NHA Practice Phlebotomy Questions and Answers

NHA Practice Phlebotomy Questions and Answers A phlebotomy technician has a requisition for collecting fasting blood glucose and albumin specimens from a patient. What action should the technician take before collecting the patient's blood? 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 hours. Eating 8 to 12 hours prior to the exam can cause inaccurate results. A phlebotomy technician is preparing to use an evacuated tube system to obtain a venous blood specimen from a patient. The tourniquet is in place and the technician has cleansed the puncture site. What procedural steps should the technician perform next? The next step the technician should take is to ask the patient to make a fist this action allows for the patient's veins to become more prominent for puncture site selection. A phlebotomy technician is performing a total cholesterol point-of-care test for a patient. What findings should the technician immediately report to the provider? 300 mg/dL [ The technician should identify that a finding of 300 mg/dL is above the reference range of 140 to 200 mg/dL for total cholesterol.] A phlebotomy technician is collecting a patient's blood specimen in a lavender-topped tube. How many times should the technician gently invert the tube before setting it in the specimen collection tray? 8 to 10 times to ensure adequate mixing of the additive and the blood. [Inverting the tube more than 10 times can result in hemolysis, which is the breakdown of red blood cells.] A patient arrives at a clinic with a requisition for a chemistry panel. A technician notices that the patient's last name on the requisition differs from the patient's provided identification. What actions should the technician? Contact the ordering provider to correct the requisition form.[The technician should return the requisition form to the patient's provider to verify the information. The provider can either adjust the incorrect information or provide a new requisition.] A phlebotomy technician is preparing a patient's arm for venipuncture. What techniques should technician use when applying an antiseptic solution? Back and forth strokes. [ The technician should apply the antiseptic solution using back and forth strokes because this motion is effective in decontaminating the site.] A tourniquet should be left on a patient's arm for what amount of time? No longer than 60 seconds to avoid affecting test results. A phlebotomy technician is transporting blood specimens to a laboratory. What actions should the technician take? Place the specimens in a lockable container to avoid spills during transportation. According to the Clinical and Laboratory Standards Institute's (CLSI) order of draw guidelines, what samples should a phlebotomy technician collect first? Blood culture samples should be collected first to prevent cross-contamination. A phlebotomy technician is required to obtain what from a potential blood donor? A complete medical history should be obtained before a patient may donate blood. While performing a venipuncture, a phlebotomy technician is stuck with a used needle. What actions should the technician take first? Flush the injured area with running water to prevent infection. When should a phlebotomy technician perform external liquid controls for a quality control on CLIA-waived glucose POC test? When a new lot number or kit is opened. A phlebotomy technician is performing a venipuncture for a patient. The patient suddenly reports "feeling faint." After removing the tourniquet and the needle, what actions should the technician take next? Have the patient put her head between her legs. This position helps prevent syncope. A phlebotomy technician is interviewing a patient before performing a venipuncture. During the interview, the patient states that he lives nearby and ran to the facility to " get in some running time today." What precautionary actions should the technician take? Have the patient rest comfortably for at least 15 min before the venipuncture because strenuous exercise affects coagulation. Prior to transport, what specimens should a phlebotomy technician place in an ice bath within 30 min after collection? Arterial blood gas (ABG) should immediately be place in an ice bath to stop the metabolic activity of the red blood cells for delivery to the laboratory. A phlebotomy technician is using a glucose monitor for point-of-care (POC) testing of a patient who has been fasting for 12 hr. What result should the technician immediately notify the provider? Fasting blood glucose of 130 mg/dL should immediately be notified to the provider because it's above the expected reference range of 70 to 110 mg/dL. A phlebotomy technician is preparing to collect a blood specimen from a patient who is allergic to alcohol. What antiseptic solutions should the technician use to prepare the insertion site? Chlorhexidine is an alternative antiseptic solution for patients who have allergies to alcohol or latex. What regulations ensures that a phlebotomy technician is proficient to perform job duties and responsibilities? The Clinical Laboratory Improvement Act (CLIA) provides quality control guidelines, patient test management, and testing of personnel and proficiency. It also regulates laboratories for proven competency. A phlebotomy technician is preparing to collect a vancomycin peak level for a patient in an inpatient setting. What actions should the technician take prior to collecting the blood specimen? The technician should ask the attending nurse if the patient's vancomycin dose schedule is