Phlebotomy Test Final Winter 2010
Name:
For the questions below list the order of draw according to tube color, number of tubes used and any
preparation needed such as inversion times and whether or not it is a fresh frozen specimen. You may
refer to your lab handouts as reference.
1. Your labs are as follows; TSH, Type and Cross, Lipid Panel, Blood Cultures
2. Your labs are as follows; Dilanitin level, Gentamyacin Peak, stat cardiac enzymes
3. Your labs are as follows; WBC, Hct (hematocrit), AST, ALT, PTT
4. Fasting 6 hour Glucose, Hgb A1C, Tegretol level
5. Serum Albumin, Alk Phos, Na, K, Cl, CO2, Albumin
6. Hepatic Function, T4, T3 uptake, CBC/Diff
7. Bili Direct, Bili Total, BUN(Blood urea nitrogen),
8. Blood Alcohol level, PT, Blood Cultures, Sickle cell
9. Serum Amylase, BMP, TIBC(total iron binding capacity), ESR
10. LDL, HDL, lithium level, ESR (erythrocyte sedimentation rate), IgG
11. Tegretol level, Vacomycin trough, Cardiac enzyme profile
12. Cre (creatinine), Ca, T3 uptake, Stat Electrolytes
13. HDL, Triglycerides, ALT, Phenobarbitol level, PTT
14. Renal Function, BMP (Basic Metabolic Profile), stat Myoglobin
15. WBC/Diff, Hgb, Theophylline level, Cl, Mg (Magnesium level)
16. Serum Dilantin level, Hemogram, Homocysteine
17. Lipid profile, IgM, IgE
18. PTT, CMP, Hepatits Profile
19. HgbA1C, 4 hour fasting Glucose, serum digoxin level
20. HCG Serum, Na, K, Hct
21. Electrolytes, Mg, Ca, Albumin, Erythrocyte count, blood alcohol level
22. HBsAG, CBC, Renal Function, stat cardiac enzymes
23. Blood alcohol level, PTT, PT
24. FSH, LDH, Dilantin level, Hgb, Serum HCG
25. ESR, BUN, CRE, PT, Alk Phos
26. HCG, Cardiac enzymes, Hgb A1C
27. HB core IgM, D. Bilirubin, PT
28. BNP, PSA, Rheumatoid Factor
29. GFR, ICA (ionized Calcium), C-Reactive Protein
30. AFP Maternal, Salicylate level, Acetaminophen level
31. Platelet Count, PT, RF
32. AST (SGOT), ABO/Rh, LH (luteninizing hormone)
33. PRG (Progesterone), Mg, Homocysteine
34. BMP, PTT, stat troponin
35. CMV IgM Antibody, CK Total, Iron, creatinine GFR,
36. Lead Blood level, Aldosterone, BMP
37. PTT, Blood Cultures, BUN
38. Epstein-Barr Abs, Blood Glucose Type and screen
39. HDL, WBC, Varicella IgG Ab
40. Theophylline level, Hep B surface Ab(HBSAB), fasting 2 hour glucose
The following questions are multiply choice and true or false, and matching
41. When performing a venipuncture, a number of things can go awry. However, a good
phlebotomist takes every precaution to eliminate error and protect both themselves and the
patient. Match the venipuncture errors with the probable cause.
a. Ischemia from cutting off circulation
1. Drawing in or near an infected site
b. Septicemia
2. Too deep of needle insertion
c. Hematoma
3. Improper pressure dressing
d. Bleeding out
4. Moving needle back and froth/side/side
e. Nerve injuries
5. Not sterilizing area/needle unsterile
f.
6. Tourniquet left on too long
Local infection
42. It doesn’t matter how long the needle is left uncapped.
a. True
b. False
43. When preparing to do a venipuncture for a blood alcohol level you would…
a. Prepare the site with an alcohol swab and let air dry.
b. Prepare the site with a betadine swab and let air dry.
c. Wash site with soap and water only.
44. When preparing to do a blood glucose level you would….
a. Prepare the site with an alcohol swab and let air dry.
b. Prepare the site with a betadine swab and let air dry.
c. Wash site with soap and water only.
