The Draw
Never leave the tourniquet on for more than____.
60 seconds/ 1 minute
1- As soon as it is removed from the holder
A request is given to draw a specimen from an inpatient by the name of John Doe. Which of the following is an acceptable way to confirm the pt.'s identity?
a) Ask the pt. , "Are you Mr. John Doe?', and see if he says "YES".
b) Match the ID band and requisition with the pt.'s verbal statement of ID.
c) See if the ID band matches the requisition to be sure of the pt.'s identity.
1- B Match the ID band and requiaition with the pt's verbal statment of ID.
What two identifiers should the phlebotomist use when drawing a blood specimen?
a) SSN, DOB
b) DOB, Name
B- DOB, Name
A substance used to kill bacteria on surfaces and instruments is known as a ________.
Disinfectant
This is a 2 part question: What is the recommended angle of needle insertion for an antecubital vein and a hand vein respectively
a) 20 degree or less for both arm and hand
b) 15 degree or less, 10 degree or less
c) 20 degree or less, 15 degree or less
B- 30 degree or less, 10 degree or less
1- EDTA prevents coagulation by:
a) inhibiting thrombin
b) binding calcium
c) releasing fibrinogen
2-Heparin prevents blood from clotting by:
a) activating calcium
b) binding calcium
c) inhibiting thrombin
1- B- Binding calcium
2- C-inhibiting thrombin
1-A phlebotomist has tried 2 times to collect a protime specimen from a pt. with difficult veins, collecting a partial tube each time. What is the appropriate action for the phlebotomist to take?
a) Ask another phlebotomist to attempt to collect the specimen
b) Submit the fullest tube with a notation that it was a "difficult draw"
c) Pour both tubes together and submit the pooled specimen for testing
2-A phlebotomist starts to perform a venipuncture. As the needle touches the skin, the pt. moves his arm. The phlebotomist is started an pulls the needle away from the arm. How should the phlebotomist proceed after apologizing to the pt.?
a) Replace the needle, clean the site, warn the pt., and finish the draw.
b) Clean the site again, anchor the vein, and complete the venipuncture
1- A -Ask another phlebotomist to attempt to collect the specimen
2- A- replace the needle, clean the site, warn the pt. and finish the draw.
1- What would be the system of choice to identify laboratory specimens from an unconscious, unidentified woman in the ER?
a) Assign a name to the pt. such as Jane Doe
b) Assign a number to the pt. until admitted
c) Use a 3 part identification band and labels
2- Doing which of the following during the vein selection process is bad for the specimen?
a) lowering the pt.'s arm
b) allowing the patient to pump her fist
Using a warm towel to increase blood flow
1- C- Use a 3 part identification band and labels
2-A- Allowing the pt to pump her fist.
1- The hole at the tip of the needle is called______.
2- Evacuated tubes fill with blood automatically because a _______ exists in the tube
1- Bevel
2- Vacuum
This is a 3 part question:
1) A pt excessively pumps his fist during specimen collection. What effect could this have on the specimen?
a) hemostasis
b) hemolysis
c) hemoconcentration
2-The antecubital vein most commonly used for routine venipuncture is the:
a) Median cubital
b) Lower subclavian
c) Cephalic
3- The minimum length of time typically required for blood collected in glass red top tubes to clot?
a) 20 minutes
b) 30 minutes
c) 5 minutes
1- C- Hemoconcentration
2- A- Median Cubital
3- B- 30 minutes
1- There is no additive in red top tube, therefore:
a) the sample is whole blood
b) the sample yields serum
c) coagulation is prevented
2-A rapid serum tube contains:
a) citrate
b) EDTA
c) Thrombin
3-A yellow top tube containing SPS solution is sometimes used to collect a specimen for?
a) Paternity Testing
b) Drug Screening
c) Blood cultures
1- A- the sample is whole blood
2- C- Thrombin
3- C- Blood cultures
1-A provider has ordered a fasting triglyceride level on an outpatient. How long should the pt. fast before the specimen is collected?
