NHA Phlebotomy Exam 2023 Questions with complete solutions.

OSHA - ANSWER-Establishes regulations and guidelines to direct phlebotomists to work at the highest level of safety possible when handling bio hazards and chemicals. The blood borne pathogens standard (OSHA) - ANSWER-- addresses use of PPE - availability to the Hep B immunization - Each workplace must have a exposure control plan - has guidelines to ensure safety - provides standard plans for after an exposure. - engineering controls and record keeping protocols PPE for venipuncture and capillary (OSHA) - ANSWER-well fitting gloves Airborne infection PPE (OSHA) - ANSWER-N99 or N95 mask What do you do when you have an accidental needle stick? (OSHA) - ANSWER-First you wash the area with soap and water (basic first aid), then undergo medical examination that includes you and the patient get tested for HIV, HBV and HCV. Then document the exposure in sharps injury log. What do you include in a sharps injury log? (OSHA) - ANSWER-date and time of incident, type of sharps used, who was involved (patient or staff w/o names), location and a detailed description of how it occurred. What is the joint commission? - ANSWER-- accredits and certifies healthcare organizations - independent, nongovernmental, and nonprofit - focuses on continual improvement of patient safety and quality of care through regulations and standards The national patient safety goals program (JC) - ANSWER-sets requirements for issues including training of health care professionals, communication of test results, and accurate IDs (2-factor method) Clinical and Laboratory Standards Institute (CLSI) - ANSWER--develops standards and guidelines in order for a laboratory to be accredited - provides guidelines for phlebotomists for better accuracy and patient care (like for the use of tubes and needles). standards include level of additives and their use for which tests, order of draw, processing and handling, depth of needle and location needed for capillary collection - provides guidelines for quality control, patient care, risk reductions, and time saving and cost cutting measures. Centers for Disease Control and Prevention (CDC) - ANSWER-- helps ID and and educate about infections, illnesses and disease preventions. - IDs new disease and works to prevent spreads - Provides guidelines for PPE sharps handling and hand hygiene - recommends standard precautions when handling body fluids HIPPA - ANSWER-- Protects every patients PHI (protected health info) which is any and all info that relates to the patients medical record or electronic health record. - details what info is confidential and any authorized release of that info Info protected under HIPPA - ANSWER-demographic info, treatment, meds, diagnostic testing. Any info w/o a way to ID the patient is not protected When is the phlebotomist responsible for the patient? - ANSWER-Before, during and immediately after venipuncture What happens if you go through with the venipuncture without consent? - ANSWER-It would be considered assult Techniques to find a vein - ANSWER-warming the area, wiping it with an alcohol wipe, and lowering the limb below the level of the patients heart Why do phlebotomists avoid the wrist? - ANSWER-potential ulnar nerve damage or inadvertent arterial access Why is the basilic vein the least desirable for venipuncture? - ANSWER-it is close to the brachial artery and it is most painful Why would a phlebotomist avoid the legs and feet of a patient who has diabetes mellitus? - ANSWER-To prevent possible infection What do you do if a hematoma develops? - ANSWER-Stop the procedure What do you do if the patient shows early signs of a seizure or syncope? - ANSWER-You immediately stop the procedure and lie them on the floor or in their bed. Give them a cold compress and stay with them until they recover Quality control - ANSWER-a measure of precision or of how well an instrument is functioning over time Quality assurance - ANSWER-ensuring a test is as accurate as possible What do you write in the equipment log - ANSWER-The time and date you ran a quality control test and the results of the test How often should you clean lab equipment? - ANSWER-several times per day Why would a centrifuge be shaking excessively? - ANSWER-The tubes need to be about the same size and volume. The tubes also have to be placed directly across from each other What could happen if the centrifuge shakes too much - ANSWER-tube breakage or improper centrifuging What do you do if a piece of equipment is not working correctly or at all? - ANSWER-Make a repair report (state the date, description of issue, and the steps you took to try to fix the problem) How can you ensure quality control when using glucometers? - ANSWER-Use of external controls, matching test strip codes and reviewing expiration dates When do you use external controls when using a glucometer? - ANSWER-- when opening a new package of strips and each day you preform a test - drastically out of range readings - use at room temp and not past expiration date What step should the phlebotomist take after seeing 2 widely divergent test results in a glucometer? - ANSWER-Preform liquid controls (running controls will help to troubleshoot the problem) What should the phlebotomist do about the defective glucometer strips? - ANSWER-Contact the manufacturer and follow instructions for sending back the strips While collecting a blood specimen, a phlebotomist notices the glass collection tube is cracked. What would be the correct action? - ANSWER-dispose of the tube in a sharps container A phlebotomist is taking blood from a patient with a MRSA infected wound, what should they do once once the procedure is done? - ANSWER-Dispose of their gown before leaving the room A phlebotomist is performing a blood alcohol test. What antiseptic should they use? - ANSWER-Chlorhexidine gluconate (ethanol, iodine tincture and isopropyl alcohol all has alcohol in it and would skew the results) If a centrifuge where to catch on fire, which class of fire would it be? - ANSWER-Class C (it involves electrical equipment) What is the current procedure for CPR on an infant? - ANSWER-30 compressions, 