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WorksheetsPractice exam for NHA
Total questions: 164
Worksheet time: 8hrs 12mins
For purposes of accreditation, clinical laboratories may be inspected by which of the following?
College of American Pathologists (CAP)
Clinical and Laboratory Standards Institute (CLSI)
Occupational Safety and Health Administration (OSHA
Centers for Disease Control and Prevention (CDC)
The agency that provides proficiency testing for the laboratory is the
Health Maintenance Organization (HMO)
Preferred Provider Organization (PPO)
College of American Pathologists (CAP)
Diagnosis-Related Group (DRG)
Which of the following should a blood collector NOT be tested for after an accidental needlestick?
Hepatitis B virus (HBV)
Human immunodeficiency virus (HIV)
Hepatitis C virus (HCV)
Rubella
Which of the following types of consent is most common in blood collection?
expressed
informed
consent for minors
implied
Collecting a large evacuated tube using a 23-gauge needle
May cause a hemolyzed specimen
Is recommended for geriatric pt
Is required for certain automated tests
May cause a loss of vacuum in the tube
Which of the following is the most acceptable order of tube draw?
Light blue, green, and lavender
Lavender, green, and light blue
Green, light blue, and lavender
Green, lavender, and light blue
Which of the following needles has the largest diameter?
16 gauge
18 gauge
20 gauge
22 gauge
The needle holder can be used as a needle safety device. True/ False
(a)
Which of the following is performed first when the last tube is collected?
Gauze is placed over the needle.
The filled tube is removed from the holder
The needle is removed
Pressure is applied to the site
If a patient refuses to have blood drawn, the blood collector should
Send another blood collector to collect the specimen.
Report the situation to the supervisor.
Return the requisition form to the laboratory.
Ask someone to hold the patient and collect the specimen.
Tubes are angled downward during blood collection to
Ensure they fill completely
Prevent patient discomfort
Prevent blood refluxing into the needle
Ensure mixing of blood and anticoagulant
When using a syringe to fill blood collection tubes
Fill all the evacuated tubes with the same needle used for collection.
Allow the evacuated tubes to fill according to the vacuum in the tube; do not force the plunger.
Activate the needle safety device after filling all the evacuated tubes with the blood transfer device.
Use the blood transfer device only for potentially combative patients.
Which of the following is not a preexamination variable?
Patient age
Patient height
Posture
Time of day
Which of the following may require a surgical procedure to relieve pressure?
nerve injury
hematoma
compartment syndrome
iatrogenic anemia
Patients are most likely to be in a basal state at
6am
10am
2pm
6pm
The best reason why the majority of patient specimens are drawn in the early morning hours is because
The patient will not be in the basal state early in the morning because this state requires several hours of normal physical activity by the patient.
Patients should have consumed a meal no less than 3 hours prior to the time of collection.
The patient will be in the basal state, having restrained from strenuous exercise and having fasted for approximately 12 hours.
Patients are generally more agreeable with collection times scheduled early in the morning.
When blood is inoculated into blood culture bottles using a winged blood collection set
The anaerobic bottle is inoculated first.
The safety device is activated first.
The aerobic bottle is inoculated first.
The volume of blood inoculated is increased.
The most important consideration when collecting a blood culture is
aseptic technique
the puncture site
minimizing the number of sticks
the amount of blood collected
To ensure patient safety and medication effectiveness, the blood levels of many therapeutic drugs are monitored. The specimens that are typically drawn to do this are
A trough level drawn before the next scheduled dose is given and a peak level drawn after the dose is given
A trough level drawn as a fasting specimen at 6:00 a.m. and a peak level drawn 2 hours later
A peak level drawn before the next scheduled dose is given and a trough level drawn after the dose is given
A peak level drawn as a fasting specimen at 6:00 a.m. and a trough level drawn 2 hours later
Which of the following decreases plasma volume and can make locating veins difficult?
muscle weakness
pt with alzheimer's disease
malnutrition
arthritic pt
Which of the following is not a microcollection container?
heparin capillary tubes
microtainer tubes
micropipettes
5mL syringe
Labels can be wrapped around microcollection tubes or groups of microhematocrit tubes.
