Most important step in venipuncture?
What is PPE?
Personal Protective Equipment
What is the best way to let a clean site dry?
OSHA requires all phlebotomist to be trained regarding what?
Blood borne pathogens and needle saftey
All specimens are considered hazardous and infectious so we must use what?
Universal and or Standard precautions
What organization should be contacted regarding employee safety and unsafe working conditions?
OSHA (occupational safety and health administration
What does MSDS mean and what is it part of?
Material Safety Data Sheet (right to know law)
What color tube, and additive is used for CBC, Hct, Hgb, Sed rate?
Which tube has no additive?
What color tube and which additive is used for protime and APTT?
Lt. Blue, sodium citrate
What is the ratio of blood to additive in a light blue tube?
9 to 1
Which additive is the best choice for an ethanol specimen?
What color tube is an ethanol specimen drawn in?
In case of a needle stick accident you should?
Cleanse the site, get patient information if able, and notify your supervisor
What is the purpose of the tourniquet?
To find the vein
How long can the tourniquet be in place?
What is the first thing you must do after every finger stick?
Wipe away the first drop
Why is it necessary to keep the centrifuge lid closed until it comes to a complete stop?
It reduced the chance of aerosol and microbial contamination
What angle should your slider be when making blood smears?
What should you do if a standard size tube collapses the veins?
Use a pediatric tube
Which cleansers are most common for blood culture site preparation?
povidone iodine or 2% chlorhexidine
What characteristics do sharps disposal containers have?
Spill proof, tamper proof, and puncture resistant.
When used for decontamination, the dilution for bleach in water should be what?
10% bleach, 90% water
Which point of care test is done to determine a platelet plug formation?
Bleeding time (also known as platelet function assay)
Where in the wrist area are ABGs done and which artery?
Outer aspect of the wrist and from the radial artery
Which are the smallest vessels in the body?
Which are the smallest veins in the body?
The respiratory system is responsible for?
Breathing and the exchange of oxygen and carbon dioxide
Common site cleanser for a venipuncture is?
70% isopropyl alcohol
When anticoagulated blood is spun down in the centrifuge, how does it separate?
Plasma (top), buffy coal = WBCs & platelets (middle), Red blood cells (bottom)
MSDS is part of the?
Right to Know Law
When you leave the patient's room, make sure that?
Everything is returned to where you found it including the bed rails, (up if up, down if down)
What is the difference between serum and plasma?
Serum= the fluid portion of clotted bloodPlasma= fluid portion of unclotted blood which contains all of its clotting factors (fibrinogen)
The Validation of a persons feelings
QA indicators are what?
System that filters, eliminates wastes, regulates water balance is the?
If a patient has fragile skin or excessive hair, where should the tourniquet be placed?
Over their clothing or a piece of coflex/coband
When drawing on a burn victim?
Look for a site that is the least damaged or scarred for the draw
Even if you wear gloves, your hands should be washed when?
Before and after specimen collection, toilet use, every time they could become soiled
What happens if you squeeze too much during a finger stick/capillary puncture?
Errors in the results by diluting with tissue fluid
If an I.V is present you much draw blood where?
Below the I.V
What vein is most likely to be used for an obese patient?
If swelling occurs or a hematoma begins to form at the venipuncture site you must?
Remove the tourniquet and needle and apply pressure
The most prevalent work related acquired infection in the laboratory is?
Fibrin strands may be present in serum because?
It was centrifuged
What should you do if the information is not correct on the patient's I.D bands/requisitions?
Do not draw the blood until the patient is properly identified/banded
If a patient who is legally responsible for himself says NO to a blood draw, what should you do?
Do not draw
Two forms of outpatient I.D are?
Spelling name and birthdate
Bursting capillaries cause small red pin-point clusters are known as?
Reverse or protective isolation is for the protections of?
What is the name of the system used for unidentified patients?
Special 3 part I.D system
What is the most common complications of phlebotomy?
What happens when the tourniquet is on to long?
How do you transport Bilirubin?
By protecting it from light
What test is ordered to determine PH and blood gas?
Arterial Blood Gases (ABGs)
What test would be ordered to detect hematuria?
What test would be ordered if the patient is suffering from FUO? (fever of unknown origin)
What tube is used for STAT electrolytes and what is the additive?
Green top and Heparin is the additive
Sample mailers have a few distinctive warnings to their label. They are?
Biohazard sign, send to CDC in case of breakage, name and address of sender and receiver
What is the chain of custody?
The tracking of legal samples
Doctors order glucose monitoring for patients with which disorder?
How long do Red blood cells live for?
What is a reticulocyte and how long does it live for?
