PRELIMINARY TERM EXAMINATION PMLS 2 (LABORATORY)

Alinsunurin, Nitzi C. March 11-15, 2022

BSMT1-A Prof. Michael Aguilar
Part I:
1. It is the preferred vein for venipuncture in the H pattern because it is typically large,
closer to the surface, and the most stationary, making it the easiest and least painful
to puncture and the least likely to bruise.
a. Median cubital
b. Cephalic
c. Basilic
d. Dorsal metacarpal vein
ANSWER: A. Median Cubital
Because it is large and has a low habit of moving once the needle is inserted to
a patient’s vein.

2. It is the preferred method of blood collection because blood is directly collected from
the vein into a tube, minimizing the risk of specimen contamination and exposure to
blood contamination.
a. ETS
b. Needle and syringe
c. Winged infusion set
d. Pricking
ANSWER: A. ETS
Because first and foremost, it is the safest way of blood, since the blood is
travels directly from the vein to the evacuated tubes, so that there is no exposure to
air or any other contaminants therefore, the blood is safe; second it also allows for
the collection of multiple tubes in a single venipuncture.

3. All of the following statements concerning tourniquet application are correct, except.
a. It is applied to a patient’s arm during venipuncture
b. it should be fastened tight enough to restrict venous flow but not arterial flow
c. distends the veins, making them larger and easier to find, and stretches the walls
so they are thinner and easier to pierce.
 PRELIMINARY TERM EXAMINATION PMLS 2 (LABORATORY)

d. It must not be left on longer than 3 minutes because specimen qualities ca be

affected
ANSWER: B. it should be fastened tight enough to restrict venous flow but not
arterial flow
The tourniquet is used in phlebotomy to not restrict venous flow, because the
tourniquet simply distends the veins to make them larger, allowing the phlebotomist
to find the veins more easily. In addition, the return of venous blood to the heart can
be slowed down, that enables the collection of blood.

4. It is a number that relates to needle diameter or bore

a. Gauge
b. Bevel
c. Bore
d. Shaft
ANSWER: A. Gauge
Because it indicates the diameter of the lumen, that’s why gauge is related to
needle diameter. As the gauge increases, the diameter decreases. Gauge is also color-
coded, so each gauge has a specific measurement that is dependent only by the
gauge’s color.

5. All of the following statements concerning phlebotomy needles are correct, except.
a. length selection depends on vein depth and user preference
b. the larger the gauge, the bigger is the bore
c. Gauge is selected for the size and condition of the vein and amount of blood
required for the test
d. needles are available with or without safety features
ANSWER: B. the larger the gauge, the bigger is the bore
The needle’s gauge and bore or hole relationship is that the greater the gauge,
the smaller the hole.

6. Most ETS tubes contain additives. If the additive is an anticoagulant, the blood will
not clot and the specimen will be the whole blood that can be centrifuged to obtain
plasma. All of the following statements concerning usage of ETS tubes are correct,
except.
 PRELIMINARY TERM EXAMINATION PMLS 2 (LABORATORY)

a. an additive function optimally when the tube is filled to its stated volume and gently
inverted immediately after collection to mix the additive with the blood
b. Shaking or vigorous mixing can hemolyze the blood, making it unsuitable for testing
c. additive reliability is guaranteed until an expiration date on the label if the tube is
handles and stored properly.
d. Specimen quality will not be affected even though the tube is partially filled as long
as the tube is inverted immediately after collection of blood
ANSWER: D. Specimen quality will not be affected even though the tube is
partially filled as long as the tube is inverted immediately after collection of
blood
Because, even if the tube is immediately inverted after blood collection, tubes
that are not filled to the proper volume, whether over-filled or under-filled it may
affect specimen quality and it can cause in inaccurate results. This is due to the fact
that each tube has a vacuum that only allows a certain amount of blood to enter. The
proper blood-to-anticoagulant ratio is determined by the amount of blood drawn into
a tube containing anticoagulant.