45. It is preferable to always use a butterfly when drawing blood.
a. True
b. False
46. If a patient’s mentation changes while you are in the room you should..
a. Immediately call for assistance using the call light
b. Check patients breathing, airway, and pulse
c. Remain with the patient until help arrives
d. All of the above
47. Improper collection techniques can result in which of the following?
a. Death of the patient
b. Laboratory error
c. Omission of treatment due to improper lab results
d. Possible law suit
e. All of the above
48. A phlebotomist should record which of the following on their lab slips?
a. I.V. medication infusing
b. Anatomical draw site
c. Needle gage
d. Needle type, ie, butterfly, vs vaccutainer and needle
e. Patients comments
f.
All of the above
g. A, b, c, d, only
49. When drawing around a bandaged arm, you would..
a. Never draw around a bandaged arm because it could be infected
b. Attempt to draw lower than the bandage
c. Use a butterfly at a smaller angle
50. When using a tourniquet, you would…..
a. Lift up the patients sleeve and make sure that you can see the tourniquet at all times.
b. Place the tourniquet around the patient’s clothes to prevent injury.
c. Remove the tourniquet prior to finishing the draw.
d. All of the above
e. A and C only
51. Your shift begins at 6:30 AM, the following draws for the following four patients, you must do
before 8:00 Am. List the order of priority of your draws, color of tubes and any preparation
needed and number of tubes.
a. Blood cultures
b. Stat Cardiac enzymes
c. Routine CBC
d. Gentamycin Peak
52. You are assigned the following draws for one patient list the order of priority that you would
begin your draws.
Indicate the color of tubes, number of tubes and any preparation needed.
a. Type and cross match
b. Dilantin level
c. Stat lytes
d. Lipid profile
53. When drawing Stat Electrolytes, you would use which of the tubes?
a. Lithium Heparinized green tube
b. Sodium Heparinized green tube
c. Yellow tube
d. Litium heparinized pink tube
54. Troponin, and Mynoglobin levels are…
a. Usually stat
b. Cardiac labs
c. Time labs
d. All of the above
55. A patient is in your chair and you are drawing Dilantin levels. What signs and symptoms should
you watch for.
a. Blank stare
b. Tremors
c. Twitching
d. Convulsions
e. High blood pressure
f. A,b,c, and d only
56. Knowing that your patient is a diabetic, what is the most important concept that you must
ensure?
a. Sterility
b. Tube color
c. Comfort
57. A type and cross match is a test that…….
a. Used to identify the patient’s blood type
b. Requires a pink tube
c. Is usually a stat draw
d. Must be drawn first
e. All of the above
f.
A,B,and C only
58. How are blood culture bottles prepped for collection?
a. Aerobic first than anaerobic using a butterfly
b. Anaerobic firs then aerobic using a butterfly
c. Anaerobic first then aerobic using a vaccutainer
59. What would be the order of draw for a Glu, CBC, and chemistry profile
60. When drawing a Vancomycin Peak, you see that the patient still has medication infusing
through the IV. You would do which of the following?
a. Go ahead and draw the peak
b. Come back after medication has infused
c. Record the time that the medication will finish and add 35” minutes, then come back at that
time.
61. When a preservative tube is used, the blood component that is separated to the top is …
a. Serum
b. Plasma
c. Formed elements.
62. What is more important, feeling a vein or seeing a vein?
63. You have to draw a glucose on a patient that has total parenteral nutrition infusing. What must
you know about this type of infusion?
a. That the nurse must shut off the drip for 20 minutes
b. You must draw from the other arm if possible
c. If you were to draw from the patient prior to having the IV shut off, their glucose would be
at an abnormally high level.
d. All of the above
64. You are have the following draws for one patient; cardiac enzymes (stat), cbc, and blood
cultures. (list the order of draw, tube colors and any prep necessary.
