NCCT INTERACTIVE REVIEW MEDICAL INSURANCE EXAM
QUESTIONS AND ANSWERS
An inpatient with a left-sided mastectomy has a hematoma in the left arm and an
active IV in the right arm. Which of the following is an appropriate site for
venipuncture?
A. distal to the IV
B. proximal to the hematoma
C. proximal to the IV
D. distal to the hematoma
distal to the IV
Rationale: Drawing from an arm on the side which has had a mastectomy may cause
lymphadema and should not be used. If there is an active IV in the other arm, blood
may be drawn as far below it as possible. If the IV is close to the hand, the phlebotomist
may ask the nurse to turn it off for two minutes prior to the draw. Another option, if a
small amount of blood is needed and the test requests allow, is a dermal puncture of
one of the fingers of the right hand.
A tourniquet was left on the arm for an extensive period of time before the
performance of a venipuncture. Which of the following is most likely to occur?
A. The patient will have excessive bleeding.
B. The blood specimen will be hemolysed.
C. The blood specimen will be hemoconcentrated.
D. The patient will develop a hematoma.
The blood specimen will be hemoconcentrated.
Rationale: Hemoconcentration is decrease in the volume of plasma in relation to the
number of red blood cells. Prolonged tourniquet use impedes circulation and will cause
this to happen, but will likely not cause hemolysis or a hematoma. Hematocrit is a
,measure of the volume of red blood cells in a whole blood sample, and is not a
physiological complication at all.
While performing a capillary stick on a six-month-old infant's heel, the lancet
should be no longer than
A. 2.0 mm
B. 2.0 cm
C. 3.0 cm
D. 3.0 mm
2.0 mm
Rationale: CLSI recommends that capillary blood collection on infants less than one
year of age be performed on medial or lateral plantar surface of the heel and that the
puncture must not exceed 2.0 mm. WHO Guidelines on Drawing Blood: Best Practices
in Phlebotomy recommends that the depth of heel punctures not exceed 2.4 mm as
pain fibers/receptors significantly increase in abundance and the potential for bone
injury also increases. Given the CLSI and WHO recommendations, 2.0 mm is the most
appropriate answer. 2.0 cm and 3 cm are equal to 20 mm and 30mm, respectively,
which is wider than the thickness of an average adult finger. It is important to note that
units are very important (1.0 cm equals 10mm). 3.0 mm puncture may only be
appropriate in performing capillary puncture on adults with excessive scarring and
callouses on the fingers. Callouses are often the result of manual work and is also seen
in musicians who play certain string instruments. In these situations, it is warranted to
perform a deeper puncture in order to penetrate the callous and obtain blood from the
capillary bed in the dermis, middle vascular layer of the skin located just deep to the
epidermis.
A patient brings in written lab test results, including a mix of POC and higher
complexity tests, and asks the phlebotomist for help with interpretation. Which of
the following should the phlebotomist do?
A. Explain the interpretation behind the POC tests, but let the patient read the
,directions with the higher level tests.
B. Refer the patient to the physician for interpretation of all results.
C. Hand the patient pre-printed test explanations downloaded from the CDC web
site.
D. Explain the interpretation behind the POC care tests, but refer the patient to the
physician for the higher complexity tests.
Refer the patient to the physician for interpretation of all results.
Rationale: The phlebotomist is able to collect blood specimens via capillary puncture
and venipuncture, process specimens and perform CLIA waived point of care tests.
Phlebotomists are not able to interpret or analyze results whether the tests are
categorized as waived, moderate or high complexity. It is always best to instruct the
patient to consult with the physician for interpretation of the results.
Which of the following should be included on a patient's laboratory requisition?
A. test priority
B. chief complaint
C. insurance information
D. patient signature
test priority
Rationale: The exact information required on requisitions for testing by different
laboratories may vary slightly. The common items always requested are: patient name,
indication of insurance (id#/provider), testing requested, priority of the testing (STAT,
routine, timed, etc.), and ordering physician. Many requisitions also ask for an indication
for testing, ICD codes, patient diagnosis, etc. A patient signature, next of kin, and
insurance contact number are not typically required.