An immature red cell and lives for about one day
What does a glucose test monitor?
All I.V supplies must be handled with care and kept?
What is a sphygmomanometer used for?
Medical ethics can identify a professional as?
Define negligence vs. malpractice?
Negligence is failure to exercise due careMalpractice is negligence by a professional
Sedrate or ESR is drawn on what color tube?
Which PPE will keep you the safest when body substance or wounds are present?
What has to be supplied by chemical manufacture according to the Right to Know Law?
MSDS (Material Safety Data Sheet)
Parenteral transmission means infection can enter through everything except?
The digestive tract
Does the tourniquet need to be on the entire time?
No, its the phlebotomist call
In what direction is a concentric circle?
Center to periphery
What test is ordered to confirm hyper or hypoglycemia?
If something is easily combustible what color and number would you expect to see?
IF a moderate health hazard would exist what color and number would you expect to see?
If you do not let the cleaners dry before performing a blood culture you might get what?
Contaminated specimen/false positive. Skin prep is the #1 contamination of a blood culture
How many ml would be in a typical 24-hour urine container?
2000ml or 2L
How do you transport cold agglutinin after collection?
At body temperature
Cardio vascular system includes?
Heart and vessels
It is your job as a part of being a health professional to?
Make your patient as comfortable and at ease as possible
What could happen if you carelessly remove a stopper from an evacuated tube of blood?
Could cause an aerosol (like popping the champagne bottle)
What is included in the microorganism category that can exist in body fluids?
Fungus, bacterium, virus
What are examples of timed tests?
GTT, Medication monitoring
Selection of a preferred care giver has to do with what?
Insurance PPO/HMO. Not a patient right
What does contamination mean?
It is not clean anymore
Extrinsic coagulation function is evaluated by what test?
Protime, Prothrombin time, PT
CLSI (Clinical Laboratory Standards Institute) is formerly known as?
NCCLS (National Committee for Clinical Laboratory Standards)
Every year laboratory employees must take a test to demonstrate what?
What should you do if you get blood on a requisition or on the side of a tube?
Wipe off with disinfectant
Positive body language is?
Being sure of yourself, being confident. It is not being irate or cowering.
Which fingers are used for skin puncture, most often?
Third and fourth digits.
Leg and foot draws can only be done?
With a doctor order
If you are drawing for a CBC, and having difficulty because of vein damage or bruising, it is acceptable to get the blood by which method?
Skin puncture; "finger stick"; capillary draw
What could cause "failure to obtain blood
Missing the vein altogether, not going deep enough, or going through the vein
Urinary track infection is the most common?
What is the most common size needle used for venipuncture?
Which is larger 18 or24?
When using additive tubes, when should you start the mixing process?
What is the additive in a grey top tube?
Na fluoride and K oxalate
What is the additive in additive in a green top tube?
TDM means therapeutic drug monitoring. It is important to know the?
Time of the last dose
The feathered edge of a smear is how many layers thick?
What is the first step in phlebotomy?
Introduction and explanation
What is the difference between "inpatient" and "ambulatory patient"?
Inpatient stays overnight and the ambulatory is out patient
What is a VAD?
Vascular Access Device
What would you do if a patient has an I.V. In the right arm?
Look for a vein in the left arm
A patient states she/he has had a mastectomy on the left breast. What would you NOT DO?
You will not put a tourniquet or BP cuff on that arm. No blood samples from that arm.
If a patient had fragile skin, what would you use for a bandage?
An alternative to adhesive/coflex is gauze all around and then taped
What are the three common veins for venipuncture?
Median antecubital, cephalic, and basilic
What is the requirement by the government when shipping specimens?
Container must be water tight
Services and results that meet accepted standards are?
Extracting too much blood especially from infants could put the patient in danger of becoming what?
What would you do if you found two or three requisitions from different doctors for the same order?
Make sure that they are not duplicates
The nurse asks you to go to room 312 and draw Robert Jones. When you get to 312 the patient's arm band says Roger Jones. What would you do?
Nothing until you get the correct I.D confirmed
What is Hemostasis?
The ability to stop bleeding.
In order to ensure Hemostasis all of these must be in good working order/have the proper amount?
All the vessels, coagulation factors, and the platelets
Q.N.S. Stands for?
Which part of the analytical process are phlebotomists involved in?
Doing the right thing when nobody is looking is?
AIDS stands for what?
Acquired Immune Deficiency Syndrome
What happens if a specimen is misplaced for several days at room temp?
You must re-draw
One thing the healthcare industry did to lessen the spread of infection?
They started using disposable equipment
Name the 3 types of blood cell?
