1Safety and Compliance26%
Twenty-six questions on working safely and within the rules: workplace safety regulations and operational standards, patient privacy, scope of practice, quality control for equipment and for point-of-care tests, sharps and biohazard disposal, what to do after an exposure, precautions and protective equipment, infection control, emergencies, first aid and incident documentation.
- 1AFollow workplace safety regulations, such as OSHA and NIOSH requirements.
- 1BFollow operational standards from bodies such as The Joint Commission, CLSI, and the CDC.
- 1CProtect patients' health information as HIPAA requires.
- 1DStay within the phlebotomy scope of practice and meet its ethical standards.
- 1ECarry out quality control on laboratory equipment: inspection logs, reporting and troubleshooting faults, and refrigerator and freezer temperature checks.
- 1FCarry out quality control for point-of-care and CLIA-waived tests: calibration, test controls, and storage controls.
- 1GIdentify sharps and biohazardous waste and dispose of them as the bloodborne pathogens standard requires.
- 1HFollow the exposure control plan after an occupational exposure such as a needlestick, blood spill, or eye splash.
- 1IApply transmission-based precautions: airborne, droplet, and contact.
- 1JUse personal protective equipment under standard precautions: gloves, gowns, masks, respirators, and eye protection.
- 1KFollow hygiene and infection control practices that stop infections from spreading.
- 1LRecognize emergencies and respond, for example by performing CPR or responding to a code.
- 1MStart first aid when needed, such as wound care and control of heavy bleeding.
- 1NMeet documentation and reporting requirements, such as incident reports and charting rules.
Where people lose points: Getting the order wrong after an exposure. A needlestick or splash question usually offers reporting, documenting and cleaning the site as separate options; immediate care of the site comes first, then reporting under the exposure control plan. Also match the precaution to the route: airborne, droplet and contact precautions call for different protective equipment, and questions describe the patient's condition and expect you to choose.
2Patient Preparation20%
Twenty questions on everything before the needle: reading and verifying the order, introducing yourself, identifying the patient, obtaining consent, checking that test requirements such as fasting were met, asking about allergies and history, explaining the procedure, positioning, and choosing a site. It also covers registration, insurance and copayment tasks and instructing patients on collecting non-blood specimens.
- 2AShow respect for diversity, cultural sensitivity, and empathy.
- 2BCommunicate effectively with patients, coworkers, and other health professionals.
- 2CObtain, review, and verify the order or requisition, including STAT, routine, and timed draws.
- 2DIntroduce yourself to the patient with your name, title, and department.
- 2EPositively identify the patient using the required identifiers while following HIPAA.
- 2FObtain the patient's implied, informed, or expressed consent.
- 2GGet permission from a legal guardian when the patient cannot consent, such as a child or a person with cognitive impairment.
- 2HConfirm insurance coverage and review the orders and requisitions.
- 2ICollect copayments and follow the site's documentation and billing procedures.
- 2JCreate new patient accounts and help patients register.
- 2KCheck that the patient followed the test requirements, such as fasting, medication timing, or basal state, and act on the answer.
- 2LAsk the patient about factors that affect collection, such as allergies, medical history, and fainting, and adapt accordingly.
- 2MExplain the phlebotomy procedure to the patient.
- 2NPosition the patient for comfort, safety, and a good collection.
- 2OChoose the venipuncture site according to CLSI standards to reduce risk and get a good result.
- 2PTeach patients how to collect non-blood specimens such as stool, urine, semen, and sputum.
- 2QMake sure all required information is entered in the electronic medical or health record.
Where people lose points: Identification done the easy way. The patient gives you the required identifiers and you compare them with the order; a yes to "Are you Mr. Lopez?" is not identification, and a mismatch is resolved before you draw, not after. The other regular trap is the patient who did not follow the test requirements: the answer is neither to draw as if nothing happened nor to send them away on your own authority, but to follow the procedure for it and make sure the fact is recorded.
3Routine Blood Collections28%
Twenty-eight questions, the largest domain: choosing and checking equipment, adapting technique to the patient, applying the tourniquet, selecting and cleaning the site, anchoring the vein, inserting the needle, filling tubes in the right order, watching the patient, handling complications, withdrawing the needle and activating its safety feature, mixing tubes, capillary collection, aftercare and labeling.
- 3ASelect and assemble the collection equipment: evacuated tube system, needle, syringe, or winged set.
