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A phlebotomist is performing a venipuncture on a patient who is allergic to alcohol. Which of the following is an appropriate antiseptic to use in place of the alcohol?
Detailed Rationale
Chlorhexidine gluconate (2% solution) is the recommended alcohol alternative for skin antisepsis in venipuncture, providing broad-spectrum antimicrobial activity with low allergy risk (CDC and CLSI GP41). Sterile water/saline lack germicidal properties; antiseptic foam is not standard for venipuncture.
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Which of the following specimens has a phlebotomist appropriately prepared for transport?
Detailed Rationale
Ammonia in green-top (heparin) tubes requires immediate chilling in an icy water mixture to slow enzymatic degradation and ensure sample stability during transport (CLSI C34-A3). Red-top needs 30 min clotting; serum from lavender-top risks contamination; bilirubin requires opaque protection, not clear bags.
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A non-blood specimen that is delivered to the laboratory should have which of the following information included?
Detailed Rationale
For non-blood specimens like urine or sputum, the source (e.g., midstream urine, expectorated sputum) is critical for accurate interpretation and processing per CLSI guidelines (GP41), as it informs contamination risks and test validity. Color, temperature, and clarity are assessed upon receipt but not required on labels; temperature control is handled during transport, and clarity is a lab observation.
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OSHA is responsible for regulating which of the following?
Detailed Rationale
OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030) mandates universal precautions (now standard precautions) to protect workers from infectious materials through engineering controls, PPE, and training. Immunization schedules are CDC/ACIP; patient privacy is HIPAA; lab accuracy is CLIA/CAP.
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Which of the following information should the physician's office provide to a phlebotomist for laboratory specimen collection?
Detailed Rationale
The laboratory requisition form is essential as it details patient demographics, tests ordered, diagnosis codes, and physician info for billing and processing (CLSI H03-A6), ensuring chain-of-custody and result routing. Accession numbers are lab-generated; NPI is for claims; encounter forms are clinical notes, not requisitions.
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A patient suspected of having a severe medication reaction goes into shock. Which of the following first aid measures should the phlebotomist take?
Detailed Rationale
In anaphylactic shock, maintaining an open airway is the immediate priority (ABC: Airway, Breathing, Circulation per AHA/Red Cross guidelines) to prevent hypoxia; call emergency services next. Upright position risks airway compromise; cooling/oral fluids are contraindicated in shock due to aspiration risk.
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After anchoring the vein, which of the following actions should the phlebotomist take next?
Detailed Rationale
With the vein anchored (tourniquet on, site palpated/visible), the next step is to insert the needle and perform venipuncture promptly to minimize patient discomfort and vein collapse (CLSI H3-A6 order: tourniquet, site selection, clean, anchor, insert). Cleaning precedes anchoring; needle exam is pre-procedure; tourniquet is already applied.
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Which of the following actions is appropriate when transporting a specimen for ABG analysis?
Detailed Rationale
ABG specimens in heparin syringes must be transported on ice to slow metabolic changes (pH, pCO2, pO2 stability <15 min at RT; CLSI C46-A), preventing erroneous results. SST is for serum chemistry; citrate anticoagulates for coagulation; light resistance is for bilirubin.
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A phlebotomist should recognize that the Clinical and Laboratory Standards Institute (CLSI) recommends that a heel stick depth should not penetrate deeper than which of the following depths for an infant patient?
Detailed Rationale
CLSI H3-A6 limits heelstick lancet depth to 2.0-2.4 mm in newborns to avoid bone penetration and osteomyelitis risk while accessing capillaries. Deeper punctures increase complications; shallower may yield insufficient sample.
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A phlebotomist has inadvertently squeezed a patient's puncture site firmly during a capillary procedure. Which of the following complications could result from this action?
Detailed Rationale
Excessive squeezing in capillary collection causes mechanical shear on RBCs, leading to hemolysis (hemoglobin release, invalidating tests like K+ per CLSI H3-A6). Hemostasis is clotting (desired); homeostasis is balance; hypobilirubinemia is low bilirubin, unrelated.
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A phlebotomist needs to collect a PT from a patient with a difficult vein. Which of the following is the best tube for the draw?
Detailed Rationale
PT requires 3.2% sodium citrate in light blue-top tubes for proper anticoagulation ratio (CLSI H21-A5); their smaller volume (e.g., 1.8 mL) suits fragile veins, reducing draw difficulty vs. larger tubes. Light green (PST) for chemistry; lavender for CBC; royal blue for trace elements.
