NHA PHLEBOTOMY TECHNICIAN EXAMS, PRACTICE EXAMS AND STUDY GUIDE EXAMS, Exams of Nursing

Download NHA PHLEBOTOMY TECHNICIAN EXAMS, PRACTICE EXAMS AND STUDY GUIDE EXAMS and more Exams Nursing in PDF only on Docsity! 1 | P a g e NHA PHLEBOTOMY TECHNICIAN EXAMS, PRACTICE EXAMS AND STUDY GUIDE EXAMS WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED RATIONALES ANSWERS LATEST 2024 ALREADY GRADED A+ (NEWEST) NHA PHLEBOTOMY TECHNICIAN EXAM 1. Besides gloves which of the following PPE should a phlebotomist wear when drawing on a patient with pneumonia? A. Face mask B. Gown C. N95 Respirator D. Shoe covers A. Face mask 2. A phlebotomists noticed that a blood collection tube is cracked what steps should the phlebotomists take? A. Send tube to the lab as is. B. Discard the tube in a glove. C. Discard tube in a sharp's container. D. Dispose of tube in the trash C. Discard tube in a sharp's container. 3. A parent asks the phlebotomist for the results of their young adults point of care test (POCT) test, what steps should the phlebotomists take? A. Write down the results for the parent and the patient. B. Ask the patient to leave the room and tell the parent. C. Show the parent the results in the hallway. D. Ask the patient for the permission to disclose results with the parent present. B. Ask the patient to leave the room and tell the parent. 4. A patient starts to cry and is unwilling to extend her arm for the third draw of a glucose tolerance test (GTT), what is the proper statement for the phlebotomist to make? A. "I will get a nurse to hold your hand." B. "May I perform the draw?" 2 | P a g e C. "You may come back tomorrow to get the draw done." D. "I will draw the blood anyway." B. "May I perform the draw?" 5. While performing a glucose monitor quality control check the phlebotomist should record which of the following? A. Date of battery charge B. Water bath temperature C. Date of patient test results D. Time of lunch break A. Date of battery charge 6. A phlebotomist gets a glucometer reading of 250 mg/dL on a patient, a second test reads in the normal range, which of the following could have happened? A. Too little blood was used. B. The first drop of blood was used. C. The finger was dirty. D. The test strips were left open. C. The finger was dirty. 7. What should a phlebotomist use to clean up a large blood spill? A. Chlorine Bleach B. Hydrogen Peroxide C. Povidone-Iodine D. Isopropyl Alcohol A. Chlorine Bleach 8. If a phlebotomist experiences an accidental needle stick which of the following should be included in the sharps log? A. The patients vein location B. The time the phlebotomist got to work C. The department where the injury D. The nurse's name C. The department where the injury 9. Which of the following types of transmission-based precautions should be used for streptococcal pharyngitis? A. Contact B. Standard C. Airborne D. Droplet D. Droplet 5 | P a g e C. Random D. Late in the evening A. First-morning 22. Which of the following questions should the phlebotomist ask a patient with hearing aids in order to ensure the patient understands the procedure? A. "Did you hear what I said?" B. "Would you like me to repeat the directions?" C. "Can you read my lips?" D. "Do you understand the words that are coming out of my mouth?" B. "Would you like me to repeat the directions?" 23. Which of the following is an acceptable from of identification on an outpatient? A. Attached ID band, full name, accession number B. Picture ID, full name, date of birth C. Accession number, date of birth D. Date of draw, time to draw B. Picture ID, full name, date of birth 24. Upon entering a patient's room, the phlebotomist notices that the patient's identification band is on the bed rail, the patient doesn't like to wear it, what should be the phlebotomists next course of action? A. Ask the nurse to replace the identification band on the patient. B. Ask the patients neighbor to replace the band. C. Proceed with the draw. D. Ask the patient for their driver's license. A. Ask the nurse to replace the identification band on the patient. 25. An older adult patient comes into an outpatient facility to have blood drawn, accompanied by a younger adult, the phlebotomist should do which of the following? A. Obtain consent from the patient and proceed with the draw. B. Speak to the patient in a loud voice. C. Speak to the patient in a normal tone. D. Stand close to the patient while speaking. A. Obtain consent from the patient and proceed with the draw. 26. A patient has been admitted for life threatening cardiac symptoms, which of the actions should the phlebotomist take? A. Proceed with collecting the patients' blood. B. Ask for the patient's phone number. C. Proceed with other duties. D. Ask for consent from a family member. A. Proceed with collecting the patients' blood. 6 | P a g e 27. A phlebotomist has an order to draw a patient who recently had a dose of Antibiotic medication, which of the following levels would the phlebotomist be collecting? A. Trough B. Random C. Peak D. Fasting C. Peak 28. In an outpatient setting which of the following is required on the patient's requisition form? A. Patient medical record number and bed number B. Provider's name and provider's DEA number C. Patient's billing information and test status. D. Patient's driver's license number C. Patient's billing information and test status. 29. Before drawing a patient for peak and trough levels a phlebotomist should do which of the following? A. Ask the nurse when the doctor will be in. B. Ask the nurse when the medication was administered. C. Ask the patient what medication they are taking. D. Perform the draw. B. Ask the nurse when the medication was administered. 30. A patient has indigested a fatty meal just before having their blood drawn, which of the following should the phlebotomist expect the sample to look like? A. The specimens will be lipemic. B. The specimen will be clotted. C. The specimen will be QNS. D. The specimen will b e fatty. A. The specimens will be lipemic. 31. Which of the following tests will be affected by a patient taking warfarin? A. PT B. HDL C. TSH D. LDL A. PT 32. A patient informs the phlebotomist that they may experience syncope while having blood drawn what action should the phlebotomist take? A. Draw from the patient's foot. B. Place the patient in an upright position. C. Place the patient in a supine position. D. Perform capillary draws. 7 | P a g e C. Place the patient in a supine position. 33. During a routine blood draw a patient asks the phlebotomist why blood is being collected, what would be the best response for the phlebotomist to give? A. "The test is critical to your health." B. "You should ask your provider about the test." C. "Your health is failing." D. "In order to rule out cancer." B. "You should ask your provider about the test." 34. For a blood culture to be collected properly the phlebotomist should do which of the following? A. Swab the area twice to make sure it Is sterile. B. Use an evacuated lavender tube to perform the draw. C. Wipe the antiseptic off before the draw. D. Leave the tourniquet on longer for the collection. A. Swab the area twice to make sure it Is sterile. 35. A phlebotomy technician is preparing to collect a blood sample from a patient for a cholesterol test. Which of the following statements should the technician make? A. "Please sit for at least 5 minutes before the test." B. "Please take any prescribed medication after the test." C. "Avoid eating red meat the day before the test." D. "Avoid any caffeine on the day of the test." C. "Avoid eating red meat the day before the test." 36. In order to prevent reflux or back flow of anticoagulants the phlebotomist should place patients arm in which position? A. A 30-degree angle. B. Elbow bent at a 90 degree angle. C. Fully extended from the shoulder to the wrist. D. Hanging down at the patient's side. C. Fully extended from the shoulder to the wrist. 37. To collect a coagulation test on a 4-year old patient the phlebotomist should use which of the following methods? A. Winged infusion set. B. Finger stick. C. Heel stick D. ETS system A. Winged infusion set. 38. Upon entering a patient room, the phlebotomist notices that the patient has an IV in both arms, which action should be phlebotomist take? A. Ask the nurse to turn the IVs off for 10 minutes. 10 | P a g e B. "Get out of the chair." C. "May I draw your blood?" D. "I will get the doctor" C. "May I draw your blood?" 50. Upon drawing a deep median cubital vein, a phlebotomist should use which of the following? A. Withdraw with the bevel up at a 5 degree to 10 degree angle. B. Withdraw with the bevel up at a 25 degree to 30 degree angle. C. Withdraw with the bevel up at a 15 degree to 40 degree angle. D. Withdraw with the bevel up at a 5 degree to 15 degree angle. C. Withdraw with the bevel up at a 15 degree to 40 degree angle. 51. Upon performing a hand draw the phlebotomist notices a hematoma forming, which of the following could be the cause of the formation of the hematoma? A. Needle missing the vein B. Needle at too small C. Needle completely through the vein D. Needle beside the vein C. Needle completely through the vein 52. Which of these tubes should a phlebotomist collect for the following tests, WBC, coagulation, and random serum glucose? A. Sodium citrate, SPS, and Na Oxalate B. SST, EDTA, and NA Citrate C. SPS, heparin, and sodium fluoride D. SPS, ACD, and EDTA B. SST, EDTA, and NA Citrate 53. Which of the following locations is appropriate to perform a dermal puncture on an adult patient? A. To side of the center of the index finger B. The tip of the ring finger C. On the tip of the pinky finger D. The side parallel to the center of the ring finger D. The side parallel to the center of the ring finger 54. Which of the following is the correct capillary collection order of draw for electrolytes, CBC, and FSH test? A. Green micro collection container, yellow micro collection container, then red micro collection container. B. Lavender micro collection container, red micro collection container, then green micro collection container. C. Lavender micro collection container, green micro collection container, then red micro collection container. 11 | P a g e D. Red micro collection container, green micro collection container, then lavender micro collection container. C. Lavender micro collection container, green micro collection container, then red micro collection container. 55. Upon completion of a venipuncture on a patient the phlebotomist must label tubes with preprinted labels, which of the following information should the phlebotomist include on the label? A. Phlebotomists initials, date and time of collection B. Patients social security number, accession number, and time of collection C. Physicians initials, date, and time of collection D. Phlebotomists initials, provider's name, and patient's date of birth A. Phlebotomists initials, date and time of collection 56. Which of the following actions should a phlebotomist take if they accidentally puncture an artery during a venipuncture? A. Instruct the patient to lay down. B. Apply pressure on the site for at least 30 minutes. C. Apply pressure for 2 minutes. D. Apply pressure on the site for at least 5 minutes. D. Apply pressure on the site for at least 5 minutes. 