FINAL

1. The order of blood flow through the nephron is: D) Afferent arteriole, efferent arteriole, peritubular capillaries, vasa recta 2. Increased production of aldosterone causes: C) Increased plasma sodium levels 3. The primary chemical affected by the renin-angiotensin-aldosterone system is: D) Sodium 4. For active transport to occur, a chemical: A) Must combine with a carrier protein to create electrochemical energy 5.The enzyme renin is produced by the kidney: *(Bonus)* B) In response to low plasma sodium levels 6. Production of antidiuretic hormone is controlled by the: C) State of body hydration 7. The most routinely used laboratory method for measuring the glomerular filtration rate is: C) Creatinine clearance 8. The most common error in measuring the glomerular filtration rate using the creatinine clearance is: B) Inaccurate timing of urine collection 9. Calculate the creatinine clearance for a patient of average size from the following data: Urine volume: 720 mL for 12hrs/ Urine creatinine: 120 mg/dL/ Serum creatinine: 1.5 mg/dL B) 80 mL/min 10. A 12-hour urine specimen with a volume of 360 mL is collected for a creatinine clearance. What is the volume (V) used to calculate the clearance? A) 0.5 mL/min 11. Given the following information, calculate the Osmolar clearance: Urine volume: 720 mL in 24 hrs.Urine osmolarity: 700 mOsmPlasma osmolarity: 300 mOsm B) 1.2 mL/min 12. All the following are parts of the routine urinalysis EXCEPT: D) Cytodiagnostic examination

13. Urine from a patient with diabetes insipidus has: *(Bonus)* D) Increased volume and decreased specific gravity 14. Person taking diuretics can be expected to produce: B) Polyuria 15. A urine specimen may be rejected by the laboratory for all of the following reasons EXCEPT: D) The container uses a screw-top lid 16. The primary cause of the changes that take place in unpreserved urine is: A) Bacteria growth 17. A urine specimen containing a large amount of precipitated amorphous material may have been preserved using: A) Refrigeration 18. Before analysis, a refrigerated urine specimen must be: D) Returned to room temperature 19. All the following specimens are acceptable for a urine culture, EXCEPT: B) Timed specimen 20. Quantitation of a substance that varies with daily activities should be performed on a: C) 24-hour specimen 21. Documentation of appropriate handling of specimens for drug analysis is provided by the: D) Chain of custody form 22. Where should labels on urine specimen container be placed: A) Container 23. What is the maximum length of time a urine specimen should remain unpreserved at room temperature before testing? B) 2 hours 24. Increased turbidity in urine that remains at room temperature is usually caused by: C) Bacterial growth 25. The primary pigment responsible for normal urine color is: B) Urochrome 26. A dark yellow urine producing yellow foam may contain: D) Bilirubin

27. Which of the following colors and causes match: C) Black---melanin 28. Specimens that contain intact red blood cells can be visually distinguished from those that contain hemoglobin because: C) Red blood cells produce a cloudy specimen 29. Urine from a patient diagnosed with hepatitis will appear:*(Bonus)* B) Amber 30. The presence of a white precipitate in freshly voided urine can be caused by: C) Amorphous phosphates in alkaline urine 31. The addition of dilute acetic acid to a cloudy urine specimen will dissolve: D) Amorphous phosphate 32. The specific gravity of urine is directly proportional to its: B) Dissolved solids 33. A urine specific gravity measured by refractometer is 1.028, and the urine temperature is 29C. The specific gravity should be reported as: C) 1.028 34. A urine specimen is diluted 1:10, and the specific gravity reads 1.006. The actual specific gravity is: C) 1.060 35. Bacterial decomposition of urea produces urine that has an odor resembling: C) Ammonia 36. A pale urine is primary indication of impaired renal function: B) False 37. Urine specific gravity can be measured by both physical and chemical methods A) True 38. The density of urine specimen can affect the frequency of a sound wave. A) True 39. Quality control on reagent strips must be performed whenever a/an C) New bottle of strips is opened 40. Failure to blot the edge of the reagent strip may result in errors in interpretation caused by: B) Runover

