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| Section | Objectives |
|---|---|
| Patient Preparation | - Site selection and preparation - Specimen labeling procedures - Patient identification and communication |
| Routine Blood Collections | - Equipment selection and use - Venipuncture procedures - Order of draw |
| Specimen Processing and Handling | - Common errors and rejection criteria - Quality assurance procedures - Specimen transport and storage |
| Special Collections | - Capillary puncture (fingerstick/heel stick) - Non-routine specimen collection methods - Pediatric and geriatric considerations |
| Safety and Compliance | - OSHA regulations and patient safety - HIPAA and patient confidentiality - Infection control and standard precautions |
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NEW QUESTION # 123
A phlebotomist notices that a serum separator tube has not clotted before centrifugation. Which of the following actions should the phlebotomist take?
Answer: A
Explanation:
The phlebotomist should allow the serum separator tube to clot completely before centrifugation. Serum specimens require clot formation before centrifugation so the liquid serum can separate properly from the clot. Centrifuging before clotting is complete can cause fibrin strands, incomplete separation, instrument issues, and possible specimen rejection. Shaking the tube vigorously is incorrect because it can hemolyze the specimen and disrupt cellular integrity. Transferring the specimen into a plasma tube is unsafe and invalid because the specimen was not collected with the correct anticoagulant at the correct blood-to-additive ratio. Proper processing means respecting the requirements of the tube collected: serum tubes must clot for the required time, additive tubes must be gently inverted, and specimens must be centrifuged according to time, speed, and temperature requirements. This item tests processing discipline, not speed. A phlebotomist must protect specimen integrity from collection through transport and processing. Reference topics: Processing Specimens; serum separation; clotting time; centrifugation; specimen rejection.
NEW QUESTION # 124
Which of the following collections requires the phlebotomist to discard the first voided specimen and save all subsequent urine for a full day?
Answer: A
Explanation:
A 24-hour urine collection requires the patient to discard the first voided specimen and then save all subsequent urine for the full collection period, including the final void at the ending time. Discarding the first void empties the bladder and establishes the start of the timed interval. A clean-catch urine culture requires cleansing and collecting a midstream specimen in a sterile container, not saving urine for 24 hours. A random urinalysis is collected at a single time and does not require timed accumulation. A sputum culture is a respiratory specimen, not a urine collection. Patient instruction is critical because one missed urine specimen can invalidate the entire 24-hour collection. The phlebotomist should explain start and stop times, storage requirements, preservative hazards if present, labeling, and return instructions. The patient should not change fluid intake unless instructed by the provider. Reference topics: Special Collections; 24-hour urine; patient instructions; non-blood specimens; timed collection.
NEW QUESTION # 125
A phlebotomist is instructing a patient who has a prescription for a 24-hr urine collection. Which of the following instructions should the phlebotomist include?
Answer: C
Explanation:
For a 24-hour urine collection, the patient should discard the first urine on the day of collection, record the start time, and then collect all urine passed during the next 24 hours, including the final specimen at the end time. Discarding the first void empties the bladder and establishes a clean starting point for the timed collection. Keeping the specimen at room temperature is usually incorrect because many 24-hour urine specimens require refrigeration, ice, or preservatives depending on the ordered test. Urinating directly into the large collection container may be unsafe or impractical, especially if the container contains preservative; patients are commonly given a separate collection device and then transfer urine as instructed. Doubling fluid intake is incorrect because it can dilute analytes and alter test results unless specifically ordered by the provider. The phlebotomist must explain timing, storage, missed specimens, labeling, and return instructions clearly because incomplete collection is a major preanalytical error. NHA CPT competencies include non-blood specimen collection, patient instructions, timed urine collection, specimen storage, and specimen integrity. Reference topics: Special Collections; 24-hour urine; non-blood specimens; patient preparation.
NEW QUESTION # 126
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: B
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 # 127
Which of the following actions should a phlebotomist take to prevent reflux during venipuncture?
Answer: A
Explanation:
To prevent reflux, the patient's arm should be kept in a downward position so the collection tube remains below the puncture site. Reflux occurs when blood or tube additive flows backward from the tube into the patient's vein. Keeping the tube below the venipuncture site and allowing tubes to fill properly reduces this risk. Holding the tube above the puncture site increases the chance of backflow. Removing the tube before it fills can create incorrect blood-to-additive ratios and does not prevent reflux. Inserting the needle bevel down is incorrect technique; venipuncture needles are inserted bevel up to enter the vein smoothly and reduce trauma. Reflux prevention also includes using proper tube position, avoiding excessive movement, not pushing tube contents toward the patient, and releasing the tourniquet appropriately. This is especially important with additive tubes because additive contamination of the patient's circulation, while uncommon, is a preventable safety concern. Reference topics: Routine Blood Collections; reflux prevention; evacuated tube technique; arm positioning; tube handling.
NEW QUESTION # 128
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