Which of the following laboratory departments performs a CBC and ESR?
Correct Answer: C
CBC and ESR testing are performed in the hematology department. A complete blood count evaluates formed elements of blood, including red blood cells, white blood cells, hemoglobin, hematocrit, platelet count, and sometimes differential cell counts. ESR, or erythrocyte sedimentation rate, is also a hematology procedure because it measures the rate at which red blood cells settle in anticoagulated blood over a defined time. Chemistry handles serum or plasma analytes such as glucose, electrolytes, enzymes, renal markers, liver markers, and metabolic panels. Serology focuses on immune reactions, antibodies, antigens, and infectious or immunologic testing. Microbiology deals with organisms, cultures, stains, and susceptibility testing. Knowing laboratory departments helps the phlebotomist route specimens correctly, answer workflow questions accurately, and understand tube selection and specimen handling requirements. For CBC and ESR, anticoagulated whole blood is typically required, commonly collected in lavender-top EDTA tubes depending on the laboratory's procedure. NHA CPT competencies include laboratory departments, blood components, specimen processing, specimen transport, and communication of laboratory information. Reference topics: Processing Specimens; hematology department; CBC; ESR; specimen routing.
Question 12
Which of the following should a phlebotomist do if a specimen must remain warm during transport?
Correct Answer: B
If a specimen must remain warm during transport, the phlebotomist should use an approved warming device according to facility policy. Some tests, such as cold agglutinin-related specimens or specific specialized assays, may require warm handling to prevent analyte or cellular changes. Placing the specimen on ice or refrigerating it would violate warm-transport requirements and could compromise results. Leaving it near a sunny window is uncontrolled, unsafe, and may expose the specimen to light or excessive heat. Temperature requirements must be controlled and documented when required. The phlebotomist should not improvise with unapproved heat sources because overheating can also damage specimens. Proper specimen handling means knowing whether the specimen should be transported at room temperature, chilled, frozen, protected from light, or kept warm. Failure to follow special handling instructions creates preanalytical error and may require recollection. Reference topics: Processing Specimens; warm specimens; transport requirements; temperature control; specimen integrity.
Question 13
Which of the following complications can a phlebotomist cause by underfilling a gray-topped tube?
Correct Answer: D
Underfilling a gray-topped tube can contribute to hemolysis and specimen rejection because the blood-to-additive ratio becomes incorrect. Gray-top tubes commonly contain sodium fluoride and potassium oxalate. When the tube is underfilled, the additive concentration becomes excessive relative to the blood volume, which can damage cells and interfere with specimen integrity. Hemolysis means red blood cells rupture, releasing intracellular contents into the serum or plasma and potentially altering test results. Iatrogenic anemia is caused by excessive or repeated blood removal from a patient, not by underfilling one additive tube. "Homeostasis" is the body's general maintenance of internal stability and is not a phlebotomy complication in this context; the clinically relevant term would be hemostasis. Thrombocytosis means an elevated platelet count and is not caused by underfilling a gray-top tube. The technical lesson is blunt: additive tubes must be filled to the required volume and mixed gently by inversion. Reference topics: Processing Specimens; preanalytical error; tube fill requirements; additive ratio; hemolysis.
Question 14
Which of the following practices violates standard precautions?
Correct Answer: D
Reusing a tourniquet visibly contaminated with blood violates standard precautions. Any reusable equipment contaminated with blood must be cleaned and disinfected according to facility policy, and single-use items must be discarded. Blood is treated as potentially infectious regardless of the patient's diagnosis or appearance. Wearing gloves during venipuncture is correct practice. Treating all blood as potentially infectious is the core principle of standard precautions. Washing hands after glove removal is also required because gloves can have microscopic defects or hands can become contaminated during removal. A contaminated tourniquet can transfer bloodborne pathogens or other organisms to patients, staff, and surfaces. Phlebotomists should inspect equipment before use, avoid placing supplies on contaminated surfaces, use disposable tourniquets when required, and disinfect reusable items appropriately. Infection-control failures often occur through routine shortcuts, not dramatic emergencies. This question tests whether the technician understands standard precautions as everyday behavior, not just PPE vocabulary. Reference topics: Safety and Compliance; standard precautions; reusable equipment; blood contamination; infection prevention.
Question 15
Which of the following is the purpose of applying a tourniquet for venipuncture?
Correct Answer: B
The purpose of applying a tourniquet is to enlarge veins. A properly applied tourniquet partially restricts venous return while arterial flow continues briefly, causing the selected vein to become more prominent, easier to palpate, and easier to access. This improves site selection and helps establish blood flow into the collection device. The tourniquet must not be applied too tightly or left on too long because prolonged stasis can cause hemoconcentration, discomfort, petechiae, or altered laboratory values. "To solidify veins" is incorrect because veins do not become solid; they become distended. "To shrink veins" is the opposite of the intended effect. "To roll veins" is also incorrect; rolling veins are a collection problem controlled by proper anchoring, not an intended effect of tourniquet use. The phlebotomist should apply the tourniquet above the intended site, palpate appropriately, remove it within accepted time limits, and release it before needle withdrawal. NHA CPT routine collection content includes standard tourniquet application and removal procedures, palpation, site selection, anchoring, and procedural steps for removing the tourniquet, tubes, and needle. Reference topics: Routine Blood Collections; tourniquet application; vein palpation; venipuncture preparation.
