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Quiz Session - Attempts With Random Questions

NHA CPT Exam Questions

Page 7 of 50

121.

A phlebotomist has had a difficult time with a patient who has a timed order for peak drug level. First, he didn't have the correct supplies. Next, he had trouble finding an adequate site for venipuncture. Then, the patient became sick and started vomiting. The phlebotomist went to get the nurse and helped her clean the patient. Finally, he was able to draw a blood specimen for the peak drug level. However, he did not note what time the sample was taken. He decides to label the specimen using the time that the test was ordered. He does not indicate that the sample was collected late. 

Which of the following is most likely to happen in this scenario?

  • The pharmacist could miscalculate the patient's next dose, and the blood level could exceed toxic levels.

  • The pharmacist could miscalculate the patient's next dose, and the blood level could drop below a therapeutic level.

  • The pharmacist could decide to discontinue the therapeutic drug monitoring.

  • The pharmacist could decide to discontinue the medication. 

Correct answer: The pharmacist could miscalculate the patient's next dose, and the blood level could exceed toxic levels.

When a patient is taking a high-risk medication that needs therapeutic drug monitoring (TDM), the phlebotomist must record an exact collection time. If the phlebotomist took the sample late, the drug's blood level had time to decrease. The test results would indicate a falsely lower result. This incorrect lower level may influence the pharmacist's calculations for the following dosage. If the pharmacist adjusted based on the lower level, the following dose might raise the medication level to a dangerous level for the patient.

Collection timing is most critical for aminoglycoside drugs, such as amikacin, gentamicin, and tobramycin. 

In this scenario, it is unlikely that the pharmacist would decide to stop the medication or stop monitoring drug levels. Additionally, the doctor would be the one to discontinue medication. 

122.

Which set of diagnosis and billing codes is based on medical conditions, symptoms, or body systems?

  • ICD

  • CPT

  • PPS

  • FFS

Correct answer: ICD

The International Classification of Diseases (ICD) codes specify medical conditions, symptoms, and body systems for medical diagnosis and billing.  

The Current Procedural Terminology (CPT) codes are used to describe medical procedures, such as tests and surgeries, when billing insurance companies. 

The Prospective Payment System (PPS) was implemented in 1983 to limit and standardize the Medicare and Medicaid payments made to hospitals. 

The Fee for Service (FFS) system is a payment model of reimbursement for healthcare providers by a third-party payer, such as insurance. 

123.

During a routine blood draw, when is it safe and appropriate for the phlebotomist to remove their exam gloves?

  • After disposing of contaminated materials and trash

  • After the tubes are transported to the lab

  • Before labeling the tubes

  • Before bandaging the venipuncture site

Correct answer: After disposing of contaminated materials and trash

The phlebotomist must follow the proper procedure to ensure safety at each step. After successful blood collection, the steps are:

  1. Withdraw the needle, activate safety features, and apply gauze and pressure to the site.
  2.  Discard blood collection equipment.
  3. Transfer blood if a syringe system is used, then dispose of the syringe equipment. 
  4. Label and prepare all tubes for transport.
  5. Check the patient's arm or venipuncture site. If the bleeding has stopped, apply a bandage. 
  6. Dispose of any other used materials (such as bloody gauze).
  7. Thank the patient, remove gloves, and sanitize your hands. 
  8. Transport specimens to the lab. 

In this process, gloves are removed after disposing of contaminated materials. If you remove gloves before then, you risk contact exposure to blood. 

You shouldn't wear gloves until after transport since this could mean traveling with the patient's germs or blood on your gloves and spreading them. 

124.

Which of the following is not considered a step in the process of entering an order into the Laboratory Information System (LIS)?

  • Venipuncture

  • Modify

  • Approve

  • Cancel

Correct answer: Venipuncture

The LIS is the lab's computer software system that is used to record, process, manage, and store data about the tests that are completed. Venipuncture is not an action performed in the Laboratory Information System (LIS).

The other options, including modifying, approving, and canceling, are all actions that can be completed in the lab's computer system.

125.

Terry, a phlebotomist, finishes drawing blood from Ms. Wilson and applies pressure to the puncture site. He notices a small amount of bruising starting to form beneath the skin.

What should Terry do to manage this situation effectively?

  • Continue to apply pressure and observe the site for another 5–10 seconds before bandaging

  • Apply ice to the area immediately

  • Advise Ms. Wilson to take pain medication if the bruising worsens

  • Apply a tight bandage to reduce arterial flow to the site

Correct answer: Continue to apply pressure and observe the site for another 5–10 seconds before bandaging

Terry should continue to apply pressure and observe the site to ensure the bleeding has stopped and to minimize the risk of further bruising before applying a bandage. Applying direct pressure will help stop bleeding from the hole in the vein wall and allow the site to form a clot.

