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Quiz Session - Attempts With Random Questions

NHA CPT Exam Questions

Page 10 of 50

181.

How long after a tube's expiration date may the tube be used for sampling?

  • Nothing may be used after its expiration date

  • One day

  • One week

  • 30 days

Correct answer: Nothing may be used after its expiration date

Expiration dates are calculated based on the material the device is made out of, the additives inside the device, and the effects of temperature and light that will surround the device. Because of this, expiration dates are very firm and do not allow for leeway.

182.

What type of reaction would you expect to see when administering a purified protein derivative (PPD) test to a person who has been exposed to tuberculosis?

  • Induration

  • Anaphylaxis

  • Shortness of breath

  • Blurry vision

Correct answer: Induration

Recall that induration is a hard, red bump that indicates lymphocytes have rushed to the PPD injection site. Induration at the injection site may mean a positive result. However, it does not mean that there is an active infection. More testing is required following a positive PPD test.

Anaphylaxis is a severe allergic reaction that affects the entire body. Though it is rare, it is possible that a person could have an anaphylactic reaction to a PPD test, but it is not an expected reaction. Shortness of breath and blurred vision could be signs of anaphylaxis, and are rare and unexpected reactions to a PPD test.

183.

What is the primary law that governs patient privacy in the United States?

  • The Health Insurance Portability and Accountability Act (HIPAA)

  • The False Claims Act

  • Stark Law

  • The Clinical Laboratory and Improvement Act (CLIA)

Correct answer: The Health Insurance Portability and Accountability Act (HIPAA)

The Health Insurance Portability and Accountability Act (HIPAA) is the premier piece of legislation guarding privacy information in the healthcare industry. The phlebotomist will not always have patient information due to HIPAA, but will be required to keep all patient interactions within the health care team private.

184.

When should a catheter be used to collect a urine sample from a patient?

  • When the patient is having trouble voiding

  • When the patient needs a reliable drug test for court

  • When the patient is sleeping

  • When the patient refuses to give a urine sample

Correct answer: When the patient is having trouble voiding

Catheters are an effective way to retrieve urine samples from patients who cannot voluntarily give a urine sample. Do not confuse this with a patient who refuses to give a urine sample; a patient must always give consent. Unconscious patients are also good candidates for catheters, and babies are sometimes catheterized for specimens. Placing a catheter should be avoided whenever possible as catheterization can introduce bacteria, resulting in infection.

185.

During a procedure in the laboratory, Mark gets blood on the sleeve of his lab coat. He is unaware of this contamination. At lunchtime, he touches the dried blood spot when he removes his lab coat and heads to lunch. He doesn't wash his hands before eating. 

What type of biohazard exposure could Mark encounter in this scenario?

  • Ingestion exposure

  • Percutaneous exposure

  • Permucosal exposure

  • Inhalation exposure

Correct answer: Ingestion exposure

Since his hands could have been affected by the blood splatter on his sleeve, Mark risks consuming bloodborne pathogens from his skin if he touches his mouth or eats without washing his hands. Ingestion exposure happens when contaminated materials come into contact with the mouth or are mistakenly consumed.

  • Percutaneous exposure: exposure through punctures, cuts, or needle sticks in the skin
  • Permucosal exposure: exposure through mucous membranes of the mouth, nose, and eyes
  • Inhalation exposure: inhalation of airborne particles or droplets containing infectious microorganisms
  • Ingestion exposure: eating contaminated substances, such as food or liquids, leading to exposure through the gastrointestinal system

186.

What is an advantage of using the direct-draw collection bottle or the butterfly collection system for blood cultures?

  • They eliminate the hazard of inoculating bottles with a syringe.

  • They reduce the amount of oxygen injected into the anaerobic bottles.

  • They are less painful for neonates.

  • They are less expensive.

Correct answer: They eliminate the hazard of inoculating bottles with a syringe.

The traditional syringe method of blood culture collection requires the phlebotomist to draw blood into the barrel of a syringe and then inoculate the culture bottle(s). There is some risk of puncturing oneself with this method. 

Using a direct-draw method or butterfly collection system allows the phlebotomist to draw the blood directly into the bottle(s) instead.

187.

Certified phlebotomist Jocelyn is performing a venipuncture on Mr. Clark. She has anchored the vein and lined up the needle. As she slides the needle into the skin, she feels a noticeable decrease in resistance. 

What should Jocelyn do next?

  • Stop advancing the needle and anchor the holder

  • Remove the needle immediately

  • Continue advancing the needle approximately 5 mm

  • Ask the patient to relax

Correct answer: Stop advancing the needle and anchor the holder

When Jocelyn feels a decrease in resistance, she has likely advanced the needle into the vein. Next, she should stop advancing the needle and press her fingers against the arm to anchor the holder. Then, she can insert the tube into the holder to establish blood flow. 

188.

