Safety & Compliance
A phlebotomist accidentally experiences a needlestick injury after performing a venipuncture. Which action should the phlebotomist take FIRST?
A. Complete incident paperwork before cleaning the site
B. Wash the affected area with soap and water
C. Report directly to the laboratory supervisor without treatment
D. Apply a tourniquet above the injury site
Answer: B. Wash the affected area with soap and water
A phlebotomist is preparing to collect a fasting lipid panel. The patient states they drank orange juice 4 hours earlier because they “felt weak.” Which action should the phlebotomist take?
A. Proceed with collection because only solid food affects results
B. Document the juice intake and collect the specimen immediately
C. Follow facility protocol and notify the provider that fasting was interrupted
D. Ask the patient to drink water and wait 30 minutes before collection
Answer: C. Follow facility protocol and notify the provider that fasting was interrupted
A phlebotomist is collecting specimens from a patient who has a mastectomy on the right side and an IV infusing in the left arm. Which action should the phlebotomist take?
A. Collect below the IV site on the left arm
B. Draw from the right arm using a butterfly needle
C. Consult the provider for further collection instructions
D. Stop the IV for 2 minutes and collect above the site
Answer: C. Consult the provider for further collection instructions
A phlebotomist is collecting a specimen for a chilled ammonia test. Which action is the BEST choice to ensure accurate test results?
A. Keep the specimen at room temperature until processing
B. Warm the tube before collection
C. Immediately place the specimen in an ice slurry after collection
D. Centrifuge the specimen after 2 hours
Answer: C. Immediately place the specimen in an ice slurry after collection
A serum separator tube is centrifuged 7 minutes after collection because courier pickup is arriving early. Which action is the BEST response?
A. Refrigerate the specimen to complete clot formation
B. Continue processing because serum separation occurred
C. Allow additional clotting time before reprocessing the specimen
D. Transfer the serum into another tube immediately
C. Allow additional clotting time before reprocessing the specimen
A phlebotomist notices a sharps container is filled above the recommended level. Which action is MOST appropriate?
A. Push the contents down to create more space
B. Continue using the container until the shift ends
C. Replace the sharps container according to facility policy
D. Dispose of sharps in a biohazard trash bag temporarily
Answer: C. Replace the sharps container according to facility policy
A phlebotomist enters a patient’s room to collect a specimen and finds the patient wearing an identification band with a different spelling of the last name than the requisition. Which action should the phlebotomist take FIRST?
A. Ask a family member which spelling is correct
B. Proceed if the date of birth matches
C. Delay collection until the discrepancy is resolved
D. Correct the spelling on the requisition form personally
Answer: C. Delay collection until the discrepancy is resolved
A phlebotomist is preparing to collect a CBC and PT/INR using an evacuated tube system. Which tube should be collected FIRST?
A. Lavender tube
B. Light blue tube
C. Red tube
D. Green tube
Answer: B. Light blue tube
A patient receiving heparin therapy requires a PTT specimen. The phlebotomist notices the patient has a heparin lock in the left arm and an IV infusing normal saline in the right arm. Which collection method is the BEST choice?
A. Collect distal to the IV after stopping it for 30 seconds
B. Collect above the IV site without notifying the nurse
C. Request a nurse perform a line draw from the heparin lock
D. Perform a capillary puncture instead of venipuncture
Answer: C. Request a nurse perform a line draw from the heparin lock
A bilirubin specimen remains exposed to fluorescent lighting during accessioning for approximately 12 minutes. Which action is the BEST response?
A. Continue routine processing because exposure time was brief
B. Protect the specimen from light immediately
C. Refrigerate the specimen uncovered before testing
D. Delay testing until recollection occurs automatically
B. Protect the specimen from light immediately
A phlebotomist is preparing to enter a room requiring airborne precautions. Which personal protective equipment (PPE) is MOST important to wear?
A. Surgical mask
B. Face shield only
C. Gown and gloves only
D. N95 respirator
Answer: D. N95 respirator
A patient becomes increasingly anxious before venipuncture and begins breathing rapidly. Which action should the phlebotomist take FIRST?
A. Continue quickly to shorten the procedure time
B. Encourage the patient to breathe slowly and remain calm
C. Apply the tourniquet immediately to avoid delay
D. Tell the patient anxiety is common during blood draws
Answer: B. Encourage the patient to breathe slowly and remain calm
During venipuncture, the phlebotomist observes bright red blood pulsing rapidly into the tube. Which action should the phlebotomist take FIRST?
