NHA Phlebotomy Questions & Answers

NHA Phlebotomy Questions & Answers The phlebotomist is watching her hands at the beginning of the shift. What action should she take? Use enough soap to form a lather. Rationale: The technician should form a lather by rubbing her hands together for at least 15 seconds, covering all surfaces of her hands and fingers with soap. Which of the following test results are affected when a phlebotomy technician uses providone-iodine to cleanse a site for dermal puncture? Potassium Rationale: Providone-iodine is contradicted for potassium tests b/c it can cause a false elevation of potassium in a specimen. A phlebotomy tech is removing his gloves after a venipuncture procedure. Which of the following actions should the tech take? Remove the first glove so that it turns inside out during removal. Rationale: When removing gloves, the tech should turn the first glove inside out during removal to decrease chances of contact with blood. A phlebotomy tech is preparing to dispose contaminated sharps. According to OSHA standards which of the following actions should the tech take? Replace the sharps container when it is 2/3 full Rationale: -According to OSHA standards, the technician should replace the sharps container when it is two-thirds full. -The technician should discard covered lancets into rigid, leak-proof, plastic containers. -To prevent needlestick injuries, the technician should not break, bend, recap, or manipulate contaminated needles -The technician should discard the entire evacuated tube system intact and should not disassemble it prior to disposal. A phlebotomy tech is preparing to perform a fingerstick for a patient. Which of the following actions should the tech take first? Confirm the identity of the patient. Rationale: The technician should identify the patient prior to performing any other steps of the procedure. For which of the following procedures should a phlebotomy tech follow chain of custody guidelines? Blood culture testing. Rationale: Chain of custody guidelines apply to drug screenings, forensic studies, blood alcohol tests, and paternity testing. After exiting a patient's room, which of the following is the last piece of personal protective equipment (PPE) a phlebotomy technician should remove? Mask. Rationale: When removing PPE, the technician should first remove the GLOVES, then the GOGGLES, and then the GOWN. The mask is the last piece of PPE the technician should remove before or after exiting the patient's room, depending on the isolation reason. After verifying a patient's identity, a phlebotomy technician sees that the patient's laboratory results are ready. Which of the following actions should the technician take? Inform the patient to contact the ordering provider to obtain the results. Rationale: -Only the ordering provider can discuss laboratory results with the patient. The technician should instruct the patient to contact the provider to obtain the laboratory results. -outside of the nurse's, lab manager's & phlebotomist's scope of practice (don't discuss results with pt.) A phlebotomy technician should comply with HIPAA to protect which of the following? Patients' information. Rationale: HIPAA, or the Health Insurance Portability and Accountability Act, protects patients' personal health information. A phlebotomy technician should select a tube that has which of the following anticoagulants to collect a sample for a PT/PTT test? Sodium citrate. Rationale: The technician should use a collection tube that has the anticoagulant sodium citrate to collect a sample for a PT/PTT test. A phlebotomy technician is using an evacuated needle holder and blood collection tubes to collect blood form a patient. Which of the following actions should the tech take? Push the first collection tube gently into the holder. Rationale: -The technician should gently push the first collection tube into the holder to secure the placement of the tube. -The technician should palpate above the puncture site if blood flow is not established. -The technician should insert the needle with the bevel side facing upward. -The technician should insert the needle at a 30° angle or less to avoid hitting an artery, tendon, or nerve. A phlebotomy technician is disposing of used supplies when he accidentally receives a needlestick injury. According to OSHA guidelines, which of the following actions should the tech take first? Wash the puncture site with soap and water. Rationale: -The first step the technician should take after a receiving a needlestick injury is to decontaminate the puncture site by washing it with soap and water for 30 seconds. -Reporting the incident to a supervisor is not the first step the technician should take after receiving a needlestick injury. After the puncture site is decontaminated, the technician should report the injury to the supervisor, who will complete an incident report. The supervisor will then direct the technician to a medical facility for evaluation and treatment. -After the puncture site is decontaminated, the technician should report the injury to the supervisor, who will complete an incident report. The