65. The following preservative is in a purple top tube
a. Na fluoride
b. K Oxalate
c. K2 EDTA
66. The following preservative is in a gold top tube.
a. There is no preservative in a gold top tube, only a Silicon separator
b. Broth
c. Na Citrate
67. PT, PTT, and any of the Factor’s are considered
a. Coagulation studies
b. Hematology studies
c. Metabolic chemistry studies
68. Purple top tubes are used for which of the following studies?
a. Coagulation
b. Hematology
c. Metabolic
d. Glucose
69
Tube color
ADDITIVE
uses
Chemistries, Immunology and Serology,
Blood Bank (Crossmatch)
Tube color
ADDITIVE
Serum separator tube (SST) contains a gel
MODE OF
at the bottom to separate blood from
ACTION
serum on centrifugation
USES
Chemistries, Immunology and Serology
e.
f.
Purple
Top
ADDITIVE
MODE OF
Forms calcium salts to remove calcium
ACTION
USES
g.
Light Blue
Top
ADDITIVE
MODE OF
Forms calcium salts to remove calcium
ACTION
Coagulation tests (protime and
prothrombin time), full draw required
USES
h.
Green Top
ADDITIVE
MODE OF
Inactivates thrombin and thromboplastin
ACTION
For lithium level, use sodium heparin
For ammonia level, use sodium or lithium
heparin
USES
i.
j.
Light
Gray Top
ADDITIVE
MODE OF Antiglycolytic agent preserves glucose up
ACTION
to 5 days
Glucoses, requires full draw (may cause
hemolysis if short draw)
USES
k.
l.
Yellow ADDITIVE
MODE OF
Preserves viability of microorganisms
ACTION
USES
Microbiology - aerobes, anaerobes, fungi
m.
Pink Top
ADDITIVE
MODE OF
Forms calcium salts
ACTION
USES
Immunohematology
70) Whenever a glucose meter is cleansed or its battery
changed, it is crucial to ____________.
A.
B.
C.
D.
monitor values with quality control material
call a clinical laboratory scientist for assistance
double check the first three tests run afterward
notify the manufacturer for QC instructions
71)
3.) When using tubes with additives, how soon after
collection should mixing begin?
A.
B.
C.
D.
within 5 minutes
after all tubes are drawn
immediately
after the tubes clot
72.)
What technique should be incorporated to encourage
bleeding for an infant heelstick?
A.
B.
C.
D.
lancing with the grain
using an ice compress
pre-warming the foot
try multiple punctures
73.)
Personal integrity is expected of all health care
professionals and is exemplified by _____________.
A.
B.
C.
D.
doing what's right when no one is looking
getting things done before the shift is over
being on time or early for appointments
being a jack of all trades in the laboratory
74.)
When preparing to perform phlebotomy on a patient with a
complete hearing loss, it is best to
_______________________.
A.
B.
C.
D.
just draw the blood without saying anything
find an alternate means of communication with the patient
communicate only with his "hearing" visitor at the moment
speak very loudly to him during the entire process
75.)
In hospitals and clinics, the most frequently used needle
for drawing blood has a gauge of ______________.
A.
B.
C.
D.
15
18
21
24
76)  The blade of the lancet should:
1.
2.
3.
4.
?
?
?
?
Be held firmly against the skin
Be placed across the finger-print
Have a controlled depth
All of the above
77)  Skin punctures should not exceed a depth of:
1.
2.
3.
4.
?
?
?
?
3 mm
2 mm
1 mm
4 mm
78)  Capillary tubes used for collecting blood gases:
1.
2.
3.
4.
?
?
?
?
should be anticoagulated
should be collected before other samples
should be immediately placed on ice
all of the above
79)  The first drop of blood that forms following a skin puncture should be:
1.
2.
3.
4.
?
?
?
?
bright red
hemolyzed
wiped away
all of the above
80)  The following sites should not be used for collection of capillary samples:
1.
2.
3.
4.
?
?
?
?
baby finger
thumb
very side or tip of the finger
all of the above
81)  The first drop of blood that forms following skin puncture is wiped away because:
1.
2.
3.
4.
?
?
?
?
it contains excess tissue fluid
platelets have to be removed from the site
it may contain residual alcohol
both a) and c)
82)  Capillaries are located:
1.
2.
3.
4.
?
?
?
?
only in the antecubital fossa
less than 2 mm below the skin surface
both a) and b)
none of the above
83)  The venipuncture site generally stops bleeding because of:
1.