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A dialysis patient in the ICU has a shunt placement in the right forearm and an IV placed in the left hand. Which of the following options best describes the optimal collection of a CBC?
Detailed Rationale
The right antecubital fossa avoids the shunt (risking damage/infection) and IV (dilution artifact); it's a standard venipuncture site with good vein access for EDTA lavender tubes in CBC (CLSI H3-A6 prioritizes non-IV, non-shunt sites). Hand sites increase pain/hemolysis; left AC has IV.
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A report of laboratory results is required to have which of the following information?
Detailed Rationale
CLIA regulations (42 CFR 493.1291) mandate that laboratory reports include the date and time of specimen collection to ensure result accuracy, traceability, and clinical relevance, allowing providers to evaluate if results are timely (e.g., for troponin in acute MI). Phlebotomist's initials are documented on the specimen container for chain-of-custody; patient diagnosis is provided by the ordering physician on the requisition; values of previous tests may be included optionally for trending but are not required.
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Which of the following is the correct angle of insertion when performing venipuncture using the evacuated tube method?
Detailed Rationale
The recommended bevel insertion angle for venipuncture with evacuated tubes is 15-30° to the skin surface (CLSI H3-A6), minimizing tissue trauma, ensuring smooth vein entry, and reducing hematoma risk; 30° is the upper limit for optimal visualization and control. Steeper angles (50°, 75°, 90°) increase bevel shearing and failed insertions; shallower risks subcutaneous poking.
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A new medical office and an old medical office are merging and combining all medical equipment into one office. Which of the following blood glucose monitors will have quality control measurement daily?
Detailed Rationale
CLIA-waived point-of-care devices like all blood glucose monitors require daily quality control testing (CLIA 42 CFR 493.1200 and manufacturer protocols, e.g., FDA guidance) to verify accuracy across all units in use, regardless of origin, preventing erroneous patient results from drift or malfunction post-merger. Selective QC risks overlooking faulty legacy devices.
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When a phlebotomist performs a heel stick for the purposes of obtaining a PKU test, it is important to
Detailed Rationale
For newborn PKU screening via heelstick (tandem mass spectrometry on dried blood spots), wiping the first drop removes tissue fluid contamination that could dilute analytes and cause false negatives (AAP and CLSI H3-A6 guidelines), ensuring representative capillary blood. Heel warmers improve flow but not for 30 min (5-10 min max); pressure dressings are unnecessary; central arch risks nerve damage—lateral/medial preferred.
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A patient has bilateral scarring on their forearms from past burn injuries and needs a venipuncture procedure. Which of the following veins should the phlebotomist use for the venipuncture draw?
Detailed Rationale
With bilateral forearm scarring, dorsal hand veins (cephalic/dorsal metacarpal) are an alternative site (CLSI H3-A6 order of draw sites: AC fossa first, then hand veins) as they avoid scarred, fragile tissue prone to infiltration or failure. Axillary risks nerve/artery injury; median cubital/basilic are forearm sites affected by scarring.
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A large spill has occurred in a laboratory involving venous blood. Which of the following actions should the phlebotomist take?
Detailed Rationale
For blood spills, OSHA and CDC guidelines (Bloodborne Pathogens Standard 29 CFR 1910.1030) require immediate disinfection with 10% bleach solution contact time of at least 10 minutes (often rounded to 60 seconds for initial soak), followed by cleanup with PPE to inactivate HIV/HBV. Covering delays disinfection; evacuation is for chemical fires; thickeners are for mercury spills.
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Which of following is a phlebotomist required to document on a CBC specimen label?
Detailed Rationale
CLSI H3-A6 and CAP accreditation require at minimum two patient identifiers (e.g., full name and ID number like MRN/DOB) on labels to prevent mislabeling and wrong-patient errors in CBC (EDTA lavender tube). Insurance is on requisition; phlebotomist name/certification may be optional for chain-of-custody but not identifiers.
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Which of the following accommodations should a phlebotomist make to increase a patient's comfort for venipuncture?
Detailed Rationale
For anxious or vasovagal-prone patients, supine positioning during venipuncture reduces syncope risk by maintaining cerebral perfusion and allowing quick recovery (AHA and CLSI patient comfort guidelines). Palm down hinders vein visualization; elbow bend tenses muscles; waist-level hand strains the arm.
