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| Section | Objectives |
|---|---|
| Special Collections | - Pediatric and geriatric considerations - Non-routine specimen collection methods - Capillary puncture (fingerstick/heel stick) |
| Patient Preparation | - Patient identification and communication - Specimen labeling procedures - Site selection and preparation |
| Routine Blood Collections | - Equipment selection and use - Order of draw - Venipuncture procedures |
| Specimen Processing and Handling | - Common errors and rejection criteria - Quality assurance procedures - Specimen transport and storage |
| Safety and Compliance | - OSHA regulations and patient safety - HIPAA and patient confidentiality - Infection control and standard precautions |
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質問 # 73
A phlebotomist is collecting a blood culture from a 6-month-old infant who has no known allergies. Which of the following disinfectants should the phlebotomist use?
正解：A
解説：
Chlorhexidine gluconate is the best answer for blood culture skin antisepsis in this 6-month-old infant with no known allergies. Blood cultures require stricter skin disinfection than routine venipuncture because contamination can produce false-positive culture results, unnecessary antibiotics, repeat testing, and delayed diagnosis. Sodium polyanethol sulfonate is not a skin disinfectant; it is an anticoagulant/additive used in blood culture media to support organism recovery. Sodium hypochlorite is a bleach-type disinfectant used for environmental decontamination, not patient skin preparation for venipuncture. Hydrogen peroxide is not the standard blood culture skin antiseptic. Chlorhexidine is widely used for effective skin antisepsis, and CDC guidance recognizes chlorhexidine-containing agents in healthcare infection-control contexts when age, skin maturity, and clinical risk are considered. For collection technique, the phlebotomist should cleanse the site properly, allow the antiseptic to dry, avoid repalpating unless sterile technique is used, collect adequate volume, and label/document accurately. Reference topics: Special Collections; blood culture collection; pediatric skin preparation; contamination prevention.
質問 # 74
Which of the following is the correct method for cleaning a small blood spill?
正解：C
解説：
A small blood spill should be cleaned using an approved disinfectant according to facility policy. Blood is treated as potentially infectious, so spill response requires gloves, appropriate PPE, containment, removal of visible material, disinfection with correct contact time, and proper disposal of contaminated materials. Dry gauze alone does not disinfect the surface and can spread contamination. Air freshener has no disinfection role. Covering the spill and leaving it to dry is unsafe because dried blood may still represent a contamination hazard and creates exposure risk for staff and patients. The specific disinfectant may vary by facility, but it must be appropriate for bloodborne pathogens and used as directed. The phlebotomist must also avoid direct hand contact, dispose of materials in designated biohazard waste when required, and perform hand hygiene after glove removal. This question tests standard precautions, environmental safety, and infection-control discipline. Reference topics: Safety and Compliance; blood spill cleanup; disinfectants; standard precautions; biohazard waste.
質問 # 75
Which of the following conditions requires a blood transfusion due to cumulative blood loss for neonatal patients?
正解：B
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 # 76
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?
正解：A
解説：
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.
質問 # 77
Which of the following terms means a decrease in white blood cells?
正解：C
解説：
Leukopenia means a decreased number of white blood cells. "Leuko-" refers to white blood cells, and "-penia" means deficiency or decrease. Leukocytosis means an increased white blood cell count and is often associated with infection, inflammation, stress response, or hematologic disorders. Thrombocytopenia means a decreased platelet count, which can increase bleeding risk after venipuncture. Erythrocytosis means an increased red blood cell count. This terminology matters to phlebotomy because laboratory orders and patient conditions often use hematologic language. The phlebotomist does not diagnose these conditions, but understanding terms helps the technician anticipate safety concerns and specimen requirements. For example, thrombocytopenia may require longer pressure after collection, while leukopenia may be associated with immunocompromised status and strict infection-control awareness. A CBC is the common test used to evaluate red cells, white cells, hemoglobin, hematocrit, and platelets. Reference topics: Phlebotomy Fundamentals; medical terminology; hematology; CBC components; blood cell disorders.
質問 # 78
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