EXAM SIMULATOR

Question 1

The space within the blood vessel where the blood flows is called:

• Tunica media
• Tunica intima
• Lumen
• Tunica adventitia.

Answer 1

Lumen

The lumen is the space within the blood vessel where the blood flows.
The walls of arteries and veins consist of 3 layers. They include:
* Tunica adventitia - composed of connective tissue is the outer layer of the blood vessel wall
* Tunica media - middle layer made up of smooth muscle and elastic tissue
* Tunica intima - the inner layer made up of endothelial cells

Question 2

Tunica adventitia

Answer 2

• composed of connective tissue is the outer layer of the blood vessel wall

Question 3

Tunica media

Answer 3

• middle layer made up of smooth muscle and elastic tissue

Question 4

Tunica intima

Answer 4

• the inner layer made up of endothelial cells

Question 5

What can happen to the sample if a phlebotomist fails to notice the collection tube used is expired when drawing blood for testing?

• The tube may overfill.
• The tube may leak.
• The blood may break.
• The tube may underfill.

Answer 5

The tube may underfill.

The vacuum of a tube is reliable only until the expiration date, therefore the tube may underfill. Certain tests, such as coagulation tests, will be affected. Even if the tube fills completely, the integrity of the sample may be compromised because the additive may not properly function.

The tube will not leak as long as the tube stopper is not removed.

The physical integrity of the tube is not the reason for assigning an expiration date to a blood collection tube.

Question 6

All of the following are examples of efforts taken to maintain sample integrity during transportation to the laboratory EXCEPT:

• Control shipping temperature.
• Protect from direct exposure to light.
• Minimize the transport time.
• Tubes kept in horizontal (flat) position while being taken to the lab.

Answer 6

Tubes kept in horizontal (flat) position while being taken to the lab.

Efforts to preserve the analytes of interest in a sample include minimizing the transport time, ensuring a controlled temperature that is ideal for the intended measurands, and shielding samples from direct exposure to light. Best practices in transporting specimens to the lab include keeping tubes in a vertical, upright position to avoid hemolysis.

Question 7

Hemolysis may be caused by all of the following EXCEPT:

• Applying vigorous suction when drawing blood into a syringe.
• Inverting a blood tube too vigorously (shaking) when mixing anticoagulant with blood to prevent clotting.
• Forcefully expelling blood from a syringe into a collection tube.
• Failing to invert the blood tube after collecting to mix it with anticoagulant.

Answer 7

Failing to invert the blood tube after collecting to mix it with anticoagulant.

Hemolysis DOES NOT occur due to failure to invert the blood tube after collecting to mix it with the anticoagulant. When an anticoagulated blood tube is not properly inverted when collected, pre-analytical clotting is the typical result.
Hemolysis commonly occurs when: vigorous suction is applied when drawing blood into a syringe, inverting a blood tube too vigorously (shaking) when mixing anticoagulant with blood, or forcefully expelling blood from a syringe into a collection tube.

Question 8

A body in “Prone Position” is referred to as?

• Lying face down on his/her stomach.
• Lying on the left or right side of the body
• As an erect body, standing position with arms at rest and palms forward.
• Lying or reclining body, face up on his/her back.

Answer 8

Lying face down on his/her stomach.

“Prone Position” is referred to as lying face down on his/her stomach.
“Lateral Recumbent Position” is referred to as lying on the left or right side of the body.
“Normal Anatomic Position” is referred to as an erect body, standing position with arms at rest and palms forward.
“Supine Position” is referred to as a lying or reclining body, face up on his/her back.

Question 9

What is the end of the needle that attaches to the syringe or tube holder called?

• Lumen
• Bevel
• Shaft
• Hub

Answer 9

Hub

The hub is the end of the needle that attaches to the syringe or tube holder.
The lumen is the inside portion of the needle tube.
The slanted tip of the phlebotomy needle is called the bevel. It is cut on a slant in order to aid in the piercing of the skin and penetrate the vein with ease.
The shaft is the tube body of the needle.

Question 10

Which of the following statements is TRUE regarding “protected health information”
(PHI)?

• PHI includes a patient’s past, present, and future physical or mental health conditions.
• PHI only includes information that is transmitted on paper or electronically; it does not include oral information.
• A patient’s past physical or mental health conditions are not considered PHI.
• A patient’s mental health condition is not considered PHI.

Answer 10

PHI includes a patient’s past, present, and future physical or mental health conditions.

PHI includes information that is transmitted in any form (orally, on paper, or electronically). It includes a patient’s past, present, and future physical or mental health conditions.

Question 11

What is structure H from the figure below?

• Descending aorta
• Inferior vena cava
• Superior vena cava
• Aorta

Answer 11

Descending aorta

Structure His the descending aorta which transports oxygenated blood to the lower trunk and lower extremities.

Question 12

All of the following anticoagulants will produce a significant effect on calcium levels in plasma, EXCEPT?

• EDTA
• Heparin
• Oxalates
• Citrates

Answer 12

Heparin

EDTA, Oxalates, and Citrates prevent coagulation by removing calcium from the blood, while heparin prevents coagulation by forming a complex with antithrombin Ill and stops the coagulation - cascade.

Question 13

What is capillary blood composed of?

• Venous blood, arterial blood, pericardial fluid, and pleural fluid
• Arterial blood, venous blood, interstitial fluid, and intracellular fluid
• Interstitial fluid, Intracellular fluid, venous blood, arterial blood, and peritoneal fluid
• Intracellular fluid, pleural fluid, pericardial fluid, venous blood, and arterial blood

Answer 13

Capillary blood is a mixture of venous and arterial blood, interstitial fluid, and intracellular fluid.

Pericardial fluid is the fluid that fills the cavity which surrounds the heart.