supervisor will then direct the technician to a medical facility for evaluation and treatment. -the technician has the option to receive counseling after an initial evaluation by occupational health A phlebotomy technician is preparing to draw blood from a pt. in an inpatient setting. The pt. extends his arm and turns his head away. This action by the pt. is an example of which of the following types of consent? Implied consent. Rationale: By extending his arm to the technician, the patient is giving implied consent. When should a phlebotomy technician perform external liquid controls for quality control on a CLIA-waived glucose point-of-care test? When a new lot number or kit is opened. Rationale: -The technician should perform external liquid controls when a new lot number or kit is opened. -External liquid controls should be performed as specified by the manufacturer's instructions, such as upon receipt of a new lot number, when a lot number is stored incorrectly, and when results are questionable. A phlebotomy tech is performing a veinpucture for a pt. who begins to seize. Which of the following actions should the tech take? Discontinue the draw. Rationale: -During a seizure, it is important for the technician to discontinue the draw and protect the patient from self-injury -The technician should place a patient who is seizing in the supine position, rather than the prone position. -The technician should not attempt to put anything in the patient's mouth, because this might cause injury to the patient. -An attempt to restrain the patient might cause injury to the patient and the technician A phlebotomy technicians is preparing to draw blood from a patient's arm and observes a sore at the site where the tourniquet is placed. Which of the following actions should the tech take? Tie the tourniquet over the patient's sleeve. Rationale: The technician should tie the tourniquet over the patient's sleeve to prevent any further damage to the skin. Which of the following tubes should a tech collect first when obtaining dermal samples? Lavender. Ratioanle: -The technician should collect the dermal samples using a lavender-topped tube first because this tube minimizes platelet clumping and microclot formation. -Because hematology tests are most affected by clotting, the technician should use the lavender-topped tube first. -Because hematology tests are most affected by clotting, the technician should use the lavender-topped tube first. Furthermore, red-topped tubes for serum specimens are collected last because it is necessary for them to clot. -Because hematology tests are most affected by clotting, the technician should use the lavender-topped tube first. A phlebotomy technician should identify that which of the following additives is used to prevent the breakdown of glucose? Sodium fluoride. Rationale: The technician should identify that sodium fluoride is an additive used to prevent the breakdown of glucose. A phlebotomy technician in an outpatient setting is identifying a patient before performing a venipuncture procedure. To confirm the patient's identity, which of the following questions should the tech ask? "Would you please state and spell your full name and provide your date of birth?" Rationale: The technician should ask the patient to state and spell his full name, as well as provide his date of birth to confirm the patient's identity. Which of the following is a potential consequence of a phlebotomy technician mislabeling a blood bank specimen? A transfusion reaction. Rationale: The technician mislabeling a blood bank specimen can result in a fatal transfusion reaction. A phlebotomy technician should invert anticoagulant tubes to prevent which of the following complications? Hemolysis. Rationale: The technician should invert anticoagulant tubes to prevent hemolysis, which is the destruction of red blood cells. According to OSHA standards, which of the following vaccines must employers offer to their phlebotomists at no cost? Hepatitis B. Rationale: OSHA requires employers to offer the hepatitis B vaccine to at risk employees within 10 days of hire at no cost to the employee. During a routine venipuncture, a phlebotomy technician notices that a patient is becoming pale and diaphoretic. The tech should identify that the pt. is at risk for which of the following conditions? Syncope. Rationale: -The technician should identify that the patient becoming pale and diaphoretic is an indication that the patient might faint. The technician should immediately take precautions to prevent the patient from falling. (diaphoretic: (chiefly of a drug) inducing perspiration. (of a person) sweating heavily.) NOT= -Seizure: The technician should identify that a patient will usually exhibit involuntary movement before a seizure. -Nausea: The technician should identify that a patient usually reports lightheadedness before experiencing nausea. -Petechiae: The technician should identify that a patient who has a coagulation disorder is at risk for developing petechiae, which are caused by broken capillary vessels and appear as small, nonraised red spots on the patient's skin. A phlebotomy technician