CMLA Phlebotomy 3 — Questions and Answers
Question 1: What does 'reflux' mean in the context of venipuncture, and how is it prevented?
- Backflow of tube additive into the vein; prevented by keeping arm downward and tube below venipuncture site (Correct answer)
- Excessive blood flow; prevented by tourniquet
- Air entering the tube; prevented by inverting the tube
- Vein collapse; prevented by using a smaller needle
Correct answer: Backflow of tube additive into the vein; prevented by keeping arm downward and tube below venipuncture site
Reflux occurs when additive flows back from the tube into the patient's vein; maintaining a downward arm position and correct tube angle prevents this.
Question 2: A phlebotomist notices a patient's arm has petechiae after tourniquet application. This most likely indicates:
- Capillary fragility or a platelet disorder (Correct answer)
- Proper tourniquet tension
- Venous distension
- Allergic reaction to the tourniquet material
Correct answer: Capillary fragility or a platelet disorder
Petechiae are small hemorrhages caused by capillary fragility or a low platelet count (thrombocytopenia), signaling a potential bleeding disorder.
Question 3: Which specimen requires transport in a biohazard bag with a separate compartment for the requisition form?
- All clinical laboratory specimens (Correct answer)
- Only blood cultures
- Only urine specimens
- Only specimens requiring refrigeration
Correct answer: All clinical laboratory specimens
OSHA and CLSI standards require all patient specimens to be transported in leak-proof biohazard bags with the requisition kept separate to prevent contamination.
Question 4: What action should a phlebotomist take if a patient begins to faint (syncope) during venipuncture?
- Remove the needle immediately, apply pressure, and lower the patient's head or have them lie down (Correct answer)
- Complete the draw quickly before the patient faints
- Ask the patient to breathe deeply and continue drawing
- Apply smelling salts and continue the procedure
Correct answer: Remove the needle immediately, apply pressure, and lower the patient's head or have them lie down
Immediate needle removal prevents injury, and lowering the head increases cerebral blood flow to manage vasovagal syncope.
Question 5: What is the maximum recommended time a tourniquet should remain applied before venipuncture?
- 1 minute (Correct answer)
- 3 minutes
- 5 minutes
- 30 seconds
Correct answer: 1 minute
Tourniquet application beyond 1 minute causes hemoconcentration and can alter analyte results such as potassium, calcium, and protein.
Question 6: A yellow-top (ACD) tube is primarily used for:
- Blood bank specimens and HLA typing (Correct answer)
- Routine chemistry panels
- Complete blood count
- Coagulation testing
Correct answer: Blood bank specimens and HLA typing
ACD (acid citrate dextrose) tubes preserve cellular integrity and are used for blood bank and molecular/HLA testing.
Question 7: Which of the following veins is considered the first choice for routine venipuncture in adults?
- Median cubital vein (Correct answer)
- Cephalic vein
- Basilic vein
- Dorsal hand vein
Correct answer: Median cubital vein
The median cubital vein is preferred because it is large, well-anchored, and least likely to roll or cause nerve injury.
CMLA Phlebotomy 3
What does 'reflux' mean in the context of venipuncture, and how is it prevented?