NHA Certified Phlebotomy Technician (CPT) Exam — Questions and Answers

Question 1: A patient's chart is marked with a latex allergy. Which item must be removed from the blood draw setup?

Tourniquet (Correct answer)
Alcohol swab
Gauze pad
Vacutainer needle

Correct answer: Tourniquet

Standard tourniquets are often made of latex and must be replaced with a latex-free alternative for patients with latex allergies.

Question 2: How should a phlebotomist properly dispose of a full, sealed sharps container?

Place it in the regular trash bin.
Take it to a local pharmacy for disposal.
Place it in a designated biohazard waste collection bin for pickup. (Correct answer)
Empty the contents into a larger sharps container.

Correct answer: Place it in a designated biohazard waste collection bin for pickup.

Full and sealed sharps containers are considered regulated medical waste (biohazardous waste). They must be placed into a designated, leak-proof, and properly labeled secondary container or bin for disposal by a licensed medical waste management company, in accordance with federal, state, and local regulations.

Question 3: Which label color indicates a biohazardous specimen bag?

Green with white text
Yellow with black text
Red with black text
Orange with black biohazard symbol (Correct answer)

Correct answer: Orange with black biohazard symbol

Biohazard bags are orange or orange-red and must display the universal biohazard symbol in black.

Question 4: A requisition lists the patient's name as 'John Smith' but the wristband reads 'Jonathan Smith.' What should the phlebotomist do?

Draw the blood since the last name matches
Stop and clarify the discrepancy with nursing staff before drawing (Correct answer)
Draw only the most urgent tests and clarify later
Ask the patient to verbally confirm and proceed

Correct answer: Stop and clarify the discrepancy with nursing staff before drawing

Any discrepancy between the requisition and patient identification must be resolved before specimen collection to prevent a patient identification error.

Question 5: Which fluid a lumbar puncture can extract.

Peritoneal
Pleural
Synovial
Cerebrospinal (Correct answer)

Correct answer: Cerebrospinal

A lumbar puncture, commonly known as a spinal tap, is a medical procedure used to collect cerebrospinal fluid (CSF). CSF is the clear fluid that surrounds and protects the brain and spinal cord. Analyzing this fluid can help diagnose a wide range of neurological conditions and infections.

Question 6: What does a positive Allen test result indicate before radial artery puncture?

The patient has poor venous access
Adequate collateral circulation exists from the ulnar artery (Correct answer)
Anticoagulant therapy is present
The radial artery is blocked

Correct answer: Adequate collateral circulation exists from the ulnar artery

A positive Allen test confirms adequate ulnar artery collateral flow, meaning the hand will remain perfused even if the radial artery is damaged.

Question 7: A phlebotomist sustains a needlestick injury after drawing blood from a patient with unknown HIV status. What is the FIRST action to take?

Immediately report to the supervisor and complete an incident report
Test the source patient for HIV immediately
Start post-exposure prophylaxis (PEP) within 2 hours
Wash the wound thoroughly with soap and water (Correct answer)

Correct answer: Wash the wound thoroughly with soap and water

The first action after a needlestick is to immediately wash the wound thoroughly with soap and water for several minutes.

Question 8: Specimens for cold agglutinin testing must be transported at which temperature?

On ice at 4°C
Body temperature at 37°C (Correct answer)
Room temperature at 22°C
Frozen at -20°C

Correct answer: Body temperature at 37°C

Cold agglutinin specimens must be kept at 37°C during transport because cold temperatures cause the antibodies to agglutinate RBCs in the tube, giving false results.

Question 9: When a chemical spill occurs in the phlebotomy area, what should the phlebotomist consult FIRST?

Hospital administration policy manual
OSHA website
Safety Data Sheet (SDS) for the chemical (Correct answer)
Coworker with experience in spills

Correct answer: Safety Data Sheet (SDS) for the chemical

The SDS provides immediate, specific information on the chemical's hazards, protective measures, and spill cleanup procedures.

Question 10: For a urine culture collected by midstream clean-catch, the specimen must be delivered to the lab within what timeframe if not refrigerated?

30 minutes
12 hours
2 hours (Correct answer)
6 hours

Correct answer: 2 hours

Urine for culture must reach the lab within 2 hours at room temperature; beyond that, bacteria multiply and distort quantitative culture results.

Question 11: A laboratory rejects a light blue top tube for a coagulation test. Which of the following is the most likely reason for specimen rejection?

The tube was inverted 8 times after collection.
The tube was only filled to 75% capacity. (Correct answer)
The tube was transported at room temperature.
The tube was not protected from light.

Correct answer: The tube was only filled to 75% capacity.

Coagulation testing requires a specific ratio of blood to anticoagulant (9:1). An underfilled tube (short draw) will have an incorrect ratio, with too much anticoagulant, which will lead to inaccurate and prolonged clotting times. Most tubes have an indicator mark and must be filled to ±10% of that volume.

Question 12: What is the primary purpose of inverting a collection tube after drawing blood?

To mix the blood with the tube additive thoroughly (Correct answer)
To label the tube by noting the draw order
To activate clotting for serum separation
To prevent the needle from clogging

Correct answer: To mix the blood with the tube additive thoroughly

Gentle inversion (typically 3–8 times depending on tube type) ensures the blood mixes completely with the additive to achieve the intended anticoagulant or preservative effect.

Question 13: A phlebotomist cannot locate a vein after two unsuccessful attempts. What is the appropriate next step?

