NCCT Phlebotomy Exam 2023 with All Questions and Answers
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What is the first step in performing a venipuncture? - ANSWER identify the patient
To prevent error and maintain a culture of safety, at least 2 identifiers (ex. full name and
date of birth) must be verified prior to performing a procedure.
What is the proper way to identify a patient prior t...
NCCT Phlebotomy Exam 2023 with All
Questions and Answers
What is the first step in performing a venipuncture? - ANSWER identify the patient
To prevent error and maintain a culture of safety, at least 2 identifiers (ex. full name and
date of birth) must be verified prior to performing a procedure.
What is the proper way to identify a patient prior to performing a venipuncture? -
ANSWER Ask the patient to state his/her full name and DOB and compare to the chart.
Before a venipuncture, the medical assistant should ask the patient to state his/her full
name and DOB (comparing what is stated to what is written in the chart or on a wrist
band patient identifier). This minimizes the risk for mis-identification errors because it
cross-checks what the patient says against written documentation. This provides a
verified identity so that all tubes collected will be associated with the correct patient
(provided the medical assistant labels them properly).
Using the guidelines for any method of venipuncture, what action should the medical
assistant perform directly after confirming patient identity? - ANSWER Review the
requirements for collecting and handling the blood specimen as ordered by the physician
To ensure accuracy and quality, it is important to anticipate your needs before beginning
the actual venipuncture (i.e. tube color/size, minimum acceptable blood volume, whether
or not the specimen needs to be placed on ice). Therefore, the medical assistant would
identify the patient, then review the requirements for collecting and handling the blood
specimen as ordered by the physician. Next, assemble the appropriate equipment and
select the proper evacuated tubes for test to be performed. Then, apply the tourniquet
and thoroughly palpate the selected vein. Finally, position the patient's arm and cleanse
the site with an antiseptic wipe, then proceed with the venipuncture protocol.
What should be avoided as a form of patient identification? - ANSWER insurance
number
An insurance number is not a common means of positive patient identification (entire
families can share the same insurance policy number). Patients must be positively
identified for medical services, whether they have insurance or not. Insurance
information is necessary for billing purposes. The only true unique identifier listed among
these choices is the social security number. Patient name and date of birth are also
commonly used to confirm identification.
Name the two most used patient identifiers. - ANSWER Patient's name/date of birth
,Name and DOB are most often used as positive patient identifiers as they are easily
documented and work for inpatients or outpatients. Bed numbers should never be used
as identifiers for inpatients or outpatients, nor should physician name associations.
Medical record numbers are valuable for inpatients, with name and DOB being used
most often.
Prior to any type of inpatient specimen collection, a phlebotomist must correctly verify
their patient's identity by using which two-step procedure? - ANSWER Check ID
bracelet, and ask patient to verbally confirm their identity.
The correct answer is to check the ID bracelet and ask the patient to verbally confirm
his/her identity. Patients may not have foot bed charts or IV bags, and the goal is to
select the BEST answer of all choices. If a patient has both an ID bracelet and can verify
his/her own identity, it is ideal.
The phlebotomist is drawing blood from a patient that is taking blood thinners. What is a
necessary piece of additional equipment to have at the drawing station? - ANSWER
non-adhering bandage
Non-adhering bandage material would be helpful for patients on anticoagulant therapy
who may bleed more extensively than typical patients after venipuncture. It is necessary
to contain the bleed with a bandage, but adhesive might bruise once removed from a
patient who has anticoagulated blood.
In which of the following time frames should a tourniquet be routinely released on a
patient while performing a blood draw? - ANSWER within one minute
The standard time limit for having a tourniquet on a patient is one minute. Inaccurate
laboratory test results may occur if a tourniquet is not removed within one minute. When
a tourniquet is applied, the local blood flow is stopped. This leads to concentration of the
blood and blood entering the surrounding tissue. This may result in falsely high values
for all protein-based analytes, increased packed cell volume, and changes in other
cellular elements. The most current edition of the CLSI Procedures for the Collection of
Diagnostic Blood Specimens by Venipuncture, H3-A6, states that the tourniquet
application for preliminary vein selection should not exceed one minute. For most
patients, it is easy to release the tourniquet within the one-minute period. Most veins are
easily located and the venipuncture procedure can be completed quickly.
A medical assistant has active symptoms of the common cold. Under which of the
following conditions may he perform venipuncture? - ANSWER The medical assistant
may perform venipuncture provided he is wearing a mask and afebrile.
