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Phlebotomy Practice Tes Flashcards

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USMLE® Step 1 flashcards
1
Q

When an infection is spread through droplet, the tech should don

A. Gloves
B. Gloves, mask/ face shield
C. Gloves. Gown, Mask/face shield
D. Gloves, gown, N95, Eye Protection

A

C. Gloves. Gown, Mask/face shield

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2
Q

Physician office labs are often accredited by

A. CLIA
B. COLA
C. CAP
D. Joint Commision

A

A.CLIA
Clinicial Laboratory Improvement Amendemnts

COLA: Commission on Laboratory Accreditation is an independent accreditor that meets CLIA and OSHA requirements

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3
Q

When a specimen requires immediate chilling, the appropriate procedure is to

A. Place the specimen on cubes on ice
B. Place the specimen in a mixture of ice and water
C. Place the specimen in the refrigerator
D. Place the specimen on dry ice

A

Place the specimen in a mixture of ice and water

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4
Q

Considering the order of draw, which collections tube/bottle should be filled first?

A. Light blue - capped
B. Green
C. Red and Black
D. Blood Culture

A

D. Blood Culture

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5
Q

When taking collection tubes with blood specimens from an isolation room, the specimens should be

A. Sealed in a leaked proof bag
B. Covered with sterile draps
C. Placed in a labeled paper bag
D. Transported as usually

A

A.

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6
Q

When using micro-collection tubes for a finger stick, the collection tube should be filled first is

A. Gray
B. Lavender
C. Green
D. Yellow

A

B

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7
Q

In the US, all Lab testing, expect for research is regulated by

A. CMS
B. FDA
C. CAP
D. OSHA

A

A

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8
Q

If a vein collapses during a blood draw, the initial action should be to

A. Rotate the needle
B. Insert the needle further into the vein
C. Apply pressure above the venipuncture site
D. Slightly withdrawn the needle

A

C.

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9
Q

The lab test that is most affected by hemolysis is

A. TP
B. Ca
C. acid phosphatase
D. K

A

D

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10
Q

If a physician has order venipuncture for blood, C&S, CBC, BMP for an adult, what is the correct order of the draw?

A. C&S, CBC, BMP
B. C&S, BMP, CBC
C. CBC, BMP, C&S
D. CBC, C&S, BMP

A

A.

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11
Q

Which of the following is permitted in the lab?

A. Eating food
B. Applying makeup
C. Using the telephone
D. Changing contact lenses

A

C

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12
Q

Mouth pipetting of a blood sample is

A. Used for skin punctures only
B. Optional
C. Reserved for pathologist only
D. Prohibited

A

D.

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13
Q

If the phelb drops an unused glass collection tube, causing it to break and scatter pieces of glass, the phleb shoud

A. clean up the glass with wet paper towel
B. Ask the nursing staff to clean up the glass
C. Guard the area and notify housekeeping
D. Notify a supervisor

A

C

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14
Q

If the lab institutes policy and procedural changes, the phleb should expect to

A. be consulted
B. Received a salary increased
C. Receive appropriate training
D. Evaluate the procedures

A

C

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15
Q

A phleb who wear contact lenses should

A. Avoid wearing them in the lab
B. Wear only hard lens
C. Wear only soft lens
D. Wear protective googles in the labs

A

D

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16
Q

An indication that a localized infection has progressed to septicemia is

A. Chills and fever
B. Erythema
C. Localized edema
D. Bradycardia

A

A

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17
Q

Lab. accreditation agencies generally require that labs follow the standards of the

A. CMS
B. CLSI
C. CAP
D. FDA

A

B

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18
Q

Which of the following should NOT results in a lawsuit for negligence?

A. Doing a fingerstick on a 6 mos old infant
B. Providing information about a test a child’s mother
C. Misidentifying a patient
D. Lowering a bedrail and leaving it down

A

B

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19
Q

Which of the following information does NOT have to be provided as part of informed consent?

A. Methods
B. Risks
C. Benefits
D. Cost of testing

A

D

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20
Q

STAT blood tests are often performed on plasma rather than serum because

A. Serum requires longer processing time
B. Plasma provides better accuracy
C. Plasma collection is easier
D. Plasma less are less expensive.