True
False
Scraping a microcollection tube across the puncture site is acceptable if the first drop of blood has been wiped away
true
false
Puncture devices should be firmly placed on the skin before activation.
true
false
It is acceptable to use povidone-iodine instead of alcohol for dermal punctures.
True
False
To obtain the best flow of blood from a dermal puncture, the blood collector should
Alternately apply and release pressure to the site
Tightly squeeze the area above the site
Frequently wipe the site with alcohol
Firmly massage the area around the puncture site
Using a lancet that produces a puncture deeper than recommended may cause
Septicemia
Hemolysis
Osteomyelitis
Specimen contamination
Alternating between venipuncture and dermal puncture collection techniques is not recommended when comparing test results for
bilirubin
hemoglobin
reticulocytes
glucose
Which is the right way to handle specimens for filter paper newborn screening tests?
Stack specimens after drying
Dry specimens in sunlight
Suspend specimens horizontally to air dry.
Stack specimens while they are drying
A healthcare provider questions the low bilirubin result on a jaundiced baby. This discrepancy may be due to
Puncturing too deeply into the heel
Exposing the specimen to the bili light
Collecting blood in an amber container
Collecting too much blood
Point-of-care testing (POCT) is not routinely performed in which of the following areas?
Physician's office
Intensive care unit
Operating room
Comprehensive laboratory
A method used to monitor the accuracy of procedures is
Quality control
Quality management
Proficiency testing
Competency testing
Prevention of common point-of-care testing (POCT) errors include all of the following except
Correct patient identification
Documentation of results
Patient misconception
Result interpretation
Clinical Laboratory Improvement Amendments (CLIA) requires documentation of competency assessment for personnel performing point-of-care testing (POCT).
true
false
All of the following types of specimens can be analyzed with the HemoCue Glucose 201 Analyzer except
capillary blood
arterial blood
venous blood
urine
Which of the following is a disadvantage of point-of-care testing (POCT)?
Operators have few opportunities to maintain their skill level
Ease of use
Decreased specimen volume
Compliance with the Clinical Laboratory Improvement Amendments (CLIA)
According to Clinical Laboratory Improvement Amendments (CLIA), a test that can be purchased over the counter for home use is called
waived
moderate complexity
inaccurate
high complexity
A procedure manual differs from a package insert by containing
Reagent storage requirements
Sources of error
Test procedure steps
Instructions for recording results
When are test results are available using the HbA1c analyzer?
30 sec
1 min
2 min
3 min
Which of the following professionals cannot perform provider-performed microscopy procedures (PPMPs)?
physicians
phlebotomists
nurse practitioners
dentists
Implanted ports are used only for administration of chemotherapy and cannot be used for blood collection.
true
false
The most common all-purpose peripheral IV catheter is
14 gauge
16 gauge
20 gauge
24 gauge
Blood can be routinely collected from a midline peripheral catheter.
true
false
Why is it necessary to flush peripheral IVs and central venous catheters (CVCs)
To maintain patency of the catheter
To make sure medications are mixed
To prevent hemolysis of specimen
To ensure the catheter tip is clean
Flushing peripheral IVs and central venous catheters (CVCs) is performed to maintain patency of the catheter.
true
false
Central venous catheters (CVCs) are inserted into the
Superior vena cava
Basilic vein
radial artery
Brachial artery
Blood cannot be drawn from a peripherally inserted central catheter (PICC) line that is infusing total parenteral nutrition (TPN).
True
False
When drawing blood from a central venous catheter (CVC)
A syringe larger than 20 mL must be used.
Heparin is first injected into the catheter.
The first 5 mL of blood is always discarded
A double or triple lumen catheter must be present.
20 mL of blood must be discarded or used for other tests before drawing blood for
Blood cultures
Coagulations tests
Chemistry tests
Hematology tests
Peripheral access devices include peripheral IV lines and midline peripheral catheters.
