Phlebotomy Scenarios
A patient has a cast on the left arm and an IV in the right forearm. A venipuncture in the patient's right arm must be done:
A. above the IV in the same vein
B. above the IV in a different vein
C. through the port on the IV tubing
D. below the IV in a different vein
D. below the IV in a different vein
The liquid portion of the blood within the body is:
Plasma
Which of the following is a normal finding in a plasma specimen?
a. Light yellow color
b. dark golden amber color
c. milky white
d. pink to red
A substance used to clean surfaces other than living tissue:
A. Antiseptic
B. Bacteriostatic
C. Disinfectant
D. Sepsis
C. Disinfectant
The container for a 24 hour urine collection should be:
A. no larger than 500 ml
B. labeled and stored in a refrigerator
C. made of clear plastic and stored at room temperature
D. taken to the lab any time within 72 hours after the collection is completed.
B. labeled and stored in a refrigerator
Coagulation tubes have this specimen
plasma
A patient's laboratory requisition requests the specimen by collected by fingerstick. The phlebotomist about to perform the fingerstick notices that the patient's hand feels cold. It is appropriate for the phlebotomist to:
A. perform the skin puncture without any special preparation
B. warm the patient's skin prior to performing the puncture
C. place the patient's hand in a basin of room temperature water
D. disregard the request for a fingerstick and substitute a venipuncture instead
B. warm the patient's skin prior to performing the puncture
A phlebotomist must collect from a patient in isolation with contact precautions. The appropriate personal protective equipment (PPE) is:
A. gloves only
B. gloves and mask
C. gloves and gown
D. gloves, face shield, and gown
C. gloves and gown
A tourniquet is applied to the arm above a venipuncture site to:
3 to 4 inches above the antecubital space
Bedside glucose testing is usually performed on patients with what condition?
A. Diabetes
B. Hemophilia
C. Kidney failure
D. Liver disease
A. Diabetes
Skin puncture for neonatal screening specifies that:
A. the first drop of blood should not be wiped away
B. the first drop of blood is wiped away
C. either capillary blood or venous blood can be used
D. touching or contaminating the filter paper circles will not affect results
B. the first drop of blood is wiped away
These three test tubes are for whole blood specimens
Yellow Sterile, Lavender, and Pink
The laboratory receives a STAT request for a blood glucose level on a patient in the emergency department. It is appropriate to:
a. treat any request from the emergency department as routine
b. treat the request as a medical emergency: collecting and processing the blood immediately
c. add the request to those for other patients in the same vicinity that will be collected and returned tot he laboratory sometime within the next hour.
d. wait for the phlebotomist trainee, who needs the practice, to return from lunch
B
The performance and speed of centrifuges should be checked:
A. weekly
B. daily
C. every 3 months
D. once a year
C. every 3 months
The industry-wide stopper color for tubes chemically clean enough to be used for collecting blood specimens for the determination of trace elements is:
A. GREEN
B. LIGHT BLUE
C. ROYAL/NAVY BLUE
D. LAVENDAR
C. ROYAL/NAVY BLUE
A blood specimen for a 2-hour postprandial glucose test is collected:
2 hours after the patient consumes a meal
A specimen for a blood ammonia test is to be preserved from the time of collection until it is tested in the laboratory. The best course of action is to keep the tube:
place sample one ice or ice slurry
These three tubes have plasma as their specimens
Blue, Green, and Grey
A patient has recently had a radical mastectomy of the right breast. The best site for venipuncture in this patient is the:
left arm
The arteries used for arterial puncture, listed in order of preference, are:
A. radial, brachial, femoral
B. femoral, brachial, radial
C. radial, carotid, brachial
D. brachial, temporal, femoral
A. radial, brachial, femoral
After completing venipuncture by evacuated tube, it is appropriate to:
A. lay the needle on the patient's bed while mixing and labeling tubes
B. dispose of the needle in a nearby sharps container
C. recap the needle, mix and label tubes
D. let the patient hold the needle since he is probably curious about it
B. dispose of the needle in a nearby sharps container
The part of a needle that attaches to the collecting tube or syringe:
HUB
Which blood specimen would be rejected as unsatisfactory?
