NHA CPT Practice Test/Study Guide | Phlebotomy

1st in order of draw

Yellow Tubes

Which tube is sterile?

Yellow Topped Tubes

Additive for Yellow Tubes

SPS, ACD

Common Test for Yellow Tubes

Blood Cultures

Department: Yellow Tubes

Microbiology

Inversion: Yellow Tubes

8-10 times

Specimen: Yellow Tubes

Whole Blood

2nd in order of draw

Light Blue Tubes

Additive: Light Blue Tubes

Sodium Citrate

Common Test: Light Blue Tubes

PT, APTT, Coagulation Studies

Department: Light Blue Tubes

Coagulation Studies

Inversion: Light Blue Tubes

3-4 times

Specimen: Light Blue Tubes

Plasma

3rd in order of draw

Red Tubes

Additive: Red Tubes

None

Common Test: Red Tubes

Immunology, Serology, Blood Bank

Department: Red Tubes

Chemistry

Inversion: Red Tubes

5 times

Specimen: Red Tubes

Serum

4th in order of draw

Tiger (speckled) Topped Tubes

Additive: Tiger (speckled) Topped Tubes

Clot Activator

Test: Tiger (speckled) Topped Tubes

CMP, Endocrine, Immunology, Serology

Department: Tiger (speckled) Topped Tubes

Chemistry

Inversion: Tiger (speckled) Topped Tubes

5 times

Specimen: Tiger (speckled) Topped Tubes

Serum

5th in order of draw

Gold Tubes

Additive: Gold Tubes

Thrombin (Causes blood to clot in <5 minutes)

Common Test: Gold Tubes

STAT

Department: Gold Tubes

Chemistry

Inversion: Gold Tubes

5-6 times

Specimen: Gold Tubes

Serum

6th in order of draw

Green Tubes

Additive: Green Tubes

Heparin

Common Test: Green Tubes

STAT Chemistry Test, Ammonia Electrolytes, ABGs

Department: Green Tubes

Chemistry or Molecular Lab

Inversion: Green Tubes

8-10 Times

Specimen: Green Tubes

Plasma

7th in order of draw

Lavender/Purple Tubes

Additive: Lavender Tubes

EDTA

Common Test: Lavender Tubes

CBC, ESR, Hemaglobin

Department: Lavender Tubes

Hematology

Inversion: Lavender Tubes

8-10 times

Specimen: Lavender Tubes

Whole Blood

8th in order of draw

Gray Tubes

Additive: Gray Tubes

Sodium Fluoride and Potassium Oxalate

Common Test: Gray Tubes

Lactic Acid, Blood Alcohol Levels, FBS, Glucose Tolerance

Department: Gray Tubes

Chemistry

Inversion: Grey Tubes

8-10 times

Specimen: Grey Tubes

Plasma

Additive: Tan Tubes

K2, EDTA

Test: Tan Tubes

Lead

Department: Tan Tubes

Chemistry

Inversion: Tan Tubes

Chemistry

Specimen: Tan Tubes

Plasma

Additive: Royal Blue

Heparin, EDTA, None

Common Test: Royal Blue

Toxiology, Trace Metal

Department: Royal Blue

Chemistry

Inversion: Royal Blue

8-10 Times

Specimen: Royal Blue

Plasma or Serum

Additive: Black Tube

Sodium Citrate

Common Test: Black Tubes

ESR

Department: Black Tubes

Chemistry

Inversion: Black Tubes

8-10 times

Specimen: Black Tubes

Whole Blood

1st vein of choice

Median Cubital

2nd vein of choice/1st vein of choice for obese patients

Cephalic

3rd vein of choice

Basilic

1st choice area to stick for a venipuncture

Antecubital area.

Point Of Care

In a patient's home/bedside

What does NAACLS stand for?

National Accrediting Agency for Clinical Laboratory Sciences.

What does PPE stand for?

Personal Protective Equipment

Verbal Communication

The actual words spoken, the pace and tone of voice.

What does STAT mean?

Short Turn Around Time

What is quality control?

Daily controls that are used in analytical testing to determine acceptable ranges of test results.

Iatrogenic Anemia

Too much blood loss from a blood draw.