Erythocytes, leukocytes, thrombocytes
Parents sometimes get a prescription for a topical anesthetic for their child, which is called?
Which cell is the transport cell?
RBC transports oxygen and nutrients
If a language barrier between you and the patient, what would you do?
Must have a translator
As healthcare workers, it is very important to be aware of surroundings?
Do not walk by spills without reporting them. Do not rush around corners in the halls. Get out of patient's way.
Which is the most prevalent blood borne pathogen among the laboratory healthcare workers?
Injury could occur on an infant's foot if you used a lancet that penetrated deeper than?
Checking the expiration dates on collection tubes is part of?
Quality assurance or quality control
Blood cultures are drawn in a set of two bottles. Name the differences between the bottles?
One is aerobic (has air in it) the other is anaerobic (no air)
What five things must be on a specimen label?
Pt. name, Pt. #, date of specimen, time specimen was taken in military time, and initials of person performing the lab
What might cause clotting of an anticoagulated specimen?
If red blotches appears after a tourniquet is applied of skin is in contact with gloves. What would you suspect?
The patient might have a latex allergy
If you are collecting blood and the patient stops breathing, what would you do?
Stop everything and call for help
TB isolation requires what?
N95 respirator, gown and gloves (all airborne isolation's require these)
What would you do with expired tube?
Why would you put a stick in a centrifuged specimen?
To check for presence of Fibrin (serum only)
A family member wants family records. Who regulates this matter?
The patient must give written permission for medical personnel to release information. The confidentiality law that regulates this is HIPAA
You have a trauma and a timed test. Which should you do first?
Trauma, then the timed test
Why do you use a N95 for TB patients?
Because TB is an airborne mycobacteria
What is another name for a "winged apparatus"?
The joint commission is responsible for what?
Requires healthcare institutions to have an infection control program in place. QA, medical record protocol
How many hours does the patient fast for a GTT? (Glucose Tolerance Test)
8 to 12 hours
How many draws are needed for a GTT?
TWO, plus the number of hours for the test
Who is the Director of the Laboratory?
List the Priority of Draw?
ER/STAT, Timed, ASAP, Fasting, Routine
If a phlebotomist mis-I.D.'s a patient and this action causes harm to come to the patient, it is an act of?
Which patient is most likely to have more than (1) I.D bracelet?
Newborn, patient admitted through ER, Patient getting transfusion
Name the gel in a SST or PST tube?
Name the Order of Draw for non-capillary blood samples?
Yellow for BC (SPS)Lt. Blue (Na citrate)Red and/or SSTGreen (heparin)Lavender (EDTA)Grey (Na flouride/ K oxalate)
Name the Order of Draw for capillary blood samples?
Lavender? EDTA specimens; other additive specimens; Red/serum specimens
What is Hirudo Medicinalis?
A european medicinal leech
What initials are used to designate a phlebotomist certified by the National Credentialing Agency?
CLPlb (NCA)Clinical Laboratory Phlebotomist
What initials are used to designate a phlebotomist in CA certified by the American Certification Agency? What do the initials mean?
CPT (ACA)Certified Phlebotomy Technician
What does ETS stand for?
Evacuated Tube System
What is this?
What is this?
What do the colors mean?
Red is flammableBlue is health hazardYellow is reactiveWhite is for special issues (e.g radioactive or water reactive)
What numbers can this have and what do they mean?
0 means no hazard1 means slight danger2 means moderate danger3 means severe danger4 means extreme danger
What type of controls do mechanical devices have?
Give two examples of engineering controls?
Sharps containersSafety needlesHazard signsSafety transfer devicesBiohazard bagsMSDS
Give an example of a "Work Practice Control"?
Hand washing, Designated areas for activities like eating
What 3 factors relate to radiation exposure?
1. Distance- how far away2.Shielding- how you are protected/barrier3. Time- how long exposed
What acronym is used for Fire Response? What do the letters mean?
What does CAP stand for?
College of American Pathologist
What does CLIA stand for?
Clinical Laboratory Improvement Amendment (of 1988)
What does agglutinate mean?
Clumping or sticking together
What is the difference between STAT and ASAP?
STAT- immediatelyASAP- as soon as possible/ when possible
Does Ca mean the same thing as CA?
NO, Ca=calcium and CA=cancer
What is Homeostasis?
The "steady state"; state of equilibrium or balance
What gland is referred to as the Master Gland? What body system is it part of? Where is it? What does it regulate?
The pituitary gland; part of the Endocrine system; found in the brain; regulates body function via hormone production
What body system uses chemical substances and electrical impulses to control and coordinate body activities?
The Nervous system
What are the two main structural divisions in the Nervous System?
