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

Question 1: How often must phlebotomists receive bloodborne pathogen training per OSHA requirements?

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

Correct answer: Annually

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

Question 2: Which federal regulation governs bloodborne pathogen exposure control in the workplace?

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

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 3: Which antiseptic is the standard choice for routine venipuncture site preparation?

Iodine tincture
Hydrogen peroxide
70% isopropyl alcohol (Correct answer)
Povidone-iodine swabs

Correct answer: 70% isopropyl alcohol

70% isopropyl alcohol is the standard antiseptic for venipuncture site preparation due to its rapid bactericidal action and quick drying.

Question 4: 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?

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

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 5: Which temperature range is correct for transporting most routine chemistry specimens?

Body temperature at 37°C
Refrigerated at 2–8°C
Room temperature (20–25°C) (Correct answer)
Frozen at -20°C

Correct answer: Room temperature (20–25°C)

Most routine chemistry specimens are transported at room temperature (20–25°C) unless otherwise specified by the test requirement.

Question 6: A phlebotomist is sending a frozen plasma specimen to a reference laboratory. Which of the following is the correct procedure for transport?

Transport the separated plasma in a plastic screw-cap vial on dry ice.
Wrap the frozen plasma tube in foil and place it in a standard mailer.
Place the original glass collection tube in a biohazard bag with a frozen gel pack.
Ship the unspun whole blood tube in a refrigerated container. (Correct answer)

Correct answer: Ship the unspun whole blood tube in a refrigerated container.

Frozen specimens must be maintained in a frozen state during transport. This is typically achieved by shipping the separated plasma, which should be in a plastic transport vial to prevent breakage, on dry ice. Glass tubes can break when frozen.

Question 7: What is the purpose of an Exposure Control Plan (ECP) in a phlebotomy setting?

To track laboratory test turnaround times
To document patient consent for blood draws
To outline procedures minimizing employee exposure to bloodborne pathogens (Correct answer)
To establish billing codes for phlebotomy services

Correct answer: To outline procedures minimizing employee exposure to bloodborne pathogens

An Exposure Control Plan documents procedures and policies that minimize employee risk of exposure to bloodborne pathogens.

Question 8: A glucose tolerance test (GTT) requires the patient to fast for how long before the test begins?

8–12 hours (Correct answer)
4 hours
2 hours
24 hours

Correct answer: 8–12 hours

Patients must fast for 8–12 hours before a GTT to establish a true baseline fasting glucose level.

Question 9: Which of the following analytes requires the blood collection tube to be protected from light as soon as it is drawn?

Potassium
Bilirubin (Correct answer)
Lactic Acid
Glucose

Correct answer: Bilirubin

Bilirubin is a light-sensitive analyte. Exposure to light, especially direct sunlight or fluorescent light, can cause it to break down, leading to falsely low test results. Therefore, the tube must be protected, often by wrapping it in aluminum foil or using an amber-colored tube.

Question 10: In the order of draw, why are coagulation tubes (light-blue) drawn before other additive tubes?

To prevent sodium citrate from contaminating other tubes
To avoid tissue thromboplastin from altering coagulation results (Correct answer)
To allow the longest clotting time before serum tests
Because they require the most blood volume

Correct answer: To avoid tissue thromboplastin from altering coagulation results

Tissue thromboplastin released during skin puncture can activate coagulation; drawing the coagulation tube early (after a discard tube when using a butterfly) minimizes this contamination.

Question 11: A gray-topped tube is selected for blood collection. What is the primary function of the sodium fluoride additive in this tube?

To separate serum from the cells.
To enhance the clotting process.
To bind with calcium and prevent coagulation.
To preserve glucose in the sample. (Correct answer)

Correct answer: To preserve glucose in the sample.

Gray-topped tubes contain sodium fluoride, which is an antiglycolytic agent that inhibits the breakdown of glucose (glycolysis) within the blood sample. They also contain potassium oxalate, an anticoagulant. This combination ensures an accurate glucose measurement, especially if testing is delayed.

Question 12: 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 13: Which actions should be avoided to provide patients with quality care?