Make a third attempt on the same arm
Ask another qualified phlebotomist or supervisor to attempt the draw (Correct answer)
Apply a heat pack and retry immediately
Document the failure and skip the test

Correct answer: Ask another qualified phlebotomist or supervisor to attempt the draw

After two failed attempts, standard practice requires requesting another qualified collector to attempt the draw rather than continuing.

Question 14: When preparing a patient for a blood draw, which of the following is a key element of obtaining informed consent?

Assuming consent is given if the patient extends their arm.
Explaining the procedure in simple terms and asking for permission to proceed. (Correct answer)
Telling the patient that the doctor ordered the test and they must comply.
Having the patient sign a detailed legal document before every routine draw.

Correct answer: Explaining the procedure in simple terms and asking for permission to proceed.

Informed consent involves explaining the procedure to the patient in a way they can understand and getting their permission to perform it. For routine phlebotomy, this is typically a verbal explanation and confirmation. While extending an arm can imply consent (implied consent), a direct explanation and verbal agreement constitute a more thorough informed consent process.

Question 15: An irate patient grabs a phlebotomist's arm during a blood draw. This is an example of which type of workplace hazard?

Chemical hazard
Psychosocial/workplace violence hazard (Correct answer)
Physical hazard
Biological hazard

Correct answer: Psychosocial/workplace violence hazard

Physical assault or threatening behavior from patients falls under workplace violence, classified as a psychosocial hazard.

Question 16: Which of the following needle disposal containers is OSHA-approved for sharps disposal?

Puncture-resistant, leak-proof sharps container (Correct answer)
Cardboard box lined with a plastic bag
Any lidded plastic container
Standard red biohazard bag

Correct answer: Puncture-resistant, leak-proof sharps container

OSHA requires puncture-resistant, leak-proof, and properly labeled sharps containers for safe disposal of needles.

Question 17: What does the RACE acronym stand for in fire safety response?

Remove, Activate, Contain, Extinguish
Rescue, Alert, Contain, Evacuate
Remove, Alarm, Confine, Extinguish
Rescue, Activate, Contain, Extinguish (Correct answer)

Correct answer: Rescue, Activate, Contain, Extinguish

RACE stands for Rescue patients in danger, Activate the alarm, Contain the fire by closing doors, and Extinguish if safe to do so.

Question 18: During a routine venipuncture, the tourniquet should not be left on the patient's arm for longer than:

1 minute (Correct answer)
3 minutes
2 minutes
30 seconds

Correct answer: 1 minute

Leaving a tourniquet on for more than one minute can lead to hemoconcentration, which is an increase in the concentration of blood components, potentially altering test results. It can also cause patient discomfort and complications.

Question 19: Which two of the following are the circulatory system's primary purposes?

Lymphatic vessels and Lymph nodes
Pulmonary circulation and systemic circulation
Cardiovascular system and lymphatic system (Correct answer)
Heart and Blood vessels

Correct answer: Cardiovascular system and lymphatic system

The circulatory system is broadly divided into two main components: the cardiovascular system and the lymphatic system. The cardiovascular system circulates blood, oxygen, and nutrients, while the lymphatic system collects excess fluid, filters waste, and plays a crucial role in immune function. These two systems work in conjunction to maintain fluid balance and transport substances throughout the body.

Question 20: Which statement about patient education before blood collection is CORRECT?

Patients should be informed of the procedure in terms they can understand (Correct answer)
Patient education is the physician's responsibility, not the phlebotomist's
Detailed anatomical explanations reduce patient anxiety
Patients should always be told that the procedure is painless to reduce anxiety

Correct answer: Patients should be informed of the procedure in terms they can understand

Clear, plain-language communication helps the patient understand the procedure and provides implicit informed consent.

Question 21: A specimen labeled 'STAT' should be processed within what timeframe from receipt in the laboratory?

Within 5 minutes
Within 4 hours
Within 2 hours
Within 30–60 minutes (Correct answer)

Correct answer: Within 30–60 minutes

STAT specimens require processing and result reporting within 30–60 minutes of receipt to meet clinical urgency standards and patient care needs.

Question 22: What does a 'short draw' in a coagulation tube cause?

Falsely shortened PT/aPTT
Hemolysis of the sample
No effect on results
Falsely prolonged PT/aPTT due to excess anticoagulant relative to blood volume (Correct answer)

Correct answer: Falsely prolonged PT/aPTT due to excess anticoagulant relative to blood volume

Underfilling a citrate tube leaves excess anticoagulant relative to blood, falsely prolonging clotting times.

Question 23: What is the Allen test used for before an ABG draw?

To locate the median cubital vein
To confirm adequate collateral circulation in the hand before radial artery puncture (Correct answer)
To assess pain tolerance
To test for latex allergy

Correct answer: To confirm adequate collateral circulation in the hand before radial artery puncture

The Allen test compresses both radial and ulnar arteries to verify that the hand has adequate collateral blood flow before radial artery puncture.

Question 24: What is the primary purpose of inverting tubes after collection?

To mix the anticoagulant or additive with blood (Correct answer)
To warm the specimen for processing
To prevent hemolysis
To separate serum from cells

Correct answer: To mix the anticoagulant or additive with blood

Gentle inversion ensures the additive is thoroughly mixed with the blood to prevent clotting or inadequate preservation.

Question 25: Before collecting a timed specimen (e.g., 2-hour postprandial glucose), what is most important to confirm?