41. Reagent strip chemical tests may be inaccurate if the specimen is: B) Tested immediately after refrigeration 42. When performing reagent strip quality control, the: A) Positive reading should match the reference value by plus or minus one color block 43. The principle of the reagent strip test for pH is: A) A double indicator reaction 44. A urine specimen with a pH of 9.0 indicates that the patient should be: D) Asked to collect a new specimen 45. Urinary pH provides valuable information for the: A) Identification of urinary crystals 46. Which of the following is a cause of prerenal proteinuria? B) Multiple myeloma 47. When using the reagent strip protein method, false-positive results may occur in the presence of *(Bonus)* D) Highly alkaline urine 48. The principle of the reagent strip test for protein is the: D) Protein error of indicators 49. The SSA test should be performed on: D) Urine that has been centrifuged 50. Pediatric urine specimens are additionally tested for the presence of: D) Galactose using Clinitest 51. A urine specimen is analyzed for glucose by a glucose oxidase reagent strip and a copper reduction test. If both results are positive, which of the following interpretations is correct? B) Glucose only is present 52. While performing a Clinitest, you observe that the color changes rapidly form blue to orange and then back to blue. You should: *(Bonus)* C) Repeat the test using fewer drops of urine to check for "pass through" 53. Ammonium sulfate is added to red urine. The urine had a positive reaction for blood, but there were no RBCs in the sediment. After centrifugation, the sedimented ammonium sulfate is red. The abnormal color is caused by: B) Hemoglobin

54. Which of the following can produce a negative nitrite test in the presence of significant bacteriuria? A) Production of nitrogen from the presence of many bacteria 55. What do the following results suggest? Color: Yellow/ Protein: Trace/ Blood: Negative/ Clarity: Hazy/ Glucose: Negative/ Urobilinogen: 0.1EU/ SG: 1.019/ Ketones: Negative/ Nitrite: Positive/ pH: 8.0/ Bilirubin: Negative/ Leukocytes esterase: Positive C) Urinary tract infection

1. As supervisor of the UA laboratory, you have just adopted a new procedure. You should: D) Place a complete, referenced procedure in the procedure manual 2. Urinalysis procedure manuals are reviewed: C) Annually by a designated person 3. Following rejection of a specimen, a technologist must: D) Both A and C A) Document the problem C) Document corrective actions taken 4. Reagents must be labeled with all of the following except: C) Instructions for use 5. When you receive a specimen and a requisition form that do not match, you should: A) Notify the personnel who collected the specimen 6.Instruments used in the urinalysis laboratory are kept in good working condition by: *(Bonus)* B) Performing routine preventive maintenance 7. The ability to obtain the published (expected) result on a control sample is reffered to as: B) Accuracy 8. Obtaining the same result after testing the same specimen three times is called test: C) Precision 9. Proficiency testing should be performed: B) By personnel performing the tests routinely 10. The least regulated level of CLIA '88 testing categories is: A) Waived 11. All of the following are accrediting agencies recognized as meeting CLIA'88 standards except: B) NCCLS 12. Waived tests performed in a hospital urinalysis laboratory must meet the CLIA'88 standards for: C) Moderate-complexity testing 13. Customers of the laboratory include all of the following except: B) Accreditation agencies 14. Diseases affecting the glomerulus are primarily caused by: C) Immunological disorders

15. The buildup of crescentic formations on the glomerular capillaries is characteristic of: B) Rapidly progressive glomerulonephritis 16. Goodpasture syndrome and Wegener's granulomatosis are associated with the presence of which of the following in the urine sediment? *(Bonus)* B) Red blood cell casts 17. The presence of heavy proteinuria is most characteristic of: D) Nephrotic syndrome 18. A decrease in systemic blood flow affects the renal tubules by producing: B) Ischemia 19. Glucosuria and generalized amino aciduria are characteristics of: A) Fanconi syndrome 20. Infection of the bladder is termed: C) Cystitis 21. Increased urinary eosinophils diagnostic for: B) Acute interstitial nephritis 22. Causes of acute renal failure include all of the following except: B) Goodpasture syndrome 23. Most renal calculi are composed of: D) Calcium 24. The microscopic hematuria associated with renal lithiasis is caused by: C) Tissue irritation 25. All the following may be helpful in preventing the formation of renal calculi except: B) Increased exercise 26. A patient with a history of intermittent hematuria following strenuous exercise has an elevated serum immunoglobulin A level. What is the most probable disorder? B) IgA nephropathy 27. Following ingestion of mushrooms found growing in his garden, a man develops symptoms of oliguria, lethargy, and edema. Many RTE cells are observed in his urinalysis. What is the most probable disorder? B) Acute tubular necrosis 28. Phenylketonuria is caused by:

C) Lack of the enzyme phenylalanine hydroxylase 29. The Guthrie is a: A) Bacterial inhibition test 30. All of the following disorders are caused by defects in the phenylalanine-tyrosine pathway except: B) Hartnup's disease 31. A disease that causes large amounts of branched-chain amino acids to be excreted in the urine is: C) Maple syrup urine disease 32. Urine with an odor of "sweaty feet" and a positive ketone test indicates: C) Organic acidemia 33. Which of the following reacts with p-nitroaniline to produce an emerald-green color: D) Methylmalonic acid 34. The finding of a "blue diaper" is indicative of a defect in the metabolism of: C) Tryptophan 35. The finding of increased amounts of the serotonin degradation product 5-HIAA in the urine indicates: D) Argentaffin cell tumors 36. All of the following porphyrin compounds will exhibit fluorescence under ultraviolet light except: D) Porphobilinogen 37. The most common cause of acquired porphyria is B) Lead poisoning 38. Symptoms of inherited porphyrias include all of the following except:* A) Fanconi's syndrome 39. The presence of porphobilinogen in the urine can be suspected when: A) Acidic urine turns a port wine color after standing 40. All of the following porphyrin compounds can be found in urine except: C) Protoporphyrin 41. Hurler's and Sanfilippo's syndromes present with mental retardation and increased urinary: D) Mucopolysaccharides

42. The presence of "orange sand" in an infant's diaper is indicative of: D) Lesch-Nyhan disease 43. The screening test result for PKU is:*(Bonus)* A) Ferric Chloride 44. The screening test result for Homocystinuria is: C) Silver nitroprusside 45. The odor of Phenylketonuria: C) Mousy 46. The number of fields that should be examined when quantitating urinary sediment constituent is: C) 10 47. All the following are reported as the quantity per *high*-power field EXCEPT: A) Casts 48. The purpose of including glucose as a significant chemical parameter by a laboratory that performs macroscopic screening is to check for the presence of: D) Candida albicans 49. Glitter cell is term used to describe a specific type of: C) Neutrophil 50. The location of epithelial cells in the urinary tract in ascending order is: A) Squamous, transitional, renal tubular 51. Which of the following structures could be found in both a vaginal wet prep and a urine sediment? D) Both A and C A) Yeast cells C) Clue cell 52. Waxy casts are most easily differentiated from hyaline casts by their: D) Refractivity 53. Identification of crystals is based on shape and: A) Urine pH and crystal solubility 54. The description for Triple phosphate crystal: B) Coffin lid 55./Schistosoma haematobium/ would most likely be found in the urine from a: *(Bonus)* A) Foreign-service employee

1. The functions of the cerebrospinal fluid include all of the following EXCEPT: *(Bonus)* B) Transmission of neurologic impulses 2.A xanthochromic CSF specimen will appear: C) Yellow and clear 3. The third tube of CSF collected from a lumbar puncture should be used for: D) Hematology tests 4. When using the cytocentrifuge, a daily control slide of saline and albumin is prepared to check: C) For bacterial contamination 5. Three tubes of CSF are submitted to the laboratory. They are numbered 1,2,and 3, and they show blood in all tubes but decreasing in amount as one inspects tubes 1 through 3. This observation should be interpreted as: B) A traumatic or bloody tap and, in all likelihood, no pathogenic significance should be attached to the presence of the blood. 6. A slightly hazy CSF specimen is diluted 1:10 with acetic acid. A total of 50 cells are counted in five squares on both sides of the Neubauer counting chamber. The count is reported as: *(Bonus)* D) 500 WBCs/uL 7. The presence of xanthochromia and an increased D-dimer test in the CSF in indicative of: C) A cerebral hemorrhage 8. Examination of a CSF shows 1000 WBCs, of which 75% are lymphocytes and 25% are monocytes. This finding is consistent with: C) Viral meningitis 9.Damage to the blood-brain barrier by /Mycobacterium tuberculosis/ may cause the CSF to: C) Contain a pellicle or clot 10.The CSF/serum albumin index is performed to determine: *(Bonus)* C) The integrity of the blood-brain barrier 11. CSF electrophoresis to confirm the diagnosis of multiple sclerosis would be expected to show: A) Increased IgG with oligoclonal bands not seen on serum electrophoresis 12. To determine if fluid draining from the ear of a patient with severe head injury is CSF, the fluid should be: B) Electrophoresed for the presence of transferrin isoforms