A

A

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21
Q

A Patient with an order for blood test has a clapped PICC line in the left arm so the Phleb should draw from the

A. Right arm
B. Left arm, distal to the PICC Line
C. Left arm, proximal to the PICC line
D. PICC Line

A

A

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22
Q

In the most state, the qualifications of phleb are determined by

A. State licensing requirement
B. Accreditation agencies
C. Employers
D. CLSI

A

C

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23
Q

Which of the following panels of tests may provided the best information about a patient with suspected liver dysfunction?

A. BMP
B. CMP
C. Lipid Profile
D. Electrolyte panel

A

B

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24
Q

The primary function of RBC is to

A. Transport o2 and CO2
B. Fight infection
C. Aid in blood clotting
D. Prevent blood clotting

A

A

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25
Q

Lipid profile may be completed on

A. Whole blood
B. Serum only
C. Plasma only
D. Serum or plasma

A

D

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26
Q

After a specimen of blood is removed from the body, the min time it will take to clot is about

A. 5 min
B. 10 min
C. 20 Min
D. 30 Mins

A

D

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27
Q

The greatest risk when a tube breaks during centrifugation is

A. Aerosolization of sample
B. Laceration/ Puncture wound
C. Equipment damage
D. Electric Shock

A

A

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28
Q

Which of the following tests/panel is NOT part of dementia screening?

A. HIV Antibody test
B. Kidney function panel
C. Thyroid Function Panel
D. Liver function panel

A

D

Liver test are done to try differentiate Alzheimer disease from dementia related disorder.

HIV can cause changes in thinking or memory either as a direct result of the infection or due to “opportunistic infections” that occur because HIV has weakened the body’s immune system

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29
Q

If a hospital lab is accredited by CAP, how freq. is the accreditation reviewed?

A. Annually
B. Every 2 years
C. Every 3 years
D. Every 4 years

A

B

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30
Q

Is plasma is needed for a chemistry test, the blood may collected in a tube containing ____

A. Sodium Heparin
B. Sodium fluoride
C. Na2EDTA
D. Clot Activator

A

A

if plasma is needed for a chemistry test, the blood my be collected in a tube containing lithium heparin (green or gray capped) or sodium heparin (green capped)

both are require 8 inversions after collection

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31
Q

Which of the following is NOT part of the WBC count and differential?

A. Neutrophils
B. Basophils
C. Monocytes
D. Thrombocytes

A

D.

Total WBC count : 4,300-10,800 cells/ mm3
Neutrophils: 54% to 62%
Lymphocytes: 24% - 44%
Monocytes: 3% - 6%
Basophils: 0% - 1%

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32
Q

The most effective means of reducing the risk of infection during venipuncture is

A. Skin antisepsis
B. Disinfection of environmental surface
C. Handwashing
D. Rapid processing

A

C

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33
Q

Following venipuncture with excessive bleeding, a saturated bloodstained gauze should be placed a

A. Paper bag
B. Hazardous waster container
C. Bedside wastebasket
D. Sharps container

A

B

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34
Q

Which of the following is NOT a part of the renal system?

A. Adrenal glands
B. Kidneys
C. Bladder
D. Ureters

A

A

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35
Q

A blood specimen for a CBC should be collected in a tube that contains

A. No additive
B. ACD
C. Na2EDTA
D. Clot Activator

A

C

Na2EDTA ( an anticoagulant)
lavender topped

CBC includes Hgb ( Hemoglobin)
Hct ( Hematocrit)
RBC
RBC indices
WBC and differential
Platelet count

36
Q

Which of the following WBC counts is within the normal range of values?

A. 4,000 cells/ mm3
B. 8,000 cells/mm3
C. 11,000 cells/mm3
D. 20,000 cells/mm3

A

b

Normal range is 4,300-10,800 cells/mm3

WBC vary with age and some diurnal variation occurs with the lowest level in the morning and the highest level in the afternoon.

