Phlebotomy Review Answers April 2021 PDF

PHLEBOTOMY REVIEW CHAPTER 1 PHLEBOTOMY PAST AND PRESENT AND HEALTH CARE SETTING 1. Another name for blood bank is A) immunohematology. B) immunology. C) microbiology. D) serology. 2. With which other hospital department would the laboratory coordinate therapeutic drug...

PHLEBOTOMY REVIEW CHAPTER 1 PHLEBOTOMY PAST AND PRESENT AND HEALTH CARE SETTING 1. Another name for blood bank is A) immunohematology. B) immunology. C) microbiology. D) serology. 2. With which other hospital department would the laboratory coordinate therapeutic drug monitoring? A) Nuclear medicine B) Pharmacy C) Physical therapy D) Radiology 3. Electrolyte testing includes A) bilirubin, creatinine. B) BUN, cholesterol. C) glucose, uric acid. D) sodium, potassium. 4. Promoting good public relations is a part of the phlebotomist's role because A) a phlebotomist is a representative of the laboratory throughout the facility. B) good public relations promotes a harmonious relationship with the staff. C) patients often equate venipuncture experiences with the overall hospital care. D) All of the options are correct. 5. The term “phlebotomy” is derived from Greek words that, literally translated, mean A) blood collection. B) capillary puncture. C) vein dissection. D) vein incision. 6. Which of the following is NOT a phlebotomist's duty? A) Collecting blood specimens B) Performing laboratory computer operations C) Starting intravenous (IV) lines D) Transporting specimens to the laboratory.  7. Which of the following is an example of a barrier to effective communication with a patient? A) The patient does not speak English. B) The patient is a very young child. C) The patient is emotionally upset. D) All of the answers are correct. 8. Which of the following is an example of a confirming response to a patient? A) I do not know what you mean. B) I have no idea how long it will take. C) I understand how you must be feeling. D) I'm on a tight schedule right now. 9. Which of the following is an example of negative kinesics? A) Eye contact B) Frowning C) Touching D) Smiling 10. Which of the following communicates unprofessionalism? A) Clean laboratory coat B) Long hair pulled back C) Short, clean fingernails D) Intense odor of cologne 11. It is improper telephone protocol to A) answer the phone promptly. B) clarify and record information. C) hang up on angry callers. D) prioritize callers, if necessary. 12. What does acknowledge a patient's beliefs, customs, knowledge, and attitudes exemplify? A) Empathy B) Sympathy C) Compassion D) Diversity awareness 13. A phlebotomist who gets the specimen for the doctor even if he or she must take shortcuts is exhibiting? A) integrity B) unprofessionalism C) professionalism D) negligence CHAPTER 2 QUALITY ASSUARANCE AND LEGAL ISSUE 1. Drawing a patient's blood without his or her permission can result in a charge of A) assault and battery. B) breach of confidentiality. C) invasion of privacy. D) respondeat superior. 2. Two phlebotomists in an elevator are discussing a patient's condition. They are overheard by the patient's daughter. This is an example of A) failure to exercise due care. B) improper or unskilled care. C) invasion of privacy. D) res ipsa loquitur. 3. Malpractice is a claim of A) assault and battery. B) breach of confidentiality. C) improper treatment. D) invasion of privacy. 4. If a phlebotomist __________, he or she is negligent. A) does not obtain a specimen from a combative patient B) fails to put the needle and holder in the sharps container C) puts the bedrail in an upright position when leaving D) reports obvious changes in the patient's condition 5. A national organization that sets standards for phlebotomy procedures is A) CMLTO. B) CSMLS. C) MLPAO. D) CLSI. 6. Which action will compromise the quality of a specimen? A) Drawing electrolytes in an amber tube B) Mixing a serum separator tube five times C) Partially filling a liquid EDTA tube D) Placing a cold agglutinin in a heat block 7. Which one of the following examples is unrelated to quality control? A) Checking expiration dates of evacuated tubes B) Documenting maintenance on centrifuge C) Employees filling out their time sheets daily D) Recording refrigerator temperature daily  8. Which analyte test result will be adversely affected by chilling? A) Ammonia B) Lactic acid C) Potassium D) Renin 9. When the threshold value of a clinical indicator of QA is exceeded and a problem is identified A) a corrective action plan is implemented. B) an incident report must be filed. C) the patient specimens must always be redrawn. D) the patient's physicians must be notified. 10. Which one of the following conditions is LEAST likely to be a reason for specimen rejection? A) An icteric bilirubin specimen B) A clotted specimen for a CBC C) A lipemic fasting glucose specimen D) A hemolyzed electrolyte specimen 11. A specimen was mislabeled on the floor. The phlebotomist is required to fill out an incident report form. What information is NOT part of the report? A) Description of the consequence B) Details of the corrective action taken C) Explanation of the problem D) Suggestion for new guidelines 12. Which of the following is an example of a QA indicator? A) All phlebotomists will carefully follow universal precautions. B) No eating, drinking, or smoking are allowed in laboratory work areas. C) The blood culture contamination rate will not exceed the national rate. D) The phlebotomist watches for the patient's implied consent before blood collection. 13. The only phlebotomist in an outpatient drawing center is not familiar with the test that a physician has ordered. What is the most appropriate action to take? A) Call the physician's office for assistance. B) Draw both a serum and a plasma sample. C) Refer to the collection manual for instruction. D) Send the patient to another drawing center.  14. Some test specimens require immediate cooling in ice and water slurry to A) prevent activation of cold agglutinins. B) prevent the specimen from clotting. C) separate serum more completely. D) slow down metabolic processes. 