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| Section | Objectives |
|---|---|
| Patient Preparation | - Explaining procedures and obtaining consent - Patient identification and communication - Site selection and preparation |
| Safety and Compliance | - Needlestick prevention and biohazard disposal - OSHA standards and safety protocols - Infection control and PPE usage |
| Specimen Collection | - Capillary puncture procedures - Order of draw and tube handling - Venipuncture techniques |
| Professional Practice | - Communication and professionalism - Ethics and patient confidentiality (HIPAA) |
| Specimen Processing and Handling | - Specimen transport and storage - Quality control and rejection criteria - Labeling and documentation |
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41. Frage
A patient refuses a blood draw after the phlebotomist explains the procedure. Which of the following actions should the phlebotomist take?
Antwort: D
Begründung:
The phlebotomist should notify the nurse or provider according to facility policy. A competent adult patient has the right to refuse a blood draw, even when the test is ordered. Proceeding against the patient's refusal is unethical and can constitute battery. Asking a family member to pressure the patient is inappropriate because consent must come from the patient or legally authorized representative when applicable, not from coercion. Using a smaller needle does not address refusal unless the patient specifically refused because of needle size and then gives consent after discussion. The phlebotomist should remain professional, clarify the patient's concern within scope, avoid arguing, document or report the refusal as required, and allow authorized clinical personnel to follow up. This question tests patient rights, consent, communication, and scope of practice. Phlebotomy is invasive, so consent is not optional. The technician's authority ends where patient refusal begins unless a specific emergency or legal policy applies through authorized medical personnel. Reference topics: Patient Preparation; patient refusal; consent; patient rights; communication; documentation.
42. Frage
Which of the following actions should a phlebotomist take to identify a patient who was admitted to a facility?
Antwort: A
Begründung:
For an admitted patient, the phlebotomist should check the patient's identification band. Inpatient identification depends on matching the patient's wristband to the requisition or collection order using required identifiers, commonly full name and date of birth or medical record number. Stating the patient's name and date of birth for the patient to confirm is weaker because it allows passive agreement and does not require the patient to actively provide identifiers. Using the medical chart alone is not sufficient because charts can be misplaced, opened to the wrong patient, or outdated. Comparing the wristband to bedside equipment is also unsafe because equipment stickers may be incorrect, moved, or not patient-specific enough to serve as the primary identifier. The correct process protects against wrong-patient collection, mislabeling, transfusion risk, diagnostic error, and specimen rejection. Reference topics: Patient Preparation; inpatient identification; wristband verification; two patient identifiers; requisition matching; specimen labeling. NHA places patient identification and preparation procedures under core CPT exam domains.
43. 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.
44. Frage
A phlebotomist notices that an outpatient appears confused and cannot state their date of birth. Which of the following actions should the phlebotomist take?
Antwort: C
Begründung:
The phlebotomist should use an approved alternate identification process. If a patient cannot reliably state their date of birth because of confusion, cognitive impairment, language barrier, or illness, the technician must follow facility policy for identification. This may involve a caregiver, legal guardian, identification band, photo identification, nurse verification, or other approved method depending on the setting. Proceeding using the requisition only is unsafe because the requisition is not the patient. Asking the patient to guess is obviously unreliable and creates wrong-patient risk. Labeling the specimen later in the laboratory is also unsafe because labeling must occur immediately after collection in the patient's presence or according to strict facility procedure. Accurate patient identification is the first major defense against specimen mislabeling, wrong diagnosis, wrong treatment, and patient harm. The phlebotomist must not improvise identity verification just to keep workflow moving. Reference topics: Patient Preparation; patient identification; alternate identification; outpatient collection; specimen labeling.
45. Frage
A phlebotomist should identify which of the following as the best site for phenylketonuria collection on an infant?
Antwort: A
Begründung:
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.
46. Frage
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