A. a green-stoppered tube that is only 2/3 full
B. a gold stoppered tube that is 3/4 full
C. a lavender stoppered tube that is 1/2 full
D. a light blue-stoppered tube that is 1/3 full
D. a light blue-stoppered tube that is 1/3 full
This specimen type must sit for 30-60 minutes to clot before you are able to centrifuge.
Serum
Low and high controls are required for a glucose meter. These are run:
A. in duplicate, and results averaged
B. exactly the same as patient samples are run
C. once every hour
D. only at the end of a shift
B
A patient is given urine collection materials and told to collect a urine sample by cleaning the urethral meatus, starting to void without collection, and collecting the remainder of the voided urine a specimen cup. This urine sample is:
A. random urine
B. a clean- catch, midstream urine
C. catheterized
D. a suprapubic aspiration
B. a clean- catch, midstream urine
When collecting blood with a syringe, pulling back quickly and hard on the plunger can:
A. speed up the venipuncture and minimize discomfort to the patient
B. determine if the needle is properly placed in the vein
C. collapse the vein and hemolyze the blood
D. cause the needle to go through the vein and create a hematoma
C. collapse the vein and hemolyze the blood
What is the term used to describe a vein that is hardened due to repeated venipunctures, chemotherapy, or disease?
A. Blocked
B. Edematous
C. Occluded
D. Sclerosed
D. Sclerosed
Peak and trough specimens are collected for therapeutic drug monitoring. The trough specimen is typically collected.
A. 30 minutes before a dose
B. 30 minutes after a dose
C. 1 hour after a dose
D. 2 hours after a dose
A. 30 minutes before a dose
A chemistry test on your requisition specifies that they want a plasma specimen. You'll need to draw one of these two tube
Green or Grey
To prevent tampering and misidentification of samples for legal purposes, everyone who handles the specimen must provide:
A. documentation of their identity and the date and time the sample is handled
B. photo identification
C. proof of bonding
D. proof of current licensure or valid certification
A. documentation of their identity and the date and time the sample is handled
Most specimens collected for therapeutic drug monitoring are collected in a tube with what color stopper?
A. BLUE
B. LAVENDAR
C. GREEN
D. RED
RED
Which of the following represents an inappropriate technique for labeling of blood collection tubes?
A. the phlebotomist labels the vacutainer tubes before calling an outpatient into the drawing area
B. filled vacutainer tubes are mixed well and then labeled
C. labeling must at least include the patient identification number, time, and date of phlebotomy, and the phlebotomist's initials
D. double bagging is accomplished by placing the filled vacutainer tubes in a clear bag with the labels of tubes visible
A. the phlebotomist labels the vacutainer tubes before calling an outpatient into the drawing area
What is the most important concept in handling forensic blood specimens?
A. Having someone witness the blood collection
B. Collecting urine to compare to the blood
C. Chain of custody
D. Patient consent
C. Chain of custody
After centrifuging a green-stopped tube containing blood to be tested for an electrolyte panel, the phlebotomist notes that the serum is pink, indicating
A. icterus and an acceptable specimen
B. lipemia and a non-fasting specimen
C. hemolysis and an acceptable specimen
D. hemolysis and an unacceptable specimen
D. hemolysis and an unacceptable specimen
Thixotropic or polymer gel
Which of the following describes the appropriate response by the phlebotomist?
A. A liver function profile was not collected because the patient was not fasting.
B. A patient on withhold since midnight has a fasting blood glucose collected at 0400. No note was added to the requisition.
C. A lipid profile was collected at the same time as a 2-hour postprandial glucose.
D. A patient on withhold for 8 hours reports drinking water. A blood glucose level was collected, and no report was added to the requisition.
D. A patient on withhold for 8 hours reports drinking water. A blood glucose level was collected, and no report was added to the requisition.
A blood gas specimen that is not iced must be transported to the laboratory within what time frame?
A. 2 hours
B. 5-10 minutes
C. ≤30 minutes
D. 1 hour
B. 5-10 minutes
A blood specimen collected in a gold top tube will produce which of the following after centrifuging?
A. Plasma
B. Whole blood
C. Serum
D. Anticoagulated blood
C. Serum
What organ processes bilirubin to keep its level from becoming too high in the blood?
LIVER
For which of the following cases would a capillary puncture be contraindicated?
A. Obese patients
B. Patients at risk for venous thrombosis
C. Geriatric patients
D. Severely dehydrated patients
D. Severely dehydrated patients
SST tube clots in15-30 minutes where as Red glass tubes take 30-60 minutes. SST tubes clot faster for this reason.
SST tubes have a clot activator
Blood culture collection sites are prepared by swabbing the venipuncture site with iodine, which is left on for at least:
A. 10 seconds
B. 20 seconds
C. 30 seconds
D. 2 minutes
If the bevel is stuck to the wall of the vein, what should be done?
A. Switch tubes
B. Slightly rotate the needle
C. Pull back on the needle
D. Terminate the procedure
B. Slightly rotate the needle
slight rotation of the needle will break the suction and allow for uninterrupted blood flow
All of the following are reasons for specimen rejection except for what?
A. Collection from the wrong vein
B. Mislabeled specimen
C. Incompletely filled tubes
D. Hemolysis
A. Collection from the wrong vein
Blood smears from EDTA specimens must be made within what time period after collection to prevent distortion of cell morphology?
A. 30 minutes
B. 1 hour
C. 12 hours
D. 24 hours
B. 1 hour
A portable instrument for a simple, fast method of testing for anemia measures which of the following?
A. ACT
B. Cholesterol
C. Hemoglobin
D. PTT
C. Hemoglobin
Two tests that can be drawn in a blue top tube
APTT, PT (INR), or D-Dimer
Proper placement of the needle within a vein is indicated by all of the following EXCEPT:
A. flash of blood in the hub of the needle or tubing of a butterfly
B. swelling around the venipuncture site
C. Feeling a slight give or pop as the needle enters the vein
D. seeing a return of blood in the syringe or evacuated tube
B. swelling around the venipuncture site
Where is the tourniquet placed for arterial blood gas collection?
A. 2 inches above the puncture site
B. 2 inches below the puncture site
C. Just above the elbow
D. No tourniquet is used
D. No tourniquet is used
Before drawing blood in an inpatient setting, information found on the requisition form should be matched against which of the following?
A. Information on the door of the patient's room
B. The patient's chart
C. The patient's wristband
D. Information obtained from the nurse
C. The patient's wristband
Which of the following is a therapeutic drug that might be measured?
A. Albumin
B. Dilantin
C. Hemoglobin
D. Sodium
B. Dilantin
Coumadin (warfarin) therapy can be monitored using which of the following tests?
A. ACT
B. APTT
C. Potassium
D. PT
D. PT
What type of lab tests that are drawn in a royal (navy ) tube.
Trace Metals
What happens when a patient with cold agglutinins body temperature falls?
A. The antibodies die.
B. The agglutinins attach to RBCs.
C. The agglutinins attach to WBCs.
D. The agglutinins attach to platelets.
B. The agglutinins attach to RBCs.
Which of the following conditions might be treated with a therapeutic phlebotomy?
A. Hemophilia
B. Hemochromatosis
C. Thalassemia
D. Toxoplasmosis
B. Hemochromatosis
How should blood be transferred from a syringe to a vacuum tube?
A. Using the needle that was used to draw the blood, insert the needle into the stopper on the vacuum tube.
B. Remove the needle and remove the tube stopper. Expel blood from the syringe into the tube.
C. Activate the safety device on the needle, remove, and attach a needless transfer device to the syringe.
D. Put a cap on the syringe and transfer it to the laboratory instead of putting in a vacuum tube.
C. Activate the safety device on the needle, remove, and attach a needless transfer device to the syringe.
Whole blood specimens collected in EDTA are stable for how long?
A. 1 hour
B. 12 hours
C. 24 hours
D. 48 hours
C. 24 hours
Which of the following is an inherited disease that causes decreased blood clotting?
A. Anemia
B. Hemophilia
C. Leukemia
D. Thrombocytopenia
B. Hemophilia
You're using a butterfly to collect both an anaerobic and aerobic blood culture, lactic acid, PSA, and platelet from a patient. The tests will need to be drawn in this order.
Aerobic, Anaerobic, PSA, Platelet, and Lactic Acid.