15. QC protocols prohibit use of outdated evacuated tubes because A) additives that speed up clotting become crystallized in the tube. B) bacteria begin to grow in these tubes, yielding erroneous results. C) stoppers may shrink, allowing specimen leakage if the tube is inverted. D) tubes may not fill completely, changing additive-to-sample ratios. 16. Unauthorized release of confidential patient information is called A) a type of negligence. B) failure to use due care. C) invasion of privacy. D) violation of discovery. 17. Which preanalytical factor that can affect validity of test results is not always under the phlebotomist's control? A) Patient identification B) Patient preparation C) Specimen collection D) Specimen handling CHAPTER 3 INFECTION CONTROL/SAFETY 1. According to standard first aid procedures, severe external bleeding is best controlled by A) applying a tourniquet. B) applying direct pressure. C) keeping the injured area below the level of the heart. D) raising the victim's head above the level of the injury. 2. Class C fires A) involve combustible metals. B) involve electrical equipment. C) occur with flammable liquids. D) occur with ordinary materials. 3. An example of employee screening for infection control is A) HBV vaccination. B) immune globulin shots. C) measles vaccination. D) PPD testing. 4. The purpose of “protective” (REVERSE) isolation is to A) prevent airborne transmission of contagious diseases. B) protect others from patients with transmissible diseases. C) protect patients who are highly susceptible to infection. D) provide a safe environment for psychiatric patients. 5. What is the proper order for putting on the following protective clothing? A) Gloves first, then goggles, then gown, mask last B) Gown first, then gloves, then goggles, mask last C) Gown first, then mask, then goggles, gloves last D) Mask first, then goggles, then gown, gloves last 6. What is the FIRST thing the phlebotomist should do in the event of an accidental needlestick? A) Check the medical records of the patient for BBP status. B) Go to employee health service and get a tetanus booster. C) Leave the area so that the patient does not notice the injury. D) Wash the site with soap and water for at least 30 seconds. 7. The main principles involved in radiation exposure are A) exposure time, distance, and shielding. B) exposure time, radiation level, and glove use. C) time of day, amount of radiation, and source. D) time of day, distance, and eye protection. 8. Examples of nosocomial infections include A) when a catheter site of a patient in ICU becomes infected. B) when a healthcare worker contracts hepatitis from a needlestick. C) when a patient is admitted with symptoms of Hanta virus. D) when a patient breaks out with measles the day after admission.  9. Which of the following is an example of a potential permucosal exposure to biohazardous microorganisms? A) Drinking water from a contaminated glass B) Getting stuck by a needle used on an AIDS patient C) Rubbing an eye with a contaminated hand D) Touching infectious material with chapped hands 10. In what instance might a patient be placed in protective isolation? A) The patient has chickenpox. B) The patient has hepatitis. C) The patient has severe burns. D) The patient has tuberculosis. 11. Which of the following is an example of a work practice control that reduces the risk of exposure to bloodborne pathogens? A) A biohazard symbol B) An exposure control plan C) Hand decontamination D) HBV vaccination 12. Which type of contact infection transmission involves transfer of an infective microbe to the mucous membranes of a susceptible individual by means of a cough or sneeze? A) Direct B) Droplet C) Fomite D) Indirect 13. Which type of PPE must be removed after leaving the patient's room and closing the door? A) Face mask B) Gloves C) Gown D) Respirator  14. CLSI guidelines state that scrubs or slacks worn in the lab should be how far off of the floor? A) ½ to 1 inch B) 1 to 1½ inches C) 1½ to 2 inches D) 2 to 2½ inches 15. A body fluid splash to the eyes requires the victim to immediately flush the eyes with water or sterile saline for a minimum of A) 3 minutes. B) 5 minutes. C) 10 minutes. D) 15 minutes. 16. An N-95 respirator must be worn when entering the room of a patient who has which type of precaution sign on the door? A) Airborne B) Contact C) Droplet D) Standard CHAPTER 6 CIRCULATORY SYSTEM 1. Which of the following veins is NOT an antecubital vein? A. Basilic B. Cephalic C. Femoral D. Median 2. A patient has the antecubital veins listed below. All the veins are large and easily palpated, but the basilic vein is the most visible. Which one should be chosen for venipuncture? A. Basilic B. Median C. Median basilic D. Median cephalic 3.The liquid part of the blood containing the clotting factor FIBRINOGEN is known as: A. Plasma B. Red Blood Cells C. Buffy coat D. Serum  E. Thrombocytes 4.The liquid part of the blood without the clotting factor FIBRINOGEN is known as: a. Plasma b. Red Blood Cells c. Buffy coat d. Serum e. Thrombocytes 5.The breakdown of blood is termed: A. Hematoma B. Hemolysis C. Hematemesis D. Hematuria E. Hemorrhaging 6.Upon standing, a blood specimen to which an anticoagulant has been added separates into: A. Plasma and blood cells B. Serum and blood cells C. Plasma, Buffy coat and blood cells D. Serum, Buffy coat and blood cells 7. How is serum obtained? A. From whole blood that has been centrifuged B. By using a tube containing an anticoagulant C. From clotted blood that has been centrifuged D. From whole blood that has been left standing 8. Whole blood is obtaining by: A. Using a tube containing an anticoagulant B. Centrifuging a clotted blood specimen C. By using a red top tube D. By using a tube that does not contain an anticoagulant Chapter 07: Blood Collection Equipment, Additives, and Order of Draw 9. What is the proper blood-to-additive ratio for a light-tube collected for a coagulation test? A. 4:1 B. 8:1 C. 3:1 D. 9:1 10. Which needle gauge has the largest lumen? A. 18 B. 20 C. 21 D. 22 11. The tests performed in the following department are typically collected in a tube with a light- blue stopper. A. Chemistry B. Coagulation C. Hematology D. Microbiology 12. A tube with a green stopper normally contains A. EDTA. B. citrate. C. heparin. D. oxalate. 13. The purpose of an antiglycolytic agent is to A. enhance clotting. B. inhibit microbes. C. preserve glucose. D. prevent clotting. 