Safety and Compliance practice questions

Answer: B) Upper right chest below the collarbone and lower left side below the armpit

Standard adult AED placement puts one pad on the upper right chest and the other on the lower left side of the chest, so the shock passes through the heart. Always follow the diagrams on the pads.

• AIncorrect. This is the standard position reversed. The upper pad goes on the right side of the chest and the lower pad goes on the left side.
• BCorrect. In the standard adult position, one pad goes on the upper right chest beside the sternum and the other on the lower left side of the chest, so the heart lies between them. Follow the diagrams printed on the pads.
• CIncorrect. Pads placed next to each other let the current pass between them without crossing the heart. The pads have to be on opposite sides of the heart.
• DIncorrect. Neither pad goes over the middle of the sternum. The lower pad goes on the side of the chest below the armpit, not over the nipple or breast tissue.

Answer: A) Remove the gloves, perform hand hygiene, and put on a new pair

Under the OSHA Bloodborne Pathogens Standard, contaminated disposable gloves must be replaced and can't be cleaned for reuse. Hands must be washed after the gloves are removed.

• ACorrect. OSHA requires contaminated disposable gloves to be replaced as soon as practical, and hands must be washed after the gloves are removed.
• BIncorrect. OSHA does not allow disposable (single-use) gloves to be washed or decontaminated for reuse.
• CIncorrect. Contaminated gloves must be removed and replaced. Putting another pair on top leaves the contaminated gloves in place.
• DIncorrect. Hands must be washed right away, or as soon as feasible, after gloves are removed. Wearing gloves doesn't replace hand hygiene.

Answer: B) Prohibited

• AIncorrect. It's prohibited.
• BCorrect. It risks mucous membrane exposure.
• CIncorrect. It's prohibited.
• DIncorrect. It's prohibited in work areas.

Answer: A) Refer the patient to the facility's medical records (release-of-information) process to request a copy

Patients have a HIPAA right to copies of their health information, including lab test reports. The phlebotomist should refer them to the facility's formal release-of-information process rather than releasing results personally.

• ACorrect. Under 45 CFR 164.524, individuals have a right to inspect and get a copy of their health information, including lab test reports. Facilities handle these requests through a formal process. That process may require a written request and must verify the requester's identity and authority.
• BIncorrect. Individuals have a HIPAA right to access their own protected health information, including lab test reports. They are not limited to getting results through the ordering provider.
• CIncorrect. Phlebotomists generally are not authorized to release records. Handing over results outside the formal process skips the required identity and authority verification and the documentation.
• DIncorrect. The 2014 CMS/OCR/CDC rule removed the HIPAA access exceptions for CLIA-certified and CLIA-exempt laboratories. Patients can now get their completed test reports, including directly from the laboratory.

Answer: A) The type and brand of the device involved in the incident

OSHA requires the sharps injury log to record the type and brand of device, the department or work area, and how the incident happened. It must protect the injured employee's confidentiality and be kept as long as 29 CFR 1904.33 requires.

• ACorrect. 29 CFR 1910.1030(h)(5)(i) requires the log to include the type and brand of device involved, the department or work area, and an explanation of how the incident occurred.
• BIncorrect. The log is not required to identify the source patient or list a diagnosis. Its purpose is to track devices and circumstances so that sharps can be evaluated and made safer.
• CIncorrect. Post-exposure evaluation results belong in the employee's confidential medical record, not the sharps injury log. The log must also be kept in a way that protects the injured employee's confidentiality.
• DIncorrect. Hepatitis B vaccination status is kept in the employee's confidential medical record. It is not one of the required sharps injury log entries.

Answer: A) Remove it in the work area before going to the break room

Under the OSHA Bloodborne Pathogens Standard, all PPE, including lab coats, is removed before leaving the work area, even if it looks clean. The employer is responsible for laundering it.

• ACorrect. OSHA requires all PPE to be removed before leaving the work area, whether or not it looks contaminated.
• BIncorrect. A coat can carry contamination you can't see. It must come off before leaving the work area either way. Visible contamination only means it must also be removed right away or as soon as feasible.
• CIncorrect. The employer must clean, launder and dispose of required PPE. Contaminated coats should not go home with employees.
• DIncorrect. Wearing the coat into the break room carries possible contamination into a clean area. It has to come off before leaving the work area.

Answer: A) Removing stoppers from blood tubes at an open bench, where blood droplets could spatter

Face shields, or masks combined with eye protection, are required whenever splashes, spray, spatter or droplets of blood may be generated, for example when removing tube stoppers at an open bench.

• ACorrect. OSHA requires face and eye protection whenever splashes, spray, spatter or droplets of blood may be generated. Opening tubes at an open bench can produce aerosols and spatter.
• BIncorrect. A routine fingerstick produces a small drop of blood and isn't expected to cause splashes or spray. Gloves are the standard protection.
• CIncorrect. Capped tubes are closed, so labeling them carries no reasonable expectation of splash or spatter.
• DIncorrect. Sealed, bagged specimens in transport don't create a splash or spray risk, so face protection isn't required.

Answer: B) Its fill line, about three-quarters full

• AIncorrect. Replace it at the fill line.
• BCorrect. Overfilling causes needlesticks.
• CIncorrect. That's wasteful.
• DIncorrect. Replace it at the fill line.

Answer: B) Order or collection until the result is reported

• AIncorrect. It measures test timing.
• BCorrect. Labs monitor it as a quality indicator.
• CIncorrect. It covers the whole testing process.
• DIncorrect. It measures test timing.

Answer: B) The patient's current result with that patient's previous result

A delta check compares a patient's current result with that same patient's previous result. A change beyond the set limit can flag errors such as a mislabeled specimen (wrong blood in tube).

• AIncorrect. A delta check compares results from the same patient, not results across patients in one run.
• BCorrect. A delta check compares the change between a patient's sequential results with a set limit. A large unexplained change can point to errors such as wrong blood in tube.
• CIncorrect. That describes comparing analyzers or methods, not a delta check against the patient's history.
• DIncorrect. That is routine quality control on control material. A delta check uses the patient's own previous results.