Negligence

Failure to act or perform duties according to the standards of the profession.

Assault

The threat of carrying out bodily harm.

Battery

Actually touching or hurting someone.

Fomites

Germs/doorknobs.

Standard of Care

Is typically defined as the level and type of care that a reasonably competent and skilled health care professional, with a similar background and in the same medical community, would have provided under the circumstances that led to the alleged malpracti

Informed Consent

Voluntary permission by a patient to allow touching after given information.

Implied Consent

Sticking arm out.

How long should you wash your hands?

15 seconds

How long should patient's wait if they are dizzy?

20 minutes

What does HIPAA stand for?

Health Insurance Portability and Accountability Act.

What's HIPAA?

Protects security, privacy and confidentiality of personal health information.

What does CLIA stand for?

Clinical Laboratory Improvement Amendments.

What's CLIA?

Federal guidelines that regulate all clinical laboratories across the U.S.

Nosocomial

Hospital acquired infections.

What does BBP stand for?

Blood Born Pathogens.

Universal Precautions

Treat all blood as if it was infected.

Chain of Infection

The process by which infections are transmitted; source - mode - host.

Standard Precautions

A set of safe guards designed to reduce the risk of transmission of microorganisms.

PPE ON

Gown, Mask, Goggles, Gloves

PPE OFF

Gloves, Goggles, Mask, Gown

What does PASS stand for?

Pull, Aim, Squeeze, Sweep.

When chemicals get in your eyes, how long do you wash your eyes for?

15 minutes

Osteomyletis

Inflammation of the bone caused by bacterial infection.

Osteochondritis

Inflammation of the bone and cartlidge.

Order of Collection - Capillary Draw

Blood gases - EDTA - Tubes with Additives - Serum Tubes

Hemolysis

Destruction of blood cells.

Preanalytical Phase

Before the actual testing and analysis are performed, labeling, transporting, evaluating, processing.

Analytical Phase

Examination process-quality control, troubleshooting, erroneous results.

Postanalytical Phase

Reporting final test results, storing specimens, obtain info for follow-up.

Critical Values

Ranges

EPA

Regulates chemical disinfectants.

True or False: You can't use fingersticks for coagulation test.

True.

Within what time frame should you transport blood to the lab?

45 minutes.

How long can you prewarm a site for?

3-5 minutes

What degrees should warm towels be?

42 degrees C

What do we wipe away the 1st drop of blood?

Interstitial Fluid.

How long does it take to clot without an additive?

30 minutes.

How many links are there in the chain of infection?

2

How do you organize supplies?

By expiration date.

What are Ethics?

a set of principles or values based on religious and moral teachings.

Cardio-

Heart

Erythro-

Red

Hemo-

Blood

Anti-

Against

-opsy

To View

Homeo-

Same or Similar

Serology

The study of antibodies in the serum.

Internal Stakeholder

Individuals who reside inside the company as board members, executives, managers, employees, and trade unions and who benefit directly from their contributions to the growth of the company.

What kind of diploma is required to enter most phlebotomy programs?

High School or Equivalent

Iatrogenic

Describes anemia that results when excessive amounts of blood are taken from a patient.

ABG

Arterial Blood Gases

A test that measures that oxygen and carbon dioxide levels in blood.

APTT

Activated Partial Thromboplastin Time

BMP

Basic Metabolic Panel

Is a blood test that gives information about: sugar (glucose) and calcium levels in the blood. how the kidneys are functioning. The body's electrolyte and fluid balance.

BBP

Blood-Borne Pathogen

BC or B/C

Blood Culture

BT

Bleeding Times

Bleeding Time

A medical test performed to assess platelet function.

C&S

Urine Culture and Sensitivity

A microscopic study of the urine culture performed to determine the presence of pathogenic bacteria in patients with suspected urinary tract infection.

CBC

Complete Blood Count

Provides info about the types and numbers of cells in your blood.

CLSI

Clinical and Laboratory Standards Institute.

Is a volunteer-driven, membership-supported, not-for-profit, standards development organization.

CMP

Comprehensive Metabolic Panel

Is a blood test that measures your sugar (glucose) level, electrolyte and fluid balance, kidney function, and liver function. Glucose is a type of sugar your body uses for energy.

