NCCT PHLEBOTOMY LATEST EXAM QUESTIONS AND
ANSWERS
The medical assistant is collecting four tubes of blood on a patient who begins
wheezing. She asks the patient if he is okay, he states that he has asthma. The
medical assistant is in the process of switching to the fourth tube when the
patient faints in the phlebotomy chair. Which of the following steps should the
medical assistant take?
Stop the collection, apply pressure to site, call for help, and assist the patient.
When a patient faints, the most important consideration is patient safety. Since the
patient was in an outpatient phlebotomy chair, he had some protection from falling,
giving the phlebotomist time to stop the collection and apply pressure to the site to avoid
bleeding. Since it was important to remain with the patient, the phlebotomist would call
for help and tend to the patient's needs. Ammonia salts would not be advisable in a
wheezing patient, as they might aggravate any type of existing lung condition.
Which of the following is a likely complication from repeated phlebotomy
procedures in the same area?
sclerosed veins
Repeated punctures in a vein would cause hardening of the vessel tissue, known as
sclerosis. Thrombosis refers to clot formation. Petechiae are tiny red or purple spots on
the skin caused by broken capillaries. Varicose veins are caused by weakened valves
and veins in the legs. One-way vein valves typically keep blood flowing from the legs up
toward the heart, but when they don't work properly, blood collects in the legs and
pressure builds. The veins become weak, large, and twisted.
During a blood draw, a patient begins complaining of discomfort and tingling, at
which time the phlebotomist notices bruising and discoloration at the site. How
should the phlebotomist proceed?
Release the tourniquet, withdraw the needle, and apply pressure.
,The correct response is to release the tourniquet, withdraw the needle, and apply
pressure to avoid any further damage or pain at the venipuncture site. The tourniquet
MUST be released before the needle is withdrawn. The application of pressure by the
phlebotomist is meant to stop any bleeding. The use of ice and bending of the arm are
not typically recommended after any phlebotomy procedures.
A patient's past history indicates episodes of syncope. Which of the following
would be the best course of action the phlebotomist would perform to prevent
complications of syncope?
Have the patient lie down on a hospital bed or exam table.
Syncope is a temporary loss of consciousness and posture, commonly referred to as
fainting, which is usually related to insufficient blood flow to the brain for any number of
reasons. If a patient has a history of syncope episodes, it would be advisable to position
the patient to avoid the possibility of injury and to enable ease of oxygenated blood flow
to the brain. The angle of the needle has no bearing upon the possibility of syncope and
wouldn't prevent injury in case of a fall. Holding pressure over the venipuncture site only
prevents bleeding. Placing an object in a patient's mouth to prevent biting the tongue is
not advised in cases of either seizure or syncope.
When a complete metabolic profile (CMP) and complete blood count (CBC) are
ordered at the same time, why should the CMP be drawn first?
Tubes without additives should be drawn before tubes with additives.
A blood specimen will naturally clot (yielding a serum component) when collected in a
tube without an additive to anticoagulate it and keep it whole blood (which has a plasma
component). With the exception of blood cultures and coagulation tests (e.g. PT, PTT),
serum tubes (for CMP, Lytes, etc.) should be collected before tubes with additives (e.g.
lavender top for CBC) to avoid contamination of the serum tube with the additive (can
cause erroneous results in the serum tube). CLSI lists the order of draw as follows: 1.
, Blood cultures 2. Coagulation tube (e.g. blue closure) 3. Serum tube with or without clot
activator, with or without gel (e.g. red closure) 4. Heparin tube with or without gel
plasma separator (e.g. green closure) 5. EDTA tube with or without gel separator (e.g.
lavender closure, pearl closure) 6. Glycolytic inhibitor (e.g. gray closure)
Which of the following specimens is most susceptible to cross contamination and
should always be drawn first?
blood culture
Since blood cultures test for sepsis (infection in the blood stream), the skin should be
specially prepared to avoid contaminating the specimen during the collection process
with normal skin bacteria. The exact preparation protocol may vary slightly among
services, but most phlebotomy procedures will either use an iodine solution,
ChloraPrep, or equivalent chlorhexidine-based skin antisepsis solutions. When blood
cultures are ordered along with other laboratory testing, collect the blood cultures first.
The regular alcohol pre-draw prep is sufficient for the CBC, cholesterol, and hematocrit
(HCT can be ordered separately, but is included within a CBC).
Which of the following evacuated tubes should the medical assistant draw first?
light blue top
CLSI lists the order of draw as follows: 1. Blood cultures 2. Coagulation tube (e.g. blue
closure) 3. Serum tube with or without clot activator, with or without gel (e.g. red
closure, gold shield,etc.) 4. Heparin tube with or without gel plasma separator (e.g.
green closure) 5. EDTA tube with or without gel separator (e.g. lavender closure, pearl
closure) 6. Glycolytic inhibitor (e.g. gray closure) Other tube additives affect coagulation
tests. Collecting the light blue top tube (for coagulation testing) in this scenario prevents
contamination of the specimen with tissue thromboplastin (which will adversely affect
the test).