Ice and pain medication are not indicated in this situation. Also, Terry should be cautious about applying a bandage that is too tight. He should not apply the bandage until the bleeding stops, and should never apply one that would cut off blood flow. 

126.

Which of the following is not a major factor in preparing a quality film on a blood smear slide?

  • How long the slide is allowed to dry

  • How fast the spreader slide is moved

  • The angle at which the pusher slide is held 

  • The pressure applied on the slides

Correct answer: How long the slide is allowed to dry

Blood smear slides should be allowed to air-dry naturally. The length of time the slide takes to dry should not affect the slide's quality.

The quality of the blood smear is, however, affected by speed, angle, pressure, and the drop size used to prepare the blood smear slide.

127.

When explaining the venipuncture procedure to a patient:

  • The phlebotomist should speak to a non-responsive patient as if they were alert.

  • The phlebotomist should not talk to a non-responsive or comatose patient.

  • The phlebotomist should communicate through touch, rather than verbally, for unresponsive patients.

  • The phlebotomist should explain the venipuncture procedure using medical jargon.

Correct answer: The phlebotomist should speak to a non-responsive patient as if they were alert.

Even if the patient is non-responsive, it is best to continue to explain the procedure as if the patient were alert.

Comatose patients often hear, but they are unable to respond. Explaining what is being done often prevents the patient from moving when blood is drawn. It also conveys respect and compassion to the patient.

128.

Which of the following sets of specimen tubes is typically collected for synovial fluid analysis?

  • An EDTA tube, a sterile tube for C&S, and a non-additive tube

  • An EDTA tube, a coagulation tube, and a sterile tube for C&S

  • A heparin tube, an oxalate tube, a sterile tube for C&S, and a non-additive tube

  • A heparin tube, a coagulation tube, and a non-additive tube

Correct answer: An EDTA tube, a sterile tube for C&S, and a non-additive tube

Synovial fluid analysis may be performed to diagnose joint disorders and other inflammatory conditions. It is typically collected in 3 tubes:

  •  An EDTA or heparin tube for cell counts, identification of crystals, and smear preparation
  • A sterile tube for C&S
  • A nonadditive tube for macroscopic appearance, chemistry, and immunology tests and to observe clot formation

129.

Why is the first drop of blood drawn in a capillary puncture wiped away?

  • To remove surface contaminants and interstitial fluids

  • To increase the flow of blood

  • To slow the flow of blood

  • To ensure only venous blood is flowing

Correct answer: To remove surface contaminants and interstitial fluids

It is general practice to wipe away the first drop of blood when performing a capillary puncture to ensure the removal of surface contaminants and because the first drop contains interstitial fluid that may alter the test results.

130.

Removing more than what percentage of an infant's blood volume at one time can lead to cardiac arrest? 

  • 10%

  • 20%

  • 3%

  • 25%

Correct answer: 10%

Removing more than 10% of an infant's blood volume at once can cause cardiac arrest or shock. 

Most facilities do not allow more than 3% of blood volume to be withdrawn at one time or 10% in one month.

131.

What is a typical length of time a patient is asked to fast before a blood test?

  • 8–12 hours

  • 1 hour

  • 14–18 hours

  • 30 minutes

Correct answer: 8–12 hours

Fasting samples are generally taken 8 to 12 hours after a patient last ate or drank and are often obtained early in the morning. Both black coffee and smoking affect metabolism and therefore affect fasting samples.

132.

What is the best temperature needed to maintain a sputum sample?

  • Room temperature

  • 5 degrees Celsius (41 F)

  • 72 degrees Fahrenheit (22.2 C)

  • 0 degrees Fahrenheit (-17.7 C)

Correct answer: Room temperature

Sputum comes from the lungs, which generally inhale air at room temperature, so it is acceptable to store sputum at room temperature. Standard precautions must be maintained, however.

133.

When approaching a room with a "DNAR" sign, the phlebotomist knows which of the following is true about this patient?

  • Refuses life-saving treatment

  • Lost their newborn during childbirth

  • Is a high fall risk

  • Is unable to consent to treatment

Correct answer: Refuses life-saving treatment

DNAR stands for do not attempt resuscitation. In the hospital setting, it is sometimes referred to as a "no-code order" because it means that the patient does not want any attempt made to revive them if they go into cardiac or respiratory arrest (i.e., "code").

134.

To prepare a routine peripheral blood smear, what angle should the pusher or spreader slide be held at?

  • 30 to 45 degrees

  • 10 to 20 degrees

  • 45 to 60 degrees

  • 90 degrees

Correct answer: 30 to 45 degrees

For a routine blood smear, it is recommended to hold the second slide to move the blood drop at 30 to 45 degrees. 