True
False
What does the term venipuncture refer to in phlebotomy
Drawing blood from a vein
Inserting a needle into an artery
Collecting blood from a capillary
Administering medications through an IV line
Which of the following terms refers to the liquid portion of blood after it has clotted and the clot has been removed?
Plasma
Serum
Erythrocytes
Leukocytes
What is the medical term for a bruise that occurs when the blood leaks out of a vein and into the surrounding tissue?
Hematoma
Thrombosis
Petechiae
Ecchymosis
Which of the following terms describe the process of stopping bleeding
Hemostasis
Anticoagulation
Coagulation
Hemolysis
What does the term anticoagulant refer to in phlebotomy
A substance that prevents blood clotting
A substance that promotes blood clotting
A type of blood cell
A method of collecting blood samples
Which term describes the process of disinfecting the skin before performing venipuncture
Sterilization
Antiseptic
Hemolysis
Hemostasis
What is the medical term for the liquid portion of blood that remains after clotting and contains clotting factors?
Plasma
Serum
Erythrocytes
Leukocytes
What does the term phlebotomist refer to
A healthcare professional trained to draw blood
A type of blood cell
An instruments used to collect blood samples
A medication used to prevent blood clotting
Which is the term for the process of removing RBC from a blood sample to obtain a plasma sample?
hemolysis
centrifugation
Hemostasis
Coagulation
What does the term hematoma refer to in phlebotomy
Collecting of blood outside of blood vessels
Clotting of blood within a blood vessel
Abnormally low number of RBCs
Increased number of WBCs in the blood
What is the primary purpose of phlebotomy
To administer medications
To collect blood for testing
To provide IV fluids
To sterilize instruments
Which vein is most commonly used for venipuncture
Brachial vein
femoral vein
cephalic vein
median cubital vein
what is the proper angle for needle insertion during a venipuncture
10-15 degrees
15-30 degrees
30-45 degrees
45-60 degrees
How should a phlebotomist identify a conscious pt before collecting blood
Ask the nurse to verify
Check the room number
Ask the pt to state their name and DOB
Use the pt clothing tag
What is the most effective way to prevent the spread of infection
wearing gloves
using hand sanitizer
washing hands with soap and water
wearing a face shield
what PPE is required when performing a blood draw
gloves only
gloves, lab coat, and googles
gloves and lab coat
gloves and face mask
where should used needles be disposed of
regular trash bin
red biohazard bag
sharps container
sink disposal
What should a phlebotomist do if they experience a needle stick injury
Keep working and repot it later
Wash the area, report to supervisor, and follow protocol
finish the draw and go home
ignore it unless symptoms appear
which agency is responsible for enforcing workplace safety
FDA
OSHA
CDC
CMS
what does CLIA regulate
waste disposable
medical billing
laboratory testing quality
health insurance claims
The blood borne pathogens standard is issued by
CDC
WHO
OSHA
NIH
what is required before performing a venipuncture on a pt
written consent from a physician
implied or informed consent from a pt
verbal order from a nurse
approval from family
which of the following could be considered negligence
Documenting all steps of the procedure
performing a blood draw without gloves
explaining the procedure to the pt
using hand sanitizer after removing gloves
what is HIPAA designed to protect
pt test results
lab equipment
phlebotomist licensing
sample collecting order
a pt refused a blood draw. what should the phlebotomist do
restrain the pt
notify the provider and document the refusal
proceed with collection carefully
leave and discard the supplies
what is the first step when preparing to draw blood from a pt
apply the tourniquet
introduce yourself and verify patient identification
select the correct needle size
cleanse the site with alcohol
which of the following is the proper order draw for venipuncture tubes
blue, red, green, lavender
red, green, blue, lavender
blue, red, lavender, green
lavender, blue, red, green
what is the most common site for venipucture
Basilic vein
Cephalic vein
Median cubital vein
Jugular vein
what should you do if a pt has a history of fainting during blood draws
ask them to lie down before the draw
use a smaller needle
have the pt drink extra fluids beforehand
perform the draw quickly to minimize discomfort
What is the purpose of applying a tourniquet
to locate the vein
to prevent blood from clotting
to increase blood flow
to cause the veins to dilate