That a tourniquet was applied for less than 1 minute
That the patient consumed the correct meal or glucose load at the specified time (Correct answer)
That the patient's IV line has been flushed
That the patient has been NPO since midnight

Correct answer: That the patient consumed the correct meal or glucose load at the specified time

Postprandial timing begins from the start of the meal or glucose load, so confirming the exact meal time is critical.

Question 26: Royal blue-top tubes are used for which specialized testing category?

Routine chemistry panels
Coagulation studies
Trace element and toxicology testing (Correct answer)
Blood cultures

Correct answer: Trace element and toxicology testing

Royal blue tubes are manufactured with low metal content specifically for trace element (heavy metal) and toxicology testing to prevent contamination.

Question 27: What does the acronym 'PPE' stand for in a healthcare setting?

Personal Protective Equipment (Correct answer)
Patient Protection Equipment
Professional Phlebotomy Essentials
Pathogen Prevention Ensemble

Correct answer: Personal Protective Equipment

PPE stands for Personal Protective Equipment and includes gloves, gowns, masks, and eye protection used to prevent exposure to infectious agents.

Question 28: Which condition causes a patient's veins to be difficult to locate and may require a butterfly needle on a hand vein?

Dehydration (Correct answer)
Tachycardia
Obesity
Hypertension

Correct answer: Dehydration

Dehydration reduces blood volume and vein distension, making veins harder to locate and palpate.

Question 29: Which antiseptic is the GOLD STANDARD for skin preparation before blood culture collection?

Benzalkonium chloride
Hydrogen peroxide
70% isopropyl alcohol alone
Povidone-iodine or chlorhexidine gluconate (Correct answer)

Correct answer: Povidone-iodine or chlorhexidine gluconate

Chlorhexidine gluconate or povidone-iodine provides the broad-spectrum antimicrobial coverage needed to prevent contamination of blood cultures.

Question 30: Which artery is the preferred site for arterial blood gas (ABG) collection due to good collateral circulation?

Ulnar artery
Femoral artery
Brachial artery
Radial artery (Correct answer)

Correct answer: Radial artery

The radial artery at the wrist is the first choice for ABG collection because it is superficial, easily palpated, and the ulnar artery provides collateral circulation if the radial artery is compromised.

Question 31: What happens to the pee that was taken at 7 a.m. on the final day of a 24-hour urine sample?

None of the above
Saved (Correct answer)
Discarded
Dilute

Correct answer: Saved

For a 24-hour urine collection, the final urine voided at the end of the 24-hour period (e.g., 7 a.m. on the final day) must be saved and added to the collection. This ensures that all urine produced within the exact 24-hour timeframe is included. Saving this last sample makes the total volume and analyte measurements accurate and representative of the full collection period.

Question 32: A patient who is blind cannot read their ID wristband. How should the phlebotomist verify identity?

Photograph the patient for visual verification in the record
Use the room number and requisition as the sole identifiers
Have a nurse read the wristband aloud to the patient for confirmation
Ask the patient to verbally state their full name and date of birth and confirm against the wristband (Correct answer)

Correct answer: Ask the patient to verbally state their full name and date of birth and confirm against the wristband

The patient can verbally state their identifiers while the phlebotomist visually confirms the wristband independently, fulfilling the two-identifier requirement.

Question 33: Which specimen type is required for a prothrombin time (PT) test?

Urine in a sterile cup
Whole blood in an EDTA tube
Serum in a red-top tube
Plasma in a sodium citrate tube (Correct answer)

Correct answer: Plasma in a sodium citrate tube

PT testing requires plasma anticoagulated with sodium citrate (light blue-top tube) because sodium citrate chelates calcium to preserve coagulation factors.

Question 34: Which of the following best describes a midstream clean-catch urine collection?

The entire void is collected into a sterile container
The first portion of the urine stream is collected
The urethral area is cleaned, the first portion discarded, and the middle portion collected (Correct answer)
A catheter is inserted to obtain the specimen

Correct answer: The urethral area is cleaned, the first portion discarded, and the middle portion collected

A clean-catch midstream collection involves cleansing the urethral area, discarding the initial stream (which flushes contaminants), and collecting the midstream portion.

Question 35: How long should a tourniquet be left on before venipuncture is performed?

No more than 1 minute (Correct answer)
As long as needed to find the vein
5 minutes
2–3 minutes

Correct answer: No more than 1 minute

Leaving a tourniquet on longer than 1 minute causes hemoconcentration and alters test results.

Question 36: When performing a capillary puncture on an infant, which part of the heel is the correct puncture site?

The medial or lateral plantar surface of the heel (Correct answer)
The posterior curvature of the heel
The central plantar surface of the heel
The arch of the foot

Correct answer: The medial or lateral plantar surface of the heel

The medial or lateral plantar surface of the heel is the safe zone for infant heel sticks, avoiding the posterior curve where the calcaneus is closest to the skin.

Question 37: What does SDS stand for in laboratory safety?

Specimen Decontamination Schedule
Standard Disposal System
Safety Data Sheet (Correct answer)
Sharps Disposal Standard

Correct answer: Safety Data Sheet

SDS stands for Safety Data Sheet, which provides information on hazardous chemicals including handling, storage, and emergency measures.

Question 38: A gray-top tube containing sodium fluoride is primarily used for which test?

Prothrombin time
Complete blood count
Thyroid function tests
Glucose and lactate testing (Correct answer)

Correct answer: Glucose and lactate testing

Sodium fluoride in gray-top tubes inhibits glycolysis, preserving glucose levels for accurate glucose and lactate measurements.