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There has been a chemical spill in the laboratory. To which of the following should a phlebotomist refer for directions to clean up the spill?
Detailed Rationale
Safety Data Sheets (SDS, formerly MSDS) per OSHA Hazard Communication Standard (29 CFR 1910.1200) provide chemical-specific spill cleanup instructions, including PPE, absorbents, and neutralization for safe handling. CLIA regulates labs; OSHA sets standards but SDS details them; CDC offers general guidance.
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Which of the following blood collection systems uses interchangeable multi-sample tubes that allow a phlebotomist to draw several blood specimens at the same time?
Detailed Rationale
The evacuation system, also known as the vacuum tube system, uses a holder with interchangeable multi-sample tubes (like BD Vacutainer tubes) that create negative pressure to draw blood directly into the tubes. This allows efficient collection of multiple specimens in one venipuncture without changing needles, reducing patient discomfort and contamination risk. Option B uses a single syringe for one draw at a time. Option C is for infusion access, not multi-sample. Option D is for capillary microcollections, not venipuncture tubes.
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Which of the following forms commonly accompanies a toxicology drug screen for legal purposes?
Detailed Rationale
For legal toxicology drug screens (e.g., workplace or forensic testing), a chain of custody form is essential to document the handling, transfer, and integrity of the specimen from collection to analysis, ensuring admissibility in court. It prevents tampering allegations. Option B is a general lab order form. Option C refers to clinical visit notes. Option D is a medical billing form unrelated to specimen tracking.
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A phlebotomist should identify that a blood spot collection for inborn errors of metabolism requires which of the following?
Detailed Rationale
Newborn screening for inborn errors of metabolism (e.g., PKU) via blood spot on filter paper requires the specimen to air-dry completely (typically 2-4 hours) before packaging to prevent bacterial growth, hemolysis, or inaccurate results. Option A is incorrect as collection is ideally 24-48 hours post-birth. Option B requires full saturation, not just half. Option C advises wiping away the first drop to avoid tissue fluid contamination.
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Blood collection tubes fill correctly during venipuncture due to which of the following factors?
Detailed Rationale
Evacuated tubes fill due to the vacuum (negative pressure) inside, which draws blood from the vein once the needle punctures it. Venous pressure is low (~5-10 mmHg), but the vacuum provides the suction force. Option A involves arteries, not venipuncture. Option B overstates venous pressure. Option C: Tourniquet increases venous pressure slightly but doesn't fill the tube.
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A phlebotomist is collecting a urine drug screen from a Department of Transportation employee. The phlebotomist should take the specimen temperature at which of the following times following collection?
Detailed Rationale
DOT regulations (49 CFR Part 40) require urine specimen temperature to be checked within 4 minutes of collection to verify it's fresh (90-100°F) and not substituted. This prevents fraud detection delays. Later times (B, C, D) risk cooling below detectable range.
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Which of the following actions should a phlebotomist take first when a patient refuses a collection procedure?
Detailed Rationale
Patient autonomy requires informed consent; first, educate on the procedure's medical necessity to encourage voluntary participation or clarify refusal. This respects rights under HIPAA and ethical standards. Documentation (C) and notification (D) follow if refusal persists. Dismissing (B) skips education.
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A phlebotomist is preparing to draw blood from a patient for therapeutic drug monitoring. Which of the following questions should the phlebotomist ask?
Detailed Rationale
Therapeutic drug monitoring (TDM) for lithium requires timing the draw relative to the last dose for accurate peak/trough levels, as lithium has a narrow therapeutic range (0.6-1.2 mEq/L). Options B and D relate to glucose tolerance tests. Option C is for alcohol screening.
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Which of the following is an appropriate technique when preparing a site for venipuncture after applying antiseptic?
Detailed Rationale
CDC and CLSI guidelines recommend allowing alcohol-based antiseptics to air-dry (15-30 seconds) for full disinfection and to avoid stinging or contaminating the needle with wet antiseptic, which could hemolyze samples. Wiping (A) removes antiseptiBlowing/waving (C, D) introduces contaminants or moisture.
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A phlebotomist allows another administrative employee to use their login password to enter a patient's laboratory results. Which of the following regulates the confidentiality that has been breached in this situation?
Detailed Rationale
HIPAA (Health Insurance Portability and Accountability Act) mandates protected health information (PHI) security, including unique user IDs and passwords; sharing violates the Security Rule (45 CFR 164.312). OSHA focuses on safety. FDA regulates devices. CLIA regulates labs but not IT security.