14. The solution normally used to clean the site before routine venipuncture is A. 70% isopropanol. B. benzalkonium chloride. C. chlorhexidine gluconate. D. povidone-iodine. 15. When nitrile or vinyl strap tourniquets become soiled with blood, it is best to A. autoclave and reuse them. B. throw them away. C. wash them in bleach. D. wipe them with alcohol. 16. What is the most important factor in choosing which gauge needle to use for venipuncture? A. Age and weight of the patient B. Number of tubes to be drawn C. Size and condition of the vein D. Type of test being performed 17. Which additive is usually present in a tube with a lavender stopper? A. Citrate B. EDTA C. Heparin D. Oxalate 18. Glass particles present in serum separator tubes A. deter coagulation. B. enhance clotting. C. inhibit glycolysis. D. prevent hemolysis. 19. Heparin prevents blood from clotting by A. activating calcium. B. binding calcium. C. inhibiting thrombin. D. preserving thrombin. 20. Which of the following is classified as a disinfectant? A. Benzalkonium chloride B. Isopropanol C. Povidone-iodine D. Sodium hypochlorite 21. The slanted tip of the needle that enters the vein is called the A. bevel. B. gauge. C. hub. D. lumen. 22. According to CLSI standards, which of the tubes listed below is filled last when using a syringe? A. EDTA B. Heparin C. Sodium citrate D. Sterile SPS 23. When using a winged infusion blood collection set, if the first tube is an additive tube, it is important to collect a few milliliters of blood into a nonadditive tube first to A. avoid carry-over. B. exhaust all of the vacuum in the tube. C. maintain proper blood-to-additive ratio. D. prevent reflux. 24. A phlebotomist collects a light-blue-top, lavender-top, and gray-top tube from an inpatient. Respectively, which of the following additives do the tubes most likely contain? A. Citrate, EDTA, sodium fluoride B. EDTA, citrate, potassium oxalate C. Heparin, EDTA, thixotropic gel D. Sodium fluoride, thrombin, citrate 25. A rapid serum tube contains A. citrate. B. EDTA. C. heparin. D. thrombin. 26. The tube additive that is responsible for the most carryover problems is A. citrate phosphate dextrose. B. ethylenediaminetetraacetic acid. C. sodium polyanethol sulfonate. D. thixotropic gel separator. 27. Which of the following substances is a biocide? A. Hydrogen peroxide B. Isopropyl alcohol C. Povidone iodine D. All of the options are correct. 28. You must collect a routine hematology test, a coagulation test, and a stat chemistry test. Which of the following are the tubes you would most likely use, listed in the correct order of draw? A. Green-top, purple-top, royal-blue-top, B. Light-blue-top, green-top, purple-top. C. Orange-top, lavender-top, green-top. D. Red-top, light-green-top, purple-top. Chapter 08: Venipuncture Procedures 29. A request is given to draw a specimen from an inpatient by the name of John Doe. Which of the following is an acceptable way to confirm the patient's identity? A. Ask the patient, “Are you Mr. John Doe?” and see if he says “Yes.” B. Check the patient's ID band and say, “I see that you are John Doe.” C. Match the ID band and requisition with the patient's verbal statement of ID. D. See if the ID band matches the requisition to be sure of the patient's identity. 30. The following tests have all been ordered at the same time on different inpatients. Only one phlebotomist is on duty. Which test should the phlebotomist collect first? A. ASAP CBC in the cardiac unit B. Routine Hgb in long-term care C. STAT electrolytes in the ER D. Timed blood culture in ICU 31. Doing which of the following during the vein selection process is bad for the specimen? A. Allowing the patient to pump her fist B. Lowering the patient's arm C. Palpating the antecubital area D. Using a warm towel to increase blood flow 32. Using which of the following communication strategies before obtaining a blood specimen from a child demonstrates poor technique? A. Establishing rapport with the child B. Greeting the parent and the child C. Telling the child it won't hurt D. Telling the child what to expect 33. The patient is just finishing a big breakfast as the phlebotomist arrives to draw a fasting specimen. What should the phlebotomist do? A. Check with the patient's nurse to see if the specimen should still be collected. B. Draw the specimen since breakfast was just eaten and probably not absorbed. C. Draw the specimen, but write “nonfasting” on the lab requisition. D. Refuse to collect the specimen and fill out an incident report slip. 34. What may happen if you mix a specimen too vigorously? A. Glycolysis B. Hemoconcentration C. Hemolysis D. Microclot formation 35. Never leave a tourniquet on for more than A. 30 seconds. B. 1 minute. C. 2 minutes. D. 3 minutes. 36. What is the most critical error a phlebotomist can make? A. Collecting a timed specimen late B. Failing to collect a specimen C. Giving a patient a hematoma D. Misidentifying a patient specimen 37. What is the best way for a newly trained phlebotomist to handle a venipuncture on a patient with needle phobia? A. Ask an experienced phlebotomist to do the draw. B. Use a small gauge butterfly needle for the draw. C. Have the patient lie down for the draw. D. Tell the patient it will only hurt a little. 38. What would be the system of choice to identify laboratory specimens from an unconscious, unidentified woman in the emergency room? A. Assign a name to the patient such as Jane Doe. B. Assign a number to the patient until admitted. C. Process the specimens after she is identified. D. Use a three-part identification band and labels. 39. The priority designation for a test request is based on all of the following EXCEPT A. age and gender. B. diet restrictions. C. patient condition. D. timed collection. 