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| Section | Objectives |
|---|---|
| Topic 1: Special Collections | - Pediatric and geriatric considerations - Non-routine specimen collection methods - Capillary puncture (fingerstick/heel stick) |
| Topic 2: Patient Preparation | - Site selection and preparation - Patient identification and communication - Specimen labeling procedures |
| Topic 3: Specimen Processing and Handling | - Common errors and rejection criteria - Specimen transport and storage - Quality assurance procedures |
| Topic 4: Routine Blood Collections | - Venipuncture procedures - Order of draw - Equipment selection and use |
| Topic 5: Safety and Compliance | - HIPAA and patient confidentiality - Infection control and standard precautions - OSHA regulations and patient safety |
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64. Frage
Which of the following is a possible complication of venipuncture collection for a patient who has been on warfarin therapy?
Antwort: D
Begründung:
Prolonged bleeding is the expected complication for a patient on warfarin therapy. Warfarin is an anticoagulant, meaning it interferes with normal clot formation and can increase bleeding time after venipuncture. The phlebotomist should be alert for delayed hemostasis, apply firm pressure after needle removal, avoid having the patient bend the arm sharply, and confirm that bleeding has stopped before applying a bandage and leaving the patient. Blood clotting is the opposite of the expected medication effect. Hemostasis is the normal stopping of bleeding, not a complication. Petechiae can occur from tourniquet pressure, fragile capillaries, or platelet-related issues, but in this question the medication-specific risk is prolonged bleeding. Proper technique reduces complications: release the tourniquet, withdraw the needle smoothly, activate the safety device, apply pressure, and monitor the puncture site. Reference topics: Routine Blood Collections; post-procedure care; anticoagulant therapy; bleeding complications; hemostasis; patient observation. NHA includes routine venipuncture complications and post-collection care within the CPT test plan.
65. 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: A
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.
66. Frage
Which of the following actions should a phlebotomist take after receiving a critical value?
Antwort: B
Begründung:
A critical value must be reported to the provider directly and promptly according to facility policy. Critical values represent results that may indicate an immediate threat to the patient's health, so delayed communication can create patient-safety risk. The phlebotomist should follow the organization's read-back, documentation, escalation, and notification procedure, especially when the result comes from point-of-care or waived testing performed by the phlebotomist. Waiting until all collections are completed is unsafe because critical values require timely clinical action. Asking a colleague to repeat the testing is not the correct first response unless the facility's procedure specifically requires confirmatory testing and the phlebotomist is authorized to perform it. Recording the value in the chart for later nurse review is also insufficient because it does not ensure immediate provider notification. Critical value handling is part of specimen processing, communication, patient safety, and point-of-care testing responsibility. NHA CPT competencies include reporting abnormal or critical results, communicating with clinical personnel, documenting results, and following testing protocols. Reference topics: Processing Specimens; Special Collections; point-of-care testing; critical value reporting.
67. Frage
Which of the following actions should a phlebotomy technician take upon withdrawing a winged infusion needle?
Antwort: C
Begründung:
Upon withdrawing a winged infusion needle, the phlebotomy technician should activate the safety device. Winged infusion sets have a built-in safety mechanism designed to shield or retract the needle after use, reducing the risk of needlestick injury and bloodborne pathogen exposure. The device should be activated immediately according to the manufacturer's instructions and then disposed of in an appropriate sharps container. Disposing of a 16-gauge needle is not the best answer because winged sets for routine phlebotomy are not typically described as 16-gauge, and disposal occurs after safety activation. Placing a capillary pipette in clay relates to microhematocrit tube sealing, not venipuncture completion. Depressing a syringe plunger is unrelated to winged needle removal and could create exposure or specimen-handling problems if done incorrectly. The critical safety action is engineering-control use: activate the safety feature without recapping or unnecessary handling. Reference topics: Routine Blood Collections; Safety and Compliance; winged infusion sets; needle withdrawal; sharps safety; needlestick prevention. NHA CPT domains include equipment selection, needle removal, safety-device use, and exposure-control procedures.
68. Frage
A phlebotomist should avoid using a site with burned skin during venipuncture for which of the following reasons?
Antwort: D
Begründung:
Burned skin should be avoided for venipuncture because the tissue barrier is compromised and the site carries an increased risk of infection. A venipuncture intentionally breaches the skin, so selecting tissue that is already injured, inflamed, fragile, or poorly healed increases the chance of introducing microorganisms and worsening local tissue damage. Burned areas can also have altered circulation, scarring, tenderness, edema, and impaired healing, making vein assessment and needle control less reliable. Although damaged skin elasticity can make puncture technically difficult, the best clinical reason in this item is infection risk. Inaccuracy of laboratory results is more directly associated with sites such as IV arms, edematous tissue, hematomas, or improperly handled specimens. Vein sclerosis is associated with repeated venipuncture, medication irritation, or diseased veins, not simply the use of burned skin. The NHA CPT test plan includes venipuncture site selection, contraindicated collection sites, infection control, and patient safety under routine blood collection and safety competencies. Reference topics: Routine Blood Collections; Safety and Compliance; site selection; infection prevention.
69. Frage
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