should identify that which of the following tube selections indicates the correct order of draw for a venipuncture? Green, lavender, gray. Rationale: The technician should identify that this is the appropriate order of draw to avoid additive cross-contamination. A phlebotomy tech is preparing to collect a blood specimen from the antecubital site of a pt. Which of the following devices can be used to help stabilize the arm for the collection? Phlebotomy wedge Rationale: A phlebotomy wedge is a vinyl-covered device that stabilizes the patient's arm. ADD INFO: Supply clamp- A supply clamp attaches supplies, such as blood tubes and other equipment, to bed rails, countertops, wheelchairs, and chair arms. This device does not help to stabilize the arm. Hand immobilizer- A hand immobilizer uses straps to keep the patient's hand still and can only be used if authorized by the provider. Hand brace- A hand brace is used to improve manifestations of carpal tunnel syndrome. This device does not help to stabilize the arm. A phlebotomy technician is preparing to use an evacuated tube system to obtain a venous blood specimen from a pt. The tourniquet is in place and the technician has cleansed the puncture. Which of the following procedural steps should the tech perform next? Uncap the needle and inspect it. Rationale: The next step the technician should take is to uncap the needle and inspect it. Which of the following actions by a phlebotomy tech can result in a grossly hemolyzed specimen? Using an incorrect needle gauge. Rationale: -If the technician uses a large-gauge needle to draw from a vein with a small lumen, it can cause a grossly hemolyzed specimen. -Following an incorrect order of draw The technician should identify that an incorrect order of draw would most likely contaminate, not hemolyze, a specimen. -Applying the tourniquet too close to the draw siteThe technician should identify that applying the tourniquet too close to the draw site would most likely result in hemoconcentration, not hemolysis. -Failing to invert the tube The technician should identify that failing to invert the tube would most likely affect clotting and not result in hemolysis. A phlebotomy technician should identify that which of the following series of venipuncture steps in the appropriate order? Assess the site, cleanse the site, and insert the needle. Rationale: The technician should assess the site, cleanse the site, and then insert the needle. -The technician should assess the site before cleansing it. -The technician should remove the tourniquet prior to removing the needle. -The technician should place the tourniquet before inserting the needle. The technician should label the tubes at the bedside, after the draw. A phlebotomy tech is performing a capillary blood collection for an older adult patient. Which of the following sites should the tech select? The distal phalanx of either middle finger. Rationale: The technician should select the distal phalanx of either of the patient's middle fingers when performing a capillary blood collection for an older adult patient. This site is preferred over others due to the reduced risk of penetrating bone. A phlebotomy tech is using an evacuated needle holder and blood collection tubes to collect from a patient. Which of the following actions should the tech take? Push the first collection tube gently into the holder. Rationale: The technician should gently push the first collection tube into the holder to secure the placement of the tube. -The technician should insert the needle at a 30° angle or less to avoid hitting an artery, tendon, or nerve. For an older adult patient who has difficult-to-access veins, a phlebotomy technician should select which of the following veins to perform a venipuncture? Dorsal veins Rationale: The technician should select the veins on the back of the patient's hand because they might be the only accessible site if the patient is an older adult who has difficult-to-access veins. -The technician should not use superficial veins for an older adult patient who has difficult-to-access veins. Superficial veins tend to infiltrate easily. -The technician should not use veins in the wrist as a puncture site for a patient who is an older adult and has difficult-to-access veins. -The technician should only draw from veins in a patient's foot when supervised by a provider. How often should a phlebotomy tech run quality control tests on point-of-care testing instruments? Daily Rationale: The technician should ensure the accuracy of point-of-care testing instruments by performing daily quality control tests. A phlebotomy technician must comply with which of the following OSHA requirements when performing a venipuncture? Wear gloves when contact with blood is anticipated. Rationale: The technician should always wear gloves if contact with blood is likely to occur. Which of the following actions should a tech take when performing venipuncture using evacuated tube system? Position the needle at a 30° angle in the same direction as the vein and with the bevel up. Rationale: The technician should position the needle in the same direction as the