Complete your Phlebotomy continuing education with these practice questions and answers. This guide covers blood collection procedures, infection control, patient identification, and safety protocols.

Q: General guidelines for cleaning up a spill include:

Answer: Cleaning up visible blood first, then disinfecting the entire area of potential contamination

Q: What is the name of the blood cell responsible for transporting oxygen and carbon dioxide?

Answer: Erythrocyte

Q: Name the blood vessels that flow from the heart to the body tissues, whose vessels walls contain smooth muscle?

Answer: Arterial blood vessels

Q: Name the three most common arm veins used in phlebotomy? digestive

Answer: Cephalic, median cubital, and basilic veins

Q: Where is the antecubital fossa located?

Answer: The bend of the elbow, front of the arm

Q: The human body’s largest filter; it is part of both the circulatory and digestive

Answer: The liver

Q: This system detects changes to the internal and external environments of the body and directs or coordinates a response

Answer: . The nervous system

Q: In what part of blood is fibrinogen found?

Answer: Plasma

Q: How long can the hepatitis B virus survive in dried blood?

Answer: b. Up to 1 week

Q: With regard to hand hygiene:

Answer: Hand hygiene should be performed upon entering and before exiting a patient’s room

Q: Which of these statements about respirators is true?

Answer: Before wearing a respirator, you must receive medical clearance and be fit-checked to a specific respirator

Q: Gloves:

Answer: Should be worn with nonprotein-based hand lotion only

Q: What is the correct order for removing personal protective equipment (PPE)?

Answer: Remove gown and gloves, perform hand hygiene, remove googles or face shield, remove mask or respirator, perform hand hygiene again

Q: With regard to isolation control measures, which of these statements accurately describe Standard Precautions?

Answer: The purpose of these precautions is to prevent transmission of pathogens regardless patient’s diagnosis or infection status

Q: s Which of these is true regarding testing with POCT instruments?

Answer: C. Adherence to guidelines regarding calibrating equipment, running controls, performing maintenance, and keeping records is essential for a PCT program

Q: There is a no need for quality assurance or controls when using POCT instruments 87. What is the most common hematology test performed via POCT? differential

Answer: Hemoglobin (Hgb)

Q: The rapid strep test is used to detect which of the following organisms?

Answer: Group A streptococcus

Q: organization by meeting and documenting established requirements, called: Programs that train phlebotomists receive accreditation or approval from a professional

Answer: Standards

Q: Which of these is accurate with regard to “informed consent” for phlebotomy procedure?

Answer: When a patient refuses, you should follow your institution’s policy to ensure that the patient’s physician is notified promptly

Q: As it relates to phlebotomists, what does patient confidentiality mean?

Answer: Discussions about specific patients should never occur in public areas such as elevators, hallways, or cafeterias

Q: What is the cause of iatrogenic anemia?

Answer: Excessive removal of blood at the request of a physician

Q: Which of these circumstances would require that a new sample be collected?

Answer: Unlabeled or mislabeled specimen

Q: A 10ml blood sample represents aboutof a newborn’s total blood volume.

Answer: 0.2%

Q: Which of the following is true concerning blood culture in infants and small children?

Answer: A sample of 1-5 ml is required for blood cultures in this group

Q: 83. What should you do when assigned to draw blood on a newborn whose ID bracelet does not list first name?

Answer: Draw the blood, using the hospital ID number as the ultimate proof of identity

Q: Which of the following are advised when drawing blood from geriatric patients?

Answer: Ease the patient’s anxiety by being friendly, empathetic and cheerful, taking time listen to and talk with him or her

Q: Regarding point-of-care testing (POCT):

Answer: POCT is also known as alternate site testing

Q: When more than one blood test is requested:

Answer: The proper order of draw must be observed in order to reduce the risk of transferring material from an earlier tube to a later tube.

Q: If your patient who requires a blood draw is sleeping, what should you do?

Answer: Gently try to wake the patient and give him/her time to get oriented, confirm identity, and give informed consent before starting the draw.

Q: Which of the following sites should not be used for venipuncture?

Answer: Arms with an IV device in place, unless no other sites are available

Q: 75. What are some effects of leaving a tourniquet on for more than 1 minute?

Answer: Leaving a tourniquet on for more than 1-minute results in hemoconcentration

Q: Regarding syncope (fainting) during venipuncture:

Answer: If the patient is conscious but woozy, have him/her lower the head between the knees, and apply a cold compress to the neck or forehead

Q: Which of the following may cause hemolysis (rupture of red blood cells)? a.

Answer: Excessively shaking or rotating the blood

Q: Which of these tests are seriously affected by hemolysis?

Answer: Aspartate aminotransferase, potassium, and lactate dehydrogenase

Q: What are typical criteria for rejection of an ABG specimen?