13. Measurement of CSF lactate levels is a valuable aid for all of the following EXCEPT: D) Distinguishing between viral and fungal meningitis 14. India ink preparations are useful in the diagnosis of: A) Fungal meningitis 15. Using 1:10 dilution, 64 wbcs are counted in five large squares on both side of the hemocytometer. Calculate the WBC count. C) 640 cells/uL 16. A patient previously diagnosed with acquired immunodeficiency arrives in the emergency room with symptoms of meningitis. A lumbar puncture is performed.In addition to Gram's stain, what additional testing should be performed?*(Bonus)* D) Both A and B A) India Ink preparation B) Electrophoresis 17. What diagnostically significant observation might be made on one of the test from the previous question? C) Starburst microbial pattern 18. What type of meningitis would most probably be suspected in this patient? A) Fungal 19. Using the lab results to determine the type of infection they represent: WBC count: 1000 per L/ Lymphocytes: 10%/ Neutrophils: 90%/ Protein: 150 mg/dL/ Glucose: 15 mg/dL/ Blood Glucose: 90 mg/dL/ Lactate: 40 mg/dL A) Bacterial 20. The CSF glucose in a patient with a blood glucose of 90 mg/dL is 60mg/dL. These results are representative of: C) Normal CSF 21. All of the following statement on synovial fluid are true EXCEPT that it: B) Is found only in the knee 22. Which of the following descriptions of synovial fluid does not match? D) Sepsis: Uniform blood 23. Crystals found in synovial fluid during attacks of gout are: A) Monosodium urate 24. Synovial fluid is produced by: *(Bonus)* B) Ultrafiltration of plasma 25. The primary cells seen in normal synovial fluid include all of the following EXCEPT: B) Neutrophils

26. A cloudy, yellow-green synovial fluid with 100,000 WBCs, a predominance of neutrophils, and a decreased glucose is classified as: C) Septic 27. A clear, pale yellow synovial fluid with with good viscosity and a WBC count of 1000 is classified as: A) Noninflammatory 28. To determine is an unknown fluid is synovial fluid, the fluid can be tested: C) By adding acetic acid and observing clot formation 29. The milky-appearing synovial fluid is associated with the presence of: D) Monosodium urate crystals 30. The recommended diluting fluid for synovial fluid cell count is: D) Saline 31. Neutrophils that contain precipitated rheumatoid factor in their cytoplasm are called: C) Ragocytes 32. Vacuolated macrophages containing ingested neutrophils seen in synovial fluid are called: A) Reiter's cells 33. Before performing a cell count on a highly viscous synovial fluid, it may be necessary to incubate the fluid with: D) Hyaluronidase 34. Examination of synovial fluid under direct polarized reveals intracellular needle-shaped crystals that appear white against the black background. When a red compensator is added and the crystals are aligned with the slow vibration, they appear yellow against the red background. These crystals are: *(Bonus)* B) Monosodium urate showing negative birefringence 35. All of the following diseases are frequently associated with join disorders EXCEPT: B) Tuberculosis 36. A synovial fluid with a normal WBC count from a patient with a normal serum uric acid contains extracellular birefringent crystals under polarized light. A possible reason for this finding is that the: D) Specimen was collected in powdered EDTA 37. Fat droplets seen in synovial fluid are associated with:

D) Both A and B

A) Crush injuries B) Chronic inflammation

38. Synovial fluid crystals seen in patients undegoing renal dialysis most commonly are: C) Calcium oxalate 39. A turbid synovial fluid with yellow-green color is indicates:*(Bonus)* B) Infection 40. Crystals frequently seen with chronic inflammation are: B) Cholesterol 41. Peritoneal lavage is performed to: C) Detect intra-abdominal bleeding 42. The pathological accumulation of fluid in a body cavity is termed a/an:*(Bonus)* D) Effusion 43. Peritoneal fluid is collected by a procedure called: C) Paracentesis 44. All of the following are unique characteristics of malignant cells EXCEPT: C) Cellular clumping 45. Differentiation between a hemothorax and a hemorrhagic effusion on a bloody pleural fluid is done by: B) Performing a hematocrit value, because a hemothorax will give a value close to that of blood 46. A pleural fluid pH of less than 6.0 is indicative of: D) Esophageal rupture 47. Request for amylase and alkaline phosphatase determinations on ascitic fluid are received in suspected cases of: B) Gastrointestinal perforations 48. Which of the following tests is valuable in the diagnosis of esophageal rupture? A) Pleural pH 49. A milky pleural fluid that *stains strongly positive with Sudan III* indicates: A) Thoracic duct leadkage 50. A milky, green-tinged pleural fluid: *(Bonus)* D) Stains weakly with Sudan III 51. Differentiaion between an ascitic fluid transudate or exudate is most