vein and at a 30° angle with the bevel up. A phlebotomy tech is collecting a blood specimen from a pt. to measure the trough levels of a a medication. The tech should collect the specimen at which of the following times? Within 15 min before the patient receives the next dose of medication. Rationale: The technician should collect the specimen no more than 15 min prior to administration of the next dose of medication. The trough level is the lowest concentration of medication in the patient's blood. For which of the following tests should a phlebotomy tech follow chain of custody guidelines? Blood alcohol Rationale: For a blood alcohol level test to be admissible in court, the technician must follow chain of custody guidelines during collection. During a venipuncture, a patient reports a sharp pain radiating down his arm. Which of the following actions should a phlebotomy tech take? Release the tourniquet and remove the needle. Rationale: The technician should release the tourniquet and remove the needle because the needle might have contacted the patient's nerve. A phlebotomy tech is teaching a pt. about collecting a sputum specimen at home. Which of the following instructions should the tech include? Spit thick secretions into the container after coughing deeply. Rationale: -Sputum is a thick secretion that is obtained from the lungs and is used for testing. Coughing deeply ensures that a majority of the fluid in the specimen is sputum, rather than saliva. -The technician should instruct the patient to keep the sputum specimen at room temperature. -The technician should inform the patient that mouthwash could destroy the micro-organisms that need to be tested in the sputum specimen. -The technician should instruct the patient to collect the specimen upon waking in the morning. A phlebotomy tech has a request to collect a routine CBC from a healthy 10-month-old infant. Which of the following collection sites should the tech select? Either heel Rationale: The technician should use a heelstick to collect specimens from infants who are under 1 year of age, even if there is a well-developed vein available. The heelstick is sufficient for collection and causes less trauma. When collecting a routine blood sample, which of the following veins should a phlebotomy tech attempt to draw from first? Median cubital Rationale: -The technician should attempt to draw from the patient's median cubital vein first. The median cubital vein is the preferred vein for routine blood samples because of its location, distance from large nerves, and large size. 1. Radial- The radial vein is a small, deep vein that runs near the radial nerve. The technician should attempt to draw from another vein first. 2. Ulnar- The ulnar vein is a small and deep vein that runs near the ulnar nerve. The technician should attempt to draw from another vein first. 3. Distal cephalic- The distal cephalic vessel is the second-best vein to draw from for a routine blood sample. The technician should attempt to draw from another vein first. A phlebotomy tech should identify that which of the following is the next step after removing a needle from a patient's arm? Engage the needle safety device. Rationale: The next step the technician should take after removing the needle is to engage the needle safety device. A phlebotomy tech is preparing to collect a blood specimen from a patient for a coagulation study. The patient states, "I faint every time I get my blood drawn." Which of the following statements should the tech make? "I will perform the draw while you are lying down." Rationale: Because the patient is prone to fainting, the technician should place him in a supine position to prevent injury from a potential fall. -The technician should recognize that smelling salts are used to stimulate a patient from a sleep state, not to prevent a patient from fainting. -The technician's skill level does not affect whether the patient will faint. The technician should acknowledge that the patient might faint and should take preventive action. A phlebotomy technician is collecting a blood specimen from a patient for blood cultures. Which of the following additives do the blood collection tubes require? Sodium polyanethol sulfonate (SPS) Rationale: The technician should use a yellow-topped tube, which contains the additive sodium polyanethol sulfonate, when collecting a blood specimen for a blood culture. A phlebotomy technician has a requisition for collecting fasting blood glucose and albumin specimens from a pt. Which of the following actions should the tech take before collecting the patient's blood? Make sure the patient has fasted for the past 8 to 12 hr. Rationale: The technician should verify the patient has not had anything to drink, other than water, and has not eaten for the past 8 to 12 hr. Eating 8 to 12 hr prior to the exam can cause inaccurate results. A phlebotomy tech is preparing to remove PPE following a venipuncture for a pt. in an isolation room. Which of the following pieces of equipment should the tech remove first? Gloves Rationale: The technician should remove the gloves first because they are the piece of