NHA CPT NHA Certified Phlebotomy Technician - Set 5 - Part 2

Correct Answer: Hand carry; never send by pneumatic

citrated coagulation specimens should be hand-carried rather than sent through pneumatic tube systems. Mechanical activation of platelets in the citrate tube can falsely shorten partial thromboplastin time during transport. Option b is incorrect because sending citrated specimens via pneumatic tube without precautions risks mechanical activation of platelets. Hospitals typically validate their pneumatic systems and exclude coagulation specimens from routine pneumatic transport. The standard reflects current practice in routine clinical phlebotomy. Option c is incorrect because tube transport with ice does not solve the mechanical activation problem. Cold accelerates platelet activation rather than preventing it, and citrated coagulation specimens should be hand-carried. The standard reflects current practice in routine clinical phlebotomy. Option d is incorrect because tubing only after centrifugation does not match standard practice for citrated coagulation specimens. Coagulation spec

Correct Answer: Coagulation, platelets, cryoglobulins, blood gases

the standard exclusions include coagulation specimens, platelet function tests, cryoglobulins, and blood gases. Mechanical stress, temperature shifts, and air bubble introduction make pneumatic transport unsuitable for these specimens. Option a is incorrect because routine chemistry tubes are typically allowed in pneumatic transport rather than excluded. The exclusion list targets specific specimens with mechanical or temperature sensitivity that pneumatic systems cannot accommodate safely. Option b is incorrect because the list with EDTA tubes, blood cultures, and urinalysis does not match standard exclusion criteria. EDTA hematology specimens are typically allowed, while the actual exclusions involve coagulation and gas-sensitive tests. Option c is incorrect because lavender EDTA tubes alone are typically not excluded from pneumatic transport. The exclusion list targets coagulation, platelets, cryoglobulins, and blood gases specifically rather than routine hematology tubes. The stand

Correct Answer: UN3373 Category B

routine diagnostic patient specimens ship as UN3373 Category B, Biological Substance, Category B. The classification covers most clinical specimens that do not meet the high-risk Category A pathogen criteria. Option a is incorrect because UN2814 Category A applies only to cultures of high-risk pathogens like Yersinia pestis or Ebola virus. Routine diagnostic patient specimens ship as Category B rather than this higher tier. Option c is incorrect because UN1845 is the dry ice classification used as a refrigerant rather than a specimen category. Dry ice can accompany Category B specimens, but the specimen itself ships as UN3373 Biological Substance. Option d is incorrect because exempt human specimen applies to specimens with minimal pathogen likelihood like routine wellness screening. Most diagnostic specimens ship as UN3373 Category B unless specifically known to be exempt.

Correct Answer: Primary, secondary leak-proof, rigid outer

the triple packaging system places the primary tube with absorbent material first, a leak-proof secondary container second, and a rigid outer packaging third. The outer carries the UN3373 diamond label and shipper information. Option a is incorrect because a single bag with absorbent fails to meet the three-layer requirement of IATA Packing Instruction six fifty. Category B substances require three distinct layers for safe transport. Option b is incorrect because two layers fall short of the three-layer requirement under IATA rules. The standard explicitly requires primary, secondary, and outer layers, not a simplified two-layer system. The standard reflects current practice in routine clinical phlebotomy. Option d is incorrect because four layers including dry ice always overstates the requirement. Dry ice is added only when the specimen needs frozen transport, while the three-layer rule applies regardless of refrigerant.

Correct Answer: One point two meters

the outer packaging must pass a drop test from one point two meters with a fully loaded simulated payload. The test confirms the packaging withstands routine handling without leakage during transport. Option b is incorrect because half a meter is below the IATA drop test standard and would not validate packaging strength adequately. The standard sets one point two meters to simulate realistic handling drops. Option c is incorrect because three meters exceeds the IATA standard and would represent unrealistic drop heights. The standard at one point two meters reflects realistic mishandling rather than extreme falls during transport. Option d is incorrect because ten meters far exceeds any practical drop test standard and is not used in IATA validation. The standard sits at one point two meters, providing realistic packaging strength without overengineering it.

