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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 - Specimen transport and storage - Quality control and rejection criteria |
| Professional Practice | - Communication and professionalism - Ethics and patient confidentiality (HIPAA) |
| Specimen Collection | - Order of draw and tube handling - Venipuncture techniques - Capillary puncture procedures |
| Safety and Compliance | - OSHA standards and safety protocols - Infection control and PPE usage - Needlestick prevention and biohazard disposal |
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NEW QUESTION # 108
Which of the following actions can cause hemolysis during venipuncture?
Answer: D
Explanation:
Using a needle with a gauge that is too small can cause hemolysis. A small-bore needle can create excessive mechanical force as blood passes through the lumen, damaging red blood cells and releasing intracellular contents into serum or plasma. Hemolysis can alter test results, especially potassium, lactate dehydrogenase, and other analytes affected by red-cell rupture. Allowing alcohol to dry before puncture is correct practice because it reduces stinging and helps prevent contamination. Releasing the tourniquet before needle removal is also correct because it reduces pressure and supports safer needle withdrawal. Mixing additive tubes by gentle inversion is required; the danger occurs when tubes are shaken vigorously. Additional hemolysis causes include probing, drawing through a hematoma, forcing blood from a syringe into a tube, rough transport, incorrect centrifugation, and delayed processing. A phlebotomist must choose equipment appropriate to the patient's vein while maintaining specimen quality. Reference topics: Routine Blood Collections; hemolysis; needle gauge selection; specimen integrity; preanalytical error.
NEW QUESTION # 109
A phlebotomist is instructing a patient who has a prescription for a 24-hr urine collection. Which of the following instructions should the phlebotomist include?
Answer: B
Explanation:
For a 24-hour urine collection, the patient should discard the first urine on the day of collection, record the start time, and then collect all urine passed during the next 24 hours, including the final specimen at the end time. Discarding the first void empties the bladder and establishes a clean starting point for the timed collection. Keeping the specimen at room temperature is usually incorrect because many 24-hour urine specimens require refrigeration, ice, or preservatives depending on the ordered test. Urinating directly into the large collection container may be unsafe or impractical, especially if the container contains preservative; patients are commonly given a separate collection device and then transfer urine as instructed. Doubling fluid intake is incorrect because it can dilute analytes and alter test results unless specifically ordered by the provider. The phlebotomist must explain timing, storage, missed specimens, labeling, and return instructions clearly because incomplete collection is a major preanalytical error. NHA CPT competencies include non-blood specimen collection, patient instructions, timed urine collection, specimen storage, and specimen integrity. Reference topics: Special Collections; 24-hour urine; non-blood specimens; patient preparation.
NEW QUESTION # 110
Which of the following complications can a phlebotomist cause by underfilling a gray-topped tube?
Answer: D
Explanation:
Underfilling a gray-topped tube can contribute to hemolysis and specimen rejection because the blood-to-additive ratio becomes incorrect. Gray-top tubes commonly contain sodium fluoride and potassium oxalate. When the tube is underfilled, the additive concentration becomes excessive relative to the blood volume, which can damage cells and interfere with specimen integrity. Hemolysis means red blood cells rupture, releasing intracellular contents into the serum or plasma and potentially altering test results. Iatrogenic anemia is caused by excessive or repeated blood removal from a patient, not by underfilling one additive tube. "Homeostasis" is the body's general maintenance of internal stability and is not a phlebotomy complication in this context; the clinically relevant term would be hemostasis. Thrombocytosis means an elevated platelet count and is not caused by underfilling a gray-top tube. The technical lesson is blunt: additive tubes must be filled to the required volume and mixed gently by inversion. Reference topics: Processing Specimens; preanalytical error; tube fill requirements; additive ratio; hemolysis.
NEW QUESTION # 111
Which of the following actions should a phlebotomist take when using a syringe for venipuncture?
Answer: D
Explanation:
When using a syringe for venipuncture, the phlebotomist should transfer blood into tubes using a safety transfer device. A syringe may be used for fragile veins or situations where vacuum pressure could collapse the vein, but it introduces additional handling risk. Pulling the plunger forcefully can cause vein collapse, pain, and hemolysis. Removing tube stoppers and pouring blood into tubes is unsafe because it exposes the specimen and staff to blood, increases contamination risk, and disrupts additive ratios. Attaching a used needle to fill evacuated tubes is dangerous and creates needlestick risk. A safety transfer device allows blood to move from the syringe into evacuated tubes while maintaining a closed system and preserving order of draw. The phlebotomist should also avoid excessive force, fill tubes correctly, mix additive tubes gently, activate safety features, and discard sharps immediately. Reference topics: Routine Blood Collections; syringe method; blood transfer device; hemolysis prevention; sharps safety.
NEW QUESTION # 112
Which of the following should a phlebotomist review on a requisition prior to collection for an outpatient draw?
Answer: C
Explanation:
Before collecting an outpatient specimen, the phlebotomist must review the requisition to confirm what test is ordered and what specimen requirements apply. Specimen requirements include tube type, additive, minimum volume, handling conditions, fasting status, timing, temperature, light protection, and whether the specimen requires special processing or transport. This step prevents preanalytical errors such as collecting the wrong tube, insufficient volume, wrong timing, or improperly handled specimens. Medications and allergies can be clinically relevant during patient interview, but they are not the primary item reviewed on the requisition for collection accuracy unless the test requirement specifically involves medication timing or patient compliance. Insurance authorization is administrative and should not drive the technical collection step. The requisition is the controlling document for collection, because it links patient identification, ordering provider, diagnosis or test code, test priority, and ordered tests. The NHA CPT outline includes obtaining, reviewing, and verifying orders or requisitions, confirming testing requirements, and understanding requisition field requirements. Reference topics: Patient Preparation; requisition review; testing requirements; specimen requirements; outpatient collection workflow.
NEW QUESTION # 113
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