57. Which of the following equipment is appropriate to use for a heel stick on a 10-month-old infant? A. Butterfly with a 21-gauge needle and a lavender evacuated tube B. Lancet with a 2 mm depth and a lavender micro collection container C. Lancet with a 1 mm depth and a green micro collection container D. Syringe with a 25-gauge needle and a grey evacuated tube B. Lancet with a 2 mm depth and a lavender micro collection container 58. Which of the following is the correct order of draw for a Clotting time test, WBC, and lipid profile test? A. Light blue, gold, lavender B. Purple, orange, light blue C. Serum, grey, light yellow SPS D. Green, light yellow ACD, serum A. Light blue, gold, lavender 59. Upon performing a routine venipuncture, the vein of the patient collapses, which of the following could be the cause? A. Using a 25-gauge winged infusion set B. Inserting a micro evacuated tube C. Applying the blood pressure cuff to 40 mmHg D. Applying the tourniquet too tightly D. Applying the tourniquet too tightly 12 | P a g e 60. Which of the following test should be collected first? A. Blood Culture B. Cholesterol C. Complete Blood Count (CBC) D. Basic Metabolic Panel (BMP) A. Blood Culture 61. Which of the following is the proper way to process a WBC differential test, testosterone test and a glucose test? A. Prepare a slide from an orange-topped tube and centrifuge a light blue-topped tube and a yellow- topped tube. B. Prepare a slide from a red-topped tube and centrifuge a light-blue topped tube and a lavender- topped tube. C. Prepare a slide from a lavender-topped tube and centrifuge a red-topped tube and a gray-topped tube. D. Prepare a slide from a light-blue topped tube and centrifuge a light blue-topped tube and a red- topped tube. C. Prepare a slide from a lavender-topped tube and centrifuge a red-topped tube and a gray-topped tube. 62. To properly prepare a peripheral blood smear from a capillary puncture, which of the following should be done first? A. Pipette the blood onto the center of the slide. B. Touch the slide to the second drop of blood. C. Touch the slide to the first drop of blood. D. Pipette the blood to the bottom of the slide. B. Touch the slide to the second drop of blood. 63. Which of the following is the proper order of draw for a blood culture test, a PTT and a CBC test using the syringe method? A. SPS tube, anaerobic bottle, EDTA, light-blue-topped tube B. Aerobic bottle, anaerobic bottle, light blue topped tube, EDTA C. Lavender tube, light-blue-topped tube, aerobic bottle, anaerobic bottle D. Anaerobic bottle, aerobic bottle, light blue tube and lavender tube D. Anaerobic bottle, aerobic bottle, light blue tube and lavender tube 64. Which of the following is the correct way to collect two sets of blood cultures? A. Collect one set from the patient's right arm and one set from a different site on the same arm. B. Collect one set from the antecubital region and one set from the back of the patient's leg. C. Collect one set from the patient's left arm and one set from the same location 5 minutes later. D. Collect one set from the finger and one set from the heel of the foot. A. Collect one set from the patient's right arm and one set from a different site on the same arm. 15 | P a g e B. Yellow-topped tube, light blue-topped tube, red-topped tube 77. If a patient has type O blood which of the following types of blood can the patient receive? A. Type B B. Type AB C. Type A D. Type O D. Type O 78. Which of the following statements should a phlebotomist make to a patient who will be collecting a fecal specimen at home? A. "Do not mix urine with the fecal specimen." B. "Do not mix water with the urine sample." C. "Do not mix soda with the fecal sample." D. "Scoop urine from the toilet into the container." A. "Do not mix urine with the fecal specimen." 79. Which of the following would indicate a possible blood donors' eligibility to donate blood? A. Diastolic blood pressure 110 mmHg B. Temperature 37.7 degrees Celsius (99.8F) C. Hematocrit level 42% D. Pulse rate 40/min C. Hematocrit level 42% 80. Which of the following is the correct action to take after collection of a neonatal screening card? A. Place the card incubator B. Place the card on a flat, dry surface for 3 hours. C. Place the card inside of a biohazard bag D. Stack cards on top of one another B. Place the card on a flat, dry surface for 3 hours. 81. Of the following options, which is the best action to take when loading a centrifuge? A. Place tubes of equal volume across from each other. B. Place tubes of equal volume adjacent to each other. C. Place tubes of unequal volume across from each other. D. Place tubes of unequal volume adjacent to each other. A. Place tubes of equal volume across from each other 82. Before loading serum specimens into the centrifuge, how long should the phlebotomist allow the serum specimens to clot? A. 75 min B. 10 min C. 30 min D. 3 min 16 | P a g e C. 30 min 83. Which of the following specimens needs to be protected from light? A. Coagulation B. BUN C. CMP D. Bilirubin D. Bilirubin 84. A phlebotomist is processing six evacuated tubes on the same patient, one of the tubes is not labeled, what would be the phlebotomists nest course of action? A. Print a barcoded label for the unlabeled specimen. B. Recollect the unlabeled specimen. C. Process the specimen scoring to policy. D. Hand-write on the label in ink specimen. B. Recollect the unlabeled specimen. 85. Which of the following actions is true for urine drug test collection? A. Draw patients' blood also. B. Instruct the patient to flush the toilet. C. Seal the specimen in a tamper-proof container D. Use the patients credit card for identification. C. Seal the specimen in a tamper-proof container 86. Upon collection of a blood alcohol test the phlebotomist should do which of the following? A. Use 70% Isopropyl alcohol to clean the site. B. Use sterile alcohol to clean the site. C. Use name and address of Attorney. D. Add date and time of specimen collection. D. Add date and time of specimen collection. 87. A patient submits a urine drug screen to the phlebotomist with a temperature reading of 29.4 celsius (85 degrees), which of the following actions should the phlebotomist take? A. Have the patient provide another sample under observation. B. Have the patient provide their phone number. C. Accept the specimen as is. D. Ask the patient to return tomorrow. A. Have the patient provide another sample under observation. 88. Which of the following should the medical specimen accessioner do in order to complete the chain of custody form? A. Make sure the list doctors name B. Keep several copies of the form 17 | P a g e C. Include their name on the form D. Include the transportation method C. Include their name on the form 89. Which of the following test results would a phlebotomist release to a reproductive specialist for a female patient? A. AST and ALT B. FSH and LH C. BBP and GTT D. PT and PSA B. FSH and LH 90. Which of the following is not required on a laboratory requisition? A. Patients gender B. Patients full name C. Patients' blood type D. Patient date of birth C. Patients' blood type 91. Which of the following actions should the phlebotomist take prior to collecting blood? A. Print the specimen label B. Print the daily schedule C. Accept the specimen in processing D. Look at previous lab results A. Print the specimen label 92. A phlebotomist should know that which of the following can be found in the laboratory information system? A. Venipuncture order B. Previous laboratory results C. Witness name and signature D. Current patients' whereabouts B. Previous laboratory results 93. Of the following choices, which one would be the best in accessing a patient's medical records in the laboratory information system? A. Laboratory requisition number B. Medical laboratory number C. Provider name and phone number D. Patient identification number D. Patient identification number 94. Which of the following would a phlebotomist expect a patient to have if their POCT glucometer reading is 46 mg/dL? 20 | P a g e Reference Laboratories These large independent laboratories perform routine and highly specialized tests that cannot be done in smaller ones. The phlebotomist may do either on-site or off-site collections. Medical Facilities the Phlebotomist May Find Work -Physician Officer Laboratories -Reference Laboratories -Urgent Care Centers -Nursing Home Facilities -Wellness Clinics The Circulatory System The function of this system is to deliver oxygen, nutrients, hormones, and enzymes to the cells (exchange is done at the capillary level) and to transport cellular waste such as carbon dioxide and urea to the organs (lungs and kidneys, respectively) where they can be expels from the body. Pulmonary Circulation (Heart) This carries deoxygenated blood from the right ventricle to the lungs (oxygenation takes place at the alveoli) and returns oxygenated blood from the lung to the left atrium. Systemic Circulation (Heart) This carries oxygenated blood from the left ventricle throughout the body. The Tricuspid Valve This is an atrioventricular valve, being situated between the right atrium and right ventricle. The Pulmonic Valve A semi lunar valve situated between the right ventricle nd the pulmonary artery. The Mitral Valve This is another atrioventricular valve, being situated between the left atrium, and left ventricle; also called the bicuspid valve. The Aortic Valve A semi lunar valve situated between the left ventricle and the aorta. Endocardium The endothelial inner layer lining of the heart. Myocardium The muscular middle layer of the heart. The coronary arteries, which supply blood to the heart, are found in this layer. 21 | P a g e Epicardium The fibrous outer layer of the heart. The coronary arteries, which supply blood to the heart, are found in this layer. The Blood Vessels Aorta, Arteries, Arterioles, Capillaries, Venules, Veins, Superior and Inferior Vena Cava. Tunica Adventitia The outer connective tissue of the blood vessels (except the capillaries). Tunica Media The middle smooth muscles of the blood vessels (except the capillaries). Tunica Intima The inner endothelial layer of the blood vessels (except the capillaries). The aorta, arteries, and arterioles carry what type of blood from the heart to the various parts of the body? Oxygenated. The venules, veins and the superior and inferior vena Cavan carry what type of blood back to the heart? Deoxygenated. The capillaries are composed only of a layer of what? Endothelial Cells. What connect the arterioles and venules together? The capillaries. Capillary Blood Is a mixture of arterial and venous blood. The average adult has how much blood? 5 to 6 liters Plasma The liquid portion of blood. Formed Elements The cellular portion of blood. Plasma comprises how much of the circulating blood? 22 | P a g e 55% Plasma Contains Proteins, Amino Acids, Gases, Electrolytes, Sugars, Hormones, Mineral, Vitamins, and Water (92%). It also contains waste products such as urea that are destined for excretion. The Formed Elements constitute of how much of the blood? 45% Erythrocytes Red Blood Cells. Formed Elements are what? 99% Erythrocytes, the Leukocytes and Thrombocytes. Leukocytes White Blood Cells. Thrombocytes Platelets. All bone cells normally originate from where? Bone Marrow. Erythrocytes Contain Hemoglobin. Hemoglobin Oxygen-carrying protein. There is how much red blood cells per microliter of blood? 