Correct Answer: Reject below ninety percent of fill line

the citrate tube must be filled to at least ninety percent of the marked draw line. Below that threshold, excess citrate prolongs prothrombin and partial thromboplastin times falsely, requiring redraw of the specimen. Option a is incorrect because below fifty percent is far below the ninety percent threshold. Specimens at fifty percent fill produce dramatically distorted coagulation results, but the rejection threshold sits at ninety percent rather than fifty. Option b is incorrect because below twenty-five percent fill is too lenient for coagulation specimens. The rejection threshold is far stricter, at ninety percent of the marked fill line, due to the nine-to-one ratio sensitivity. Option c is incorrect because below ten percent fill is essentially empty and obviously rejected. The actual threshold for rejection is much higher, at ninety percent of the marked fill line, to maintain assay accuracy.

Correct Answer: Reject and request redraw

clotted EDTA tubes are rejected because clumped cells produce inaccurate platelet counts and pseudothrombocytopenia. The laboratory requests a redraw rather than running invalidated hematology specimens with visible clots. Option a is incorrect because running anyway with a noted clot reports invalidated results that mislead clinicians. The standard rejects clotted EDTA tubes outright rather than reporting unreliable counts with caveats during routine analysis. Option c is incorrect because centrifuging to remove the clot does not restore the cellular profile of the specimen. The clumped cells stay clumped, and the analyzer cannot count cells trapped in clots accurately. Option d is incorrect because filtering and running quickly does not restore accuracy and is not standard practice. The clumped cells in clots cannot be released and counted, so the standard rejects the specimen entirely.

Correct Answer: Potassium, lactate dehydrogenase, AST, magnesium

potassium, lactate dehydrogenase, aspartate aminotransferase, and magnesium are most affected by hemolysis interference. All four concentrate intracellularly, so red cell rupture releases them into serum and falsely elevates results. Option b is incorrect because sodium, chloride, glucose, and urea are similar inside and outside cells, so hemolysis affects them minimally. The dominant hemolysis interference falls on potassium and other intracellular analytes specifically. Option c is incorrect because bilirubin, calcium, and total protein are not the primary hemolysis-sensitive analytes. Hemolysis can interfere with bilirubin photometric measurement, but the dominant clinically significant effect is on potassium. Option d is incorrect because albumin, alkaline phosphatase, and cholesterol are not the main hemolysis-sensitive analytes. The classic interference set is potassium, lactate dehydrogenase, aspartate aminotransferase, and magnesium primarily. The standard reflects current prac

Correct Answer: Lipemic, optical interference

the cloudy milky white appearance is called lipemia, caused by elevated triglycerides or recent fatty meal. Lipemia produces optical interference with photometric assays through turbidity exceeding analyzer tolerance limits during measurement. Option a is incorrect because hemolyzed serum is pink to red, not cloudy white. Hemolysis affects potassium and other intracellular analytes, while the cloudy milky white appearance is specifically lipemia rather than hemolysis. Option b is incorrect because icteric serum is yellow to dark amber from elevated bilirubin, not cloudy white. Icterus is a separate interference category from lipemia, with each having distinct visual appearance and assay interference patterns. Option d is incorrect because clear serum shows no interference and indicates normal lipid and bilirubin levels. The cloudy white appearance described in the scenario is lipemia, which does interfere with photometric chemistry assays.

Correct Answer: Reject and require redraw

unlabeled specimens are rejected outright and require redraw. Running an unlabeled specimen risks issuing wrong-patient results, which is a serious patient safety hazard with immediate clinical and regulatory consequences. Option a is incorrect because running anyway and labeling later allows the specimen to be confused with another patient's during analysis. The standard rejects unlabeled specimens immediately without exception during processing. The standard reflects current practice in routine clinical phlebotomy. Option b is incorrect because matching label to requisition manually based on the assumed identity bypasses the bedside identification standard. Specimens must be labeled at the bedside in the patient's presence, not retrospectively at the bench. Option c is incorrect because centrifuging first and labeling after spinning still produces a specimen with broken bedside labeling. The standard requires bedside labeling in the patient's presence rather than later