40. A phlebotomist arrives to draw a specimen from an inpatient. The patient's door is closed. What should the phlebotomist do? A. Knock softly, open it slowly, and ask permission to enter. B. Knock softly and wait for someone to come to the door. C. Leave to draw another patient and come back later. D. Open the door and proceed directly into the room. 41. The patient asks if the specimen about to drawn is for a diabetes test. How should the question be answered? A. If the test is for glucose, say, “Yes, it is.” B. Say, “It's best to discuss that with the doctor.” C. Say, “No,” even if the test is for diabetes. D. Tell the patient that you do not know. 42. An unconscious patient is not wearing an ID band. There is an ID band taped to the patient's IV pole with information that matches the requisition. What should the phlebotomist do? A. Call the laboratory supervisor and ask how to proceed. B. Draw the specimen and fill out an incident report form. C. Draw the specimen and then ask the nurse to ID the patient. D. Only draw the specimen after an ID band has been applied. 43. Which of the following is the job of a student phlebotomist? A. Explaining to the patient why a particular test was ordered B. Letting the patient know that you are a student phlebotomist C. Telling a patient what can happen if he or she refuses to be drawn D. Telling the patient what disease or condition he or she might have 44. An inpatient is sound asleep when the phlebotomist arrives to draw a blood specimen. What should the phlebotomist do? A. Draw the patient quickly before he or she wakes up. B. Raise the head of the bed and shake the patient's arm. C. Turn on a bright light and say patient's name loudly. D. Wake the patient gently to avoid a startle reaction. 45. The first step in the testing process begins when the A. laboratory technician receives the sample. B. specimen.is collected from the patient. C. specimen is delivered to the laboratory. D. test is ordered by the healthcare provider. 46. If a venipuncture site is still bleeding after 5 minutes the phlebotomist should A. alert the patient's nurse or other healthcare provider. B. bandage the site and come back to check on it later. C. tell the patient to apply pressure for 15 minutes. D. wrap an elastic bandage tightly around the site. 47. What is the recommended angle of needle insertion for an antecubital vein and a hand vein, respectively? A. 20 degrees or less for arm and hand B. 25 degrees or less, 15 degrees or less C. 30 degrees or less, 10 degrees or less D. 40 degrees or less, 20 degrees or less 48. An elderly patient arrives at an outpatient clinic for a blood draw. He is accompanied by his daughter, who mentions that he is hard of hearing. How should the phlebotomist proceed? A. Address all questions directly to the patient's daughter. B. Get close to the patient's face and speak very loudly. C. Repeat every question and statement twice. D. Speak distinctly in a normal tone of voice. 49. A tourniquet used for venipuncture procedures should be A. applied 3 to 4 inches above the intended venipuncture site. B. tight enough to slow venous flow, but not affect arterial flow. C. snug, or slightly tight, but not uncomfortable to the patient. D. All of the options are correct. 50. A phlebotomist starts to perform a venipuncture. As the needle touches the skin, the patient moves his arm. The phlebotomist is startled and pulls the needle away from the arm. How should the phlebotomist proceed after apologizing to the patient? A. Anchor the vein, tell the patient not to move this time, and finish the draw. B. Clean the site again, anchor the vein, and complete the venipuncture. C. Replace the needle, clean the site, warn the patient, and finish the draw. D. Take a break and ask another phlebotomist to collect the specimen. 51. The phlebotomist has made two unsuccessful attempts to collect a fasting specimen from an outpatient. What should the phlebotomist do next? A. Ask another phlebotomist to collect the specimen. B. Call a supervisor and ask permission to try again. C. Make a third attempt on the patient’s other arm. D. Tell the patient to come back the next morning. 52. An additive tube should be mixed A. after the next tube is placed in the holder. B. as soon as it is removed from the holder. C. when all the tubes have been collected. D. while the label is being put on the tube. 53.What length and gauge of needle most used for venipuncture? A) 1” 18gauge B) 1 ½ “16 gauge C) 1 ½ “, 21-23 gauge D) 1 ½”, 19-28 gauge 54.The lab manual indicates a group of chemistry tests require 4mL of serum. What is the minimum amount of blood and stopper color of vacuum tube/s should be selected? A)4ml lavender-stoppered tube B) 7ml gold- stoppered tube C) 10 ml gold-stoppered tube D) 4 ml lavender-stoppered tube 55.After collecting a group of chemistry tests requiring serum, the next step IMMEDIATELY after is to: A) Centrifuge the specimen for 15 minutes B) Stand the specimen upright position for 30 minutes C) Pipette the serum and place it in a transfer tube D) Gently rotate the tube 8 to 10 times 56.Which of the following tests would not be performed on a plasma or serum sample? A) Iron B) Lipoprotein electrophoresis C) Electrolytes D) Hemoglobin 57.What happens to the needle if an angle of less than 15 degrees for venipuncture? A) Enters above the vein B) Goes completely through the vein C) Break sand harms patient D) Penetrates a tendon 58.Which instance most closely resembles basal state? A patient who has. A) Been lying down for an hour B) Just arrived for a fasting blood test C) Just awakened after fasting all night D) Worked all night but did not eat at work 59.The MLA must draw blood specimen from a patient with IVs in both arms. Which is the best to do? Draw the specimen. A) Above an IV. B) Below an IV. C) From an ankle vein. D) From an IV. Chapter 09: Pre-examination/Preanalytical Considerations 60. Which instance most closely resembles basal state? A. A patient who has been lying down for an hour B. A patient who has just arrived for a fasting blood test C. A patient who has just awakened at 0600 after fasting all night D. A patient who has worked all night but did not eat at work 61. You must draw a protime specimen from a patient with IVs in both arms. Which of the following is the best thing to do? A. Draw the specimen above an IV. B. Draw the specimen below an IV. C. Draw the specimen from an ankle vein. D. Draw the specimen from an IV. 62. It is not a good idea to collect a CBC specimen from a screaming infant because the A. platelets are more likely to clump. B. specimen will be hemoconcentrated. C. specimen will be more likely to hemolyze. D. white blood count may be falsely elevated. 