobic bottle is filled first as the tubing of the butterfly set will introduce air into the
container. Once the tubing is filled with blood, the anaerobic bottle is attached and filled.
The same order is used regardless of the size or draw volume of the bottles.
Mycobacterium is the causative agent of tuberculosis and not a collection device.
Question:
5. Which of the following is the reason a phlebotomist should
avoid milking a finger during a capillary puncture?
A. The specimen may be contaminated with interstitial fluid.
B. The specimen may be contaminated with staphylococcus
aureus.
C. The specimen may be contaminated with isopropyl and
cause hemolysis.
D. The collection site may be contaminated by the
phlebotomist's gloves.
Answer:
The specimen may be contaminated with interstitial fluid.
Rationale
Milking a capillary puncture, in an effort to obtain more blood, involves excessive
squeezing and the possible introduction of tissue fluid into the specimen, thereby diluting
or contaminating the result. The phlebotomist needs to assure the area is warm to
encourage good blood flow, perform an adequate puncture with the correct device,
wipe the first drop of blood away and continue with a "squeeze, collect and release"
rhythm to allow blood flow to recover after the squeezing and collection. Contamination
with staphylococcus aureus can occur if the puncture area is not adequately cleaned or
is retouched after cleaning. Contamination with isopropyl alcohol can occur when the
area is not allowed completely dry resulting in the possibility of hemolysis of the
specimen.
Question:
, 6. A three-month-old patient was sent to the lab for an H&H.
How should the phlebotomist collect the sample?
A. venipuncture, antecubital fossa
B. dermal puncture, great toe
C. dermal puncture, middle finger
D. dermal puncture, heel stick
Answer:
dermal puncture, heel stick
Rationale
Capillary blood samples may be taken from the lateral side heel of children until they
begin to walk at which time the heel becomes tougher and more difficult to penetrate. In
this case, as the patient is 3 months old, a heel stick would be the best choice. The middle
finger or great toe are not used. Since a very small amount of blood is needed, a
venipuncture in the antecubital area is not necessary.
Question:
7. Which of the following tests can be collected by capillary
puncture? (Select the two (2) correct answers.)
A. blood cultures
B. blood gas
C. bilirubin
D. erythrocyte sedimentation rate
E. PTT
Answer:
blood gas, bilirubin
Rationale
Collecting blood samples by capillary (dermal) puncture is an alternative to venipuncture
when a small amount of blood is needed and the procedure is appropriate for the test
requested. Blood gasses and bilirubin determinations may be done with this method.
Blood cultures and erythrocyte sedimentation rates (ESR) require a larger amount of
blood. Coagulation tests that require plasma specimens such as the PTT are not done by
dermal puncture.
Question:
UPDATED Questions with 100% Verified Answers
Question:
1. Which of the following specimens is likely to be considered
STAT?
A. therapeutic drug levels
B. lactic acid
C. electrolytes
D. blood smears
Answer:
lactic acid
Rationale
A lactic acid level is likely to be a STAT order as this analyte deteriorates very quickly after
being drawn and is usually associated with emergency situations. Therapeutic drug levels,
electrolytes and blood smears are much more stable analytes.
Question:
A phlebotomist is assigned to manage an outpatient draw
station. Prioritize the following patients in the correct order.
(Click and drag the options in the left column to their correct
position in the right column.)
2-hour post-prandial glucose level due in 40 minutes
type and screen on a pre-operative patient due for surgery
that day
weekly PT/INR
STAT troponin level on a patient sent over from a doctor's
office
Answer:
STAT troponin level on a patient sent over from a doctor's office, type and screen on a
pre-operative patient due for surgery that day, 2-hour post-prandial glucose level due in
40 minutes, weekly PT/INR
Rationale
It is important that a phlebotomist be able to prioritize blood draw orders. This assures
,that patients get correct and timely medical treatment. A STAT troponin level is used to
triage the possibility of heart attack. The type and screen for surgery the same day is
needed so the Blood Bank staff can assure blood components can be ready if necessary.