Structural= 1. Central Nervous System 2. Peripheral Nervous System
What are the two main functional divisions in the Nervous system/
Functional=1. Somatic (voluntary) 2. Autonomic (involuntary)
What anatomical plane divides the body into front and back?
Frontal, also known as Coronal
What anatomical plane divides the body into top and bottom?
Transverse, also known as horizontal
What anatomical planes divides the body into equal/unequal right and left?
Midsagittla is equal right and left; Sagittal can be unequal right and left
What anatomical terms describe the front and the back of the body?
Front= anterior or ventralBack= posterior or dorsal
What anatomical terms describe the top and the bottom of the body?
Top= superior or cranialBottom= inferior or caudal
What anatomical term describe if something is near another structure, or farther away?
Near= proximalAway= distal
What word describes the palm of the hand?
What word describes the bottom or sole of the foot?
What anatomical terms describe something that is either on or neat the surface of the body, or inside the body?
External is superficial or near the surface of the bodyInternal is deep inside the body
What anatomical terms describe if something is near the middle of the body or more to the side of the body?
Medial is closer to the middle of the bodyLateral is more the side/outside of the body
What body organs remove erythrocytes from circulation when they are old or damaged?
The liver and the spleen
What is the longest vein in the body?
The saphenous vein
Name four body cavities?
1. Cranial2. Thoracic3. Abdominal4. Pelvic
Where is the primary place RBCs and WBCs are made? What fraction or percent for each?
In the bone marrow1/4 (25%) for RBCs3/4 (75%) for WBCs
What does hematocrit measure? What is the abbreviation for this test?
Hematocrit measures the VOLUME of RBCs in blood; Hct
What does a differential blood count measure? Can you name 5 types of WBCs?
The number of each of the different blood cell types; The 5 kinds of WBCs are neutrophils, eosinophils, basophils, lymphocytes and monocytes
What are the two different numbers in blood pressure readings called, and what do they represent?
Systolic-when the heart chambers are contractingDiastolic- when the heart chambers are resting
What color vacuum tube is used for a blood culture? What is the additive?
Yellow; SPS (sodium polyanethol sulfonate)
What does AFB stand for? What kind of test is it?
Acid-fast bacillus; blood or sputum test; Turberculosis
What does a hemoglobin test measure?
Hemoglobin measures the iron containing pigment in RBC's that can carry oxygen and carbon dioxide; Hgb or Hb
How does the additive heparin work?
Heparin prevents clotting by inhibiting thrombin formation
How does the additive EDTA work?
EDTA prevents clotting by binding (chelating) calcium(Ca)
How does the additive Sodium Citrate work?
Na citrate prevents clotting by binding (chelating) calcium (Ca)
What does the additive Sodium Flouride do?
Na flouride prevents glycolysis (sugar breakdown) and inhibits the growth of bacteria
How does the additive Potassium Oxalate work?
K+ oxalate prevents coagulation by precipitating calcium (Ca)
Which blood type is the universal recipient?
Universal recipient= AB (had both A and B antigen)
Which blood type is the universal donor?
Universal donor= O (had no antigens)
Where did the RH abbreviation come from? What does it stand for?
The Rhesus monkey.A protein, known as the D antigen (represented by a + sign if the protein is present)
Which RH factor puts a woman at risk of having her 2nd child born with hemolytic disease of the newborn (HDN)?
RH- (negative), if her babies are both RH +
What is ABORH?
The abbreviation for blood type and RH factor classification system.
DO platelets aggregate or agglutinate?
Aggregate is a total mass by addition of partsAgglutination is the process of adhering
Coagulation factors circulating in the blood stream are part of which coagulation pathway- Intrinsic or Extrinsic?
Coagulation step aided by the release of thromboplastin from injured tissue is part of which pathway- Intrinsic or Extrinsic?
The circulatory system can be divided into what two distinct parts?
1. Pulmonary system (heart and lungs); and2. Systemic system ( the rest of the blood vessels in the body)
When doing therapeutic drug monitoring, the lowest blood (serum) level-just before the next does-is known as what?
When a drug is circulating at the highest level in your bloodstream (serum), it is known as what? How long does it take for this affect to occur?
Peak; 30-60 minutes after the last dose
Matching blood types for transfusion occurs in which part of the clinical laboratory?
Testing bleeding time occurs in which part of the clinical laboratory?
Hematology- specifically coagulation testing
Testing for tuberculosis occurs in which part of the clinical laboratory?
Testing a lipid profile occurs in which part of the clinical laboratory?
Testing for antibodies (e.g. for hepatitis, lupus, or HIV) occurs in which part of the clinical laboratory?
