NHA Phlebotomy Technician (CPT) — All Questions

A patient who has been vomiting for two days arrives dehydrated for routine blood work. What should the phlebotomist expect?

• a.The veins will be unusually easy to find, because dehydration makes the vessel walls more rigid
• b.Every result will read lower than usual, because the remaining blood is thinner than normal
• c.The specimen will hemolyze automatically, so a redraw should be scheduled in advance
• d.Veins that are harder to find and results affected by hemoconcentration✓

Dehydration reduces plasma volume, so veins are less well filled and harder to enter, and the analytes left behind are more concentrated, which raises hematocrit, protein and several chemistry values. The condition of the patient is documented so the provider can interpret the results, and it makes the draw harder rather than easier.

An inpatient is wearing two identification wristbands with different medical record numbers. What should the phlebotomist do?

• a.Stop and ask the nurse to resolve it and remove the band that does not belong✓
• b.Use the band that looks newer, since the older one is clearly left over from a previous admission
• c.Use whichever band matches the requisition and draw the specimen
• d.Cut off both bands and ask the patient to state a name and date of birth instead

Two bands mean the patient may have two records, and a specimen filed under the wrong one can separate a result from the history that explains it or, in the blood bank, from a known antibody. The nurse or admitting staff sorts it out before any blood is drawn. Choosing the newer looking band or the one that happens to match is guessing, and removing identification is not a phlebotomist's decision.

A sign above an inpatient's bed reads: no venipuncture, right arm. What should the phlebotomist do?

• a.Use the right arm anyway if the left has no usable vein, and note the reason on the requisition
• b.Use the left arm, and if that is not possible ask the nurse or provider how to proceed✓
• c.Ignore the sign, since it is not part of the medical record and may be out of date
• d.Draw from the right arm below the level of the elbow, which the restriction does not cover

That sign usually reflects a mastectomy, a fistula, a graft, a cast or an affected limb after a stroke, and the restriction covers the whole arm rather than part of it. The other arm is used, and if it cannot be, the nurse or provider decides, which may mean a hand vein on the permitted side or an order to proceed anyway. A phlebotomist does not override the restriction alone.

A patient with right-sided weakness after a stroke needs a blood draw. Which arm is preferred and why?

• a.The right arm, because the weakened side has less muscle tone and the veins are easier to enter
• b.Either arm, because a stroke has no bearing on which limb may be used for a venipuncture
• c.The left arm, because circulation and sensation are better on the unaffected side✓
• d.Neither arm, because a patient after a stroke must be drawn by capillary puncture only

The unaffected side has better perfusion, normal sensation and normal muscle activity, so it heals better and the patient can report nerve pain if it occurs. An affected limb may also be edematous. The restriction is a preference rather than an absolute rule, and it is documented, but a stroke does not restrict the patient to skin puncture.

An outpatient arrives at the drawing centre with no order and says her doctor told her to come. What should happen?

• a.Draw a standard panel of common tests so the patient does not have to make a second trip
• b.Contact the ordering office to obtain the order before any specimen is collected✓
• c.Ask the patient which tests she remembers being mentioned and collect those tubes
• d.Send her away and tell her to bring a paper order signed by her doctor next time

A specimen cannot be collected without an order that says what is being tested and why, and the clinic can usually send or confirm one within minutes. Choosing tests from memory, the patient's or the phlebotomist's, produces results nobody ordered and a bill nobody expected. Turning the patient away without trying to obtain the order wastes a trip that a phone call might save.

A patient in a long term care facility is confused and has no wristband. Who may confirm the patient's identity?

• a.Another resident who has shared the dining room with the patient for several years now
• b.A staff member who knows the resident, and the identity is documented✓
• c.The name printed on the door of the room, which the facility keeps current on its records
• d.The phlebotomist's own recollection from having drawn the same resident several weeks earlier

Where no wristband is worn, a caregiver who knows the resident makes the identification and it is recorded, so there is an accountable person behind the name on the tube. A door sign is a location, another resident is not a reliable source, and a phlebotomist's memory of a face is exactly the kind of informal identification that produces a mislabelled specimen.