You have an order to collect a urine specimen from a patient who was admitted to the hospital this morning. You arrive at the patient's room and learn that the patient had a urinary catheter inserted approximately one hour ago. 

What should you do next?

  • Notify the nurse

  • Collect urine from the drainage bag

  • Collect urine from the sampling port

  • Leave the specimen cup for the patient

Correct answer: Notify the nurse

A urinary catheter is a sterile, hollow, flexible tube that is inserted into the urethral opening into the bladder to collect and drain urine. If a urine specimen is ordered on a patient who has a catheter, you should notify the patient's nurse so that they can collect the specimen for you by aspirating a sterile specimen from the designated port in the catheter system. Catheter ("cath") specimens are collected by nurses and other trained medical personnel, and it is outside the scope of practice for a phlebotomist. 

You should not collect urine from the catheter drainage bag because it may be contaminated.

189.

During a venipuncture procedure, what sensation or feeling lets you know that you have punctured the vessel wall and have inserted the bevel into the vein?

  • Decreased resistance

  • Increased resistance

  • Slight vibration

  • Inability to advance forward

Correct answer: Decreased resistance

When the needle enters the vein, you will feel a slight "give" or decrease in resistance. Some phlebotomists describe this as a "pop," although it is more of a feeling than a sound. 

It is especially important to recognize this decreased resistance when using an ETS needle and tube holder because some needles do not provide visual confirmation that the vein has been entered. 

190.

Juan is a mobile phlebotomist. Juan has drawn 3 tubes of blood for a routine order, which he now places inside a transport cooler. 

Where should Juan place the transport box before heading back to the lab?

  • On the floor behind the driver's seat

  • In the passenger's seat

  • On the floor of the passenger's side

  • On the seat behind the driver

Correct answer: On the floor behind the driver's seat

The transport box should be placed on the floor of the vehicle behind the driver's seat, where it has no direct exposure to the sun or air vents. If this is not possible, it must be held in place on the back seat with a seat belt. Special care should be taken to protect specimens from the effects of extreme heat or cold. 

191.

To collect a specimen for human leukocyte antigen phenotyping to evaluate transplant compatibility, what color tube should you draw?

  • Yellow

  • Blue

  • Green

  • Red

Correct answer: Yellow

Yellow top acid citrate dextrose (ACD) tubes are used for immunohematology tests such as DNA testing and human leukocyte antigen (HLA) phenotyping. These are used for determining transplant compatibility and in paternity evaluations. 

The acid citrate prevents coagulation by binding to calcium with little effect on cells and platelets. 

ACD tubes require 8 inversions immediately after collection to prevent clotting. 

192.

Phlebotomy technician Tom just completed a blood draw on Mr. Mitchell. Mr. Mitchell mentions to Tom that his doctor told him to be careful since he is on blood thinners. Tom shows him how to apply pressure at the puncture site. 

Which of these actions would Tom demonstrate for Mr. Mitchell to avoid complications?

  • Extend the arm and apply pressure for 3–5 minutes.

  • Fold the arm at the elbow to apply pressure for 3–5 minutes.

  • Lower the arm below heart level and immediately apply a bandage.

  • Fold the arm and check the puncture site every 30–60 seconds. 

Correct answer: Extend the arm and apply pressure for 3–5 minutes.

Keeping the arm extended and applying pressure for 3–5 minutes is critical, especially for patients on blood thinners. This will allow the puncture site in the vein to clot so that blood does not escape. As a result, the patient will be less prone to excessive bleeding or bruising. 

Studies show that folding the arm back at the elbow to fold pressure or keep gauze in place after a blood draw increases the chance of bruising by keeping the wound open or disrupting the platelet plug when the arm is lowered.

193.

To calculate the blood volume of an adult, which equation should you use?

  • 1 kilogram of body weight = 70 milliliters of blood volume

  • 1 pound = 7 milliliters of blood volume

  • 10 kilograms of body weight = 7 liters of blood volume 

  • 10 pounds of body weight = 7.1 liters of blood volume 

Correct answer: 1 kilogram of body weight = 70 milliliters of blood volume

Calculating total blood volume may be necessary for certain patients at risk of iatrogenic anemia. Actual blood volume is based on weight and is calculated using the equation of 1 kilogram of body weight = 70 milliliters of blood volume.

194.

Which of the following is used by the laboratory to connect specimens to the right patients?

  • Accession number

  • MR number

  • Hospital ID number

  • Patient account number

Correct answer: Accession number

The accession number is different from the patient identification number, medical record number, and healthcare facility identification number assigned to the patient at admission. The accession number is assigned by the lab when an order is received. 

This unique accession number is then used by the lab to identify the specimen and all associated processes and paperwork and tie them to the patient. This process of accessioning the test request ensures prompt and accurate reporting from the time the order is received by the lab until the time final results are reported. 

  • Medical record (MR) numbers assign health records to individual patients.
  • Hospital ID numbers are assigned by hospitals to individual patients. 
  • Patient account numbers are used to bill for services. 