All of the above (Correct answer)
Repeated draws
Excessive punctures
Probing on their medical condition

Correct answer: All of the above

Providing quality patient care involves minimizing discomfort and potential harm. Repeated draws and excessive punctures cause unnecessary pain, anxiety, and potential complications for the patient. Probing into a patient's medical condition is also inappropriate, as it oversteps the phlebotomist's role and can violate patient privacy.

Question 14: A phlebotomist is preparing to collect a blood specimen for an ammonia level. Which of the following handling procedures is critical for ensuring the accuracy of the test result?

The specimen must be placed in an ice slurry immediately after collection. (Correct answer)
The specimen must be allowed to clot for at least 60 minutes before processing.
The specimen must be protected from light by wrapping it in foil.
The specimen must be kept at body temperature (37°C) until centrifugation.

Correct answer: The specimen must be placed in an ice slurry immediately after collection.

Ammonia levels in a blood specimen increase rapidly at room temperature. Chilling the specimen immediately in an ice slurry slows down the metabolic processes that lead to this increase, ensuring an accurate measurement.

Question 15: What does a green-top tube typically contain?

No additive
Heparin (lithium or sodium) (Correct answer)
Sodium citrate
EDTA

Correct answer: Heparin (lithium or sodium)

Green-top tubes contain heparin (lithium or sodium), which inhibits thrombin and is used for plasma chemistry tests.

Question 16: While preparing to draw blood from an inpatient, the phlebotomist notices that the name on the requisition form matches the name the patient states, but the date of birth on the requisition form is different from the patient's armband. What is the most appropriate action for the phlebotomist to take?

Correct the date of birth on the requisition form and then proceed.
Draw the blood and make a note of the discrepancy on the sample label.
Ask a nurse to confirm the patient's identity and resolve the discrepancy before drawing blood. (Correct answer)
Proceed with the draw since the name is correct.

Correct answer: Ask a nurse to confirm the patient's identity and resolve the discrepancy before drawing blood.

Patient safety and specimen accuracy are paramount. Any discrepancy in patient identification information must be resolved before the blood collection proceeds. The phlebotomist should not attempt to correct the information themselves or proceed with the draw. Involving the nursing staff is the correct protocol to ensure the patient is properly identified and the records are corrected.

Question 17: A patient refuses to state their name for identification. What is the BEST next step?

Check the patient's wristband and ask them to confirm their date of birth (Correct answer)
Reschedule the draw for when the patient is more cooperative
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 18: Which vein is considered the first choice for routine venipuncture in adults?

Cephalic vein
Median cubital vein (Correct answer)
Dorsal hand vein
Basilic vein

Correct answer: Median cubital vein

The median cubital vein is the preferred site because it is large, well-anchored, and poses minimal risk to adjacent nerves and arteries.

Question 19: What exactly is contamination?

The process by which a healthcare worker becomes unclean or dirty.
The process by which a person skin becomes unclean or dirty.
When a patient becomes unclean or dirty.
The process by which an area or object becomes unclean or dirty. (Correct answer)

Correct answer: The process by which an area or object becomes unclean or dirty.

Contamination refers to the presence of unwanted substances, particularly microorganisms, on an area or object, making it unclean or potentially infectious. In healthcare, this term is critical for maintaining sterility and preventing the spread of pathogens. It emphasizes that surfaces, equipment, or supplies can become contaminated, posing a risk to patients and staff.

Question 20: A phlebotomist sustains a needlestick injury after drawing blood from a patient with unknown HIV status. What is the FIRST action to take?

Test the source patient for HIV immediately
Immediately report to the supervisor and complete an incident report
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 21: 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?

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

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 22: 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 23: What is the maximum number of venipuncture attempts recommended per phlebotomist per patient per CLSI guidelines?

1 attempt only
2 attempts (Correct answer)
4 attempts
As many as needed

Correct answer: 2 attempts

CLSI guidelines recommend no more than 2 venipuncture attempts by one phlebotomist before seeking assistance from another collector.

Question 24: Which condition is a contraindication for venipuncture from a specific arm?

