CSLB General Building (B) — All Questions

A newly hired phlebotomist asks about the hepatitis B vaccine. Under the Bloodborne Pathogens Standard, what must the employer do?

• a.Provide it only after the employee has a documented exposure
• b.Require the employee to pay half the cost of the series
• c.Offer the vaccination series at no cost within 10 working days of assignment to at-risk duties✓
• d.Provide it only if the employee has worked there for one year

The standard requires employers to offer the hepatitis B vaccination series free of charge within 10 working days of initial assignment to duties with occupational exposure. Employees may decline, but they must sign a declination form and may request the vaccine later at no cost. Charging the employee, waiting for an exposure or imposing a service requirement all violate the rule.OSHA 29 CFR 1910.1030

Which description matches a compliant sharps container?

• a.A clear plastic bag labeled with a biohazard symbol
• b.A cardboard box lined with a red bag
• c.A rigid, puncture-resistant, leak-proof container that is closable and labeled with the biohazard symbol✓
• d.Any lidded container kept in a locked cabinet

Sharps containers must be closable, puncture resistant, leak proof on sides and bottom, and labeled or color coded as biohazardous. Bags and cardboard cannot resist punctures and allow injuries and leakage. Storing an ordinary container in a locked cabinet does not meet the construction or labeling requirements, and containers must also be replaced before they are overfilled.OSHA 29 CFR 1910.1030

After a successful draw, what is the correct handling of the used needle?

• a.Activate the safety device immediately and drop the whole assembly into the sharps container✓
• b.Bend it so it cannot be reused, then discard it
• c.Recap it with two hands and then discard it
• d.Carry it to the laboratory and discard it there

Contaminated needles must not be recapped, bent, sheared or removed by hand, and the engineered safety feature is activated immediately at the point of use. The intact needle and holder are discarded together in the nearest sharps container. Recapping with two hands is the classic cause of needlesticks, and transporting an unprotected sharp exposes everyone along the route.OSHA 29 CFR 1910.1030

A phlebotomist sustains a needlestick from a used needle. What is the correct first action?

• a.Squeeze the site hard to force out blood
• b.Apply a caustic agent such as bleach to the wound
• c.Finish the shift and report the injury at the end of the day
• d.Wash the site immediately with soap and running water, then report the exposure✓

Immediate washing with soap and running water is the recommended first step, followed by prompt reporting so post-exposure evaluation, source testing and prophylaxis can begin within the effective window. Squeezing the wound damages tissue and has no proven benefit. Applying bleach or other caustics injures tissue, and delaying the report can push treatment past the point where it works best.OSHA 29 CFR 1910.1030

A phlebotomist finishes drawing a patient on contact precautions for Clostridioides difficile. Which hand hygiene is required?

• a.Use an alcohol-based hand rub only
• b.Wash with soap and running water✓
• c.Use an alcohol rub twice in a row
• d.Change gloves without performing hand hygiene

Alcohol-based rubs do not kill C. difficile spores, so hands must be washed with soap and running water, which physically removes them. Soap and water are also required whenever hands are visibly soiled. Repeating an alcohol rub does not add sporicidal activity, and changing gloves alone does not decontaminate the hands underneath.CDC Guideline for Hand Hygiene in Healthcare Settings

Which removal sequence for personal protective equipment best limits self-contamination?

• a.Gloves, goggles or face shield, gown, mask✓
• b.Mask, gown, gloves, goggles
• c.Gown, gloves, mask, goggles
• d.Goggles, mask, gloves, gown

Gloves are the most contaminated item and come off first, followed by eye protection, then the gown, and finally the mask, which is removed last and outside the patient room. Removing the mask early exposes the face while the hands are still contaminated. Hand hygiene is performed after glove removal and again after all PPE is off.CDC Guideline for Isolation Precautions

A phlebotomist is sent to draw a patient in airborne precautions for suspected tuberculosis. What is required?

• a.A surgical mask and gloves
• b.A gown and face shield only
• c.A fit-tested N95 or higher respirator, with the room door kept closed✓
• d.No additional protection if the draw takes under five minutes

Airborne precautions require a fit-tested N95 or higher-level respirator and an airborne infection isolation room with the door closed. A surgical mask does not filter droplet nuclei that stay suspended in air. Gowns and face shields address contact and splash risks, and short exposure time does not remove the inhalation hazard.CDC Guideline for Isolation Precautions

A patient is on contact precautions for MRSA. What PPE does the phlebotomist wear to enter and draw blood?

