CSLB General Building (B) — All Questions

How should an outpatient be identified before venipuncture?

• a.Ask, Are you Mr. Johnson, and proceed if the patient says yes
• b.Ask the patient to state full name and date of birth, then match both to the requisition✓
• c.Confirm the name on the sign-in sheet
• d.Match the room number and the last four digits of the record number

Two independent identifiers must be actively stated by the patient and matched against the requisition, most commonly full name and date of birth. Asking a yes-or-no question invites a confused or hard-of-hearing patient to agree incorrectly. A sign-in sheet is not a verified identifier and outpatients have no room number, which is never an acceptable identifier in any setting.CLIA

An inpatient scheduled for a type and screen has no identification wristband. What should the phlebotomist do?

• a.Draw the specimen and note the missing band on the label
• b.Ask the roommate to confirm the patient's identity
• c.Ask the nurse to verify identity and apply a new wristband before collecting✓
• d.Use the name on the door and the chart at the bedside

An inpatient must wear an attached identification band, and blood bank specimens have the strictest identification requirements because a mismatch can cause a fatal transfusion reaction. The nurse verifies identity and applies a new band before collection proceeds. Roommates, door signs and bedside charts are not verified patient identifiers and can be wrong after a room change.CLIA

A patient scheduled for a fasting lipid panel reports drinking black coffee two hours ago. What should the phlebotomist do?

• a.Notify the laboratory or provider and document the non-fasting status before collecting or rescheduling✓
• b.Draw the specimen and say nothing since coffee has no calories
• c.Send the patient home for a full 24 hour fast
• d.Collect the specimen and label it as fasting anyway

A fasting specimen typically requires 9 to 12 hours with only water, and coffee stimulates metabolism and can alter results, so the deviation must be reported and documented. Recording a non-fasting sample as fasting falsifies the record and misleads interpretation. Fasting longer than about 12 hours can itself distort results, so a 24 hour fast is not appropriate.

During a 3-hour glucose tolerance test the patient vomits 20 minutes after drinking the glucose solution. What is the correct action?

• a.Give a second glucose drink and restart the timing
• b.Notify the provider or laboratory immediately, since the test usually must be discontinued and rescheduled✓
• c.Continue the collections and note the vomiting on the last tube
• d.Shorten the test to one hour

Vomiting means the glucose load was not absorbed, so the remaining timed results are meaningless and the provider or laboratory decides whether to stop and reschedule. Repeating the drink is not the phlebotomist's decision and doubles the dose risk. Continuing the draws or arbitrarily shortening the protocol produces uninterpretable data.

A 9-year-old is brought for a blood draw by an adult neighbor with no documented authorization. What should the phlebotomist do?

• a.Proceed because the child agrees to the draw
• b.Proceed because any adult present may consent
• c.Ask the child to sign the consent form
• d.Verify legal authorization from a parent or guardian before collecting✓

A minor cannot give legal consent for a procedure, so authorization must come from a parent, legal guardian or a documented designee. A neighbor without documented authority cannot supply it, and a child's agreement is assent rather than consent. Having the child sign a form creates a record with no legal standing.

A competent adult inpatient refuses the ordered blood draw. What is the correct response?

• a.Respect the refusal, notify the nurse or provider, and document it✓
• b.Tell the patient that refusing will delay discharge
• c.Have a family member hold the arm still
• d.Draw anyway because a provider ordered it

A competent adult has the right to refuse any procedure, and proceeding without consent may constitute battery. The correct steps are to stop, explain the purpose of the test respectfully, notify the nurse or ordering provider and document the refusal. Coercing the patient or restraining an arm is never acceptable regardless of the order.

Midway through a draw an outpatient becomes pale, sweaty and says the room is spinning. What is the first action?