COC

Combined Oral Contraceptive

CSF

Cerebrospinal fluid.

A watery fluid that is continuously produced and absorbed and that flows in the ventricles within the brain and around the surface of the brain and spinal cord.

CVC

Central Venous Catheter

A catheter (tube) that is passed through a vein to end up in the thoracic (chest) portion of the vena cava (the large vein returning blood to the heart) or in the right atrium of the heart.

diff

Differential white count.

Test that measures each type of white blood cell in your blood.

DVT

Deep Vein Thrombosis

g/dl

grams per deciLiter

GTT

Glucose Tolerance Test

Test to check how your body breaks down sugar.

HBsAG

hepatitis B surface antigen

HCG

Human chorionic gonadotropin

Is a hormone produced in the body during pregnancy.

HCT

Hematocrit

Test that measures the percentage of the volume of whole blood that is made up of red blood cells.

HgB

Hemoglobin

Protein in red blood cells that carries oxygen.

HgB A1C

Hemoglobin A1c

A test that measures the level of hemoglobin A1c in the blood as a means of determining the average blood sugar concentrations for the preceding two to three months.

HLA

Human leukocyte antigens

A blood test to look for a protein that is found on the surface of white blood cells.

INR

International normalized ratio

Is a laboratory measurement of how long it takes blood to form a clot.

PICC

Peripherally inserted central catheter

A long catheter introduced through a vein in the arm, then through the subclavian vein into the superior vena cava or right atrium to administer parenteral fluids (as in hyperalimentation) or medications or to measure central venous pressure.

POCT

Point-of-care Testing

SE

Side Effect

TDM

Therapeutic drug monitoring

Is a branch of clinical chemistry and clinical pharmacology that specializes in the measurement of medication concentrations in blood.

ACE

Angiotensin Converting Enzyme

This is important to the formation of angiotensin II. Angiotensin II causes arteries in the body to constrict and thereby raises the blood pressure. ACE inhibitors lower the blood pressure by inhibiting the formation of angiotensin II.

BAC

Blood Alcohol Concentration

It describes how we measure alcohol in the blood.

MI

Myocardial Infarction

Also known as a heart attack.

HIV

Human Immunodeficiency Virus

Infects humans and causes damage by taking over cells in the immune system�the part of the body which usually works to fight off germs, bacteria and disease.

AIDS

Acquired Immune Deficiency Syndrome

Is a group of symptoms that can eventually result from an HIV infection.

WBC

White Blood Cells

PLT

Platelets

QNS

Quality Not Sufficient

RBC

Red Blood Cells

PKU

Phenylketonuria

Is an inherited condition caused by a faulty gene.

What are blood cultures testing for?

Tests that aid in identifying the specific bacterial organism causing infections in the blood.

Cannula

A tube that can be inserted into a cavity or blood vessel and used as a channel for transporting fluids.

Clean-Catch Midstream

A urine specimen that is used for detecting bacteria and/or for microscopic analysis.

Creatinine Clearance Test

Analytic procedure to determine whether or not the kidneys are able to remove creatinine from the blood.

Diabetes Mellitus

Metabolic disease in which carbohydrate utilization is reduced due to a deficiency in insulin and characterized by hyperglycemia, glycosuria, water and electrolyte loss, ketoacidosis, and in serious conditions, coma. In milder forms of non-insulin-depende

FUO

Fevers of Unknown Origin

What is a Fistula?

An artificial shunt or passage, commonly used in the arm of a patient undergoing kidney dialysis; the vein and artery are fused through a surgical procedure.

Can you draw blood in a fistula?

No

What is another option for a tourniquet in obese patients?

Blood Pressure Cuff.

What is a Modified Allen Test?

One hand is examined at a time: The hand is elevated and the patient is asked to clench their fist for about 30 seconds. Pressure is applied over the ulnar and the radial arteries so as to occlude both of them. Still elevated, the hand is then opened.

What is malpractice?

The legal term for improper or unskillful care of a patient by a member of the health care team or any professional misconduct, or unreasonable lack of skill.

