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| Section | Objectives |
|---|---|
| Specimen Processing and Handling | - Quality control and rejection criteria - Specimen transport and storage - Labeling and documentation |
| Specimen Collection | - Venipuncture techniques - Capillary puncture procedures - Order of draw and tube handling |
| Safety and Compliance | - Needlestick prevention and biohazard disposal - OSHA standards and safety protocols - Infection control and PPE usage |
| Professional Practice | - Communication and professionalism - Ethics and patient confidentiality (HIPAA) |
| Patient Preparation | - Explaining procedures and obtaining consent - Site selection and preparation - Patient identification and communication |
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問題 #99
A phlebotomist centrifuges a serum specimen before it has fully clotted. Which of the following is most likely to occur?
答案：C
解題說明：
If a serum specimen is centrifuged before it has fully clotted, fibrin strands can form in the serum. These strands can interfere with testing instruments, cause sample aspiration problems, and lead to inaccurate results or specimen rejection. Serum specimens must be allowed to clot for the required time before centrifugation. Centrifugation does not increase specimen volume, neutralize additives, or sterilize blood. Blood specimens remain potentially infectious regardless of processing. This question tests the difference between serum and plasma. Serum is the liquid portion after clotting; plasma is the liquid portion of anticoagulated blood. If the phlebotomist rushes serum processing, the specimen may look separated but still contain fibrin. The correct workflow includes observing required clot time, balancing centrifuge tubes, using the correct speed and duration, and removing specimens promptly after centrifugation when required. Speed is not quality; specimen integrity is quality. Reference topics: Processing Specimens; clotting time; serum processing; centrifugation; fibrin formation.
問題 #100
OSHA requires employers to provide which of the following to employees who are at risk for bloodborne pathogen exposure?
答案：B
解題說明：
OSHA requires employers to offer the hepatitis B vaccine to employees who have occupational exposure risk to bloodborne pathogens. Phlebotomists routinely handle blood, contaminated needles, sharps, and potentially infectious materials, so they fall into the category of workers who require bloodborne pathogen protection under workplace safety standards. Hepatitis B is a bloodborne viral infection that can be transmitted through needlestick injuries, mucous membrane exposure, or contact with contaminated blood. The vaccine is an important preventive measure and must be offered according to employer exposure-control procedures. Medical insurance and life insurance are employee benefit issues, not OSHA bloodborne-pathogen requirements. Phenylketonuria screening is a newborn metabolic screening test and has no connection to employee exposure prevention. In practice, the phlebotomist must also follow standard precautions, use PPE, activate safety devices, dispose of sharps immediately, report exposures, and comply with the facility exposure-control plan. Reference topics: Safety and Compliance; OSHA Bloodborne Pathogens Standard; hepatitis B vaccination; occupational exposure; needlestick prevention.
問題 #101
Which of the following specimens should a phlebotomist protect from light immediately after collection?
答案：C
解題說明：
Bilirubin specimens should be protected from light immediately after collection because bilirubin is photosensitive. Exposure to light can degrade bilirubin and produce falsely decreased results. The phlebotomist should follow facility procedure, which may include wrapping the tube in foil or using an amber transport container. Blood urea nitrogen is not classically light-sensitive; it is generally handled as a routine chemistry analyte unless special facility requirements apply. Sodium testing does not require light protection. Hemoglobin A1c reflects long-term glycemic exposure through glycated hemoglobin and is not light-sensitive in the same way bilirubin is. The broader technical principle is that specimen handling requirements are test-specific. Some specimens require chilling, some must remain warm, some require rapid transport, some must avoid light, and some require timed collection. Failure to follow these requirements creates preanalytical error even when the venipuncture itself was performed correctly. Reference topics: Special Collections; Processing Specimens; light-sensitive specimens; bilirubin handling; specimen integrity.
問題 #102
Which of the following is an example of a postanalytical error?
答案：C
解題說明：
Failing to report a critical value promptly is a postanalytical error because it occurs after testing has produced a result. Postanalytical processes include result reporting, documentation, communication, verification, and delivery to the appropriate provider or clinical team. Collecting the wrong tube, underfilling a citrate tube, and hemolyzing a specimen during collection are preanalytical errors because they occur before laboratory analysis. These preanalytical errors may lead to specimen rejection or inaccurate results. Critical values require urgent communication because they may indicate an immediate threat to patient safety. The phlebotomist's role depends on facility policy; if performing point-of-care testing, the technician may be responsible for documenting and reporting results through a defined workflow. A delayed critical result can be just as dangerous as an incorrect specimen because the patient may not receive timely intervention. This question tests the three phases of laboratory testing: preanalytical, analytical, and postanalytical. Reference topics: Processing Specimens; postanalytical error; critical value reporting; documentation; laboratory workflow.
問題 #103
Which of the following actions is required before using a new lot number of point-of-care testing strips?
答案：B
解題說明：
Quality control testing should be performed before using a new lot number of point-of-care testing strips. Lot-to-lot variation can affect test performance, and QC confirms that the strips, controls, meter, and operator process are producing acceptable results before patient testing begins. Freezing strips is incorrect unless a manufacturer specifically requires a storage condition, and most reagent strips have controlled storage requirements that must not be improvised. Mixing old and new lots is unsafe because it creates traceability problems and can invalidate quality control. Using strips only for "control patients" is meaningless; patient specimens should not be used to validate unverified supplies. For waived testing and point-of-care testing, the phlebotomist must follow manufacturer instructions, document QC results, check expiration dates, store materials properly, and stop patient testing when controls fail. If QC is outside range, patient results should not be reported until corrective action is completed. Reference topics: Safety and Compliance; Special Collections; point-of-care testing; quality control; reagent lot verification.
問題 #104
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