Severe stress or physical excretion may result in a transient increase in WBC by 2,000 - 5,000 cells/mm3.
The WBC is reported as an absolute number and the differentials as both absolute numbers and percentages.

37
Q

The myocardial infarction panel does NOT include

A. Troponin
B. Myoglobin
C. CK-MB
D. Creatinine

A

D. Creatinine is not part of the panel

Troponin test is only test specific to cardiac muscle.

Levels increase w/in 3-4 hours of an MI and stay elevated for 10-14 days.

Myoglobin begins to increase w/in 2-3 hours for an MI, peaking w/in 8-12 hours and returns back to normal w/in 24 hours. This is not specific to the heart muscles this is also in the skeletal muscle.

(CK-MB) Creatinine kinase isoenzyme MB increases within 3-4 hours, peaking at 18-24 hours and returning to normal within 72 hours.

38
Q

A blood sample in a gray-capped evacuated collection tube should be inverted a min of

A. 5 times
B. 6 times
C. 8 times
D. 12 times

A

C.

39
Q

A viral infection may be result in increased

A. Neutrophils
B. Lymphocytes
C. Monocytes
D. Thrombocytes

A

B.

Lymphocytes is part of WBC

Comprise 24%-44% in adults.

Bacterial infection often results in decreased lymphocytes but increase neutrophils.

40
Q

An electrolyte panel includes

A. CO2, CI, K, NA
B. CO2, CI, CA, K
C. CI, K, Na, PO4
D. CO2, PO4, NA, K

A

CO2, CI, K, NA

CO2 - Carbon dioxide
CI - chloride
K - potassium
NA - sodium

Test can be done with either plasma or serum.

With:
Red topped
Tiger topped
Green topped

41
Q

Which of the following evacuated collection tubes should NOT be used to collect a specimen for BMP?

A. Red topped with clot activator
B. Red/Black SST
C. Lavender
D. Green

A

C.

Lavender contains anticoagulant ( Na2EDTA)

42
Q

The primary reason that specimens are rejected in the lab is because

A. Breakage
B. Overfilling
C. Incorrect Additive
D. Hemolysis

A

D. Hemolysis

Occurs:
*when from an area distal to the antecubital
*Wrong needle size
*alcohol on the skin has not dried and contaminates the specimen
*venipuncture technique is poor
*Syringe is used to withdraw blood
*tourniquet is left in place for longer than one minute.

43
Q

To aliquot a specimen means to

A. Divide the specimen into portions
B. Dilute a specimen
C. Concentrate a specimen
D. Centrifugate the specimen

A

A.

Aliquot means the divide the specimen in smaller portions.

44
Q

If asked to transport a urine specimen to the lab, the phleb should realize the longest the specimen can be stored at room temperature is

A. 30 mins
B. 1 hr
C. 1.5 hr
D. 2 hr

A

D.

If a specimen will not be processed w/in 60 mins thne it may be transferred into UA tube containing preservative.

If specimen is unpreserved and processing will be delayed beyond 2 hours, then the specimen must be protected from exposure to light and can be refrigerated for up to 24 hours.

45
Q

If 3 tubes, each containing 2 mL of CSF, are collected, which tube should be used for C&S?

A. First
B. Second
C. Third
D. Order doesn’t matter

A

B

CSF ( cerebrospinal fluid)

*The first tube is Chemistry & immunological, but may be contaminated with bacteria found on the skin
*The second tube is C+S; should not contaminated with skin bacteria.
*Third tube is used for cellular examination.

46
Q

The type of fluid that is collected with a thoracentesis is

A. Peritoneal
B. Pericardial
C. Pleural
D. Synovial

A

C.

Fluid from the pleural cavity that surrounds the lungs.

Synovial - Arthrocentesis joint
Peritoneal - paracentesis ( abd cavity)
Placenta -

47
Q

A patient hospitalized for chemotherapy for renal cancer would most likely be treated in which department?

A. Oncology
B. Hematology
C. Endocrinology
D. Cardiology

A

A.

48
Q

Which of the following may violate the chain of custody for a forensic specimen?