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An adult patient gives implied consent to a phlebotomist when which of the following occurs?
Detailed Rationale
Implied consent for routine phlebotomy occurs through voluntary actions like extending the arm, indicating agreement without verbal/written affirmation (per AMA and state laws for competent adults). Options A and B are explicit releases. Option D requires legal authorization for surrogates.
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Which of the following should a phlebotomist anticipate for a patient who has been taking warfarin?
Detailed Rationale
Warfarin is an oral anticoagulant (vitamin K antagonist) that inhibits clotting factors II, VII, IX, and X, prolonging prothrombin time (PT) and international normalized ratio (INR), leading to increased bleeding risk and time during venipuncture. Phlebotomists should use gentle techniques, monitor for hematoma, and apply pressure longer post-draw. Option A relates to metabolic tests. Option B is unrelated to anticoagulants. Option D is for lactate or ammonia stability.
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Which of the following items should a phlebotomist recognize as part of the aseptic technique protocol?
Detailed Rationale
Aseptic technique in phlebotomy prevents microbial contamination via standard precautions (CDC guidelines): hand hygiene, gloves, surface disinfection, and avoiding touch contamination. These are core to sterile procedures. Option B prevents needlestick injuries, not asepsis. Option C tracks test accuracy. Option D addresses crises.
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Which of the following needles should a phlebotomist use for a venipuncture using a winged infusion set and a 5 mL syringe?
Detailed Rationale
Winged (butterfly) infusion sets with a 5 mL syringe for venipuncture typically use 23-gauge needles for adults, balancing blood flow (adequate for small volumes) with vein access in fragile sites like hands/antecubital. 18-gauge is too large (traumatic). 25/27-gauge are for pediatrics/microdraws, risking hemolysis/slow fill.
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Which of the following information should a phlebotomist document during a glucose tolerance test?
Detailed Rationale
Glucose tolerance tests (GTT) require precise timing: document completion of the 75-100g glucose load to schedule timed draws (e.g., fasting, 1hr, 2hr) accurately for diagnosing diabetes (OGTT per ADA). Flavor (A) is irrelevant. Water (C) isn't standardized. Blood volume (D) isn't critical if sufficient.
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Which of the following pairs of blood tests is appropriate for a fasting specimen?
Detailed Rationale
Fasting (8-12 hours) is required for accurate glucose (elevated postprandially) and triglycerides (lipemia interferes) levels, per CLSI guidelines. BUN/ALP (B), creatinine/total protein (C), LDH/albumin (D) are non-fasting stable.
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A phlebotomist reports a stat result to a provider by verbal report. The phlebotomist should follow this with documentation that contains which of the following?
Detailed Rationale
Verbal stat reporting (critical results) requires written follow-up per Joint Commission (NPSG.02.03.01) including the provider's name for accountability, audit trail, and communication verification. Insurance (A), room (B), phone (D) aren't essential for result relay.
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A phlebotomist has entered incorrect information in a patient's paper chart after a venipuncture procedure. Which of the following actions should the phlebotomist take to correct the error?
Detailed Rationale
Paper chart corrections follow legal/medical standards (e.g., HIPAA, Joint Commission): single line through error, write correction above, date/initial to maintain audit trail without obliteration. Erasing (D) or delegating (B) risks tampering appearance. Provider notification (A) if clinically significant.
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A laboratory is scheduled for a routine annual inspection with the primary focus on equipment maintenance logs. Which of the following areas will be the focus of the inspection?
Detailed Rationale
Equipment maintenance logs in annual inspections (CLIA, CAP, Joint Commission) emphasize electrical safety: grounding, cords, outlets to prevent shocks/fires, as analyzers/centrifuges are electrically powered. Mechanical (A) is structural. Chemical (B)/radiation (C) are separate.
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According to the Joint Commission, which of the following should a phlebotomist use as a unique identifier when establishing correct inpatient identification?
Detailed Rationale
Joint Commission NPSG.01.01.01 requires two patient identifiers (e.g., name/DOB) verified verbally for inpatients to prevent wrong-patient errors in phlebotomy; verbal confirmation ensures active patient involvement. Room/bed (A/B) aren't unique. Chart demographics (C) are passive.
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A phlebotomist is planning to collect a specimen to measure a patient's serum cortisol level. Which of the following factors should the phlebotomist consider?