Presence of a functioning dialysis fistula (AV fistula) (Correct answer)
Patient preference for the left arm
Presence of light body hair
Mild dehydration

Correct answer: Presence of a functioning dialysis fistula (AV fistula)

A functioning AV fistula for dialysis must never be used for routine venipuncture due to risk of infection, clotting, or damage to the access site.

Question 25: A patient's chart is marked with a latex allergy. Which item must be removed from the blood draw setup?

Gauze pad
Alcohol swab
Vacutainer needle
Tourniquet (Correct answer)

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 26: The body's internal and external environments are monitored by this system, which then detects changes and guides or coordinates a reaction.

The respiratory system
The circulatory system
The endocrine system
The nervous system (Correct answer)

Correct answer: The nervous system

The nervous system is the body's control and communication center, responsible for monitoring both internal and external environments through sensory receptors. It detects changes, processes this information, and then coordinates appropriate responses by sending signals to muscles and glands. This intricate network allows the body to react to stimuli and maintain homeostasis.

Question 27: What is the purpose of chilling a specimen for arterial blood gas (ABG) analysis?

To slow cellular metabolism and preserve gas values (Correct answer)
To keep the specimen from separating
To prevent clotting in the syringe
To prevent hemolysis during transport

Correct answer: To slow cellular metabolism and preserve gas values

Chilling an ABG specimen in ice water slows cellular metabolism, which would otherwise alter O2, CO2, and pH values during transport to the lab.

Question 28: An outpatient arrives for a fasting glucose tolerance test. The phlebotomist confirms the patient's name and date of birth against the requisition. Which of the following is the MOST critical next step in patient preparation?

Check for allergies to latex or adhesives.
Select and prepare the venipuncture site.
Ask the patient if they have complied with the fasting requirements. (Correct answer)
Explain the procedure and obtain verbal consent.

Correct answer: Ask the patient if they have complied with the fasting requirements.

Verifying patient compliance with dietary restrictions, such as fasting, is essential for the accuracy of many tests, especially a glucose tolerance test. Failure to confirm this could lead to inaccurate results and necessitate a re-draw.

Question 29: All healthcare professionals should maintain sterility when handling _________ since germs and other microbes can be found anywhere.

All of the above (Correct answer)
IV supplies
Instruments
Catheters

Correct answer: All of the above

Maintaining sterility is critical for all healthcare professionals when handling items that come into contact with a patient's internal body or compromised skin. Catheters, instruments, and IV supplies are examples of medical devices that must be sterile to prevent the introduction of microorganisms into the body. This practice, known as aseptic technique, is fundamental in preventing healthcare-associated infections (HAIs).

Question 30: A potential factor that could lead to tube rupture during centrifugation is _______.

Too much blood in the tube
Unbalanced centrifuge (Correct answer)
Centrifuging too long
Not enough blood in the tube

Correct answer: Unbalanced centrifuge

An unbalanced centrifuge is a significant safety hazard and can lead to tube rupture. When tubes of unequal weight or volume are placed opposite each other, the centrifuge vibrates excessively, creating stress on the tubes and potentially causing them to break. This can result in sample loss, biohazard exposure, and damage to the equipment.

Question 31: What does the term 'hemolysis' mean in the context of a blood specimen?

Rupture of red blood cells releasing hemoglobin (Correct answer)
Excessive white blood cell count
Clotting of the specimen
Contamination with bacteria

Correct answer: Rupture of red blood cells releasing hemoglobin

Hemolysis causes falsely elevated potassium and other intracellular analytes, often requiring recollection.

Question 32: How long can a serum specimen typically remain at room temperature before centrifugation must occur?

Up to 24 hours
Up to 30 minutes
Up to 2 hours (Correct answer)
Up to 8 hours

Correct answer: Up to 2 hours

Most serum specimens should be centrifuged within 2 hours of collection to prevent analyte degradation and hemolysis.

Question 33: Which of the following should phlebotomists not take into account while working with elderly people?

