NCCT INTERACTIVE REVIEW MEDICAL INSURANCE EXAM
QUESTIONS AND ANSWERS
When disposing of hazardous materials, the phlebotomist must adhere to the
guidelines and standards set forth by.
A. CMS.
B. FDA.
C. CLIA.
D. OSHA.
OSHA.
Rationale: In the United States, the treatment, storage and disposal of hazardous waste
is regulated by the Hazardous Waste Operations and Emergency Response
(HAZWOPER) standards set forth by the Occupational Safety and Health Administration
(OSHA). The Clinical Laboratory Improvement Amendment (CLIA) regulates
laboratories by providing a classification system based upon method complexity. The
Federal Drug Administration regulates pharmaceuticals. Laboratory Managers merely
enforce regulations as defined by the government and other regulatory agencies.
While performing a venipuncture, the phlebotomist removes the filled tubes, but
forgets to remove the tourniquet prior to needle withdrawal. Which of the
following is the most likely result?
A. syncope
B. hematoma
C. hemoconcentrated specimen
D. hemolyzed specimen
hematoma
Rationale: A hematoma is a large painful bruise at the puncture site, caused or created
by blood seeping into the surrounding tissues, one of the causes is the delay in
tourniquet release and pulling the vacuum tube out. Since the tourniquet is causing the
,veins to bulge this will prevent quick clotting, and cause bruising. Syncope is fainting;
hemoconcentration is when the concentration of blood cells are increased. Hemolysis
specimens indicate the destruction of red blood cells after drawing the specimen, or
during the procedure.
A patient on coumadin therapy is at the lab for a weekly coagulation test. Which
of the following tubes should the phlebotomist collect for this test?
A. green top
B. red top
C. light blue top
D. lavender top
light blue top
Rationale: 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.
The phlebotomist is drawing plain red, purple, green, and blue top tubes. Upon
completion of the blood draw the phlebotomist noticed that he missed an order
requiring an SST. The phlebotomist should share the
A. green
B. purple
C. red
D. blue
red
Rationale: A plain red tube and an SST tube both will yield serum once clotted and
centrifuged. Therefore, it is possible to share the plain red top specimen for the SST
, test. There is no need to re-stick the patient. The lavender and blue top tubes both
contain anticoagulant, thus they produce plasma (not serum) when centrifuged. They
would not be good substitutes for an SST specimen.
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?
A. 18-gauge needle and syringe
B. capillary puncture
C. evacuated tube system
D. 23-gauge butterfly needle and syringe
23-gauge butterfly needle and syringe
Rationale: A butterfly with a smaller gauge needle device 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 provides better control than
an evacuated tube. A capillary collection would be the last resort as it might not provide
enough sample. An 18-gauge needle would be too large for this collection. The 23-
gauge butterfly and syringe is the best initial choice in this case.
Which of the following is included in an exposure control plan?
A. dates of each employee's last tetanus booster
B. contaminated needlestick injury evaluation process
C. maintenance of MSDS and incident report logs
D. emergency exit markings in compliance with OSHA standards
contaminated needlestick injury evaluation process
Rationale: It is important to document and make sure that all employees have annual
training to be in compliance with OSHA regulations. According to the OSHA Bloodborne
Pathogens Standard, an Exposure Control Plan must meet certain criteria: It must be
QUESTIONS AND ANSWERS
When disposing of hazardous materials, the phlebotomist must adhere to the
guidelines and standards set forth by.
A. CMS.
B. FDA.
C. CLIA.
D. OSHA.
OSHA.
Rationale: In the United States, the treatment, storage and disposal of hazardous waste
is regulated by the Hazardous Waste Operations and Emergency Response
(HAZWOPER) standards set forth by the Occupational Safety and Health Administration
(OSHA). The Clinical Laboratory Improvement Amendment (CLIA) regulates
laboratories by providing a classification system based upon method complexity. The
Federal Drug Administration regulates pharmaceuticals. Laboratory Managers merely
enforce regulations as defined by the government and other regulatory agencies.
While performing a venipuncture, the phlebotomist removes the filled tubes, but
forgets to remove the tourniquet prior to needle withdrawal. Which of the
following is the most likely result?
A. syncope
B. hematoma
C. hemoconcentrated specimen
D. hemolyzed specimen
hematoma
Rationale: A hematoma is a large painful bruise at the puncture site, caused or created
by blood seeping into the surrounding tissues, one of the causes is the delay in
tourniquet release and pulling the vacuum tube out. Since the tourniquet is causing the
,veins to bulge this will prevent quick clotting, and cause bruising. Syncope is fainting;
hemoconcentration is when the concentration of blood cells are increased. Hemolysis
specimens indicate the destruction of red blood cells after drawing the specimen, or
during the procedure.
A patient on coumadin therapy is at the lab for a weekly coagulation test. Which
of the following tubes should the phlebotomist collect for this test?
A. green top
B. red top
C. light blue top
D. lavender top
light blue top
Rationale: 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.
The phlebotomist is drawing plain red, purple, green, and blue top tubes. Upon
completion of the blood draw the phlebotomist noticed that he missed an order
requiring an SST. The phlebotomist should share the
A. green
B. purple
C. red
D. blue
red
Rationale: A plain red tube and an SST tube both will yield serum once clotted and
centrifuged. Therefore, it is possible to share the plain red top specimen for the SST
, test. There is no need to re-stick the patient. The lavender and blue top tubes both
contain anticoagulant, thus they produce plasma (not serum) when centrifuged. They
would not be good substitutes for an SST specimen.
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?
A. 18-gauge needle and syringe
B. capillary puncture
C. evacuated tube system
D. 23-gauge butterfly needle and syringe
23-gauge butterfly needle and syringe
Rationale: A butterfly with a smaller gauge needle device 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 provides better control than
an evacuated tube. A capillary collection would be the last resort as it might not provide
enough sample. An 18-gauge needle would be too large for this collection. The 23-
gauge butterfly and syringe is the best initial choice in this case.
Which of the following is included in an exposure control plan?
A. dates of each employee's last tetanus booster
B. contaminated needlestick injury evaluation process
C. maintenance of MSDS and incident report logs
D. emergency exit markings in compliance with OSHA standards
contaminated needlestick injury evaluation process
Rationale: It is important to document and make sure that all employees have annual
training to be in compliance with OSHA regulations. According to the OSHA Bloodborne
Pathogens Standard, an Exposure Control Plan must meet certain criteria: It must be