How should a phlebotomist begin an encounter with an outpatient in the waiting area?

• a.Call out the patient's full name and diagnosis so the right person knows to come forward
• b.Beckon the next person in the queue and start walking toward the drawing room at once
• c.Announce the tests that have been ordered so patients can sort themselves into the right rooms
• d.Call the patient by name, introduce yourself and your role, then confirm identity privately✓

A name may be called in a waiting room, but the diagnosis and the tests belong to the patient alone and are not announced. Identity is then confirmed away from other ears, using two identifiers. Introducing yourself and your role is both courteous and part of the patient's right to know who is about to perform a procedure on them.

A patient who is visually impaired arrives for a blood draw. Which practice is most appropriate?

• a.Take the patient's arm and steer her to the chair without speaking, which is quicker for both
• b.Have a family member carry out the identification so the patient does not have to be asked
• c.Say who you are, describe each step before it happens, and offer your arm to guide her✓
• d.Hand the patient a printed information sheet describing the procedure she is about to undergo

Describing what is about to happen replaces the visual cues the patient cannot use, and offering an arm to hold lets her stay in control of her own movement rather than being steered. She confirms her own identity as any other competent adult does, and a printed sheet is of no use to someone who cannot read it.

A patient becomes agitated and swings an arm as the phlebotomist prepares the site. What is the correct response?

• a.Have a colleague hold both of the patient's arms down so the collection can be completed
• b.Stop, step back out of range, and get help before deciding whether to continue✓
• c.Speak sharply to the patient so the behaviour stops and the draw can go ahead as planned
• d.Continue quickly with a shorter needle, which reduces the injury risk if the arm moves

Personal safety comes first, and a moving arm plus a needle is how both the patient and the phlebotomist get hurt. The phlebotomist withdraws to a safe distance, calls for assistance and lets the nursing staff assess what is driving the behaviour, which may be pain, delirium or low blood sugar. Restraint is a clinical decision made by others, and no needle length makes the situation safe.

A patient tells the phlebotomist she drank several glasses of wine last night before a fasting liver panel this morning. What should the phlebotomist do?

• a.Draw the specimen and report what the patient said, so the result can be read in context✓
• b.Cancel the collection, because alcohol within twelve hours invalidates every liver test
• c.Draw the specimen and say nothing, since alcohol has no effect on any liver measurement
• d.Advise the patient that her results will certainly be abnormal and that she should stop drinking

Recent alcohol can move several results, so the information is passed on rather than acted on alone, and the provider decides whether it changes the interpretation or whether the test should be repeated. Cancelling on the phlebotomist's own judgement removes a clinical decision from the clinician, and predicting an abnormal result or giving lifestyle advice is outside the role.

A patient asks to see the requisition before agreeing to the draw. How should the phlebotomist respond?

• a.Refuse, because a requisition is an internal laboratory document and not the patient's property
• b.Refuse politely and offer to describe the tests verbally, which is easier for a patient to follow
• c.Show it, since the information on it is the patient's own✓
• d.Show it only after the specimen has been collected and the tubes have all been labelled

The requisition holds the patient's name, the ordering provider and the tests requested, all of which are her own health information, and there is no reason to withhold it. Letting her read it supports informed cooperation. Deferring until after the draw defeats the purpose of asking, and treating her own information as an internal document is a common but mistaken habit.

A patient's culture makes her uncomfortable being touched by a phlebotomist of the opposite sex. How should this be handled?

• a.Explain that staffing does not permit preferences and complete the draw as assigned
• b.Try to accommodate the request where staffing allows, and document what was done✓
• c.Refuse the request, since accommodating it would be unfair to the other patients waiting
• d.Ask the patient to justify the request before deciding whether it can be accommodated

Where another phlebotomist is available, honouring the preference costs little and preserves the patient's dignity and her willingness to come back. Where it is not possible, the situation is explained and options such as a chaperone are offered. Demanding a justification for a personal or religious preference is intrusive, and dismissing it invites a refusal of care.