2.
3.
4.
?
?
?
?
fibrin clot formation and fibrinolysis
vasoconstriction and platelet plug formatmion
the adhesive bandage that is applied to the site
anticoagulants
84.) Identify the safest choices for vein selection:
1.
2.
3.
4.
?
?
?
?
basilic, median cubital, cephalic
cephalic, accessory cephalic, median cubital
great saphenous, cephalic, basilic
dorsal, basilic, median cubital
85)  Use of winged infusion sets are:
1.
2.
3.
4.
?
?
?
?
the major reason for needle-stick injuries
required for collecting skin puncture samples
required when the patient’s skin is extremely calloused
only to be used when collecting from the antecubital fossa area
86)  Bleeding time tests are performed to determine:
1.
2.
3.
4.
?
?
?
?
the platelet count
blood coagulation factor deficiencies
platelet function
all of the above
87.)  The following is a high risk procedure that should not be used by the phlebotomist:
1.
2.
3.
4.
?
?
?
?
inserting the needle at a 15-degree angle
anchoring the vein
collecting blood from the cephalic vein
probing
88)  The following practices may result in litigation:
1.
2.
3.
4.
?
?
?
?
injury to nerves
reflux of vacuum tube contents
injury to veins
all of the above
89)  Winged infusion sets are recommended:
1.
2.
3.
4.
?
?
?
?
for drug levels
when drawing blood from normal healthy veins
when drawing blood from from thin, fragile veins
for blood bank testing
90)  Tissue thromboplastin:
1.
2.
3.
4.
?
?
?
?
may interfere with coagulation studies
occurs during passage of the needle through the skin and tissue
affects PT and PTT testing
all of the above
91.)  Nerve compression may occur:
1.
2.
3.
4.
?
?
?
?
when blood is collected from the basilic vein
when the vein is transfixed
when blood leaks from the vein
all of the above
92.)  Nerve injury may be caused by:
1.
2.
3.
4.
?
?
?
?
nicking the nerve with the blood collection needle
severing the nerve with the blood collection needle
compression or pinching caused by a hematoma
all of the above
93)  It is acceptable to use winged infusion sets routinely:
1.
2.
3.
4.
?
?
?
?
for normal healthy veins
because I can’t hold the needle steady
to prevent hemolysis
none of the above
94)  While performing a venipuncture, the blood starts to flow into the tube and then stops.
What is/are the most likely causes?
1.
2.
3.
4.
?
?
?
?
the vein has collapsed
the tube vacuum is defective
the needle bevel is in the lumen of the vein
both a) and b)
95)  The following steps should be performed when the phlebotomist suspects nerve injury to
the patient:
1.
2.
3.
4.
?
?
?
?
immediately withdraw the needle
apply pressure to the site to prevent formation of a hematoma
document the incident
all of the above
96)  Knowing when to quit is an important aspect of venipuncture. What is the maximum
number of attempts that should be made to collect a specimen from a patient, before having
someone else attempt to collect the specimen?
1.
2.
3.
4.
?
?
?
?
once
twice
three times
until I get it
97)  The following is/are true concerning pre/trough and post/peak gentamicin levels:
1.
2.
? this drug is toxic and may cause damage to the kidneys and hearing
? pre- levels are collected to ensure that the previous dose has cleared before
administering the next dose
3. ? post- levels are collected to ensure that the dose is high enough to be effective but
not so high that it is toxic
4. ? all of the above
98.)  Glucose tolerance tests may be performed:
1.
2.
3.
4.
?
?
?
?
to assist in the diagnosis of diabetes mellitus
when patients have borderline fasting glucose results
when patients have borderline postprandial glucose results
all of the above
99.)  Technical errors that could result in litigation include the following:
1.
2.
3.
4.
incorrect angle of insertion
probing
placing the needle bevel in the lumen of the vein
both a) and b)
100.)  Which of the following is not considered a bloodborne pathogens:
1.
2.
3.
4.
TB
Hepatitis B virus (HBV)
Hepatitis C virus (HCV)
Human immunodeficiency virus (HIV)