A. Signing the chain of custody form
B. Asking a nurse to temporarily stored the specimen
C. Placing the specimen in the transfer bag
D. Documenting the patient’s identification

A

B.

49
Q

Blood draws from a GTT are usually done at

A. 30 mins, 1 hour, 2 hour, 4 hours
B. 30 mins, 60 mins, 90 mins, 2 hours
C. 2 hour, 4 hours, 6 hours, 8 hours
D. 1 hour, 2 hour, 3 hours

A

D.

Prior to beginning the timed portion of the test, FBS ( fasting blood sugar) is done to ensure that the level is within a safe range.

If so, glucose is drunk within 5 mins and the timed period of the test begins.

NPO during testing period.

50
Q

Using a foot vein for a blood draw….

A. Is prohibited
B. Posed no increased risks
C. increases risk of blood clots
D. Is Negligent

A

C.

Due to circulation is often impaired in the legs and feet, esp. in older and/or diabetic patients.

Increased of ulceration of the site.

To be drawn with physicians order

51
Q

If a patient has severely impaired circulation in the legs and has had a recent bilateral mastectomy, the best choice for a blood draw is probably….

A. Foot or ankle veins
B. Artery
C. Dominant Arm
D. Nondominant Arm

A

B.

*This is outside the scope of a phlebotomist.

52
Q

The organization that develops and publishes the National Patient Safety Goals is …

A. The Joint Commission
B. COLA
C. CAP
D. CLIA

A

A.

53
Q

If the patient is very thin with prominent viens that require a low needle angle for venipuncture, the best choice is….

A. 21 gauge needle with tube holder
B. Winged infusion set with syringe
C. 21 gauge needle with syringe
D. 23 gauge needle with syringe

A

B.

Butterfly needle.

54
Q

If protocol for blood C&S requires skin antisepsis with alcohol (isopropyl 70%) followed by tincture of iodine (2%), but the patient is allergic to iodine, an acceptable alternate procedure is….

A. Wash with soap and water and cleanse once with alcohol
B. Cleanse twice with alcohol
C. Cleanse 3 times with alcohol
D. Wash with soap and water and cleanse twice with alcohol.

A

D.

*Must allow the skin to dry after each cleansing.

55
Q

If a patient complains of feeling faint and appears suddenly pale and shaky during a venipuncture, the initial response should be to …

A. Complete blood draw
B. Call for help
C. Remove needle
D. Tell patient to place head between legs

A

C.

If not removed during a syncope episode, can cause trauma.

Patient needs to recuperate before another attempted

56
Q

The maximum volume of blood that may be drawn from a 20 lbs infant in an 8 week period ….

A. 20 mL
B. 60 mL
C. 100 mL
D. 140 mL

A

b.

CLSI regulations recommend no more than 10% of total blood volume to be drawn from a pediatric patient over an 8 week period.

Using the 65-75 mL/kg conversion recommended by CLSI,

20lbs x (1kg/2.2lbs) = 9.1 kg

9.1kg x 65 mL/kg = 592mL; 9.1kg x 70 mL/kg=637mL

so the allowable amount of blood to be drawn in this timeframe is 59-64mL.

57
Q

Handwritten patient ID labels are often used instead of preprinted labels for …

A. Blood bank testing
B. Cost saving
C. Genetic testing
D. C&S

A

A.

Due to high risks of having a transfusion reaction if a person gets the wrong blood types.

58
Q

For the patient receiving warfarin ( Coumadin), the INR is usually maintained at…

A. 0.5-1.0
B. 1-2
C. 2-3
D. 3-4

A

C.

59
Q

Which of the following is NOT an example of a preanalytical error?

A. Incorrect patient ID on printed lab results
B. Blood drawn from an edematous arm
C. Incorrect additive in specimen
D. Tourniquet left in place for 3 mins

A

A.

PRE-analytical error is before testing
POST-analytical error is after testing

60
Q

Which of the following is NOT usually required on a computer-generated requisition for a blood test?

A. Patient’s name and birthdate
B. Patient allergies/sensitivities
C. Test status (Specific guideline)
D. Patient address

A

D.