The phlebotomist needs to draw a blood culture, sedimentation rate, PTT, and a
glucose test. Which of the following is the correct order of draw?
A. gray, light blue, lavender, red
, B. red, yellow, light blue, lavender
C. yellow, red, lavender, gray
D. yellow, light blue, lavender, gray
yellow, light blue, lavender, gray
Rationale: Blood culture is collected using the Sterile yellow/Yellow tube containing
anticoagulant SPS. SPS helps to facilitates bacterial growth. Sedimentation rate (ESR -
erythrocyte sedimentation rate) is collected using the Lavender/Purple tube containing
anticoagulant Potassium EDTA. EDTA is ideal for whole blood testing such as ESR
because EDTA prevents platelet aggregation and maintains the natural morphology
(shape) of cells for analysis. PTT (partial thromboplastin time) is collected using the
Light blue tube containing anticoagulant Sodium citrate. Citrate is ideal for coagulation
tests because it preserves clotting factors for testing. Glucose is collected using the
Gray tube containing Potassium oxalate and Sodium fluoride. Oxalate is the
anticoagulant. Fluoride is the antiglycolytic agent (glycolytic inhibitor) that prevents
glucose breakdown in order to yield accurate glucose blood test results. The CLSI
recommended Order of Draw is as follows: Sterile yellow, Light blue, Red, Gold/SST,
Green/PST, Lavender/Purple, and Gray. According to the recommended Order of Draw,
in order to prevent the effect of cross-contamination, the above tubes must be collected
in the following order: Yellow, Light blue, Lavender, Gray.
Which of the following specimens requires a heat block for transportation?
A. ammonia
B. lactic acid
C. PSA
D. cryofibrinogen
cryofibrinogen
Rationale: Some blood specimens require special treatment and handling to preserve
the analyte while being transported to the lab for testing. Lactic acid and ammonia are
chilled in ice slurries as they deteriorate very quickly at room temperature.
QUESTIONS AND ANSWERS
An inpatient with a left-sided mastectomy has a hematoma in the left arm and an
active IV in the right arm. Which of the following is an appropriate site for
venipuncture?
A. distal to the IV
B. proximal to the hematoma
C. proximal to the IV
D. distal to the hematoma
distal to the IV
Rationale: Drawing from an arm on the side which has had a mastectomy may cause
lymphadema and should not be used. If there is an active IV in the other arm, blood
may be drawn as far below it as possible. If the IV is close to the hand, the phlebotomist
may ask the nurse to turn it off for two minutes prior to the draw. Another option, if a
small amount of blood is needed and the test requests allow, is a dermal puncture of
one of the fingers of the right hand.
A tourniquet was left on the arm for an extensive period of time before the
performance of a venipuncture. Which of the following is most likely to occur?
A. The patient will have excessive bleeding.
B. The blood specimen will be hemolysed.
C. The blood specimen will be hemoconcentrated.
D. The patient will develop a hematoma.
The blood specimen will be hemoconcentrated.
Rationale: Hemoconcentration is decrease in the volume of plasma in relation to the
number of red blood cells. Prolonged tourniquet use impedes circulation and will cause
this to happen, but will likely not cause hemolysis or a hematoma. Hematocrit is a
,measure of the volume of red blood cells in a whole blood sample, and is not a
physiological complication at all.
