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PHLB 212 PHLEBOTOMY FINAL EXAM (IVY TECH) WITH
COMPLETE SOLUTIONS
What is the smallest gauge needle recommended for venipuncture? 23g The color coding of the needles indicates the gauge size a basal state exists in the early morning, 12 hours after the last ingestion of food which is the recommended vein for venipuncture? median cubital what is the maximum time a tourniquet should be on an arm? 1 minute which of the following anticoagulants is in the green top tube? Heparin The patient has had a mastectomy on the right side, where do you draw? the antecubital area on the left side leaving the tourniquet on for too long can cause? Hemoconcentration Having the bevel half in and half out of the vein can cause a hematoma what is the purpose of an anticoagulant? keep the blood from clotting when a red blood cell bursts its called? Hemolysis Trace metals are collected in what color tubes? Royal blue top tubes which phase of testing includes the most factors that could affect the test result? pre-examination
Swelling due to fluid buildup in the tissues Edema Syncope is the same as Fainting which stage of testing does drawing blood fall into? pre-examination Which of the following is not a reason for performing blood tests? checking blood pressure which of the following tube contains gel to seperate the cells from the serum gold top which of the following tubes contain EDTA purple top identifying the patient is included in which phase of testing? pre-examination The suffix that is used to mean cell is? Cyte The root that is used to mean clot is? Thromb Hemostasis refers to: blood clotting Which of the bodies systems provides carbon dioxide and oxygen exchange? Respiratory Where does hematopoiesis take place? the bone marrow Which of the following is not a function of the cardiovascular system? storage of minerals for later use Troponin I is a test used to aid in the diagnosis of myocardial infarction (heart attack) Which of the following reflects the primary function of the red blood cells? blood clotting
Second choice Cephalic third choice basilic basilic vein location pinky side of the antecubital area cephalic vein location thumb side of the antecubital area median cubital location middle of the antecubital area What effect does alcohol have if it is not allowed to dry when performing a skin puncture? prevents a normal drop from forming Skin puncture techniques are most often used when small amounts of blood are needed Capillary blood from a skin puncture is composed of: Arterial, venous and interstitial fluid Which of the following might have an adverse effect on the quality of test from a skin puncture? Using the first drop Which of the following is the correct sequence for performing a finger stick? cleanse the site, squeeze the finger, puncture the skin, wipe off the first drop Excessive massaging or milking of the finger can cause Hemolysis and tissue fluid contamination Capillary blood cannot be used for which tests? blood cultures and sedrates Once blood is added to the evacuated tube containing additives, how soon should it be mixed? Immediately the correct order of draw for a skin puncture is purple green red What is the maximum time a tourniquet should be on the arm? 1 minute a vein that has patency has bounce and resilience
After cleansing an arm with alcohol what is the appropriate procedure? Allow the site to air dry What is the best angle for inserting the needle during venipuncture? Less than 30 degrees When a butterfly set is used what is essential when drawing a light blue coagulation tube? Draw a discard tube first to prime the tubing The proper way to transfer blood from a syringe into a tube is? Safely remove the needle, attach a transfer device, insert tube. The best way to keep a vein from rolling is to: Anchor the vein What is the purpose for the venipuncture order of draw? To keep one tubes additive from contaminating another What is the purpose for the capillary order of draw Fill the tube that you want to keep from clotting first Which of the following is in the light blue tube Sodium Citrate (Na) Which of the following tubes has no additives Red You need to draw a gold top, green top, and blood cultures, name the order
- Blood culture
- Gold
- Green
You need to draw purple top, red top and gray top, name the order
- Red
- purple 3.gray You are using a butterfly set to draw green top, light blue top, and purple top, name the order
- *discard
- Light blue
- green
- purple What is likely to happen if a tube containing anticoagulant is not mixed correctly? tiny clots may form