accurate prior to collection. This action ensures an accurate peak level for therapeutic medication monitoring. What actions should a phlebotomy technician take to prevent bleeding from a venipuncture site after the needle is removed? Apply pressure to prevent leakage of blood in the tissues and to reduce the chance of a hematoma. A phlebotomy technician is removing his gloves after a venipuncture procedure. What actions should the technician take? When removing gloves, the technician should turn the first glove inside out during removal to decrease chances of contact with blood. A phlebotomy technician enters a patient's room to perform a venipuncture and notices that the patient is sleeping. What actions should the technician take? The technician should wake the patient before performing the collection to verify his identity and obtain consent. For what reasons should a phlebotomy technician avoid drawing blood from the leg or foot of a patient who has diabetes? These areas are more susceptible to infection due to have a slowed ability to heal.The technician should consult the patient's provider before drawing a specimen from the lower extremities A phlebotomy technician is applying a tourniquet prior to collecting a blood specimen from a patient. What actions should the technician take? Truck a partial loop of the tourniquet underneath the tourniquet. [The technician should tuck a section of a free end of the tourniquet under the circumferential portion next to the patient's skin because this enables the tourniquet to be quickly released.] A phlebotomy technician is collecting a urine specimen from a patient for a per-employment drug test. What actions should the technician take? 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 into another bottle. For what procedures should a phlebotomy technician follow chain of custody guidelines? Chain of custody guidelines apply to drug screenings, forensic studies, blood alcohol tests, and paternity testing. A phlebotomy technician is preparing to draw blood from a patient's arm and observes a sore at the site where the tourniquet is to be placed. What actions should the technician take? The technician should tie the tourniquet over the patient's sleeve to prevent any further damage to the skin. A phlebotomy technician is collecting a blood specimen from a patient who has pneumonia. Besides glove, what PPE should the technician wear? The technician should wear a mask when collecting a blood specimen from a patient who has pneumonia, which requires droplet precautions. The technician should wear the mask when working within 3 feet of the patient. A phlebotomy technician is preparing to collect a patient's troponin T level. What troponin T levels should the technician immediately report to the provider? 0.3 ng/mL [The technician should identify that troponin T level of 0.3 ng/mL is above the expected reference range 0 of 0.2 ng/mL and therefore is a critical value.] A phlebotomy technician is processing a semen specimen what action should the technician take? The technician should deliver the specimen to the laboratory within 2 hours for optimal test results. A phlebotomy technician is preparing to store a blood specimen. At what temperatures should the technician store the specimen? The technician should store the blood specimens at 2 to 8° C ( 35.6° to 46.4° F) A phlebotomy technician is preparing to collect a blood specimen for a blood alcohol level test. What antiseptics should the technician use to clean the venipuncture site? The technician should use a non-alcoholic antiseptic such as soap and water when collecting a specimen for a blood alcohol level test. This prevents introducing alcohol into the specimen and affecting the test results. A phlebotomy technician collects multiple specimens from a premature infant. What is a possible result of this procedure? Iatrogenic anemia which is caused by too much blood loss in a short amount of time. For what reasons should a phlebotomy technician place a specimen in a biohazard bag for transport to an outside Laboratory? The Biohazard bag prevents a possible exposure incident. A phlebotomy technician is performing a blood glucose test. What glucose level should the technician identify as being outside the expected range? A blood glucose level of 200 mg/dL is above the expected range of 70 to 126 mg/dL. What results are affected when a phlebotomy technician uses Povidone-iodine to cleanse a site for a dermal puncture? Povidone-iodine is contraindicated for potassium tests because it can cause a false evaluation of potassium in a specimen. A phlebotomy technician is preparing to draw a peak level for a medication that was administered orally to a patient. After verifying when the patient received the medication, how long should the technician wait prior to attempting the draw? The technician should collect a peak level 1 to 2 hours following an oral Administration to ensure that the medication is not at a toxic level. A phlebotomy technician should select a tube that has what additives when collecting a blood specimen for a CBC? The technician should use a collection tube that contains EDTA when collecting a specimen for a CBC. A phlebotomy technician is obtaining a blood culture specimen from an adult patient. What action should the technician take? The technician should withdraw the blood into a sterile safety syringe after obtaining a blood culture specimen from an adult patient. A phlebotomy technician is collecting a blood specimen from an adolescent patient who weighs 42.6 kg (94 lb). What amount is appropriate to collect if the maximum allowable volume of blood is 1%? The technician can draw a maximum volume of 42.6 ml within 24 hours from a patient who weighs 42.6 kg (94 lb). The formula for this is kg X 100 X .01 "if the maximum allowable blood volume was 5% then it would be .05" A phlebotomy technician should identify that the total blood volume of an infant who weighs 3.3 kg (7.3 lb) is? Multiply the number of kilograms by 100. 