Testing a person's WBC occurs in which part of the clinical laboratory?
Testing for fungal infection occurs in which part of the clinical laboratory?
When testing for blood alcohol level, what type of skin cleaner can you use?
Soap and water or Povidone iodine; benzalkonium chloride
What is NAACLS?
National Accrediting Agency for Clinical Laboratory Sciences
What is CLIAC?
Clinical Laboratory Improvement Advisory Committee
What is COW?
Certificate of Waiver
What is GLP?
Good Laboratory Practices
The single, most important way to prevent the spread of infection while preforming phlebotomy is by?
After drawing the blood from a patient, the phlebotomist should dispose of the needle by?
depositing it in an approved "sharps container
Negligence by a professional person is called?
Which of the following is the single most common source of HIV and HBV in the workplace?
The heart, lymphatic organs, and blood vessels are in the?
The venipuncture site should be cleansed in a circular motion from the center to the?
Within the capillaries, blood cells?
Give away oxygenpick up carbon dioxidepick up waste products
Which is not an infection control method?
Safe working conditions for employees are regulated by?
Which of the following types of tourniquets are used in specimen collection?
VelcroBlood pressure cuffPliable strap
The color of normal serum is usually?
straw to yellow
Which of the following conditions would stop a phlebotomist from drawing blood in a patient's vein?
same side mastectomy
Chemicals that prevent blood from clotting are called?
Red and white blood cell counts are examples of what type of test?
Treating all specimens as if they are hazardous and infectious is the basis for?
Drugs used to destroy or kill bacteria that cause disease are called?
When the heart is contracting, the pressure is highest. The pressure is called the?
The process by which an object or area becomes unclean is known as?
The healthcare worker is protected by law if it can be determined that he or she acted as expected when compared with fellow workers. This is called?
Respondent superiorreasonable careduty of care none of the above
Which of the following is not known to transmit HIV?
Consent to treatment based upon full understanding of all possible risks of unpreventable results of that treatment is called?
assumption of risk
Infections that can spread from person to person are called?
A tube adapter that has been visibly contaminated with blood should be disposed of in?
a bio hazardous waste container
A violation of a person's right to have his or her name, photograph, or private affairs made public without giving consent is called?
invasion of privacy
OSHA requires training and educational information on blood borne pathogens to be given to employees?
at no cost
Characteristics of capillaries include?
a. being thin-walled in structureb. forming microscopic pathwaysc. connecting arterioles with venulesd. all of the above
Arterioles, the smallest arteries, subdivide into?
The branch of study of moral issues, questions, and problems arising in the practice of medicine and in biomedical research is called?
If a test requires serum, rather than plasma, a tube with what color top should be drawn?
When using evacuated tubes for blood collection, it is crucial to remember to?
a. never under fill tubes that contain anticoagulantb. never use tubes past their expiration dates c. immediately invert any tubes that contain additivesd. all of the above
The rubber sleeve (at the end opposite the needle tip) on an evacuated tube needle makes it possible for use with?
Because bacteria and other micro-organisms can be found anywhere, all health care personnel should maintain sterility when handling?
a. IV suppliesb. cathetersc. instrumentsd. all of the above
When entering a room marked with isolation signs?
read isolation signs to determine what PPE is appropriate
What information must be included if the phlebotomist must manually label a blood collection tube from an outpatient?
a. patients full name and phlebotomist initialsb. date of patient birth and or social security numberc. date and time of drawd. all of the above
The study of blood is called?
The term asepsis literally means?
with out bacteria
The use of a chemical procedure to destroy all microbial life, including highly resistant bacterial endospores, is called?
Capillary blood sampling may be used if the laboratory test require?
very little blood
The tube to collect whole blood with an EDTA additive in it, has what color stopper?
Diastolic pressure is?
the bottom number of blood pressure readings
Do not draw blood ________ an intravenous infusion.
Which of the following legally enforces the Blood-borne Pathogen Standard?
Common symptoms of shock include all of the following except?
Which of the following causes AIDS?
Eating and drinking are permissible in a laboratory setting?
only in designated clean areas
In health care, when all evaluated services and results compare within acceptable standards, principles of ________ are being used?
The tissue that covers and protects the body is?
A possible cause of tube breakage during centrifugation might be?
A tube containing sodium citrate as an additive is the?
blue top tube
The lack of physical or mental fitness is?
The correct order of draw for a skin puncture is?
lavender, green, red
What is the term for difficulty breathing?
When using a blood pressure cuff as a tourniquet, inflate the cuff between mm hg?
40-60 mm hg (60-80 mm hg)