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A phlebotomist enters a patient's room and observes the patient to be motionless and cyanotic. Which of the following actions should the phlebotomist take first?
Detailed Rationale
When a patient is found motionless and cyanotic, indicating a potential medical emergency, the phlebotomist should first attempt to elicit a response by asking loudly if they are okay. This is the initial step in assessing responsiveness and determining if further emergency actions, such as CPR or calling for help, are needed. Performing maneuvers or rescue breaths without assessing responsiveness first is not the correct initial step.
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Which of the following is the minimum required number of unique patient identifiers a phlebotomist should use prior to a blood draw?
Detailed Rationale
According to safety guidelines and accreditation standards (e.g., from The Joint Commission), a minimum of two unique patient identifiers must be used before any blood draw or patient care activity to ensure accurate patient identification. Common identifiers include the patient's full name, date of birth, and medical record number.
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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
Prothrombin Time (PT) testing requires a light blue top tube, which contains sodium citrate as an anticoagulant. This additive is crucial for coagulation studies. Light green tubes contain lithium heparin (for plasma chemistry), lavender tubes contain EDTA (for CBC), and royal blue tubes are for trace elements.
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While collecting a blood sample, the patient slumps over in the phlebotomy chair. Which of the following actions should the phlebotomist take first?
Detailed Rationale
When a patient slumps over or shows signs of fainting during blood collection, the immediate priority is patient safety. The phlebotomist should stop the procedure immediately to prevent injury (e.g., from falling) and assess the patient's condition. Alerting the supervisor, documenting, or moving the patient are subsequent steps after ensuring immediate safety.
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A phlebotomist is preparing to perform venipuncture on a patient who had a right-sided mastectomy. Which of the following is the correct site to perform the collection?
Detailed Rationale
After a mastectomy, especially with lymph node removal, venipuncture should be avoided on the affected side (in this case, the right arm) due to the risk of lymphedema, infection, or nerve damage. Therefore, the left antecubital fossa (left arm) would be the appropriate and safest site for blood collection.
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A patient who is on droplet precautions requires daily blood glucose monitoring. Besides gloves, what piece of personal protective equipment must the phlebotomist w drawing the sample?
Detailed Rationale
For patients on droplet precautions, a mask is required in addition to gloves, as respiratory droplets can be expelled during procedures and transmit infections. Shoe covers, gowns, and goggles are typically for different types of precautions (e.g., contact, airborne, or procedures with splash risk), but a mask is fundamental for droplet precautions.
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Which of the following samples should a phlebotomist present to the laboratory first for processing?
Detailed Rationale
A "stat" (immediate) potassium level from an emergency room patient indicates a critical and time-sensitive need for the result, as abnormal potassium levels can be life-threatening. Therefore, this sample should be prioritized for processing over the other options, which typically do not require such immediate attention.
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Which of the following areas should a phlebotomist use for a capillary collection from a 2-month-old infant?
Detailed Rationale
For infants, capillary collection (heel stick) is recommended on the lateral (outer) section of the plantar (bottom) heel. This area has adequate tissue depth and minimizes the risk of injuring underlying bone, nerves, or blood vessels. The central area, posterior curvature, or palmar surface are not recommended due to higher risk of injury.
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Which of the following pairs of blood tests is appropriate for a fasting specimen?
Detailed Rationale
Glucose and triglycerides are both highly affected by recent food intake and therefore require a fasting specimen for accurate measurement. Glucose levels rise after eating, and triglyceride levels can be significantly elevated. The other listed pairs (BUN & alkaline phosphatase, Creatinine & total protein, Lactate dehydrogenase & albumin) typically do not require fasting.
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A culture and sensitivity test is sent to which of the following divisions of a clinical laboratory?
Detailed Rationale
Culture and sensitivity tests, which involve growing microorganisms from a sample and testing their susceptibility to antibiotics, are performed in the Microbiology department of a clinical laboratory. Serology deals with antibodies and antigens, Histology with tissue pathology, and Chemistry with chemical components of blood and body fluids.
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Which of the following criteria is acceptable in determining the quality of a peripheral blood smear?
Detailed Rationale
A high-quality peripheral blood smear should have a "feathered edge," which is a thin, uniform area where the cells are spread in a single layer and are easily visualized under a microscope. This ensures accurate morphological assessment of blood cells. The other options describe smears that are either too thick or too limited in coverage.
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Which of the following refers to the process of cleaning up a blood specimen spill on a counter?
Detailed Rationale
Disinfection is the process of eliminating most pathogenic microorganisms on inanimate objects or surfaces, which is the primary goal when cleaning up a blood specimen spill. Neutralization refers to counteracting an acid or base. Containment involves isolating the spill, and sterilization is a more rigorous process that eliminates all forms of microbial life, usually for medical instruments.
