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| Section | Objectives |
|---|---|
| Specimen Processing and Handling | - Specimen transport and storage - Common errors and rejection criteria - Quality assurance procedures |
| Safety and Compliance | - Infection control and standard precautions - HIPAA and patient confidentiality - OSHA regulations and patient safety |
| Routine Blood Collections | - Venipuncture procedures - Equipment selection and use - Order of draw |
| Special Collections | - Non-routine specimen collection methods - Pediatric and geriatric considerations - Capillary puncture (fingerstick/heel stick) |
| Patient Preparation | - Patient identification and communication - Specimen labeling procedures - Site selection and preparation |
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77. Frage
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?
Antwort: D
Begründung:
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.
78. Frage
A phlebotomist is collecting blood from a patient with small fragile veins. Which of the following devices is most appropriate?
Antwort: C
Begründung:
A winged infusion set is most appropriate for a patient with small fragile veins. Butterfly devices provide better control, flexible tubing, and a shallower insertion angle, making them useful for hand veins, pediatric patients, geriatric patients, or difficult venous access. A 16-gauge needle is too large for routine diagnostic venipuncture and would likely damage fragile veins. A blood culture bottle adapter is used for blood culture collection but does not solve the problem of fragile vein access by itself. A lancet is used for dermal puncture, not venous collection, and may not provide the volume or specimen type required for ordered venipuncture tests. When using a winged infusion set, the phlebotomist should anchor the vein carefully, insert bevel up at a low angle, stabilize the device, monitor for infiltration, and activate the safety mechanism immediately after withdrawal. Equipment selection is a clinical safety decision, not a convenience choice. Reference topics: Routine Blood Collections; winged infusion set; fragile veins; equipment selection; venipuncture technique.
79. Frage
A phlebotomist is preparing for a blood alcohol level test that will be admitted as evidence in a court of law. Which of the following preparations should the phlebotomist document?
Antwort: B
Begründung:
For a forensic blood alcohol level, the phlebotomist should document use of a non-alcohol-based preparation, represented here by chlorhexidine preparation rather than ethanol or isopropyl alcohol. The critical issue is legal defensibility: using an alcohol-containing skin antiseptic can create a challenge that the collection process contaminated or affected the blood alcohol evidence. Ethanol and isopropyl alcohol are both inappropriate choices for this context because they are alcohols. The direction of rubbing ethanol-up and down or circular-is irrelevant; the problem is the substance itself. Chlorhexidine is the only non-ethanol/non-isopropyl option listed and is therefore the correct answer, assuming the facility's forensic kit or protocol specifies an acceptable non-alcohol preparation. The phlebotomist must also maintain chain of custody, identify the patient/donor correctly, use the proper tube, seal the specimen, document collection time, and transfer the specimen according to legal procedure. Reference topics: Special Collections; blood alcohol collection; forensic specimens; chain of custody; documentation. NHA's CPT outline includes forensic studies and chain-of-custody collection requirements.
80. Frage
Which of the following sites should a phlebotomist use for collecting a capillary blood specimen from an adult patient?
Antwort: D
Begründung:
For an adult capillary blood specimen, the third digit with the cut perpendicular to the fingerprint grooves is the best answer. The third digit is the middle finger, one of the preferred fingers for dermal puncture because it usually has adequate tissue depth and blood flow. The incision should be made perpendicular to the fingerprint lines so blood forms a rounded drop instead of running along the fingerprint grooves, which improves collection efficiency and reduces specimen smearing. The second digit, or index finger, is generally avoided because it may be more calloused or sensitive and is used frequently for touch. The fifth digit should be avoided because it has less tissue depth and greater risk of bone injury. A cut parallel to fingerprint grooves is technically poor because blood can track along the grooves and make collection more difficult. Correct adult capillary collection requires site warming when needed, antisepsis, complete drying, appropriate lancet depth, wiping away the first drop when required, and avoiding excessive squeezing. Reference topics: Routine Blood Collections; dermal puncture; adult capillary site selection; lancet orientation; microcollection technique.
81. Frage
Which of the following collections requires the phlebotomist to discard the first voided specimen and save all subsequent urine for a full day?
Antwort: C
Begründung:
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.
82. Frage
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