equipment most likely to be contaminated with bodily fluids. A phlebotomy tech is reviewing a lab requisition before obtaining blood specimens from a pt. The tech should verify that the req includes which of the following info? A specimen identification code Rationale: Requisitions should include a unique specimen identification code, as well as the patient's identification information, such as the patient's full name and date of birth. "I will collect the specimen in a sterile container and return it to the lab within 1 hour." Rationale: An at-home semen specimen should be collected in a sterile container, kept warm, and delivered to the laboratory within 1 hr. -The patient should abstain from ejaculation for 2 to 7 days, depending on laboratory protocol, prior to the test. Abstaining for any other amount of time can alter the results of the test. -A clean condom is not an appropriate collection device for a semen specimen. Furthermore, the specimen should be delivered to the laboratory within 2 hr. -The specimen should not be refrigerated because refrigeration can reduce the specimen's sperm count. A phlebotomy tech is preparing several specimens for transport to the facility lab. Which of the following specimens should the tech protect from bright light by placing it in an amber/brown biohazard bag for transport? Vitamin B6. Rationale: The technician should protect a vitamin B6 specimen, which is photosensitive, from bright light by placing it in an amber/brown biohazard bag for transport. Things that need to be chilled during transport: 1.Ammonia 2.Lactic Acid 3.Blood gas A phlebotomy technician is preparing to perform a venipuncture for a 2-year old child. The child asks if the blood draw will hurt. Which of the following statements should the tech make? "You will feel a small prick." Rationale: The technician should be honest with the child and explain that a small pricking sensation is expected. A tech should identify that which of the following is one of the Joint Commission's 2016 National Patient Safety Goals? Identify patients correctly. Rationale: Technicians should use at least two forms of identification to identify patients correctly. The Joint Commission's National Patient Safety Goals help health care facilities address areas of concern regarding patient safety. The 2016 goals include identifying patients correctly, improving staff communication, using medicines safely, using alarms safely, preventing infections, identifying patient safety risks, and preventing mistakes in surgery. A phlebotomy technician is following Clinical and Laboratory Standards Institute's (CLSI) clinical laboratory workflow pathway. As part of the post-examination phase of this process, which of the following actions should the tech take? Enter critical laboratory data. Rationale: Entering critical laboratory data is part of the post-examination phase of the CLSI clinical laboratory workflow pathway. -Review and verify results, process the specimen, provide post-puncture care are all part of the pre-examination phase of CLSI workflow pathway A phlebotomy technician is collecting a urine specimen from a patient for pre-employment drug screening. Which of the following findings should indicate to the tech that tampering has possibly occurred? The temperature of the specimen is 30° C (86° F). Rationale: The technician should identify that a specimen temperature of 30° C (86° F) is below the expected range of 32° to 38° C (90° to 100° F) and indicates possible tampering. -This finding is expected and does not indicate tampering. Creatinine levels below 20 mg/dL can indicate tampering. -This finding is expected and does not indicate tampering. A specific gravity of less than 1.003 or greater than 1.025 can indicate tampering. A phlebotomy tech is preparing to obtain a blood specimen from a pt. in an outpatient setting. Using standard precautions, which of the following pieces of PPE should the tech wear? Gloves Rationale: Following standard precautions, the technician should wear gloves when collecting a blood specimen from a patient in an outpatient setting. A phlebotomy tech enters a patient's room to obtain a stat specimen. The patient's provider and a nurse are speaking with the pt. Which of the following actions should the tech take first? Introduce himself to the patient and the health care team members. Rationale: The technician should first introduce himself to the patient and the health care team members before requesting permission to obtain the stat specimen. Which of the following actions should a phlebotomy tech take when labeling specimens? Labeling specimens at the time of collection and in the presence of the patient Rationale: The technician should label specimens at the time of collection and in the presence of the patient. -the technician should include the patient's first and last name on the label, along with the patient's date of birth, to ensure proper identification. A provider orders a stat specimen, but a phlebotomy technician forgets to fill out the patient ID # on the collection tube. The technician should expect the lab that received the specimen to take which of