which of the following is the most important action to take before drawing blood from a pt
ask the pt if they have any allergies
verify the pt identity using at least 2 identifiers
apply the tourniquet tightly to the arm
sterilize the needle with alcohol
what angle should the needle be inserted for a standard venipuncture
15 to 30 degrees
45 to 60 degrees
90 degrees
5 to 10 degrees
what is the purpose of the antiseptic wipe used before drawing blood
to increase blood flow
to reduce the risk of infection
to decrease pain
to prevent the needle from bending
what should you do if you accidentally puncture an artery instead of a vein
remove the needle immediately and apply pressure
continue to procedure as usual
switch to the other arm
use a larger needle
what is the recommended way to dispose of a used needle
throw it in the regular trash
place it in a sharps container
place it in a biohazard bag
re cap the needle and dispose of it
when should you release the tourniquet after the needle has been inserted
after the blood flow starts
immediately before inserting the needle
when the needle is removed
5 min after the blood has been drawn
what is the term for the procedure of drawing blood from a vein
phlebotomy
venipuncture
arterial puncture
capillary collection
what is the most appropriate action if a blood sample is collected but the pt start to feel faint
ask the pt to sit up slowly
remove the needle quickly and apply pressure
ask the pt to take deep breaths
immediately stop the procedure and call for help
which of the following veins should be avoided for venipuncture
median cubital vein
cephalic vein
basilic vein
jugular vein
what should you do if a hematoma develops during a blood draw
remove the needle and apply pressure to the site
leave the needle in place and apply ice
continue with the procedure
use a larger needle to draw blood
what is the purpose of using a butterfly needle
for smaller veins or when drawing blood from pediatric pt
to speed up the blood draw process
to minimize the pain for the pt
for drawing arterial blood gases
what should be done if blood flow is slow or stops during a venipuncture
slightly adjust the angle of the needle
withdraw the needle and try another site
apply more pressure on the tourniquet
ask the other to squeeze their fist
what is the recommended method for ensuring for ensuring pt comfort during blood collection
speak to the pt in a calm reassuring voice
perform the blood draw quickly as possible
ask the pt to relax after the needle insertion
apply an ice pack before the procedure
what is the correct procedure for collecting blood from a pediatric pt
use a larger needle for faster collection
perform the procedure with the child sitting up
use a butterfly needle and avoid veins in the hand
ask the child to lie down during the procedure
what should you do if a blood collection tube breaks during a draw
leave the area and notify a supervisor immediately
continue the blood draw using another tube
dispose of the broken tube and use a new one
try to collect blood with another tube from the same site
which of the following is a pre analytical variable that can affect lab results
analyzer calibration
specimen hemolysis
physician interpretation
data entry error
which of the following pt condition can affect lab test results and should be documented
pt marital status
recent exercise
favorite food
religious beliefs
what is the most likely cause of a hematoma during venipuncture
using a butterfly needle
excessive tourniquet time
failure to apply adequate pressure after needle removal
choosing a large vein
which factor may cause hemoconcentration during venipuncture
drawing blood without a tourniquet
leaving the tourniquet on for more than 1 min
collecting blood from a fasting pt
using a 23 gauge needle
A lipemia specimen appears
clear and colorless
dark red with clots
cloudy or milky
yellow and transparent
which complication is most likely to occur if a pt is not properly identified before a blood draw
vasovagal response
hemolysis
misdiagnosis due to incorrect results
hematoma
what should you do if a patient reports feeling faint during a blood draw
continue the procedure quickly
ignore the pt
stop the procedure and lower their head
draw blood while the pt is standing
which is NOT a preexamination variable
posture
patients gender
time of specimen collection
tube inversion after collection
A tourniquet should be left on for at least 3 min to ensure good blood flow
true
false
Hemolysis can result from using a small need or shaking the tube too vigorously
true
false
Drawing blood from a site with an IV may lead to inaccurate test results