Correct Answer: CLIA eighty-eight

CLIA eighty-eight, the Clinical Laboratory Improvement Amendments of nineteen eighty-eight, is codified at forty-two CFR Part four ninety-three. CMS administers the program with technical guidance from CDC and FDA. Option b is incorrect because the HIPAA Privacy Rule covers patient health information privacy rather than laboratory testing standards. Privacy is a separate regulatory regime from the analytical and quality requirements of CLIA. Option c is incorrect because the Bloodborne Pathogens Standard governs occupational exposure to blood and OPIM. It addresses worker safety rather than laboratory testing standards, which fall under CLIA jurisdiction instead. The standard reflects current practice in routine clinical phlebotomy. Option d is incorrect because the Hazard Communication Standard governs chemical labeling and safety data sheets. It addresses chemical hazard communication rather than laboratory testing accuracy and quality requirements. The standard reflects current prac

Correct Answer: Certificate of Waiver

a Certificate of Waiver covers FDA-classified waived tests like urine pregnancy strips, urine dipsticks, and rapid strep antigens. The certificate must be renewed every two years and confines the clinic to that simple-complexity menu. Option a is incorrect because a Certificate of Compliance applies to nonwaived testing surveyed by CMS or a state agency. A clinic running only waived tests would not need that certificate, so applying for it would impose unnecessary inspection burden and cost. Option b is incorrect because a Certificate of Accreditation supports nonwaived testing inspected by a CMS-deemed accreditor like CAP or COLA. A waived-only menu does not require that level of oversight, so the simpler waiver certificate fits the practice better. Option d is incorrect because Provider-Performed Microscopy permits a provider to perform certain microscopic procedures in addition to waived tests. The clinic plans no microscopy work, so selecting this certificate would extend authority

Correct Answer: The 1-3s rule, requiring run rejection

a single value beyond three standard deviations violates the 1-3s rule, which forces run rejection because the deviation is too large to attribute to chance. The technician investigates and reruns controls before releasing results. Option a is incorrect because the 1-2s rule is a warning fired by one value beyond two standard deviations. The current value also exceeds three standard deviations, so the stricter 1-3s rejection rule applies. Option b is incorrect because the R-4s rule looks at range between two consecutive controls exceeding four standard deviations on opposite sides. The scenario describes a single control value, so range-based logic does not apply. Option c is incorrect because treating the 1-2s rule as a rejection trigger overstates the warning. The rule fires as a warning rather than a rejection, and stricter rules like 1-3s drive actual run rejection decisions.

Correct Answer: Proficiency testing

proficiency testing programs send blinded specimens at regular intervals so the laboratory compares its values against peer results. CAP runs the largest such program globally, and CLIA mandates participation for nonwaived analytes. Option a is incorrect because Westgard rules are statistical control rules applied to internal quality control runs using Levey-Jennings charts. They monitor daily analyzer performance with control material rather than blinded external specimens. Option c is incorrect because sentinel event review investigates rare patient-harm events such as wrong-site surgery or transfusion incompatibility. It does not involve mailed unknown specimens, since sentinel review focuses on root cause analysis. Option d is incorrect because tracer methodology is the inspection technique Joint Commission surveyors use to follow a patient's care path through several departments. Tracer activity is conducted by surveyors on site rather than through periodic mailed specimens.

Correct Answer: Eighty percent acceptance rate

the standard PT acceptance threshold is eighty percent. Laboratories scoring below that on any analyte across two of three consecutive testing events face unsuccessful PT performance and corrective action requirements. Option b is incorrect because fifty percent acceptance is too lenient and would not protect against systematic analytical errors. The standard tightens to eighty percent specifically to ensure adequate analytical performance across testing events. Option c is incorrect because thirty percent acceptance is essentially failing performance and would not satisfy CLIA requirements. The standard sits much higher, at eighty percent, which laboratories must achieve consistently. The standard reflects current practice in routine clinical phlebotomy. Option d is incorrect because one hundred percent acceptance is unrealistic given normal analytical variation. The eighty percent threshold acknowledges variability while maintaining quality, and one hundred percent would not be achie

