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| Section | Objectives |
|---|---|
| Topic 1: Routine Blood Collections | - Order of draw - Equipment selection and use - Venipuncture procedures |
| Topic 2: Patient Preparation | - Specimen labeling procedures - Patient identification and communication - Site selection and preparation |
| Topic 3: Special Collections | - Non-routine specimen collection methods - Pediatric and geriatric considerations - Capillary puncture (fingerstick/heel stick) |
| Topic 4: Specimen Processing and Handling | - Common errors and rejection criteria - Specimen transport and storage - Quality assurance procedures |
| Topic 5: Safety and Compliance | - HIPAA and patient confidentiality - Infection control and standard precautions - OSHA regulations and patient safety |
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問題 #54
Which of the following questions should a phlebotomist ask to verify fasting status?
答案：C
解題說明：
The phlebotomist should ask, "When was the last time you had anything to eat or drink other than water?" This question directly verifies fasting status and avoids a vague yes/no answer. Patients may misunderstand fasting and think coffee, juice, gum, candy, or a small snack does not count. Asking about medication is important for some tests, but it does not verify fasting. Asking why the provider ordered the test is outside the phlebotomist's interpretive role and may lead to unauthorized clinical discussion. Asking whether the patient has had the test before does not confirm current preparation. Accurate fasting verification is part of patient preparation and preanalytical quality control. If the patient has not fasted as required, the phlebotomist should follow facility policy, notify appropriate personnel, document noncompliance if collection proceeds, or reschedule if instructed. Poor preparation can produce misleading chemistry results and unnecessary repeat testing. Reference topics: Patient Preparation; fasting verification; patient interview; basal-state requirements; preanalytical variables.
問題 #55
Which of the following sites should a phlebotomist use as the second choice to perform venipuncture on an adult patient?
答案：C
解題說明：
The cephalic vein is the second-choice vein for routine adult venipuncture. The median cubital vein is preferred first because it is usually large, well anchored, superficial, and located away from major nerves and arteries. If the median cubital vein is unavailable or unsuitable, the cephalic vein is typically selected next because it is generally accessible and safer than the basilic vein. The basilic vein is usually the last choice in the antecubital area because it lies closer to the brachial artery and median nerve, increasing the risk of serious complications if the needle placement is poor. The median antebrachial vein may be visible in the forearm but is not the standard second-choice site for routine venipuncture. Proper site selection is not cosmetic; it is risk control. The phlebotomist must evaluate vein size, depth, resilience, direction, and surrounding anatomy while avoiding sites with edema, hematoma, burns, scarring, IV lines, infection, or mastectomy restrictions. Reference topics: Routine Blood Collections; antecubital vein selection; median cubital, cephalic, and basilic veins; site safety.
問題 #56
Which of the following actions should a phlebotomist take after removing the needle from a venipuncture site?
答案：B
解題說明：
After removing the needle, the phlebotomist should apply pressure with clean gauze. Direct pressure supports hemostasis and reduces bruising, bleeding, and hematoma formation. Asking the patient to bend the elbow tightly is incorrect because it can increase pressure at the puncture site and promote hematoma formation or continued bleeding under the skin. Recapping the needle is unsafe and increases needlestick risk; the safety device should be activated and the needle discarded in an approved sharps container. Labeling the tube cap only is also incorrect because caps can be removed or switched. The specimen label must be placed on the tube or container itself according to facility policy. After pressure is applied, the phlebotomist should check that bleeding has stopped before applying a bandage, especially for patients on anticoagulants or with bleeding disorders. Post-procedure care is not an afterthought; it is part of patient safety and specimen workflow. Reference topics: Routine Blood Collections; needle removal; post-procedure care; hemostasis; labeling requirements.
問題 #57
Which of the following additives is commonly found in a gray-top tube used for glucose testing?
答案：C
解題說明：
Sodium fluoride is commonly found in gray-top tubes used for glucose testing. Sodium fluoride inhibits glycolysis, which helps preserve glucose concentration after collection by slowing cellular glucose consumption. Many gray-top tubes also contain potassium oxalate as an anticoagulant. Sodium citrate is found in light-blue tubes used for coagulation studies because it binds calcium reversibly. EDTA is found in lavender-top tubes and is commonly used for hematology testing such as CBC. SPS is sodium polyanethol sulfonate, an additive used in blood culture bottles or yellow SPS tubes because it supports organism recovery by reducing certain inhibitory effects. Tube additives are not trivia; they determine specimen type and test validity. A glucose specimen collected in the wrong tube or processed late may produce inaccurate results because cells continue metabolizing glucose after collection. The phlebotomist must match test, tube, additive, order of draw, fill volume, and handling requirements. Reference topics: Special Collections; glucose testing; gray-top tube; sodium fluoride; additive function.
問題 #58
Which of the following PPE should a phlebotomist wear when there is a risk of blood splatter during collection?
答案：D
解題說明：
When there is a risk of blood splatter, the phlebotomist should wear eye and face protection, such as a face shield or goggles with a mask. Standard gloves protect the hands but do not protect the mucous membranes of the eyes, nose, and mouth. Sterile gloves are not routinely required for standard venipuncture; clean gloves are typically used unless a sterile procedure is specified. Shoe covers are not the primary protection for facial splash exposure. An N95 respirator protects against airborne particles but does not replace splash protection unless combined with appropriate eye and face protection when needed. The correct PPE is based on anticipated exposure. A routine venipuncture may require gloves only, but procedures with splash risk require additional barriers. The phlebotomist must evaluate the procedure, patient behavior, specimen type, and environment before collection. PPE use also includes proper donning, removal, disposal, and hand hygiene after glove removal. Reference topics: Safety and Compliance; PPE selection; standard precautions; splash exposure; mucous membrane protection.
問題 #59
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