1.5 in deep (using 2 fingers) What piece of PPE should a phlebotomist remove first after a draw in an isolation room? - ANSWER-gloves (the most contaminated piece of PPE first) A phlebotomist gets a very large glucometer reading the first try and then is back in the normal range the second reading. What could have caused the first inaccurate reading? - ANSWER-too much blood was used A phlebotomist comes in the get another set of blood for a GTT (glucose tolerance test) and the patient starts to cry and doesn't comply. What statement should you say? - ANSWER-May I please perform the draw? A GTT requires multiple timed draws at set intervals. What department is responsible for processing cholesterol, troponin, and HDL tests? - ANSWER-Chemistry (body chemistry) What substance is used to clean a cerebral spinal specimen spill? - ANSWER-Chlorine bleach (1:10 bleach to water) What pieces of PPE are minimum requirements to wear for aliquoting a blood specimen? - ANSWER-face shield and gloves What pathogen is the phlebotomist at most risk for in the case of an accidental needle stick? - ANSWER-Hepatitis B virus (HBV) Who can order lab tests? - ANSWER-Physicians, physician assistants, and nurse practitioners What info is on the requisition form? - ANSWER-- Patients name, DOB, sex, and ID number - It can also have allergies, tendency to faint, excessive bleeding, and sites to avoid - it has space for date and time of collection, billing info and diagnostic coding What would you review the req form for? - ANSWER-duplicate test orders or missing info What info needs to be on the tube label if there is no bar code? - ANSWER-date and time of collection, your initials, the patients full name, DOB and other identifiers. What are two identifiers that you can use when IDing the patient? - ANSWER-patients name, DOB, home address, phone number, or social (if available) - compare what they say with the req form How can you cross check patient identifiers - ANSWER-you can cross check the patients drivers license with the req form, or their hospital band. Never use a patients room or bed number Exceptions for teenage consent - ANSWER-married, in the military, emancipated, or otherwise self supporting Most common pretesting preparations - ANSWER-- fasting (8-12 hours not eating or drinking other than water) - Medications - basal state (first thing in the morning or after sleeping) before the blood collection make sure they completed the requirements Things to ask the patent before continuing - ANSWER-allergies, fainting tendencies, blood thinners, what arm they wish for you the use, current medications, drug and alcohol use How long after a fainting spell should you stay with them? - ANSWER-at least 15 minutes Complications that can occur with venipuncture - ANSWER-Excessive bleeding or bruising, severe pain or lack of sensation, and infections What to do in the case of excessive bleeding - ANSWER-apply pressure and ice to the site and call for What to do in the case of excessive bruising - ANSWER-apply pressure and ice to the site and call for What to do in the case of severe pain or lack of sensation? - ANSWER-It can indicate nerve damage. stop the procedure and use ice if available What to do in the case of infection? - ANSWER-If the site becomes red, swollen and painful, they may have infection. Alert the patient to sign of infection and to contact a physician if they appear What are acceptable ways to position your patient while taking blood - ANSWER-- On a bed (increases comfort and safety if they fall) - chair with arm rests and adjustable heights What are some examples of unacceptable ways to potion your patient while taking blood? - ANSWER-- standing - sitting on a high stool - edge of an examination table When would you not use a finger for dermal puncture? - ANSWER-If the finger is: - cold - cyanotic (blue) - scarred - swollen - covered in a rash Where do you collect capillary blood from an infant? - ANSWER-On the sides of their heel What places can you get blood from if the antecubital fossa is not available? - ANSWER-- Hand veins (next choice after AF) - ankle and foot veins (last choice) What are characteristics of hand veins? - ANSWER-- more fragile - often roll - often small - more painful than antecubital fossa - short and thin - best to use a butterfly needle (never draw from the wrist) What are characteristics of ankle and foot veins? - ANSWER-- last choice - difficult to access - easy to injure - often painful - usually needs physician approval (never collect from a diabetes or peripheral vascular disease patient due to poor circulation) Why do you palpate for a vein? - ANSWER-- to insure it is a vein and not an artery (arteries have a pulse) - ensure the vein is subtable for collection (soft, bouncy, flexible) - determine depth, direction and dimension of the vein What sites should not be used for venipuncture? - ANSWER-- above an IV (IV fluids can mix w/ sample) - an arm with a shunt for hemodialysis (could damage the shunt) - central venous access device (could damage it) - side of a mastectomy - site w/ an edema - site w/ scarring - site w/ hematoma What are types of veins that should not be used for venipuncture? - ANSWER-- Sclerotic veins: hard, inflexible, narrow - Tortuous veins: twisted, dilated, lack elasticity - Fragile: thin, weak, difficult to puncture (common in elderly, newborns, pediatric patients) - phlebitic veins: tender and warm w/ a red area around them (painful for patients) - Thrombotic veins: veins w/ a clot (can feel hard and inflexible). Patients report tenderness when touched What are the common non blood specimens will need to be collected? - ANSWER-urine, stool, sputum, and semen What factors are examined in urine? - ANSWER-appearance, color, odor, pH, specific gravity, cultures, and presence or absence of many other components (protein, glucose, hemoglobin) Steps to instructing someone to take a urine sample - ANSWER-- give patient a clean, disposable container and a label w/ their info - fill between 30-60 mL - make sure to be refrigerated if not immediately taken to the lab - after the cup is filled and cleaned from debris, but the label on the cup