4.2 to 6.2 Million RBC's (abbreviation) Red Blood Cells. The normal life span of a red blood cell is how long? 120 days. The Leukocytes Function Is to provide the body protection against infections. Normal amount of white blood cells for an adult 25 | P a g e Sclerosed Veins These veins feel hard or cord-like. Can be caused by disease, inflammation, chemotherapy or repeated venipunctures. Thrombotic Veins Unsuitable for venipuncture. Tortuous Veins These are winding or crooked veins. These veins are susceptible to infection, and since blood flow is impaired, the specimen collected may produce erroneous test results. Do not draw blood from an arm with what running into it? IV Fluids. The fluid will alter the test results. Select another site. Do not draw blood from an artificial a-v fistula site. Such as those surgically implanted in dialysis patients. Venipuncture Basic Step In performing this is to have necessary supplies and/or equipment organized for proper collection of specimen and to ensure the patient's safety and comfort. What is the 1st thing needed before doing a venipuncture? Laboratory requisition slip and pen. Antiseptic -Prepackaged 70% isopropyl alcohol pads are the most commonly used. -For collections that require more stringent infection control such as blood cultures and arteria punctures. Povidone-iodine solution is commonly used. -For patients allergic to iodine, chlorhexidine gluconate is used. Vacutainer Tubes Color-coded for specific tests and available in adult and pediatric sizes. Order of Draw 1st Blood cultures tubes or vials Order of Draw 2nd Sodium citrate tubes Order of Draw 1st (color) Yellow Order of Draw 2nd (color) 26 | P a g e Light Blue Order of Draw 3rd Serum tubes with or without clot activator or gel Order of Draw 3rd (color) Red Order of Draw 4th (color) Gold/Tiger Order of Draw 5th Heparin Tubes Order of Draw 5th (color) Green Order of Draw 6th EDTA Tubes Order of Draw 6th (color) Lavender Vacutainer Needles These are disposable and are used only once for single-tube draw and multi-draw. Needle Sizes Differ both in length and gauge, 1-inch and 1.5-inch long are routinely used. Gauge The diameter of the bore of the needle. The smaller the number the bigger the gauge. Needle Adapters Also called the tube holder. One end has a small opening that connects the needle, and the other end has a wide opening to hold the collection tube. Winged Infusion Sets Used for venipuncture on small veins such as those in the hand. They are also used for venipuncture in the elderly and pediatric patients. The most common size is 23 gauge, 1/2 to 3/4 inch long. Sterile syringes and needles 10-20 ml syringe is used when the Vacutainer methos cannot be used. 27 | P a g e Tourniquets -Prevents the venous outflow of blood from the arm causing the veins to bulge thereby making it easier to locate the veins. The most common tourniquet is? Latex Strip (be sure to check for latex allergy before use) What can also be used as a tourniquet? Blood pressure cuffs. Chux An impermeable pad used to protect the patient's clothing and bedding. Specimen Label To be placed on each tube collected after the venipuncture. Gloves Must always be worn when collecting blood specimen. Needle Disposal Container Must be clearly marked puncture-resistant biohazard disposal container. NEVER RECAP NEEDLE WITHOUT A SAFETY DEVICE. Hematoma The most common complication of phlebotomy procedure. This indicates that blood has accumulated in the tissue surrounding the vein. The two most common causes are the needle going through the vein and/or failure to apply enough pressure on the site after needle withdrawal. Hemoconcetration The increase in proportion of formed elements to plasma caused by the tourniquet being left on too long (more than 2 minutes). Phlebitis Inflammation of a vein as a result of repeated venipunture on that vein. Petechiae These are tiny non-raised red spots that appear on the skin from rupturing of the capillaries due to the tourniquet being left on too long or too tight. Thrombus This is a blood clot usually a consequence of insufficient pressure applied after the withdrawal of the needle. 30 | P a g e the specimen must be kept warm until the serum is separated from the cells. Collected in red-topped tubes pre-warmed in the incubator at 37 C for 30 minutes. Chilled Specimens Some tests require that the specimen collected by chilled immediately after collection in crushed ice or ice and water mixture. Some of the tests that requires chilled specimen are: Arterial blood gases, ammonia, lactic acid, pyruvate, ACTH, gastrin, and parathyroid hormone. Light-Sensitive Specimens Specimens are protected from light by wrapping the tubes in aluminum foil immediately after they are draw. Exposure to light could alter the test results for: Bilirubin, Beta-Carotene, Vitamins A & B6, and Porphyrins. Dermal Punctures When venipucture is inadvisable, it is possible to perform a majority of laboratory tests on micro samples obtained by skin puncture, with the exception of ESR, blood cultures and other test that require a large amount of serum. Dermal punctures may be done on who? Both Pediatric and Adult Patients. Dermal puncture should never be done with what? A surgical blade or hypodermic needle b/c they can be difficult to control. Osteomyelitis Inflammation of the bone and bone marrow. Dermal puncture should be done with what? Lancet Dermal Puncture Range for Adults 3.0mm Dermal Puncture Range for Infants 0.85mm Site Selection for Dermal Puncture (Infants) The heel is used on infants less than 1 year of age. Areas recommended are the medial and lateral areas of the planter surface of the foot. 31 | P a g e The American Academy of Pediatrics recommends that heel punctures for infants no exceed what? 2.0mm Site Selection for Dermal Puncture (Older Children and Adults) The distal segment of the 3rd and 4th finger on the non-dominant hand. Puncture is made in the fleshy portion of the finger slightly to the side of the center perpendicular to the lines of the fingerprint. Order of Draw for Capillary Specimens 1. Lavender Tube 2. Tubes with other additives 3. Tubes without additives Lavender Top Tubes Contains the anticoagulant ethylenediaminetetraacetic acid (EDTA). The tubes must must be filled at least two-thirds full and inverted 8 times. Ethylenediaminetetraacetic Acid Abbreviation EDTA EDTA Inhibits coagulation by binding to calcium present in the specimen. Common Test for Lavender Top Tubes CBC, Hemoglobin and Hematocrit determinations, ESR, Sickle Cell Screening CBC Complete Blood Count Complete Blood Count Includes RBC count, WBC count, and Platelet count. ESR Erythrocyte Sedimentation Rate Needleless Systems This is a new term defined as devices that provides an alternative to needles for various procedures to reduce the risk of injury involving contaminated sharps. Needleless Systems Includes IV medication systems which administer medication or fluids through a catheter port using non-needle connections and Jet injection systems that deliver liquid medication beneath the skin or through a muscle. 32 | P a g e Medical Asepsis The destruction of pathogenic microorganisms after they leave the body. Handwashing Is the most important means of preventing the spread of infection. Uses plain soap to remove soil and transient bacterial. Hand Antisepsis Requires what? That all healthcare personnel learn proper hand washing procedures. Barrier Protection Provides a barrier against infections. Personal Protective Equipment -Gloves -Masks -Goggles -Face Shields -Respirator PPE Personal Protective Equipment Stadard Precautions This is an infection control method designed to prevent direct contact with blood and other body fluids and tissues by using barrier protection and work control practices. Isolation Precautions The CDC recommended universal precautions, which is a method of infection control that assumed that all human blood and bloody fluids were potentially infectious. Light Blue Top Tube Contains the anticoagulant Sodium Citrate, which also prevents coagulation by binding to calcium in the specimen. Sodium Citrate Is the anticoagulant used for coagulation studies because it preserves the coagulation factors. Light Blue Top Inverted 3 to 4 times Light Blue Top Tube Common Test 35 | P a g e Sterile Common Test Yellow Top Tube Blood Cultures Yellow Top Tube Inverted 8-10 times Red Top Tubes Inverted No need to invert the tube after collection. Types of Hazards: Biologic Infectious agents that can cause bacterial, viral, fungal, or parasitic infections. Types of Hazards: Sharps Needles, lancets, and broken glass can puncture and cut and cause blood-borne pathogen exposure. Types of Hazards: Chemical Preservatives and chemicals used in the laboratory. Types of Hazards: Electrical High-voltage equipment can cause burns and shock. Types of Hazards: Fire or Explosive Bunsen burners, oxygen and chemicals can cause burns or dismemberment. Types of Hazards: Physical Wet floors, heavy lifting can cause falls, sprains and strains. Types of Hazards: Allergic Reaction Latex sensitivity that can cause allergic reactions ranging from simple dermatitis to anaphylaxis. External Hemorrhage Controlling the bleeding is most effectively accomplished by elevating the affected part above heart level and applying direct pressure to the wound. When should you not attempt to elevate? (External Hemorrhage) If a fracture is suspected. Shock Insufficient return of blood flow to the heart, results in inadequate supply of oxygen to all organs and tissues of the body. 36 | P a g e Common Symptoms of Shock -Pale, cold, clammy skin -Rapid, weak pulse -Increased, shallow breathing rate -Expressionless face/staring eyes First Aid for Shock -Maintain an open airway for the victim -Call for assistance -Keep the victim lying down with the head lower than the rest of the body -Attempt to control bleeding or cause of shock (if known) -Keep the victim warm until help arrives Cardiopulmonary Resuscitation Most healthcare institutions require their professionals to be certified. Cardiopulmonary Resuscitation Abbreviation CPR Chain of Infection Agent, Portal of Exit, Mode of Transmission, Portal of Entry, Susceptible Host. Agents Are infectious microorganisms that can be classified into groups namely: viruses, bacteria, fungi, and parasites. Portal Of Exit The method by which an infectious agent leaves its reservoir. Mode of transmission Specific ways in which microorganisms travel from the reservoir to the susceptible host. 5 Types of Mode of Transmission Contact (direct and indirect), Droplet, Airborne, Common Vehicle, Vectorborne. Portal of Entry Allows the infectious agent access to the susceptible host. Common Entry Sites (Portal of Entry) Broken skin, Mucous Membranes, and Body Systems exposed to the external environment such as respiratory, gastrointestinal, and reproductive. Susceptible Host 37 | P a g e The infectious agent enters a person who is not resistant or immune. Standard Precautions This is an infection control method designed to prevent direct contact with blood and other body fluids and tissues by using barrier protection and work control practices. Gold Tube Top Immunology, serology Common Test for the Gold Top Tube Serum separator tube (SST) contains a gel at the bottom to separate blood from serum on centrifugation. Transmission-Based Precautions The 2nd tier of precautions and are to be used when the patient is known or suspected of being infected with contagious disease. Contact Precautions Are designed to reduce the risk of transmission of microorganisms by direct or indirect contact. Airborne Precautions Are designed to reduce the risk of airborne transmission of infectious agents. Droplet Precautions Are designed to reduce the risk of droplet transmission of infectious agents. Disinfection The third procedure used in medical asepsis using various chemicals that can be used to destroy many pathogenic microorganisms. Latex Sensitivity Is an emerging and important problem in the health care field. Needle Stick Prevention Act passed when? November 2000. Informed Consent This is consent given by the patient who is made aware of any procedure to be performed, its risks, expected outcomes, and alternatives. Patient Confidentially This is the key concept to HIPAA. 