63. You have no choice but to draw a specimen from a site with a hematoma. Where should you obtain the specimen? A. Distal to the hematoma B. In the area of the hematoma C. Proximal to the hematoma D. None of the options is correct 64. Prolonged tourniquet application may cause a change in blood composition primarily because of A. hemoconcentration. B. hemoglobin. C. hemolysis. D. homeostasis. 65. Which of the following vascular access devices is placed in a peripheral vein for the purpose of blood collection and administration of medication? A. Fistula B. Heparin lock C. Implanted port D. PICC 66. A phlebotomist has attempted twice to draw a partial thromboplastin time (PTT) specimen from a patient with difficult veins. Both times the phlebotomist has been able to draw only a partial tube. What should the phlebotomist do? A. Collect the specimen by skin puncture. B. Have another phlebotomist attempt to draw the specimen. C. Pour the two tubes together and mix well. D. Submit the fullest tube for testing, noting the draw was difficult. 67. Why do pregnant patients have lower reference ranges for red blood cell counts? A. Body fluid increases in pregnancy, diluting red blood cells. B. Constant nausea leads to hemoconcentration of the blood. C. Poor appetite leads to transient anemia. D. The growing fetus uses up the mother's iron reserves. 68. Levels of which analyte can differ by 50% or more between morning and late afternoon? A. BUN B. CBC C. Cortisol D. Sodium 69. Which situation is the best way to tell that you may have accidentally punctured an artery? A. A hematoma starts to form. B. The blood obtained is dark red. C. The blood pulses into the tube. D. There is no way to tell. 70. If blood is drawn too quickly from a small vein, the vein will have a tendency to A. bruise. B. collapse. C. disintegrate. D. roll. 71. How long before obtaining blood for testing should drugs known to interfere with blood tests be discontinued? A. 1 to 4 hours B. 4 to 24 hours C. 24 to 36 hours D. 48 to 72 hours 72. A fistula is a(n) A. implanted port attached to an indwelling line. B. permanent fusion of an artery and a vein. C. special winged infusion set left in a patient's arm. D. temporary fusion of an artery and a vein. 73. When a test requires a fasting specimen, but the serum is __________, it is a clue that the patient was not fasting. A. hemoconcentrated B. hemolyzed C. jaundiced D. lipemic 74. Tests influenced by diurnal variation are often ordered as __________ tests, and it is important to collect them as close as possible to the time ordered. A. fasting B. postprandial C. STAT D. timed 75. Tattooed areas should be avoided as venipuncture sites because A. fresh tattoo sites may be more prone to infection. B. tattoos can mask an adverse reaction to the draw. C. there could be an undetected infection in that area. D. All of the options are correct. 76. An arm that is paralyzed has A. damage to the nerves. B. lost muscle function. C. no ability to feel pain. D. All of the options are correct. 77. Which of the following is the BEST way to avoid reflux when drawing a blood specimen? A. Fill tubes from the bottom up. B. Do not overfill additive tubes. C. Use the correct order of draw. D. All of the options are correct. 78. If a patient is complaining of sharp radiating pain from the needle insertion site, the phlebotomist should A. ask the patient if it is OK to continue. B. complete the draw and put ice on the site C. immediately terminate the venipuncture. D. tell the patient the pain will stop soon. 79. Hemolysis can erroneously elevate A. ammonia. B. magnesium. C. potassium. D. All of the options are correct. 80. A tube fails to fill with blood during a venipuncture. Which of the following might lead you to think that the vein has collapsed? A. A hematoma quickly starts to form at the site. B. The vein disappears when you engage the tube. C. There is a hissing sound as the tube is engaged. D. You sense a slight needle vibration or quiver. 81. The creatinine clearance rate decreases in elderly patients due to a normal decline in A. hormone levels. B. kidney function. C. physical activity. D. red blood cells. Chapter 10: Capillary Puncture Equipment, Principles and Procedures 82. A blood smear from an EDTA specimen should be made A. any time after collection. B. within 1 hour of collection. C. within 4 hours of collection. D. within 12 hours of collection. 83. Why are capillary blood gases less desirable than arterial blood gases (ABGs)? A. Skin puncture blood contains tissue fluid. B. Skin puncture blood is only partly arterial. C. The blood is exposed to air during collection. D. All of the options are correct. 84. What is the Clinical and Laboratory Standards Institute (CLSI) recommended maximum depth of heel puncture? A. 1.0 mm B. 1.4 mm C. 2.0 mm D. 2.4 mm 85. Why are EDTA specimens obtained before other specimens when collected by skin puncture? A. To minimize effects of platelet clumping B. To minimize tissue fluid contamination C. To prevent contamination from carryover D. To reduce negative effects of hemolysis 86. Why should a laboratory report form indicate the fact that a specimen has been collected by capillary puncture? A. Because test results can vary depending on the method of collection B. So that subsequent specimens will be collected by skin puncture also C. So that the patient's nurse can check the site for signs of infection D. To satisfy liability insurance requirements and for billing purposes 87. Which of the following is the safest area for infant heel puncture? A. The area of the arch B. The central area C. The lateral plantar surface D. The posterior curvature 88. A capillary puncture should be done rather than a venipuncture in all of the following situations EXCEPT when A. a child is less than 1 year old. B. a light-blue-top tube is needed. C. the patient has difficult veins. D. the test uses very little blood. 89. The purpose of wiping away the first drop of blood during skin puncture is to A. avoid bacterial contamination. B. eliminate tissue fluid contamination. C. minimize platelet aggregation. D. reduce effects of hemoconcentration. 