the following actions? Reject the specimen. Rationale: The technician should expect the laboratory to reject a mislabeled specimen. -The technician should not transfer the specimen to a properly labeled tube. The collection tube already has a specific amount of additive, and transferring the specimen into another tube would alter the desired amount of additive. Which of the following PPE provides a tech with the best protection when drawing blood from a pt. who has active TB? N95 respirator Rationale: The technician is required by the CDC to wear an N95 respirator when working with patients who have active tuberculosis. An N95 respirator eliminates all particles in the air that are larger than 0.3 microns. A phlebotomy tech is collecting a unit of blood from a donor. Which of the following actions should the tech take? Instruct the donor to open and close his hand gently throughout the collection. Rationale: To ensure a quality collection, the technician should instruct the donor to open and close his hand gently throughout the collection. A tech should identify that which of the following phrases is represented by the abbreviation "SD"? Standard deviation Rationale: The abbreviation "SD" represents standard deviation, which is a number used to measure the variance of a set of findings from the average. If the standard deviation is greater than 2, or less than -2, then the technician should take corrective action. A phlebotomy tech is using a point-of-care test system to determine a patient's WBC count. For which of the following results should the tech immediately notify the provider? 1.8/mm3 Rationale: The technician should immediately report a finding of 1.8/mm3 to the provider, because this finding is outside the expected reference range of 4.4 to 11/mm3 for white blood cells. A phlebotomy tech is instructing a pt. how to collect a clean-catch urine specimen. Which of the following cleansers should the tech instruct the pt. to use when cleansing around her urinary meatus? Mild antiseptic soap Rationale: Mild antiseptic soap is an appropriate cleanser for the patient to cleanse around her urinary meatus before collecting a clean-catch urine specimen. -Hydrogen peroxide is not suitable for cleansing around the urinary meatus. -Povidone-iodine is not suitable for cleansing around the urinary meatus. -Isopropyl alcohol is not suitable for cleansing around the urinary meatus. A phlebotomy tech is collecting a blood specimen from a patient who has cutaneous diphtheria. Besides the gloves, which of the following pieces of PPE should the tech wear? Gown Rationale: The technician should wear a gown to protect the skin from infections that can be transmitted by contact. Because cutaneous diphtheria is spread through contact, the technician should wear a gown. -cutaneous diphtheria: The disease is characterized by shallow skin ulcers, which can occur anywhere on the body and are usually chronic. A phlebotomy technician is collecting blood from a patient for donation. The collection bag only fills halfway and the vein collapses. Which of the following actions should the tech take? Use a new collection bag to draw a new unit of blood. Rationale: The technician should use a new collection bag to draw a new unit of blood. The technician should take this action because collection bags have a specific amount of the additive citrate phosphate dextrose to prevent coagulation. -The technician should fill a blood collection bag from a single site and discard a collection bag that is not properly filled. -A collection bag cannot be kept if it is half full. The technician should discard a collection bag that is not completely full. -Combining two separate collection bags would result in a collection bag that contains an incorrect amount of the anticoagulant citrate phosphate dextrose. The technician should discard a collection bag that is not properly filled. A phlebotomy technician should identify that which of the following is an identifier for a specimen as long as it remains in the lab? Accession number Rationale: The accession number identifies a specimen as long as it remains in the laboratory. -ICD-10 codes classify diagnoses and diseases and do not identify specimens. -The Current Procedural Terminology code identifies a service provided to the patient. -The medical record number is a number assigned to every patient upon admission to a medical facility. Which of the following actions should a phlebotomy tech take to locate a vein using the warming technique? Encase the warm towel in a plastic bag. Rationale: The technician should encase the warm towel in a plastic bag to maintain the towel's temperature and to keep the patient's skin dry. -The technician should heat a clean towel to 42° C (107.6° F). -The technician should wrap the warm towel around the site for 3 to 5 min. -The technician should ask the patient to rinse her hands in warm water for 1 min to enhance the visibility of the veins. More than 1 min of hand washing in warm water can affect the temperature and quality of the blood being drawn. A phlebotomy technician is collecting a venipuncture blood specimen from a patient for