7. This H-patterned vein is located in the lateral aspect of the antecubital fossa, which
is fairly well anchored and often the only vein can be felt in obese patients.
a. Median cubital
b. Cephalic
c. Basilic
d. Dorsal metacarpal
ANSWER: B. Cephalic
Because the median cubital and basilic can not be palpated it is because the
cephalic vein rises, so the cephalic vein is the one can be palpated in obese patients.
Also, it is the second most commonly used vein for venipuncture in the H-shaped
pattern, but it is also more difficult to palpate than the medial cubital.

8. This H-patterned vein is located on the medial side of the antecubital fossa, wherein
this vein is not well-anchored, and rolls easily. This vein is not used unless no other
vein in either arm is more prominent.
a. Basilic
b. Cephalic
c. Median cubital vein
 PRELIMINARY TERM EXAMINATION PMLS 2 (LABORATORY)

d. Dorsal metacarpal veins

ANSWER: A. Basilic
When no other vein is more prominent in both arms, this vein is the last choice
for venipuncture. It is also the least preferable site because of the risk of accidental
puncture in major nerve of the arms, which is the medial cutaneous nerve (brachial
artery.) This is also the most painful vein to puncture.

9. The best site for collecting blood by skin puncture from a newborn is.
a. Big toe
b. Palm
c. Earlobe
d. Lateral portion of the heel
ANSWER: D. Lateral portion of the heel
It is the best side to perform skin puncture from a newborn because it is a low-
risk area for puncturing the newborn’s bone.

10. What is the range of the gauge of needle appropriate for venipuncture?
a. 21 and 23
b. 23
c. 21
d. 20 to 25
ANSWER: C. 21
It is the most commonly used range of the gauge of needle for venipuncture, because
21g is small enough that it doesn’t results in any discomfort or pain to the patient
while in use.

11. What do you call a complication in venipuncture which occurs when there is a
swelling caused by an abnormal accumulation of fluid in the tissues?
a. Hematoma
b. Edema
c. Damaged veins
d. Collapsed veins
 PRELIMINARY TERM EXAMINATION PMLS 2 (LABORATORY)

ANSWER: A. Hematoma
Hematoma occur when blood leaks into the surrounding tissues as a result of vein’s
partial insertion. It is also possible that the patient will get a bruise as a result of it.
When the venipuncture site starts to swell, this is an indication that venipuncture has
a complication.

12. What do you call a complication in venipuncture which occurs when a swelling or
mass of blood has escaped from a vein?
a. Hematoma
b. Edema
c. Damaged veins
d. Collapsed veins
ANSWER: A. Hematoma
This type of venipuncture complication occurs only when the phlebotomist inserts
the needle too deeply into the patient’s vein. Therefore, swelling can occur because
veins are broken, allowing blood to flow into the surrounding tissues.

13. These parts of the vascular system are only one cell thick that allows exchange of
gases and other substances between tissues and the blood.
a. Capillaries
b. Arteries
c. Veins
d. Nerves
ANSWER: A. Capillaries
It allows food and oxygen to enter cells while enables waste to exit cells.
Capillaries must also contain blood while remaining to allow vital substances to be
transported in and out of the bloodstreams quickly as possible. Moreover, capillary is
the third choice in collecting blood because it contains a lot of substance however, it
is easily punctured in order to obtain blood samples.

14. This component of the evacuated tube system describes as a plastic cylinder with a
small opening for a needle at one end, and a large opening for tubes at the other end.
a. Tube holder or Adapter
b. Barrel
 PRELIMINARY TERM EXAMINATION PMLS 2 (LABORATORY)

c. Plunger
d. Hub
ANSWER: A. Tube holder or Adapter
It is used in evacuated tube system because the small opening allows needle to be
inserted into the patient’s vein and the large opening allows the tube to be placed and
easily to removed. Moreover, in an evacuated tube system, and adapter or tube holder
is used to collect blood directly from the vein, minimizing contamination.