• a.N95 respirator and goggles
• b.Gown and gloves, donned before entering the room✓
• c.Gloves only, since the skin is intact
• d.Surgical mask only

Contact precautions require a gown and gloves put on before room entry and removed before exit, because transmission occurs through direct and indirect surface contact. An N95 is reserved for airborne precautions and a surgical mask for droplet precautions. Gloves alone leave the uniform free to pick up organisms from bedding and equipment.CDC Guideline for Isolation Precautions

Droplet precautions are ordered for a patient with suspected pertussis. What does the phlebotomist do?

• a.Wear no PPE because droplets fall quickly to the ground
• b.Wear a fit-tested N95 and place the patient in negative pressure
• c.Wear a gown but no facial protection
• d.Wear a surgical mask when working within about three to six feet of the patient✓

Droplet precautions call for a surgical mask on close approach, since respiratory droplets travel only a short distance before settling. Negative pressure rooms and N95 respirators are used for airborne organisms, not droplet spread. A gown alone leaves mucous membranes unprotected, and the fact that droplets settle is exactly why close-range protection is needed.CDC Guideline for Isolation Precautions

Two phlebotomists discuss a patient's positive test result by name in a crowded elevator. Which principle is violated?

• a.Chain of custody
• b.Informed consent
• c.Quality control documentation
• d.Protection of patient health information and the minimum necessary rule✓

Identifiable health information may be disclosed only to those with a legitimate need to know, and a public elevator conversation exposes it to people with no treatment relationship. Chain of custody concerns forensic specimen tracking, quality control concerns test accuracy, and informed consent concerns permission for a procedure. None of those cover casual disclosure of results.HIPAA

A pre-employment drug screen requires chain of custody. What does this documentation establish?

• a.That the specimen was collected while the donor was fasting
• b.Every person who handled the specimen and every transfer from collection to reporting✓
• c.That the correct tube additive was used
• d.That the laboratory participates in proficiency testing

Chain of custody is a legal record documenting identity, handling and transfer of a specimen at every step so its integrity can be defended in court. It typically includes a tamper-evident seal, dated signatures at each transfer and secure storage. Fasting status, additive selection and proficiency testing are quality issues but are not what a chain of custody form proves.

Which statement about CLIA-waived testing is accurate?

• a.Waived tests do not require any manufacturer instructions to be followed
• b.Waived status means the facility needs no CLIA certificate at all
• c.Waived tests are simple, low-risk methods that must still be run exactly per the manufacturer instructions✓
• d.Waived tests may be reported without patient identification

CLIA-waived tests, such as many point-of-care glucose meters, are considered simple with a low risk of error, but the facility still needs a Certificate of Waiver and must follow the manufacturer instructions exactly. Deviating from the instructions voids waived status. Patient identification and result documentation requirements apply to waived testing just as they do to all laboratory testing.CLIA

A point-of-care glucose meter's control result falls outside the acceptable range. What should be done?

• a.Stop patient testing, troubleshoot and repeat the control, and document the action before reporting results✓
• b.Report the patient results and repeat the control at the end of the shift
• c.Average the failed control with the previous passing control
• d.Ignore the failure if the patient result looks clinically reasonable

An out-of-range control indicates the system cannot be trusted, so patient testing stops until the cause is corrected and an acceptable control is obtained, with all steps documented. Reporting results from an unverified instrument risks patient harm. Averaging controls or judging results by clinical appearance defeats the purpose of objective quality control.CLIA

How often must an employer review and update the written Exposure Control Plan?

• a.Only when a new employee is hired
• b.At least annually, and whenever new tasks or procedures affect exposure✓
• c.Every five years
• d.Only after a documented exposure incident

The Exposure Control Plan must be reviewed and updated at least annually and whenever new or modified tasks and procedures change occupational exposure, including when safer devices become available. A five-year cycle is far too long and hiring alone is not the trigger. Waiting for an exposure incident is reactive and does not satisfy the standard.OSHA 29 CFR 1910.1030

A phlebotomist has just drawn an outpatient and the next patient is waiting. What is correct glove practice?