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Which of the following tests has a fasting requirement?
Detailed Rationale
HDL (High-Density Lipoprotein) cholesterol, as part of a lipid panel, typically requires the patient to fast for 9-12 hours prior to collection to ensure accurate results, as food intake can significantly affect lipid levels. BUN (Blood Urea Nitrogen) and CBC (Complete Blood Count) usually do not require fasting. ABG (Arterial Blood Gas) tests also do not have a fasting requirement.
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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 (e.g., urine, CSF, tissue), the specimen source (e.g., urine, cerebrospinal fluid, biopsy site) is crucial for accurate testing and diagnosis. Without this information, the laboratory cannot perform the correct tests or interpret results appropriately. Specimen color, temperature, or clarity may be observed, but the source is a mandatory identifier.
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Which of the following tests is performed to identify bacteremia?
Detailed Rationale
A blood culture is specifically performed to detect the presence of bacteria in the bloodstream (bacteremia) and identify the specific microorganisms causing the infection. Glucose tolerance tests diagnose diabetes, peripheral blood smears examine blood cell morphology, and lactic acid tests measure lactate levels, none of which directly identify bacteremia.
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Which of the following means of receiving an order for specimen collection is considered to be the most accurate method?
Detailed Rationale
Automated requisitions are generally considered the most accurate method for receiving specimen collection orders because they minimize human error associated with manual transcriptions or verbal communications. They are typically generated directly from the electronic health record (EHR) system, reducing misinterpretations, illegibility issues, or lost orders. Manual, multipart, and verbal requisitions all carry higher risks of errors.
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Which of the following actions is required immediately after a phlebotomist experiences an accidental needlestick injury when drawing blood from a patient who has HI
Detailed Rationale
The first and most immediate action after an accidental needlestick injury, especially involving a patient with a known or suspected bloodborne pathogen, is to report the exposure to the supervisor. This initiates the necessary protocol for exposure assessment, post-exposure prophylaxis (PEP), and documentation. While washing the site is important, it usually comes immediately after the injury itself and then reporting. Sending the patient for testing or saving the device are not the immediate first steps for the phlebotomist's safety protocol.
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Which of the following is an appropriate technique for specimen collection?
Detailed Rationale
Performing a finger stick on a toddler patient is an appropriate technique for capillary blood collection when venipuncture is not feasible or necessary. Heel sticks are typically for infants less than one year old. Thumb sticks are generally not recommended due to the high density of nerve endings and potential bone damage.
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Which of the following methods should a phlebotomist use to invert tubes to prevent clotting?
Detailed Rationale
Inverting tubes in a gentle figure-eight motion 4 to 8 times is the recommended method to ensure proper mixing of the anticoagulant or additive with the blood without causing hemolysis. Shaking can cause hemolysis, rolling between palms might not mix adequately, and passing from hand to hand is not a proper mixing technique.
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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) is the U.S. law that protects the privacy and security of patient health information. Sharing login credentials and unauthorized access to patient laboratory results is a direct breach of HIPAA regulations. OSHA focuses on workplace safety, FDA on food and drug safety, and CLIA on laboratory testing quality.
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A phlebotomist has orders for the following tests: CBC, chemistry panel, lead, and a toxicology screen via capillary puncture. Which of the following should be collected?
Detailed Rationale
For a CBC (Complete Blood Count), a lavender top tube containing EDTA is the correct choice. EDTA is an anticoagulant that preserves cell morphology for hematological tests. While other tests like chemistry panel, lead, and toxicology screen might use different tubes, the CBC specifically requires a lavender top tube, which is often collected via capillary puncture into a microcollection tube of this type.
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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
For therapeutic drug monitoring, it is crucial to know when the patient's last dose of the medication (e.g., lithium) was administered. This information is essential for determining peak and trough levels and ensuring accurate interpretation of the drug concentration in the blood. Fasting status, alcohol consumption, or glucose solution consumption are relevant for other types of tests but not specifically for therapeutic drug monitoring unless specified for that particular drug.
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Which of the following is used to stabilize a patient's arm during a venipuncture?
Detailed Rationale
A phlebotomy wedge is specifically designed to provide stable support for a patient's arm during venipuncture procedures, ensuring the arm remains still and the vein is accessible. Arm restraints are used to limit movement but are generally more restrictive and used in different contexts. A blood pressure cuff is used to measure blood pressure or create venous distention, not to stabilize the arm. A phlebotomy cart holds supplies and equipment but does not stabilize the patient's arm.
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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?
Detailed Rationale
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.
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In which of the following locations should a phlebotomist directly dispose of a contaminated microscope slide?