40 | P a g e PT/APTT/Coagulation Studies Light Blue Tube Department Coagulation Studies Light Blue Tube Inversion 3-4 Times Light Blue Tube Specimen Plasma ematoma What is the most common complication in phlebotomy? True True or False? The bevel part of the needle should always be face up. 45% How much percent of the blood is formed elements? (Answer should in __% format) False True or False? In coagulation studies, blood can be tested using capillary tubes. Postprandial Another term for "after meal" is _____. Vascular Which phase of hemostasis is when blood vessels constrict due to injury? Veins Which blood vessels contains valves that help move blood against the force of gravity? Fomite The process of inanimate things transmitting disease is known as _____. False True or False? Employees at risk of BBP (Blood Borne Pathogens) are not required to vaccinate for HBV (Hepatitis B) or sign a waiver. 41 | P a g e True True or False? In microbiological urine testing, it should be a clean-catch midstream urine sample Hemolyzed Plasma appears pink or red in what kind of blood? Syncope Another term for fainting. Three Sodium Fluoride will maintain glucose stability for how many days? (Write out the number) EDTA What is the additive in pink or lavender top tubes? Standard Precaution What prevents the spread of disease at the mode of transmission point in the chain of infection? (2 words) Aspirin What medicine will affect a bleeding time test? True True or False? Activated Partial Thromboplastin Time (APTT) is not a part of CBC. Profile A group of tests requested as one unit is known as _____. True True or False? Infection is harmful only when it causes illness. Gloves What is the main barrier protection for performing skin puncture and venipuncture? Hemolyze Excessive squeezing of punctured finger will _____ the blood sample. Capillaries What blood vessels have passage for both oxygenated and deoxygenated blood? 42 | P a g e Endothelial What is the innermost layer of a blood vessel? Tourniquet Applying the _____ to the arm enlarges the veins so they are easier to find and puncture. Nosocomial Using antimicrobial sanitizer may avoid _____ infection. Blood Vessels The three components of the circulatory system are: Heart, Blood and _____ _____ (Plural Term) True True or False. A Lavender Top Tube is not for coagulation studies. Body Fluids A blood borne infection occurse when there is an exchange of _____ _____ (Plural Term) with blood. Supervisor If blood was drawn from the wrong patient, who should you report the incident to? (1 word) Hepatitis B What is the most common nosocomial (Hospital related) infection? Accession _____ number blood collection is the tracking number for the specimen. Green What color tube contains the additive Lithium Haparin / Sodium Heparin? Sclerosed The adjective describing a hard and cord-like vein. (Hint: Word ends in -ed) Outward You should cleanse the area of puncturing in an outword or inward spiral stroke? False True or False? When you see a sign that the patient is about to faint, you should continue the venipuncture. 45 | P a g e The Occupational Safety & Health Administration (OSHA) guidelines reduce risk and injuries to WORKERS OR PATIENTS? Hospital Test Request Form In which form do we find the type of test needed and the patient's information? (Hint: 4 words) High Fowler If the patient faints during the procedure, position him in sitting position. What is the more medically correct for this position? (2 words) B If you don't introduce yourself and ask permission to enter the patients room, what ethical rule are you breaking? A) Negligence B) Invasion of Privacy C) Abandonment (Type the correct letter) Quality Assurance Procedure manuals, instrument maintenance, quality control and proficiency testing are all standards of _____ _____. Hemoglobin The protein in red blood cells that helps carry oxygen is located in the _____. White Blood Cells Which cells fight infection? (3 words, plural form) Green In capillary blood sampling, the order of draw is: blood culture, lavender, _____, gray, last is SST (Serum Tube). First Assessment is the FIRST or SECOND step in patient care process? Lumbar Tap _____ _____ is for CSF Sampling. C 46 | P a g e If you miss puncturing the vein twice with a diabetic patient you should: A) Use a vein in the other arm B) Palpate the vein and try again C) Ask another phlebotomist for help D) Give up, go home and drink a beer (Type the correct letter) 70% For routine skin puncture use __% isopropyl alcohol. (include % in answer) Metabolic The amount of blood pumped by the heart depends on the body's _____ rate. Universal _____ Standard should always be followed for practicing venipuncture. 5 The human body holds a total amount of _ liters of blood. (Type the number) HBV What is the abbreviation for the Hepatitis B Virus? Reverse Isolation If the patient is susceptible to infection, he/she must be placed in _____ _____. Light Blue Partial Thromboplastin Time (PTT) test is akin to which color tube top? Lavender Central Venous Catheter (CVC) test is akin to which color tube top? Green An Ammonia test is akin to which color tube top? Red A Cardia Enzyme test is akin to which color tube top? True True or False? If there is an IV line on one arm, blood must be drawn from the other arm. Below 47 | P a g e If there is no other place to draw blood in a patient with an IV line on one arm (Ex: Pt. missing other arm) you may draw blood ABOVE or BELOW the IV line? Hematuria Blood in urine is also known as _____. Capillary On a patient's finger, what blood vessel is drawn from for labwork? Physology The study of function is known as _____. (Word ending in -ology) Glucose An Antiglycolytic preserves _____. Glucose The combining form "Glyco-" pertains to what? Glucose The additives in a gray tube (Usually Flouride Oxalate or Sodium Oxalate) is useful for preserving what? Green A STAT Electrolyte test pertains to what color tube top? False True or False? A Phlebotomist can draw blood from an artery. Oxygen Drawing blood from an artery to test the PH of blood and blood arterial gasses is also useful for testing the amount of what simple chemical? PH What 2-letter abbreviation refers to how alkaline or acidic something is? Heparin What is the blood's natural anticoagulant? An Activated Partial Thromboplastin Time test (APTT) also monitors this. Bubbles What would form if a centrifuge was in use without a cover? 50 | P a g e Ventricle The Aortic Valve allows blood from the left ____ to outside the heart. Oxygen and Carbon Dioxide Arterial blood gas measures the pressure of which two chemical elements found in the air? (Hint: _____ and _____ _____) Hypoglycemia The more medically correct term for the condition of having low blood sugar is called what? False True or False? Using a 25 gauge needle will not cause hemolysis. 18 and 21 The standard size needle to be used in venipuncture is between __ and __ gauge. (Answer format: # and #) 5 In a Glucose Tolerance Test (GTT), how many tubes of blood are drawn in 3 hours? Homeostasis The state of internal equilibrium is known as? Royal Blue What color tube top must be used when testing for blood lead levels? Wipe Off When puncturing skin on the finger, you must _____ _____ the first drop of blood. Therapeutic Drug Monitoring Peak and Trough level refers to what kind of test? (3 words) Yellow In a sample for blood culture, a test is performed to see the microbes present. What color tube top is needed? Alcohol At times, iodine is used instead of _____ for cleaning the skin. Chain of Custody 51 | P a g e What is it called when a transfer of specimen is necessary for crime or police work-related sampling? (3 words) Plasma A tube with anticoagulant will yield this clear liquid found in the blood. Thromboplastin Once you damage skin with venipuncture, the first vial of blood collected will have a lot of _____. Light Blue In using the syringe method, what color tube must be filled first? True True or False? Policies followed by laboratory personnel must consider patient's bill of rights. Intestinal Fecal specimens are checked for _____ infections. Glucose If you discover the patient has hyperglycemia, you should contact the nurse immediately. Hyperglycemia is having an above normal _____ level. STAT If an organism sampled will decay fast, it falls under _____ microbiology. (Hint: 4 letter acronym) A The MINIMUM amount of blood to be taken for an infant's blood culture is: A) 0.5 mL B) 1.0 mL C) 1.5 mL D) 2.0 mL (Type the correct letter) Material Safety Data Sheet An MSDS will give you the composition of chemicals being used. What does the acronym MSDS stand for? True True or False? Physician's approval is needed for venipuncture of the brachial cephalic vein. Shock 52 | P a g e A patient is pale, cold, clammy and diaphoretic (sweaty) after phlebotomy. In one word, describe what the patient is experiencing. Hemoconcentration If a patient pumps their hand open and closed, what will occur in the blood that can alter lab results? 5% A patient gets risk of iatrogenic anemia (too much loss of blood) if blood drawn is more than __% of their body weight. (Answer should include % sign) Green The order of draw for capillary specimen differs from the usual order of draw. Fill in the blank in the sequence: Lavender, _____, Gray, SST (Red) The single most important way to prevent the spread of infection while performing phlebotomy is by? Washing Hands After drawing blood from a patient, the phlebotomist should dispose of the needle by? Deposit it in an approved "Sharps Container" Negligence by a professional person is called? Malpractice Which of the following is the single most common source of HIV and HBV in the workplace? Blood The heart, lymphatic organs, and blood vessels are in the? Cardiovascular System The venipuncture site should be cleansed in a circular motion from the center to the? Periphery: the outer limits or edge of an area or object Red and white blood cell counts are examples of ________ tests? Hematology Treating all specimens as if they are hazardous and infectious is the basis for? Universal Precautions Drugs used to destroy or kill bacteria that cause disease are called? Antibiotics 55 | P a g e A phlebotomy technician is preparing to collect a blood specimen from a patient who is allergic to alcohol. Which of the following antiseptic solutions should the technician use to prepare the insertion site? Chlorhexidine: alternative antiseptic solution for patients who have allergies to alcohol or latex A phlebotomy technician is using a glucose monitor for point-of-care testing of a patient who has been fasting for 12 hrs. For which of the following results should the technician immediately notify the provider? 