Which is the following term is synonymous with POC testing? alternate site testing Which of the following should occur first in the collection of blood cultures? Disinfect the rubber stopper on the bottle with 70% alcohol Which artery is most commonly used for ABG's? Radial Artery During a GTT test glucose level draw times are figured from the finishing of the glucose drink What is the rationale for performing the Allen's test? To determine if collateral circulation is present A contaminated blood culture is likely if the vein is palpated after cleansing post prandial refers to after eating To obtain a trough level, the patients blood should be collected immediately before the administration of the medication What is the disadvantage of POC testing? Cost to perform test What types of tests can be performed with POC? Glucose, pregnancy, Strep throat, Influenza Which is not a reasonto run a control on a POC test? to see how many tests have been performed that day What is the best method for collecting blood cultures? with a butterfly- straight into the bottle When collecting blood for trace elements you should use royal blue stoppered tube A patient reports that during a previous blood draw he felt lightheaded and almost passed out. What should the phlebotomy technician do? (A) Call the patient's doctor to verify that the draw should be performed (B) Give the patient a cup of juice or light snack before the draw (C) Perform the draw according to standard procedures, but make sure a trained first aid provider is nearby (D) Perform the draw with the patient reclined or in a supine position
(D) Perform the draw with the patient reclined or in a supine position A requisition calls for the following tests: CBC, CMP, and PTT. Which of the following reflects the proper order of draw? (A) EDTA, SST, citrate (B) Citrate, SST, EDTA (C) SST, citrate, EDTA (D) EDTA, citrate, SST (B) Citrate, SST, EDTA What part of the evacuated tubes system allows multiple collection tubes to be filled with one puncture?* (A) The interior needle/tube holder (B) The syringe barrel (C) The bevel (D) The lumen (A) The interior needle/tube holder
- When drawing a specimen for an ammonia test, what should a phlebotomy technician have ready for specimen transportation?* (A) A heating block (B) An amber transport tube (C) An ice slurry (D) Ice cubes (C) An ice slurry When blood culture is ordered along with other tests, which tube is filled first?* (A) Yellow ACD (B) Yellow SPS (C) Lavander EDTA (D) Light Blue sodium citrate (B) Yellow SPS Which of these patient reactions should be documented, but is not a cause for discontinuing a draw or likely to affect analytes? (A) Syncope in a seated patient (B) Petechiae (C) Hematoma (D) Nerve involvement (B) Petechiae
A) Both sets must be filled from the same venipuncture site B) The sets must be filled from two different venipuncture sites C) The sets are filled from the same venipuncture site if possible, and from two sites only if the blood flow stops before all bottles are filled D) One set is filled from a venipuncture site and the second set is filled from a capillary puncture site B) The sets must be filled from two different venipuncture sites
- Which of the following information on a requisition form is essential for a phlebotomy technician to match exactly with information provided by the patient?* (A) Complete date of birth (B) Insurance account number (C) Diagnosis code(s) (D) Address/facility room number (A) Complete date of birth Which of the following is a HIPAA violation?* (A) Failing to log out of the patient record on a visible screen before calling the next patient in (B) Discussing which tests were ordered for a patient with the patient's physician (C) Asking a fellow phlebotomist for help finding a good venipuncture site on a patient the colleague has worked with previously (D) Calling a patient's first name to summon her to a drawing station (A) Failing to log out of the patient record on a visible screen before calling the next patient in A patient with a DNR order in place becomes unresponsive during the course of a blood draw. The phlebotomy technician should* (A) Discontinue the blood draw and immediately start CPR if trained to do so (B) Discontinue the blood draw, document the time at which the patient became unresponsive, and move on to the next patient (C) Complete the blood draw and then call for help (D) Discontinue the blood draw and immediately call for help (D) Discontinue the blood draw and immediately call for help
- Which of the following is within the range of common microcollection tube volumes?* (A) 0.5 mL (B) 5 mL (C) 5000 u (D) 2 mL
(A) 0.5 mL
- In which of the following cases should a phlebotomy technician seek out interpretation services?* (A) A patient whose first language is not English indicates that she is comfortable communicating in English and seems to understand well (B) A patient does not speak English and is accompanied by her 10-year old grandson who speaks fluent English (C) A patient does no speak English, but the PBT's speaks the patient's language and has been trained in interpretation by her facility (D) A patient speaks moderately fluent English and communicates that she understands the procedure, rolling up her sleeve and nodding (B) A patient does not speak English and is accompanied by her 10-year old grandson who speaks fluent English Which set of differences is true of collection of donor blood as compared to routine venipuncture for diagnostic testing?* (A) A smaller needle is used and the patient is first given a brief medical exam (B) A larger needle is used and the patient is not required to provide consent (C) A larger needle is used and the patient is first given a brief medical exam (D) A smaller needle is used and the patient is first tested for anemia (C) A larger needle is used and the patient is first given a brief medical exam
