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| Section | Objectives |
|---|---|
| Topic 1: Routine Blood Collections | - Order of draw - Venipuncture procedures - Equipment selection and use |
| Topic 2: Safety and Compliance | - OSHA regulations and patient safety - HIPAA and patient confidentiality - Infection control and standard precautions |
| Topic 3: Special Collections | - Non-routine specimen collection methods - Capillary puncture (fingerstick/heel stick) - Pediatric and geriatric considerations |
| Topic 4: Patient Preparation | - Patient identification and communication - Specimen labeling procedures - Site selection and preparation |
| Topic 5: Specimen Processing and Handling | - Common errors and rejection criteria - Quality assurance procedures - Specimen transport and storage |
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質問 # 41
Which of the following conditions requires a blood transfusion due to cumulative blood loss for neonatal patients?
正解：A
解説：
Anemia is the condition that can require blood transfusion due to cumulative blood loss in neonatal patients. Neonates have a small total blood volume, so repeated laboratory collections can remove a clinically significant amount of blood over time. This is called iatrogenic blood loss and is a major concern in premature or critically ill infants who require frequent testing. If blood loss becomes excessive relative to the infant's circulating volume, hemoglobin and hematocrit can decline, producing or worsening anemia and potentially requiring transfusion. Osteochondritis involves inflammation of bone and cartilage and is unrelated to cumulative phlebotomy blood loss. Osteomyelitis is bone infection, a possible complication of improper heel puncture, but it is not the transfusion-related condition tested here. Galactosemia is a metabolic disorder screened in newborn testing, not a condition caused by repeated blood collection. The phlebotomist must use pediatric tubes, collect only the required volume, avoid unnecessary redraws, and follow minimum-volume requirements. Reference topics: Special Collections; neonatal blood collection; pediatric microcollection; iatrogenic anemia; blood volume limits.
質問 # 42
Which of the following agencies is responsible for setting guidelines for bloodborne exposure incidents?
正解：A
解説：
The Occupational Safety and Health Administration is responsible for workplace safety regulation, including requirements related to bloodborne pathogen exposure. In phlebotomy, bloodborne exposure incidents include needlesticks, blood splashes, mucous membrane exposure, and contact with non-intact skin. OSHA's Bloodborne Pathogens Standard requires employers to maintain exposure control plans, provide training, use engineering controls such as safety needles and sharps containers, support appropriate PPE, and establish procedures for exposure reporting and follow-up. CMS is primarily linked to Medicare, Medicaid, and healthcare payment/quality oversight, not direct bloodborne exposure incident standards. The FDA regulates medical devices, drugs, biologics, and related safety approvals. CLIA governs laboratory testing quality standards, not occupational blood exposure response. The option wording on the screen says "Occupational Safety of Health Administration," but the correct agency is OSHA: Occupational Safety and Health Administration. NHA CPT safety content includes OSHA, bloodborne pathogens, sharps disposal, biohazards, exposure control protocols, needlestick reporting, and workplace safety regulations. Reference topics: Safety and Compliance; OSHA; Bloodborne Pathogens Standard; exposure control protocols.
質問 # 43
A blood specimen is rejected by the laboratory for testing. Which of the following actions should the phlebotomist take?
正解：C
解説：
The phlebotomist should contact the patient to repeat the venipuncture collection, following facility policy and provider notification procedures. A rejected specimen cannot be tested reliably, so the practical correction is recollection using the proper tube, volume, labeling, handling, and transport requirements. Waiting until the next yearly visit is unacceptable because the ordered test was needed for current clinical care. Shredding documentation is improper unless performed under approved records-management procedures, and it does not solve the missing valid specimen. Sending laboratory results by mail is impossible or inappropriate when the specimen was rejected and no valid result exists. Specimen rejection usually results from preanalytical problems such as wrong tube, insufficient volume, hemolysis, clotting in an anticoagulant tube, unlabeled or mislabeled specimen, expired supplies, improper temperature, or delayed transport. The phlebotomist's job is to correct the collection failure promptly and prevent recurrence. Reference topics: Processing Specimens; specimen rejection; recollection; preanalytical error; specimen integrity.
質問 # 44
Which of the following actions should a phlebotomist take to prevent reflux during venipuncture?
正解：C
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 # 45
From which of the following sites should a phlebotomist take a capillary collection from a 3-year-old child?
正解：D
解説：
For a 3-year-old child, the correct capillary collection site is the middle finger. Finger puncture is appropriate for older infants and children when the finger pad is sufficiently developed, commonly using the middle or ring finger on the palmar surface. Heel puncture is primarily used for infants, especially newborns, because the recommended medial or lateral plantar heel area provides a safer capillary site before the fingers are large enough. The antecubital fossa is used for venipuncture, not capillary puncture. The vastus lateralis is an intramuscular injection site, not a blood collection site. Proper capillary technique requires warming if needed, cleaning and drying the site, using an appropriate-depth lancet, wiping away the first drop when required, avoiding excessive squeezing, and collecting in the correct order. In a child, site choice must protect bone, nerves, and tissue while obtaining an adequate specimen. Reference topics: Routine Blood Collections; dermal puncture; pediatric capillary collection; site selection; microcollection safety. NHA CPT content includes dermal puncture procedures and capillary collection site selection.
質問 # 46
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