Processing practice questions

Answer: A) Upright, stopper on top

• ACorrect. Keeping tubes upright helps clotting and reduces hemolysis and stopper contamination.
• BIncorrect. This can affect clotting and contaminate stoppers.
• CIncorrect. Blood would sit against the stopper.
• DIncorrect. Shaking causes hemolysis.

Answer: A) Allow it to clot completely, centrifuge, transfer the serum to a labeled tube, then freeze the serum

For frozen serum, let the specimen clot completely, centrifuge it promptly, move the serum to a labeled transfer tube, and then freeze it. Whole blood is never frozen, because that causes hemolysis.

• ACorrect. Serum is only available after the blood has fully clotted and been centrifuged. CDC guidance is to transfer the separated serum to leakproof vials and freeze it right away.
• BIncorrect. Freezing whole blood ruptures the red cells, causing hemolysis that contaminates the serum. Separate the serum before freezing.
• CIncorrect. Spinning before the clot has formed doesn't give clean serum, and freezing serum on top of the cells causes hemolysis.
• DIncorrect. Serum should be separated from the cells promptly. CDC guidance says to centrifuge within about 60 minutes of collection. Leaving serum on the cells for a long time can change analyte results.

Answer: C) Urinalysis

• AIncorrect. That handles transfusion testing.
• BIncorrect. That handles tissues.
• CCorrect. It's sometimes part of clinical microscopy.
• DIncorrect. That handles antibody tests.

Answer: B) Beta-carotene

• AIncorrect. It isn't light-sensitive.
• BCorrect. Vitamin A and some other vitamins are also light-sensitive.
• CIncorrect. It isn't light-sensitive.
• DIncorrect. It isn't light-sensitive.

Answer: A) Rejected, and the correct tube recollected

• ACorrect. The wrong additive can invalidate results.
• BIncorrect. The wrong tube is rejected.
• CIncorrect. Transferring doesn't fix it.
• DIncorrect. That's improper.

Answer: A) Immediately notify the patient's nurse or provider, following facility protocol

A critical (panic) value must be reported immediately to the nurse or provider responsible for the patient, following facility protocol. Routine charting, delays, or telling only the patient are not acceptable.

• ACorrect. Critical values point to a possibly life-threatening condition. CLIA requires immediately alerting the person responsible for the patient, as the facility's critical-value protocol directs.
• BIncorrect. Routine chart review could leave a life-threatening result unaddressed for hours. Critical values must be called to the responsible person right away.
• CIncorrect. Some protocols allow a repeat check, but making notification depend on a second critical result delays care and could hide a real critical value.
• DIncorrect. Telling only the patient doesn't get the result to the clinician who must act on it right away, and interpreting results is outside the phlebotomist's scope.

Answer: D) To prove who handled it

• AIncorrect. Storage is a separate requirement.
• BIncorrect. The purpose is legal tracking, not speed.
• CIncorrect. Billing is separate.
• DCorrect. It records each person who handled the specimen so results hold up legally.

Answer: A) The nurse repeats the patient's name and potassium value back to the caller

When a critical value is reported by phone, the person receiving it reads back the patient identifier and result. The caller then documents the read-back to confirm the result was received accurately.

• ACorrect. Read-back by the receiver closes the communication loop. It is a required part of critical value notification and is documented along with who gave and who received the result.
• BIncorrect. A verbal acknowledgment does not show that the nurse heard the value and patient identity correctly. Only a read-back does that.
• CIncorrect. Repeating the result from the caller's side does not check what the receiver actually heard and wrote down.
• DIncorrect. Releasing the result electronically does not replace direct notification with read-back by the person receiving it.

Answer: D) On ice (chilled)

• AIncorrect. Sunlight does not help preserve ammonia.
• BIncorrect. Body-temperature transport is for specimens such as cold agglutinins.
• CIncorrect. Whole blood is not frozen for transport.
• DCorrect. Chilling slows changes that would falsely raise the ammonia level.

Answer: A) It is sent to a reference laboratory, following that lab's collection, packaging and transport requirements

Reference laboratories do specialized or low-volume tests that the local lab doesn't offer. Specimens are processed and packaged to the reference lab's requirements before they are sent.

• ACorrect. When the primary lab can't perform a test, the specimen is sent out to a reference lab. The phlebotomist must follow the reference lab's instructions for tube type, processing, temperature and packaging.
• BIncorrect. The hospital lab doesn't offer the test, so holding the specimen won't get it tested. Delays can also make the specimen unusable.
• CIncorrect. Reporting a different test's result as the ordered test is a serious error. Tests the lab can't perform are sent out.
• DIncorrect. The laboratory handles send-out testing. It processes, packages and ships the specimen to the reference lab rather than returning it to the provider.