Provide a protective environment
Thin fragile veins
Visual acuity (Correct answer)
Mobility issues

Correct answer: Visual acuity

When working with elderly patients, phlebotomists must consider factors like thin, fragile veins, mobility issues, and the need for a protective environment due to age-related physiological changes. While visual acuity can be impaired in the elderly, it is generally the patient's concern for their own safety and comfort, not a direct factor the phlebotomist *doesn't* take into account during the venipuncture process itself in the same way as vein fragility or mobility.

Question 34: 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 transported at room temperature.
The tube was not protected from light.
The tube was inverted 8 times after collection.
The tube was only filled to 75% capacity. (Correct answer)

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 35: Which artery is most commonly used for arterial blood gas (ABG) collection?

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

Correct answer: Radial artery

The radial artery at the wrist is the preferred ABG site because it is accessible, has collateral circulation, and is away from major nerves.

Question 36: Which of the following is the one factor that causes the majority of HIV and HBV infections at work?

Saliva
Pleural fluid
Semen
Blood (Correct answer)

Correct answer: Blood

Blood is the primary vehicle for transmitting bloodborne pathogens like HIV (Human Immunodeficiency Virus) and HBV (Hepatitis B Virus) in occupational settings. Exposure to infected blood, often through needlestick injuries or contact with open wounds, is the most common route of transmission for healthcare workers. Therefore, strict adherence to bloodborne pathogen precautions is essential to prevent these infections.

Question 37: What is the primary purpose of inverting tubes gently after collection?

To remove air bubbles
To activate the clot faster
To separate plasma from serum
To mix the additive uniformly with the blood specimen (Correct answer)

Correct answer: To mix the additive uniformly with the blood specimen

Gentle inversion mixes the additive (anticoagulant, clot activator, etc.) thoroughly with the blood to ensure proper preservation.

Question 38: For PTT, which tube is utilized?

Green
Gray
Red
Light Blue (Correct answer)

Correct answer: Light Blue

The light blue top tube contains sodium citrate, an anticoagulant that prevents blood from clotting by binding calcium. This specific additive is crucial for coagulation studies, such as the Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT or PTT). It ensures that the blood's clotting factors are preserved in their natural state for accurate testing.

Question 39: Which of the following is a key requirement of the Needlestick Safety and Prevention Act?

Requiring patients to be informed of the type of needle being used.
Prohibiting the use of butterfly needles on pediatric patients.
Mandating that all phlebotomists receive the Hepatitis C vaccine.
Requiring employers to involve non-managerial employees in the evaluation and selection of safer medical devices. (Correct answer)

Correct answer: Requiring employers to involve non-managerial employees in the evaluation and selection of safer medical devices.

The Needlestick Safety and Prevention Act amended the OSHA Bloodborne Pathogens Standard to include several new requirements. A significant one is the mandate for employers to solicit input from frontline, non-managerial employees who are responsible for direct patient care in identifying, evaluating, and selecting effective engineering and work practice controls, such as safety-engineered sharps devices.

Question 40: What does the RACE acronym stand for in fire safety response?

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

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 41: The human body is always covered in?

Algae
Bacteria (Correct answer)
Dead cells
Hair

Correct answer: Bacteria

The human body is naturally covered in a vast ecosystem of microorganisms, primarily bacteria, known as the microbiome. These bacteria reside on the skin, in the gut, and other areas, playing essential roles in health. While some can be pathogenic, many are commensal or beneficial, and their presence is a normal physiological state.

Question 42: Please choose one of the following factors that doesn't require extra attention when working with infants:

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

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 43: Which specimen requires protection from light during transport and processing?

Whole blood CBC
Bilirubin (Correct answer)
Serum potassium
Sodium

Correct answer: Bilirubin

Bilirubin is photosensitive and degrades rapidly when exposed to light, requiring amber bags or foil wrapping during transport.

Question 44: People-to-person transmissible infections are referred to as ________.

Communicable (Correct answer)
Indirect
Environmental
Vector-borne

Correct answer: Communicable

Communicable infections are those that can be transmitted from one person to another, either directly (e.g., through touch, droplets) or indirectly (e.g., through contaminated objects or vectors). This term highlights the ability of the pathogen to spread within a population, making infection control measures essential.