• a.Hold an ammonia inhalant under the patient's nose
• b.Continue the draw quickly before the patient faints
• c.Release the tourniquet, remove the needle, and lower the patient's head while keeping the patient seated or supine✓
• d.Leave the patient to get help from the front desk

Presyncope is managed by immediately stopping the draw and removing the needle so an unconscious patient is not injured, then lowering the head or laying the patient flat to restore cerebral perfusion. Continuing the collection risks a fall with the needle in place. Ammonia inhalants are discouraged because they can trigger bronchospasm, and the patient must never be left alone.

A swelling appears rapidly at the site while the tube is filling. What should the phlebotomist do?

• a.Tighten the tourniquet to slow the swelling
• b.Continue until the tube is full, then apply a bandage
• c.Release the tourniquet, remove the needle, and apply firm direct pressure for several minutes✓
• d.Massage the area to disperse the blood

Rapid swelling indicates a hematoma from blood leaking into tissue, so the draw is stopped and firm direct pressure is applied for several minutes, longer if the patient takes anticoagulants. Tightening the tourniquet increases venous pressure and worsens the leak. Continuing the draw enlarges the hematoma, and massaging spreads blood through the tissue and increases bruising.

On needle insertion the patient reports sudden shooting, electric pain radiating to the hand. What should be done?

• a.Discontinue immediately, remove the needle, and report the event✓
• b.Redirect the needle deeper to find the vein
• c.Reassure the patient and finish the draw quickly
• d.Loosen the tourniquet and continue

Shooting, electric or radiating pain and tingling suggest nerve involvement, and the needle must be removed at once to prevent lasting injury, with the event reported and documented. Continuing or redirecting the needle deepens the contact and increases the risk of permanent damage. Loosening the tourniquet does nothing about the nerve contact itself.

Small red pinpoint spots appear on the arm under the tourniquet. What do they indicate?

• a.An allergic reaction to the tourniquet latex
• b.The beginning of a hematoma
• c.Contamination of the site
• d.Petechiae, suggesting capillary fragility or a platelet problem, and a tendency to bleed at the site✓

Petechiae are tiny non-raised red spots from capillary leakage and often warn that the patient may bleed longer after the draw. They are not an allergic reaction, which appears as raised itchy welts, and not a hematoma, which is a diffuse swelling and bruise. They do not indicate contamination, but they do mean pressure should be held longer after needle removal.

During a draw the blood is bright red and pulses into the tube, filling it very quickly. What should the phlebotomist do?

• a.Continue since fast filling means a good draw
• b.Suspect arterial puncture, remove the needle at once, and apply firm pressure for at least five minutes✓
• c.Apply a bandage without pressure and send the patient on
• d.Reposition the needle and collect the remaining tubes

Bright red blood that pulsates and fills rapidly suggests an artery was entered, so the needle is withdrawn immediately and firm pressure is held at least five minutes, with the patient observed and the event reported and noted for the laboratory. Continuing or repositioning risks significant bleeding. A bandage without sustained pressure will not control arterial bleeding.

A frightened 6-year-old is scheduled for a venipuncture. Which approach is most appropriate?

• a.Explain the steps in simple honest words, offer a comfort position with the caregiver, and work efficiently✓
• b.Promise the child that it will not hurt at all
• c.Tell the child that the draw will be canceled if the crying continues
• d.Show the child the needle in detail so there are no surprises

Honest, simple explanations paired with a caregiver comfort hold reduce anxiety and improve first-attempt success, and working efficiently shortens the stressful period. Promising no pain destroys trust as soon as the needle enters. Threats increase distress, and displaying the needle usually escalates fear rather than reducing it.

Before beginning a draw, what should the phlebotomist explain to the patient?

• a.The likely diagnosis based on the tests ordered
• b.The cost of each test and the insurance coverage
• c.Who the phlebotomist is, that blood will be collected, and roughly what will happen✓
• d.The reference ranges the results will be compared against

Introducing oneself, stating that a blood specimen will be collected and briefly describing the procedure supports implied consent and reduces anxiety. Interpreting test results or offering a diagnosis is outside the phlebotomist's scope of practice. Billing questions belong to the business office, and reference ranges are part of the physician's interpretation.HIPAA