- 3BCheck equipment quality: sterility, expiration date, and manufacturing defects.
- 3CAdapt the collection technique for patients with special needs, such as burns, dementia, or bleeding disorders.
- 3DAdjust the collection to analyzer instructions, such as using minimum-volume tubes.
- 3EApply and remove the tourniquet using the standard procedure.
- 3FChoose the final collection site by looking and palpating.
- 3GClean the collection site with an antiseptic.
- 3HAnchor the vein below the puncture site.
- 3IInsert the needle of the venipuncture device at the site.
- 3JFollow the order of draw during venipuncture.
- 3KWatch the patient for warning signs during the collection and stop the draw when necessary.
- 3LRecognize and respond to complications such as no blood flow, hematoma, petechiae, or nerve pain.
- 3MWithdraw the venipuncture device and activate its safety feature.
- 3NMix tube additives by inversion as the manufacturer directs.
- 3OPerform a dermal puncture for capillary collection.
- 3PFollow the order of draw for capillary collection.
- 3QGive post-procedure care: confirm bleeding has stopped, bandage the site, and advise the patient.
- 3RLabel every specimen.
Where people lose points: The order of draw, which appears twice. Task 3J is the order for venipuncture and task 3P the order for capillary collection, and they are not the same sequence; learn both, and learn why each tube sits where it does, so a question about additive carryover does not depend on a mnemonic alone. Then complications: for each of no blood flow, a forming hematoma, and sharp or shooting pain, know the first action, including when it is to stop the draw.
4Special Collections12%
Twelve questions on draws that change the routine: blood cultures, metabolic screening such as newborn tests, blood donation, tolerance tests with timed specimens, blood alcohol and drug-screen collections, non-blood specimens, point-of-care tests, assisting with pediatric and geriatric patients, and working out how much blood can safely be taken from a small or frail patient.
- 4ACollect blood cultures.
- 4BAssist other health professionals with specimen collection, for example with pediatric or geriatric patients and vascular access lines.
- 4CGather information and collect blood samples for metabolic screening, such as PKU or galactosemia.
- 4DPerform phlebotomy for blood donation.
- 4ECalculate or look up safe blood volume limits for higher-risk patients, such as children and older adults.
- 4FCollect or process non-blood specimens such as throat cultures, nasal swabs, and wound cultures.
- 4GPerform point-of-care tests such as hemoglobin and hematocrit, blood glucose, urine pregnancy, and urinalysis.
- 4HPerform tolerance tests such as gestational glucose, lactose, and 2-hour postprandial glucose.
- 4IPrepare the site correctly for blood alcohol testing.
- 4JCollect specimens for drug screening.
Where people lose points: Carrying the routine into a collection that forbids it. A blood alcohol specimen is not prepared the way a routine site is. A blood culture stands or falls on skin antisepsis and sterile technique. A tolerance test depends on its timing. For each special collection, learn the one or two steps that differ from a routine draw and the reason, because that difference is what the question will be about. Task 4E is a calculation; practice it.
5Processing14%
Fourteen questions on what happens after collection: centrifuging, aliquoting, refrigerating or freezing; protecting specimens from heat, light and delay; chain of custody; research protocols and shipping; using the laboratory information system; reporting critical values; getting results to the provider; and arranging a recollection.
- 5APrepare specimens for testing or transport: centrifuging, aliquoting, freezing, or refrigerating.
- 5BProtect specimen integrity by meeting handling requirements for temperature, light, and time.
- 5CFollow chain of custody rules when required, such as for forensic or blood alcohol specimens.
- 5DFollow clinical research laboratory protocols for tube processing, specimen bags, shipping documents, and packaging.
- 5ECoordinate communication with non-laboratory staff about collection and processing.
- 5FEnter and retrieve specimen data in the laboratory information system.
- 5GRecognize and report critical values from point-of-care and CLIA-waived tests.
- 5HMake sure results reach the ordering provider and the medical record is updated.
- 5IContact the patient when a specimen must be collected again.
Where people lose points: Thinking the job ends at the bandage. A correctly drawn specimen can still be ruined by the wrong temperature, exposure to light, or too long a wait before processing, and questions describe the handling and ask what went wrong. Chain of custody questions turn on documentation: every person who holds the specimen is recorded, without gaps. Critical values are reported at once, to the right person, following the facility's procedure.