1. During a venipuncture, the needle is in the vein and blood flow is established. When the second tube is attached, blood flow stops. Which of the following actions should the phlebotomist take?
A. Withdraw the bevel of the needle completely.
B. Rotate the bevel of the needle. Correct
C. Increase tourniquet pressure.
D. Activate a new evacuated tube.
Explanation
Rotating the bevel of the needle is the appropriate initial action to reestablish blood flow. This slight adjustment can dislodge any minor obstruction or reposition the needle tip within the vein without fully withdrawing it, which risks losing venous access or causing traumIncreasing tourniquet pressure is not recommended as it can cause vein collapse or hemoconcentration; activating a new tube assumes the issue is with the tube, not the needle position; and complete withdrawal defeats the purpose of maintaining the venipuncture site.
2. In which of the following locations should a phlebotomist directly dispose of a contaminated microscope slide?
A. Specimen bag
B. Biohazard bag
C. Red sharps container Correct
D. Medical waste container
Explanation
A contaminated glass microscope slide must be disposed of directly in a red sharps container because glass slides are considered sharps hazards due to their potential to break and cause percutaneous injuries. This container is specifically designed for biohazardous sharps to prevent needlestick-like injuries and cross-contamination. Specimen bags or medical waste containers are unsuitable for sharps, as they do not provide puncture-resistant protection, and while biohazard bags handle soft waste, they are not appropriate for rigid, sharp items like slides.
3. When performing a blood smear, which of the following actions should a phlebotomist take to ensure a quality result?
A. Hold the two slides at 90° to each other when performing the smear.
B. Allow the blood drop to clot slightly prior to performing the smear.
C. Hold the slides at 30° to each other when performing the smear. Correct
D. Allow the blood drop to clot completely prior to performing the smear.
Explanation
Holding the slides at a 30° angle to each other during the smear creates an optimal wedge-shaped spread that ensures an even distribution of red blood cells in a monolayer, which is essential for accurate microscopic evaluation of cell morphology. A 90° angle would produce a thick, uneven smear; allowing clotting (even slightly) prevents proper spreading and fixation; complete clotting would make the sample unusable for smear preparation.
4. A phlebotomist is instructing a patient who has a suspected UTI about urine sample collection. The phlebotomist should instruct the patient to
A. Collect the sample in a clean container.
B. Collect the sample midstream. Correct
C. Collect a first-morning specimen.
D. Collect a 24-hr urine sample.
Explanation
For suspected urinary tract infection (UTI), a midstream clean-catch urine sample is the gold standard to reduce contamination from urethral or external flora, allowing for accurate culture and sensitivity testing. While a clean container is necessary, it alone does not address contamination; first-morning specimens are better for certain tests like protein but not ideal for UTI due to overnight bacterial buildup; 24-hour collections are used for quantitative analyses like creatinine clearance, not UTI diagnosis.
5. Which of the following means of receiving an order for specimen collection is considered to be the most accurate method?
A. Multipart requisition
B. Manual requisition
C. Automated requisition Correct
D. Verbal requisition
Explanation
Automated requisitions, typically generated through electronic health records (EHR) systems, minimize transcription errors, ensure real-time updates, and integrate patient identification with test orders, making them the most accurate method per standards like those from CLSI and CAP. Multipart or manual requisitions are prone to handwriting errors or mismatches; verbal orders carry high risk of miscommunication and require documentation verification.