ANSWERS
The medical assistant is collecting four tubes of blood on a patient who begins
wheezing. She asks the patient if he is okay, he states that he has asthma. The
medical assistant is in the process of switching to the fourth tube when the
patient faints in the phlebotomy chair. Which of the following steps should the
medical assistant take?
Stop the collection, apply pressure to site, call for help, and assist the patient.
When a patient faints, the most important consideration is patient safety. Since the
patient was in an outpatient phlebotomy chair, he had some protection from falling,
giving the phlebotomist time to stop the collection and apply pressure to the site to avoid
bleeding. Since it was important to remain with the patient, the phlebotomist would call
for help and tend to the patient's needs. Ammonia salts would not be advisable in a
wheezing patient, as they might aggravate any type of existing lung condition.
Which of the following is a likely complication from repeated phlebotomy
procedures in the same area?
sclerosed veins
Repeated punctures in a vein would cause hardening of the vessel tissue, known as
sclerosis. Thrombosis refers to clot formation. Petechiae are tiny red or purple spots on
the skin caused by broken capillaries. Varicose veins are caused by weakened valves
and veins in the legs. One-way vein valves typically keep blood flowing from the legs up
toward the heart, but when they don't work properly, blood collects in the legs and
pressure builds. The veins become weak, large, and twisted.
During a blood draw, a patient begins complaining of discomfort and tingling, at
which time the phlebotomist notices bruising and discoloration at the site. How
should the phlebotomist proceed?
Release the tourniquet, withdraw the needle, and apply pressure.
,The correct response is to release the tourniquet, withdraw the needle, and apply
pressure to avoid any further damage or pain at the venipuncture site. The tourniquet
MUST be released before the needle is withdrawn. The application of pressure by the
phlebotomist is meant to stop any bleeding. The use of ice and bending of the arm are
not typically recommended after any phlebotomy procedures.
A patient's past history indicates episodes of syncope. Which of the following
would be the best course of action the phlebotomist would perform to prevent
complications of syncope?
Have the patient lie down on a hospital bed or exam table.
Syncope is a temporary loss of consciousness and posture, commonly referred to as
fainting, which is usually related to insufficient blood flow to the brain for any number of
reasons. If a patient has a history of syncope episodes, it would be advisable to position
the patient to avoid the possibility of injury and to enable ease of oxygenated blood flow
to the brain. The angle of the needle has no bearing upon the possibility of syncope and
wouldn't prevent injury in case of a fall. Holding pressure over the venipuncture site only
prevents bleeding. Placing an object in a patient's mouth to prevent biting the tongue is
not advised in cases of either seizure or syncope.
When a complete metabolic profile (CMP) and complete blood count (CBC) are
ordered at the same time, why should the CMP be drawn first?
Tubes without additives should be drawn before tubes with additives.
A blood specimen will naturally clot (yielding a serum component) when collected in a
tube without an additive to anticoagulate it and keep it whole blood (which has a plasma
component). With the exception of blood cultures and coagulation tests (e.g. PT, PTT),
serum tubes (for CMP, Lytes, etc.) should be collected before tubes with additives (e.g.
lavender top for CBC) to avoid contamination of the serum tube with the additive (can
cause erroneous results in the serum tube). CLSI lists the order of draw as follows: 1.
, Blood cultures 2. Coagulation tube (e.g. blue closure) 3. Serum tube with or without clot
activator, with or without gel (e.g. red closure) 4. Heparin tube with or without gel
plasma separator (e.g. green closure) 5. EDTA tube with or without gel separator (e.g.
lavender closure, pearl closure) 6. Glycolytic inhibitor (e.g. gray closure)
Which of the following specimens is most susceptible to cross contamination and
should always be drawn first?
blood culture
Since blood cultures test for sepsis (infection in the blood stream), the skin should be
specially prepared to avoid contaminating the specimen during the collection process
with normal skin bacteria. The exact preparation protocol may vary slightly among
services, but most phlebotomy procedures will either use an iodine solution,
ChloraPrep, or equivalent chlorhexidine-based skin antisepsis solutions. When blood
cultures are ordered along with other laboratory testing, collect the blood cultures first.
The regular alcohol pre-draw prep is sufficient for the CBC, cholesterol, and hematocrit
(HCT can be ordered separately, but is included within a CBC).
Which of the following evacuated tubes should the medical assistant draw first?
light blue top
CLSI lists the order of draw as follows: 1. Blood cultures 2. Coagulation tube (e.g. blue
closure) 3. Serum tube with or without clot activator, with or without gel (e.g. red
closure, gold shield,etc.) 4. Heparin tube with or without gel plasma separator (e.g.
green closure) 5. EDTA tube with or without gel separator (e.g. lavender closure, pearl
closure) 6. Glycolytic inhibitor (e.g. gray closure) Other tube additives affect coagulation
tests. Collecting the light blue top tube (for coagulation testing) in this scenario prevents
contamination of the specimen with tissue thromboplastin (which will adversely affect
the test).
