NHA Phlebotomy Technician (CPT) — All Questions

A patient in a hospice unit is ordered a routine chemistry panel and tells the phlebotomist he does not want any more tests. What should the phlebotomist do?

• a.Explain that the panel is routine and complete the collection
• b.Accept the refusal, notify the nurse so the order can be reviewed, and document it✓
• c.Draw the specimen because a hospice patient's goals of care do not affect laboratory orders
• d.Ask the family whether they would like the specimen collected despite what the patient said

A competent patient's refusal stands wherever he is, and in a comfort focused setting it is also a signal that an order may no longer match the goals of care. Reporting it lets the team review the order rather than repeat the conversation tomorrow. Persuading the patient, drawing anyway or asking the family to overrule him all disregard his stated wish.

A patient who is a nurse asks the phlebotomist to use a butterfly needle because that is what always works on her. What should the phlebotomist do?

• a.Explain that equipment selection is the phlebotomist's decision and use the usual straight needle
• b.Use the butterfly for every future patient, since a nurse's advice reflects clinical experience
• c.Consider the request along with what the veins show, and use a winged set if it is suitable✓
• d.Ask her to sign a statement accepting responsibility for the equipment she has requested

A patient who has been drawn many times often knows what works, and that history is useful information rather than an instruction to be resisted. The phlebotomist still palpates and chooses equipment that fits the vein and the tubes ordered. Generalising one patient's preference to everyone is not evidence, and asking for a signed waiver over a needle choice is disproportionate.

Why is it important to tell a patient roughly how many tubes will be drawn before starting?

• a.It prepares the patient for the time it takes and reduces alarm when tubes keep changing✓
• b.It is a legal requirement that a written tube count be given to every outpatient beforehand
• c.It allows the patient to choose which of the ordered tests she is willing to have collected
• d.It lets the patient decide how long the tourniquet stays on

Patients who are not told often assume something has gone wrong when a fourth or fifth tube appears, and a brief warning prevents that alarm and the movement that can come with it. It is good practice rather than a legal requirement. Choosing among ordered tests is a conversation for the provider, and tourniquet time is set by the standard, not by preference.

A patient says she feels fine but has fainted at every previous blood draw. What is the most sensible precaution?

• a.Draw her standing, so that she has less distance to fall if she does lose consciousness
• b.Draw her reclined or in a chair with a locking arm, and stay with her afterwards✓
• c.Give her a sugary drink first, because low blood sugar is what causes fainting at a blood draw
• d.Complete the draw as fast as possible, since a short procedure cannot trigger a faint

A history of syncope is the strongest predictor of the next one, so the position is chosen for what happens if she faints rather than for whether she feels fine now. Reclining prevents a fall, and staying with her afterwards catches a delayed episode. Vasovagal fainting is not caused by low blood sugar, and speed does not prevent it.

Which statement about drawing blood from a minor is generally correct in the United States?

• a.A minor of any age may consent to a blood draw as long as they arrive at the clinic alone
• b.A minor may never be drawn without a parent physically present in the room at the time
• c.A parent or legal guardian normally gives permission, with exceptions set by state law✓
• d.The phlebotomist decides whether a minor is mature enough to give permission for the draw

Permission for a minor normally comes from a parent or legal guardian, but every state carves out exceptions, commonly for emancipated minors and for care such as sexually transmitted infection testing, so the facility's policy and state law govern. A parent's physical presence is not always required, and maturity is not a judgement a phlebotomist makes at the chair.

How should a phlebotomist document a patient's refusal of an ordered blood draw?

• a.Write refused on the requisition and leave it at the nursing station without saying anything
• b.Record who refused, the date and time, what was said, and who was notified✓
• c.Record only that the specimen was not obtained, since the reason is confidential to the patient
• d.Ask the patient to write and sign a statement explaining why she declined the collection

A refusal is a clinical event, so the note says who declined, when, in the patient's own words where possible, and which nurse or provider was told. That record is what protects both the patient and the phlebotomist when the missing result is questioned. A single word on a form conveys none of it, and no patient is required to write a justification.

A patient is scheduled for a fasting draw and asks whether she may take her morning blood pressure tablet with water. What is the correct answer?

• a.No medication may be taken during a fast, because any tablet will invalidate the results
• b.Refer the question to her provider or the laboratory, and do not advise stopping a medication✓
• c.Yes, all oral medications are safe during a fast and none of them affect any blood test
• d.Yes, but only if she waits until after the specimen has been collected to swallow the tablet

Whether a medication may be delayed is a clinical judgement, and telling a patient to skip an antihypertensive is outside a phlebotomist's role and can cause real harm. The question goes to the prescriber or the laboratory, whose test directory often states it. A blanket yes and a blanket no are both wrong because it depends on the drug and the test.

Why should a phlebotomist ask a patient about previous reactions before starting a draw?

• a.So the results can be compared with the patient's reaction at the previous appointment
• b.So the phlebotomist can decide whether the patient is exaggerating the difficulty of the draw
• c.So the laboratory can add a comment about the patient's anxiety to the printed report
• d.So syncope, latex allergy and a difficult access history can be planned for in advance✓

Asking turns a surprise into a plan: a fainter is reclined, a latex allergy changes every item that touches the skin, and a history of difficult access changes the equipment and who performs the draw. None of it concerns the results themselves, and none of it is a judgement about whether the patient is exaggerating.