NHA Phlebotomy Technician (CPT) — All Questions

Which finding on a filled tube tells the phlebotomist that the draw volume was correct?

• a.The blood reaches the very top of the tube and touches the stopper
• b.The tube feels heavy enough that the additive is certain to be fully dissolved in the blood
• c.The blood stops at the manufacturer's fill indicator and the vacuum has exhausted itself✓
• d.The blood covers about half the tube, leaving room for the additive to mix during inversion

An evacuated tube draws exactly the volume its vacuum was calibrated for, so the tube stops filling on its own at the indicated line and that is the signal to remove it. No tube is designed to fill to the stopper, and a half-filled additive tube has the wrong blood to additive ratio, which prolongs a coagulation time or shrinks red cells depending on the additive. Weight is not a usable check.

An inpatient's requisition is marked as a timed draw for six in the morning, and the phlebotomist arrives at seven fifteen. What should be recorded?

• a.The actual time the specimen was drawn, with a note explaining the delay✓
• b.The ordered time of six in the morning, because that is the time the provider requested
• c.No time at all, since the laboratory computer stamps the specimen when it is received
• d.An average of the ordered time and the actual time, which is the fairest representation

The collection time recorded is the time the blood was actually drawn, and the reason for a missed window is documented so the provider can judge whether the result still answers the question. Recording the ordered time is a false entry that can lead to a drug dose or an insulin adjustment based on a level from the wrong point in the cycle. A receipt stamp is not a collection time.

What should a phlebotomist do with a tube that was accidentally drawn out of the standard order?

• a.Nothing, as long as all of the tubes were inverted immediately after they were filled
• b.Report it, and redraw the affected tube if the laboratory says the test could be compromised✓
• c.Discard every tube from the draw and start again with a fresh venipuncture on the other arm
• d.Note it on the requisition and send the tubes, since the laboratory expects occasional variation

The person who knows the sequence was wrong is the only one who can say so, and the laboratory then decides which results are at risk, because that depends on which additive reached which tube. Silence lets a falsely high potassium or a prolonged clotting time be reported as real. An automatic full redraw takes blood the patient may not need to give again.

A phlebotomist is about to draw a patient whose requisition and wristband show the same name but different dates of birth. What should happen?

• a.Draw the specimen and label it with the date of birth that appears on the wristband
• b.Draw the specimen and label it with the date of birth printed on the requisition form
• c.Stop and resolve the discrepancy with the nurse before any blood is collected✓
• d.Ask the patient which date is correct and change the requisition to match the answer

Two identifiers that do not agree mean identity has not been established, and no specimen is collected until the record is corrected by the staff responsible for it. Choosing one source over the other guesses at which document is wrong, and altering a requisition is outside the phlebotomist's role even when the patient's answer sounds convincing. Two patients can share a name.

Which action should a phlebotomist take immediately after entering a patient's room and before touching any equipment?

• a.Put on gloves straight from the box at the door so the hands are covered from the outset
• b.Set the collection tray down on the bedside table so both hands are free to work
• c.Open the tube packaging so the tubes are ready the moment the vein has been located
• d.Perform hand hygiene, then introduce yourself and confirm the patient's identity✓

Hand hygiene comes before patient contact, followed by introduction and identification, and gloves go on after the hands are clean and immediately before the puncture. Gloves put on over unwashed hands transfer whatever was on them, a tray placed on a bedside table contaminates a patient surface, and opening supplies before the site is chosen wastes them if plans change.

A patient asks the phlebotomist what the ordered tests are for. What is the appropriate response?

• a.Explain what each test measures and what an abnormal result would probably mean for the patient
• b.Say which tests were ordered, and refer questions about their purpose to the provider✓
• c.Decline to say anything at all about the requisition, since test names are protected information
• d.Give a general reassurance that the tests are routine and that the results are certain to be normal

Naming the tests is within a phlebotomist's role, while interpreting them or explaining why they were ordered belongs to the person who ordered them. Refusing to say anything is unnecessary secrecy toward the patient whose own information it is, and promising a normal result is a prediction the phlebotomist cannot make and the patient may remember.

Which set of details must a phlebotomist document after a failed venipuncture attempt on an inpatient?

• a.The attempt, the site used and who was notified or asked to complete the collection✓
• b.The name of the vein only, since no specimen was obtained and there is nothing else to report
• c.The patient's stated reason for having difficult veins and their history of previous draws
• d.Nothing, because documentation is required only when a specimen actually reaches the laboratory

An unsuccessful attempt still happened to the patient, so the record shows that it was made, where, and how the order was resolved, whether by a colleague, by the nurse or by contacting the provider. That record prevents a fourth and fifth puncture by someone who does not know what has already been tried, and it is exactly the note that is missing when a complaint is reviewed.