130 mg/dl: fasting blood glucose of 130 mg/dl is above the expected reference range of 70 to 110 mg/dl A phlebotomy technician should identify that which of the following is an identifier for a specimen as long as it remains in the laboratory? Accession Number: identifies a specimen as long as it remains in the laboratory A phlebotomy technician is reviewing a laboratory test requisition form before obtaining blood specimens for a patient. Which of the following actions should the technician take prior to performing the venipuncture? Check the requisition form for the duplicate test orders: discrepancies and missing information prior to performing the venipuncture A phlebotomy technician should identify that which of the following is the first step in the blood collection procedure? Test Requisition: ensure you have the provider's order for a test before preforming a blood collection An unconscious patient is brought to the emergency department, and several blood tests are ordered. A phlebotomy technician should collect the patients blood because he has received which of the following types of consent? IMPLIED Consent: implied consent can be obtained when a patient is unconscious and in an emergency situation A phlebotomy technician is collecting capillary blood drops on a filter paper card to screen a newborn for phenylketonuria. Which of the following actions should the technician take? Apply blood to the printed side of the filter paper: only apply blood to the printed side of the paper Which of the following actions should a phlebotomy technician take to locate a vein using the warming technique? Encase the warm towel in a plastic bag: maintain the towels temperature and to keep the patients skin dry 56 | P a g e A phlebotomy technician should transport a semen sample at which of the following temperatures? 36º - 38º C: semen samples should be stored and transported at 37º C (98.6º F) A phlebotomy technician is educating a patient about the at-home collection of a semen specimen. Which of the following statements by the patient indicates an understanding of the procedure? "I will collect the specimen in a sterile container and return it to the lab within 1 hour.": specimen should be collected in a sterile container, kept warm, and delivered to the laboratory within 1 hour A phlebotomy technician is assembling the equipment he will need for collecting donor units of blood. Which of the following needle sizes should the technician select? 18-guage After placing the tourniquet on a patients arm, the phlebotomist notices small red spots below the tourniquet. Which of the following terms describes these spots? Petechiae: small micro capillary bleeds that are associated with coagulation abnormalities A phlebotomy technician is transporting blood specimens to a laboratory. Which of the following actions should the technician take? Place the specimens in a lockable container: to avoid spills during transportation A phlebotomy technician is obtaining a blood specimen from a patient. The patient reports experiencing a sharp, painful, and tingling sensation going down her arm and into her hand. The technician should recognize that which of the following complications of venipuncture is occurring? Nerve injury: the patient is experiencing nerve injury, which causes a sharp, painful, and tingling sensation that radiates down the patients arm A phlebotomy technician has a requisition form for a series of tests on a patients serum. The technician should select a collection tube that contains which of the following additives? Thrombin: GREEN Tube which helps accelerate clotting for serum specimens A phlebotomy technician is preparing to collect a vancomycin peak level for a patient in an inpatient setting. Which of the following actions should the technician take prior to collecting the blood specimen? Ask the attending nurse in the patients vancomycin dose schedule accurate: the technician should ask this prior to collection. The action ensures an accurate peak level for therapeutic medication monitoring (TMM) 57 | P a g e Mixing of tubes containing anticoagulant should occur? As soon as possible Blood pressure and venipuncture should NOT be performed using the right arm if the patient? If the patient had a right mastectomy Has an IV infusing the right hand Has a full arm cast on the right arm ALL OF THE ABOVE The most important step in the performance of a venipuncture is? Identifying the patient Each sample on a filter paper collection card should consist of __________ drop (s) of blood? One The fragile skin of very ill neonates often means the the phlebotomist might want to find an alternative for which post puncture step? Using adhesive tape What is the purpose of the accession number? It provides a unique tracking number for the specimen with its test order One of the three superficial veins commonly used for venipuncture is the ________ ? Median cubital If a phlebotomist notices that there are three orders for A.M. hemoglobins on Mrs. Jones one of which was written by a different Dr., you should? Check for duplicate orders The function of Neutrophils is? To produce antibodies Which of the following organizations requires employees to be assessed for competency? The Joint Commission When using glass slides to make a blood smear, the recommended angle of contact between slides is ________ degrees? 30 degrees What could be the danger of drawing too much blood from an infant with low birth weight? Anemia The Federal Government requires that specimens be transported in __________________ ? 60 | P a g e A specimen for blood lead level is drawn in a? Royal Blue top tube If a patient has an intravenous line in the arm, the phlebotomist should? Draw blood from the opposite limb Patient confidentiality is defined as? A patients right to authorize the use of their information What is the purpose of warming the site prior to a dermal puncture? Increase the blood flow If a patient is dehydrated due to severe vomiting and the physician orders a test for STAT electrolytes, which of the following tubes would be used? Green top tube Which of the following tests is not part of a complete blood count (CBC)? Activated partial thromboplastin time (APPT) What specimens are kept warm/room temperature? Cold agglutinins When the tourniquet is tied too tight, the capillaries in the area may rupture causing? Petechiae: a small red or purple spot caused by bleeding into the skin A 13-yr old girl came into your clinic for a pregnancy test. The same day she returned without her parents and wants the results of her test. The phlebotomist should? Tell her she should contact her physician The life span of an erythrocyte is? 120 days All the employees at risk for blood borne pathogen (BBP) exposure are required by OSHA to? Vaccinate for HBV or sign a waiver Identify the term BATTERY? Touching someone without their consent To draw for coagulation studies the phlebotomist should? Fill the tube to the top: Lt Blue tube 61 | P a g e FORMITE is defined as? Inanimate things transmitting disease EDEAMA is? Fluid in the tissue Define CYANOSIS: Blue coloring of the skin due to lack of oxygen According to STANDARD Precautions, blood and body fluids from which group are considered biohazards? ALL blood and body fluids The additive in a Pink/Lavender tube is? EDTA Hematuria is defined as? Blood in the urine: Hema-blood/turia-urine Red top tubes clot for? 30-60 minutes Which test is used to determine drug abuse? Urine The innermost layer of a blood vessel is called? Endothelial The main Blood Borne Pathogen (BBP) OSHA regulation requires which of the following to prevent needle stick injuries? Use of the approved needle safety devices to cover the exposed needle Point of Care testing procedures? Is performed at the patients bedside A patient has been taking aspirin. Which of the following is likely to be affected? Bleeding time Which of the following is also referred to as SST? Speckled-Red/Gray top tubes A patient has a SYNCOPAL (fainting) episode during a blood draw, the phlebotomist should? 62 | P a g e Call for assistance Of the following tests which test must be put immediately into ice water? Arterial blood gas (ABG) OSHA requires that all health care personnel exposed to blood or other body fluids receive a vaccine against? Hepatitis B virus (HBV) Which of these vessels has valves? Vein A test involving multiple collections of blood and urine over specified time intervals is called? GTT (Glucose Tolerance Test) In which test must alcohol never be used to cleanse the venipuncture site? Alcohol (BAC) The artery that lies on the thumb side of the wrist is? Radial Which vein is most often the prominent vein in an obese patient? Median Cubital What should a phlebotomist do if blood was drawn from the wrong patient? Report the incident immediately to the supervisor Which two arteries are occluded when performing the Allen test? Radial and Ulnar When making a blood smear, the goal is? To get a feathered edge Patients suspected of having Methicillin Resistant Staphylococcus Aureus (MRSA) should be isolated with ______________ precautions? Contact What is the temperature range that will provide the needed warmth but not burn the infant? 39º - 42º C / 102.2º - When inserting the needle the bevel should be? UP 65 | P a g e While collecting blood from a combative patient you receive a splash of small blood drops to your face. What should you do? Wash your face thoroughly and report the incident following your facilities protocol What is the phrase used to describe the sequential tracking of a criminal blood sample that is to be used in evidence? Chain of Custody A routine venipuncture draw site is commonly cleaned with a __________ % solution of isopropyl alcohol? 