90. Capillary puncture blood most closely resembles A. arterial blood. B. intracellular fluid. C. tissue fluid. D. venous blood. 91. Capillary puncture blood reference ranges are higher for which of the following analytes? A. Calcium B. Glucose C. Phosphorus D. Total protein 92. Which microtube would be used to collect a specimen for a CBC? A. Gray top B. Green top C. Purple top D. Red top 93. What is PKU? A. A contagious condition caused by a lack of phenylalanine B. A hereditary inability to metabolize phenylalanine C. An acquired condition caused by a lack of phenylalanine D. An inherited condition caused by a lack of thyroid hormone 94. It is necessary to control depth of lancet insertion during capillary puncture to avoid A. bacterial contamination. B. excessive bleeding. C. injuring the heel bone. D. puncturing an artery. 95. What is the purpose of warming the site before skin puncture? A. It is comforting to the patient. B. It increases blood flow up to seven times. C. It makes the veins more visible. D. It minimizes hemolysis of the specimen. 96. Which of the following is a preferred capillary puncture site? A. Earlobe B. Little finger C. Middle finger D. Thumb 97. If the alcohol is still wet when a capillary puncture is made it can A. cause hemolysis of the specimen. B. lead to errors in the testing process. C. prevent round drops from forming. D. All of the options are correct. 98. What causes a microhematocrit tube to fill with blood? A. Capillary action B. The pull of gravity C. Vacuum suction D. All of the options are correct. 99. Which of the following scenarios represents correct capillary puncture technique? A. Puncturing perpendicular to the fingerprint whorls B. Scooping up blood that is running down the finger C. Using povidone-iodine to clean the heel of an infant D. Wiping the alcohol dry so the puncture doesn't sting 100. Capillary puncture is the preferred method of obtaining blood from infants because A. capillary blood is preferred for some tests. B. removing tubes of blood can lead to anemia. C. venipuncture in infants may damage veins. D. All of the options are correct. 101. A laboratory report form should indicate when a specimen has been collected by capillary puncture because A. repeat tests will need to use capillary blood. B. some test results vary with specimen source. C. the information helps with inventory control. D. risk management requires that information. 102.The purpose of warming the heel before capillary blood gas collection is to: A. comfort and calm the infant. B. reduce effects of platelet clumping. C. minimize tissue fluid contamination. D. help arterialize the specimen. 103.Newborn screening tests primarily detect: A. elevated bilirubin levels B. contagious diseases. C. inherited disorders D. glucose metabolism issues. 104.Several blood specimens and a slide are being collected by capillary puncture. How is the slide made? A. last to avoid the effects of tissue thromboplastin. B. from an EDTA specimen upon return to the lab. C. after EDTA containers but before serum ones. D. first to avoid the effects of platelet clumping. 105.What does platelet clumping on a blood smear made from an EDTA specimen indicate? A. specimen has micro clots in it. B. patient has a clotting disorder. C. tube was incompletely filled. D. EDTA tube was contaminated. 106.When collecting specimens from a newborn's heel, which specimen is collected first? A. bilirubin B. CBC C. PKU D. glucose Chapter 11: Special Collections and Point-of-Care Testing 107. Of the following tests, which is MOST likely to result in fatal consequences if the patient is misidentified? A. Blood cultures B. Drug screen C. Postprandial glucose D. Type and crossmatch 108. Which test requires strict skin antisepsis procedures before specimen collection? A. Blood culture B. Blood urea nitrogen C. Complete blood count D. Type and crossmatch 109. What type of additive is recommended for collecting an ethanol test specimen? A. EDTA B. No additive C. Sodium citrate D. Sodium fluoride 110. When performing a GTT, the timing should begin A. as soon as the patient finishes the drink. B. one-half hour after the drink is finished. C. right after the patient arrives in the lab. D. when the fasting specimen is collected. 111. According to CLSI, _______________is the recommended blood culture site skin disinfectant for infants 2 months and older. A. povodine-iodine B. benzalkonium chloride C. chlorhexidine gluconate D. 70% isopropyl alcohol 112. To prevent introducing a contaminating substance into a trace-element collection tube, it is suggested that the phlebotomist A. collect the trace-element tube last in the order of draw. B. draw it by itself using a syringe or evacuated tube system. C. use a syringe and transfer blood into the royal-blue-top tube last. D. use only a royal-blue-top short-draw tube with heparin or EDTA. 113. All POC glucose analyzers approved for hospital use have which of the following in common? A. They have the ability to use capillary, venous, or arterial blood samples. B. Data can be downloaded to a data management program. C. They require the use of an authorized operator ID number. D. All of the options are correct. 114. When collecting a blood culture specimen directly from a butterfly into blood culture bottles, which should be filled first? A. Aerobic B. Anaerobic C. Either aerobic or anaerobic, it does not matter D. Neither aerobic or anaerobic; a discard tube must be drawn first 115. A chain of custody is A. a special protocol used when collecting forensic specimens. B. necessary in patient management for therapeutic phlebotomy. C. required for the POC quality assurance program for nursing. D. part of the type and crossmatch procedure for blood bank. 116. For which condition is a unit of blood withdrawn from a patient as treatment? A. Acute leukemia B. Autologous donation C. Hemochromatosis D. Rh incompatibility 117. Which of the following tubes can be used to collect blood for a type and crossmatch? A. ETS gray top B. Pink top C. Royal blue top D. Gel barrier 118. An autologous blood transfusion is a transfusion of blood A. directly from the donor to the patient. B. donated by the patient for the patient. C. donated by a compatible relative. D. given by an anonymous donor. 