ID - Patient name/ DOB
Relevant allergies/sensitivities - example latex sensitivity
Test status - guidelines for testing example Fasting

61
Q

The primary purpose of therapeutic drug monitoring ( TDM) is to…

A. Identify optimal dosing
B. Determine abuse of drug
C. Wean patient off of drugs
D. Prevent adverse effects

A

A.

Testing is done when the medications peaks

1-2 hours after oral
1 hour after IM
30 mins after IV

Testing is also done at the trough ( lowest) level which is usually 15 mins prior to the next scheduled dose.

62
Q

A specimen for bilirubin test should be..

A. Processed within 15 mins
B. Maintained by body temperature
C. Protected by light
D. Chilled immediately

A

C.

Light may cause the substances that are to tested to deteriorate.
Tubes can be wrapped in aluminum foil or placed in a special canister that blocks light.

Other test that require light protection:

Vitamin A
Vitamin B6
beta-carotene
porphyrins

63
Q

The artery that carries the blood directly from the heart to other vessels and parts of the body is the..

A. Carotid
B. Vena cava
C. lliac
D. Aorta

A

D.

64
Q

If the needle hits the median nerve during an antecubital venipuncture, the most common patient complaints is …

A. Numbness
B. Dull aching pain
C. Muscle twitching
D. Severe shocking-like pain

A

D.

If this occurs, the initial response should be to immediately remove the needle and apply pressure because continuing the venipuncture may result in permanent damage to the nerve.
Usually resolved within hours

if the Nerve is damage the patient may develop permanent pain and weakness including complex regional pain syndrome

65
Q

Which the following procedures is NOT used to help visualize superficial veins?

A. Tap the vein
B. Apply warm, moist compress
C. Raise the arm
D. Massage ( distal to proximal)

A

C.

the arm should be lowered as this helps to fill the vein.

66
Q

Which of the following equipment is NOT part of that needed for routine venipuncture?

A. Cotton balls
B. Gauze sponges
C. Tube holders
D. Needles

A

A.

No longer used as small particles of lint may adhere to the skin and injected with the venipuncture.

67
Q

If a physician has order 4 different blood test for a patient, the first thins that the phleb should consider is..

A. the time needed for venipuncture
B. The order of draw
C. The needle size
D. The equipment needed

A

B.

68
Q

When the collecting a blood specimen from a 2 month old infant, the primary interactions will be between the phleb and the…

A. Infant
B. Nurse
C. Parent
D. Physician

A

C.

69
Q

If the blood must be drawn from 3 year old child, the phleb should…

A. Ask the parent to wait outside the room
B. Explain the procedure the parent only
C. Ask the nurse to hold the child
D. Explain the procedure to the child

A

D.

70
Q

A standard blood specimen should be transported…

A. In a biohazard bag at room temp.
B. In a clear bag on ice
C. In a biohazard bag once
D. In a sterile container that is puncture proof.

A

A.

Standard blood specimens do not require chilling on transport and should be transported in a biohazard bag at room temp.

71
Q

If a venipuncture is required from an elderly patient with obvious tremors of the upper extremities, the best solution is to …

A. Ask the patient to keep the arm still
B. Ask a nurse to assist in stabilizing the arm
C. Use an ankle or foot vein
D. Refuse to do the venipuncture

A

B.

72
Q

Which of the following governmental agencies requires the use of needleless blood transfer devices?

A. CMS
B. FDA
C. CDC
D. OSHA

A

D.

Part of OSHA’s bloodborne Pathogen Standard.

73
Q

If a person is donating blood at a blood bank, the maximum volume of blood that the person can donate at one time is…

A. 200 mL
B. 250 mL
C. 500 mL
D. 650 mL

A

C.

Requirements include:

Age 17 or older
Weight: 110 lb or more

Should bring a list pf medications to ensure medications do not preclude donation of blood such as isotretinoin ( Accutane)
Antibiotics
metronidazole (Flagyl)
anticoagulants
Time from last donation.