Pleural fluid is the fluid that fills the pleural cavity which surrounds the lungs.

Peritoneal fluid is the fluid that fills the abdominal cavity.

Question 14

An electrolyte panel is composed of which of the following tests?

• Sodium, potassium, glucose, chloride
• Potassium, glucose,
  chloride, albumin
• Sodium, potassium, chloride, CO2
• Chloride, cholesterol, chloride, glucose

Answer 14

Sodium, potassium, chloride, CO2

Electrolytes are essential for the normal function of nerve, muscles, and heart activities.

An electrolyte panel is composed of sodium, potassium, chloride, and CO2*

Glucose is a carbohydrate, albumin is a protein, and cholesterol is a lipid.

Question 15

When collecting a urine specimen for workplace drug testing, which of the following situations may indicate that the specimen has been tampered with or adulterated?

• The temperature of the specimen reads 34 °C.
• The specific gravity test result is 1.001.
• The color of the specimen is amber.
• The specific gravity test result is 1.020

Answer 15

The specific gravity test result is 1.001.

A specific gravity result of less than 1.003 is an indication of dilution of the specimen with water.

Normal urine specific gravity results should fall between 1.003 and 1.025.

The normal temperature of a freshly collected urine specimen ranges between 32° to 38° C or 90° to 100°F.

An amber color specimen is not an unusual finding if the specific gravity and temperature are withing normal ranges.

Question 16

From the white blood cell values listed below, which is within the normal reference ranges?

• 2,700/mm’
• 3,800/mm3
• 5,500/mm3
• 15,000/mm3

Answer 16

5,500/mm3

An approximate reference range for white blood cells is between 4,500-11,000/mm3.

From the above values, only 5,500/mm3 is within the normal reference range.

Question 17

What could be a cause
for the incomplete formation of a gel barrier between cells and serum in a gel separator tube?

• A swing-bucket type centrifuge is used
• The blood in the tube is allowed to clot before centrifugation
• Blood is centrifuged 5 minutes longer than the recommended time
• An expired test tube

Answer 17

An expired test tube

If the test tube is expired, there is no longer a manufacturer’s guarantee that the vacuum of the tube, the additive, or the gel separator is still able to perform as expected. The expiration date on the tube should be inspected before using it.

Using a swing-bucket centrifuge and allowing the blood in the tube to clot are recommended procedures for the proper formation of the gel barrier.

Allowing the tube to centrifuge 5 minutes longer than the recommended time will not prevent the formation of a complete gel barrier, it will actually enhance it.

Question 18

What type of anticoagulant is generally suitable for TDM analysis?

• Heparin
• EDTA
• Citrate
• Oxalate

Answer 18

Heparin

When considering therapeutic drug monitoring (TDM), heparinized plasma is generally suitable for most drug analyses.

Calcium-binding anticoagulants add various anions and cations that may interfere with analysis or cause a drug to distribute differently between cells and plasma. As a result, specimen tubes that contain ethylenediaminetetraacetic acid (EDTA), citrate, or oxalate are generally considered unacceptable specimen types for TDM. Furthermore, some drugs tend to be absorbed into the gel of certain separator collection tubes, which is why it is important to follow the manufacturer’s recommendations.

Question 19

You are collecting a blood specimen to be used for forensic (legal) alcohol testing. Which of the following must be done before you can start the specimen collection process?

• Label the tubes in the presence of the patient.
• Must inform the patient that the blood about to be collected is for alcohol testing.
• Seal the collection tubes in front of the patient.
• Collect the specimen, the patient does not need to be informed what the blood is collected for.

Answer 19

Must inform the patient that the blood about to be collected is for alcohol testing.

Before starting the blood collection process, the patient must be informed that the specimen collected will be tested for blood alcohol.

Labeling the blood tubes and sealing them in front of the patient is done after collection is complete.

Question 20

The following statements about the urine specimen are true EXCEPT:


• The urine specimen should be tested within two hours of collection if the specimen is stored at room temperature.
• The urine specimen should be at room temperature before testing.

• The urine specimen should always be centrifuged before performing the chemical reagent strip testing.

• The urine specimen must be well-mixed before performing the chemical reagent strip testing.

Answer 20

The urine specimen should always be centrifuged before performing the chemical reagent strip testing.

The intended answer is, “The urine specimen should always be centrifuged before
performing the dipstick testing.” Unfortunately, this is not the case. Urine specimens are not to be centrifuged before chemical reagent strip analysis.

The urine specimen should be tested within two hours of collection if the specimen is stored at room temperature. It should be at room temperature and be well-mixed before performing the chemical reagent strip testing.

Question 21

Which of the following veins is the first choice for venipuncture?

• Median cubital vein
• Cephalic vein
• Basilic vein
• Any of the listed veins can be accessed for venipuncture, there is no specific choice order.

Answer 21

Median cubital vein

The median cubital vein is the first choice for venipuncture because is usually larger and closer to the surface of the skin. It is also better anchored and more stable than the other two.

The cephalic vein is the second choice for venipuncture. It is typically harder to palpate than the median cubital vein and is located close to the lateral cutaneous nerve.

The basilic vein is not as well anchored as the cephalic and median cubital veins and tends to roll easily. This can cause an accidental puncture of the median nerve or the brachial artery. The basilic vein is the last choice to use due to its proximity to the median nerve and the brachial artery.

Question 22

All of the following will interfere with blood test results, EXCEPT?
The correct answer is highlighted below

• Hemolysis
• Icterus
• Lipemia
• Tube gel barrier

Answer 22

Tube gel barrier

The gel barrier found in some tubes is an inert substance meant to separate plasma from the cellular components of blood and does not interfere with test results. The most commonly encountered interfering components of the sample itself that may cause erroneous analysis are hemolysis, lipemia, icterus, and viscosity.