15. All of the following can result from venipuncture procedural error and have adverse
effects on the patient, except.
a. Hematoma
b. Iatrogenic anemia
c. Nerve injury
d. Sclerosed veins
ANSWER: B. Iatrogenic anemia
Because it occurs when a large amount of blood is drawn from the patient. As a
phlebotomist, you must draw a certain amount of blood from the patient, which is
then placed in evacuated tubes and/or only the required amount of blood must be
drawn. There is also a time limit for when the patient must be given blood given for
the test if blood is required again. Furthermore, Iatrogenic anemia also occurs in
accidents where a large amount of blood is lost, such as vehicle accidents. Therefore,
it doesn’t only occur of venipuncture procedural error.

16. Causes slow blood flow

a. Needle not deep enough
b. Needle beside the vein
c. Collapsed vein
ANSWER: C. Collapsed vein
Because the blood is no longer free to flow through that particular vein, which
causes slow blood flow. Repeated injections into the same vein can cause a collapsed
vein. This could take several days or weeks to recover from it; if not, collapsed vein
can become permanent.
 PRELIMINARY TERM EXAMINATION PMLS 2 (LABORATORY)

17. Major source of safety information for employees who may use hazardous materials
in their occupation
a.MSDS
b. Hazard communication standard
c. CDC
d. OSHA
ANSWER: B. Hazard communication standard
It educates employees about the dangers or hazards of chemicals, such as
explosive, gases, and flammable substances that they might use inside their
workplace, to ensure that the employees are safe while handling hazardous materials.
Also, it educates the employees on proper disposal of hazardous materials to ensure
that their environment, including the public is safe against hazardous materials.

18. According to the Hazards Identification System developed by NFPA, the blue diamond
indicates
a. the reactivity –stability hazard of the chemical
b. any special hazard information about the chemical
c. the flammability hazard of the chemical
d. the health hazard associated with the chemical
ANSWER: D. the health hazard associated with the chemical
The color blue represents a health hazard because it simply provides
information about a specific item, such as chemicals that require a sign or information
for proper handling and use. Therefore, employees should use this information as a
reminder of the precautions they must take to protect themselves from chemical
hazards.

19. Yellow color of the diamond in the NFPA label indicates

a. Flammable. Store in an area segregated for flammable reagents
b. Health Hazard. Toxic if inhaled, ingested or absorbed through the skin. Store in a
secure area.
c. Reactive and oxidizing reagents. May react violently with air, water or other
substances. Store away from flammable and combustible materials.
d. Corrosive, may harm skin, eyes, or mucous membranes.
 PRELIMINARY TERM EXAMINATION PMLS 2 (LABORATORY)

ANSWER: C. Reactive and oxidizing reagents. May react violently with air, water
or other substances. Store away from flammable and combustible materials.
To reduce the risk of hazard and damage to employees and other people in
case of leaks, spills, and fires, it’s important to know that all reactive and oxidizing
agents should be stored separately.

20. Red color of the diamond in the NFPA label indicates

a. Flammable. Store in an area segregated for flammable reagents
b. Health Hazard. Toxic if inhaled, ingested or absorbed through the skin. Store in a
secure area.
c. Reactive and oxidizing reagents. May react violently with air, water or other
substances. Store away from flammable and combustible materials.
d. Corrosive, may harm skin, eyes, or mucous membranes.
ANSWER: A. Flammable. Store in an area segregated for flammable reagents
Red is the color of flammable because we are used to the fact that the color red
refers to fire or any flammable materials, and when we see that, we should be cautious
when handling and storing flammable materials, such as flammable reagents. Because
wrong handling or storing it may cause fire and damage to all people. Therefore, to
prevent that to happen, flammable materials should be stored in a secure location to
avoid fire and other hazard or damage.

21. Which additive prevents glycolysis?

a. EDTA
b. Heparin
c. Potassium oxalate
d. Sodium fluoride
ANSWER: D. Sodium fluoride
Because it doesn’t function as an anticoagulant to prevent blood clotting, but
rather than as a glucose preservative, therefore it acts as a physical barrier to
glycolysis.