Question 39: Under HIPAA, which situation allows a phlebotomist to share a patient's lab results?

When a coworker asks out of curiosity
When the information is needed for treatment by another authorized provider (Correct answer)
When the patient has been discharged from the hospital
When a family member requests the results over the phone

Correct answer: When the information is needed for treatment by another authorized provider

HIPAA permits sharing protected health information for treatment purposes with authorized healthcare providers involved in the patient's care.

Question 40: Which Personal Protective Equipment (PPE) is REQUIRED when performing a routine venipuncture on a standard patient?

Gloves and eye protection
Gloves only (Correct answer)
Gloves and surgical mask
Gloves, gown, and face shield

Correct answer: Gloves only

Standard precautions require gloves for all venipunctures; additional PPE is added based on anticipated splash risk.

Question 41: The body's covering and defense is made of _________ tissue.

Muscle
Nerve
Connective
Epithelial (Correct answer)

Correct answer: Epithelial

Epithelial tissue forms the covering of all body surfaces, lines body cavities and hollow organs, and is the major tissue in glands. Its primary functions include protection from physical, chemical, and biological wear and tear, secretion, absorption, and filtration. It acts as the body's first line of defense against the external environment.

Question 42: A phlebotomist notices a hard, cord-like feel along the vein. What does this suggest?

Superficial phlebitis only in elderly patients
Sclerosis or scarring of the vein from repeated venipuncture or IV therapy (Correct answer)
A healthy, well-hydrated vein
An ideal site for blood draw

Correct answer: Sclerosis or scarring of the vein from repeated venipuncture or IV therapy

A cord-like, indurated vein indicates sclerosis (scar tissue), making it a poor choice for venipuncture due to difficult access and unreliable flow.

Question 43: What is the MINIMUM number of patient identifiers required before performing a blood draw, per The Joint Commission standards?

One (name only)
Four (name, DOB, MRN, and address)
Two (e.g., name and date of birth) (Correct answer)
Three (name, DOB, and MRN)

Correct answer: Two (e.g., name and date of birth)

The Joint Commission requires at least two patient identifiers (such as name and date of birth) before any specimen collection.

Question 44: The organ that is both a component of the circulatory and digestive systems and is the largest filter in the human body:

The kidneys
The lungs
The liver (Correct answer)
None of the above

Correct answer: The liver

The liver is a vital organ that serves multiple functions in both the circulatory and digestive systems. In the digestive system, it produces bile for fat digestion and processes absorbed nutrients. In the circulatory system, it filters blood coming from the digestive tract, detoxifies chemicals, and metabolizes drugs, making it the body's largest filter.

Question 45: Which site is CONTRAINDICATED for venipuncture in a patient who has had a mastectomy on the left side?

Right forearm
Right antecubital fossa
Right hand dorsal veins
Left antecubital fossa (Correct answer)

Correct answer: Left antecubital fossa

The ipsilateral (same-side) arm of a mastectomy is contraindicated due to lymphedema risk and altered circulation.

Question 46: Please choose one of the following factors that doesn't require extra attention when working with infants:

Ensuring warmth.
Accurately monitoring the total volume of withdrawn blood.
Using protective restraints where necessary. (Correct answer)
Providing a protective environment.

Correct answer: Using protective restraints where necessary.

When performing phlebotomy on infants, critical factors requiring extra attention include precisely monitoring the total blood volume drawn to prevent iatrogenic anemia, maintaining the infant's warmth, and ensuring a safe, protective environment. The use of protective restraints, while essential for safety and procedure success, is often considered a standard safety protocol for pediatric procedures. It is not an 'extra' physiological or environmental factor demanding unique, heightened attention beyond routine safety considerations in the same way the other options are.

Question 47: Which federal regulation governs bloodborne pathogen exposure control in the workplace?

CDC Standard Precautions Guidelines
HIPAA Privacy Rule
CLIA 88
OSHA 29 CFR 1910.1030 (Correct answer)

Correct answer: OSHA 29 CFR 1910.1030

OSHA 29 CFR 1910.1030 is the Bloodborne Pathogens Standard that mandates exposure control plans for healthcare workers.

Question 48: A specimen for lactic acid testing should be transported:

Frozen immediately after collection
At room temperature in a red-top tube
In a light-protected amber bag
On ice in a gray-top or lithium heparin tube (Correct answer)

Correct answer: On ice in a gray-top or lithium heparin tube

Lactic acid specimens must be placed on ice immediately and processed quickly because glycolysis by red blood cells will falsely elevate lactate levels.

Question 49: A serum separator tube (SST) must be inverted how many times after collection?

5 times (Correct answer)
3–4 times
10 times
0 times — do not mix

Correct answer: 5 times

SST tubes should be gently inverted 5 times to activate the clot activator coating while avoiding hemolysis from over-mixing.

Question 50: A phlebotomist must verify a patient's identity. Which is the BEST two-identifier method?

Ask the patient's room number and confirm by glancing at the door sign
Use only the wristband barcode scan without asking the patient
Confirm by asking a nearby nurse who the patient is
Ask the patient to state their full name and date of birth, then compare to the order (Correct answer)

Correct answer: Ask the patient to state their full name and date of birth, then compare to the order

Active patient participation in stating name and DOB, compared to the order, is the safest two-identifier method for preventing specimen mix-ups.