A colleague asks the phlebotomist to look up a neighbour's laboratory results in the hospital system out of curiosity. What is the correct response?

• a.Look them up but do not print or write anything down, which leaves no trace of the access
• b.Look them up only if the neighbour is a patient of the same department that both staff work in
• c.Look them up and share only whether the results were normal, without giving any actual numbers
• d.Decline; access is limited to what your own job requires and every look-up is logged✓

Access to a record is permitted only for a work purpose that concerns that patient, and curiosity is never one. Audit trails record every view, and staff are dismissed and fined for exactly this. Reading without printing still counts as access, working in the same department does not create a treatment relationship, and reporting a result as normal is still a disclosure.

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.

When is an alcohol-based hand rub an acceptable substitute for washing with soap and water?

• a.Whenever the phlebotomist is in a hurry, since the rub takes less time than a proper wash
• b.When hands are not visibly soiled and the patient is not on precautions for a spore-forming organism✓
• c.After any contact with blood, because alcohol kills bloodborne viruses on the skin surface
• d.Only at the start of a shift, before the hands have touched any patient or any equipment

An alcohol rub is effective and fast on hands that are not visibly soiled, but it does not remove spores, so soap and water are required after caring for a patient with Clostridioides difficile and whenever hands are soiled or contaminated with blood. Convenience is not a criterion, and hand hygiene is performed throughout a shift rather than once at the start.CDC Guideline for Hand Hygiene in Healthcare Settings

What must an employer record in the sharps injury log under the Bloodborne Pathogens Standard?

• a.The full name of every injured employee, so that repeat injuries can be traced to individuals
• b.The names of every patient whose blood was on the device
• c.The device involved, the department where it happened, and how the incident occurred✓
• d.Only injuries that led to a confirmed infection, since the others produced no lasting harm

The log is maintained to spot patterns in devices and settings, so it records the type and brand of device, the work area and an explanation of the incident, and it is kept in a way that protects the injured employee's confidentiality. Patient names are not part of it, and recording only injuries that led to infection would hide almost every event the log exists to find.OSHA 29 CFR 1910.1030

A phlebotomist must wear an N95 respirator to enter an airborne isolation room. What has to have happened first?

• a.The phlebotomist must have been fit tested and trained for that model and size of respirator✓
• b.The phlebotomist must have worn a surgical mask under the respirator for a better seal
• c.The phlebotomist must have obtained written permission from the patient to enter wearing one
• d.The phlebotomist must have shaved within the last week, whether or not facial hair is present

A respirator protects only if it seals, and the seal depends on the model and size, which is why fit testing, training and a user seal check before each use are required. Facial hair along the sealing surface does break the seal, but the requirement concerns the seal rather than a weekly shave. A mask underneath breaks the seal, and no patient permission is involved.

A phlebotomist discovers a small fire in a supply room. Using the RACE sequence, what comes first?

• a.Confine the fire by shutting every door and window in the corridor outside the room
• b.Rescue anyone in immediate danger✓
• c.Extinguish the fire with the nearest extinguisher before it can spread any further
• d.Alarm, by pulling the nearest fire alarm and telephoning the switchboard operator

RACE runs rescue, alarm, confine, extinguish. People come out of danger first, then the alarm is raised, then doors are closed to slow the spread, and only then does anyone attempt an extinguisher, and only on a small fire with a clear exit behind them. Reversing the order leaves someone in a room nobody has cleared.

Where does a phlebotomist find the health hazards and first aid measures for a disinfectant used in the drawing room?