accurately made using the: B) Serum-ascites albumin gradient 52. The test performed on peritoneal lavage fluid is the: A) RBC count 53. An ascitic fluid absolute neutrophil count of 1000/uL is most indicative of: C) Bacterial peritonitis 54. A screening test performed on a cloudy, green ascitic fluid would be a/an: D) Ictotest 55.A peritoneal fluid with a positive CEA and a negative CA 125 indicates: *(Bonus)* A) Gastrointestinal malignancy 56. An ascitic fluid exudate with a positive CA125 and a negative CEA D) Ovarian malignancy 57. Peritoneal fluid with an elevated creatinine level C) Ruptured bladder 58. Pleural fluid with a hematocrit of 30% (blood hematocrit:34%) A) Hemothorax 59. Increased serous fluid can be caused by all of the following EXCEPT: C) Increased plasma sodium 60. The findin gof a mesothelioma cell in pericardial fluid is indicative of: D) Metastatic malignancy

1. Absence of a normal sperm acrosome: B) Affects ovum penetration 2. Yellow color in a semen specimen may be caused by all of the following EXCEPT: B) Preservation at room temperature 3. Normal semen should liquefy: B) Within 1 hour 4. Semen viscosity is most closely related to:*(Bonus)* D) Specimen liquefaction 5. Before analysis, semen specimens should be: C) Allowed to liquefy 6. Prior to reporting a postvasectomy specimen as negative for the presence of sperm, the specimen must be: D) Centrifuged 7. Evaluation of sperm motility includes: D) Both A and B A) Determining slow and fast movement B) Differentiation between forward and lateral movement 8. When performing sperm morphology analysis, the minimum number of sperm that should be evaluated is: C) 200 9. When using routine morphology criteria, the normal value is greater than: B) 30% normal forms 10. Using a 1:20 dilution and the 5 RBC counting squares of the Neubauer counting chamber, and average of 54 sperm is counted. The sperm concentration is: B) 54,000,000/mL 11. The motility component of a sperm analysis includes all of the following EXCEPT evaluation of the: D) Motility of normal and abnormal sperm 12. The sugar on interest in cases of infertility is: C) Fructose 13. The immunobead test detects *(Bonus)* A) Male antisperm antibodies 14. Sperm function tests include all of the following EXCEPT the: C) Meiosis and mitosis assay

15. Spermatogenesis takes place in the: B) Seminiferous tubules 16. Using a 1:20 dilution of a specimen with a volume of 3 mL, an average of 86 sperms are counted in the 5 RBC squares of the Neubauer hemocytometer. Calculate the concentration and sperm count: B) 86 million/mL and 258 million/specimen 17. Using a 1:20 dilution of a specimen with a volume of 4 mL, 30 sperm are counted in 2 large squares (WBC) of the Neubauer hemocytometer. Calculate the sperm concentration and sperm count: B) 3 million/mL and 12 million/specimen 18. A dark green amniotic fluid is associated with: A) Meconium 19. A primary function of amniotic fluid is to: B) Provide protection for the fetus 20. The volume of amniotic fluid increases after the first trimester as a result of: C) Production of fetal urine 21. Amniotic fluid for fetal lung maturity testing should be preserved: A) In the refrigerator 22. To differentiate between maternal and fetal blood in blood-streaked amniotic fluid, the fluid is tested for:*(Bonus)* B) Fetal hemoglobin 23. An increased level of alpha fetoprotein in amniotic fluid should be further tested for: C) Acetylcholinesterase 24. Alpha fetoprotein is produced by the fetal: D) Liver 25. An amniocentesis is performed on a woman whose last two pregnancies have resulted in still births due to hemolytic disease of the newborn. A screening test performed at the hospital is positive for bilirubin, and the specimen is sent to a reference laboratory for a bilirubin scan. Doctors are concerned when the report comes back negative, and question if the: C) Specimen was exposed to light 26. The purpose of plotting amniotic fluid bilirubin on a Liley graph is to: D) Determine further treatment 27. The A450 of an amniotic fluid is plotted in zone 3 of a Liley graph. The physician should:

C) Request testing for fetal lung maturity 28. The foam, or shake test is a screening test for amniotic fluid: B) Surfactants 29. Microviscosity of amniotic fluid is measured by: D) Fluorescence polariztion 30. The test for amniotic fluid lamellar bodies uses: D) An automated cell counter 31.The Amniostat agglutination test is performed on amniotic fluid from pregnant women to detect the presence of:*(Bonus)* B) Phosphatidyl glycerol 32. The most frequent concern of premature delivery is underdevelopment of the: D) Lungs 33. Lamellar bodies contain: C) Phospholipids 34. When performing an L/S ratio by thin-layer chromatography, a mature fetal lung will show: C) Lecithin twice as concentrated as sphingomyelin 35. The method of choice for testing amniotic fluid contaminated with hemoglobin for fetal lung maturity is: B) Amniostat 36. The normal brown color of the feces is produced by: B) urobilin 37. Stools from persons with steatorrhea contain excess amounts of: D) fat 38. A black, tarry stool is indicative of: A) Upper GI bleeding 39. A pale, frothy stool is indicative of: C) Excess fat 40. The recommended specimen for quantitative fecal testing is a: C) 72-hour specimen 41. The unpleasant odor associated with fecal analysis is caused primarily by: C) bacterial metabolism 42. Large orange-red droplets seen on direct microscopic examination of

stools mixed with Sudan III represent: C) neutral fats 43. Wet preparations for the detection of fecal neutrophils are stained with: *(Bonus)* D) methylene blue 44. Increased neutrophils in a stool may indicate: D) /Salmonella/ infection 45. To prevent false-positive fecal occult blood tests, patients should avoid eating all of the following for 3 days before testing /*except*/: B) chicken 46. What is the recommended procedure for collecting a 24-hr urine sample? D) Void the first morning specimen, start the timing, and collect all other specimens including the next morning's specimen 47. Which fluid is aspirated from the peritoneal cavity? A) Ascites 48. What additional information is typically required when labeling a nonblood specimen? D) Specimen type and source 49. Which of the following tests requires a 24-hour urine specimen? A) Creatinine clearance 50. A first morning specimen is preferred for hCG testing because it is C) typically more concentrated. 51. Drugs of abuse can be detected in D) all of the above A) hair B) saliva C) urine 52. This type of urine collection involves the aspiration of urine directly through the wall of the bladder using a sterile needle and syringe. D) Suprapubic 53. Fluid found around the heart is called pericardial. A) True 54. DNA analysis can be done using a buccal swab on the inside of the cheek. A) True 55. Part of a phlebotomist's job may be to instruct a patient on how to collect a clean catch midstream urine specimen. A) True

1. Which needle gauge has the largest lumen? A) 18 2. The tests performed in the following department are typically collected in a tube with a light blue stopper B) Coagulation 3. A tube with a green stopper normally contains C) Heparin 4. What is the most important factor in choosing which gauge needle to use for venipuncture? C) Size and condition of the vein 5. Which additive is usually present in a tube with a lavender stopper? B) EDTA 6. The slanted tip of the needle that enters the vein is called the: A) bevel 7. According to CLSI standards, which tube is filled last when using a syringe: A) EDTA 8. A type of needle used to collect blood from small or difficult veins is known as a butterfly. A) True 9.EDTA is the most common source of carryover problems *(Bonus)* A) True 10. In a routine ETS venipuncture, the lavender tube should be drawn before the red tube. B) False 11. In a routine ETS venipuncture, the red tube should be drawn before the green tube. A) True 12. There is a request to draw a specimen from an inpatient by the name of John Doe. Which of the following is an acceptable way to confirm the patient's identity? *(Bonus)* C) Match the ID band and requisition with his verbal statement if ID. 13. The following tests have all been ordered at the same time on different in inpatients. There is only one phlebotomist on duty. Which test should the phlebotomist collect first? C) STAT electrolytes in the ER

