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Quiz Session - Attempts With Random Questions

NHA CPT Exam Questions

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1.

Who submits the order for venipuncture?

  • The physician or mid-level provider

  • The phlebotomist

  • The nurse

  • The patient

Correct answer: The physician or mid-level provider

In a healthcare setting, the physician or a mid-level provider (such as a Nurse Practitioner or Physicians Assistant) submits an order for venipuncture. This order will include which tests will be submitted to the laboratory. Multiple tests can be run on a single tube, so it is vital for the phlebotomist to ensure that they get enough sample and in the correct sample containers.

2.

Melissa is working in a pediatric office laboratory. Today, she is collecting a specimen from a toddler with a suspected infection. The child's primary symptom is diarrhea. 

Which type of transmission-based precautions should Melissa follow?

  • Contact precautions

  • Droplet precautions

  • Airborne precautions

  • Reverse isolation

Correct answer: Contact precautions

A phlebotomist working with someone who has sudden (acute) diarrhea should follow transmission-based precautions to prevent the spread of any germs that are making patients sick. Adults and children with diarrhea, especially those in diapers, may have an enteric pathogen ("stomach bug"). Contact precautions along with standard precautions are used for patients with suspected gastrointestinal infections and diarrhea. 

Reverse isolation, airborne precautions, and droplet precautions would not be effective in preventing the spread of an enteric pathogen because they do not prevent transmission by contact with surfaces and the patient's skin.

3.

You have entered the room to perform a venipuncture. Your patient's identification bracelet has incorrect information.

What should you do?

  • Do not proceed with venipuncture, notify the nurse.

  • Perform the venipuncture, then print a new identification band.

  • Verbally identify the patient by their stated name and date of birth, then perform venipuncture.

  • Perform the venipuncture, and keep the blood tubes in your pocket until you fix the identification information.

Correct answer: Do not proceed with venipuncture, notify the nurse.

Any healthcare setting has the potential to be very hectic and patients can move without staff members being consulted first, such as when a patient goes to imaging or the restroom. Whenever a patient sample is collected, the phlebotomist must make sure that the patient is wearing a patient identification bracelet and that the information on the patient identification bracelet is correct.

4.

A phlebotomist palpates a venipuncture site just after cleaning it with an alcohol-based solution provided by the healthcare facility. What is the next step the phlebotomist should take?

  • Clean the site again

  • Continue with venipuncture

  • Notify the nurse

  • Document the contact in the patient's chart

Correct answer: Clean the site again

Once the venipuncture site has been cleaned, nothing can touch it except for sterile materials, including the needle being used to puncture the patient's skin. If the phlebotomist is forced to palpate the site again, they must clean the site again using the appropriate technique.

5.

Phlebotomist Bob is verifying the identity of his patient before collecting a blood specimen in an outpatient lab. He asks the patient to state their full legal name and date of birth, which match the lab requisition forms. However, when Bob asks the patient to spell their name, he notices an error. 

What should Bob do next?

  • Change the patient's name in the LIS and print new labels before collection. 

  • Ask the patient to call their insurance when they get home to update their information. 

  • Collect the specimen and write the correct information on the labels and paperwork.

  • Cancel the patient's appointment and reschedule them after their information is updated.

Correct answer: Change the patient's name in the LIS and print new labels before collection. 

The phlebotomist must verify the accuracy of the patient's information and correctly identify the patient before collecting a specimen.

Any errors in the name or date of birth should be corrected in the Laboratory Information System (LIS) as soon as they are discovered. In the outpatient lab setting, the phlebotomist may be able to do this, or they may have a patient registration person who can make corrections/updates. 

If this situation occurs in an inpatient setting, the phlebotomist should notify the patient's nurse, and the unit secretary could likely contact patient registration and have the patient's record updated. Again, the phlebotomist would defer specimen collection until any errors were resolved.

6.

What is a test requisition?

  • A lab order

  • The minimum volume required to perform a test

  • A billing code

  • The office that the order originates from

Correct answer: A lab order

The test requisition, often referred to as a "test req" or "lab order," is a laboratory form used by healthcare providers to request (order) laboratory testing for their patients. 

Test requisitions are part of the patient's medical record and require specific information to ensure that the right patient is tested, the physician's orders are met, the correct tests are performed at the proper time under the right conditions, and the patient is billed properly. 

7.

How should the bevel of the needle be positioned when the phlebotomist inserts the needle into the patient's vein?

  • Facing up

  • Facing down

  • Facing the patient's body

  • Facing the phlebotomist's dominant side

Correct answer: Facing up

It is universal practice in the medical field that the bevel of the needle faces straight up when the phlebotomist inserts the needle into the patient's vein. The purpose of this is to ensure maximum blood flow and decrease the amount of pain the patient feels.

8.