22. The following supplies were gathered for a routine venipuncture. Which item is
incorrect?
a. ETS tubes
 PRELIMINARY TERM EXAMINATION PMLS 2 (LABORATORY)

b. Iodine swab
c. Safety needle
d. Tourniquet
ANSWER: B. Iodine swab
It is because in routine venipuncture, 70% isopropyl alcohol or ethanol is used
instead of an iodine swab. This is due to the fact that an iodine swab should only be
used before bandaging burns, minor cuts, and scrapes.

23. Which of the following tubes can be used to collect a serum specimen?
a. Light blue top
b. Green top
c. PST
d. Red top
ANSWER: D. Red top
Because it doesn’t contain an anticoagulant, so that clotted whole blood is
obtained in this tube.

24. A tourniquet is used in venipuncture to:

a. Concentrate the blood specimen
b. Find and enter veins more easily
c. Keep the vein from collapsing
d. All of the above
ANSWER: B. Find and enter veins more easily
Because it applies pressure to the arm in order to control the blood flow and
to also facilitate the findings of the vein because the veins are distending, making
them larger and easier to find, and it stretches the walls so they are thinner and easier
to puncture.

25. You are about to perform routine venipuncture on a patient with no known allergy to
antiseptics. Which of the following substances would you use to clean the site?
a. 5.25% sodium hypochlorite
b. 70% isopropyl alcohol
 PRELIMINARY TERM EXAMINATION PMLS 2 (LABORATORY)

c. Antibacterial soap and water

d. Povidone-iodine
ANSWER: B. 70% isopropyl alcohol
Because it diffuses more slowly due to its higher water content, it is the
substance recommended for cleaning the venipuncture because it also punctures
cells and easily kills bacteria.

26. Which of the following needles has the largest diameter?

a. 18-gauge
b. 20-gauge
c. 21-gauge
d. 23-gauge
ANSWER: A. 18-gauge
Because the lower the gauge, the larger the needle.

27. What causes evacuated tubes to fill with blood automatically?

a. Arterial blood pressure
b. Fist pumping by the patient
c. Pressure from the tourniquet
d. Premeasured tube vacuum
ANSWER: Premeasured tube vacuum
Because of the presence of a vacuum inside the tube, evacuated tubes
automatically fill with blood. Furthermore, the amount of vacuum is already
premeasured to ensure that the tube tends to draw the exact number of bloods.
Therefore, a blood-filled tube that has lost his vacuum, the tube will not fill blood.

28. Lavender-top tubes are most commonly used to collect:

a. Chemistry tests
b. Coagulation specimens
c. Hematology tests
d. Immunology tests
 PRELIMINARY TERM EXAMINATION PMLS 2 (LABORATORY)

ANSWER: C. Hematology tests

Because Lavender-top tubes contain an EDTA anticoagulant, which is the best
to preserve cellular morphology of the blood cells. Therefore, this ensures that
hematology test results are accurate.

29. Of the following tubes or containers, which is filled last in the recommended order of
draw?
a. Blood culture bottle
b. Lavender top
c. Light blue top
d. Red top
ANSWER: B. Lavender top
Unlike other additives, it is the last in the order of draw because it causes a lot
of carryover problems. Because if it comes first before other additives, the order of
draw process may repeat again from the beginning due to its carryover.

30. A butterfly is typically used for:

a. Coagulation specimens
b. Difficult and hand veins
c. Draws from a basilic vein
d. All of the above
ANSWER: B. Difficult and hand veins
Because a small needle length makes it easier to insert the needle into veins
that are difficult to reach with a standard needle, as well as superficial veins, which is
very near to the surface that can also be used for IV injections.

31. EDTA can be found in:

a. Lavender-top tubes
b. Purple-top tubes
c. White-top tubes
d. All of the above
ANSWER: D. All of the above
 PRELIMINARY TERM EXAMINATION PMLS 2 (LABORATORY)

Because lavender and purple top tubes are the same, the only difference is the
name, whereas white top tubes also contain EDTA and gel because they are used to
collect plasma for molecular diagnostics.