CLIA'88

Essentially applies to every clinical laboratory testing facility in the United States.

Oncology

The study of tumors and cancer.

Microbiology

The study of bacteria and fungi.

Homeostasis

Another terms for a "steady-state.

Vascular System

The network of blood vessels that includes arteries, veins, and capillaries.

Gas exchange in the capillaries is what?

Oxygen and Carbon Dioxide.

True or False: You label tubes before you draw a patients blood.

False.

True or False: You label tubes after a venipuncture but before you leave the room.

True.

Where does a CSF specimen originate?

The spinal column.

What is the 1st thing you do if a fire occurs?

Pull the nearest fire alarm.

OSHA

Require health care facilities to protect workers
exposed to biological hazards.

Isolation Precautions

The CDC recommended universal precautions, which is a method of infection control that assumed that all human blood and bloody fluids were potentially infectious.

Role Of The Phlebotomist

-Collect routine capillary and venous specimens for testing as requested
-Prepare specimen for transport, ensuring its stability
-Transport specimen to the laboratory
- Promote good public relations with hospital staff and patients
-Comply with new and re

Phlebotomist

Is a member of a service-oriented industry that requires professional behavior at all times.

Professsionalism

Is an attitude and a set of personal characteristics needed to succeed in this field.

Characteristics Imperative to a Phlebotomist

-Dependability
-Honest
-Integrity
-Empathy and Compassion
-Professional Appearance
-Interpersonal Skills

The Circulatory System

The function of this system is to deliver oxygen, nutrients, hormones, and enzymes to the cells (exchange is done at the capillary level) and to transport cellular waste such as carbon dioxide and urea to the organs (lungs and kidneys, respectively) where

Systemic Circulation (Heart)

This carries oxygenated blood from the left ventricle throughout the body.

The Tricuspid Valve

This is an atrioventricular valve, being situated between the right atrium and right ventricle.

The Mitral Valve

This is another atrioventricular valve, being situated between the left atrium, and left ventricle; also called the bicuspid valve.

The Aortic Valve

A semi lunar valve situated between the left ventricle and the aorta.

Endocardium

The endothelial inner layer lining of the heart.

Myocardium

The muscular middle layer of the heart. The coronary arteries, which supply blood to the heart, are found in this layer.

Epicardium

The fibrous outer layer of the heart. The coronary arteries, which supply blood to the heart, are found in this layer.

The Blood Vessels

Aorta, Arteries, Arterioles, Capillaries, Venules, Veins, Superior and Inferior Vena Cava.

Capillary Blood

Is a mixture of arterial and venous blood.

The average adult has how much blood?

5 to 6 liters

Plasma

The liquid portion of blood.

Plasma comprises how much of the circulating blood?

55%

Erythrocytes

Red Blood Cells.

Thrombocytes

Platelets.

All bone cells normally originate from where?

Bone Marrow.

The normal life span of a red blood cell is how long?

120 days.

The average platelet is how many micro liters of blood?

140,000 to 440,000

Hemostasis

Is the process by which blood vessels are repaired after injury.

Stage 1 of Hemostasis

Vascular Phase

Injury to a blood vessel causes it to constrict slowing the flow of blood

Stage 2 Hemostasis

Platelet Phase

Stage 3 Hemostasis

Coagulation Phase

This involves a cascade of interactions of coagulation factors that converts the temporary platelet plug to a stable fibrin clot.

Stage 4 Hemostasis

Fibrinolysis

Sclerosed Veins

These veins feel hard or cord-like. Can be caused by disease, inflammation, chemotherapy or repeated venipunctures.

Thrombotic Veins

Unsuitable for venipuncture.

Do you draw blood from an arm with what running into it?

No. The fluid will alter the test results. Select another site.

Venipuncture Basic Step

In performing this is to have necessary supplies and/or equipment organized for proper collection of specimen and to ensure the patient's safety and comfort.

What is the 1st thing needed before doing a venipuncture?

Laboratory requisition slip and pen.

Antiseptic most commonly used?

Isopropyl alcohol pads

For patients allergic to iodine or alcohol pads what should you use?

Chlorhexidine

Vacutainer Tubes

Color-coded for specific tests and available in adult and pediatric sizes.