• a.On the manufacturer's website, which is the only place the current information is published
• b.In the facility's exposure control plan, which lists every chemical the department stocks
• c.On the safety data sheet, which the employer must keep accessible to employees✓
• d.On the shipping carton, which carries the same information as the product's technical file

Under the hazard communication standard the manufacturer supplies a safety data sheet in a standard sixteen section format, and the employer keeps it where employees can reach it during every shift without asking permission. The exposure control plan covers bloodborne pathogens rather than chemicals, and a carton is discarded long before the product is.OSHA 29 CFR 1910.1200

What is the correct sequence for putting on personal protective equipment before entering an isolation room?

• a.Gown first, then mask or respirator, then goggles, and gloves last✓
• b.Gloves first, then the gown, then the mask, and the goggles at the end
• c.Mask first, then gloves, then gown, then goggles, working from the head downward
• d.Goggles first, then gloves, then the gown, and the mask at the end

Gloves go on last so they can be pulled over the gown cuffs and sealed, and they are removed first because they are the most contaminated item. Putting gloves on early means handling a gown and a mask with gloved hands and then working with cuffs that are not covered. The order is not simply head to toe, and eye protection is fitted after the mask so it sits correctly over it.

Which item meets the definition of regulated waste that must go into a red biohazard bag?

• a.A glove with a small smear of dried blood on the fingertip
• b.A gauze pad saturated with blood that would release liquid if it were compressed✓
• c.An empty tube wrapper from a packet of sterile gauze opened at the bedside
• d.A paper towel used to dry the phlebotomist's hands after washing them

Regulated waste means liquid or semi-liquid blood, items caked with dried blood that could be released when handled, contaminated sharps and pathological waste. A dressing that would drip or release blood under compression qualifies. A lightly soiled glove, packaging and hand towels go in ordinary waste, and treating everything as regulated waste raises cost without raising safety.OSHA 29 CFR 1910.1030

A blood spill on a hard floor is to be decontaminated with household bleach. What dilution is commonly specified?

• a.Full strength bleach poured directly onto the spill
• b.One part bleach to one hundred parts water, which is gentler on flooring
• c.One part bleach to nine parts water, giving a one to ten dilution, made up fresh✓
• d.One part bleach to fifty parts water, kept mixed in a spray bottle for the month

A one to ten dilution of household bleach is the concentration usually specified for blood spills, and it is prepared fresh because hypochlorite loses activity over time in a bottle. The spill is absorbed first, then the surface is cleaned and disinfected with the required contact time. Weaker dilutions are used for general surfaces, and full strength bleach damages surfaces and irritates airways.

Blood splashes into a phlebotomist's eye during a difficult draw. What is the immediate action?

• a.Rub the eye with a clean gauze pad and finish the collection before leaving the room
• b.Instil an antibiotic eye drop from the department supply cupboard as soon as possible
• c.Close the eye and wait for it to water, which washes the contaminant out naturally
• d.Flush the eye at an eyewash station for the stated time, then report the exposure✓

Prolonged irrigation with water or saline at an eyewash station, usually for at least fifteen minutes, is the first step, followed immediately by reporting so the source patient can be assessed and post-exposure prophylaxis considered within the window in which it works. Rubbing drives contaminant across the surface, tears are not sufficient irrigation, and antibiotic drops treat the wrong problem.

What does the minimum necessary standard require of a phlebotomist?

• a.Access only the information the task requires, and disclose only what the recipient needs✓
• b.Keep every conversation about patients to the shortest number of words possible
• c.Collect the smallest volume of blood that will still complete the ordered tests
• d.Store patient records for the minimum period that state retention law allows

The standard governs the amount of protected health information that is used, requested or disclosed for a given purpose. A phlebotomist looks up the test order rather than browsing the chart, and tells the nurse what is relevant rather than everything known. It has nothing to do with blood volume, retention periods or the length of a sentence.HIPAA

Which of these is generally treated as a permissible incidental disclosure rather than a violation?