Where should venipuncture be performed on a patient receiving IV therapy?

  • The opposite arm

  • As close to the IV site as possible

  • Wait until IV therapy is finished, then perform venipuncture for additional samples

  • Wait until IV therapy is finished, then collect samples from the IV site

Correct answer: The opposite arm

The opposite arm is the most appropriate location for venipuncture for a patient who is receiving IV therapy. By the time the blood reaches the opposite arm, it has already circulated through the body and organs, resulting in a more accurate sample.

Venipuncture should never be attempted on the same arm that IV fluids are running proximal to (above) the IV site because this will result in a flawed sample. If an appropriate venipuncture site cannot be found on the opposite arm, then the most appropriate response is to consult with the patient's nurse.

9.

What does "trough level" refer to?

  • The lowest level or amount of a substance in the blood

  • Blood levels when the patient is sleeping

  • The highest level of a drug in the blood

  • The maximum volume of blood that can be drawn in therapeutic phlebotomy

Correct answer: The lowest level or amount of a substance in the blood

Trough levels are monitored to ensure that levels of the drug stay within the therapeutic range. Trough-level specimens are easiest to collect because they are collected when the lowest serum concentration of the drug is expected, usually immediately before administration of the next scheduled dose.

10.

According to the American Society for Microbiology, laboratory detection of bacteremia or fungemia depends on two to four sets of blood cultures. What is the current recommendation for the number of blood culture bottles to collect in the case of a fever of unknown origin (FUO)?

  • Two or three sets of cultures from different sites, collected at the same time

  • One set of cultures from one site

  • Two or three sets of cultures from different sites, collected two to three hours apart

  • Four sets of cultures from one site, collected two to three hours apart

Correct answer: Two or three sets of cultures from different sites collected at one time

The recommendation for FUO is two or three sets of cultures, collected at once, one right after another from different sites. If these are negative after 24 to 48 hours, two more cultures from different sites are typically collected.

Other ASM recommendations are as follows:

  • For signs and symptoms of sepsis, collect two sets of blood cultures ASAP before starting antibiotics.
  • For critical situations when it is not reasonable to wait to start the antibiotics, collect two to three sets of cultures at the same time from different sites.
  • For suspected bacteremia or fungemia, when blood cultures are persistently negative, use an alternative media bottle (Myco/F Lytic media) to check for mycobacteria and fungi.

11.

Where would you expect to find policies and procedures related to exposure control and fire safety in the workplace?

  • Safety Manual

  • Infection Control Manual

  • Quality Assurance Manual

  • Medical Records

Correct answer: Safety Manual

The Laboratory Safety Manual should contain policies and procedures related to:

  • Chemical, electrical, fire, and radiation safety
  • Exposure control
  • Disaster plans
  • Handling hazardous materials

The Occupational Safety and Health Administration (OSHA) requires every business to have a workplace safety manual.

12.

When the phlebotomist explains the collection procedure to the patient and the patient agrees to the test, what kind of consent was collected?

  • Informed consent

  • Implied consent

  • Accepting consent

  • Applied consent

Correct answer: Informed consent

Consent can at times seem like a complex subject. However, all questions regarding consent can be answered by referring to the patient's rights.

Informed consent stems from the patient's right to be informed of their treatment and the patient's right to consent to or refuse treatment. By informing the patient of the venipuncture procedure and the patient consenting to that procedure, the phlebotomist has received informed consent.

Implied consent stems from a situation where the patient cannot give consent, such as when the patient is unconscious. In this case, if it is reasonable to assume that the patient would give consent to the treatment if they were conscious, implied consent is assumed.

13.

A phlebotomy technician is called from the laboratory to assist another healthcare provider on a post-surgical unit. The nurse needs a blood sample from a patient who is refusing to allow venipuncture. The elderly patient is "a hard stick." On arrival, the upset patient has four different puncture sites and Band-Aids on his left hand and arm. 

Which of the following is the best statement for the phlebotomist to make?

  • "I understand your frustration. I will do my best to make this easy for you."

  • "Please don't be upset with me sir; it is not my fault that you have been through this four times."

  • "Calm down, sir. If you try to relax, we can get this over quickly and painlessly."

  • "Who made all of these puncture marks? You really should not let them stick you more than twice."

Correct answer: "I understand your frustration. I will do my best to make this easy for you."

Effective communication is important in difficult situations or when patients are upset. "I understand" and "I'll try my best" are good responses because they validate the patient's feelings and convey that you are trying to help them. 

Responses such as "calm down," "it's not my fault," or telling a patient what they should have done differently can be perceived as confrontational and are not the best response to an upset patient.

14.

What is galactosemia?