32. Blood in which type of tube normally clots within five minutes?
a. PST
b. RST
c. SPS
d. SST
ANSWER: B. RST
Rapid Serum Test is a type of tube that normally clots and provides serum
within five minutes because it contains thrombin as a clot activator. Therefore, RST
can clot within five minutes because of thrombin.

33. Which of the following is a biocide?

a. 70% isopropanol
b. Hydrogen peroxide
c. Povidone-iodine
d. All of the above
ANSWER: D. All of the above
Because all of the chemicals mentioned are capable of either killing or
inhibiting the growth of microorganisms.

34. Mixing an additive correctly involves turning the wrist how many degrees and back
again?
a. 45
b. 90
c. 120
d. 180
ANSWER: D. 180
To prevent blood clotting of the blood specimen, the additive must be mixed
with the blood immediately at 180 degrees.
 PRELIMINARY TERM EXAMINATION PMLS 2 (LABORATORY)

35. If a CBC, PT, plasma potassium, and glucose (drawn with a glycolysis inhibitor) are all
to be collected during a multipletube draw on a patient, which of the following choices
shows the correct stopper colors to use in the correct order of draw?
a. Lavender, light blue, gold, green
b. Light blue, green, lavender, gray
c. Red, royal blue, green, lavender
d. Yellow, orange, lavender, gray
ANSWER: B. Light blue, green, lavender, gray
Prothrombin time (PT) is one of the most common coagulation tests in sodium
citrate, which comes in a light blue top tube. The lavender top tube should be used for
a complete blood count (CBC). The green top tube is a potassium-containing blood
tube. Finally, a glycolysis inhibitor is contained in the gray top tube, which is used to
keep glucose levels in whole blood as well as for another chemistry tests.

36. A green-colored stopper indicates the tube contains:

a. Citrate
b. EDTA
c. Heparin
d. Oxalate
ANSWER: C. Heparin
Because sodium and/or lithium heparin is present in the green top tube.
Heparin is used to collect plasma or whole blood samples for chemistry tests after it
has been treated with heparin.

37. A trace element-free tube stopper is:

a. Green/gray
b. Lavender
c. Royal blue
d. Yellow
ANSWER: C. Royal blue
A trace element-free tube stopper is Royal blue because it contains no
additives and is only used in trace elements such as Carbon, Hydrogen, Oxygen,
nitrogen, Phosphorus, and Sulfur, but it does contain EDTA and heparin. The Royal
 PRELIMINARY TERM EXAMINATION PMLS 2 (LABORATORY)

blue top tube is also used in laboratory tests such as chemistry trace elements,
toxicology, and nutrient analyses.

38. Thixotropic gel is found in:

a. PPTs
b. PSTs
c. SSTs
d. All the above
ANSWER: D. All the above
PPTs, PSTs, and SSTs are all contain thixotropic gel because it is used to
prevent contamination and allow separation. This is due to the fact that PPTs are used
to collect blood for the preparation of undiluted plasma, PSTs are used to collect
serum, and SSTs are use to collect serum from the blood cells within 15 minutes.

39. A transillumination device is used to:

a. Contain sharps
b. ID patients
c. Locate veins
d. Transfer blood
ANSWER: C. Locate veins
It is a device that allows a phlebotomist to easily locate veins by placing it
directly on the skin’s surface. Veins can be seen due to the bright colored LEDs that
this device produces.

40. The ratio of blood to anticoagulant is most critical for:

a. Coagulation specimens
b. Light blue stoppers
c. Sodium citrate tubes
d. All the above
ANSWER: B. Light blue stoppers
Because this tube contains sodium citrate, which is used as an anticoagulant
in coagulation tests. It also produced a plasma sample with a blood-to-anticoagulant
 PRELIMINARY TERM EXAMINATION PMLS 2 (LABORATORY)

ratio of 9.1. Insufficient collection tube filling will reduce this ratio, affecting test
results.