a blood assay. The tech should fill which of the following tubes first? Yellow-topped tube Rationale: The technician should fill the tube with the yellow top first to decrease the probability of bacterial contamination. A tech is collecting a urine specimen from a pt. for a pre-employment drug test. Which of the following actions should the tect take? Verify that the specimen contains at least 45 mL of urine. Rationale: The technician should verify that the specimen contains at least 45 mL of urine. This amount allows for 30 mL to be put in one specimen bottle and 15 mL to be put in another bottle. A phlebotomy technician is preparing to collect a blood specimen from a small vein of an older adult pt. Which of the following actions should the tech take to keep the vein from collapsing? Use a small needle for the draw site. Rationale: The technician should use a small needle to collect a blood specimen from the small vein of an older adult to prevent the vein from collapsing. -Pulling the syringe's plunger back quickly increases the risk of collapsing the older adult patient's vein. -Using a large evacuated tube increases the risk of collapsing the older adult patient's vein. -Probing the vein with the needle increases the risk of collapsing the older adult patient's vein. Which of the following actions should a phlebotomy tech take after collecting an ammonia specimen? Place the specimen tube in an ice-water slurry. Rationale: The technician should place the specimen tube in an ice-water slurry. Chilling the specimen slows down metabolic processes and protects the analytes. -Protect the specimen tube from light. The technician should take this action for a bilirubin specimen. -Keep the specimen tube warm. The technician should take this action for a cold agglutinin specimen. -Keep the specimen at body temperature. The technician should take this action for a semen specimen. A phlebotomy tech should transport a semen sample at which of the following temperatures? 36° to 38° C Rationale: The technician should identify that semen samples should be stored and transported at 37° C (98.6° F). A phlebotomy tech is performing a heelstick to obtain capillary blood for testing a newborn's bilirubin level. Which of the following actions should the tech take? Use an amber-colored microcontainer. Rationale: The technician should use an amber-colored microcontainer when obtaining a bilirubin level from a newborn. Bilirubin is photosensitive, and this tube protects the specimen from exposure to light. -The technician should use a lancet with a penetration depth of less than 2.0 mm. This action reduces the risk of penetrating bone during the heelstick. -The technician should avoid using surgical blades to make punctures, because it puts the technician and the newborn at risk for injury. -The technician should use the most medial or lateral plantar section of the newborn's heel as the puncture site (not posterior curvature of the heel). A phlebotomy technician is assembling the equipment he will need for collecting donor units of blood. Which of the following needle sizes should the tech select? 18-gauge Rationale: The technician should select an 18-gauge needle for the collection of donor units of blood. -The technician should select a 21- to 23-gauge needle for laboratory assays. A phlebotomy tech is collecting a blood specimen from a pt. Which of the following techniques should the tech use to anchor the vein just before inserting the needle? Use the thumb to anchor the vein 5 cm (2 in) below the puncture site. Rationale: Veins have a tendency to roll away from the needle, especially the basilic vein. The technician should hold the vein in place to help anchor it and prepare it for the puncture 2.5 to 5 cm (1 to 2 in) below the puncture site. -Anchor the vein 7.5 to 10 cm (3 to 4 in) above the puncture site.The technician should hold the vein 2.5 to 5 cm (1 to 2 in) below the puncture site to anchor it. -A tourniquet does not anchor the vein and must be above the puncture site to facilitate blood flow. Within which of the following time periods should a phlebotomy technician collect a newborn blood-spot test screening card? Within 72 hr Rationale: The technician should collect the newborn screening card within 72 hr of birth. A phlebotomy technician is washing her hands at the beginning of her shift. Which of the following actions should the tech take? Use enough soap to form a lather. Rationale: The technician should form a lather by rubbing her hands together for at least 15 seconds, covering all surfaces of her hands and fingers with soap. To prevent hospital-acquired infections, a phlebotomy technician should clean items that have been contaminated by blood with a 1:10 dilution of which of the following substances and water? Sodium hypochlorite Rationale: The technician should use a 1:10 dilution of sodium hypochlorite, or chlorine bleach, with water to disinfect items that are contaminated by blood. A phlebotomy technician is obtaining a blood specimen from a pt. The tech notices swelling and large hematoma forming at the puncture site. Which of the following actions should the