74
Q

The organ that lies in the RUQ of the abdomen, superior to the intestines , is the …

A. Liver
B. Stomach
C. Pancreas
D. Kidney

A

A. Liver

RUQ
above the intestines
*liver
*gallbladder

RLQ
*appendix
*intestines

LUQ
*Stomach spleen
*pancreas

LLQ
*Intestines

75
Q

A preservative used in the laboratory is categorized as which type of hazard?

A. Biologic
B. Chemical
C. Physical
D. Explosive

A

B

76
Q

Which type of fire extinguisher can be used to put out an electrical fire?

A. Type A (water)
B. Type B (foam)
C. Type D (dry metal power)
D. Type ABC (ammonium phosphate)

A

D.

Electrical fire is considered type C.

Type A - ordinary combustible
B. Type B - flammable liquid
C. Type D - combustible metals.

77
Q

Phleb are most likely to develop sensitivity to latex because..

A. Exposure to latex tourniquets
B. Wearing latex gloves
C. Cross-reactivity to food allergies
D. Exposure to latex-capped collection tubes

A

B.

78
Q

The HIV test is an example of which type of laboratory test?

A. Immunologic
B. Chemical
C. Microbiologic
D. Coagulation

A

A.

Immunologic - testing of antibodies and antigens to detect a response to disease Such as HIV, HBV

Chemical - Testing for biochemical factor in blood. Such as BMP, CMP, FBS

Microbiologic- Testing of blood samples to identify pathogenic agents such as C&S

Coagulation - Testing of blood clotting mechanisms of the blood for both diagnostic purpose and to monitor anticoagulation therapy. Such as PT, PTT, INR, Fibrinogen

79
Q

According to the American Hospital Association’s The Patient Care Partnership, patients do NOT have the right to expect …

A. Clean, safe environment
B. Privacy protection
C. Cost-effective care
D. Involvement in care

A

C.

Rights included:

High-quality care: knowing names and qualifications of caregivers

Clean and safe environment: freedom from error, abuse, and neglect

Privacy protection: notice of privacy practices and HIPPA

Involvement in care: discussions of medical condition, treatment options, treatment plan and decision making

Discharge planning: IDing community resources and coordination of care

Assistance with billing claims: filing claims

80
Q

If, after filling a collection, the phleb notes blood on the outside of the collection tube, the correct action is to …

A. Discard the specimen in a biohazard waste container
B. Wipe tube with disinfectant and seal in a biohazard bag
C. Discard the specimen in a sharp container
D. Transport to lab in glove hand

A

B.

81
Q

Bandages are usually avoided in children younger than 2 years because..

A. They are not needed
B. Toddles often have a latex allergies
C. They may cause contact dermatitis
D. They pose a choking hazard

A

D.

The tech should maintain pressure on a puncture or venipuncture sites, elevating the extremity for 2-3 mins, and checking the make sure the bleeding has stopped.

( Children should be conducted in heel)

82
Q

Which equipment poses the greatest risk of transfer of bacteria in a hospital?

A. Floors
B. Bedside
C. Bedrails
D. Door handles

A

C

frequently used by both patient and healthcare provider w/o routinely disinfected.

*C-Diff survive 5 mos on inanimate surfaces
*Hepatitis B survives 1 week
*Flu survives 8 hours.

83
Q

The highest normal value for hemoglobin is usually found in a(n)…

A. Neonate
B. Child (6 years)
C. Adult male
D. Adult female

A

A.

Neonate highest level 1 week after birth.

Highest normal values:
*Neonate (15.3-23.6g/dL)
*Adult male (12.6-17.4 g/dL)
*6 year (10.9-145 d/dL)
*Adult female (11.7-16.1d/dL)

84
Q

PEP after needlestick injury is available for…

A. HIV and HCV
B. HIV and HBV
C. HBV and HVC
D. HIV only

A

B

PEP (postexposure prophylaxis)

For accidently needlestick, person should immediately wash the area with soap and water and notify supervisor and seek medical care in ER for from an appropriate healthcare provider.

85
Q

Blood is supplied to the myocardium (heart muscle) by the…

A. Aorta
B. Vena cava
C. Coronary arteries
D. Coronary veins

A

C.

Medical Assistant (8 decks)

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