  • An inherited condition in which babies do not have the enzyme needed to metabolize milk sugars

  • A genetic disorder that causes babies to make thick mucous that can obstruct the lungs and pancreas

  • A genetic condition in which babies have a defect in the enzyme that breaks down phenylalanine

  • An inherited condition characterized by insufficient levels of thyroid hormones

Correct answer: An inherited condition in which babies do not have the enzyme needed to metabolize milk sugars

Galactosemia testing is part of the Newborn Screening (NBS) state-mandated testing of newborns to identify rare but serious health conditions that can be present at birth, even though affected infants may not show signs right away.

Other conditions that are checked as part of the NBS include:

  • Cystic fibrosis: A genetic disorder that causes babies to make thick mucous that can obstruct the lungs and pancreas
  • Phenylketonuria: A genetic condition in which babies have a defect in the enzyme that breaks down phenylalanine
  • Hypothyroidism: An inherited condition characterized by insufficient levels of thyroid hormones

15.

When using the needle and syringe technique to collect a blood sample, how should a phlebotomist hold the syringe?

  • With their dominant hand

  • With their non-dominant hand

  • With their thumb and first finger only

  • With both hands

Correct answer: With their dominant hand

When using the needle and syringe technique, the phlebotomist should hold the syringe with their dominant hand and use the other hand to pull back the plunger. The reasoning here is that the phlebotomist can maintain correct positioning of the needle in the vein to ensure adequate blood flow and reduce the risk of hematoma.

16.

What is the definition of the term "vasoconstriction"?

  • The narrowing of the vessels that carry blood

  • The widening of the vessels that carry blood

  • Decreased cardiac output

  • Increased blood pressure

Correct answer: The narrowing of the vessels that carry blood

Vasoconstriction refers to the constriction of the vessels that carry blood which limits blood flow. Patients are not generally on medications that cause vasoconstriction; however, the phlebotomist might encounter vasoconstriction as a result of fear or anxiety in a patient.

17.

After the last tube is drawn from the venipuncture site, the phlebotomist should:

  • Activate the needle's safety feature after withdrawing it from the site

  • Leave the tourniquet on until the needle is withdrawn

  • Place gauze over the puncture site and apply pressure while sliding the needle out.

  • Have the patient fold their elbow back to hold pressure

Correct answer: Activate the needle's safety feature after withdrawing it from the site

After obtaining blood for collection tubes, the phlebotomist should withdraw the needle and activate the needle's safety feature. Failure to promptly engage the safety mechanism exposes you or the patient to a needlestick injury. After the needle device is discarded, then the phlebotomist can attend to the patient and the puncture site.

The tourniquet should be removed when the blood flow is established and certainly before removing the needle. Phlebotomists should avoid applying pressure while the needle is still under the skin because it can cause pain and bruising. Studies show that folding the arm back at the elbow also causes bruising by disrupting the platelet plug when the arm is lowered.

18.

The Joint Commission (TJC) sets standards for healthcare facilities. One of the TJC safety goals is improving accuracy of patient identification (ID). 

Which of the following does not meet the TJC standard for patient ID? 

  • Using patient room number and name posted on the door placard

  • Using an electronic ID, such as a bar code reader

  • Using a patient's hospital band for ID

  • Matching the patient's spoken name to the requisition

Correct answer: Using patient room number and name posted on the door placard

A patient's room number is not considered a patient identifier and cannot be used to identify a patient. According to TJC, bar code readers, patient ID bands, and a patient's spoken name can all be used to identify patients.

19.

What is the amount of blood needed to accurately perform a blood culture test for an adult patient?

  • 8-10 mL per bottle

  • 2-4 mL per bottle

  • 6-8 mL per bottle

  • 1-2 mL per bottle

Correct answer: 8-10 mL per bottle

Much like blood tubes, the additives in blood culture bottles require a very specific amount of blood to produce the results needed. In 10 mL of blood, it is very possible that only one or two microorganisms are present, so the full amount, 8-10 mL, is needed. For adults, the recommended volume of blood is 20-30 mL per blood culture set.

20.

Which of the following is the correct sequence for routine Evacuated Tube System (ETS) venipuncture?

  • Inspect the needle, ask the patient to make a fist, anchor the vein, insert the needle

  • Inspect the needle, anchor the vein, insert the needle, ask the patient to make a fist

  • Anchor the vein, insert the needle, ask the patient to make a fist, inspect the needle

  • Inspect the needle, insert the needle, anchor the vein, ask the patient to make a fist

Correct answer: Inspect the needle, ask the patient to make a fist, anchor the vein, insert the needle

The needle should be visually inspected before use, so that should be done before proceeding to the next steps. The patient should make a fist next to stimulate blood flow to the chosen site before venipuncture. However, making a fist after the needlestick could cause a hematoma. 

The vein should also be anchored before needle insertion to firmly secure it and prevent any movement when trying to pierce the vein.

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