240 to 330 mL For what reason should a phlebotomy technician document the total volume of blood drawn from a patient? To determine if the patient is at risk for developing iatrogenic anemia. [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 hour period and 10% of blood volume over an 8-week period for Pediatric or critically ill patients.] A phlebotomy technician is collecting a venipuncture blood specimen from a patient for a blood assay. The technician should fill what tube first? The technician should fill the tube with the yellow top first to decrease the probability of bacterial contamination. According to OSHA standards, what vaccines must employers offer to their phlebotomists at no cost? OSHA requires employees to offer the hepatitis B vaccine to at-risk employees within 10 days of hire at no cost to the employee. A phlebotomy technician should transport a semen sample at what temperatures? 36° to 83° C [The technician should identify that semen sample should be stored and transported at 37° C (98.6° F)] A phlebotomy technician is collecting a blood specimen from a patient to measure the trough level of medication. The technician should collect the specimen at what time? The technician should collect the specimen no more than 15 minutes prior to administration of the next dose. The trough level is the lowest concentration of medication in the patient's blood. A phlebotomy technician is performing a venipuncture on a patient who recently had a mastectomy on her right side. The technician should draw blood from what location? Left-arm [The patient should 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.] A phlebotomy technician is preparing to collect a blood specimen from the hand of a patient whose veins are difficult to access. What device should the technician use? The technician should use a hand immobilizer to access difficult veins in the patient's hand. Hand immobilizer uses straps to keep the patient's hand still during the collection procedure. A phlebotomy technician should invert anticoagulant tubes to prevent what complications? The technician should invert anticoagulant tubes to prevent hemolysis which is the destruction of red blood cells. A phlebotomy technician is following the clinical and laboratory standards Institute's (CLSI) Clinical Laboratory workflow pathway. As part of the postexamination phase of this process, what actions should the technician take? enter critical laboratory data What action should a phlebotomy technician take when performing a venipuncture using an evacuated tube system? position the needle at a 30° angle in the same direction as the vein with the bevel up. A phlebotomy technician is using a point-of-care test system to determine a patient's white blood count WBC. What result should the technician immediately notify to the provider? the technician should immediately report a finding of 1.8/mm³ cubed to the provider because this finding is outside the expected reference of 4.4 to 11/mm³ for white blood cells. A phlebotomy technician is collecting a blood sample from a patient who has cutaneous diphtheria. Besides gloves what pieces of personal detective equipment should the technician where? The technician should wear a gown to protect the skin from infection that can be transmitted by contact. Because cutaneous diphtheria is spread through contact. A phlebotomy technician is collecting a blood specimen from a patient for blood culture. What additives do the blood collection tubes required? Sodium polyanethol sulfonate [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 should identify a phrase is represented by the abbreviation "SD"? 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 technician is instructing a patient about proper semen specimen collection for the determination of fertility potential. What instruction should the technician include? Protect the specimen from exposure to light. When performing a hand draw what step should a phlebotomy technician take before removing the needle? The technician should disengage the tube from the adapter before removing the needle. this prevents contamination and the dripping of blood. For an older adult patient who has difficult to access veins, a phlebotomy technician should select what veins to perform a venipuncture? dorsal veins [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 has difficult access veins.] A phlebotomy technician is collecting blood specimens from a patient for multiple blood assays. The technician should fill the tube that has what additives first? the technician should first fill a light blue top tube which contains the additive sodium citrate. A phlebotomy technician is performing a heel stick to obtain capillary blood for testing a newborn's bilirubin level. What action should the technician take? The technician should use an amber-colored microcontainer when obtaining a bilirubin level from a newborn. Bilirubin is photosensitive, and this will protect the specimen from exposure to light. A phlebotomy technician is preparing to collect a blood specimen from a small vein of an older adult patient. What action should the technician take to keep the vein