• a.Posting an anonymised photograph of an unusual specimen on a personal social media account
• b.A visitor overhearing a normal-volume identity check through a curtain in a shared room✓
• c.Leaving a printed requisition face up on a counter in the outpatient waiting area
• d.Discussing a patient's results with a colleague who is not involved in that patient's care

An incidental disclosure is a secondary one that cannot reasonably be prevented while care is being delivered, provided reasonable safeguards and the minimum necessary rule are applied, and being overheard through a curtain is the standard example. A photograph of a specimen can still be traced, an exposed requisition is a failure of a safeguard that is easy to apply, and gossip with an uninvolved colleague is a straightforward breach.HIPAA

A patient asks for a copy of her own laboratory results. What does the privacy rule generally provide?

• a.Results may be released only to the ordering provider, who then decides what to share
• b.Results may be released to the patient only after the provider has signed a release form
• c.Patients have a right of access to their own records, through the facility's release process✓
• d.Results may never be released directly to a patient because they require interpretation

The privacy rule gives an individual a right of access to their own designated record set, including laboratory results, and federal rules on information blocking have made electronic release faster. The request goes through health information management or the patient portal rather than the phlebotomist, but the answer is that the patient may have them, not that she may not.HIPAA

Where should a sharps container be placed in an outpatient drawing room?

• a.In a locked cupboard, so that no visitor or child can reach the contents of the container
• b.On the floor beside the chair, where it cannot be knocked over
• c.In the corridor outside, so one container serves several rooms and is emptied less often
• d.Close to the point of use and at a height the user can see into without reaching up✓

A container that is near, visible and at working height means the needle travels the shortest possible distance while it is still exposed, which is when injuries happen. Height matters because a user must see the opening and the fill line. Carrying a needle to a corridor or a cupboard lengthens that journey, and a container on the floor invites spills and contact with hands and feet.

What should a phlebotomist do with a laboratory coat worn during patient collections before going to the cafeteria?

• a.Remove it and leave it in the work area, because contaminated clothing does not leave the department✓
• b.Wear it, since it protects street clothes from any spill in the cafeteria queue
• c.Turn it inside out and wear it, which places the contaminated surface against the body
• d.Wear it only if no visible blood is present on the sleeves or on the front of the coat

Protective clothing worn during patient care stays in the work area and is laundered by the employer rather than taken into public spaces or home. Contamination is not always visible, so the absence of a stain proves nothing. Turning a coat inside out puts the contaminated surface against skin and clothing and spreads the problem rather than containing it.

How should specimens be transported from a patient care unit to the laboratory?

• a.Carried loose in a gloved hand, so a dropped tube can be caught before it hits the floor
• b.In a closed leak-proof bag or container marked with the biohazard symbol✓
• c.In the phlebotomist's uniform pocket, which keeps both hands free for opening doors
• d.In an open rack on a tray, so the labels stay visible

A secondary container is what stands between a broken tube and everyone in the corridor, so specimens travel in a closed, leak resistant, labelled bag or box, often with an absorbent liner and a separate pouch for the requisition. Loose tubes, pockets and open racks all offer nothing if a tube cracks, and a pocket makes a broken tube a personal exposure.

Which of these is an engineering control rather than a work practice control?

• a.Never recapping a needle after it has been used on a patient
• b.Washing hands immediately after gloves are removed
• c.A retractable needle that withdraws into its own housing✓
• d.Filling tubes in the standard order of draw during every collection

An engineering control is a physical device or a change to the workplace that isolates or removes the hazard, so a self-sheathing or retractable needle, a sharps container and a splash shield all qualify. Work practice controls change how a task is performed, which covers not recapping, hand hygiene and the order of draw. The distinction matters because engineering controls are required first where feasible.OSHA 29 CFR 1910.1030

A newly hired phlebotomist declines the hepatitis B vaccine. What must the employer do?

• a.Withdraw the job offer, because the vaccine is a condition of employment in patient care
• b.Charge the employee for the vaccine later if it is requested after the decline
• c.Record the decline verbally in the personnel file and take no further action
• d.Have the employee sign the declination form, and offer the vaccine again later if she asks✓

The vaccine is offered free within ten working days of assignment, a written declination statement in the wording set by the standard is signed if it is refused, and the employee may accept it at any later date while still covered, at no cost. Refusal is not grounds for withdrawing employment, the vaccine is never charged to the employee, and a verbal note does not satisfy the requirement.OSHA 29 CFR 1910.1030

After a reported needlestick, what happens to the results of the source patient's blood testing?