195.

When preparing to collect a capillary sample from an 8-month-old baby, the phlebotomist should assess which site first?

  • Medial or lateral heel

  • Plantar surface of the great toe

  • End segment of the middle finger on the non-dominant hand

  • End segment of the fifth finger on either hand

Correct answer: Medial or lateral heel

According to the Clinical and Laboratory Standards Institute, to avoid puncturing the bone, the safest areas for heel puncture are the most medial and lateral portions of the plantar surface of the heel. The safe areas of the heel are defined as the area medial to an imaginary line extending from the middle of the great toe to the heel, and from the space between the fourth and fifth toes to the heel. Punctures within these imaginary borders decrease the risk of bone, nerve, tendon, and cartilage injury. 

Fingersticks are not recommended for children under 1 year of age. Fingersticks on the fifth finger should be avoided due to bone depth at this site.

196.

According to the current (2022) CLSI blood culture guidelines, when using a needle and syringe to collect blood for blood cultures, which blood collection bottle should be inoculated first?

  • The aerobic bottle should be filled first.

  • The anaerobic bottle should be filled first.

  • It doesn't matter which is filled first.

  • Both bottles must be drawn from different sites on the body.

Correct answer: The aerobic bottle should be filled first.

There are many different types of microorganisms. However, all of them either require air for metabolism or do not.

The current (2022) CLSI blood culture guideline recommends filling the aerobic bottle first, instead of the anaerobic one, because sometimes it is difficult to obtain 8-10 mL of blood per bottle, and the aerobic one is most critical. CLSI reasons that aerobic and faculative bacteria cause the most cases of bacteremia, and almost all yeast recoveries are from aerobic bottles. Always check your facility's policy.

197.

As a technician in the laboratory, you are ready to centrifuge a blood sample to extract serum for examination. Unfortunately, you forgot to balance the centrifuge carriers. 

Which of the following is an expected result of such a mistake?

  • It will lead to inaccurate test results.

  • The centrifuge will spin faster.

  • It will prevent hemolysis.

  • The specimen will be processed more quickly.

Correct answer: It will lead to inaccurate test results.

For accurate centrifugation, it is critical to balance the tubes in the rotor to ensure even weight distribution. Failure to do so could result in:

  • Uneven spinning
  • Inaccurate separation of serum or plasma from blood cells
  • Altered test results
  • Broken tubes
  • Spillage inside the centrifuge

If the centrifuge shakes, vibrates excessively, or is noisier than usual when turned on, it could be unbalanced and should be stopped immediately.

198.

Phlebotomist Jared is preparing to label Mrs. Lee's tubes. He is using pre-printed labels with a barcode on them.

What is the best practice for placing a barcoded label on a specimen tube?

  • Orient the label with the barcode parallel to the tube

  • Wrap the label around the tube multiple times

  • Put the label in his pocket and attach it later

  • Wrap the label around the stopper

Correct answer: Orient the label with the barcode parallel to the tube

Attaching the barcoded label lengthwise, parallel to the label and perpendicular to the stopper, ensures that the scanner will be able to read the label. 

Proper label placement, especially those with barcodes, is essential to ensuring that specimens can be scanned by the analyzer. This also helps avoid processing errors. 

199.

A common technique for tourniquet application is to bring the band around the arm, cross the ends, and then tuck one end into a loop under the tourniquet band. 

What is the purpose of the loop?

  • It lets the phlebotomist release the tourniquet quickly.

  • It secures the ends so they do not contaminate the site.

  • It allows the phlebotomist to adjust the tension in the band.

  • It keeps the tourniquet from slipping off.

Correct answer: It lets the phlebotomist release the tourniquet quickly.

The loop allows the tourniquet to be released quickly by a slight tug on the end of the tourniquet that forms it. 

A properly tied tourniquet has the ends pointing toward the shoulder. The tourniquet ends should not hang or dangle over the venipuncture site because they could contaminate the skin after you clean it. 

200.

What is true regarding the collection of CSF tubes?

  • CSF is generally collected in 3-4 special sterile screw-top tubes.

  • CSF is generally collected in 2 special sterile screw-top tubes.

  • CSF is generally collected in a single special sterile screw-top tube.

  • CSF is generally collected in a special sterile cup with a snap-on lid.

Correct answer: CSF is generally collected in 3-4 special sterile screw-top tubes.

For CSF collection, 3–4 tubes are used, and they are numbered in order of collection. 

Normally, the tubes are used as follows:

  • The first tube is used for chemistry and immunology tests.
  • The second tube is used for microbiology studies.
  • The third tube is used for cell count and differential since it is least likely to be contaminated with blood cells introduced during the procedure.
  •  If a fourth tube is collected, it is typically used for cytology, for other special tests, or as an extra tube.

Most tests require a minimum of 1 mL of fresh fluid. Laboratory protocol dictates which tests are performed on which tube, unless the physician indicates otherwise. 

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