True
False
A fasting blood test requires the pt to avoid food for at least 8 hours
True
False
syncope is a common complications during venipuncture
true
false
preanalytical errors are responsible for the majority of laboratory mistakes
True
False
which of the following is the preferred site for a dermal puncture in adults
earlobe
heel
fingertip(middle or ring finger)
thumb
when collecting a blood culture which of the following steps must be completed first
apply the tourniquet
clean site with alcohol
clean site with chlorhexidine
insert the needle
which of the following additives is typically used in blood culture bottles
EDTA
sodium citrate
SPS (sodium polyanethol sulfonate)
heparin
what is the maximum acceptable depth for a heel stick in an infant
2.4 mm
1.0 mm
2.0 mm
1.5 mm
which of the following tests requires a chain of custody
glucose tolerance test
blood culture
blood alcohol level
coagulation profile
which blood specimen is most affected by hemolysis from squeezing during capillary collection
hemoglobin
bilirubin
glucose
potassium
which tube should be filled first during a dermal puncture collection
lavender top
green top
red top
light blue top
what is the purpose of performing a modified Allen test before arterial puncture
to identify veins
to ensure ulnar circulation is adequate
to test oxygen saturation
to check for infection
how long should the site be cleaned with chlorhexidine for blood cultures
15 sec
30 sec
1 min
5 sec
which of the following must be done when collecting blood for glucose tolerance testing
use a butterfly needle
collect in red top tubes
record the exact time of collection
store the specimen at room temp only
what its the most common complication of arterial puncture
infection
nerve damage
hematoma
hemoconcentration
which specimen must be protected form light
blood cultures
bilirubin
electrolytes
complete blood count
what is the proper angle for arterial puncture in the radial artery
15-20 degrees
30-45 degrees
90 degrees
10-15 degrees
when performing a capillary puncture on an infant where should it be done
central heel
posterior curvature of the heel
lateral or medial plantar surface
big toe
which of the following conditions may require special handling of the blood specimen
iron studies
lipid panel
cold agglutination test
glucose test
which vein is most commonly used for routine venipuncture
basilic
cephalic
median cubital
dorsal metacarpal
before performing venipuncture the phlebotomist must always
sanitize the gloves
palpate the vein with the same hand used for the draw
verify the pt identity using two identifiers
ask the pt to confirm the test ordered
what angle should the needle be inserted during a venipuncture in the antecubital area
10-15 degrees
15-30 degrees
45-60 degrees
60-90 degrees
which action should be taken if a hematoma begins to form during venipuncture
apply heat
continue the draw
remove needle and apply pressure
ask the other to elevate arm
what is the correct order of draw using an evacuated tubes
red, blue, green, lavender, yellow
blue, red, green, lavender, gray
yellow, blue, red, green, lavender, grey
red, yellow, blue, lavender, green
why is the basilica vein used less frequently
its harder to locate
it rolls more easily
its closer to major arteries and nerves
its more superficial
which of the following is NOT an acceptable reason to re-anchor the vein before needle insertion
to prevent rolling
to increase blood flow
to improve visibility
to stabilize the vein
A tourniquet should not be left on for longer than
30 sec
1 min
3 min
5 min
which action ensures site antisepsis before venipuncture
wiping with gauze
scrubbing with an alcohol pad in circular motion
washing with soap and water
using betaine for all pt
what gauge needle is most commonly used for routine venipuncture
14-16 gauge
18 gauge
21-22 gauge
25-27 gauge
which vein is typically used if the median cubital is not available
subclavian
basilic
radial
temporal
what is the most important step before inserting the needle
checking expiration date on tubes
positioning the arm at a right angle
releasing the tourniquet
anchoring the vein
during venipuncture what should be done if the pt reports a sharp sudden pain
redirect the needle
remove tourniquet and withdraw the needle immediately
continue and finish quickly
loosen the tourniquet only
which of the following is a complication of improper needle angle
polycythemia
hemoconcentration
nerve damage
thrombocytopenia
which technique reduces the risk of hemolysis
vigorously shaking tubes
using a smaller gauge needle
allowing alcohol to dry
drawing blood slowly through a syringe