• a.They are given to the exposed employee under the confidentiality rules that apply to them✓
• b.They are posted on the unit noticeboard so all staff know the risk they were exposed to
• c.They are withheld from the exposed employee, who is told only whether to take prophylaxis
• d.They are released to the employee's family so that household precautions can be arranged

The source individual's blood is tested as soon as feasible where consent or law permits, and the exposed employee is informed of the results along with the applicable laws on disclosure of the source's identity and status. The employee needs that information to make a decision about prophylaxis. Nothing about it is posted publicly or released to relatives.OSHA 29 CFR 1910.1030

A phlebotomist is asked to move a heavy box of tube stock from the floor to a high shelf. What is the safest technique?

• a.Bend at the waist with the legs straight, which keeps the load closer to the shelf
• b.Bend the knees, keep the load close to the body, and avoid twisting while lifting✓
• c.Lift quickly in one movement so the back is under load for the shortest possible time
• d.Hold the box away from the body so it does not soil the front of the uniform

Bending the knees uses the legs rather than the lumbar spine, keeping the load close reduces the lever arm on the back, and turning the feet instead of twisting protects the discs. Speed does not reduce the force on the spine, holding a load away from the body multiplies it, and bending at the waist is the movement most associated with back injury.

What is the purpose of an incident report after a specimen is mislabelled and reaches the laboratory?

• a.To create a written record that identifies who was at fault so that discipline can follow
• b.To satisfy the insurer, which requires a form before it will consider paying any claim
• c.To document what happened so the process can be examined and the error prevented✓
• d.To notify the patient in writing that an error has occurred

An incident report is a factual account of what happened, written to let the organisation see where a process allowed an error through and change it. Reports that are used to assign blame stop being filed, and the events they would have described keep happening. Notifying a patient and any insurance process are separate matters handled by other people.

Which practice keeps a compressed gas cylinder safe in a laboratory area?

• a.Store it lying on its side on the floor so it cannot be knocked over
• b.Leave the protective cap off at all times so the valve can be reached in an emergency
• c.Keep it next to a radiator, which prevents condensation from forming inside the cylinder
• d.Secure it upright with a chain or strap and keep the cap on when it is not in use✓

A cylinder holds gas at very high pressure, and a valve snapped off a falling cylinder turns the cylinder into a projectile, so it is chained or strapped upright to a wall or a cart and the protective cap stays on until it is connected. Cylinders are kept away from heat, and lying one on the floor makes it easier to roll and harder to secure.

What does competency assessment mean for a phlebotomist performing waived point of care testing?

• a.Periodic documented checks that the operator still performs the test correctly✓
• b.A single certificate earned at the end of the initial training programme
• c.The manufacturer's guarantee that the device performs within its stated limits
• d.The laboratory director's signature on the annual quality control summary report

Competency is assessed and documented at defined intervals, typically at six months and then annually for a new operator, using methods such as direct observation, review of results and testing of blind samples. It is about the person rather than the device, an initial certificate does not demonstrate current competence, and a director's signature on a summary is not an assessment of an individual.

What is the purpose of a proficiency testing programme in a laboratory that performs non-waived testing?

• a.It trains new staff by giving them practice specimens with known values to analyse
• b.It sends unknown specimens from an external provider so results can be compared with peers✓
• c.It replaces daily quality control for any test that has passed it twice in a row
• d.It certifies each instrument at installation and again whenever the instrument is moved

An external provider sends specimens whose values the laboratory does not know, the laboratory tests them as it would a patient sample and returns the results, and the provider grades them against other laboratories using the same method. It is an external check on the whole testing process, and it supplements rather than replaces internal quality control.

