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| Section | Objectives |
|---|---|
| Professional Practice | - Ethics and patient confidentiality (HIPAA) - Communication and professionalism |
| Patient Preparation | - Patient identification and communication - Site selection and preparation - Explaining procedures and obtaining consent |
| Safety and Compliance | - Needlestick prevention and biohazard disposal - OSHA standards and safety protocols - Infection control and PPE usage |
| Specimen Collection | - Capillary puncture procedures - Venipuncture techniques - Order of draw and tube handling |
| Specimen Processing and Handling | - Labeling and documentation - Specimen transport and storage - Quality control and rejection criteria |
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質問 # 52
From which of the following sites should a phlebotomist take a capillary collection from a 3-year-old child?
正解:C
解説:
For a 3-year-old child, the correct capillary collection site is the middle finger. Finger puncture is appropriate for older infants and children when the finger pad is sufficiently developed, commonly using the middle or ring finger on the palmar surface. Heel puncture is primarily used for infants, especially newborns, because the recommended medial or lateral plantar heel area provides a safer capillary site before the fingers are large enough. The antecubital fossa is used for venipuncture, not capillary puncture. The vastus lateralis is an intramuscular injection site, not a blood collection site. Proper capillary technique requires warming if needed, cleaning and drying the site, using an appropriate-depth lancet, wiping away the first drop when required, avoiding excessive squeezing, and collecting in the correct order. In a child, site choice must protect bone, nerves, and tissue while obtaining an adequate specimen. Reference topics: Routine Blood Collections; dermal puncture; pediatric capillary collection; site selection; microcollection safety. NHA CPT content includes dermal puncture procedures and capillary collection site selection.
質問 # 53
Which of the following actions should a phlebotomist take when transporting specimens to an outside laboratory?
正解:D
解説:
The phlebotomist should use appropriate leakproof transport packaging when specimens are transported to an outside laboratory. Specimen transport must protect the patient sample, courier, laboratory personnel, and documentation from leakage, breakage, contamination, and temperature-related instability. Requisitions should be kept separate from the specimen container, usually in an outer pouch, so paperwork is not contaminated if leakage occurs. Removing labels is never acceptable because identification must remain intact from collection through testing. Freezing all specimens is incorrect because temperature requirements are test-specific; freezing some specimens can destroy cells, alter analytes, or make the sample unsuitable. Proper transport includes correct labeling, biohazard identification, absorbent material when required, secure closure, upright positioning when appropriate, and compliance with time, light, and temperature requirements. The phlebotomist must know the difference between routine transport, chilled transport, frozen transport, and protected-from-light transport. Reference topics: Processing Specimens; specimen transport; leakproof packaging; biohazard handling; specimen integrity.
質問 # 54
Which of the following methods should a phlebotomist use to anchor a vein?
正解:C
解説:
The vein is anchored by placing the thumb of the free hand below the intended puncture site and gently pulling the skin taut. This stabilizes the vein, reduces rolling, creates a firmer puncture surface, and supports accurate needle entry. Anchoring above the site is unsafe because it places the phlebotomist's hand in the direction of needle travel and increases needlestick risk. Using two fingers instead of the thumb provides less controlled traction and may interfere with the venipuncture angle or contaminate the prepared site. The phlebotomist should avoid touching the cleansed puncture site after antisepsis unless the site is re-cleansed. Proper anchoring is especially important for superficial or mobile veins because failure to stabilize the vein can cause missed access, hematoma formation, probing, patient discomfort, or specimen collection failure. The NHA CPT outline identifies anchoring the vein below the venipuncture site and knowledge of anchoring techniques as routine venipuncture competencies. Reference topics: Routine Blood Collections; site selection; anchoring below venipuncture site; venous anatomy and safe insertion technique.
質問 # 55
A patient has had a left-sided mastectomy. Which of the following actions should the phlebotomist take when collecting for a CBC and comprehensive metabolic panel?
正解:D
解説:
The phlebotomist should draw from the right arm because the patient has had a left-sided mastectomy. The affected side should generally be avoided for venipuncture unless a provider specifically authorizes it, due to risk of lymphedema, impaired lymph drainage, infection, and delayed tissue recovery. Drawing from the left hand still uses the affected extremity and does not solve the problem. Cleaning with soap and water only is not an appropriate substitute for standard antisepsis and does not address the mastectomy restriction. A capillary stick is not automatically acceptable for a CBC and comprehensive metabolic panel, and it may not provide the correct specimen volume or type for both tests. The better and safer approach is to use the unaffected right arm when it is available and appropriate. If the unaffected arm is inaccessible, the phlebotomist should escalate according to policy instead of improvising. Reference topics: Routine Blood Collections; venipuncture site selection; mastectomy restrictions; CBC/CMP collection; patient safety.
質問 # 56
Which of the following types of medication is an indication for an INR draw?
正解:C
解説:
An anticoagulant is the medication type most directly associated with an INR draw. INR, or international normalized ratio, is used to evaluate clotting time and is especially important for monitoring patients who take warfarin or other anticoagulant therapy. These medications reduce the blood's ability to clot, so laboratory monitoring helps determine whether the patient is within the therapeutic range or at risk for bleeding or clotting complications. Anti-inflammatory medications may affect bleeding risk in some situations, but they are not the primary indication for an INR draw. Antihistamines are used for allergic symptoms, and antiemetics are used for nausea or vomiting; neither is routinely monitored by INR. From a phlebotomy standpoint, anticoagulant therapy also alerts the technician to apply pressure longer after venipuncture and observe for prolonged bleeding. Reference topics: Special Collections; coagulation testing; point-of-care INR; medication-related collection considerations; hemostasis. The NHA CPT test plan includes special collections, waived testing, and coagulation/hemostasis-related competencies.
質問 # 57
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