• a.Keep the same gloves and disinfect them with alcohol between patients
• b.Keep the same gloves if they are not visibly soiled
• c.Wear two pairs and peel off the outer pair between patients
• d.Remove and discard gloves after each patient, perform hand hygiene, and put on a new pair✓

Gloves are single-use items that must be removed and discarded after each patient, followed by hand hygiene and a fresh pair. Alcohol degrades glove material and does not reliably decontaminate it. Absence of visible soiling does not mean absence of contamination, and double gloving is not an approved substitute for changing gloves.OSHA 29 CFR 1910.1030

Which labeling is required on a container used to transport blood specimens off the collection floor?

• a.A biohazard symbol or red color coding identifying the contents as infectious✓
• b.The phlebotomist's name only
• c.No labeling is required if the lid is closed
• d.A handwritten note that says fragile

Containers holding blood or other potentially infectious material must carry the biohazard label or be red color coded so anyone handling them knows the risk. A fragile note or a staff name conveys nothing about infectious hazard. A closed lid contains the specimen but does not warn the next handler.OSHA 29 CFR 1910.1030

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

• a.Washing hands after glove removal
• b.Not recapping used needles
• c.A needle with a retractable safety shield✓
• d.Prohibiting eating in the specimen processing area

Engineering controls are devices that isolate or remove the hazard, such as self-sheathing needles, sharps containers and splash guards. Work practice controls change how a task is performed, which is what not recapping, hand washing and food restrictions do. Both categories are required, but only the device itself is an engineering control.OSHA 29 CFR 1910.1030

Which statement best describes standard precautions?

• a.They apply only to patients with a known bloodborne infection
• b.They replace the need for transmission-based precautions
• c.They apply to every patient because infection status may be unknown✓
• d.They apply only in the emergency department

Standard precautions treat blood and body fluids from every patient as potentially infectious, because many infections are undiagnosed at the time of care. Transmission-based precautions such as contact, droplet and airborne are added on top of standard precautions, not substituted for them. The approach applies in every care setting, not just high-acuity areas.CDC Guideline for Isolation Precautions

A tube of blood breaks on the floor. What is the correct decontamination sequence?

• a.Put on gloves, cover and absorb the spill, then apply an appropriate disinfectant such as 1:10 bleach and allow the required contact time✓
• b.Spray disinfectant and wipe it up right away with a paper towel
• c.Mop the area immediately with plain water
• d.Leave it for housekeeping and mark the area with a chair

The spill is contained and absorbed while wearing appropriate PPE, then treated with an EPA-registered disinfectant or a freshly prepared 1:10 bleach solution left in place for the required contact time before final cleanup, with any glass picked up mechanically. Water does not disinfect and wiping immediately gives no contact time. Abandoning a biohazard spill leaves others exposed.OSHA 29 CFR 1910.1030

Which activity is prohibited in an area where blood specimens are handled?

• a.Wearing a buttoned lab coat
• b.Storing labeled specimens in a designated refrigerator
• c.Documenting collection times in the log
• d.Applying lip balm or eating a snack at the bench✓

Eating, drinking, smoking, applying cosmetics or lip balm and handling contact lenses are prohibited where there is a reasonable likelihood of occupational exposure, because they create a hand-to-mucous-membrane route. Wearing appropriate protective clothing and documenting collections are expected practices. Specimens may be stored in a refrigerator designated for that purpose, but food may never be stored there.OSHA 29 CFR 1910.1030

After a reported needlestick, what must the employer provide?

• a.A written warning documenting the employee's technique error
• b.A confidential medical evaluation, source testing when permitted by law, and follow-up at no cost to the employee✓
• c.A requirement that the employee use personal insurance for follow-up
• d.Reassignment away from patient care for six months

The standard requires a confidential post-exposure medical evaluation and follow-up at no cost, including source individual testing where legally permitted, prophylaxis when indicated and counseling. Disciplining the employee discourages reporting and is not a required response. Shifting cost to the employee or automatically removing them from duty is not part of the requirement.OSHA 29 CFR 1910.1030

A patient's adult daughter asks the phlebotomist for her mother's lab results. What is the appropriate response?

• a.Explain that results are released by the ordering provider and refer her to the care team✓
• b.Read the results aloud since she is immediate family
• c.Print the results and hand them over if the patient is in the room
• d.Give a general summary without naming specific values

Phlebotomists do not release results, and protected health information may not be disclosed to family members without proper authorization. Referring the request to the ordering provider respects both privacy rules and scope of practice. Being related, being present in the room or softening the disclosure into a summary does not create authorization.HIPAA