A. Continue the draw to avoid specimen loss
B. Remove the needle immediately and apply pressure
C. Lower the patient’s arm below heart level
D. Switch to a syringe collection method
Answer: B. Remove the needle immediately and apply pressure
A phlebotomist is performing a 2-hour postprandial glucose test. The patient reports finishing breakfast 45 minutes ago. Which action should the phlebotomist take?
A. Collect the specimen immediately to avoid delaying testing
B. Wait 75 more minutes before collecting the specimen
C. Reschedule the test for the following morning
D. Ask the patient to consume additional carbohydrates
Answer: B. Wait 75 more minutes before collecting the specimen
A potassium specimen transported through a pneumatic tube system arrives with visible hemolysis. Which action is the BEST response?
A. Continue testing because patient identifiers are correct
B. Store the specimen at room temperature until review
C. Recentrifuge the specimen before analysis
D. Notify the laboratory and follow recollection policy if required
D. Notify the laboratory and follow recollection policy if required
After removing gloves, a phlebotomist notices their hands are visibly soiled with blood. Which action should the phlebotomist take?
A. Use alcohol-based hand sanitizer only
B. Wipe hands with gauze and continue working
C. Wash hands thoroughly with soap and water
D. Put on a new pair of gloves immediately
Answer: C. Wash hands thoroughly with soap and water
A provider orders a timed therapeutic drug level. Which patient preparation information is MOST important for the phlebotomist to verify?
A. The patient’s preferred arm for venipuncture
B. The exact time of the patient’s last medication dose
C. Whether the patient consumed caffeine that day
D. The patient’s insurance information
Answer: B. The exact time of the patient’s last medication dose
A phlebotomist is collecting blood from an older adult patient with fragile veins. Which technique is MOST appropriate?
A. Apply the tourniquet tightly to anchor the vein
B. Use a syringe or butterfly system with gentle pressure
C. Probe deeply to maintain blood flow
D. Ask the patient to pump their fist continuously
Answer: B. Use a syringe or butterfly system with gentle pressure
A provider orders therapeutic drug monitoring for gentamicin peak and trough levels. Which collection sequence is the BEST choice?
A. Peak immediately before dose; trough 30 minutes after infusion
B. Peak 30 minutes after infusion; trough immediately before next dose
C. Peak 2 hours after infusion; trough midway between doses
D. Peak after breakfast; trough before bedtime
Answer: B. Peak 30 minutes after infusion; trough immediately before next dose
A lactic acid specimen requiring chilling is transported without ice because transport materials were unavailable. Which action is the BEST response?
A. Refrigerate the specimen after arrival only
B. Continue routine handling because the tube remained sealed
C. Notify the laboratory regarding improper transport conditions
D. Warm the specimen before centrifugation
C. Notify the laboratory regarding improper transport conditions
A phlebotomist receives a verbal request from a patient’s family member asking about laboratory results. Which response is BEST?
A. Provide only normal results to maintain reassurance
B. Refer the family member to the appropriate healthcare provider
C. Discuss the results if the family member seems concerned
D. Print a copy of the laboratory report for the family member
Answer: B. Refer the family member to the appropriate healthcare provider
A phlebotomist is preparing to collect blood from a patient who recently had a seizure and is now confused. Which action is MOST appropriate?
A. Proceed if the patient verbally agrees to the collection
B. Ask another patient nearby to witness consent
C. Verify the patient’s identity and follow facility protocol for consent
D. Delay all testing until the patient is fully alert regardless of urgency
Answer: C. Verify the patient’s identity and follow facility protocol for consent
A phlebotomist performs a venipuncture and the specimen appears hemolyzed. Which action during collection MOST likely caused this result?
A. Allowing the antiseptic to dry completely
B. Using a tube with the correct additive
C. Forcing blood rapidly through a syringe needle into a tube
D. Releasing the tourniquet within 1 minute
Answer: C. Forcing blood rapidly through a syringe needle into a tube
A phlebotomist is preparing to collect a timed cortisol specimen scheduled for 0800. The patient arrives at 0945. Which action should the phlebotomist take FIRST?
A. Collect the specimen and note the late arrival
B. Ask the patient to return the following morning without notifying anyone
C. Notify the provider or laboratory because the timed collection was missed
D. Collect the specimen and place it on ice immediately
Answer: C. Notify the provider or laboratory because the timed collection was missed
An EDTA tube is discovered uninverted several minutes after collection while awaiting transport. Which action is the BEST response?