- Blood flow slows and then stops while a phlebotomy technician is halfway through drawing a citrate tube. After adjusting the needle gently forward and backward, the technician is not able to restore the flow. What should he do?* (A) Label and submit the tube for testing halfway full (B) Label and submit the tube for testing halfway full only if a second tube is inserted and also does not fill (C) Discontinue the draw and reschedule the patient (D) Try a second citrate tube; if the second tube does not fill, perform a second venipuncture at a new site (D) Try a second citrate tube; if the second tube does not fill, perform a second venipuncture at a new site A lancet designed for heel stick on a full-term infant usually punctures at a depth of* (A) 2.2 mm (B) 2.0 mm (C) 1.0 mm (D) 0.85 mm (C) 1.0 mm
(D) Remove the tourniquet, wait two minutes, apply a blood pressure cuff inflated to just below the patient's diastolic blood pressure, then ask the patient to pump her fist rapidly while the phlebotomist attempts to palpate a vein Capillary blood will flow more easily when this is done prior to capillary puncture:* (A) The patient drinks a tall glass of water (B) The patient raises her hands above her head for 3-5 minutes (C) The patient breathes deeply just before the puncture is performed (D) The site is warmed for 3-5 minutes (D) The site is warmed for 3-5 minutes When a patient enters a phlebotomist's drawing station, how can the phlebotomist best communicate a positive, professional attitude?* (A) By having all equipment preassembled and immediately beginning the procedure (B) By facing away from the phlebotomy chair to allow the patient time to be seated without any pressure to communicate (C) By greeting the patient, introducing himself by name and title, and inviting the patient to be seated (D) By greeting the patient and then asking the patient to confirm the tests ordered (C) By greeting the patient, introducing himself by name and title, and inviting the patient to be seated Micro clotting of an anticoagulated specimen may occur if the phlebotomy technician does not* (A) Vigorously mix the specimen with the tube additive immediately after is collected (B) Use gentle inversions to mix the specimen with the tube additive immediately after it is collected (C) Centrifuge the specimen within an hour of collection (D) Place the specimen in a heating block immediately after collection (B) Use gentle inversions to mix the specimen with the tube additive immediately after it is collected In which of the following situations should a phlebotomy technician report a point-of- care testing result that is in the critical value range?* (A) When the patient appears unwell (B) When the patient complains of specific symptoms (C) Any time a repeated test is also in the critical value range (D) Any time a result is in critical value range, even if the repeated test is normal (D) Any time a result is in critical value range, even if the repeated test is normal Why is it especially important that a phlebotomy technician take care when drawing from a patient who is quadriplegic?*
(A) The patient is likely to be more sensitive to pain (B) The patient's vein are likely to collapse (C) The patient is unable to alert the phlebotomy technician to pain that might signal nerve involvement (D) The patient is at elevated risk for iatrogenic anemia (C) The patient is unable to alert the phlebotomy technician to pain that might signal nerve involvement A new patient is seated at the drawing station before the phlebotomist realizes he forgot to label and initial the collection tubes from the last patient. What would be his best course of action?* (A) Ask the new patient to wait while he labels and initials the tubes immediately (B) Set the tubes aside where they are unlikely to be confused with the new patient's tubes, then label them before calling the next patient (C) Excuse himself and try to catch the last patient before she leaves the facility, then label and initial the tubes in her presence (D) Discard the tubes and schedule a redraw for the previous patient (C) Excuse himself and try to catch the last patient before she leaves the facility, then label and initial the tubes in her presence Which of the following tests cannot be performed on capillary blood?* (A) Erythrocyte sedimentation rate (B) Complete blood count (C) Hemoglobin/hematocrit (D) Prothrombin time/international normalized ratio (A) Erythrocyte sedimentation rate At what temperature should a specimen drawn to for cryofibrinogen testing be held?* (A) 0°C (B) 5°C (C) 37°C (D) 100°C (C) 37°C Which of the following tubes contains an anti-coagulant that acts by inhibiting thrombin?* (A) An EDTA tubes (B) A heparin tube (C) A sodium citrate tube (D) A clot activator tubes (B) A heparin tube
(D) 23