a) 8 hours
b) 24 hours
c) 12 hour
2- An elderly pt. arrives at an outpatient clinic for a blood draw. He is accompanied by his daughter, who mentions that he is hard of hearing. How should the phlebotomist proceed?
a)Address all questions directly to the pt.'s daughter
b) Speak distinctly in a normal tone of voice.
c) Get close to the pt.'s face and speak very loudly
3- A phlebotomist collected a CBC an an extra clot tube on an ER pt. Upon return to the lab, the phlebotomist discovered that a provider had added a crossmatch on the same pt. The extra tube has only the last name of the pt. on it. What should the phlebotomist do?
a)Call the ER to verify the pt. information , label the tube, and send it to the blood bank.
b) Redraw the pt. and label the new tube with the required blood bank information
1- C- 12 hours
2- B- Speak distinctly in a normal tone of voice.
3-B -Redraw the pt. and label the new tube with the required blood bank information.
1-A requisition required 12 tubes to be drawn at the same time on one pt. The tourniquet was left on until the end to ensure that all tubes would be filled, and it took much longer than normal. Which of the following tests would be most affected?
a) Rapid plasma reagin
b) Red blood cell count
c) Reticulocyte count
2-Which of the following inpatient info must match the test request?
a) DOB and provider's name
b) name and the ordering provider
c) Name and medical record number
1-B RBCC
2-C- Name and medical record number
1-What happen if you mix a specimen too vigorously?
a) Glycolysis
b) Hemolysis
c) Microclot formation
2- A phlebotomist arrives to draw a specimen from an inpatient. The pt.'s door is closed. What should the phlebotomist do?
a) Knock softly and wait for someone to come to the door
b) knock softly, open it slowly and ask permission to enter.
c) Open the door and proceed directly into the room
3-When palpating for a vein before venipuncture, how is an artery distinguished from a vein?
a) Arteries have a pulse that can be felt.
b) Veins are usually deeper than arteries.
c) Arteries feel hard and cord-like
1- B- Hemolysis
2- B Knock softly, open it slowly and ask permission to enter.
3- A- Arteries have a pulse that can be felt.
1-The tube additive that is responsible for the most carryover problem is:
a) citrate phosphate dextrose
b) ethylenediaminetetraacetic acid
c) thixotropic gel
2- When using a winged infusion blood collection set, if the first tube is an additive tube, it is important to collect a few milliliters of blood into a nonadditive tube first. Which of these would be affected?
a) Citrate, EDTA, Sodium fluoride
b) Heparin, EDTA, Thixotropic Gel
3- Which tube (additive and color) is used to obtain a CBC?
1- B (EDTA)
2- A Citrate, EDTA, Sodium Fluoride
3- EDTA/Lavender
1-What is the proper blood-to-additive ratio for light blue tube collected for a coagulation test?
a) 4:1
b) 9:1
c) 8:1
2-Which of the following tubes can be used to collect a serum specimen?
a) Light blue top
b) PST
c) SST
3- The phlebotomist checks the procedure manual for the specimen requirements of an unfamiliar test and determines that the test is performed on serum. Which of the following tubes will produce a serum specimen?
a) Green top
b) Pink top
c) Red top
1- 9:1
2- C- SST
3- C- Red Top
1-An inpatient is sound asleep when the phlebotomist arrives to draw a blood specimen. What should the phlebotomist do?
a) Draw the pt. quickly before he or she wakes up.
b) Wake the pt. gently to avoid a startle reaction
2- What is the most critical error a phlebotomist can make?
a) Giving a pt a hematoma
b) Failing to collect a specimen
c) Misidentifying a pt. specimen
3- What is the most important factor in choosing which gauge needle to use for venipuncture?
a) age and weight of the pt.
b) Size and condition of the vein
1- B Wake the pt. gently to avoid a startle reaction
2-C Misidentifying a pt. specimen
3- B- size and condition of the vein
a) 26
b)18
c) 22
2-The hole at the tip of the needle is called____.