It is not uncommon for people to be able to work with the common cold. However, it is
important for medical personnel to use good judgment and not transmit diseases to their
,patients. Medical personnel should take precautions and handle patient contact in a
responsible manner. They should not have patient contact if they are febrile, since that is
when colds are highly contagious. In this instance, the medical assistant may perform
venipuncture provided he/she is wearing a mask and afebrile. The medical assistant
should wear the mask to keep from transmitting the cold via coughing or sneezing on a
patient.
What is an appropriate alternative to using a rubber tourniquet when attempting a
venipuncture on a known patient who is difficult to obtain a sample from? - ANSWER
blood pressure cuff
The only acceptable choice among the listed options is the blood pressure cuff.
Occlusion pressure may be adjusted as needed as an alternative to ensure circulation.
In compliance with CLSI (Clinical and Laboratory Standards Institute) standards, the
blood pressure cuff can provide uniform constriction, as long as the phlebotomist doesn't
inflate the cuff beyond 40 mm of mercury.
What evacuated tube should the medical assistant select for collection of electrolytes? -
ANSWER green-top
A green top tube contains heparin. Green tops are used for collection of heparinized
plasma or whole blood for special tests. Note: After the tube has been filled with blood,
the tube is inverted several times to prevent coagulation. Note: Green top tubes can
contain ammonium, lithium, and sodium in addition to the heparin. In this instance,
lithium heparin would be the green-top of choice (and sodium heparin would NOT be
used for an electrolyte test). Electrolytes can also be collected in a red-top tube.
What additive protects serum from interacting with red blood cells after a specimen has
been centrifuged? - ANSWER gel separators
Gel separators create a barrier between the serum and formed elements of the blood.
Prolonged contact of serum with formed elements can lead to pre-analytical variations in
certain tests (such as serum glucose levels). Tubes with clot activators, such as
thrombin, actually expedite the clotting process. Anticoagulant tubes keep the blood
from clotting, yielding plasma instead of serum. Sulfosalicylic acid is used in urine testing
to precipitate proteins.
The medical assistant is instructed to perform a capillary stick for newborn screening.
What collection devices should the medical assistant use? - ANSWER Heel stick lancet
The heel stick lancet (e.g., Tenderfoot) is required for infants. If a heelstick in an infant is
being performed, the phlebotomist should apply a warming device for approximately 3-5
minutes to the heel to increase blood flow to the area, which will facilitate the collection
of the capillary specimen. The bones of the distal phalanx (located in the thickest part of
, the finger) may be injured or damaged by a traditional finger stick lancet puncture.
What site should the medical assistant use for newborn screening blood collection? -
ANSWER plantar surface of the heel
A heel stick should be performed on the lateral or medial portions of the plantar surface
of the heel-skin surface (left and right). Never stick the center area of heel, the arch, or
the back of the heel. Avoid puncturing the bone by targeting the plantar surface. Draw
an imaginary line starting in the middle of the big toe to the back of the heel. Then draw
another imaginary line between the small toes to the back of the heel. The proper
collection sites will be the fleshy portions outside those lines and below where the arch
meets the heel. The anteromedial aspect, lateral surfaces and plantar curvature do not
provide good flesh for a proper collection.
The appropriate needle gauge to use for most venipuncture collections is - ANSWER
21
The 21 gauge needle is long enough and thin enough to access most veins and the
internal diameter (bore size) is wide enough to permit blood collection with little concern
about mechanical hemolysis when using evacuated tubes. Butterfly collection sets (wing
sets) typically use needles of a higher gauge, and blood donation centers typically use
needles of a lower gauge. Remember, the higher the gauge, the smaller the bore
(opening).
After several minutes of searching the medical assistant can only palpate a small vein.
The patient is prepared and the venipuncture is performed. The blood is filling the tube,
but slows and then stops even though the patient and medical assistant remained still.
What actions should the medical assistant take? - ANSWER Use a smaller tube
because the vein has collapsed.
Since blood was once filling the tube, the needle was once in the vein. Since the
phlebotomist knew this was a small vein at palpation, the fragility of the vein may have
caused the vein to collapse if the vacuum of a regular size collection tube was too
strong. Putting a smaller tube on the multi-sample needle would decrease the force of
the vacuum pulling blood from the vein. If blood flowed easily again, problem is solved!
Presuming the phlebotomist had a steady hand during the draw, the other causes could
be ruled out. Since blood filled the tube normally for a time and slowed to a stop, there is
no reason to believe the needle had been moved. And if the bevel was still in the vein at
all, blood would still be able to trickle into the tube.
The physician orders a sedimentation rate for a patient recovering from an infection.
This is indicated on the lab requisition as which of the following? - ANSWER ESR
The Erythrocyte Sedimentation Rate (ESR) is a common test to detect inflammation by
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