The angle at which the spreader or pusher slide is held during preparation will vary the results of the blood smear. An angle greater than 45 degrees makes the smear thicker. An angle less than 45 degrees makes the smear thinner.

135.

Performing external liquid Quality Control (QC) checks on waived tests should be done at which of the following time points?

  • After questionable test results

  • Before every patient test

  • At the beginning of every shift

  • After a facility power outage

Correct answer: After questionable test results

Quality Control (QC) checks should be performed according to facility policy and manufacturers' instructions. Most facilities require external QC testing:

  • If the results are questionable
  • Upon receipt of new kits
  • With each new testing personnel

QC checks before every test are unnecessary and can waste control solution. Internal QC checks identify problems without using an external solution, and therefore, it would also be wasteful to perform an external solution test when the device detects the problem with the specimen.

136.

To avoid causing iatrogenic anemia, a facility limits the amount of blood that can be drawn in a single draw to 2.5% of the patient's total blood volume. A phlebotomist has orders to obtain the following tests on a 2.2-lb preterm infant:

  • Complete Blood Count (CBC) test requiring 0.5 mL volume in one lavender microtainer tube
  • Comprehensive Metabolic Panel (CMP) test requiring 0.8 mL in a light green, red, or gold Microtainer tube — needs two Microtainer tubes
  • C-Reactive Protein (CRP) test requiring 0.4 mL in one light green, red, or gold Microtainer tube

Assuming preterm infant blood volume of 100 mL / 1 kg of body weight, which of the following is true regarding this patient?

  • All of these tests can be safely drawn. The ordered tests meet the maximum volume allowed in one draw.

  • Not all of these tests can be safely drawn. The CBC and the CRP can be drawn now, but the CMP should be deferred.

  • All of these tests can be safely drawn. The ordered tests are below the maximum volume allowed in one draw.

  • Not all of these tests can be safely drawn. The CBC and the CMP can be drawn now, but the CRP should be deferred.

Correct answer: All of these tests can be safely drawn. The ordered tests meet the maximum volume allowed in one draw.

A 2.2-lb preterm infant weighs 1 kg (0.454 kg = 1 lb), so the total blood volume is 100 mL.

If the limit for each blood draw is 2.5% of the total blood volume, the limit for this patient would be 2.5 mL per blood draw.

The ordered tests require 0.5 mL (CBC) + 0.8 mL (CMP) + 0.8 mL (CMP) + 0.4 ml (CRP) = 2.5 mL. 

137.

Which of the following is not considered a warning sign of a stroke?

  • Gastrointestinal upset

  • Facial drooping

  • Speech difficulty

  • Arm weakness

Correct answer: Gastrointestinal upset

A stroke occurs when oxygen is cut off to a part of the brain. It often affects movement in the body and may affect speech. Fast treatment is critical to preventing long-term disability or death. Outcomes are best when the patient receives treatment within 3 hours of symptom onset. 

To remember the signs of stroke, memorize the acronym FAST.  

  • F - facial drooping
  • A - arm weakness
  • S - speech difficulty
  • T - time to call 911

138.

What is hyperinsulinemia?

  • Overproduction of insulin by the body

  • Underproduction of insulin by the body

  • An autoimmune response to insulin

  • An allergic reaction to injected insulin

Correct answer: Overproduction of insulin by the body

Hyperinsulinemia is a condition in which the body overproduces insulin, which can cause dangerously low levels of blood glucose (hypoglycemia). Phlebotomists will often see blood glucose levels below 70 mg/dL.

139.

Which of the following best describes the bevel of a needle?

  • The angled, pointy tip of the needle at the end of the shaft

  • The long, hollow portion of the needle between the tip and the hilt

  • The opening of the needle

  • The part of the needle that screws onto a syringe, an evacuated tube, or IV tubing

Correct answer: The angled, pointy tip of the needle at the end of the shaft

The bevel of the needle is the part of the needle that pierces the skin.

It is connected to the needle shaft, which is the hollow length of the needle. For children and elderly people, you may need to use a shorter shaft. Similarly, bariatric individuals may require a longer shaft.

140.

From the following test requests, which one should take priority?

  • STAT order from the emergency department

  • ASAP order from a surgical unit

  • STAT order from a pediatric unit

  • STAT order from a pediatric surgical clinic

Correct answer: STAT order from the emergency department

STAT requests take priority over all other orders, both in an inpatient setting (hospital lab) and an outpatient setting. In addition, emergency department STAT orders take priority over inpatient STAT orders since these patients may be of a more critical or emergent nature. Likewise, inpatient STAT orders take priority over outpatient STAT orders if both are being run in the same lab since hospitalized patients are more critical than outpatients. 

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