A. Mix the specimen gently according to protocol immediately
B. Shake the tube vigorously to disperse possible clots
C. Centrifuge the specimen before mixing
D. Transfer the specimen into another EDTA tube
A. Mix the specimen gently according to protocol immediately
A phlebotomist notices liquid leaking from a biohazard specimen transport bag. Which action should the phlebotomist take FIRST?
A. Place the leaking bag into another biohazard bag using appropriate PPE
B. Wipe the outside of the bag with alcohol and continue transport
C. Dispose of the specimen immediately without documentation
D. Send the specimen to the laboratory without further handling
Answer: A. Place the leaking bag into another biohazard bag using appropriate PPE
A patient arrives for a glucose tolerance test (GTT) and states they smoked cigarettes before arriving. Which action should the phlebotomist take?
A. Continue testing because smoking does not affect glucose metabolism
B. Notify the provider or follow facility protocol regarding the preparation error
C. Allow the patient to rest for 10 minutes before beginning the test
D. Collect only the fasting specimen and cancel the remaining collections
Answer: B. Notify the provider or follow facility protocol regarding the preparation error
A patient becomes pale and diaphoretic during routine blood collection and states, “I feel dizzy.” Which action should the phlebotomist take FIRST?
A. Remove the needle and protect the patient from injury
B. Finish collecting all ordered specimens quickly
C. Offer the patient water during the draw
D. Ask the patient to take deep breaths while continuing collection
Answer: A. Remove the needle and protect the patient from injury
During a glucose tolerance test, a patient becomes nauseated and vomits after ingesting the glucose solution. Which action should the phlebotomist take FIRST?
A. Continue testing according to schedule
B. Document the incident and notify the provider
C. Offer water to reduce nausea
D. Collect the next timed specimen immediately
Answer: B. Document the incident and notify the provider
A coagulation specimen arrives without documented collection time information. Which action is the BEST response?
A. Continue processing because patient identifiers are correct
B. Ask another patient to confirm the collection time
C. Estimate the time using transport records
D. Follow facility protocol for incomplete specimen documentation
D. Follow facility protocol for incomplete specimen documentation
A phlebotomist prepares to dispose of a used needle after venipuncture. Which action follows OSHA guidelines?
A. Recap the needle carefully before disposal
B. Break the needle before placing it in the sharps container
C. Activate the safety device and discard it immediately into a sharps container
D. Leave the needle attached to the holder until cleanup is complete
Answer: C. Activate the safety device and discard it immediately into a sharps container
A phlebotomist is preparing to perform venipuncture on a patient in contact isolation. Which action is MOST appropriate before entering the room?
A. Label the tubes at the nurses’ station
B. Gather and prepare all necessary supplies before donning PPE
C. Apply gloves before reviewing isolation requirements
D. Leave the sharps container outside the room to avoid contamination
Answer: B. Gather and prepare all necessary supplies before donning PPE
A phlebotomist is unable to locate a vein after applying the tourniquet. Which action is MOST appropriate?
A. Slap the patient’s arm repeatedly
B. Ask the patient to lower the arm and gently make a fist
C. Insert the needle where the vein is estimated to be
D. Reapply the tourniquet over the same site multiple times
Answer: B. Ask the patient to lower the arm and gently make a fist
A phlebotomist is collecting a specimen for a blood culture from a patient with suspected sepsis. Which action is the BEST choice when collecting multiple culture sets?
A. Collect both sets from the same venipuncture site to reduce discomfort
B. Use one aerobic bottle only for all collections
C. Collect each set from different venipuncture sites
D. Cleanse only the bottle tops prior to collection
Answer: C. Collect each set from different venipuncture sites
Condensation develops inside a biohazard transport bag containing refrigerated specimens. Which action is the BEST response?
A. Continue transport because specimen labels remain visible
B. Replace the transport bag if contamination risk exists
C. Delay transport until condensation disappears completely
D. Dry the inside of the bag with gauze
B. Replace the transport bag if contamination risk exists
A phlebotomist notices a fire in a wastebasket within the laboratory. According to the RACE acronym, what should the phlebotomist do FIRST?
A. Activate the alarm
B. Rescue anyone in immediate danger
C. Contain the fire by closing doors
D. Extinguish the fire immediately
Answer: B. Rescue anyone in immediate danger
A patient states they previously developed a hematoma during blood collection. Which action should the phlebotomist take to reduce the risk of recurrence?