3- How long must pressure be applied to a site following arterial puncture?
a) 1-2 minutes
b) 10-15 minutes
c) 3-5 minutes
1- B- 18 gauge
2- Lumen
3- C-3-5 minutes
1- What is the recommended cleaning agent for venipuncture?__________
2- Which one is classified as a disinfectant?
a) Povidone-iodine
b) Benzalkonium chloride
c) Sodium Hypochlorite
3- The slanted tip of the needle that enters the vein is called the____
1. 70% isopropyl alcohol
2. C Sodium Hypochlorite
3. Bevel
1- Which one below could falsely elevate test results:
a) Carryover of additives between tubes
b) Cleaning the site for more than 30 seconds:
c) Releasing the tourniquet too soon
2-According to CLSI standards, which of the tubes listed below is filled last when using a syringe?
a) EDTA
b) Heparin
C) Sterile SPS
3) Forcing blood into a test tube from a syringe can do all of the following except:
a) hemolyze red blood cells
b) hemoconcentrate the blood
c) lead to aerosol formation
1- A- Carryover of additives between tubes
2- A-EDTA
3-B- Hemoconcentrate the blood
1- Phlebotomist is working in the ICU area. She ask the nurse for a cup of crush ice. What type of specimen is the phlebotomist about to draw that requires her to place it in an ice slurry?
a) Heparin
b) Ammonia
c) Glucose Tolerance Test (GTT)
2-The following tests have all been ordered at the same time on different inpatients. Only one phlebotomist is on duty. Which test should the phlebotomist collect first?
a) ASAP CBC in the cardiac unit
b) Timed blood culture in ICU
c) STAT electrolytes in ER
1- B- Ammonia
2- C- STAT electrolytes in ER
1- A student phlebotomist delivers a light blue top tube for a STAT pre-op PT and pTT. The student tells the specimen processor that he first put the blood into a red top tube, but then realized his mistake and poured the blood into the blue top tube. What should the processor do?
a) reject the PT specimen but not the PTT
b) tell the student to recollect the specimen
2-An unconscious pt is not wearing an ID band. There is an ID band taped to the pt.'s IV pole with information that matches the requisition. What should the phlebotomist do?
a) Draw the specimen and fill out an incident report form
b) Only draw the specimen after an ID band has been applied.
3-The pt. asks if the specimen about to drawn is for a diabetes test. How should the question be answered?
a) Say, No, even if the test is for diabetes
b) Tell the pt. that you do not know
c) Say, "its best to discuss that with your provider."
1- B Tell the student to recollect the specimen
2-B Only draw the specimen after an ID band has been applied.
3- C- it's best to discuss that with your provider
1-If a venipuncture site is still bleeding after 5 minutes the phlebotomist should?
a) alert the pt.'s nurse or other healthcare provider
b) Tell the pt. to apply pressure for 15 minutes
2-Which of the following communication strategies before obtaining a blood specimen from a child demonstrates poor technique?
a) Establishing rapport with the child
b) Telling the child it won't hurt
c) Telling the child what to expect
3-What is the best way for a newly trained phlebotomist to handled a venipuncture on a pt. with needle phobia?
a) Use a small gauge butterfly need to do the draw
b) Ask an experienced phlebotomist to do the draw
c) Tell the pt. it will only hurt a little
1- A- Alert the pt.'s nurse or other healthcare provider
2- B- Telling the child it won't hurt
3- B- Ask an experienced phlebotomist to do the draw
1-When performing venipuncture it is important to remove the last tube from the holder before removing the needle from the pt.'s arm in order to?
a) prevent blood from dripping out of the needle
b) Decrease pain associated with needle removal
c) Minimize tissue fluid contamination of the tube
2- Which agent is used on newborns and people that are allergic to alcohol and or Iodine cleaners?
a) Benzalkonium chloride
b) Chlorohexidine gluconate
c) Iodine
2-B- Chlorohexidine Gluconate