from collapsing? The technician should use a small needle to collect the blood sample from the small vein of an older adult to prevent the vein from collapsing. A phlebotomy technician is collecting a unit of blood from a donor. what action should the technician take? To ensure a quality collection the technician should instruct the donor to open and close his hand gently throughout the collection. A phlebotomy technician is preparing several specimens for transport to the facilities laboratory. What specimens should the technician protect from Bright Light by placing it in an Amber / Brown biohazard bag for transport? The technician should protect vitamin B₆ specimen which is photosensitive from Bright Light by placing it in an Amber/ Brown biohazard bag for transport. A phlebotomy technician should identify what additives are used to prevent the breakdown of glucose? The technician should identify that sodium fluoride is an additive used to prevent the breakdown of glucose. To prevent hospital-acquired infections a phlebotomy technician should clean items that have been contaminated by Blood with 1:10 dilution of what substance and water? The technician should use a 1:10 dilution of sodium hypochlorite or chlorine bleach with water to disinfect items that are contaminated by Blood. What action should a phlebotomy technician take to locate a vein using the warming technique? 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. A technician should identify that one of the joint commission's 2016 National Patient safety goals is? Identify patients correctly. [Technicians should use at least two forms of identification to identify patients collect correctly. The Joint Commission National patient safety goals help healthcare facilities address areas of concern regarding patient safety. The 2016 goals include identifying patients correctly, improving staff communication, using medicines safely, using alarm safely, preventing infections, identifying patient safety risks, and preventing mistakes in surgery.] A Phlebotomy technician is obtaining a blood specimen from a patient. The technician notices swelling and a large hematoma Forming at the puncture site. What action should the technician take? The technician should immediately remove the tourniquet and needle and apply pressure to the puncture site. Within what time should a phlebotomy technician collect a newborn's blood spot test screening card? The technician should collect the newborn screening card within 72 hours of birth. What is a potential consequence of a phlebotomy technician mislabeling a blood bank specimen? The technician mislabeling a blood bank specimen can result in a fatal transfusion reaction. What action should a phlebotomy technician take after collecting an ammonia specimen? A technician should place the specimen tube in an ice water slurry. Chilling the specimen slows down metabolic processes and protects the analytes. What personal protective equipment provides a phlebotomy technician with the best protection When drawing blood from a patient who has active tuberculosis? The technician is required by the CDC to wear an N95 respirator when working with patients who have active tuberculosis. A N95 respirator eliminates all particles in the air that are larger than 0.3 microns. A phlebotomy technician is instructing a patient how to collect a clean-catch urine specimen. What cleanser should the technician instruct the patient to use when cleansing around her urinary meatus? Mild antiseptic soap is an appropriate cleanser for the patient to clean around her urinary meatus before collecting a clean-catch urine specimen. According to the standard precautions, a phlebotomy technician should take what action when shipping specimens to a Reference Laboratory in hot weather? Standard precautions require the technician to transport specimens in an enclosed container with ice packs and a biohazard label in hot weather. A phlebotomy technician should identify that what is an identifier for a specimen as long as it remains in the laboratory? Accession number What action by a phlebotomy technician can result in a grossly hemolyzed specimen? Using an incorrect needle gauge [If the technician uses a large gauge needle to draw from a vein with a small lumen, it can cause a grossly hemolyzed specimen.] The Joint Commission recommends using the patient's full name and what pieces of information to ensure accurate inpatient identification? Medical record number [The patient's medical record number, a number assigned to the patient by a facility, is an acceptable form of patient identification. The patient's birth date and home address are also acceptable patient identifiers.] What task is within a phlebotomy technician scope of practice? Providing instructions to patients for specimen collection is within the technician's scope of practice. A phlebotomy technician should identify that the first step in the blood collection procedure is? Test requisition [The technician should ensure that she has a provider's order for a test before performing a blood collection.] A phlebotomy technician is removing a bag of contaminated items from a collection area. What action should the technician take to properly dispose of the items? Place the bag inside a second hazardous waste bag outside of the room. [This method of disposal is called double bagging and is the proper procedure for disposing of hazardous waste. This process limits the risk of cross-contamination.] A phlebotomy technician is preparing to perform a blood draw when the patient states that he is severely