Answer: Improper or absent patient identification Inadequate volume of specimen for the requested tests Air bubbles in the specimen Any of the above

Q: With regard to phlebotomy trays: a.

Answer: month Never place your tray on the patient’s bed or bedside eating table will

Q: pathogens such as methicillin-resistant Staphylococcus aureus (MRSA)? Which CLSI standard reduces the risk of pathogen transmission between patients, including skin

Answer: Dispose of the tourniquet once it has been used

Q: Which of these statements is true with regard to antiseptics used to clean the patient’s skin before venipuncture?

Answer: For maximal effectiveness, 70% isopropyl alcohol should be left in contact with the skin for 30-60 seconds

Q: d. With regards to needle shafts:

Answer: c. A small needle is less damaging to tissue, but collection is slower and the blood cells may be hemolyzed while passing through the narrower opening.

Q: Under what circumstances would you be most likely to use a winged infusion set butterfly?

Answer: When drawing blood from a hand vein or a geriatric or pediatric patient

Q: Which of the following is accurate regarding collection tubes made of glass?

Answer: Glass acts as a strong activator of platelets

Q: 58. Which statement is NOT true about the collection of serious fluid?

Answer: physician Fluid is collected in non-anticoagulant tubes for bacterial culture.

Q: What are characteristics of tissue specimens (biopsy specimens)?

Answer: Tissue specimens are not easily re-collected if improper handling ruins the sample. Biopsy procedures are expensive and uncomfortable for the patient Tissues for genetic analysis should not be placed in formalin

Q: formalin What statements are true about site selection for arterial puncture?

Answer: The more accessible and larger the artery, the easier it is to palpate and puncture The presence of collateral circulation is the primary site selection criterion

Q: Why is the ulnar artery considered “off limits” for use as an arterial puncture site?

Answer: Should the radial artery be accidentally damaged from an arterial puncture, the ulnar artery would still supply blood to the hand

Q: What are steps in performing a puncture of the radial artery?

Answer: Following the withdrawal of the needle and application of pressure by the phlebotomist for 3-5 minutes, the puncture site should be checked for bleeding, swelling, or bruising, and do not leave the patient until all bleeding has stopped.

Q: What might extreme pain during arterial puncture indicate?

Answer: Nerve involvement

Q: What is the accepted anticoagulant for collection of arterial blood gas (ABG) specimens?

Answer: Heparin

Q: Which of these are required when drawing a blood sample for the blood bank?

Answer: Patient’s full name, including middle initial Patient’s hospital ID number (or social security number for outpatients)

Q: What is the blood culture site disinfectant recommended by CLSI for infants two months and older and for patients with iodine sensitivity?

Answer: Chlorhexidine gluconate.

Q: Providone/iodine What substance is tested for in the lactose tolerance test?

Answer: Glucose

Q: Which test is ordinarily the first to be performed to exclude parentage/paternity?

Answer: ABO and Rh testing sampling

Q: What considerations need to be made in terms of therapeutic drug monitoring?

Answer: Trough levels are usually drawn immediately prior to administration of the next scheduled dose. Aminoglycoside drugs (e.g. gentamicin, amikacin, vancomycin) have short half-lives, so specimen collection timing is very critical for these drugs.

Q: 57. What body fluid is increasingly being used to monitor hormone levels and to detect alcohol and drug abuse?

Answer: Saliva

Q: When obtaining specimens by capillary puncture, what is the order of draw recommended the CLSI?

Answer: Blood gas specimens, then EDTA specimens, followed by all other additive specimens, with serum specimens last.

Q: Which statement is correct regarding precautions for performing finger puncture?

Answer: punctures should not be performed on infants or children under 1 year of because of the risk of complications.

Q: What are precautions to be observed when performing a hell puncture?

Answer: Do not puncture any deeper than 2mm Do not puncture between the medial and lateral areas of the heel

Q: What are considerations concerning capillary blood gas specimens?

Answer: Warming the site for 5-10 minutes will increase blood flow and will help to arterialize the specimen Capillary specimens are of only partial arterial composition c. Capillary specimens are temporarily exposed to air during collection, which can alter test results.

Q: What genetic disorder requires that newborn/neonatal screening (NBS) specimens be drawn shortly after birth and that another specimen is collected when the infant is about two weeks old?

Answer: Phenyiketonuria

Q: Of the following information, which item is NOT required to appear on a test requisition?

Answer: Patients height and weight.