Detailed Rationale
Cortisol exhibits diurnal rhythm (peaks 6-8 AM, nadir evening); collection timing is critical for accurate diagnosis of adrenal disorders (e.g., Cushing's). Body temp (A), alcohol (C), meals (D) have minimal direct impact.
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A patient is scheduled for a 3hr glucose tolerance test at an outpatient laboratory After verifying the patients identity which of the following actions should the phlebotomist take
Detailed Rationale
Confirming the patient fasted for the proper length of time (typically 8-12 hours for a 3-hour GTT) is essential because fasting ensures accurate baseline glucose levels before the glucose load is administered; without proper fasting, the test results will be invalid due to elevated glucose from recent food intake, leading to false positives for diabetes or glucose intolerance. Instructing to finish glucose within 30 min is correct for administration but comes after fasting confirmation. Capillary collection is not standard for GTT (venous blood is used). Vitals are not required for GTT preparation.
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Which of the following must a phlebotomist perform to demonstrate proficiency in aseptic technique
Detailed Rationale
Proper disposal of contaminated materials (e.g., needles, gauze in sharps/biohazard containers) is a core aseptic technique to prevent microbial contamination and cross-infection between patient and phlebotomist/environment. Needle angle, tube order, and vein anchoring are venipuncture skills but not primarily aseptic; they relate more to successful collection than sterility. Aseptic technique focuses on breaking infection transmission chain via hand hygiene, site disinfection, and waste handling.
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Which of the following is essential when performing quality control for CLIA waived testing
Detailed Rationale
Verifying date of expiration on QC materials, test kits, and controls is essential for CLIA-waived tests (e.g., glucose, pregnancy) because expired reagents degrade, leading to inaccurate results, false negatives/positives, and regulatory non-compliance during inspections. Sterility is not typically required for waived tests (non-sterile like urine dipsticks). Transport and requisitions are pre-analytical, not QC-specific.
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A phlebotomist should report a critical value for point of care testing to which of the following
Detailed Rationale
Critical values (e.g., glucose <50 or >400 mg/dL, potassium >6.0 mEq/L) from POCT must be immediately reported to the physician or ordered provider per lab policy/CLIA to enable timely intervention and prevent patient harm; phlebotomists are often responsible for verbal notification followed by documentation. Reporting to patient risks alarm without context. Insurance/office manager irrelevant to clinical urgency.
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Which of the following information must a phlebotomist include on the label of a venipuncture specimen
Detailed Rationale
Time of venipuncture is required on labels for timed studies (e.g., glucose tolerance, drug levels, ammonia) to calculate intervals accurately; without collection time, results may be rejected or misinterpreted. Phlebotomist credentials not needed (signature/ID optional). NPI/location not standard label elements (patient ID, DOB, date essential).
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A phlebotomist is processing a urine specimen in the laboratory Which of the following personal protective equipment is required to maintain safety regulations in the laboratory
Detailed Rationale
Surgical gloves (non-sterile, powder-free) are required for handling urine specimens per OSHA bloodborne pathogen standard (29 CFR 1910.1030) to protect skin from infectious splashes/aerosols during processing/pouring. Face shield optional unless splashing risk. Hairnet/shoe covers not standard for urine processing (food service/gowning areas).
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Which of the following specimens requires a chain of custody form
Detailed Rationale
Blood for paternity testing requires chain of custody (COC) form documenting specimen handling, collectors, times, and seals for legal/forensic purposes to prove authenticity and prevent tampering/substitution in court. HIV/TB/chlamydia are diagnostic, not typically legal; COC optional unless court-ordered.
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A phlebotomist is drawing a capillary blood specimen on a 2monthold infant Which of the following techniques should the phlebotomist use to avoid hemolysis of the specimen
Detailed Rationale
Warming the heel (e.g., warm pack 40-42°C for 5-10 min) prior to puncture increases blood flow, promotes free-flowing drops, and minimizes squeezing which lyses RBCs releasing hemoglobin (hemolysis), invalidating tests like potassium/chemistry. Excessive squeezing causes hemolysis via trauma. Puncturing wet alcohol contaminates. Scraping causes tissue fluid dilution/hemolysis.
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Which of the following causes hemolysis
Detailed Rationale
Vigorously inverting tubes (should be gentle 8-10 times) causes RBC shearing/lysis from mechanical trauma, elevating potassium/LDH falsely. Large needle ok if appropriate. Clotting ok for serum. Tourniquet <1 min ok (2 min max).
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