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| Section | Objectives |
|---|---|
| Topic 1: Specimen Collection | - Venipuncture techniques - Order of draw and tube handling - Capillary puncture procedures |
| Topic 2: Specimen Processing and Handling | - Specimen transport and storage - Labeling and documentation - Quality control and rejection criteria |
| Topic 3: Professional Practice | - Ethics and patient confidentiality (HIPAA) - Communication and professionalism |
| Topic 4: Patient Preparation | - Site selection and preparation - Patient identification and communication - Explaining procedures and obtaining consent |
| Topic 5: Safety and Compliance | - Needlestick prevention and biohazard disposal - OSHA standards and safety protocols - Infection control and PPE usage |
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質問 # 54
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?
正解：D
解説：
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.
質問 # 55
Which of the following methods should a phlebotomist use to anchor a vein?
正解：D
解説：
The vein is anchored by placing the thumb of the free hand below the intended puncture site and gently pulling the skin taut. This stabilizes the vein, reduces rolling, creates a firmer puncture surface, and supports accurate needle entry. Anchoring above the site is unsafe because it places the phlebotomist's hand in the direction of needle travel and increases needlestick risk. Using two fingers instead of the thumb provides less controlled traction and may interfere with the venipuncture angle or contaminate the prepared site. The phlebotomist should avoid touching the cleansed puncture site after antisepsis unless the site is re-cleansed. Proper anchoring is especially important for superficial or mobile veins because failure to stabilize the vein can cause missed access, hematoma formation, probing, patient discomfort, or specimen collection failure. The NHA CPT outline identifies anchoring the vein below the venipuncture site and knowledge of anchoring techniques as routine venipuncture competencies. Reference topics: Routine Blood Collections; site selection; anchoring below venipuncture site; venous anatomy and safe insertion technique.
質問 # 56
Which of the following needle gauges can be used for blood donation collection?
正解：B
解説：
Blood donation collection requires a large-bore needle because a full unit of blood must be collected efficiently while minimizing hemolysis and maintaining adequate flow into the collection bag. An 18-gauge needle is the correct option from the list. Blood donor collections commonly use larger needles than routine diagnostic venipuncture because donor collection volume is much greater than routine tube collection. A 25-gauge or 27-gauge needle is too small; it would slow flow excessively, increase mechanical stress on cells, and be inappropriate for donor collection. A 21-gauge needle is common for routine adult venipuncture but is not the best answer for blood donation collection because donor procedures require faster sustained flow. The phlebotomist must also confirm donor eligibility, follow blood bank protocol, use correct equipment, maintain aseptic technique, and monitor the donor for adverse reactions. The NHA CPT outline includes phlebotomy for blood donations and blood donation standards such as hemoglobin/hematocrit screening, weight, and complete screening. Reference topics: Special Collections; blood donation; needle gauge selection; donor collection standards.
質問 # 57
Which of the following should a phlebotomist verify for quality control protocol prior to using vacuum tubes?
正解：D
解説：
Before using evacuated vacuum tubes, the phlebotomist must verify the expiration date. Expired tubes can lose vacuum, produce inadequate draw volume, compromise the blood-to-additive ratio, or contain additives that no longer perform as intended. This can directly affect specimen integrity and may lead to inaccurate results or specimen rejection. Needle integrity is also important, but it applies to needle inspection rather than vacuum tube quality control. Visible additive may be observed in some tubes, but not all additives are easily visible, and visibility alone does not confirm the tube is acceptable for use. Name on label is not checked before using an unused tube because patient labeling occurs after collection according to facility policy and positive patient identification requirements. Tube quality control includes inspecting tubes for cracks, contamination, expired dates, defective stoppers, and compromised vacuum. NHA CPT routine collection content specifically includes selecting and assembling equipment, verifying equipment quality, checking expiration dates, and inspecting evacuated tubes required for laboratory testing. Reference topics: Routine Blood Collections; evacuated tube quality control; expiration dates; equipment inspection.
質問 # 58
A phlebotomist is collecting blood from a patient with small fragile veins. Which of the following devices is most appropriate?
正解：C
解説：
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.
質問 # 59
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