While performing a capillary stick on a six-month-old infant's heel, the lancet
should be no longer than
A. 2.0 mm
B. 2.0 cm
C. 3.0 cm
D. 3.0 mm
2.0 mm
Rationale: CLSI recommends that capillary blood collection on infants less than one
year of age be performed on medial or lateral plantar surface of the heel and that the
puncture must not exceed 2.0 mm. WHO Guidelines on Drawing Blood: Best Practices
in Phlebotomy recommends that the depth of heel punctures not exceed 2.4 mm as
pain fibers/receptors significantly increase in abundance and the potential for bone
injury also increases. Given the CLSI and WHO recommendations, 2.0 mm is the most
appropriate answer. 2.0 cm and 3 cm are equal to 20 mm and 30mm, respectively,
which is wider than the thickness of an average adult finger. It is important to note that
units are very important (1.0 cm equals 10mm). 3.0 mm puncture may only be
appropriate in performing capillary puncture on adults with excessive scarring and
callouses on the fingers. Callouses are often the result of manual work and is also seen
in musicians who play certain string instruments. In these situations, it is warranted to
perform a deeper puncture in order to penetrate the callous and obtain blood from the
capillary bed in the dermis, middle vascular layer of the skin located just deep to the
epidermis.
A patient brings in written lab test results, including a mix of POC and higher
complexity tests, and asks the phlebotomist for help with interpretation. Which of
the following should the phlebotomist do?
A. Explain the interpretation behind the POC tests, but let the patient read the
,directions with the higher level tests.
B. Refer the patient to the physician for interpretation of all results.
C. Hand the patient pre-printed test explanations downloaded from the CDC web
site.
D. Explain the interpretation behind the POC care tests, but refer the patient to the
physician for the higher complexity tests.
Refer the patient to the physician for interpretation of all results.
Rationale: The phlebotomist is able to collect blood specimens via capillary puncture
and venipuncture, process specimens and perform CLIA waived point of care tests.
Phlebotomists are not able to interpret or analyze results whether the tests are
categorized as waived, moderate or high complexity. It is always best to instruct the
patient to consult with the physician for interpretation of the results.
Which of the following should be included on a patient's laboratory requisition?
A. test priority
B. chief complaint
C. insurance information
D. patient signature
test priority
Rationale: The exact information required on requisitions for testing by different
laboratories may vary slightly. The common items always requested are: patient name,
indication of insurance (id#/provider), testing requested, priority of the testing (STAT,
routine, timed, etc.), and ordering physician. Many requisitions also ask for an indication
for testing, ICD codes, patient diagnosis, etc. A patient signature, next of kin, and
insurance contact number are not typically required.
The phlebotomist needs to draw a blood culture, sedimentation rate, PTT, and a
glucose test. Which of the following is the correct order of draw?
A. gray, light blue, lavender, red
, B. red, yellow, light blue, lavender
C. yellow, red, lavender, gray
D. yellow, light blue, lavender, gray
yellow, light blue, lavender, gray
Rationale: Blood culture is collected using the Sterile yellow/Yellow tube containing
anticoagulant SPS. SPS helps to facilitates bacterial growth. Sedimentation rate (ESR -
erythrocyte sedimentation rate) is collected using the Lavender/Purple tube containing
anticoagulant Potassium EDTA. EDTA is ideal for whole blood testing such as ESR
because EDTA prevents platelet aggregation and maintains the natural morphology
(shape) of cells for analysis. PTT (partial thromboplastin time) is collected using the
Light blue tube containing anticoagulant Sodium citrate. Citrate is ideal for coagulation
tests because it preserves clotting factors for testing. Glucose is collected using the
Gray tube containing Potassium oxalate and Sodium fluoride. Oxalate is the
anticoagulant. Fluoride is the antiglycolytic agent (glycolytic inhibitor) that prevents
glucose breakdown in order to yield accurate glucose blood test results. The CLSI
recommended Order of Draw is as follows: Sterile yellow, Light blue, Red, Gold/SST,
Green/PST, Lavender/Purple, and Gray. According to the recommended Order of Draw,
in order to prevent the effect of cross-contamination, the above tubes must be collected
in the following order: Yellow, Light blue, Lavender, Gray.
Which of the following specimens requires a heat block for transportation?
A. ammonia
B. lactic acid
C. PSA
D. cryofibrinogen
cryofibrinogen
Rationale: Some blood specimens require special treatment and handling to preserve
the analyte while being transported to the lab for testing. Lactic acid and ammonia are
chilled in ice slurries as they deteriorate very quickly at room temperature.