119. The most critical aspect of blood culture collection is A. the amount of specimen. B. skin antisepsis. C. specimen handling. D. the needle gauge. 120. Which test requires a specimen with a 9:1 ratio of blood to anticoagulant? A. Ethanol B. Glycohemoglobin C. Prothrombin time D. Red cell count 121. TDM is used by physicians to A. determine a beneficial drug dosage for a patient. B. maintain “peak” levels of a drug in a patient's system. C. maintain “trough” levels of a drug in a patient's system. D. screen inpatients for abuse of prescriptive drugs. 122. A 2-hour postprandial specimen should be drawn A. 2 hours before the patient arrives for the test B. 2 hours after the patient arrives for the test C. 2 hours before the patient has eaten a meal D. 2 hours after the patient finishes eating a meal 123. Which one of the following tests could be collected using a tube other than a trace element– free tube? A. Copper B. Lead C. Sodium D. Zinc 124. The CAP requires QC for many waived tests to be performed A. before each patient test performed. B. daily and when a new kit is opened. C. on a weekly basis as a minimum. D. when the test manufacturer specifies. 125. What is the recommended disinfectant for blood culture sites in infants 2 months and older? A. Isopropyl alcohol swab B. Chlorhexidine gluconate C. Benzalkonium chloride D. Povidone–iodine swab 126. Which one of the following statements about autologous donations is NOT true? A. Blood can be collected up to 72 hours before surgery. B. Patients must have a written order from their physician. C. Unused autologous units may be used by other patients. D. Using the patient's own blood eliminates many risks. Chapter 12: Computers and Specimen Handling and Processing 127. A specimen would most likely be accepted for testing despite which of the following problems? A. Expired evacuated tube B. Incomplete identification C. No phlebotomist initials D. Quantity not sufficient 128. Which of the following is used by the laboratory to identify a specimen throughout the testing process? A. Accession number B. Hospital number C. Mnemonic code D. Password ID 129. A barcode is a A. coded instruction needed to control computer hardware. B. confidential computer code required by HIPAA. C. series of bars and spaces representing numbers or letters. D. unique number given to each test request for ID purposes. 130. A pneumatic tube is a A. pressurized air transportation system. B. temporary computer data storage unit. C. tube connection between two computers. D. type of collection tube for blood gases. 131. An example of a preanalytical error happening during specimen processing is A. faulty collection technique. B. inadequate centrifugation. C. insufficient specimen. D. patient stress and anxiety. 132. Transporting blood specimens with the stopper up has nothing to do with A. encouraging complete clot formation. B. maintaining the sterility of the sample. C. minimizing stopper-caused aerosols. D. reducing agitation-caused hemolysis. 133. Which of the following would NOT be considered a preanalytical error? A. Failing to mix an additive tube B. Mislabeling an aliquot tube C. Misreporting patient results D. Using the wrong order of draw 134. Which of these is a source of preanalytical error that occurs before specimen collection? A. Dehydrated patient B. Misidentified patient C. Mislabeled specimen D. Wrong collection time 135. Which of the following specimens needs to be chilled? A. Ammonia B. Bilirubin C. Cold agglutinin D. Serum protein 136. Which organization develops standards for specimen handling and processing? A. CDC B. CLIA C. CLSI D. FDA 137. According to CLSI, the maximum time limit for separating serum or plasma from cells is A. 15 minutes from the time of collection. B. 30 minutes from the time of collection. C. 1.0 hour from the time of collection. D. 2.0 hours from the time of collection. 138. Which statement describes proper centrifuge operation? A. Centrifuge serum specimens before they start to form noticeable clots. B. Never centrifuge both serum and plasma specimens in the same centrifuge. C. Place tubes of equal size and volume opposite one another for balance. D. Remove evacuated tube stoppers before placing them in the centrifuge. 139. Which specimen can be centrifuged immediately upon arrival in specimen processing? A. Blood culture in an SPS tube B. Calcium in a green top tube C. CBC in a lavender stopper tube D. Creatinine in an SST tube 140. What type of specimens must be processed before routine specimens? A. STAT B. ASAP C. Timed D. All of the options are correct. 141. Which of the following is the best way to prepare routine blood specimen tubes for transportation to an offsite lab? A. Place the tubes in ice slurry. B. Seal the tubes in plastic bags. C. Wipe each tube with alcohol. D. Wrap the tubes in the requisitions. 142. Clinical and Laboratory Standards Institute (CLSI) and Occupational Safety and Health Administration (OSHA) guidelines do not require specimen transport bags to have A. a visible biohazard logo. B. liquid-tight closure tops. C. shock-resistance features. D. slip pockets for paperwork. 143. Critical values (test values that are considered life threatening) are also called A. alarm values. B. at-risk values. C. panic values. D. unstable values. 144. A test sample that is not recommended to be sent in a pneumatic tube is A. alkaline phosphatase B. blood creatinine C. serum potassium D. total bilirubin 145.If there is a question concerning the principle behind a particular specimen collection, consult the A. QC logbook. B. Floor book. C. Policy manual. D. Procedure manual. 145.Which of the following actions may cause nerve damage during a venipuncture procedure? A. entering the vein using the least number of attempts B. applying tourniquet on the patient’s wrist C. probing blindly in the patient’s arm D. Choosing the venipuncture location carefully 147.Which of the following tests may be falsely increased by removing the stopper from a blood specimen?  