technician take? Remove the tourniquet and needle. Rationale: The technician should immediately remove the tourniquet and needle and apply pressure to the puncture site. A phlebotomy tech has a mild sensitivity to latex. According to the National Institute for Occupational Safety and Health (NIOSH), which of the following actions should the tech take? Wear nitrile gloves instead of latex gloves. Rationale: If the technician or a patient has a latex sensitivity, NIOSH recommends using non-latex gloves, bandages, and tourniquets. -If the technician or a patient has a latex sensitivity, NIOSH recommends using non-latex gloves, bandages, and tourniquets. The technician should not use oil-based creams before putting on gloves, because these creams can damage the gloves. According to standard precautions, a phlebotomy technician should take which of the following actions when shipping specimens to a reference laboratory in hot weather? Place the specimens in a box with cold packs and a biohazard label. Rationale: standard precautions require the technician to transport specimens in an enclosed container with ice packs and a biohazard label in hot weather. For which of the following reasons should a tech document the total volume of blood draws from a patient? To determine if the patient is at risk for developing iatrogenic anemia Rationale: The technician should document the total blood volume drawn from a patient to help determine if it exceeds the recommended allowance of 1% to 5% of total blood volume within a 24-hr period and 10% of total blood volume over an 8-week period for pediatric or critically ill patients. 'Iatrogenic anemia' is a condition of lowered hematocrit and hemoglobin count resulting from large or frequent removal of blood samples, usually for laboratory testing. It is frequently seen in patients who are already suffering from bone marrow depression, and thus may become a comorbidity or relating to a disease. A phlebotomy tech should identify that which of the following is the total blood volume of an infantwho weights 3.3 kg (7.3 lb)? 240 to 330 mL Rationale: The technician should identify that an infant who weighs 3.3 kg (7.3 lb) has a total blood volume of approximately 240 to 330 mL. 3.3kg x 100 = 330 An unconscious patient is brought to the emergency department, and several blood tests are ordered. A tech should collect the patient's blood because he has received which of the following types of consent? Implied consent Rationale: The technician should identify that implied consent can be obtained when a patient is unconscious and in an emergency situation. A phlebotomy technician is performing a venipuncture on a patient who recently had a mastectomy on her right side. The tech should draw blood from which of the following locations? Left arm Rationale: The patient will have swelling on her right side due to lymph accumulation in the tissue. The technician should draw blood from the patient's left arm, because it is the opposite side of the mastectomy and will avoid the possibility of infection. -The technician should not draw blood from the patient's right arm, because she had a mastectomy on her right side. The patient will have swelling on the right side due to lymph accumulation in the tissue, and a venipuncture could cause an infection. A phlebotomy tech should identify that which of the following colors signifies a health hazard in the National Fire Protection Association (NFPA) 704 Marking System? Blue Rationale: A health hazard is signified by the color blue in the NFPA 704 Marking System. -A fire hazard is signified by the color red in the NFPA 704 Marking System. -A specific hazard that is not covered by another color is signified by the color white in the NFPA 704 Marking System. -Instability is signified by the color yellow in the NFPA 704 Marking System. A tech is preparing to dispose of contaminated sharps. According to OSHA standards, which of the following actions should the tech take? Replace the sharps container when it is two-thirds full. Rationale: According to OSHA standards, the technician should replace the sharps container when it is two-thirds full. -The technician should discard covered lancets into rigid, leak-proof, plastic containers. -To prevent needlestick injuries, the technician should not break, bend, recap, or manipulate contaminated needles -The technician should discard the entire evacuated tube system intact and should not disassemble it prior to disposal. A phlebotomy technician is collecting a blood specimen from an adolescent patient who weighs 42.6 kg (94 lb). Which of the following amounts is appropriate to collect if the maximum allowable volume is 1%? 40 mL Rationale: The technician can draw a maximum volume of 42.6 mL within 24 hr from a patient who weighs 42.6 kg (94 lb). 42.6 x 100mL = 4260 4260 x 0.01 (1%) = 42.6 mL A phlebotomy technician is collecting blood specimens from a patient or multiple blood assays. The tech should fill the tube that has which of the following additives first? Sodium citrate RATIONALE: The technician should first fill a light blue-topped tube, which contains the additive sodium citrate.