70 % The National Fire Protection Association label uses a color and number to indicate a deadly health hazard? Blue, #4 The most prevalent type of nosocomial infection are ____________ in origin? Urinary Tract Infection (UTI) When a glucose meter is cleaned or its battery changed it is crucial to _____________ ? Monitor values with Quality Control material A phlebotomy technician is preparing to use an evacuated tube system to obtain a venous blood specimen from a patient. The tourniquet is in place and the technician has cleansed the puncture site. Which of the following procedural steps should the technician perform next? Ask the patient to make a fist: this action allows for the patient's veins to become more prominent for puncture site A phlebotomy technician is performing a venipuncture for a patient. The patient suddenly reports "feeling faint." After removing the tourniquet and the needle, which of the following actions should the technician take next? Have the patient put her head between her legs: this position helps prevent syncope (fainting). Which of the following actions by a phlebotomy technician can result in a grossly hemolyzed specimen? Using an incorrect needle gauge: large-gauge needle to draw with a small lumen can cause a grossly hemolyzed specimen A phlebotomy technician enters a patient's room to perform a venipuncture and notices that the patient is sleeping. Which of the following actions should the technician take? Wake the patient before collection: verify his identity and obtain collection 66 | P a g e A phlebotomy technician is collecting a unit of blood from a donor. Which of the following actions should the technician take? Instruct the donor to open and close his hand gently throughout the collection When should a phlebotomy technician perform external liquid controls for quality control on a CLIA- waived glucose point-of-care test? When a new lot number or kit is opened A phlebotomy technician should identify that which of the following is one of the joint commission's 2016 National Patient Safety Goals? Identify patient's correctly To prevent hospital-acquired infections, a phlebotomy technician should clean items that have been contaminated by blood with 1:10 dilution of which of the following substances and water? Sodium hypochlorite: or chlorine bleach, with water to disinfect items that are contaminated by blood. For which of the following reasons should a phlebotomy technician avoid drawing blood from the leg or foot of a patient who has diabetes? These areas are more susceptible to infection: due to having a slowed ability to heal. The technician should consult the patient's provider before drawing a specimen from the lower extremities. A phlebotomy technician should identify that which of the following is the total blood volume of an infant who weighs 3.3 kg (7.3 lb)? 240 to 330 ml: an infant of this weight has a total blood volume of approximately 240 to 330 ml Within which of the time periods should a phlebotomy technician collect a newborn blood-spot test screening card? Within 72 hrs: of birth A phlebotomy technician is preparing to dispose of contaminated sharps. According to OSHA standards, which of the following actions should the technician take? Replace the sharps container when it's two-thirds full An unconscious patient is brought to the emergency department, and several blood tests are ordered. A phlebotomy technician should collect the patient's blood because he has received which of the following types of consent? IMPLIED Consent: can be obtained when a patient is unconscious and in an emergency situation 67 | P a g e A phlebotomy technician is collecting a blood specimen from an adolescent patient who weighs 42.6 kg (94 lb). Which of the following amounts is the minimum volume of blood the technician should draw from this patient at any one time avoiding causing anemia? 30 ml: a maximum of 30 ml at one time for a patient weighing 45.5 kg (66 to 100 lb) A phlebotomy technician is performing a heel stick to obtain capillary blood for testing a newborn's bilirubin level. Which of the following actions should the technician take? Use an amber-colored microcontainer: bilirubin is photosensitive, and this tube protects the specimen from exposure to light A phlebotomy technician is using a point-of-care test system to determine a patient's WBC count. For which of the following results should the technician immediately notify the provider? 1.8/mm this finding is outside the expected reference range of 4.4 to 11/mm A phlebotomy technician is collecting a urine specimen from a patient for pre-employment drug screening. Which of the following findings should indicate to the technician that tampering has possibly occurred? The temperature of the specimen is 30º C (86º F): is below the expected range of 32º to 36º C (90º - 100º F) and indicates possible tampering A phlebotomy technician enters a patient's room to obtain a STAT specimen. The patient's provider and a nurse are speaking with the patient. Which of the following actions should the technician take first? Introduce himself to the patient and the health care team members: before requesting permission to obtain the STAT specimen A phlebotomy technician is collecting a blood specimen from a patient to measure the trough level of a medication. The technician should collect the specimen at which of the following times? Within 15 min before the patient receives the next dose of medication: the trough level is the lowest concentration of medication in the patient's blood A phlebotomy technician should identify that which of the following series of venipuncture steps is in the appropriate order? Assess the site, cleanse the site, and insert the needle A phlebotomy technician is performing a total cholesterol point-of-care test for patient. Which of the following findings should the technician immediately report to the provider? 300 mg/dl: this finding is above the reference range of 140 to 200 mg/dl for total cholesterol. The technician should immediately report this finding to the provider 70 | P a g e A phlebotomy technician is collecting a specimen to test a patient's lithium level following a recent dose of medication. Which of the following levels should the technician collect? Peak: collect a blood specimen 15-30 min after the lithium has been administered for an optimum peak level result A phlebotomy technician is instructing a patient on how to collect a urine specimen for a culture and sensitivity test. Which of the following statements should the technician include? "You will need to collect a midstream clean-catch specimen" A phlebotomy technician is preparing to collect blood from a patient who has experienced syncope during previous draws. Which of the following actions should the technician take? Place the patient in a supine position: supine (face up) position to reduce the risk of her falling if she experiences syncope A phlebotomy technician should identify that which of the following information is required for positive identification of a patient in an outpatient facility? Picture ID, full name, date of birth: must have one piece of visual identification and two instances of verbal confirmation of identification. Verbal identification- patient must state and spell their full name A phlebotomy technician is preparing to collect a blood sample from a patient for a cholesterol test, Which of the following statements should the technician make? "Please sit for at least 5 minutes before the test": sitting or lying down before a cholesterol test will help to lower test results A phlebotomy technician is preparing a venipuncture on a patient who currently has a IV in both arms. Which of the following actions should the technician take? Ask the nurse to turn off the IV's for 2 minutes A phlebotomy technician is preparing to collect a specimen from a 3-year old patient to perform a coagulation test. Which of the following collection methods should the technician use? Winged safety butterfly: the best method for patient's with small veins, such as children A phlebotomy technician is informing a patient about the procedure for collecting a blood culture. Which of the following information should the technician include? "I will swab the area twice to make sure it is sterile": first with isopropyl alcohol and then with a chlorhexidine glucose swab A phlebotomy technician is seeking consent to perform venipuncture on an older adult patient who has been accompanied to the facility by a younger adult. Which of the following actions should the technician take? 71 | P a g e Speak to the patient in a normal tone: treat the patient with respect, asses the patient and alter the communication method A phlebotomy technician is preparing to draw a patient's blood when the patient informs him that she is taking warfarin (blood thinner Rx). The technician should identify that the results of which of the following tests is affected by this medication? PT/INR: taking an anticoagulant medication can affect PT/INR levels- checking whether the Rx is preventing blood clots A phlebotomy technician should identify that the order of draw for capillary collections is different from venipuncture for which of the following reasons? An increased rate of coagulation: thromboplastin is released when the skin is punctured, causing blood to clot more increasing the rate of coagulation A phlebotomy technician is preparing to store a blood specimen. At which of the following temperatures should the technician store the specimen? 2º - 8º C (35.6º - 46.4º F) A phlebotomy technician is preparing to enter a patient's room to collect a blood specimen. which of the following actions should the technician plan to take? Communicate name and department affiliation to the patient A phlebotomy technician is preparing to perform a venipuncture for a patient who is on droplet precautions. In addition to following a standard precautions, which of the following pieces of personal protective equipment should the technician apply before entering the patient's room? Mask A phlebotomy technician collects multiple specimens from a premature infant. Which of the following is a possible result of the procedure? Latrogenic anemia: too much blood loss in a short amount of time A phlebotomy technician is preparing to draw a blood specimen from a patient who has a clostridium difficile infection (Colitis). Which of the following precautions should the technician follow? CONTACT Precautions: Colitis- diarrhea, scabies A phlebotomy technician uses alcohol to cleanse a venipuncture site. Before preforming the venipuncture, the technician should allow the site to dry for which of the following reasons? Alcohol requires time for antiseptic action to take effect: allow to air dry so antiseptic will take effect 72 | P a g e A patient asks a phlebotomy technician to use his finger for blood work. In which of the following situations can the technician collect blood from the patient's finger? The ordered test can be performed on a capillary specimen: draw a capillary specimen if the ordered tests do not require a large amount of venous blood A phlebotomy technician performs a point-of-care glucose test for a patient in an outpatient setting. The result is in the critical value range. Which of the following actions should the technician take? Report the result to the patient's provider A patient states that he is a "difficult draw" and requests a skin puncture. The test ordered is PTT. Which of the following should a phlebotomy technician perform? A syringe draw transferred into a light blue vacuum tube: when a PTT or other coagulation test is ordered , this is the preferred method A phlebotomy technician is updating a quality control record while performing daily point-of-care tests. Which of the following information should the technician include? Expiration date: note the date from the device when updating a quality control record Which of the following collection tubes should a phlebotomy technician use when collecting for a routine chemistry test that requires serum? SST: when an SST tube is centrifuged, the thixotropic gel changes viscosity and moves between the serum and the cells A phlebotomy technician is preparing to obtain a blood specimen to determine a patient's sodium level. The technician should select a collection tube that has a top with which of the following colors? GREEN: to determine the patient's sodium level. Heparin is the additive that aids in determining sodium levels. A phlebotomy technician is preparing to draw blood specimens from a patient who is alone and