A. ionized calcium B. acid phosphatase C. pH D. pCO2 148.Which of the following situations may cause petechiae? A. Reflux of collection tube additive B. Venipuncture at site of a hematoma C. Tourniquet tied too tightly D. Inadvertent arterial puncture 149.Why should the venipuncture from a paralyzed arm be avoided? A. increased chance of hematoma B. impaired blood flow from sclerosed vein C. skin is fragile and easy injured D. increased chance of vein thrombosis 150.What is the minimum number of evacuated tubes required to collect a CBC and a PT when using a winged infusion set? A. 1 B. 3 C. 4 D. 5 151.Which of the following processes maintains integrity of thermolabile analytes? A. protecting from light B. incubating C. aliquoting immediately D. chilling 152.Nonverbal signs of an anxious patient may include A. tight eyebrows, an intense frown, narrowed eyes, or a downcast mouth B. relaxed eyebrows, mild smile, no facial wrinkles C. Raised Eyebrows, jaw drops open, no frown D. Eye lids open, mouth open, straight look. 153.Which specimen can require chain-of-custody protocol? A. glucose B. ABGs  C. HIV D. ETOH 154.Gel separator tubes should not be used to collect specimens for: A. thyroid profile. B. electrolyte panel. C. creatine kinase. D. type and screen. 155.A 2 -hours postprandial glucose test is collected: A. 6 hours after a meal. B. 2 hours after a meal. C. 2 hour after a excercise. D. 2 hour before a meal. 156.A peak drug level: A. becomes the therapeutic level. B. screens for toxicity of the drug. C. occurs just before the next dose. D. identifies a half-life of the drug. 157.What special handling is required for a carotene specimen? A. Protect the specimen from light. B. No special handling is required. C. Place the specimen in ice slurry. D. Transport at body temperature. 158.Which test requires placing the blood specimen immediately in a 37° heat block? A. cryoglobulin B. plasminogen  C. ammonia D. bilirubin 159.What is the best way to transport specimen tubes? A. upside down B. stopper up C. in ice slurry D. horizontally 160. Which of the following minimizes evaporation from the serum specimen? A. Centrifuging the specimen for no more than 15 minutes B. Placing the specimen in the refrigerator after collection C. Leaving the stopper on the tube during centrifuging D. Using a serum separator tube to collect the specimen 161. You must draw a prothrombin time specimen from a patient with IVs in both arms. Which of the following is the best thing to do? A) Draw the specimen above an IV. B) Draw the specimen below an IV. C) Draw the specimen from an ankle vein. D) Draw the specimen from an IV. 162. It is not a good idea to collect a CBC specimen from a screaming infant because the A) platelets are more likely to clump. B) specimen will be hemoconcentrated. C) specimen will be more likely to hemolyze. D) white blood count may be falsely elevated. 163.. You have no choice but to draw a specimen from a site with a hematoma. Where should you obtain the specimen? A) Distal to the hematoma B) In the area of the hematoma C) Proximal to the hematoma D) None of the options is correct 164. Prolonged tourniquet application may cause a change in blood composition primarily because of A) hemoconcentration. B) hemoglobin. C) hemolysis. D) homeostasis. 165. Which of the following vascular access devices is placed in a peripheral vein for the purpose of blood collection and administration of medication? A) Fistula B) Heparin lock C) Implanted port D) PICC 166. A phlebotomist has attempted twice to draw a partial thromboplastin time (PTT) specimen from a patient with difficult veins. Both times the phlebotomist has been able to draw only a partial tube. What should the phlebotomist do? A) Collect the specimen by skin puncture. B) Have another phlebotomist attempt to draw the specimen. C) Pour the two tubes together and mix well. D) Submit the fullest tube for testing, noting the draw was difficult. 167. Why do pregnant patients have lower reference ranges for red blood cell counts? A) Body fluid increases in pregnancy, diluting red blood cells. B) Constant nausea leads to hemoconcentration of the blood. C) Poor appetite leads to transient anemia. D) The growing fetus uses up the mother's iron reserves. 168. Levels of which analyte can differ by 50% or more between morning and late afternoon? A) BUN B) CBC C) Cortisol D) Sodium 169. Which situation is the best way to tell that you may have accidentally punctured an artery? A) A hematoma starts to form. B) The blood obtained is dark red. C) The blood pulses into the tube. D) There is no way to tell. 170. If blood is drawn too quickly from a small vein, the vein will have a tendency to A) bruise. B) collapse. C) disintegrate. D) roll. 17 A fistula is a(n) 7 A) implanted port attached to an indwelling line. B) permanent fusion of an artery and a vein. C) special winged infusion set left in a patient's arm. D) temporary fusion of an artery and a vein. 178. When a test requires a fasting specimen, but the serum is __________, it is a clue that the patient was not fasting. A) hemoconcentrated B) hemolyzed C) jaundiced D) lipemic 179. Tattooed areas should be avoided as venipuncture sites because A) fresh tattoo sites may be more prone to infection. B) tattoos can mask an adverse reaction to the draw. C) there could be an undetected infection in that area. D) All of the options are correct. 180. An arm that is paralyzed has A) damage to the nerves. B) lost muscle function. C) no ability to feel pain. D) All of the options are correct. 181. Which of the following is the BEST way to avoid reflux when drawing a blood specimen? A) Fill tubes from the bottom up. B) Do not overfill additive tubes. C) Use the correct order of draw. D) All of the options are correct. 182. If a patient is complaining of sharp radiating pain from the needle insertion site, the phlebotomist should A) ask the patient if it is OK to continue. B) complete the draw and put ice on the site C) immediately terminate the venipuncture. D) tell the patient the pain will stop soon. 183. Hemolysis can erroneously elevate A) ammonia. B) magnesium. C) potassium. D) All of the options are correct. 184. A tube fails to fill with blood during a venipuncture. Which of the following might lead you to think that the vein has collapsed? A) A hematoma quickly starts to form at the site. B) The vein disappears when you engage the tube. C) There is a hissing sound as the tube is engaged. D) You sense a slight needle vibration or quiver.