allergic to latex what action should the technician take? For a patient who has an allergy to latex, the technician should use a blood pressure cuff and inflated to 40 mm Hg which provides enough pressure to palpate a vein. A phlebotomy technician is reviewing a Laboratory test requisition form before obtaining blood specimens from a patient. What action should the technician take prior to performing the venipuncture? Check the requisition form for duplicate test orders. [The technician should check the requisition form for duplicate test orders, discrepancies, and missing information prior to performing the venipuncture.] While a phlebotomy technician is performing a blood collection several drops of blood land on the draw chair. What solution should the technician use to remove the blood? The CDC recommends the technician use a chlorine bleach solution of 1:10 to disinfect surfaces exposed to blood and other bodily fluids. A phlebotomy technician has a requisition form to perform a chromosome analysis for a patient. The technician should select a tube that contains what additives? Heparin [The technician should use a collection tube that contains the additive Heparin which is an anticoagulant that produces a plasma specimen for chromosome analysis.] What collection tubes should a phlebotomy technician use when collecting for a routine chemistry test that requires serum? SST [When an SST tube is centrifuged the thixotropic gel changes viscosity and moves between the serum and the cells.] If a patient states that he is a difficult draw and request a skin puncture. The test ordered is a PTT. What should the phlebotomy technician perform? A syringe draw transferred into a light blue vacuum tube. [In cases of difficult drawers when a PTT or other Coagulation tests is ordered, this is the preferred method.] A Phlebotomy technician is preparing to draw blood from a patient who has scabies. What pieces of PPE should the technician use? The technician should follow contact precautions when interacting with a patient who has scabies. Contact precautions require wearing gloves in a gown. Before collecting from a patient in an inpatient setting a phlebotomy technician notices that the patient does not have a wristband on his wrist but there is one attached to the patient's IV stand. What action should the technician take? The technician should not perform a blood draw on this patient until the nurse has attached a wristband to the patient. A phlebotomy technician is exposed to blood via a needle stick injury. Within how many hours should the technician initiate post-exposure prophylaxis (PEP)? The technician should initiate PEP within 24 hours of a needle stick injury. A phlebotomy technician is preparing to collect a timed to medication draw ordered for 1400. The technician should verify when the patient received his previous dose of medication with which of the following members of the interprofessional team? A technician should verify the time of the patient's previous dose of medication with the nurse when collecting a blood specimen for a timed medication draw. A phlebotomy technician is instructing a patient about how to collect a fecal occult specimen. What instruction should the technician include? The technician should instruct the patient to avoid taking ibuprofen which can cause a false positive test results. A phlebotomy technician is working with a patient who has a mycobacterium tuberculosis infection. What transmission precautions should the technician use for this patient? Airborne precautions [The technician should follow airborne precautions to prevent the transmission of small particle residue. Conditions that require airborne precautions include tuberculosis measles and varicella.] A phlebotomy technician is preparing to perform a blood draw on a patient who had a left-sided mastectomy and has an IV on her right side. In what location should the technician perform the draw? Below the IV [After asking the nurse to shut off the flow of the IV to prevent infiltration of the IV site the technician should draw blood from a site below the IV.] A phlebotomy technician is preparing to perform a venipuncture on a patient who has small rolling veins. What equipment should the technician use? The technician should use a winged infusion set which is designed for use on patients who have small rolling veins. After a phlebotomy technician performs a heel puncture for neonatal screening what is the correct procedure for collecting the blood? When performing a heel puncture the technician should wipe away the first drop of blood saturate each circle with one drop and allow it to dry for 4 hours. A phlebotomy technician uses alcohol to cleanse a venipuncture site. Before performing the venipuncture the technician should allow this site to dry for what reasons? If the site is not allowed to air-dry there's not enough time for the antiseptic to take action. Therefore the technician should allow the site to dry before performing the venipuncture. A patient asks a phlebotomy technician to use her finger for blood work. What situation can the technician collect blood from the patient's finger? The technician can draw a capillary specimen if the ordered tests do not require a large amount of venous blood. A phlebotomy technician is preparing to draw a blood specimen from a patient who has a clostridium difficile infection. What precautions should the technician follow? The technician should follow contact precautions for patients who have diseases that are transmitted by direct contact, such as C. difficile infection and scabies.