Most blood chemistry tests are performed on specimens collected in either* (A) Serum tubes or heparin tubes (B) Heparin tubes or EDTA tubes (C) Sodium citrate tubes or heparin tubes (D) Serum tubes or sodium fluoride tubes (A) Serum tubes or heparin tubes A CLIA waived test may not be performed by the following laboratory personnel:* (A) Personnel who are not trained in its use (B) Phlebotomy technicians (C) Medical technicians (D) Supervising nurses (A) Personnel who are not trained in its use Which of the following processes is part of appropriate medical asepsis in a laboratory?* (A) Using sterile gloves during venipuncture procedures (B) Placing used needles in an autoclave before disposal (C) Thoroughly cleaning a venipuncture site with 70% isopropyl alcohol (D) Performing hand hygiene after every third patient (C) Thoroughly cleaning a venipuncture site with 70% isopropyl alcohol A patient with measles is in an airborne infection isolation room. When drawing blood from this patient, a phlebotomy technician will need to wear* (A) Asurgical mask (B) An N95 respirator (C) A biohazard suit (D) A face shield (B) An N95 respirator Where is venipuncture most commonly performed if no suitable site can be found in the antecubital are of either of the patient's arms?* (A) The dorsal aspect of one of the patient's hands (B) The dorsal aspect of one of the patient's forearms (C) The lateral aspect of one of the patient's wrists (D) One of the patient's feet or ankles (A) The dorsal aspect of one of the patient's hands The Needlestick Safety and Prevention Act requires that employers*
(A) Provide biohazard suits for phlebotomy technicians (B) Involve staff in the selection of safer medical devices (C) Provide appropriate PPE at a reasonable cost to the employee (D) Make payments to employees who are victims of accidental needlesticks (B) Involve staff in the selection of safer medical devices How is a five-year-old child most likely to be positioned for venipuncture?* (A) In a parent or guardian's lap (B) In a booster seat with straps to secure the arm (C) In an adult phlebotomy chair adjusted to its highest setting (D) Sitting on his knees in a bariatric phlebotomy chair (A) In a parent or guardian's lap Which of these choices lists lab tests in the order in which tubes would be drawn to conduct tests?* (A) Glucose, thyroid panel, complete blood count (B) Thyroid panel, glucose, complete blood count (C) Complete blood count, thyroid panel, glucose (D) Thyroid panel, complete blood count, glucose (D) Thyroid panel, complete blood count, glucose A transfer device allows blood to be safely transferred from ______________ to ________________* (A) Evacuated tubes, aliquot tubes (B) A syringe, evacuated tubes (C) A patient's vein, evacuated tubes (D) A syringe, microcollection tubes (B) A syringe, evacuated tubes After introducing herself, confirming the patient's identity and matching it to the requisition, what should a phlebotomy technician do?* (A) Ask the patient what symptoms he has been experiencing (B) Apply a tourniquet and look for a suitable vein (C) Explain the procedure to the patient (D) Call the patient's doctor to confirm that the tests on the requisition are correct (C) Explain the procedure to the patient In which of the following situations must a phlebotomy technician ask nursing staff to complete a blood draw?* (A) A hospitalized patient's chart indicates blood should only be taken from a central port
(C) Pregnant women (D) Elderly patients (C) Pregnant women If blood is taken from a collection tube to perform a peripheral blood smear, what type of tubes should be used?* (A) Red top (B) Green top (C) Lavender top (D) Light blue top (C) Lavender top For which of the following tests commonly performed on newborns should an amber microcollection tube be used?* (A) Bilirubin (B) Capillary blood gas (C) Newborn metabolic screening (D) Complete blood count (A) Bilirubin A patient whose veins must be preserved for medical interventions such as chemotherapy may have blood tests conducted on* (A) Blood taken from arteries (B) Blood taken from capillaries (C) Blood taken from veins in the legs or feet (D) Blood taken from the back of the hand (B) Blood taken from capillaries When can a phlebotomy technician puncture the patient's skin for either venipuncture or capillary puncture?* (A) Right after locating a suitable site (B) Right after cleaning the site with a facility-approved antiseptic (C) After the site has been cleaned and has dried (D) One minute after site cleaning is performed (C) After the site has been cleaned and has dried If, after centrifuging a specimen, a phlebotomist notices a pink or red tint to the serum, the specimen is likely ______________________* (A) Hemolyzed
(B) Glycolized (C) Lipemic (D) Icteric (A) Hemolyzed Which of these tasks is typically considered within a phlebotomy technician's scope of practice? (Choose three)* (A) Creating peripheral blood smear slides (B) Drawing blood from an indwelling port (C) Performing a throat culture (D) Drawing blood from the dorsal aspect of the hand using a syringe and transfer device (E) Using a microscope to examine blood smears (A) Creating peripheral blood smear slides (C) Performing a throat culture (D) Drawing blood from the dorsal aspect of the hand using a syringe and transfer device Blood pulsing into collection tubes is an indication that* (A) The needle is placed in the exact center of the vein (B) The needle has struck a nerve (C) The needle has passed entirely through the vein (D) The needle has struck an artery (D) The needle has struck an artery A phlebotomist needs to collect gold, pink, and green-topped tubes by venipuncture. Which order is correct?* (A) Gold, green, pink (B)Green, gold, pink (C) Pink, green, gold (D) Gold, pink, green (A) Gold, green, pink Collection tubes with _________________ should not be used for the therapeutic drug testing* (A) Separator gel (B) Clot activator (C) Red tops (D) Internal vacuum (A) Separator gel