unresponsive. The technician should collect the specimens using which of the following forms of consent? Implied consent: Emergency situations use IMPLIED CONSENT to provide treatment to save a patient's life. The patient may be unresponsive but is still entitled to continued care. A phlebotomy technician is instructing a patient about proper semen collection for determination of fertility potential. Which of the following instructions should the technician include? Protect the specimen from exposure to bright light A phlebotomy technician is preparing to perform a lactic acid test. Which of the following actions should the technician take? 75 | P a g e 0.3 ng/mL this is above the expected range of 0 to 0,2 ng/mL, a critical value A phlebotomy technician has a requisition form for a series of tests on a patient's serum. The technician should select a collection tube that contains which of the following additives? Thrombin helps accelerate clotting for serum specimens GREEN Tube A phlebotomy technician is collecting a blood specimen from a patient to measure the trough level a medication. the technician should collect the specimen at which of the following times? Within 15 min before the patient receives the next dose of medication To prevent hospital-aquired infections, a phlebotomy technician should clean items that have been contaminated by blood with 1:10 dilution of which of the following substances and water? Sodium hypochlorite or chlorine bleach A phlebotomy technician is preparing to collect a blood specimen from the hand of a patient whose veins are difficult to access. Which of the following devices should the technician use? Hand immobilizer uses straps to keep the patient's hand still during the collection procedure A phlebotomy technician has collected a blood specimen from a patient who is in an isolation room. Which of the following pieces of (PPE) should the technician remove first? Gloves: to prevent cross-contamination A phlebotomy technician is collecting a urine specimen from a patient for pre-employment drug test. Which of the following actions should the technician take? Verify that the specimen contains as least 45 mL of urine the amount allows 30 mL to be put in one specimen bottle and 15 mL to be put in another A phlebotomy technician should identify that the order of draw for capillary collections is different from venipuncture for which of the following reasons? An increased rate of coagulation Thromboplastin is released when the skin is punctured, causing blood to clot more quickly. A phlebotomy technician is preparing to draw a peak level for medication that was administered orally to a patient. After verifying when the patient received the medication, how long should the technician wait prior to attempting the draw? 76 | P a g e 2 hr after administration collect a peak level 1 -2 hr following oral administration to ensure that the medication is not at a toxic level A phlebotomy technician has a requisition form to perform a chromosome analysis for a patient. The technician should select a collection tube that contains which of the following additives? Heparin-GREEN TUBE an anticoagulant that produces a plasma specimen for chromosome analysis For which of the following reasons should a phlebotomy technician centrifuge a serum specimen before transport to an outside reference laboratory? Cells must be separated from the serum the cells will continue to metabolize into the serum if not centrifuged A phlebotomy technician is preparing to obtain a blood specimen from a patient for thyroid studies. The technician should select a collection tube that has a top with which of the following colors? Speckled-Red/Black-SST use for thyroid studies (T3 T4 and thyroid-stimulating hormone) A phlebotomy technician should identify that a patient who has which of the following blood types is a universal RECIPIENT? Type AB: a patient with type AB blood is a universal recipient-their blood lacks both anti-A and anti-B antibodies A phlebotomy technician uses alcohol to cleanse a venipuncture site. Before performing the venipuncture, the technician should allow the site to dry for which of the following reasons? Alcohol requires time for antiseptic action to take effect Prior to transport, which of the following specimens should a phlebotomy technician place in an ice bath within 30 min after collection? Arterial blood gas (ABG) immediately place an AGB specimen in an ice bath to stop the metabolic activity of the red blood cells for delivery to the laboratory A phlebotomy technician is preparing a blood culture specimen from an adult patient. Which of the following actions should the technician take? A phlebotomy technician is preparing to draw blood from a patient's arm and observes a sore at the site where the tourniquet is to be placed. Which of the following actions should the technician take? Tie the tourniquet over the patients sleeve: to prevent any further damage to the skin 77 | P a g e A phlebotomy technician is preparing to draw blood from a patient in an inpatient setting. The patient extends his arm and turns his head away. This action by the patients an example of which of the following types of consent? Implied Consent: by extending his arm, the patient is giving implied consent After exiting a patient's room, which of the following is the last piece of PPE a phlebotomy technician should remove? Mask: first remove gloves, gown, protective eyewear-the mask should be removed last A phlebotomy technician is collecting a sample for cholesterol, troponin, and HDL, blood results. Which of the following departments is responsible for processing these tests? Chemistry: processes tests related to body chemistry A phlebotomy technician finishes performing a blood draw in an isolation room. Which of the following pieces of PPE should the technician remove first? Gloves: remove the most contaminated piece of PPE first. A phlebotomy technician is preparing to collect a specimen from a 3-year-old patient to perform a coagulation test. Which of the following methods should the technician use? Winged safety butterfly: best for patients who have small veins, such as young children A phlebotomy technician is performing a venipuncture for a potassium test, CBC, and glucose test. The technician has left the tourniquet on the patient for 3 min. Which of the following outcomes should the technician except? High potassium level: leaving a tourniquet on longer than 1 min can cause hemolysis, which creates a falsely elevated potassium level A phlebotomy technician is performing a venipuncture for a lipid profile, WBC, and a clotting time test. Which of the following is the correct order of draw? Lt Blue, SST, Lavender: Lt blue, SST, then Lavender to prevent cross-contamination A phlebotomy technician is performing a venipuncture for a bilirubin test, a cold agglutinin titer, a CBC, and a PTT test. Which of the following tubes should the technician use? One Lt Blue, two Serum (Red), and one Lavender tube Which of the following anticoagulants does NOT bind calcium in the blood? 80 | P a g e Type O: should only receive type O blood because of the interaction between the antigens and antibodies A phlebotomy technician is preparing a peripheral blood slide from a capillary puncture. Which of the following actions should the technician take? Touch the slide to the second drop of blood A phlebotomy technician is preparing a peripheral blood smear from a patient. The technician should identify that this collection technique is used for which of the following tests? WBC differential test: A phlebotomy technician is collecting a blood culture from an infant who weighs 3 kg (6.6 lb). The technician should identify that which of the following is the total blood volume for this infant? 240 to 330 mL: the total blood volume can be calculated by multiplying the infant's weight in kg by 100 and changing the units to mL Amber Bag-Biohazard UV Protected Folate, Bilirubin, Vitamin A Ice Slurry Ammonia, Lactic Acid A phlebotomist is working with the critical team to incorporate an automated carrier system into the facility's newly renovated laboratory. which of the following actions must be taken to avoid hemolysis of blood samples? Protect specimens from vibration or shock A phlebotomist is preparing to mail laboratory specimens to a reference laboratory. Which of the following information must be listed on the labels of the individual specimens? Type of specimen and its source A phlebotomy technician calls a medical assistant to inquire about a laboratory requisition. Which of the following information is required on a laboratory requisition? Patient Identification Number A phlebotomy technician is accessing the laboratory information system prior to collecting a specimen. Which of the following actions should the technician take? Print the specimen label A phlebotomy technician has received a urine drug test specimen with a thermometer reading of 29.4º C (85º F). Which of the following actions should the technician take? 81 | P a g e Have the patient provide another urine specimen under observation: if the technician suspects tampering a new sample should be collected-the temperature should be in a range of 32.2º to 37.8º C (90º to 100º F) Which of the following actions should a phlebotomy technician take when collecting a urine specimen for drug testing? Seal the specimen in a tamer-evident container A phlebotomy technician has released a specimen to a courier who is transporting it to a laboratory. Which of the following statements should the courier use to instruct the medical specimen accessioned on how to complete the chain of custody form? Write your name on the form A phlebotomy technician is performing a brief physical examination on a prospective blood donor. Which of the following measurements would indicate the donor's eligibility to donate blood? Hematocrit level 42%: the level must be 38% or higher for the patient to be eligible to donate blood A phlebotomy technician is instructing a patient about how to collect a fecal specimen at home. Which of the following instructions should the technician include? "Do not mix urine with the fecal sample." NO COMBO! urine affects the micro-organisms in the feces, which can alter test results A phlebotomy technician should recognize that which of the following blood types is COMPATIBLE with type O blood? Type O: a type O patient should only RECEIVE type O blood because of the interaction between the antigens and antibodies A phlebotomy technician is performing a venipuncture using a winged infusion set. The Red-topped tube fills, but the Lt Blue-topped tube slows and does not fill completely. Which of the following actions should the technician take? Insert a new Lt Blue-topped tube to see if it will fill: the tube might have low vacuum so try a new Lt Blue tube to try and fill completly before performing a new venipuncture The Joint Commission recommends using the patient's full name and which of the following pieces of information to ensure accurate inpatient identification? Medical Record Number: a number assigned to the patient by a facility, is an acceptable form of patient identification. The patient's birthdate and home address are also acceptable patient identifiers 82 | P a g e Which of the following test results are affected when a phlebotomy technician