ASPT Patient Preparation 4 — Questions and Answers
Question 1: A phlebotomist is asked to collect a fasting specimen from a patient who says they ate a small snack 2 hours ago. What is the best course of action?
- Collect the specimen and note 'non-fasting' on the requisition (Correct answer)
- Collect the specimen and say nothing so the patient is not inconvenienced
- Proceed without documentation since 2 hours is sufficient for most tests
- Refuse to draw and reschedule without notifying the ordering provider
Correct answer: Collect the specimen and note 'non-fasting' on the requisition
If a non-fasting specimen must be collected, the phlebotomist should document the patient's actual fasting status on the requisition so the provider can interpret results appropriately.
Question 2: What should the phlebotomist verify before performing a venipuncture on an unconscious patient?
- The patient's verbal consent
- Identification via wristband and an order for the draw (Correct answer)
- The patient's last meal time
- The phlebotomist's personal knowledge of the patient
Correct answer: Identification via wristband and an order for the draw
For unconscious patients who cannot provide verbal consent or self-identify, identity is confirmed using the wristband, and a valid order must be present before proceeding.
Question 3: Which factor most commonly causes pre-analytical error related to patient preparation?
- Incorrect needle gauge selection
- Patient not following fasting or medication instructions before the draw (Correct answer)
- Using the wrong color tube for the test ordered
- Drawing the patient in a supine position
Correct answer: Patient not following fasting or medication instructions before the draw
Non-compliance with pre-collection instructions (fasting, medication timing, exercise restriction) is the leading pre-analytical variable affecting specimen quality.
Question 4: Before a glucose tolerance test (GTT), the patient must be instructed to:
- Fast for 8-12 hours and avoid strenuous exercise before the test (Correct answer)
- Eat a normal breakfast and arrive within 30 minutes
- Drink only water for 24 hours before arriving
- Take any prescribed diabetes medications on the morning of the test
Correct answer: Fast for 8-12 hours and avoid strenuous exercise before the test
A proper GTT requires 8-12 hours of fasting with avoidance of strenuous exercise, as both food and exercise significantly alter glucose metabolism.
Question 5: A patient who is breast-feeding asks if it matters for a prolactin blood test. The correct response is:
- Breast-feeding has no effect on prolactin levels
- Breast-feeding and recent nursing can significantly elevate prolactin; the physician should be informed (Correct answer)
- The patient should stop breast-feeding for 48 hours before the test
- Prolactin must be drawn only in the first trimester when levels are most stable
Correct answer: Breast-feeding and recent nursing can significantly elevate prolactin; the physician should be informed
Breast-feeding and nipple stimulation cause acute prolactin surges, so the ordering physician must know the patient's status to interpret the result correctly.
Question 6: When preparing a patient for a blood draw, the tourniquet should not remain in place for longer than:
- 30 seconds
- 1 minute (Correct answer)
- 3 minutes
- 5 minutes
Correct answer: 1 minute
Tourniquet application beyond 1 minute causes hemoconcentration and can falsely elevate proteins, cells, and other analytes that do not cross the vessel wall.
Question 7: A patient is scheduled for a cortisol level measurement. Which preparation instruction is most critical?
- Fast for 8 hours before the draw
- Note and communicate the exact time of collection, as cortisol follows a diurnal rhythm (Correct answer)
- Avoid caffeine for 24 hours before the draw
- Collect only after physical exercise to stimulate cortisol production
Correct answer: Note and communicate the exact time of collection, as cortisol follows a diurnal rhythm
Cortisol levels follow a diurnal pattern (highest in early morning, lowest at night), so precise collection time must be documented to allow correct interpretation.
ASPT Patient Preparation 4
A phlebotomist is asked to collect a fasting specimen from a patient who says they ate a small snack 2 hours ago.
What is the best course of action?