the purpose of inverting collection tubes is to
mix anticoagulant with blood
prevent tube contamination
enhance clotting
remove air bubbles
which position is best for a pt prone to fainting
sitting upright in a high chair
standine
supine
leaning forwards
what should be done immediately after needle removal
apply tourniquet
label the tube
invert the tube
apply gauze and pressure
what does a collapsed vein indicate during venupincture
the vein is thromboses
the needle is too shallow
the vacuum pressure was too strong
the tourniquet was applied incorrectly
which of the following is true about butterfly needle sets
they are only used for arterial draws
they are used for large antecubital veins
they reduce trauma in small or fragile veins
they cannot be used with vacuum tubes
which of the following is a common point of care test used to monitor blood glucose levels
PT/ INR
HbA1c
glucometer reading
ESR
which if the following specimens should be protected from light during point of care testing
Ammonia
bilirubin
lactic acid
glucose
before performing a point of care test the phlebotomy tech must FIRST
clean the site with provide iodine
calibrate the machine
perform hand hygiene and don gloves
shake the reagent bottle
the primary purpose of quality control testing on a POCT device is to
prevent test duplicates
sure accuracy and reliability of test results
speed up the test process
eliminate the need for venipuncture
which of the following is a CLIA waived test that a phlebotomy tech may perform
blood culture
manual differential
rapid strep test
blood typing
when collecting blood from a central venous catheter (CVC) the phlebotomy tech should
use a butterfly needle directly into the port
flush the Line with 10ML of sterile water first
Discard the first 5mL of blood drawn
Use the red top tube first
what should be done after collecting a blood specimen from a vascular access device
apply a tourniquet
immediately disconnect the catheter
flush the catheter with saline or heparin per protocol
have the pt raise their arm
when preparing to collect a blood sample from a peripherally inserted central catheter (PICC) the phlebotomy tech must
use a lancet
wear a sterile gown and mask
clean the port with an alcohol pad for at least 15 sec
skip the discard tube
A POCT INR test is used to evaluate which of the following
blood sugar
WBCs count
platelet function
Coagulation status
which of the following describes the discard tube when using a VAD
it contains a clot activator
it is always drawn last
it prevent contamination of additive tubes
it removes heparin or saline from the line
a phlebotomy tech is performing POCT for cholesterol. which of the following actions is appropriate
use the first drop of blood
collect blood into an EDTA tube
Ensure the pt has fasted for 12 hours
Use a heparinized capillary tube
which of the following is a potential complication when drawing blood from a central line
hemoconcentration
hemolysis
hematoma
air embolism
the manufacturers instructions for a POCT reagent strip state it should be stored at room temp. which action violates the instructions
storing tips In a closed container
storing stips at 77 F
storing strips in a refrigerator
storing strips in a cabinet away from light
which of the following is an appropriate action after performing a POCT with a glucometer
reuse the lancet if its not visibly soiled
record results in the pt chart
dispose of test strips in the red biohazard bag
store used lancets in a regular trash bin
when using a VAD for blood draws which of the following is necessary to maintain line latency and prevent infections
heparin lock the line after every draw
replace the line with every blood draw
use alcohol to clean for 5 sec
avoid using gloves unless the other is immunocompromised
which of the following POCT test requires the use of a capillary sample
troponin
urinalysis
glucose
blood culture
which infection control step is critical before accessing a central line for blood collection
wearing a face shield
performing surgical scrub
using chlorhexidine to disinfect the hub
using sterile gauze to hold the line
A POCT hemoglobin test is primarily used to assess
WBCs
Clotting time
Anemia
dehydration
a phlebotomy tech should verify which of the following before using a POCT device
whether the pt has eating
that the POCT device has passed QC testing
the physicians credentials
the brand of lancet
which steps should follow capillary puncture for POCT
massage the site to increase blood flow
wipe the site with a dry gauze
allow alcohol to air dry before puncture
use the second drop of blood for testing