Detailed Rationale
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.
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When performing a blood smear, which of the following actions should a phlebotomist take to ensure a quality result?
Detailed Rationale
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.
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A phlebotomist is instructing a patient who has a suspected UTI about urine sample collection. The phlebotomist should instruct the patient to
Detailed Rationale
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.
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Which of the following means of receiving an order for specimen collection is considered to be the most accurate method?
Detailed Rationale
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.
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Which of the following lancet positions should a phlebotomist use for a capillary blood collection on a healthy adult patient?
Detailed Rationale
Positioning the lancet perpendicular to the fingerprint grooves (i.e., on the side of the distal phalanx) promotes better blood flow by puncturing vascular-rich tissue while avoiding painful nerve endings and calluses. Parallel to the nail bed risks hitting bone or nerves; lateral or medial portions of digits may not yield adequate flow and increase discomfort or incomplete fills.
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Which of the following actions can result in a violation of patient privacy?
Detailed Rationale
Discussing laboratory results with a patient's partner without explicit patient consent or authorization violates HIPAA Privacy Rule (45 CFR § 164.502), as it constitutes an unauthorized disclosure of protected health information (PHI) to a third party. Submissions for workers' compensation are permitted under treatment/payment exceptions; diagnosis codes to insurers are routine for billing; full names on labels are standard for chain-of-custody identification when handled securely.
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Drawing more than the recommended amount of an infant's blood volume may result in which of the following conditions?
Detailed Rationale
Excessive phlebotomy in infants can cause iatrogenic (treatment-induced) anemia by depleting red blood cell volume faster than the bone marrow can regenerate, leading to hemoglobin drops and potential transfusion needs, as per AAP guidelines limiting draws to 5% of blood volume per month. Pernicious anemia is vitamin B12 deficiency-related; hyperthermia/hypothermia relate to temperature dysregulation, not blood loss.
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If a phlebotomist's hands are visibly soiled with blood or body fluids, which of the following decontamination agents should the phlebotomist use to clean them?
Detailed Rationale
CDC and WHO guidelines specify that when hands are visibly soiled with blood or body fluids, soap and water must be used for handwashing to provide mechanical friction for removing organic material; alcohol-based agents are ineffective against visible soil and are reserved for clean hands. Sterile water lacks detergent action; alcohol rinse alone does not remove debris.
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Which of the following specimens requires a chain of custody form?
Detailed Rationale
Chain of custody forms are required for specimens involved in legal or forensic testing to document handling, ensuring integrity and admissibility in court, such as paternity blood tests that determine biological relationships. HIV, TB sputum, and chlamydia swabs are clinical diagnostic tests without legal chain requirements unless specified otherwise.
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Which of the following is caused by excessive shaking of a tube?
Detailed Rationale
Excessive shaking of a blood collection tube causes mechanical trauma to red blood cells, leading to hemolysis (rupture and release of hemoglobin), which invalidates tests like potassium or LDH levels. Hemophilia is a genetic disorder; hemoconcentration results from prolonged tourniquet use; hemostasis refers to blood clotting.
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Which of the following is the first step a phlebotomist should take to prevent the spread of infection?
Detailed Rationale
Hand hygiene via washing with antimicrobial soap and water is the primary and first step in standard precautions (CDC and WHO guidelines) to prevent infection transmission, as hands can harbor transient flora even before glove use. Gloves, antiseptics, and equipment decontamination are subsequent measures.
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A phlebotomist finds a patient who is unresponsive and not breathing. In which of the following positions should the phlebotomist place the patient before initiating CPR?
Detailed Rationale
The supine position (flat on back) is required for effective CPR (AHA guidelines) to allow proper chest compressions and airway access without obstruction. Semi-Fowler's and prone positions hinder compressions; side-lying is for recovery, not initiation.
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Which of the following sites is appropriate to prepare for dermal specimen collection on a toddler?
Detailed Rationale
The nondominant dorsal hand in toddlers provides accessible, vascularized skin for capillary puncture with minimal discomfort and risk, per CLSI guidelines for pediatric collections. Heel sites are for infants; fingers risk nerve damage; antecubital is for venipuncture.
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Which of the following areas should a phlebotomist use for a capillary collection from a 2-month-old infant?
Detailed Rationale
The lateral plantar heel in infants under 1 year is recommended (CLSI H3-A6) for heelstick capillary collections due to its rich capillary bed and lower nerve/bone density, reducing pain and complications. Central areas risk osteomyelitis; posterior curvature is bony; palmar surfaces are unsuitable for infants.
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Which of the following actions is required immediately after a phlebotomist experiences an accidental needlestick injury when drawing blood from a patient who has?