Part II.
Case no. 1:
A mobile blood collector named Chi is collecting an SST and two lavender tops (one
for a glycohemoglobin and one for a CBC) on a client named Uchiha Madara. He fills the SST,
lays it down while he places the first lavender top in the tube holder, then picks it up and
mixes it as the lavender top is filling. When the lavender top is full, he lays it down while he
places the second lavender top in the tube holder. The second lavender top fails to fill with
blood, so he makes several needle adjustments to try to establish blood flow. Nothing works,
so he decides to try a new tube. The new tube works fine. While it is filling, he picks up the
first lavender top and mixes it. After completing the draw, he labels his tubes, putting the
hematology label on the lavender top he collected first. He finishes up with the client, delivers
the specimens to the laboratory, and goes to lunch. When he returns from break his
supervisor tells him to recollect the CBC on Louise Jones because the specimen had a clot in
it.
Questions
1. What can cause clots in EDTA specimens?
ANSWER:
Clots in EDTA specimens are commonly caused by improper mixing of the
sample in the tube immediately after collection. Because it is critical that after
collecting the sample and after placing it in the tube, it is necessary to immediately
mix it so that the blood doesn’t clot, resulting in imprecise results.

2. What most likely caused the clot in this specimen?

ANSWER:
The first is that the blood is not mixed immediately and thoroughly after
collection, and the second cause is the inaccurate volume, as it is clearly stated that
the second lavender top doesn’t fill with blood.

3. How might the problem with the second lavender top have contributed to the clotting
of the first one?
ANSWER:
The second lavender top tube contributed to the clotting of the first lavender
top tube because the first one was not immediately mixed after collection, and the
 PRELIMINARY TERM EXAMINATION PMLS 2 (LABORATORY)

second lavender top tube didn’t have enough or the correct amount of blood in the
tube, so it failed to fill with blood. As a result, it contributes more to blood clotting
issues.

4. Would the problem with the second lavender top have been an issue if Chi had
handled the first lavender top properly? Explain your answer.
ANSWER:
I believe no, because if Chi immediately mixed the first lavender top tube and
if he immediately removed it from the tube holder and before he lays it down;
therefore, the second lavender top tube will not pose a problem.

5. What can Chi do to prevent this issue from happening in the future?
ANSWER:
Chi can avoid this happening again if he always keeps in mind that he needs to
immediately mix the specimens in the tubes right after collecting it, as this is what
frequently causes blood clotting

Case no. 2
Jake, a phlebotomist, is sent to the ER to collect an EDTA specimen for a STAT type
and crossmatch on an accident victim. He properly identifies the patient and is in the process
of filling the lavender-top tube when an ER nurse tells him that the patient’s physician wants
to add a STAT set of electrolytes to the test order. Jake acknowledges her request. He finishes
filling the lavender top and grabs a green top. After completing the draw, he takes the
specimens straight to the laboratory to be processed immediately.
Questions
1. One of the specimens that Jake drew is compromised. Which one is it?
ANSWER:
The green top tube, which is used to collect electrolytes that is urgent, is the
one of the specimens that Jake drew that is compromised.

2. Why is the specimen compromised, and how may test results be affected?
ANSWER:
The specimen is compromised because Jake drew the green top tube after the
EDTA tube; as a result, Jake did not follow to the order of draw, and the specimen was
contaminated by the carryover EDTA, causing in inaccurate results.
 PRELIMINARY TERM EXAMINATION PMLS 2 (LABORATORY)

3. How could Jake have avoided the problem without drawing blood from the patient
twice?
ANSWER:
Jake could have avoided this situation in the future by collecting a just few
amounts of milliliters of blood in the discard tube, which is the red glass top tube
which contains no additives, as his backup for potential needle contamination before
collecting the blood for the green top tube, in order for him to avoid drawing blood
from his patient twice.