Correct Answer: Forty-nine CFR Part forty

forty-nine CFR Part forty governs chain of custody for federally regulated drug testing programs administered by the Department of Transportation and SAMHSA. The regulation defines the chain of custody form and required collection procedures. Option a is incorrect because OSHA twenty-nine CFR 1910.1030 covers occupational exposure to bloodborne pathogens. It addresses worker safety rather than forensic chain of custody, which is regulated separately under DOT and SAMHSA rules. Option b is incorrect because the HIPAA Privacy Rule covers patient health information privacy and security. It does not govern forensic drug testing chain of custody, which is regulated under DOT Part forty rather than HIPAA. Option d is incorrect because ANSI Z358.1 covers emergency eyewash and shower equipment. It addresses workplace exposure response rather than forensic drug testing chain of custody requirements at all. The standard reflects current practice in routine clinical phlebotomy.

Correct Answer: Specimen invalidated, requires recollection

a broken tamper-evident seal invalidates the specimen for forensic purposes and requires recollection. The seal break is a fatal flaw in chain of custody, since the specimen identity can no longer be verified. Option a is incorrect because running anyway with a note does not preserve evidentiary value. The chain of custody is broken once the seal is compromised, so the result cannot serve forensic or legal purposes regardless. Option c is incorrect because repairing the seal does not restore chain of custody integrity. The original break remains documented in the chain, and any repaired seal is itself evidence of tampering rather than fixing the issue. Option d is incorrect because refrigerating the specimen does nothing to address the broken seal issue. Temperature stability is unrelated to the chain of custody integrity, which has already been irreparably compromised. The standard reflects current practice in routine clinical phlebotomy.

Correct Answer: Ninety to one hundred Fahrenheit

the SAMHSA temperature window for fresh forensic urine is ninety to one hundred Fahrenheit measured within four minutes of collection. The window confirms the specimen came from the donor's body rather than substitution. Option a is incorrect because seventy-two to eighty Fahrenheit is below the SAMHSA acceptance window and suggests substitution or cooling of a substituted specimen. Fresh urine from the body sits much warmer than this range during collection. Option b is incorrect because one hundred ten to one twenty Fahrenheit exceeds normal body temperature significantly. The high reading suggests heating to mask substitution, so the standard window stops at one hundred Fahrenheit. Option c is incorrect because below fifty Fahrenheit is far below body temperature and suggests refrigeration of substituted urine. Legitimate fresh specimens sit at the standard ninety to one hundred Fahrenheit window during collection.

Correct Answer: Thirty mL primary, fifteen mL split

SAMHSA specifies thirty milliliters minimum for the primary specimen and fifteen milliliters for the split confirmation specimen. The volumes ensure adequate material for initial screening and any required confirmation testing on positive screens. Option b is incorrect because five and ten milliliter volumes fall well below SAMHSA standards. The federal requirements specify thirty milliliters primary and fifteen milliliters split for adequate testing material. The standard reflects current practice in routine clinical phlebotomy. Option c is incorrect because ten and twenty milliliter volumes still fall below SAMHSA standards. The federal volumes are higher, with thirty milliliters primary and fifteen milliliters split being the official specification. The standard reflects current practice in routine clinical phlebotomy. Option d is incorrect because fifty and one hundred milliliter volumes exceed typical SAMHSA standards and are not the published specification. The federal standard s

Correct Answer: Reviews positive results, considers explanations

the medical review officer reviews positive drug screen results, contacts the donor to consider legitimate medical explanations, and decides whether to verify the result. The MRO is a critical safeguard against false positive reporting. Option a is incorrect because the medical review officer does not perform analytical testing of the urine. Laboratory analysts run the assay, while the MRO reviews positive results afterward for legitimate explanations. The standard reflects current practice in routine clinical phlebotomy. Option b is incorrect because the medical review officer does not witness the urine collection. A trained collector witnesses the collection, while the MRO enters the workflow only after the laboratory reports positive results. Option d is incorrect because the medical review officer does not sign off as the donor. The donor signs the chain of custody form personally, while the MRO is a separate clinician who reviews positive results.