Phlebotomy Essentials — Proficiency Exam

15 questions · pass with 50%

1. Which vein in the antecubital fossa should you attempt first for a routine adult draw?
Basilic vein, because it is closest to the surface on the medial sideCephalic vein, because it is easiest to see in most patientsMedian cubital vein, because it is well anchored and away from major nerves and arteriesWhichever vein looks most prominent when the tourniquet is applied
2. Why is the basilic vein the last choice for venipuncture?
It is too small to yield a full tube of bloodThe brachial artery and median nerve lie directly beneath and beside itIt collapses under standard evacuated tube vacuumIt is only present in about half of patients
3. A patient tells you she had a left mastectomy with lymph node removal two years ago. Her right arm has an IV running in the forearm. What should you do?
Draw from the left antecubital fossa since the surgery was two years agoDraw from the right arm above the IV site so the sample is not dilutedStop the infusion for two minutes and draw from the right arm distal to the IV, documenting the deviation, or escalate for guidanceApply a tourniquet to the left arm only briefly and draw from the left hand
4. You are palpating for a vein and feel a firm, rounded structure that gently pushes back in a rhythm. What is it and what do you do?
An artery — do not puncture it, move to another siteA well-filled vein — proceed, this is idealA tendon — reposition slightly and proceedA valve in the vein — puncture just above it
5. An older patient has a very visible cephalic vein that flattens and disappears the moment you press on it. What does this most likely indicate?
The tourniquet is too tight and should be removed entirelyThe vein is sclerosed from previous chemotherapyThe patient is having a vasovagal reactionA superficial, fragile vein with little supporting tissue that will roll or blow easily
6. What is the standard needle gauge for a routine adult antecubital venipuncture?
18G, to keep the draw fast21G25G, to minimise patient discomfort16G, the same gauge used for blood donation
7. You are drawing from a dorsal hand vein on an 84-year-old patient. Which setup is most appropriate?
21G straight needle with full-volume tubes18G straight needle to keep flow rapid23G butterfly set, allowing a shallow approach angle25G needle attached directly to an evacuated tube holder
8. You have collected 10 mL of blood in a syringe from a fragile vein. How should it go into the tubes?
Through a blood transfer device, letting each tube's own vacuum draw the blood inBy pushing the plunger gently through the collection needle into each stopperBy removing each tube stopper and pouring the blood inBy leaving the blood in the syringe and sending the syringe to the laboratory
9. You sustain a needlestick from a used needle. What is the correct immediate action?
Squeeze the wound firmly to express blood, then apply alcoholWash the site with soap and running water, then report to occupational health immediatelyApply a dilute bleach solution and finish your remaining patients firstCover the site with a plaster and report it at the end of the shift
10. When should a sharps container be replaced?
Only when items begin to protrude from the openingOnce a week regardless of contentsWhen it reaches the marked fill line, generally around two-thirds fullWhen the last needle no longer drops in freely
11. Which tube is drawn immediately after blood culture bottles?
Lavender EDTA, so the full blood count is not delayedLight blue sodium citrateGold SST for chemistryGrey sodium fluoride for glucose
12. A chemistry panel comes back with a potassium of 7.2 mmol/L in a patient with no clinical signs of hyperkalaemia. The lavender tube was drawn before the gold tube. What is the most likely explanation?
The patient was fasting for too long before the drawThe tourniquet was released before the first tube filledInsufficient inversions of the gold tubePotassium EDTA carried over from the lavender tube into the gold tube
13. A light blue citrate tube is filled only halfway. What happens to the coagulation result?
The PT and INR are falsely prolonged because excess citrate binds the calcium added by the analyserThe PT and INR are falsely shortened because there is less anticoagulant per red cellThe result is unaffected as long as there is more than 1 mL of bloodThe sample clots immediately and no result can be produced
14. How should a lavender EDTA tube be mixed after collection?
Shaken vigorously for five seconds to disperse the additive fullyRolled between the palms for thirty secondsInverted gently 8 to 10 times, immediately after removing it from the holderLeft on the tray and mixed with the other tubes once the draw is complete
15. You are using a butterfly set and the only tube requested is a light blue citrate tube for an INR. What should you do?
Draw the citrate tube directly and accept a slightly lower fillDraw a discard tube first to purge the air from the tubing, then fill the citrate tube completelySwitch to a straight needle regardless of vein qualityFill the citrate tube, then top it up from a second venipuncture

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