NCCT Phlebotomy Exam Questions with all Correct
Answers
Games and activitiesA 2 week old infant has been brought to the lab for a repeat PKU/neonatal screening.
What collection procedure is appropriate to collect the specimens? - ANSWER-capillary using heel puncture
lancet
PKU is a neonatal screening test collected on a blot card. The recommended method of blood collection on
infants less than a year old is via capillary (thus eliminating the venipuncture choices). A capillary collection
using heel puncture lancet would be the correct choice in this situation. The heel puncture lancet would go the
proper depth on an infant (there are even different sizes of lancets available for premature vs. term infants).
.A centrifuge functions in which of the following ways? - ANSWER-rotates to separate components of a
patient's blood
A centrifuge rotates to separate components of a patient's blood. Depending on specimen requirements for a
particular test, certain samples must be processed by centrifugation to maintain the integrity for testing. A
centrifuge does not serve as a specimen warmer, nor does it magnify sample components (microscopes are
used for magnification). Glucose measurements are obtained by analyzing the sample on a glucose meter or
designated laboratory instrument, not the centrifuge
.A CMP is ordered for an older adult patient whose veins continue to collapse despite drinking water. Which of
the following is the best collection method for this patient? - ANSWER-butterfly needle
A butterfly is a smaller gauge needle device and is used for smaller veins, including fragile veins on all patients,
elderly adults and small children. Other phlebotomy systems use larger gauge needles. The vacuum pressure in
an evacuated tube system would collapse the vein. A needle and syringe would also have a tendency to
collapse the vein (when the plunger of the syringe is pulled back). A capillary collection would be the last resort
if all other collection methods failed. The butterfly is the best initial choice in this case.
.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.
.A medical assistant needs to draw a bilirubin on a jaundiced infant. The medical assistant should - ANSWER-
collect the specimen in an amber tube to protect from light.
Bilirubin is a photo-sensitive analyte (can degrade by as much as 50% with an hour of light exposure). A
specimen submitted for bilirubin testing should be collected in an amber tube which will protect it from light (a
regular tube wrapped in aluminum foil could also be acceptable). It is not necessary to keep the specimen
warm with a heel warmer, nor is it necessary to chill the specimen to slow metabolism and stabilize the
specimen. As long as the specimen is properly collected, protected from light, and handled according to normal
serum protocol, it can be run as routine, thus Stat analysis is not necessary.
.A patient is at the lab for their weekly PT/INR. Which of the following tubes should the medical assistant
collect for this test? - ANSWER-light blue top
Sodium citrate (light blue top tube) is the anticoagulant of choice for coagulation studies such as PT/INR
(Protime/International Normalization Ratio) because it does not bind to calcium or inactivate heparin, which
may be required to be present in such testing. Lavender top tubes contain EDTA as the anticoagulant, which
does bind calcium. Green top tubes contain heparin and could lead to inaccurate coagulation studies.
.A patient with an order for a blood draw presents with burns covering both arms. Which of the following is the
medical assistant's best option for collecting the largest amount of blood for this patient? - ANSWER-
microtainer tube
,A microtainer tube would be the best choice in this case. If a patient has burns covering both arms, a routine
venipuncture from a brachial vein is not an option. The person collecting the blood will have the best chance at
getting the highest volume of blood from a smaller vein using a microtainer tube (has less vacuum pressure
than a regular sized tube). There are many ways to collect blood, and using a evacuated tube is generally the
best method. But in case of a burn, the best procedure would be to do a capillary finger stick and then use a
microtainer tube which works on the same principle. A PKU is collected on a Guthrie blot card and is only for
newborn screening.
.A patient's past history indicates episodes of syncope. Which of the following would be the best course of
action the phlebotomist would perform to prevent complications of syncope? - ANSWER-Have the patient lie
down on a hospital bed or exam table.
Syncope is a temporary loss of consciousness and posture, commonly referred to as fainting, which is usually
related to insufficient blood flow to the brain for any number of reasons. If a patient has a history of syncope
episodes, it would be advisable to position the patient to avoid the possibility of injury and to enable ease of
oxygenated blood flow to the brain. The angle of the needle has no bearing upon the possibility of syncope and
wouldn't prevent injury in case of a fall. Holding pressure over the venipuncture site only prevents bleeding.
Placing an object in a patient's mouth to prevent biting the tongue is not advised in cases of either seizure or
syncope.
.A phlebotomist has received a requisition for a PT/aPTT to evaluate the patient for Von Willebrand's disease.
Because of the patient's potential diagnosis, the phlebotomist should be sure to - ANSWER-hold pressure on
the draw site until bleeding has stopped.
Von Willebrand disease is an inherited condition that can cause extended or excessive bleeding. Those affected
have deficient amounts or impaired von Willebrand factor, a protein important to the clotting process. Thus,
the phlebotomist must hold steady pressure on the venipuncture site until all bleeding has stopped. The
collection site does not need confirmation from anyone, as the disease would not affect site selection. Edema is
not a problem, and use of a blood pressure cuff could force more bleeding if applied after the draw.
.A phlebotomist has received a requisition to collect a blood culture. Using a butterfly, three milliliters of blood
is collected. Into which of the following bottles is the proper dispensation of the specimen? - ANSWER-Since
the phlebotomist was only able to obtain three milliliters of blood, place all three mLs in the aerobic bottle. The
aerobic bottle would be the first bottle to innoculate if there is limited sample. It is not advisable to split the
, innoculation of 3 total mLs into both bottles since it would not adequately innoculate either bottle. The fact
that a butterfly was used in this instance indicates that the patient was probably a hard stick, thus attempting a
recollection is not the first course of action here. The first course of action is to best utilize the sample that was
collected by dispensing all of it into the aerobic bottle.
.A phlebotomist has received a requisition to collect a blood specimen on patient in isolation. When entering
the patient's room, which should the phlebotomist do first? - ANSWER-put on the gown
Ratio
nale
The phlebotomist should put on the gown, followed by the mask and gloves. To reduce the risk of
contaminating oneself with infectious agents, the order of removal of personal protective equipment is
important. As a rule, remove items in the following order: gloves, mask, then gown.
.A phlebotomist inserts a needle into a patient's vein and notices there is no blood flow into the tube. The
needle is positioned against the wall of the vein. How should the phlebotomist proceed? - ANSWER-Relax the
needle's angle slightly, and insert new tube
If the needle is believed to be positioned against the vein wall, sometimes relaxing the needle's angle slightly
will bring blood into the blood collection tube. In case the tube's vacuum was compromised, using a new tube
should provide blood flow. Retracting the needle might pull it out of the vein entirely. Starting over subjects
the patient to the discomfort of another needle stick, and inserting the needle deeper may cause the needle to
move through the vein entirely.
.A phlebotomist is asked to collect a CBC, PT and Chem 7 on a patient that requires a hand stick with a butterfly
needle into evacuated tubes. The correct order of draw for this collection would be - ANSWER-Two Light Blue
Top Tubes, Green Top Tube, Lavender Top Tube
The correct order of draw would be: two light blue top tubes (one waste and one for PT which is a coagulation
test), green top tube (for the Chem 7), and the lavender top tube (for the CBC).
.A phlebotomist is staffing the outpatient clinic at a remote site. There is a centrifuge at the site, but it is not