uses povidone-iodine to cleanse a site for a dermal puncture? Potassium: proidone-iodine is contraindicated for potassium tests because it can cause a false elevation of potassium a specimen A phlebotomy technician is preparing to draw a peak level for a medication that was administered orally to a patient. After verifying when the patient received the medication, how long should the technician wait prior to attempting the draw? 2 hr after administration: collect a peak level 1 to 2 hr following an oral administration to ensure that the medication is not at a toxic level A phlebotomy technician is preparing to perform a venipuncture on a patient. which of the following types of consent is the patient providing when she extends her arm to begin the procedure? Implied Consent: occurs when nonverbal behavior indicates agreement by extending her arm to begin the procedure A phlebotomy technician should select a tube that has which of the following anticoagulants to collect a sample for a PT/PTT test? Sodium Citrate: use this anticoagulant to collect a sample for PT/PTT test LT BLUE TUBE A phlebotomy technician is preparing to obtain a blood specimen from a patient for Thyroid studies. The technician should select a collection tube that has a top with which of the following colors? SPECKLED TUBE: when collecting a specimen for Thyroid (T3 T4 and Thyroid-stimulating hormone) For which of the following conditions does emergency first aid treatment include maintaining an open airway, controlling bleeding, and keeping the patient warm until help arrives? Shock: call for help, maintain airway, control bleeding, and keep patient warm until help arrives A phlebotomy technician is instructing a patient about how to collect a fecal occult specimen. Which of the following instructions should the technician include? Avoid taking ibuprofen (Advil): can cause false-positive results Which of the following circumstances requires performing additional EXTREME CONTROLS? When test results are out of range 85 | P a g e 30 mL: is the maximum volume that can be drawn one time from a patient who weighs 30to 45.5 kg (66 to 100 lb) A phlebotomy technician is performing a heel stick to obtain capillary blood for testing a newborns's bilirubin level. Which of the following actions should the technician take? Use an amber-colored microtainer Which of the following actions should a phlebotomy technician take when performing a venipuncture using an evacuated tube system? Position the needle at a 30º angle in the SAME direction as the VEIN and with the bevel up A phlebotomy technician is preparing a patient's arm for venipuncture. Which of the following techniques should the technician use who applying an antiseptic solution? Back and forth strokes: this motion is effective in decontaminating the site During a routine venipuncture, a phlebotomy technician notices that a patient is becoming pale and diaphoretic. The technician should identify that the patient is at risk for which of the following conditions? Syncope: diaphoretic(sweating heavily)- use precautions to prevent the patient from fainting You have an order to draw an infant screening card, 02 levels, Bilirubin, and DNA. Which should you draw first? 02 levels After performing a heel puncture for neonatal screening, which of the following is the correct procedure for collecting the blood? Saturate each circle The order of draw for capillary collections is different than venipuncture because of? An increased rate of coagulation A blood specimen was rejected by the lab with the abbreviation QNS. Why was the specimen rejected? (QNS) Quantity Not Sufficient When preparing to draw blood from a patient, the patient extends his arm and turns his head away. Which of the following form of consent does this indicate? IMPLIED Consent A phlebotomist is drawing 5 blood collection tubes. When should the tourniquet be released? 1-2 minutes 86 | P a g e A phlebotomist must choose the correct tube color and additive for the corresponding? Laboratory test Which is the proper cleansing procedure for routine venipuncture? Cleanse the site in an outward spiral A phlebotomist must centrifuge a serum specimen before shipment to an outside reference lab because? Cells must be separated from the serum During a draw, the patient becomes unresponsive. What is the next action the phlebotomist should take? Check for breathing Which of the following statements by a phlebotomist regarding skin preparation for blood cultures is appropriate? "I will cleanse the area with povidone iodine" A phlebotomist draws a CBC at the physician's office at 18:00. The laboratory closed at 17:30 and will not process specimens again until 05:00. Which of the following is proper temperature for preserving the specimen? 2 to 10 C (36º to 50º F) When performing a venipuncture on a patient of average weight, which of the following is a corrected technique needle insertion? Insert until a change in resistance Which of the following is appropriate for preparing a peripheral blood sugar? Place a 1 mm drop of blood on the center of the slide Which of the following tubes should be collected first for dermal samples? Lavender Top: Capillary draw Which of the following potential outcomes is the most damaging if data is entered incorrectly into the automated Laboratory Information System? The incorrect data may be reported to the Health Care Provider A physician ordered a Tobramycin level to be drawn one hour after dose. The Tobramycin has been ordered for 11:00. Which of the following actions should the phlebotomist take? Check with the nurse How many times should a technician invert a lavender topped tube? 87 | P a g e The technician should invert the lavender-topped tube eight to ten times to ensure adequate mixing of the additive and the blood. Order of PPE removal Gloves, goggles, gown, mask What is a phlebotomist required to obtain from a potential blood donor? The technician should obtain the patient's complete medical history before the patient may donate blood. A phlebotomy technician seesa coworker receive a major electrical shock from an instrument. Which of the following actions should the technician take first? The technician should immediately shut off the instrument to eliminate the source of the electrical shock. A phlebotomy technician is preparing to collect a vancomycin peak level for a patient in an inpatient setting. Which of the following actions should the technician take prior to collecting the blood specimen? The technician should ask the attending nurse if the patient's vancomycin dose schedule is accurate prior to collection. This action ensures an accurate peak level for therapeutic medication monitoring. Best technique to use on the arm when applying an antiseptic solution The technician should apply the antiseptic solution using back and forth strokes because this motion is effective in decontaminating the site. A phlebotomy technician receives a chemical splash to his forearm. After removing his contaminated clothing, which of the following is the minimum amount of time the technician should rinse the affected area? The technician should rinse the affected area for a minimum of 15 min after the contaminated clothing has been removed. A technician should identify that which of the following is one of the Joint Commission's 2016 National Patient Safety Goals? Technicians should use at least two forms of identification to identify patients correctly. The Joint Commission's National Patient Safety Goals help health care facilities address areas of concern regarding patient safety. The 2016 goals include identifying patients correctly, improving staff communication, using medicines safely, using alarms safely, preventing infections, identifying patient safety risks, and preventing mistakes in surgery. A phlebotomy technician is collecting a urine specimen from a patient for a pre-employment drug test. Which of the following actions should the technician take? The technician should verify that the specimen contains at least 45 mL of urine. This amount allows for 30 mL to be put in one specimen bottle and 15 mL to be put in another bottle. 90 | P a g e Cholesterol Reference Range 140 to 200 mg/dL A phlebotomy technician is preparing to enter a patient's room to collect a blood specimen. Which of the following actions should the technician plan to take? The technician should communicate her name and department affiliation to the patient when entering the room to collect a blood specimen Which of the following actions should a phlebotomy technician take when reporting laboratory results? The technician should send the laboratory results to the ordering provider. A phlebotomy technician is introducing herself to a patient and explaining the venipuncture procedure. In which of the following comfort zones is the technician working? Personal Additive used for a chromosome analysis Heparin Additive used for serum specimens Thrombin Additive used for CBC EDTA A phlebotomist is preparing to store a blood specimen. At what temperature should the technician store the specimen? 2-8 C (35.6-46.4 F) Cause of Iatrogenic Anemia Too much blood loss in a short amount of time Cause of Aplastic Anemia Bone marrow abnormalities Cause of Pernicious Anemia B12 deficiency Cause of Microcytic Anemia Hemoglobin Abnormalities (Iron Deficiency) Semen transport Within 2 hours, at body temperature, in a sterile container not a condom, do not expose to light 91 | P a g e Troponin T levels 0-0.2 ng/ml Which of the following actions should a phlebotomy technician take when preparing a peripheral blood smear? The technician should place a 1 mm drop of blood one-half inch from the edge of the slide. Tube for thyroid studies Speckled Tube for lactic acid test Grey Tube for potassium test Green Tube for coagulation studies light blue PTT test Use light blue tube, no capillary draws Tube for drug level test Red Tube for creatine kinase test Light Green Tube for erythrocyte sedimentation rate test Lavender Tube for heavy metal test Royal Blue Conditions that require airborne precautions Tuberculosis, Measles, and Varicella Conditions that require droplet precautions Pneumonia, scarlet fever, meningitis, and rubella Conditions that require contact precautions Scabies and herpes simplex 92 | P a g e Accelerates clotting for serum specimens Thrombin Which tube is first for dermal punctures? Lavender EDTA, PST, SPS Yield plasma not serum SST serum separator tube First aid treatment for shock Call for help, maintain an open airway, control bleeding, and keep the patient warm First aid treatment for syncope Call for help, lower the patient's head between their legs, and if possible, assist the patient to lie down First aid treatment for convulsions Call for help and assist the patient to lie down First aid treatment for vomiting Apply a cold compress to the patient's head, instruct the patient to breathe deeply, and offer a washcloth or tissues Clostridium difficile Contact precautions Tube for sodium level tests Green (Heparin) Fecal occult specimen collection Avoid taking ibuprofen, collect for 3 days, consume a high-fiber diet, keep the cards at room temperature What tube comes last in a dermal order of draw? Red What test results are affected when Povidone iodine is used to cleanse the site for a dermal puncture? Potassium Additive used for a PT/PTT test