Q: When drawing blood at the patient’s bedside:

Answer: Place the phlebotomy tray on the patient’s bedside table

Q: With regard to common phlebotomy additives, their functions, uses, and limitations, it is true that:

Answer: Sodium citrate binds or chelates calcium

Q: maximize patient comfort, provide good blood flow, and minimize the potential for a hemolyzed sample, the preferred needle size for routine blood draws is:

Answer: 22 to 23 gauge

Q: A needle/syringe assembly (Choose best that apply. There may be multiple answers):

Answer: d. Assists the phlebotomist in recognizing that the vein has been entered by showing a “flash” of blood into the hub of the syringe.

Q: 6. Standard Precautions included:

Answer: The assumption that all human blood and certain body fluids care treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens. Wearing gloves whenever contact with body substances, mucous membranes, or nonintact skin is possible. Refraining from all direct patient contact and the handling of patient care equipment if the phlebotomist has a weeping rash.

Q: Preanalytical errors (those errors that occur during the collecting and processing phases of laboratory practice) account for what percentage of errors that can affect the test results?

Answer: Up to 56%

Q: The most important step in the specimen collection process is:

Answer: Proper patient identification

Q: Arm identification bracelets:

Answer: Must be attached to the patient in order to be used as a means of identification.

Q: 10. In the case of outpatient identification, the clinical and laboratory standards institute (CLSI) (formerly the National Committee for Clinical Laboratory Standards- NCCLS) requires that the phlebotomist: a.

Answer: Ask the patient to state his/her full name, address, date of birth and/or unique identification number. Compare the information provided with the information on the request form.

Q: Mastectomy patients present special problems due to:

Answer: Infection in the affected limb that can result in extreme pain from edema, which can last for months. Higher concentrations of lymphocytes and waste products normal contained in the lymph fluid Lymphostasis in the affected limb.

Q: If a blood pressure cuff is used as a tourniquet, and the patient’s diastolic blood pressure is not known, inflate the cut to mm Hg.

Answer: C. 40

Q: 13. Of the three veins in the antecubital area, the preferred vein is the:

Answer: Medial vein

Q: 14. Nerve injuries associated with venipuncture in the antecubital area may result from venipuncture attempts to the:

Answer: Basilic vein

Q: The brachial artery lies in close proximity to the:

Answer: Basilic vein

Q: When using a tourniquet:

Answer: It should be loosened if it has been in place longer than one minute during vein selection. Hemoconcentration must be avoided since it can alter the specimen before it is even collected. Skin markers such as moles, skin creases, freckles, etc, may be valuable in relocating a vein when reapplying the tourniquet.

Q: Minimum fill requirements: a.

Answer: Are the primary responsibility of the phlebotomist. Do not apply to tubes without additives, Indicate that a sodium citrate (blue stopper) tube must be filled to at least 90% when submitted for a PTT testing

Q: The use of needles without safety features is prohibited by the:

Answer: Occupational safety and health administration (OSHA)

Q: Factors to be considered in the order of collection of blood samples include the fact that:

Answer: Carryover of blood from a lavender top tube to a red-topped serum/gel tube may affect the potassium result in the second tube. The tops of blood collection tubes are not sterile. Contamination of a blood culture bottle may result in a false-positive blood culture report that might necessitate lengthened hospital stay and unnecessary medication for the patient

Q: In the event that the patient shows signs of vertigo or of fainting, the phlebotomist should:

Answer: Remove the needle from the vein, apply pressure to the puncture site, and safely dispose of the blood collection equipment Place a cold compress on the patient’s forehead or the back of the neck. Call for assistance without leaving the patient’s side.

Q: Hemolysis:

Answer: Falsely lowers the red blood cell count and hematocrit Releases the contents of the red blood cell into the serum or plasma, falsely elevating test results for a number of chemical constituents. Is the most common reason that laboratories reject blood specimens.

Q: Methods that can be employed to prevent the shock reflex in needle- phobic patients include:

Answer: Having the patlent take a sedating or calming medication a half-hour or so before the blood test.

Q: General considerations regarding performance of a venipuncture include the fact that:

Answer: Toddlers, children, and adolescents require an approach that is sensitive to fear and paranoia Elderly patients may have some hearing loss or be in various stages of dementia or Alzheimer’s disease.

Q: With respect to venipuncture sites, which of the following statements are true?

Answer: Blood samples drawn from edematous sites may not reflect the physiology of the patient in general. Veins that are sclerosed due to disease, chemotherapy, or IV drug use may have impaired circulation. A heparin/saline lock should never be used for obtaining specimens for coagulation studies

Q: With regard to drawing near IV sites, select the correct statements:

Answer: Obtaining a blood sample below an IV site is permissible as long as the IV infusion has been shut off for at least two hours. When drawing below the V site, discard the first 5 cc of blood obtained. Drawing a sample above an IV site can result in diluted blood specimens that yield laboratory results completely inconsistent with the patient’s actual physiology.