For accurate results, timed tests need to be drawn within a certain window. The weekly
PT/INR can be done anytime.
Question:
3. Which of the following is the appropriate antiseptic to use in
order to achieve a high degree of antisepsis prior to blood
culture collection on a 6-month-old infant?
A. benzalkonium chloride
B. povidone-iodine (PVP)
C. betadine
D. chlorhexidine gluconate
Answer:
chlorhexidine gluconate
Rationale
CLSI recommends chlorhexidene gluconate to prepare a venipuncture site for blood
culture collection on infants older than 2 months. Iodine preparations or benzalkonium
chloride are not typically used as they may be too harsh for sensitive skin.
Question:
4. The phlebotomist has orders to draw blood cultures on a
patient with fragile veins and decides to use a butterfly
system. Which of the following should be drawn first?
A. anaerobic
B. aerobic
C. pediatric
D. mycobacterium
Answer:
aerobic
Rationale
Blood cultures are typically drawn when the patient's physician suspects a bacterial
,infection in the bloodstream (septicemia). To maximize the chance of harvesting the
infectious agent, the cultures are drawn in sets of two bottles, one aerobic (with air) and
one anaerobic (without air). A volume of 20 ml is collected aseptically with 10 ml
distributed into each bottle. If the collection is performed with a butterfly system, the
aerobic bottle is filled first as the tubing of the butterfly set will introduce air into the
container. Once the tubing is filled with blood, the anaerobic bottle is attached and filled.
The same order is used regardless of the size or draw volume of the bottles.
Mycobacterium is the causative agent of tuberculosis and not a collection device.
Question:
5. Which of the following is the reason a phlebotomist should
avoid milking a finger during a capillary puncture?
A. The specimen may be contaminated with interstitial fluid.
B. The specimen may be contaminated with staphylococcus
aureus.
C. The specimen may be contaminated with isopropyl and
cause hemolysis.
D. The collection site may be contaminated by the
phlebotomist's gloves.
Answer:
The specimen may be contaminated with interstitial fluid.
Rationale
Milking a capillary puncture, in an effort to obtain more blood, involves excessive
squeezing and the possible introduction of tissue fluid into the specimen, thereby diluting
or contaminating the result. The phlebotomist needs to assure the area is warm to
encourage good blood flow, perform an adequate puncture with the correct device,
wipe the first drop of blood away and continue with a "squeeze, collect and release"
rhythm to allow blood flow to recover after the squeezing and collection. Contamination
with staphylococcus aureus can occur if the puncture area is not adequately cleaned or
is retouched after cleaning. Contamination with isopropyl alcohol can occur when the
area is not allowed completely dry resulting in the possibility of hemolysis of the
specimen.
Question:
, 6. A three-month-old patient was sent to the lab for an H&H.
How should the phlebotomist collect the sample?
A. venipuncture, antecubital fossa
B. dermal puncture, great toe
C. dermal puncture, middle finger
D. dermal puncture, heel stick
Answer:
dermal puncture, heel stick
Rationale
Capillary blood samples may be taken from the lateral side heel of children until they
begin to walk at which time the heel becomes tougher and more difficult to penetrate. In
this case, as the patient is 3 months old, a heel stick would be the best choice. The middle
finger or great toe are not used. Since a very small amount of blood is needed, a
venipuncture in the antecubital area is not necessary.
Question:
7. Which of the following tests can be collected by capillary
puncture? (Select the two (2) correct answers.)
A. blood cultures
B. blood gas
C. bilirubin
D. erythrocyte sedimentation rate
E. PTT
Answer:
blood gas, bilirubin
Rationale
Collecting blood samples by capillary (dermal) puncture is an alternative to venipuncture
when a small amount of blood is needed and the procedure is appropriate for the test
requested. Blood gasses and bilirubin determinations may be done with this method.
Blood cultures and erythrocyte sedimentation rates (ESR) require a larger amount of
blood. Coagulation tests that require plasma specimens such as the PTT are not done by
dermal puncture.
Question:
