Deck 13: Quality Assessment and Management in Phlebotomy

Question 1

The monitoring of specimen ordering may include examination of all of the following measures except:

A) delays in the collection of timed tests.
B) timeliness of the delivery of patient reports.
C) the number of incomplete requisitions.
D) measurement of turnaround time (TAT).

Answer 1

B

Question 2

Errors in the requisitioning of a test may include:

A) generating duplicate orders.
B) reporting a test result on a paper form.
C) reporting a test result electronically to a remote printer.
D) collecting the wrong type of patient sample.

Answer 2

A

Question 3

A phlebotomist has a question about the proper patient preparation and sample for a test that is done infrequently, and so he or she has not memorized this information. The best place to access this information is the:

A) quality control manual.
B) procedure manual.
C) test reporting guide.
D) test interpretation guide.

Answer 3

B

Question 4

Phlebotomists are involved in which of the following phases of the testing process:

A) preexamination and postexamination phases.
B) preexamination phase only.
C) preexamination and examination phases.
D) postexamination only.

Question 5

Examination variables occur:

A) during the reporting of test results.
B) at variable and unpredictable times.
C) during the testing of specimens.
D) before the testing of specimens.

Question 6

Postexamination variables:

A) involve the reporting of results only.
B) may involve reporting and interpretation of test results.
C) may involve assessing the adequacy of the patient sample.
D) involve the interpretation of test results.

Question 7

Quality assessment (QA) differs from quality control (QC) because:

A) QA refers to the overall process of guaranteeing quality patient care.
B) QC refers to controls of waived tests only.
C) QA refers only to controls for lab surveys.
D) QC refers to the overall process of guaranteeing quality patient care.

Question 8

The most serious errors in phlebotomy are:

A) failures of order of draw.
B) failures to properly mix samples that require mixing.
C) failures to collect routine samples in a timely manner.
D) failures of patient identification.

Question 9

Documentation required by the Joint Commission (JC) includes all of the following except:

A) a detailed procedure manual for each procedure.
B) identification of variables associated with each procedure.
C) policies to control and monitor variables.
D) detailed procedure manuals on all nursing floors.

Question 10

Preexamination variables occur:

A) during the testing of samples.
B) during the reporting of test results.
C) at variable and unpredictable times.
D) before testing has taken place.

Question 11

Postexamination variables occur:

A) at variable and unpredictable times.
B) during the reporting of test results.
C) during the testing of specimens.
D) before testing has taken place.

Question 12

The examination phase of testing refers to:

A) processes occurring during the testing of a sample.
B) any phase of testing that is governed by policies and uniform practices.
C) any phase of testing that is governed by the laws of science.
D) processes having to do with distribution and interpretation of test results.

Question 13

The acronym QA in a laboratory's QA plan refers to:

A) quality action.
B) quality activities.
C) quality assessment.
D) quality activity.

Question 14

Justification for additional training of phlebotomists who are missing tests or collecting improper samples may be gained by examination of all of the following except:

A) monitoring the number of missed tests.
B) monitoring turnaround times.
C) monitoring the schedules of couriers delivering test results.
D) monitoring the number of contaminated patient blood cultures.

Question 15

A desirable time for "sweeps" or large numbers of patient collections is:

A) late at night, when patients are in a basal state.
B) after the outpatient collection area closes for the day.
C) early morning hours, when patients are in a basal state.
D) after physicians have finished their patient rounds.

Question 16

One effective means of detecting improper patient identification is the:

A) label check.
B) duplicate testing of all patient samples on random days.
C) Delta check.
D) examination of sharps containers for wasted tubes.

Question 17

The phlebotomy department is a central part of the laboratory quality assessment (QA) program because of:

A) its close contact with patients and other hospital personnel.
B) its responsibility for transporting patients.
C) its responsibility for reporting test results only.
D) its limited responsibility for providing quality specimens.

Question 18

A properly prepared laboratory procedure manual provides the following types of information about a laboratory test:

A) normal values for the test.
B) specimen type and method of collection required.
C) step-by-step procedure for the test.
D) all of the above

Question 19

In a laboratory test, variables:

A) can occur in all phases of testing.
B) have been eliminated using modern instruments.
C) occur during the analytical phase only.
D) are so unpredictable they cannot be studied.

Question 20

Laboratory procedure manuals must be:

A) locked up to avoid unauthorized changes.
B) available to all employees at all times.
C) reviewed for needed changes every 2 years.
D) reviewed by key personnel only.

Question 21

Application of the tourniquet on the patient's arm for longer than one minute may cause:

A) an increase in contaminated blood cultures.
B) a clotted sample in the red top tubes collected.
C) an increase in concentration of large molecules.
D) decreased pain and discomfort in the arm.

Question 22

All of the following may be effective strategies to reduce the number of contaminated blood cultures except:

A) review staffing levels for adequacy of phlebotomist coverage.
B) require all phlebotomists to attend in-service training for proper collection technique.
C) begin using another type of collection tube media immediately.
D) verify the use of proper technique by phlebotomists by the use of competency testing.

Question 23

Improper cleansing of the venipuncture site is the most frequently encountered variable associated with:

A) contaminated blood cultures.
B) hemolyzed samples.
C) clotted samples.
D) clotted microhematocrit tubes.

Question 24

Variables which can change or alter the testing system:

A) can happen by chance only.
B) can happen by chance or by human activity.
C) can happen as a result of causes that are impossible to determine.
D) can happen by human activity only.

Question 25

Turnaround time (TAT) for a test generally means:

A) the amount of time between the ordering of a test and the reporting of the result.
B) the amount of time between collecting a patient's samples and their arrival in the lab.
C) the amount of time needed to identify the patient and collect all samples.
D) the amount of time between the ordering of a test and collection of the sample.

Question 26

Errors in site selection or patient identification affect all the following except:

A) quality control sample results.
B) test results that are affected by hemolysis, such as potassium.
C) test results that are affected by intravenous fluids, such as sodium or chloride.
D) Delta checks.

Question 27

Accidental punctures with contaminated sharps can reduce productivity and lower morale among the phlebotomy staff and may delay collection and testing of other specimens. Strategies for reducing these incidents include:

A) provision of ample sharps containers.
B) immediate reports to the supervisor and documentation with incident reports.
C) regular and ongoing training in the use of safety features and phlebotomy practices.
D) all the above

Question 28

A phlebotomist is collecting a sample for potassium by fingerstick on an adult patient. The patient's hands are callused and the phlebotomist experiences difficulty in obtaining enough sample. One possible effect of this difficulty is:

A) the finger involved must not be used for future collections.
B) excessive squeezing and tissue fluid in the sample may affect the potassium result.
C) a postexamination variable is caused.
D) no significant effect on the sample is likely.

Question 29

Phlebotomy personnel must review the procedure manual (and document this review):

A) only when procedures are revised, added, or deleted.
B) once every 6 months.
C) once each year.
D) only when required to do so by a supervisor.

Question 30

Phlebotomy collection sites that should be avoided because of the possibility of specimen collection include all of the following except:

A) arm receiving intravenous fluids.
B) hematomas.
C) uncomplicated antecubital area of one of the patient's arms.
D) arm immediately adjacent to a mastectomy site.

Question 31

A failure to properly fill a light blue top tube for coagulation tests may introduce what type of variable to the test system?

A) Examination
B) Preexamination
C) Postexamination
D) No variable will result

Question 32

An effective means of increasing the accuracy of patient identification is to:

A) label all patient tubes ahead of time before beginning collections.
B) use signs on the walls or on the ends of beds showing patient names to identify them.
C) use the patient chart to identify the patient.
D) utilize wrist bands with bar codes to identify the patient.

Question 33

A Delta check helps to detect potential errors in patient results by:

A) comparing quality control results against acceptable ranges.
B) comparing patient results for selected tests that are outside of established parameters.
C) comparing randomly selected test results against reference ranges.
D) comparing patient results for all tests that are outside of established parameters.

Question 34

Justifiable complaints from patients or physicians may be caused by all of the following except:

A) a fingerstick draw for a hematocrit from a patient with a history of bilateral mastectomies.
B) repeated unsuccessful draws with poor specimen quality.
C) painful or repeated probing with an ETS.
D) inappropriately located heelsticks in a neonate.

Question 35

Phlebotomy collection sites to be avoided to prevent patient injury include:

A) arteries for routine testing.
B) arms with fistulas or shunts.
C) burned and scarred areas.
D) all are correct.

Question 36

An effective means of documenting improper patient identification is:

A) an incident report.
B) a quality control chart.
C) an acceptable Delta check.
D) verbal counseling.

Question 37

The following are valid reasons for performing Delta checks except:

A) verify that phlebotomists are following the proper order of draw.
B) verify that samples were properly inverted when required.
C) verify that sharps wastes were properly disposed of.
D) verify that patients have been properly identified.

Question 38

A phlebotomist works in a small laboratory that uses manual requisitions to order tests. The use of these manual requisitions requires the phlebotomist to check the proper box to indicate if the test is routine, stat, or ASAP. If the phlebotomist checks "routine" instead of "stat" for a sample, what type of variable is introduced into the test system?

A) Preexamination
B) No variable will result
C) Postexamination
D) Examination

Question 39

Patient preparation procedures listed in the phlebotomy procedure manual must be followed for all patient collections since these procedures may affect:

A) postexamination variables.
B) preexamination variables.
C) all variables depending on the nature of the test ordered.
D) examination variables.

Question 40

The outdate listed on a package of blood collection tubes is the:

A) last date the package of tubes may be opened.
B) last date that all the tubes in the package may be used for sensitive tests.
C) date to begin monitoring the tubes in the package for potential problems.
D) last date all the manufacturer guarantees the stability of the tubes.

Question 41

The use of pneumatic tube systems to deliver patient samples to the laboratory:

A) is suitable for all patient samples.
B) requires monitoring to check for hemolyzed or broken specimens.
C) is a win-win situation for the laboratory because sample transport is gentle and rapid.
D) is common in all sizes of hospitals, large and small.

Question 42

The best way to avoid introducing preexamination variables into specimen testing at the specimen processing stage would be to:

A) consult the procedure manual or the supervisor when questions arise.
B) process all specimens as stats.
C) automatically reject all specimens with questionable documentation or paperwork.
D) send paper copies of all test results to the client.

Question 43

An institution's quality management system (QMS) will incorporate which of the following requirements:

A) Joint Commission (JC), College of American Pathologists (CAP), International Organization for Standardization (ISO), Lean Sigma, and Six Sigma.
B) Occupational Safety and Health Act (OSHA) requirements only.
C) College of American Pathologists (CAP) requirements only.
D) Joint Commission (JC) and College of American Pathologists (CAP) requirements only.

Question 44

Preexamination variables that may be introduced into a test system by a failure to properly calibrate and maintain centrifuges include all the following except:

A) incomplete separation of cells and plasma or serum in samples.
B) deterioration of chemical elements in the samples.
C) cellular damage including hemolysis caused by excessive speed or time in the centrifuge.
D) unacceptable results for quality control specimens.

Question 45

Which of the following forms of information must be present in the patient's medical record when reporting the results of laboratory tests?

A) The turnaround time for the test
B) The results of the quality control materials run with each patient sample
C) The results of the latest Delta check for the patient's test results
D) The tests performed, the results, and the reference ranges of the tests

Question 46

Documentation of the time between the delivery of a requisition to the laboratory and the arrival of the associated specimen in the laboratory can be accomplished by the use of:

A) time entries in the computer system.
B) handwritten notes kept by the phlebotomist.
C) telephone records.
D) pneumatic tube system time entries.

Question 47

Errors in prioritizing specimens appropriately (routine versus stat) for processing are classified as:

A) postexamination variables.
B) different types of variables depending on the type of laboratory.
C) preexamination variables.
D) examination variables.

Question 48

Quality assurance (QA) activities in phlebotomy are:

A) separate from all other QA activities since patient samples must be drawn before any examination or postexamination activities can take place.
B) part of the laboratory and institutional QA activities.
C) part of the laboratory QA activities only.
D) part of the institutional QA activities only.

Question 49

The reporting of patient results by electronic means:

A) is limited to laboratory instruments only and not by point-of-care (POC) instruments.
B) is covered by preanalytical procedures and requirements .
C) is more common but still requires permanent records.
D) is not covered by accrediting agencies but is up to each laboratory to define.

Question 50

Centrifuge performance is verified using a:

A) tachometer.
B) stop-action photography instrument.
C) statement from the manufacturer.
D) series of randomly selected patient samples.

Question 51

Phlebotomists are most involved with the introduction of examination variables into the testing system:

A) whenever specimens are collected.
B) when processing specimens.
C) when performing point-of-care (POC) testing.
D) whenever any kind of testing is performed.

Question 52

When performing point-of-care testing, phlebotomists may contribute most effectively to the production of quality patient results by:

A) all responses are correct.
B) consistently using all available quality controls.
C) strictly following the procedure and manufacturer's instructions.
D) performing all required instrument calibration.

Question 53

When a test result has been entered incorrectly, the best way to enter a corrected test result in the patient's medical record is:

A) to follow the institution's policy for entering corrected reports.
B) to manually cross out the incorrect result and write the correct result next to it.
C) to manually delete the incorrect result in the computer record and type the correct result in its place.
D) to not change the patient's medical record but instead to add an explanation of the corrected result on a separate sheet of paper.

Question 54

In today's clinical laboratory, written reports of patient results:

A) are no longer used; all patient results are computerized.
B) can be placed in an inbox on the patient's floor for charting later.
C) are less important due to the increasing use of point-of-care (POC) testing.
D) are less common but must be placed in the patient's chart or entered into the computer system carefully.

Question 55

When aliquoting specimens into different tubes, the best means of labeling the pour off tubes to ensure that specimen numbers are correctly transferred is to:

A) hand-label additional labels for the pour off tubes.
B) label additional pour off tubes by hand at the patient's bedside.
C) line up the pour off tubes behind the original specimen tube in a rack and label them later.
D) use extra specimen tube labels generated by the laboratory computer system.

Question 56

Documentation in the specimen processing area must include:

A) technical processing instructions and procedures.
B) procedures for keeping records of corrective actions.
C) instructions for contacting a designated supervisor.
D) all responses are correct.

Question 57

Within an institution, a quality management system (QMS) is designed to coordinate activities in achieving which of the following goals:

A) reduction of medical errors.
B) all are correct.
C) staff competence and efficiency.
D) ensure quality results.

Question 58

Preexamination variables associated with specimen processing include all the following except:

A) centrifugation time and speed.
B) storage conditions including temperature and evaporation of samples.
C) availability of electronic test report generation instead of paper reports.
D) length of time between collection and processing.

Question 59

When corrective actions are necessary in the specimen processing area, the phlebotomist should:

A) send an e-mail to the supervisor.
B) keep a record of the actions following established procedures.
C) call the patient's physician and discuss the situation.
D) type up a summary of your actions and give it to the chief pathologist.

Question 60

Specimens should remain covered during processing and storage before actual testing to:

A) allow better fit in the centrifuge buckets.
B) reduce the chances of splashing, contamination, and evaporation.
C) reduce interference with the centrifuge's tachometer.
D) reduce the introduction of examination variables.

Question 61

The Six Sigma System utilizes the acronym DMAIC to describe its principles. In this acronym, M stands for:

A) modify current processes and collect date.
B) modernize processes to current industry standards.
C) measure current processes and collect data.
D) modernize statistical processes used in the study.

Question 62

Quality system essentials (QSEs) form the basis of a laboratory's quality management system (QMS) and contain the management information needed for a laboratory to perform quality work. Which of the following items might be studied as part of an examination of a laboratory's purchasing and inventory?

A) Total budget for purchase of reagents
B) A check to verify that all a laboratory's instrument are owned by the laboratory
C) Availability of adequate reagents, supplies, and service arrangements
D) Number of years each instrument has been in use

Question 63

Quality system essentials (QSEs) form the basis of a laboratory's quality management system (QMS) and contain the management information needed for a laboratory to perform quality work. Which of the following items might be studied as part of an examination of a laboratory's documents and records?

A) Records of adequate floor space in all departments
B) Examples of every document used by the laboratory stored in each department
C) Examples of safety notices posted in the laboratory
D) Records of the periodic review of all process and procedure documents

Question 64

The Lean System focuses on:

A) enhancing efficiency and proficiency in the system.
B) the elimination of waste in a system.
C) neither statement is correct; Lean's focus is in other directions.
D) A and B are correct.

Question 65

The Lean System utilizes a tool called "6S" that includes the words:

A) sigma, solo, sanitize, standard, sort, and spending.
B) study, sort, sigma, spend, study again and script.
C) sort, straighten, scrub, safety, standardize. and sustain.
D) sequence, sort, spend, solubilize, study. and sustain.

Question 66

Six Sigma methodology:

A) is a means of eliminating errors when properly applied to a process.
B) is a statistical modification of the original plan-do-check-act (PDCA) process.
C) has the primary goal of reducing spending on safety devices and practices.
D) is only used in the manufacturing and construction industries.

Question 67

The Lean System originated in what industry?

A) The construction industry in the United States
B) The automobile manufacturing industry in Japan
C) The health-care industry in Japan
D) The automobile manufacturing industry in the United States

Question 68

Quality system essentials (QSEs) form the basis of a laboratory's quality management system (QMS) and contain the management information needed for a laboratory to perform quality work. Which of the following items might be studied as part of an examination of a laboratory's facilities and safety?

A) Required safety precautions practiced and availability of equipment
B) A minimum amount of square feet available in every department
C) The number of windows available in the laboratory
D) Adequate space available for an employee lounge

Question 69

Quality system essentials (QSEs) form the basis of a laboratory's quality management system (QMS) and contain the management information needed for a laboratory to perform quality work. Which of the following items might be studied as part of an examination of a laboratory's external and internal assessments?

A) Development of quality indicators for the preanalytical phase of testing
B) Fire department inspection records
C) Development of quality indicators for each phase of testing
D) Development of quality indicators for the postanalytical phase of testing

Question 70

Quality system essentials (QSEs) form the basis of a laboratory's quality management system (QMS) and contain the management information needed for a laboratory to perform quality work. Which of the following items might be studied as part of an examination of a laboratory's information management?

A) Provisions for maintaining records of quality control results
B) Examples of procedures used by department
C) Provisions for maintaining the security of patient records
D) Instructions available for the running of Delta checks

Question 71

Quality system essentials (QSEs) form the basis of a laboratory's quality management system (QMS) and contain the management information needed for a laboratory to perform quality work. Which of the following items might be studied as part of an examination of a laboratory's testing equipment?

A) Records of ongoing preventive maintenance
B) Turnaround time goals achieved
C) Number of years in service
D) Annual leasing costs

Question 72

The primary goal of Six Sigma is to reduce variables and decrease errors to a level of 3.4 defects:

A) per 100 opportunities.
B) per 1 million opportunities.
C) per phlebotomist in each 40-hour week.
D) per year.

Question 73

Quality system essentials (QSEs) form the basis of a laboratory's quality management system (QMS) and contain the management information needed for a laboratory to perform quality work. Which of the following items might be studied as part of an examination of a laboratory's occurrence management or nonconforming event management?

A) Records of disciplinary actions taken against employees
B) Current acceptable ranges for all quality control materials
C) Remedial actions taken by each department
D) Temperature check records

Question 74

Quality system essentials (QSEs) form the basis of a laboratory's quality management system (QMS) and contain the management information needed for a laboratory to perform quality work. Which of the following items might be studied as part of an examination of a laboratory's process control?

A) The amount of the laboratory's process control budget
B) Quality control results and statistics
C) Records of the number of unacceptable specimens
D) Samples of reference ranges supplied with test results

Question 75

Quality system essentials (QSEs) form the basis of a laboratory's quality management system (QMS) and contain the management information needed for a laboratory to perform quality work. Which of the following items might be studied as part of an examination of a laboratory's personnel?

A) Continuing education records
B) Pension and 401K plans available
C) Number of years of service
D) Highest year of education completed

Question 76

Quality system essentials (QSEs) form the basis of a laboratory's quality management system (QMS) and contain the management information needed for a laboratory to perform quality work. Which of the following items might be studied as part of an examination of a laboratory's process improvement?

A) Evidence of utilization of Six Sigma methodology
B) Evidence of an emphasis on correcting mistakes
C) Evidence of use of quality control charts
D) Evidence of use of current information technology hardware

Question 77

The first step in a laboratory quality management system (QMS) activity is to:

A) determine the pathway of workflow through the laboratory.
B) determine the appropriate instructions for each activity in the preanalytical, analytical, and postanalytical phases of testing.
C) analyze processes and procedures that occur in each step of specimen analysis.
D) set acceptable limits for all quality control materials.

Question 78

The Six Sigma System utilizes the acronym DMAIC to describe its principles. In this acronym, D stands for:

A) describe goals and current processes.
B) determine possible future problems.
C) determine current problems.
D) define goals and current processes.

Question 79

Quality system essentials (QSEs) form the basis of a laboratory's quality management system (QMS) and contain the management information needed for a laboratory to perform quality work. Which of the following items might be studied as part of an examination of a laboratory's customer service?

A) Examination of records of specimen recollects
B) Feedback from customers including patients, patients' families, and health-care providers
C) Examination of quality control records across all departments
D) Feedback from instrument supply companies

Question 80

Quality system essentials (QSEs) form the basis of a laboratory's quality management system (QMS) and contain the management information needed for a laboratory to perform quality work. Which of the following items might be studied as part of an examination of a laboratory's organizational structure?

A) Quality control results for the previous quarter of the year
B) Turnaround time goals achieved
C) The number of personnel who are currently certified in their specialty
D) Personnel roles, responsibilities, and reporting relationships