Q: With respect to alternative venipuncture sites, select the correct statements:

Answer: Geriatric patients often have compromised hemostasis, so the phlebotomist must carefully examine the puncture site for oozing/bleeding. of the hand, it

Q: Drawing blood from a vascular access device (VAD) poses potential risks that include

Answer: Potential to introduce an air embolism Contamination of blood cultures and contamination with IV fluids high rate of hemolysis compared to venipunctures

Q: Regarding phlebotomy and total body blood volume of infants, which of the following statements are true?

Answer: One study showed that blood losses form diagnostic sampling constitute 45% of the total blood volume of the Infants studied. Patients lose 4 mg of iron for every 10 ml tube of blood drawn. 10 ml of blood drawn from a 1.1 pound premature infant constitutes 7,9% of the total blood volume.

Q: In comparing analyte concentrations in capillary vs venous blood, which of the following is true with respect to capillary blood:

Answer: Glucose is higher, but total protein is lower

Q: Applications for capillary blood collection include:

Answer: Newborn and geriatric patients. Point-of-care testing and patients performing tests at home Severely burned patients.

Q: lateral sides of the heel, the depth of the puncture must never exceed: 31. Heel punctures on infants must never be performed on the back of the heel; on the medial

Answer: 2.0mm

Q: The order of draw for capillary specimens

Answer: Lavender top (EDTA); tubes with other additives; tubes without additives

Q: Points to remember in performing a capillary blood collection include: a.

Answer: Orienting the puncture site vertically downward to aid the flow of blood directly into the collection tube Using only glass microhematocrit tubes

Q: Federal law mandates that neonatal screening consist of tests for:

Answer: Phenylketonuria (PKU) Hypothyroidism

Q: The chemical composition of arterial blood generally compares favorable with that of venous blood; some exceptions include levels of:

Answer: Ammonia Glucose 4. pH

Q: the preferred site for arterial puncture is the artery.

Answer: Radial

Q: The modified Allen test is performed to:

Answer: Establish that adequate collateral circulation exists in the wrist area prior to performing radial artery puncture

Q: 38. At the present time, is considered the preferred skin disinfectant for use in skin preparation for blood culture collection.

Answer: Chlorhexidine

Q: With regard to processing of blood cultures in the laboratory, which of these statements are true?

Answer: Agram’s stain is performed as soon as the specimen is received; if bacteria are seen, the physician is notified immediately. 3. Automated blood culture incubators monitor carbon dioxide production produced by the multiplying bacteria Excessive numbers of white blood cells (for example, in an overfilled sample bottle) can produce sufficient CO2 to trigger the automated system’s alarm, which would falsely indicate bacterial growth.

Q: Which type of sample is NOT included under the term “Standard Precautions”?

Answer: Sweat

Q: Misidentification of a patient: a.

Answer: May lead to malpractice lawsuit against the phlebotomist Can be grounds for dismissal of the person responsible Is especially serious in the case of a specimen for type and crossmatch prior to transfusion

Q: 42. Which of the following are the basic requirements for identification of a patient before performing routine blood collection?

Answer: b. Full name Date of birth

Q: 43. Which is the most important piece of identifying information that can be obtained from a patient identification bracelet (wrist band, ID band)?

Answer: Hospital ID number or medical record number

Q: What staments are true about warming devices?

Answer: Heel-warming devices are commercially available. A towel or diaper dampened with warm water can be used to warm a hand or foot before blood collection as long as it is not so hot that it scalds the patient.

Q: What are reasons that capillary puncture is the preferred method to obtain blood from infants and very young children?

Answer: Smaller volumes of blood are removed compared to venipunctures. Capillary puncture is easier than venipuncture, with less potential damage to veins and surrounding tissue. 4. Less restraint is required than when venipuncture is performed

Q: Which of these laboratory tests require that blood NOT be collected by capillary puncture? Most erythrocyte sedimentation rate methods

Answer: Most erythrocyte sedimentation rate methods Blood cultures Coagulation studies that require a plasma specimen.

Q: When obtaining specimens by capillary puncture, what is the order of draw recommended by the CLSI?

Answer: C. Blood gas specimens, then EDTA specimens, followed by all other additive specimens, with serum specimens last.

Q: Which statement is correct regarding precautions for performing finger puncture?

Answer: Finger punctures should not be performed on infants or children under 1 year of age because of the risk of complications.

Q: What are precautions to be observed when performing a hell puncture?

Answer: Do not puncture any deeper than 2mm Do not puncture between the medial and lateral areas of the heel they

Q: 50. What are considerations concerning capillary blood gas specimens? a.

Answer: Warming the site for 5-10 minutes will increase blood flow and will help to arterialize the specimen Capillary specimens are of only partial arterial composition Capillary specimens are temporarily exposed to air during collection, which can alter test results.