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| Section | Objectives |
|---|---|
| Specimen Processing and Handling | - Quality assurance procedures - Specimen transport and storage - Common errors and rejection criteria |
| Special Collections | - Non-routine specimen collection methods - Pediatric and geriatric considerations - Capillary puncture (fingerstick/heel stick) |
| Safety and Compliance | - Infection control and standard precautions - OSHA regulations and patient safety - HIPAA and patient confidentiality |
| Routine Blood Collections | - Equipment selection and use - Venipuncture procedures - Order of draw |
| Patient Preparation | - Specimen labeling procedures - Site selection and preparation - Patient identification and communication |
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問題 #112
A phlebotomist is performing a glucose tolerance test. Which of the following actions should the phlebotomist take after the patient drinks the glucose solution?
答案：B
解題說明：
After the patient drinks the glucose solution, the phlebotomist should start timing according to the test protocol. Glucose tolerance testing depends on strict timed specimen collection after ingestion of a measured glucose load. If timing is inaccurate, the results may be invalid or misleading. The patient should not eat crackers because additional food intake can alter glucose results. Exercise should also be avoided unless specifically directed because physical activity can affect glucose metabolism. Collecting all remaining specimens immediately defeats the purpose of the timed test, which evaluates the body's glucose response over defined intervals. The phlebotomist must verify fasting status, collect the baseline specimen if required, ensure the patient consumes the glucose solution within the allowed time, document the time finished, and collect subsequent specimens at exact ordered intervals. If the patient vomits, eats, leaves, or misses a timed draw, the phlebotomist should follow facility policy and notify appropriate personnel. Reference topics: Special Collections; glucose tolerance testing; timed specimens; patient preparation; test protocol compliance.
問題 #113
A phlebotomist is scheduled to perform a venipuncture on a patient who had a bilateral radical mastectomy. Which of the following actions should the phlebotomist take?
答案：B
解題說明：
The phlebotomist should contact the provider for approval. After a mastectomy, especially radical mastectomy with lymph node involvement, venipuncture on the affected side is generally avoided because impaired lymphatic drainage can increase risk for lymphedema, infection, delayed healing, and patient complications. With a bilateral radical mastectomy, both arms may be restricted, so the phlebotomist should not independently choose an alternate arm vein. Drawing from an ulnar vein is not a standard solution and could still be in a restricted extremity. Requesting surgical outpatient records is not the immediate collection action and does not provide authorization to proceed. Obtaining a specimen from the subclavian vein is outside the phlebotomist's routine scope and would be a provider-level invasive procedure. The correct approach is to pause, follow facility policy, notify the nurse or provider, and obtain explicit direction for an approved site or alternate collection method. Reference topics: Routine Blood Collections; site contraindications; mastectomy precautions; provider communication; patient safety.
問題 #114
Which of the following specimens should a phlebotomist protect from light immediately after collection?
答案：D
解題說明：
Bilirubin specimens should be protected from light immediately after collection because bilirubin is photosensitive. Exposure to light can degrade bilirubin and produce falsely decreased results. The phlebotomist should follow facility procedure, which may include wrapping the tube in foil or using an amber transport container. Blood urea nitrogen is not classically light-sensitive; it is generally handled as a routine chemistry analyte unless special facility requirements apply. Sodium testing does not require light protection. Hemoglobin A1c reflects long-term glycemic exposure through glycated hemoglobin and is not light-sensitive in the same way bilirubin is. The broader technical principle is that specimen handling requirements are test-specific. Some specimens require chilling, some must remain warm, some require rapid transport, some must avoid light, and some require timed collection. Failure to follow these requirements creates preanalytical error even when the venipuncture itself was performed correctly. Reference topics: Special Collections; Processing Specimens; light-sensitive specimens; bilirubin handling; specimen integrity.
問題 #115
Which of the following can cause a preanalytic error for serum bilirubin?
答案：A
解題說明：
Light exposure can cause a preanalytic error for serum bilirubin because bilirubin is light-sensitive. If a bilirubin specimen is exposed to light for too long, photodegradation can occur, leading to falsely decreased bilirubin results. This is why bilirubin specimens are commonly protected from light by using an amber container or wrapping the specimen in foil according to facility procedure. "Population" is not a specimen-handling variable that directly causes bilirubin degradation. "Pollutants" is too vague and does not identify the specific preanalytical issue tested here. "Location" may matter for collection site selection in some contexts, but it is not the classic handling error for bilirubin. The phlebotomist must know which specimens require special handling for light, temperature, time, transport, and processing. Failure to protect light-sensitive analytes can compromise specimen integrity before testing even begins, producing inaccurate laboratory results despite correct venipuncture technique. The NHA CPT outline directly includes maintaining specimen integrity based on handling requirements such as temperature, light, and time, as well as recognizing the impact of preanalytical errors on test results. Reference topics: Processing Specimens; bilirubin handling; light protection; preanalytical error.
問題 #116
Which of the following actions should a phlebotomy technician take upon withdrawing a winged infusion needle?
答案：D
解題說明：
Upon withdrawing a winged infusion needle, the phlebotomy technician should activate the safety device. Winged infusion sets have a built-in safety mechanism designed to shield or retract the needle after use, reducing the risk of needlestick injury and bloodborne pathogen exposure. The device should be activated immediately according to the manufacturer's instructions and then disposed of in an appropriate sharps container. Disposing of a 16-gauge needle is not the best answer because winged sets for routine phlebotomy are not typically described as 16-gauge, and disposal occurs after safety activation. Placing a capillary pipette in clay relates to microhematocrit tube sealing, not venipuncture completion. Depressing a syringe plunger is unrelated to winged needle removal and could create exposure or specimen-handling problems if done incorrectly. The critical safety action is engineering-control use: activate the safety feature without recapping or unnecessary handling. Reference topics: Routine Blood Collections; Safety and Compliance; winged infusion sets; needle withdrawal; sharps safety; needlestick prevention. NHA CPT domains include equipment selection, needle removal, safety-device use, and exposure-control procedures.
問題 #117
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