14. Communicating in this way before obtaining a blood specimen from a child is poor technique. C) Telling the child it won't hurt 15. What may happen if you mix a specimen too vigorously? C) Hemolysis 16. Never leave a tourniquet on for more than B) 1 minute 17. What is the most critical error a phlebotomist can make? D) Misidentifying a patient specimen 18. What would be the system of choice to identify laboratory specimens from an unconscious, unidentified woman in the emergency room? D) Use a three-part identification band and labels. 19. The priority designation for a test request is based on all of the following EXCEPT: A) age and gender 20. An unconscious patient is not wearing an ID band. There is an ID band taped to the patient's IV pole with the information that matches the requisition. What should the phlebotomist do? D) Only draw the specimen after an ID band has been applied. 21. What is the purpose of waiting 30 seconds for the alcohol to dry before needle insertion? D) All of the options are correct. A) To let evaporation help destroy microbes. B) To avoid a stinging sensation C) To prevent hemolysis of the specimen. 22. The process of collecting blood from a vein is known as Venipuncture *(Bonus)* A) True 23. The procedure of identifying a patient using the written requisition, arm band, and verbal confirmation is known as three-way-ID. A) True 24. It is important to mix anticoagulant tubes immediately so that they will clot properly. B) False 25. You must draw a protime specimen from a patient with IVs in both arms. Which of the following is the best thing to do? Draw the specimen B) below an IV 26. You have no choice but to draw a specimen from a site with a hematoma. Where should you obtain the specimen?

A) Distal to the hematoma 27. Which of the following vascular access devices is placed in a peripheral vein for the purpose of blood collection and administration of medication? B) Heparin lock 28. A phlebotomist has attempted twice to draw a partial thromboplastin (PTT) specimen from a patient with difficult veins. Both times the phlebotomist has been able to draw only a partial tube. What should the phlebotomist do? B) Have another phlebotomist attempt to draw the specimen 29. Which instance may lead you to suspect that you have accidentally punctured an artery? C) The blood pulses into the tube 30. If blood is drawn to quickly from a small vein, the vein will have a tendency to B) collapse 31. When a test requires a fasting specimen, but the serum is _______, it is a clue that the patient is not fasting. D) lipemic 32. Tests influenced by diurnal variation are often ordered as ______ tests, and it is important to collect them as close as possible to the time D) timed 33. When the additive from a tube "backwashes" into the patient, it is known as "reflux". A) True 34. The medical term for fainting is syncope. A) True 35. A condition in which blood components that cannot easily leave the blood stream become concentrated in the smaller plasma volume is known as "hemoconcentration". A) True 36. A person who lives on Pike's Peak is more likely to have a higher RBC count than a person who lives in Florida. A) True 37. If the blood is filling the tube very slowly and a hematoma is beginning to form, the needle may not be deep enough. A) True 38. If a patient is complaining of sharp radiating pain from the needle

insertion site, the phlebotomist should hurry and finish the draw. B) False 39. A blood smear made from an EDTA specimen should be made B) within 1 hour of collection. 40. Why are capillary blood gases less desirable than arterial blood gases (ABGs)? D) All of the above A) Skin puncture blood contains tissue fluid B) Skin puncture blood is only partly arterial C) The blood is exposed to air during collection 41. Why are EDTA specimens obtained before other specimens when collected by skin puncture? A) To minimize effects of platelet clumping 42. Why should a laboratory report form indicate the fact a specimen has been collected by capillary puncture? A) Because test results can vary depending on the method of collection 43. Which of the following is the safest area for infant heel puncture? C) The lateral plantar surface 44. The purpose of wiping away the first drop of blood during skin puncture is to B) eliminate tissue fluid contamination 45. Which microcollection container would be used to collect a specimen for a CBC? C) Purple top 46. What is a PKU? B) A hereditary inability to metabolize phenylalanine 47. It is necessary to control depth of lancet insertion during capillary puncture to avoid C) injuring the heel bone 48. What is the purpose of warming the site before skin puncture? B) It increases blood flow up to seven times 49. A good blood smear should exhibit a feather edge.*(Bonus)* A) True 50. Capillary bilirubin specimens should be protected from light. A) True 51. A microhematocrit tube is primarily used for manual potassium determinations. B) False 52. A phlebotomist should puncture a finger perpendicular to the fingerprint whorls. A) True

