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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Patient Preparation | 20% | - Patient positioning & comfort - Patient identification & verification - Requisition review & test verification - Informed consent & communication - Site selection & preparation |
| Topic 2: Safety and Compliance | 26% | - PPE & sharps disposal - Quality control & error prevention - Infection control & OSHA standards - Bloodborne pathogens & exposure control - HIPAA & patient confidentiality |
| Topic 3: Special Collections | 12% | - Pediatric & geriatric collections - Blood alcohol & legal collections - Glucose tolerance & dynamic tests - Blood cultures & sterile collection - Therapeutic drug monitoring |
| Topic 4: Specimen Processing & Handling | 14% | - Aliquoting & preservation - Documentation & tracking - Transport & storage requirements - Specimen rejection criteria - Processing & centrifugation |
| Topic 5: Routine Blood Collections | 28% | - Tourniquet use & vein assessment - Order of draw & tube selection - Capillary puncture procedures - Post-collection care & labeling - Venipuncture techniques & equipment |
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質問 # 14
A phlebotomist should identify which of the following as the best site for phenylketonuria collection on an infant?
正解：A
解説：
The best site for phenylketonuria, or PKU, collection on an infant is the medial or lateral plantar surface of the heel. PKU screening is a newborn metabolic screening test commonly collected by heel stick onto filter paper. The medial and lateral heel areas are selected because they provide adequate capillary blood flow while reducing the risk of puncturing bone. The central area of the heel is unsafe because the calcaneus may be closer to the puncture site, increasing the risk of bone injury or osteomyelitis. Fingertip puncture is inappropriate for infants because the tissue is small, bone is close to the surface, and the site does not provide the recommended specimen collection area for newborn screening. Proper PKU collection also requires warming the heel when indicated, allowing blood to flow freely, filling filter-paper circles completely from one side, avoiding layering, and allowing the specimen to dry properly before transport. NHA CPT special collection content includes collecting blood for metabolic syndromes such as PKU, filter-paper collection techniques, pediatric considerations, and minimum/maximum volume requirements. Reference topics: Special Collections; PKU collection; infant heel puncture; filter-paper specimen collection.
質問 # 15
Which of the following actions should a phlebotomist take when a specimen requires immediate processing?
正解：A
解説：
A specimen requiring immediate processing should be delivered or processed according to stat or time-sensitive protocol. Some analytes degrade rapidly, some cells change after collection, and some tests depend on strict timing. Leaving the specimen until the next courier pickup may cause inaccurate results or rejection. Marking it routine ignores the priority and may delay care. Refrigerating it overnight is inappropriate unless specifically required, and even then it would not satisfy immediate processing. The phlebotomist must recognize priority indicators such as STAT, timed, fasting, peak/trough, chilled, protected-from-light, and immediate-spin requirements. The responsibility does not end when blood enters the tube. Specimen integrity depends on timely transport, correct temperature, proper centrifugation, and accurate documentation. If a delay occurs, the phlebotomist should communicate it according to facility policy rather than silently submitting a compromised specimen. Reference topics: Processing Specimens; stat specimens; time-sensitive processing; transport priority; specimen stability.
質問 # 16
Which of the following actions should a phlebotomist take to prevent reflux during venipuncture?
正解：D
解説：
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.
質問 # 17
At which of the following angles should a phlebotomist insert an antecubital venipuncture needle?
正解：A
解説：
For antecubital venipuncture, the needle is inserted bevel up at approximately a 15° to 30° angle, with 30° commonly used as the upper accepted standard for routine venous access. From the options provided, 30° is the best answer. A 10° angle is usually too shallow for antecubital venipuncture and may cause the needle to skim the skin surface or fail to enter the vein lumen. A 45° angle is too steep and increases the risk of passing through the vein, causing hematoma, pain, or arterial/nerve injury depending on site depth and anatomy. A 25° angle can be clinically workable in some routine venipunctures, but this item is asking for the standard recognized insertion angle, and 30° is the expected test answer. Proper angle must be combined with vein anchoring, bevel-up orientation, stable equipment control, and avoidance of excessive probing. The NHA CPT outline specifically includes needle insertion, angle of needle insertion and withdrawal, and routine venipuncture technique. Reference topics: Routine Blood Collections; antecubital venipuncture; angle of needle insertion; needle withdrawal and safety.
質問 # 18
A phlebotomist is performing a glucose tolerance test. Which of the following actions should the phlebotomist take after the patient drinks the glucose solution?
正解：C
解説：
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.
質問 # 19
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