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| Section | Objectives |
|---|---|
| Patient Preparation | - Explaining procedures and obtaining consent - Site selection and preparation - Patient identification and communication |
| Specimen Processing and Handling | - Labeling and documentation - Quality control and rejection criteria - Specimen transport and storage |
| Professional Practice | - Ethics and patient confidentiality (HIPAA) - Communication and professionalism |
| Specimen Collection | - Order of draw and tube handling - Capillary puncture procedures - Venipuncture techniques |
| Safety and Compliance | - Needlestick prevention and biohazard disposal - OSHA standards and safety protocols - Infection control and PPE usage |
>> NHA Phlebotomy-Technician Unterlage <<
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48. Frage
Which of the following is the maximum allowed time for a tourniquet application before possibly affecting test results?
Antwort: D
Begründung:
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.
49. Frage
A phlebotomist is preparing to collect a CBC and a basic metabolic panel using evacuated tubes. Which of the following tubes should the phlebotomist collect first?
Antwort: C
Begründung:
For a CBC and basic metabolic panel, the green-top tube should be collected before the lavender-top tube when following the standard order of draw after sterile/blood culture tubes and coagulation tubes. A basic metabolic panel is commonly collected in a green-top heparin tube or serum tube depending on facility protocol, while a CBC requires a lavender-top EDTA tube. Additive carryover is the key concept. EDTA from a lavender tube can contaminate later specimens and falsely elevate potassium while lowering calcium because EDTA binds calcium. This makes lavender-top collection before chemistry specimens technically unsafe when chemistry testing is also ordered. Gray-top tubes are generally used for glucose or lactate testing and are collected later. Yellow SPS tubes are used for blood cultures and would be collected first only if blood cultures were ordered. The phlebotomist must know order of draw, tube additives, and the clinical consequence of additive contamination. Reference topics: Routine Blood Collections; order of draw; tube additives; CBC; chemistry specimen collection.
50. Frage
A phlebotomist is performing a glucose tolerance test. Which of the following actions should the phlebotomist take after the patient drinks the glucose solution?
Antwort: A
Begründung:
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.
51. 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.
52. Frage
Which of the following patient positions is safest for a patient who reports a history of fainting during blood draws?
Antwort: A
Begründung:
A patient with a history of fainting should be positioned reclining or lying down before collection. Syncope is a common phlebotomy complication and can lead to falls, head injury, needle injury, or specimen loss if the patient is not positioned safely. Standing is never appropriate for venipuncture because a fainting patient can collapse. Sitting on an unsupported exam table is also unsafe because the patient may fall from a height. Sitting with legs crossed can affect circulation and does not protect against syncope. The phlebotomist should ask about prior fainting, observe the patient's color and behavior, explain the procedure calmly, and stop the draw if the patient becomes pale, diaphoretic, dizzy, nauseated, or unresponsive. If syncope occurs, the phlebotomist should remove the needle when safe, activate the safety device, call for assistance, lower the patient's head or follow facility policy, and monitor the patient until help arrives. Reference topics: Patient Preparation; syncope prevention; patient positioning; adverse reactions; venipuncture safety.
53. Frage
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