Detailed Rationale
Immediate reporting to the supervisor initiates the facility's exposure control plan (OSHA Bloodborne Pathogens Standard 29 CFR 1910.1030), allowing prompt risk assessment, post-exposure prophylaxis, and documentation. CDC reporting is not immediate; patient testing is separate; device saving follows reporting.
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Which of the following needle gauge ranges should a phlebotomist select when performing a venipuncture for blood donation?
Detailed Rationale
For blood donation, 16-18 gauge needles are standard (AABB and FDA guidelines) to allow rapid flow (450-500 mL in 8-10 minutes) without excessive traumSmaller gauges (20+) prolong donation and increase hemolysis risk; larger are unnecessary.
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Every state in the U.S. requires that newborns be tested for which of the following disorders?
Detailed Rationale
All U.S. states mandate newborn screening for phenylketonuria (PKU) via heelstick blood test (HRSA/CDC recommendations) to detect this metabolic disorder early, preventing intellectual disability through dietary intervention. Septicemia/bacteremia require separate cultures; proteinuria is not a standard screen.
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Which of the following governing bodies mandates the use of safety features on needles and the immediate disposal as one unit in a biohazard container after use?
Detailed Rationale
OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030) requires engineering controls like safety needles and immediate sharps disposal in biohazard containers to prevent needlestick injuries. CDC provides guidelines; HIPAA protects privacy; CLIA regulates labs.
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Which of the following blood specimen tests are photosensitive and should be protected from light during handling and transport?
Detailed Rationale
Bilirubin is highly photosensitive, as exposure to light causes photo-oxidation and degradation of the pigment, leading to falsely low results in neonatal jaundice monitoring or liver function tests (CLSI guidelines recommend amber tubes or foil wrapping). Gastrin, ammonia, and pyruvate are not light-sensitive; ammonia requires chilling to prevent volatilization, and pyruvate needs rapid processing but no light protection.
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When a serum separation tube (SST) is collected, which of the following actions should the phlebotomist take to ensure optimal test results?
Detailed Rationale
For SSTs with clot activators, gentle inversion 5-8 times ensures complete mixing without hemolysis, followed by a 30-minute clotting period at room temperature to allow proper fibrin formation and serum separation upon centrifugation (BD Vacutainer guidelines and CLSI H3-A6). Fewer inversions may leave anticoagulant residue; excessive mixing risks hemolysis; longer clotting times are unnecessary and may cause evaporation artifacts.
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When a phlebotomy technician is introducing themselves after entering a patient's room, which of the following tones of voice should the technician use?
Detailed Rationale
A quiet and professional tone promotes patient comfort, reduces anxiety, and maintains a therapeutic environment in healthcare settings (per Joint Commission patient-centered care standards). Loud or commanding tones can intimidate; assertive/humorous may seem unprofessional or inappropriate during initial interactions.
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Which of the following tests has a fasting requirement?
Detailed Rationale
HDL cholesterol testing requires fasting (8-12 hours) to minimize postprandial lipemia effects on accurate lipoprotein measurement (AHA/ACC guidelines). BUN and CBC have no fasting needs; ABG assesses acid-base status and is unaffected by food intake.
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Which of the following is the general concept behind standard precautions?
Detailed Rationale
Standard precautions, per CDC guidelines, treat all human blood and body fluids as potentially infectious for HIV, HBV, and HCV, mandating universal barriers like gloves and hand hygiene regardless of known status to prevent transmission. Options A, B, and D relate to OSHA's Hazard Communication or general safety, not infection control.
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A culture and sensitivity test is sent to which of the following divisions of a clinical laboratory?
Detailed Rationale
Culture and sensitivity (C&S) tests involve microbial growth on media and antibiotic susceptibility determination, which is the domain of the microbiology division (CLSI M100). Serology detects antibodies; histology examines tissues; chemistry analyzes biochemicals.
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When performing a draw on a diabetic patient with small, fragile veins, the phlebotomist misses the patient's vein twice. The phlebotomist should do which of the following?
Detailed Rationale
After two unsuccessful venipuncture attempts, protocol (CLSI H3-A6 and ASPT) requires deferring to a more experienced phlebotomist to avoid patient trauma, hematoma, or nerve damage, especially in diabetics with fragile vessels prone to complications. Foot/leg draws increase infection risk; unlimited repeats violate limits (max 2-3 attempts).
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A phlebotomist has collected a lactic acid sample and needs to prepare the sample for processing and transportation. Which of the following methods is correct?
Detailed Rationale
Lactic acid samples must be chilled immediately on wet ice to -4°C to halt glycolysis and prevent artifactual increases (CLSI C29-A3); freezing can cause hemolysis upon thawing. Light protection is for bilirubin; heat blocks are for warming sites, not samples.
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