53. If a baby has a huge, fleshy big toe, it is acceptable to collect a bilirubin specimen from it. B) False 54. Of the following tests, which is most likely to result in fatal consequences if the patient is misidentified? D) Type and crossmatch 55. Which test requires strict skin antisepsis procedures before specimen collection? A) Blood Culture 56. What type of additive is recommended for collecting an ethanol test specimen? D) Sodium fluoride 57. When performing a GTT, the timing should begin A) as soon as the patient finishes the drink. 58. Which test is used to monitor heparin therapy? A) ACT 59. At what intervals is the blood blotted during a bleeding time test? C) 30 seconds 60. To prevent introducing a contaminating substance into a trace-element collection tube, it is suggested that the phlebotomist B) draw it by itself using a syringe or evacuated tube system 61. When collecting a blood culture specimen directly from a butterfly into blood culture bottles, which should be filled first? A) Aerobic 62. Which of the following tests may require special "chain of custody" documentation when collected? C) Drug screen 63. Identify the condition in which a unit of blood is withdrawn from a patient as treatment. C) Hemochromatosis 64. Which of the following tubes can be used to collect blood for a type and crossmatch? B) Pink top EDTA tube 65. An autologous blood transfusion is a transfusion of blood B) donated by the patient for the patient. 66. The most critical aspect blood of blood culture collection is

B) skin antisepsis. 67. The hormone detected in positive urine pregnancy test is C) HCG 68. TDM is used by physicians to A) Determine a beneficial drug dosage for a patient 69. A condition in which a patients has a high blood glucose level is know as hypoglycemia B) False 70. A patient who is suspected of having lead poisoning should have his or her lead test specimen drawn in a light blue tube. *(Bonus)* B) False 71. The process of entering a password and gaining access to a computer is called C) Logging on 72. A specimen would most likely be accepted for testing despite this problem. C) No phlebotomist initials 73. Which of the following is used by the laboratory to identify a specimen throughout the testing process? A) Accession number 74. A pneumatic tube is a A) pressurized air transportation system. 75. An example of a preanalytical error happening during specimen processing is B) inadequate centrifugation. 76. Which of the following would NOT be considered a preanalytical error? C) Misreporting patient results 77. this is a source of preanalytical error that occurs before specimen collection. A) Dehydrated patient 78. Which of the following specimens needs to be chilled? A) Ammonia 79. Which of the following specimens are least likely to require special handling? B) Cholesterol and uric acid 80. Which specimen can be centrifuged immediately upon arrival in specimen processing? B) Calcium in a green top tube.

81. The handling of a specimen before it is actually tested is part of the postanalytical phase. B) False 82. A specimen arrives with less volume than is needed for the test. It will be noted why the specimen was rejected by using the abbreviation QNS. A) True 83. "ASAP" or "Med Emerg" specimens must be attended to before routine specimens. A) True 84. What is the recommended procedure for collecting a 24-hr urine sample? D) Void the first morning specimen, start the timing, and collect all other specimens including the next morning's specimen 85. Which fluid is obtained by lumbar puncture? A) Cerebrospinal 86. What additional information is typically required when labeling a nonblood specimen? D) Specimen type and source 87. Which test is used to diagnose cystic fibrosis? D) Sweat chloride 88. Which of the following tests requires a 24-hour urine specimen? A) Creatinine clearance 89. A urine C & S is typically ordered to detect D) presence of UTI 90. An NP culture swab is collected to detect the presence of organisms that cause D) whooping cough 91. A first morning specimen is preferred for hCG testing because it is C) typically more concentrated. 92. Drugs of abuse can be detected in D) all of the above A) hair B) saliva C) urine 93. Which type of specimen must be protected from light? A) Amniotic fluid 94. Sputum samples are typically collected to diagnose D) tuberculosis. 95. A urine specimen collected directly from the bladder through a tube in the urethra is called: A) Catheterized

96. The fluid found around a fetus is known as amniotic fluid. A) True 97. Inserting a needle between the 2nd and 3rd lumbar vertebrae to collect fluid from the spinal cavity is called suprapubic aspiration. B) False 98. DNA analysis can be done using a buccal swab on the inside of the cheek. A) True 99. Cellular components in urine are well preserved and require no additional preservation. B) False 100. Part of a phlebotomist's job may be to instruct a patient on how to collect a clean catch midstream urine specimen. A) True 101. Which artery is typically the easiest to access during low cardiac output? B) Femoral 102. The artery of choice for ABG collection: C) Radial 103. Which of the following is the most common arterial puncture complication even when proper technique is used? A) Arteriospasm 104. Which of the following abbreviations represent a test that is typically part of ABG evaluation? C) PaO2 105. The primary reason for performing arterial puncture is to: B) evaluate blood gases.