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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Special Collections | 12% | - Therapeutic drug monitoring - Blood cultures & sterile collection - Glucose tolerance & dynamic tests - Blood alcohol & legal collections - Pediatric & geriatric collections |
| Topic 2: Patient Preparation | 20% | - Patient identification & verification - Site selection & preparation - Requisition review & test verification - Patient positioning & comfort - Informed consent & communication |
| Topic 3: Routine Blood Collections | 28% | - Tourniquet use & vein assessment - Venipuncture techniques & equipment - Capillary puncture procedures - Order of draw & tube selection - Post-collection care & labeling |
| Topic 4: Specimen Processing & Handling | 14% | - Specimen rejection criteria - Processing & centrifugation - Transport & storage requirements - Aliquoting & preservation - Documentation & tracking |
| Topic 5: Safety and Compliance | 26% | - HIPAA & patient confidentiality - PPE & sharps disposal - Infection control & OSHA standards - Bloodborne pathogens & exposure control - Quality control & error prevention |
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NEW QUESTION # 109
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?
Answer: C
Explanation:
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.
NEW QUESTION # 110
Which of the following should a phlebotomist verify for quality control protocol prior to using vacuum tubes?
Answer: D
Explanation:
Before using evacuated vacuum tubes, the phlebotomist must verify the expiration date. Expired tubes can lose vacuum, produce inadequate draw volume, compromise the blood-to-additive ratio, or contain additives that no longer perform as intended. This can directly affect specimen integrity and may lead to inaccurate results or specimen rejection. Needle integrity is also important, but it applies to needle inspection rather than vacuum tube quality control. Visible additive may be observed in some tubes, but not all additives are easily visible, and visibility alone does not confirm the tube is acceptable for use. Name on label is not checked before using an unused tube because patient labeling occurs after collection according to facility policy and positive patient identification requirements. Tube quality control includes inspecting tubes for cracks, contamination, expired dates, defective stoppers, and compromised vacuum. NHA CPT routine collection content specifically includes selecting and assembling equipment, verifying equipment quality, checking expiration dates, and inspecting evacuated tubes required for laboratory testing. Reference topics: Routine Blood Collections; evacuated tube quality control; expiration dates; equipment inspection.
NEW QUESTION # 111
When performing a capillary collection, which of the following tubes should a phlebotomist collect last?
Answer: B
Explanation:
In capillary collection, the red tube should be collected last from the options listed. Capillary order of draw differs from venipuncture order of draw because capillary blood begins clotting quickly after puncture. Tubes containing anticoagulants are collected before serum tubes to prevent platelet clumping and microclot formation that could invalidate hematology or other additive-based testing. Lavender EDTA specimens are typically prioritized early because hematology testing requires well-mixed anticoagulated whole blood. Lithium heparin is also an additive tube and should be collected before a non-additive or serum specimen. Red tubes are generally serum tubes and are collected later because clotting is expected for serum production. Microhematocrit collection depends on the procedure and whether anticoagulated capillary tubes are used, but it is not the best answer for "last" in this item. The phlebotomist must also wipe away the first drop, avoid excessive squeezing, fill microcollection containers properly, and mix additive specimens immediately by gentle inversion. NHA CPT competencies include dermal puncture, capillary order of draw, microcollection devices, and specimen integrity. Reference topics: Routine Blood Collections; capillary collection; dermal puncture; microcollection order of draw.
NEW QUESTION # 112
Which of the following is the maximum allowed time for a tourniquet application before possibly affecting test results?
Answer: C
Explanation:
The maximum recommended tourniquet application time before results may be affected is 60 seconds. A tourniquet is applied to increase venous filling and make the vein easier to locate and access, but prolonged application causes venous stasis and hemoconcentration. When blood remains trapped below the tourniquet too long, fluid shifts from the vascular space into surrounding tissue, concentrating cells, proteins, and protein-bound analytes. This can falsely elevate results such as potassium, calcium, proteins, and other chemistry values. It can also increase patient discomfort and make the collection more difficult. Thirty and forty-five seconds are acceptable but are not the maximum allowed time. Ninety seconds is too long and increases the risk of altered test values. Correct practice is to apply the tourniquet only long enough to select the site and establish blood flow, then release it promptly, especially before removing the needle. Reference topics: Routine Blood Collections; tourniquet application; hemoconcentration; venipuncture preanalytical variables.
NEW QUESTION # 113
A phlebotomist uses a point-of-care instrument to perform a prothrombin time/INR test on a patient that results in a critical value. Which of the following type of medication should the phlebotomist expect to see on the patient's medication list?
Answer: A
Explanation:
A prothrombin time/INR test evaluates the extrinsic and common coagulation pathways and is commonly used to monitor anticoagulant therapy, especially warfarin. Therefore, when a PT/INR point-of-care result is critically abnormal, the medication category most expected on the patient's list is anticoagulants. Anticoagulants interfere with clot formation and can prolong PT/INR values, creating an increased bleeding risk if outside the therapeutic range. Opioids are analgesics and do not directly monitor through PT/INR. Antidiabetics are associated with glucose monitoring, not coagulation testing. Statins are lipid-lowering medications and are usually monitored through lipid panels and liver-related considerations, not PT/INR. A critical PT/INR value must be handled according to facility policy, documented accurately, and reported through the correct clinical pathway; the phlebotomist does not interpret or treat the result independently. The NHA CPT outline covers point-of-care testing, critical values for POC and CLIA-waived testing, hemostasis, coagulation, and reporting requirements. Reference topics: Special Collections; point-of-care testing; hemostasis and coagulation; critical value reporting.
NEW QUESTION # 114
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