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| Section | Objectives |
|---|---|
| Safety and Compliance | - Infection control and PPE usage - Needlestick prevention and biohazard disposal - OSHA standards and safety protocols |
| Specimen Processing and Handling | - Quality control and rejection criteria - Specimen transport and storage - Labeling and documentation |
| Specimen Collection | - Order of draw and tube handling - Capillary puncture procedures - Venipuncture techniques |
| Patient Preparation | - Patient identification and communication - Site selection and preparation - Explaining procedures and obtaining consent |
| Professional Practice | - Communication and professionalism - Ethics and patient confidentiality (HIPAA) |
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質問 # 82
A phlebotomist should identify which of the following as the best site for phenylketonuria collection on an infant?
正解：D
解説：
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.
質問 # 83
Which of the following information should a phlebotomist document for a blood culture collection?
正解：A
解説：
For blood culture collection, the phlebotomist should document the site of collection. Blood cultures are often drawn from separate sites to help distinguish true bloodstream infection from contamination. Accurate site documentation supports interpretation if one bottle set grows organisms and another does not. It also provides traceability for collection quality, timing, and possible contamination review. Type of culture media is generally determined by the blood culture bottle system and laboratory protocol; it is not the key patient-specific documentation item in this question. Blood collection technique is expected to follow facility policy, but it is not typically the primary required field compared with date, time, collector identity, and site. Informed consent is not usually a separate required document for routine blood culture collection unless facility policy or special circumstances require it. Blood culture technique requires strict antisepsis, appropriate bottle preparation, correct order, sufficient volume, and avoidance of contamination. NHA CPT special collection content includes performing blood culture collections, blood culture locations, skin preparation, equipment, volume requirements, bottle preparation, and order of draw. Reference topics: Special Collections; blood culture collection; site documentation; contamination control.
質問 # 84
Which of the following actions should a phlebotomist take when transporting specimens to an outside laboratory?
正解：A
解説：
The phlebotomist should use appropriate leakproof transport packaging when specimens are transported to an outside laboratory. Specimen transport must protect the patient sample, courier, laboratory personnel, and documentation from leakage, breakage, contamination, and temperature-related instability. Requisitions should be kept separate from the specimen container, usually in an outer pouch, so paperwork is not contaminated if leakage occurs. Removing labels is never acceptable because identification must remain intact from collection through testing. Freezing all specimens is incorrect because temperature requirements are test-specific; freezing some specimens can destroy cells, alter analytes, or make the sample unsuitable. Proper transport includes correct labeling, biohazard identification, absorbent material when required, secure closure, upright positioning when appropriate, and compliance with time, light, and temperature requirements. The phlebotomist must know the difference between routine transport, chilled transport, frozen transport, and protected-from-light transport. Reference topics: Processing Specimens; specimen transport; leakproof packaging; biohazard handling; specimen integrity.
質問 # 85
A laboratory is scheduled for a routine annual inspection with primary focus on equipment maintenance logs. Which of the following areas will be the focus of the inspection?
正解：C
解説：
The focus is mechanical safety because equipment maintenance logs document whether laboratory equipment is being inspected, maintained, calibrated, and monitored properly. In a phlebotomy or clinical laboratory setting, mechanical safety includes safe use and maintenance of centrifuges, refrigerators, freezers, analyzers, timers, and other equipment used in specimen collection and processing. Maintenance logs demonstrate that the facility follows required quality-control procedures and that equipment problems are reported and corrected. Chemical safety would focus on chemical labeling, SDS access, storage compatibility, spill response, and exposure controls. Radiation safety would apply to radioactive materials or imaging-related hazards, not routine phlebotomy equipment logs. Electrical safety would involve cords, plugs, grounding, and electrical hazards, which may be inspected separately but are not the primary focus when the question specifically identifies equipment maintenance logs. NHA CPT safety content includes performing quality control for laboratory equipment, maintaining logs for equipment inspection, reporting and troubleshooting equipment issues, and following manufacturer recommendations for equipment maintenance and calibration. Reference topics: Safety and Compliance; equipment maintenance logs; quality control; mechanical safety.
質問 # 86
Which of the following actions should a phlebotomist take to prevent reflux during venipuncture?
正解：A
解説：
To prevent reflux, the patient's arm should be kept in a downward position so the collection tube remains below the puncture site. Reflux occurs when blood or tube additive flows backward from the tube into the patient's vein. Keeping the tube below the venipuncture site and allowing tubes to fill properly reduces this risk. Holding the tube above the puncture site increases the chance of backflow. Removing the tube before it fills can create incorrect blood-to-additive ratios and does not prevent reflux. Inserting the needle bevel down is incorrect technique; venipuncture needles are inserted bevel up to enter the vein smoothly and reduce trauma. Reflux prevention also includes using proper tube position, avoiding excessive movement, not pushing tube contents toward the patient, and releasing the tourniquet appropriately. This is especially important with additive tubes because additive contamination of the patient's circulation, while uncommon, is a preventable safety concern. Reference topics: Routine Blood Collections; reflux prevention; evacuated tube technique; arm positioning; tube handling.
質問 # 87
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