Question 51: What concentration of sodium hypochlorite (bleach) solution is recommended for decontaminating blood spills?

1:100 dilution
1:1000 dilution
1:10 dilution (approximately 5,250 ppm) (Correct answer)
Undiluted bleach

Correct answer: 1:10 dilution (approximately 5,250 ppm)

A 1:10 bleach solution (approximately 5,250 ppm available chlorine) is recommended by the CDC for decontaminating blood spills.

Question 52: A patient taking diuretics has been asked to collect a 24-hour urine specimen. What instruction is most important?

Discontinue the diuretic for 24 hours before collection
Collect only the first morning void and refrigerate
Discard the first morning void, then collect all urine for the next 24 hours (Correct answer)
Collect all urine beginning at midnight

Correct answer: Discard the first morning void, then collect all urine for the next 24 hours

The standard 24-hour urine protocol begins with discarding the first morning void and collecting all subsequent urine through and including the next morning's first void.

Question 53: What is the correct order for donning (putting on) PPE?

Gown, mask, eye protection, gloves (Correct answer)
Gloves, gown, mask, eye protection
Eye protection, gown, mask, gloves
Mask, gown, eye protection, gloves

Correct answer: Gown, mask, eye protection, gloves

The CDC-recommended donning order is gown first, then mask, then eye protection, and finally gloves.

Question 54: A patient has had a mastectomy on the right side. Which arm should be used for venipuncture?

Either arm; mastectomy has no bearing on venipuncture site selection
Left arm, to avoid the lymphedema risk on the affected side (Correct answer)
The foot veins should be used instead
Right arm, since the mastectomy was to the chest, not the arm

Correct answer: Left arm, to avoid the lymphedema risk on the affected side

After mastectomy, lymph node removal increases the ipsilateral arm's risk of infection and lymphedema, so the contralateral arm is preferred.

Question 55: What is the recommended angle of needle insertion for a routine venipuncture?

45–60 degrees
90 degrees
5–10 degrees
15–30 degrees (Correct answer)

Correct answer: 15–30 degrees

A 15–30 degree angle optimizes vein entry while minimizing the risk of passing through the vein or causing excessive trauma.

Question 56: Which ergonomic measure best reduces repetitive strain injury risk for phlebotomists?

Using a dominant hand for all procedures
Rotating tasks and taking micro-breaks to reduce repetitive motion (Correct answer)
Working faster to reduce overall task time
Wearing wrist weights to strengthen muscles

Correct answer: Rotating tasks and taking micro-breaks to reduce repetitive motion

Task rotation and scheduled micro-breaks reduce cumulative repetitive strain by allowing muscle recovery.

Question 57: A phlebotomist notices that a collected SST tube has visible clots after centrifugation. What most likely caused this?

Too few inversions after collection (Correct answer)
Using a 21-gauge needle
Drawing the tube after the EDTA tube
Labeling the tube before centrifugation

Correct answer: Too few inversions after collection

Insufficient mixing after collection prevents the clot activator in an SST from working uniformly, leading to fibrin clots in the serum.

Question 58: Which type of fire extinguisher is appropriate for electrical equipment fires in a lab?

Class A
Class C (Correct answer)
Class D
Class B

Correct answer: Class C

Class C fire extinguishers are designed for electrical equipment fires and use non-conductive agents.

Question 59: When labeling a blood specimen at bedside, when should labels be applied?

Before the draw to save time
Any time before specimen processing
Immediately after collection while still at the patient's side (Correct answer)
After returning to the lab

Correct answer: Immediately after collection while still at the patient's side

Labeling at bedside immediately after collection prevents specimen mix-ups and is required by patient safety standards.

Question 60: A plasma separator tube (PST) contains which anticoagulant?

Potassium oxalate
Sodium citrate
Lithium heparin (Correct answer)
EDTA

Correct answer: Lithium heparin

Plasma separator tubes (light green-top) contain lithium heparin as the anticoagulant along with a gel separator to isolate plasma.

Question 61: How often must phlebotomists receive bloodborne pathogen training per OSHA requirements?

Every 6 months
Every 2 years
Annually (Correct answer)
Only at initial hire

Correct answer: Annually

OSHA requires bloodborne pathogen training to be provided at initial hire and then annually thereafter.

Question 62: What is the preferred site for venipuncture in an infant under 2 years old?

Antecubital fossa
Heel capillary stick (Correct answer)
Dorsal hand veins
Femoral vein

Correct answer: Heel capillary stick

Heel capillary puncture (heel stick) is the preferred method for infants under 2 years due to vein size and safety concerns.

Question 63: A phlebotomist receives an order to draw blood for a cold agglutinin test. What is the correct handling procedure for this specimen immediately following collection?

Place the tube in a 37°C heat block or incubator. (Correct answer)
Immediately centrifuge the specimen at high speed.
Gently invert the tube 15-20 times.
Submerge the tube in an ice-water bath.

Correct answer: Place the tube in a 37°C heat block or incubator.

Cold agglutinins are antibodies that cause red blood cells to clump together at temperatures below body temperature. To prevent this from happening, which would interfere with the test, the specimen must be kept warm (at 37°C) until the serum can be separated from the cells.

Question 64: The antecubital fossa is located:

On the lateral forearm near the thumb
In the inner bend of the elbow (Correct answer)
On the back of the hand
On the inner surface of the wrist

Correct answer: In the inner bend of the elbow

The antecubital fossa is the triangular depression at the front of the elbow, where the major veins used for venipuncture are found.

Question 65: A specimen for ammonia testing must be:

Refrigerated for 24 hours before testing
Stored at room temperature for up to 2 hours
Placed on ice immediately and tested within 15–30 minutes (Correct answer)
Kept at 37°C and processed within 4 hours

Correct answer: Placed on ice immediately and tested within 15–30 minutes

Ammonia specimens must be placed on ice immediately after collection and processed within 15–30 minutes because red blood cells continue to produce ammonia at room temperature.

Question 66: When collecting a specimen from a minor under 18, whose consent is typically required before the procedure?

The minor's consent if they are over age 12
Consent is implied for all minors in a clinical setting
A parent or legal guardian, unless the minor is legally emancipated (Correct answer)
The ordering physician, who assumes consent responsibility

Correct answer: A parent or legal guardian, unless the minor is legally emancipated

Minors generally cannot provide their own medical consent; a parent or legal guardian must authorize the procedure unless the minor is legally emancipated.

Question 67: When labeling a blood culture bottle at the bedside, which information is MOST critical to include?

The phlebotomist's name in full
The date and time of collection and patient identifiers (Correct answer)
The patient's diagnosis
The type of antiseptic used for skin preparation

Correct answer: The date and time of collection and patient identifiers

Date, time of collection, and patient identifiers are essential for blood culture bottles to ensure proper result interpretation.

Question 68: A patient scheduled for a routine venipuncture expresses extreme anxiety about needles and reports a history of fainting during blood draws. Which action should the phlebotomist take to prepare the patient?

Have the patient lie down in a reclining chair or on an examination table. (Correct answer)
Inform the patient that the procedure is quick and there is nothing to worry about.
Proceed with the venipuncture quickly to minimize the patient's distress.
Offer the patient a sugary drink to prevent a drop in blood sugar.

Correct answer: Have the patient lie down in a reclining chair or on an examination table.

For patients with a history of fainting (syncope) or extreme anxiety, the safest position for a blood draw is lying down (supine) or in a reclining phlebotomy chair. This prevents injury if the patient loses consciousness.

Question 69: A pediatric patient is brought in with a parent. The child's wristband has fallen off. Who can verbally confirm the child's identity?

The parent or legal guardian present
The nursing staff assigned to that floor
Either the parent/guardian or nursing staff, and nursing must replace the band (Correct answer)
The child, if old enough to speak

Correct answer: Either the parent/guardian or nursing staff, and nursing must replace the band

For pediatric patients without a wristband, a parent/guardian or nurse can verbally confirm identity, and a new band must be applied before collection.

Question 70: A tourniquet should be released within how many minutes after application?

30 seconds
3 minutes
1 minute (Correct answer)
5 minutes

Correct answer: 1 minute

A tourniquet must be released within 1 minute to prevent hemoconcentration and falsely elevated analyte results.

Question 71: A chain of custody specimen is required. Which step is MOST critical?

Collecting the specimen in a sterile room
Documenting every person who handles the specimen and maintaining an unbroken seal (Correct answer)
Using a green-top tube for all samples
Spinning the specimen within 30 minutes

Correct answer: Documenting every person who handles the specimen and maintaining an unbroken seal

Chain of custody requires documented, unbroken transfer records to ensure the specimen has not been tampered with, critical for legal and forensic samples.

Question 72: Which of the following is a symptom of a vasovagal reaction during phlebotomy?

Hypertension and flushing
Rapid, bounding pulse
Pallor, diaphoresis, and loss of consciousness (Correct answer)
Localized redness at the puncture site

Correct answer: Pallor, diaphoresis, and loss of consciousness

Vasovagal syncope presents with pallor, sweating, nausea, bradycardia, and possible fainting due to a sudden drop in blood pressure.

Question 73: When aliquoting a specimen, which technique prevents cross-contamination between aliquots?

Storing all aliquots in the same tube
Mixing all aliquots together before distribution
Changing pipette tips between each aliquot transfer (Correct answer)
Using the same pipette for all aliquots

Correct answer: Changing pipette tips between each aliquot transfer

Changing pipette tips between each transfer prevents carryover and cross-contamination of specimens destined for different tests.

Question 74: A patient refuses to state their name for identification. What is the BEST next step?

Reschedule the draw for when the patient is more cooperative
Check the patient's wristband and ask them to confirm their date of birth (Correct answer)
Ask a family member present to confirm the patient's identity
Proceed with the draw using the requisition number only

Correct answer: Check the patient's wristband and ask them to confirm their date of birth

The phlebotomist should use the ID wristband and ask the patient to confirm their date of birth as a second identifier.

Question 75: Which type of blood vessel carries oxygenated blood away from the heart to body tissues?

Venules
Arteries (Correct answer)
Veins
Capillaries

Correct answer: Arteries

Arteries carry oxygenated blood away from the heart to peripheral tissues, with the notable exception of the pulmonary arteries which carry deoxygenated blood to the lungs.

Question 76: What color tube cap is used for a prothrombin time (PT/INR) test?

Green
Red
Light blue (Correct answer)
Lavender

Correct answer: Light blue

The light blue (citrate) tube is used for coagulation studies including PT/INR because it preserves clotting factors.

Question 77: Which of the following is true regarding the need for warming babies before a heel puncture?

To decrease flow of blood
To increase flow of blood (Correct answer)
All of the above
To soften

Correct answer: To increase flow of blood

Warming an infant's heel before a heel stick procedure is essential because it causes vasodilation, increasing blood flow to the puncture site. This enhanced blood flow helps to ensure an adequate volume of blood can be collected quickly and efficiently. This minimizes the need for repeat punctures and reduces discomfort for the infant.

Question 78: An inpatient's ID band is missing. What should the phlebotomist do?

Draw the specimen and note 'ID band absent' on the tube
Use the name on the door or bed chart as the sole identifier
Notify nursing staff and have a new band applied before drawing (Correct answer)
Ask the patient to verbally confirm their name and date of birth

Correct answer: Notify nursing staff and have a new band applied before drawing

CLSI standards require a replacement ID band before any specimen collection from an inpatient.

Question 79: A patient reports they take warfarin daily. How does this affect patient preparation for a venipuncture?

The draw cannot proceed without physician approval
Prolonged pressure (5+ minutes) should be applied to the site after the draw (Correct answer)
The patient must stop warfarin 48 hours before the draw
A larger gauge needle must be used

Correct answer: Prolonged pressure (5+ minutes) should be applied to the site after the draw

Warfarin is an anticoagulant that prolongs bleeding time, so extended pressure is needed after needle withdrawal.

Question 80: A phlebotomist accidentally sustains a needlestick after drawing blood from an HCV-positive patient. The FIRST action is to:

Notify the supervisor and complete an incident report
Apply a tourniquet above the injury
Begin post-exposure prophylaxis immediately
Wash the wound thoroughly with soap and water (Correct answer)

Correct answer: Wash the wound thoroughly with soap and water

Immediately washing the wound with soap and water is the first physical step to reduce pathogen load at the exposure site.

Question 81: A phlebotomist accidentally sustains a needlestick injury after performing a venipuncture. After immediately washing the area with soap and water, what is the next critical step in compliance with OSHA regulations?

Go to the emergency room for immediate testing.
Ask the patient about their medical history.
Complete an incident report and inform their supervisor. (Correct answer)
Discard the needle in the regular trash.

Correct answer: Complete an incident report and inform their supervisor.

Following immediate first aid (washing the site), the next essential step is to report the exposure to their supervisor and complete the necessary incident/exposure report. This initiates the facility's post-exposure evaluation and follow-up protocol, which is a requirement of the OSHA Bloodborne Pathogens Standard.

Question 82: Which position is RECOMMENDED for most routine venipuncture to reduce the risk of patient fainting?

Standing at a counter
Lying flat in the supine position only
Semi-reclined at 45 degrees, legs elevated
Sitting upright in a phlebotomy chair with armrest support (Correct answer)

Correct answer: Sitting upright in a phlebotomy chair with armrest support

A seated position in a phlebotomy chair with armrest support is standard to prevent falls if the patient experiences vasovagal syncope.

Question 83: What does the term 'hemoconcentration' refer to in phlebotomy?

Mixing of venous and arterial blood
Elevation of non-filterable blood components due to fluid shift (Correct answer)
Increased red blood cell destruction
Decreased platelet count from tourniquet use

Correct answer: Elevation of non-filterable blood components due to fluid shift

Hemoconcentration occurs when a tourniquet is left on too long, causing plasma to shift into tissue and concentrating cellular components.

Question 84: Which lab test requires a 2:1 blood-to-additive ratio in the collection tube?

Prothrombin time (PT) (Correct answer)
Basic metabolic panel
Hemoglobin A1c
CBC (complete blood count)

Correct answer: Prothrombin time (PT)

Coagulation tubes (light-blue tops) require a precise 9:1 blood-to-sodium citrate ratio; underfilling the tube dilutes the anticoagulant and falsely prolongs clotting times.

Question 85: Which test requires a specimen to be transported on ice immediately after collection?

Lipid panel
Ammonia level (Correct answer)
PT/INR
CBC with differential

Correct answer: Ammonia level

Ammonia is highly unstable and must be transported on ice to slow red blood cell metabolism that continuously produces ammonia after collection.

Question 86: What is the recommended practice for labeling a blood specimen tube?

Allow the nurse to label after the phlebotomist leaves
Label the tube before the draw at the nursing station
Label the tube at the patient's bedside immediately after collection (Correct answer)
Label all tubes at the end of the collection round

Correct answer: Label the tube at the patient's bedside immediately after collection

Specimen tubes must be labeled at the patient's bedside immediately after collection to prevent mislabeling errors.

Question 87: Which additive in a gray-top tube prevents glycolysis in glucose specimens?

EDTA
Lithium heparin
Potassium oxalate and sodium fluoride (Correct answer)
Sodium citrate

Correct answer: Potassium oxalate and sodium fluoride

Gray-top tubes contain potassium oxalate (anticoagulant) and sodium fluoride (glycolysis inhibitor) to stabilize glucose levels.

Question 88: What is the purpose of warming the heelstick site before performing a capillary puncture on a neonate?

To increase arterial blood flow and improve specimen volume (Correct answer)
To reduce the perception of pain
To prevent petechiae formation
To sterilize the skin surface

Correct answer: To increase arterial blood flow and improve specimen volume

Warming the site (up to 42°C for 3–5 minutes) causes local vasodilation, arterialization of capillary blood, and increased blood flow for adequate specimen collection.

Question 89: When performing a blood culture collection, which action is most effective in minimizing the risk of contamination from skin flora?

Scrubbing the site with an appropriate antiseptic and allowing it to fully air-dry. (Correct answer)
Using a winged infusion set with a discard tube.
Applying the tourniquet for less than one minute.
Inoculating the anaerobic bottle before the aerobic bottle.

Correct answer: Scrubbing the site with an appropriate antiseptic and allowing it to fully air-dry.

Proper skin antisepsis is a critical step to prevent contamination of blood cultures with microorganisms from the skin. This involves vigorously cleaning the site and disinfecting it with an agent like chlorhexidine or iodine, and then allowing the disinfectant to dry completely before venipuncture. Failure to allow adequate drying time is a common cause of contamination.

Question 90: What is the correct ratio of blood to anticoagulant in a sodium citrate tube for coagulation testing?

9:1 (Correct answer)
1:1
1:9
4:1

Correct answer: 9:1

Sodium citrate tubes require a 9:1 ratio of blood to anticoagulant (9 parts blood to 1 part citrate) to ensure accurate coagulation results.

Question 91: A patient requires a fasting lipid panel. Which of the following foods/drinks is acceptable before the draw?

Water (Correct answer)
Orange juice
Black coffee
A small piece of toast

Correct answer: Water

Only plain water is permitted during a fasting period; coffee, juice, and food can alter lipid and glucose values.

Question 92: Which tube is occasionally referred to as a serum separator tube?

Green
Light Blue
Red/Gray (Correct answer)
Red

Correct answer: Red/Gray

The Red/Gray tube, often called a 'tiger top' or 'gold top' tube, contains a gel separator and a clot activator. After the blood clots and the tube is centrifuged, the gel forms a physical barrier between the serum and the clotted blood cells. This allows for easy separation of the serum, which is then used for various laboratory tests.

Question 93: A sputum specimen for culture and sensitivity should ideally be collected at what time of day?

After the evening meal
After vigorous physical activity
Midafternoon when secretions are thinnest
First thing in the morning upon waking (Correct answer)

Correct answer: First thing in the morning upon waking

Early morning sputum is preferred because secretions accumulate overnight and yields the highest concentration of organisms for accurate culture results.

Question 94: Which of the following is a common cause of pre-analytical error in specimen handling?

Specimen collected from an IV line above an infusion site (Correct answer)
Incorrect reagent calibration in the analyzer
Analyzer malfunction during measurement
Laboratory technician misreading a result

Correct answer: Specimen collected from an IV line above an infusion site

Collecting blood from a site proximal to an IV infusion dilutes or contaminates the specimen with IV fluid, a classic pre-analytical error that invalidates results.

Question 95: Why is it important to ask a patient to make a fist but NOT pump it repeatedly before venipuncture?

Fist pumping is only appropriate for pediatric patients
Pumping increases the risk of hemolysis
Pumping causes veins to collapse
Repeated pumping elevates potassium levels, affecting results (Correct answer)

Correct answer: Repeated pumping elevates potassium levels, affecting results

Repeated fist pumping causes pseudohyperkalemia by releasing potassium from muscle cells into the bloodstream.

Question 96: Hemolyzing blood samples is a simple process. What is a sample that has been hemolyzed?

When RBCs are lysed (Correct answer)
Increased fats and lipids
Improper phlebotomy techniques
Increased WBC's

Correct answer: When RBCs are lysed

Hemolysis refers to the rupture or destruction of red blood cells (RBCs), which releases hemoglobin into the surrounding plasma or serum. This can occur due to improper phlebotomy techniques, incorrect specimen handling, or certain medical conditions. Hemolyzed specimens appear pink or red and can interfere with the accuracy of many laboratory tests.

Question 97: The pressure is highest when the heart is contracting. The term for this pressure is the ______.

Arterial pressure
Diastolic pressure
Heart pressure
Systolic pressure (Correct answer)

Correct answer: Systolic pressure

Systolic pressure is the top number in a blood pressure reading and represents the pressure in the arteries when the heart muscle contracts. This contraction, known as systole, forcefully pumps blood out into the body's circulatory system. It is the highest pressure exerted on the arterial walls during the cardiac cycle.

Question 98: Which specimen type requires the patient to fast for 8–12 hours before collection?

Fasting blood glucose (Correct answer)
Prothrombin time (PT)
Blood culture
Complete blood count (CBC)

Correct answer: Fasting blood glucose

Fasting blood glucose requires 8–12 hours of fasting to ensure accurate baseline glucose measurement.

Question 99: A patient reports feeling faint during venipuncture. What is the FIRST action the phlebotomist should take?

Call a code blue
Remove the needle and have the patient lower their head (Correct answer)
Complete the draw as quickly as possible before the patient faints
Administer smelling salts immediately

Correct answer: Remove the needle and have the patient lower their head

Removing the needle prevents injury, and lowering the head increases cerebral blood flow to prevent syncope.

Question 100: What is the function of EDTA in a lavender-top tube?

Inhibits bacterial growth
Preserves glucose levels
Chelates calcium to prevent coagulation (Correct answer)
Activates clotting factors

Correct answer: Chelates calcium to prevent coagulation

EDTA (ethylenediaminetetraacetic acid) chelates calcium ions, preventing blood from clotting and preserving cell morphology for CBC testing.

NHA Certified Phlebotomy Technician (CPT) Exam

This exam certifies individuals as Certified Phlebotomy Technicians, demonstrating their competency in performing venipuncture, capillary sticks, and other blood collection procedures safely and effectively.

100

Questions

120 min

Time Limit

70%

To Pass

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