A. Apply the tourniquet tightly throughout the procedure
B. Remove the needle before releasing the tourniquet
C. Apply adequate pressure after venipuncture completion
D. Ask the patient to bend the arm immediately after collection
Answer: C. Apply adequate pressure after venipuncture completion
A phlebotomist accidentally touches the cleansed venipuncture site while anchoring the vein. Which action should the phlebotomist take?
A. Continue the procedure if gloves are clean
B. Apply additional alcohol over the contaminated area only
C. Cleanse the site again before venipuncture
D. Proceed quickly before contamination spreads
Answer: C. Cleanse the site again before venipuncture
A provider orders a chain-of-custody drug screen for an employee after a workplace accident. Which action is MOST appropriate for the phlebotomist?
A. Leave the specimen unattended while completing paperwork
B. Allow the donor to label the specimen independently
C. Maintain documented control of the specimen from collection through transport
D. Store the specimen with routine laboratory samples
Answer: C. Maintain documented control of the specimen from collection through transport
A blood culture specimen is accidentally refrigerated because it was mistaken for routine chemistry testing. Which action is the BEST response?
A. Freeze the specimen to preserve integrity
B. Continue refrigeration until courier pickup
C. Notify the laboratory immediately regarding storage error
D. Centrifuge the culture bottles before transport
C. Notify the laboratory immediately regarding storage error
A phlebotomist is cleaning a blood spill on the laboratory floor. Which solution is MOST commonly used for disinfection according to facility policy?
A. Sterile water
B. Isopropyl alcohol only
C. Diluted bleach solution
D. Hydrogen peroxide gel only
Answer: C. Diluted bleach solution
A phlebotomist approaches a patient for specimen collection and notices the patient’s identification band is missing. Which action should the phlebotomist take?
A. Ask the nurse to verbally identify the patient and proceed
B. Perform the collection if the room number matches the requisition
C. Delay specimen collection until proper identification is available
D. Label the specimens after confirming with another phlebotomist
Answer: C. Delay specimen collection until proper identification is available
A phlebotomist is collecting a specimen from a hand vein using a butterfly needle. Which angle of insertion is MOST appropriate?
A. 5 to 10 degrees
B. 15 to 30 degrees
C. 45 degrees
D. 60 degrees
Answer: A. 5 to 10 degrees
A phlebotomist is collecting a specimen for a catecholamine test. Which patient instruction is the BEST choice before collection?
A. Avoid caffeine, nicotine, and strenuous exercise before testing
B. Increase fluid intake immediately before collection
C. Consume a high-protein meal the night before testing
D. Fast for only 2 hours prior to collection
Answer: A. Avoid caffeine, nicotine, and strenuous exercise before testing
A phlebotomist is instructed to aliquot plasma into transfer tubes after centrifugation. Which action is the BEST response?
A. Shake the plasma specimen before aliquoting
B. Label transfer tubes after laboratory delivery
C. Combine plasma from duplicate specimens if volume is limited
D. Transfer the plasma using proper labeling and contamination prevention procedures
D. Transfer the plasma using proper labeling and contamination prevention procedures
A phlebotomist overhears another employee discussing a patient’s diagnosis in a crowded elevator. Which regulation is MOST likely being violated?
A. CLIA
B. OSHA
C. CDC standard precautions
D. HIPAA
Answer: D. HIPAA
A patient scheduled for coagulation testing states they have been taking large amounts of aspirin for headaches. Which action should the phlebotomist take?
A. Cancel the test immediately
B. Document the information according to facility protocol
C. Advise the patient to stop taking aspirin immediately
D. Delay collection for 24 hours
Answer: B. Document the information according to facility protocol
A phlebotomist notices petechiae forming below the tourniquet during routine venipuncture. Which condition should the phlebotomist suspect?
A. Excessive platelet activity
B. Increased venous circulation
C. A possible coagulation or platelet disorder
D. Normal response to venipuncture
Answer: C. A possible coagulation or platelet disorder
. A newborn screening specimen appears layered and uneven on the filter paper card. Which action should the phlebotomist take?
A. Submit the specimen because all circles contain blood
B. Add additional blood to the partially saturated areas
C. Warm the card under a heat lamp before drying
D. Repeat the collection using a new filter paper card
Answer: D. Repeat the collection using a new filter paper card
A specimen leaks inside a secondary transport container during courier delivery. Which action is the BEST response?
A. Continue transport if the primary label remains attached
B. Wipe the outside of the container and continue delivery
C. Follow biohazard spill and exposure procedures immediately
D. Transfer the specimen into another tube without documentation
C. Follow biohazard spill and exposure procedures immediately