Needle Sizes

Differ both in length and gauge, 1-inch and 1.5-inch long are routinely used.

Vacutainer Needles

These are disposable and are used only once for single-tube draw and multi-draw.

Gauge

The diameter of the bore of the needle. The smaller the number the bigger the gauge.

Needle Adapters

Also called the tube holder.

Winged Infusion Sets

Also called butterfly. Used for venipuncture on small veins such as those in the hand. They are also used for venipuncture in the elderly and pediatric patients.

Tourniquets

Prevents the venous outflow of blood from the arm causing the veins to bulge thereby making it easier to locate the veins.

The most common tourniquet is?

Prevents the venous outflow of blood from the arm causing the veins to bulge thereby making it easier to locate the veins.

If a patient is allergic to latex, what is another tourniquet you can use?

Rubber

Chux

An impermeable pad used to protect the patient's clothing and bedding.

Phlebitis

Inflammation of a vein as a result of repeated venipunture on that vein.

Petechiae

These are tiny non-raised red spots that appear on the skin from rupturing of the capillaries due to the tourniquet being left on too long or too tight.

Thrombus

This is a blood clot usually a consequence of insufficient pressure applied after the withdrawal of the needle.

Thrombophlebitis

Inflammation of a vein with formation of a clot.

Fasting

Some test such as those for glucose, cholesterol, and triglycerides require that the patient abstain from eating for at least 8-12 hours.

Oral Glucose Tolerance Test

This test is used to diagnose diabetes mellitus and evaluate patients with frequent low blood sugar.

Chilled Specimens

Some tests require that the specimen collected by chilled immediately after collection in crushed ice or ice and water mixture.

Some of the tests that requires chilled specimen are:

Arterial blood gases, ammonia, lactic acid, pyruvate, ACTH, gastrin, and parathyroid hormone.

Light-Sensitive Specimens

Specimens are protected from light by wrapping the tubes in aluminum foil immediately after they are draw.

Dermal punctures may be done on who?

Both Pediatric and Adult Patients.

Osteomyelitis

Inflammation of the bone and bone marrow.

Dermal puncture should be done with what?

Lancet

Site Selection for Dermal Puncture (Infants)

The heel is used on infants less than 1 year of age. Areas recommended are the medial and lateral areas of the planter surface of the foot.

Heel punctures for infants do not exceed what?

2.0mm

Order of Draw for Capillary Specimens

1. Lavender Tube
2. Tubes with other additives
3. Tubes without additives

Medical Asepsis

The destruction of pathogenic microorganisms after they leave the body.

Handwashing

Is the most important means of preventing the spread of infection. Uses plain soap to remove soil and transient bacterial.

Toxicology

Analyzes plasma levels of drugs and poisons.

Liver Profile

ALP, AST, ALT, GGT and Bilirubin.

True or False: Bilirubin should be protected from the light.

True.

Reference Laboratories

These large independent laboratories perform routine and highly specialized tests that cannot be done in smaller ones. The phlebotomist may do either on-site or off-site collections.

Formed Elements

The cellular portion of blood.

Preferred sites for venipuncture is where?

Antecubital fossa.

Hematoma

The most common complication of phlebotomy procedure. This indicates that blood has accumulated in the tissue surrounding the vein.

Edema

Is the accumulation of fluid in the tissues.

Contact Precautions

Are designed to reduce the risk of transmission of microorganisms by direct or indirect contact.

Transmission-Based Precautions

The 2nd tier of precautions and are to be used when the patient is known or suspected of being infected with contagious disease.

Airborne Precautions

Are designed to reduce the risk of airborne transmission of infectious agents.

Droplet Precautions

Are designed to reduce the risk of droplet transmission of infectious agents.

Disinfection

Not okay to use on skin.

Antiseptics

Are okay to use on skin.

Latex Sensitivity

Is an emerging and important problem in the health care field.

Nosocomial Infections

Health care-associated infections.

Protective environment

Is the same as reverse isolation.

Order of Draw for Capillary Specimens Phrase

Little - Lavender
Green - Green
Mints - Mint Green
Gives - Grey
Goldie - Gold
Rashes - Red