Which action best reduces the risk of aerosol exposure when a specimen tube is opened?

• a.Open it quickly, since a fast movement gives the aerosol less time to leave the tube
• b.Point the tube opening toward the ceiling so nothing can be released toward a colleague
• c.Open it behind a splash shield or in a biosafety cabinet, wearing eye protection✓
• d.Warm the tube in the hand first, because warm liquid makes a finer aerosol

Removing a stopper releases a fine spray of the contents, so tubes are opened behind a physical barrier or inside a cabinet, with the stopper covered by gauze and turned away from the face, and eye protection worn. Speed increases the spray rather than reducing it, aiming a tube at the ceiling still releases the aerosol into the room, and warming makes the problem worse.

A phlebotomist wants to post a story about an interesting case on social media, with no name or date. Is this acceptable?

• a.Yes, because removing the name and the date makes the information no longer identifiable
• b.Yes, provided the account is private and only personal friends can read what was posted
• c.Yes, if a supervisor reads the post first and agrees that nothing identifying remains in it
• d.No, because details a reader could combine to identify the patient often remain✓

A diagnosis, a department, a date of shift and an unusual detail can identify a person even with no name attached, and staff have been disciplined for posts they believed were anonymous. Private accounts are screenshotted and forwarded, and a supervisor cannot approve a disclosure the patient has not authorised. The safe rule is not to post about patients at all.

Which precaution applies when a phlebotomist enters a room where a patient is receiving oxygen therapy?

• a.No open flame or spark-producing device, because oxygen makes any fire burn fiercely✓
• b.The oxygen must be switched off for the whole of the blood collection
• c.Only battery powered equipment may be brought into the room at any time
• d.The phlebotomist must wear a respirator because of the raised oxygen level in the air

Oxygen does not burn but it makes everything else burn faster and hotter, so flames, smoking and equipment that sparks are kept away and signs are posted. Turning off a patient's oxygen is a clinical decision that a phlebotomist never makes, ordinary electrical equipment is used in these rooms, and no respirator is needed for an enriched oxygen atmosphere.

How should a phlebotomist respond to a coworker who repeatedly draws blood without gloves because the veins feel better?

• a.Say nothing, since each employee is entitled to accept a risk that affects only themselves
• b.Report the practice through the department's usual channel, because it is a violation✓
• c.Offer to hand the coworker gloves each time so the habit gradually corrects itself
• d.Copy the practice on difficult patients, since the coworker clearly has more experience

Gloves are required for every collection, and the risk is not only to the person choosing to go without: a bloodied hand contaminates equipment, surfaces and the next patient. Persistent non-compliance is reported so it can be corrected. Silence normalises it, handing over gloves does not address a deliberate choice, and copying it spreads the hazard.

Which specimen problem is a rejection reason that the phlebotomist can prevent at the bedside?

• a.A patient whose result is outside the reference interval for that analyte
• b.An analyser flag raised during the run in the laboratory
• c.A quantity of blood that is not sufficient for the ordered test✓
• d.A delay caused by the courier vehicle breaking down on the route

Short draws, clotted anticoagulant tubes, hemolysis, mislabelling and wrong tube type are all created at the point of collection and all cause rejection, and each of them is preventable by the person holding the needle. An abnormal result is a finding rather than a defect, an analyser flag arises during testing, and a courier breakdown is outside anyone's control at the bedside.

A specimen arrives in the laboratory with a label that has the correct name but no collection date or time. What normally happens?

• a.The specimen is discarded at once and the patient is called back for a fresh collection
• b.The laboratory writes in the time the specimen was received and processes it as usual
• c.The specimen is processed and the missing information is reported as a comment
• d.The collector is contacted to complete the label, and policy decides whether it may be used✓

Only the person who collected the specimen can supply a collection time, so the laboratory contacts that person rather than filling it in, and the facility's policy decides whether a completed label is acceptable or a recollection is required. Entering a receipt time as a collection time creates a false record, and discarding without asking wastes a specimen that may be recoverable.