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| Section | Weight | Objectives |
|---|---|---|
| Special Collections | 12% | - Glucose tolerance & dynamic tests - Therapeutic drug monitoring - Blood cultures & sterile collection - Pediatric & geriatric collections - Blood alcohol & legal collections |
| Patient Preparation | 20% | - Requisition review & test verification - Informed consent & communication - Patient positioning & comfort - Patient identification & verification - Site selection & preparation |
| Safety and Compliance | 26% | - Infection control & OSHA standards - HIPAA & patient confidentiality - PPE & sharps disposal - Bloodborne pathogens & exposure control - Quality control & error prevention |
| Specimen Processing & Handling | 14% | - Transport & storage requirements - Documentation & tracking - Specimen rejection criteria - Processing & centrifugation - Aliquoting & preservation |
| Routine Blood Collections | 28% | - Capillary puncture procedures - Venipuncture techniques & equipment - Order of draw & tube selection - Tourniquet use & vein assessment - Post-collection care & labeling |
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33. Frage
A phlebotomist is preparing to collect a CBC and a basic metabolic panel using evacuated tubes. Which of the following tubes should the phlebotomist collect first?
Antwort: B
Begründung:
For a CBC and basic metabolic panel, the green-top tube should be collected before the lavender-top tube when following the standard order of draw after sterile/blood culture tubes and coagulation tubes. A basic metabolic panel is commonly collected in a green-top heparin tube or serum tube depending on facility protocol, while a CBC requires a lavender-top EDTA tube. Additive carryover is the key concept. EDTA from a lavender tube can contaminate later specimens and falsely elevate potassium while lowering calcium because EDTA binds calcium. This makes lavender-top collection before chemistry specimens technically unsafe when chemistry testing is also ordered. Gray-top tubes are generally used for glucose or lactate testing and are collected later. Yellow SPS tubes are used for blood cultures and would be collected first only if blood cultures were ordered. The phlebotomist must know order of draw, tube additives, and the clinical consequence of additive contamination. Reference topics: Routine Blood Collections; order of draw; tube additives; CBC; chemistry specimen collection.
34. Frage
A phlebotomist is preparing for a blood alcohol level test that will be admitted as evidence in a court of law. Which of the following preparations should the phlebotomist document?
Antwort: D
Begründung:
For a forensic blood alcohol level, the phlebotomist should document use of a non-alcohol-based preparation, represented here by chlorhexidine preparation rather than ethanol or isopropyl alcohol. The critical issue is legal defensibility: using an alcohol-containing skin antiseptic can create a challenge that the collection process contaminated or affected the blood alcohol evidence. Ethanol and isopropyl alcohol are both inappropriate choices for this context because they are alcohols. The direction of rubbing ethanol-up and down or circular-is irrelevant; the problem is the substance itself. Chlorhexidine is the only non-ethanol/non-isopropyl option listed and is therefore the correct answer, assuming the facility's forensic kit or protocol specifies an acceptable non-alcohol preparation. The phlebotomist must also maintain chain of custody, identify the patient/donor correctly, use the proper tube, seal the specimen, document collection time, and transfer the specimen according to legal procedure. Reference topics: Special Collections; blood alcohol collection; forensic specimens; chain of custody; documentation. NHA's CPT outline includes forensic studies and chain-of-custody collection requirements.
35. Frage
A phlebotomist is preparing to perform a phlebotomy procedure on a hospitalized patient. Which of the following steps should the phlebotomist take for the initial introduction?
Antwort: C
Begründung:
The best initial introduction is to knock on the door, greet the patient, and introduce themselves. This sequence respects privacy, establishes professional presence, and begins communication before any technical identification or collection step. Entering quietly without first knocking may be inappropriate in a patient-care environment because the patient has a right to privacy and dignity. Turning on lights immediately can be abrupt, especially for hospitalized patients who may be resting, anxious, or ill. Checking the ID band is essential, but it follows professional entry and introduction. Checking the provider's prescription or order is important before collection, but it is not the interpersonal "initial introduction" step at bedside. The correct approach supports patient cooperation, consent, and safety. After introduction, the phlebotomist should verify the order, use two identifiers, explain the procedure, assess patient readiness, and obtain consent according to facility policy. Reference topics: Patient Preparation; therapeutic communication; patient rights; bedside approach; patient identification; consent. NHA's CPT test plan includes patient communication and preparation as a major domain.
36. Frage
Which of the following should a phlebotomist do if a specimen must remain warm during transport?
Antwort: B
Begründung:
If a specimen must remain warm during transport, the phlebotomist should use an approved warming device according to facility policy. Some tests, such as cold agglutinin-related specimens or specific specialized assays, may require warm handling to prevent analyte or cellular changes. Placing the specimen on ice or refrigerating it would violate warm-transport requirements and could compromise results. Leaving it near a sunny window is uncontrolled, unsafe, and may expose the specimen to light or excessive heat. Temperature requirements must be controlled and documented when required. The phlebotomist should not improvise with unapproved heat sources because overheating can also damage specimens. Proper specimen handling means knowing whether the specimen should be transported at room temperature, chilled, frozen, protected from light, or kept warm. Failure to follow special handling instructions creates preanalytical error and may require recollection. Reference topics: Processing Specimens; warm specimens; transport requirements; temperature control; specimen integrity.
37. Frage
Which of the following actions can cause hemolysis during venipuncture?
Antwort: C
Begründung:
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.
38. Frage
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