Question 45: A phlebotomist is tasked with collecting blood for a coagulation test, a complete blood count (CBC), and a blood culture. According to CLSI guidelines, what is the correct order of draw for these tests?

Blood culture, CBC tube, Coagulation tube
CBC tube, Blood culture, Coagulation tube
Blood culture, Coagulation tube, CBC tube (Correct answer)
Coagulation tube, Blood culture, CBC tube

Correct answer: Blood culture, Coagulation tube, CBC tube

The Clinical and Laboratory Standards Institute (CLSI) establishes the standard order of draw to prevent cross-contamination of additives between tubes. The correct sequence begins with blood culture tubes to maintain sterility, followed by coagulation tubes (e.g., light blue top) to prevent contamination from clot activators, and then tubes with other additives like the EDTA tube (e.g., lavender top) for a CBC.

Question 46: A pink tube of additive contains:

SPS
EDTA (Correct answer)
ADP
Herapin

Correct answer: EDTA

Pink top tubes are specifically designed for blood bank testing, including ABO/Rh typing, antibody screening, and cross-matching. They contain EDTA (ethylenediaminetetraacetic acid), a potent anticoagulant that prevents blood clotting and preserves the morphology of red blood cells. This makes EDTA ideal for tests requiring whole blood or plasma for compatibility testing.

Question 47: Which tube additive is found in a red-top (no additive) tube?

Heparin
None — it contains no additive (Correct answer)
EDTA
Sodium citrate

Correct answer: None — it contains no additive

A plain red-top tube contains no additive; blood clots naturally and serum is obtained after centrifugation.

Question 48: A phlebotomist notices a clot in a lavender-top EDTA tube. What does this indicate?

The tube was mixed correctly
Insufficient mixing after collection (Correct answer)
The tube was centrifuged too quickly
Excess EDTA was present

Correct answer: Insufficient mixing after collection

Clotting in an EDTA tube indicates the specimen was not mixed adequately immediately after collection, allowing coagulation to begin.

Question 49: A patient's arm shows petechiae after tourniquet application. What does this finding suggest?

Normal skin response to pressure
Possible platelet or coagulation disorder (Correct answer)
Venous thrombosis at the draw site
Allergic reaction to latex gloves

Correct answer: Possible platelet or coagulation disorder

Petechiae (small pinpoint hemorrhages) under a tourniquet may indicate a platelet disorder or capillary fragility and should be reported.

Question 50: Which of the following veins is considered the safest first choice for routine venipuncture?

Dorsal hand vein
Median cubital vein (Correct answer)
Cephalic vein
Basilic vein

Correct answer: Median cubital vein

The median cubital vein is the preferred first choice because it is large, well-anchored, and less likely to roll or bruise.

Question 51: According to CLSI guidelines, what is the maximum amount of time that should elapse between the collection of a routine blood specimen for serum testing and the separation of serum from the cells by centrifugation?

8 hours
2 hours (Correct answer)
30 minutes
4 hours

Correct answer: 2 hours

For most routine chemistry tests, serum or plasma should be separated from the cells within two hours of collection to prevent metabolic changes in the cells from altering the composition of the serum/plasma, which can lead to inaccurate results.

Question 52: Which additive in a gray-top tube is used to inhibit glycolysis for glucose testing?

EDTA
Sodium fluoride (Correct answer)
Heparin
Sodium citrate

Correct answer: Sodium fluoride

Sodium fluoride (with potassium oxalate) in gray-top tubes inhibits glycolytic enzymes to preserve glucose levels.

Question 53: A requisition order shows two different patient last names (maiden vs. married). How should the phlebotomist proceed?

Clarify the discrepancy with nursing or the ordering physician before drawing (Correct answer)
Draw the specimen and flag the discrepancy on the label
Use the name that matches the patient's verbal statement and proceed
Reject the requisition and send the patient back to registration

Correct answer: Clarify the discrepancy with nursing or the ordering physician before drawing

Name discrepancies on requisitions must be resolved before collection to prevent mislabeled specimens.

Question 54: How much blood does a human body typically contain?

5 Liters (Correct answer)
10 Liters
2 Liters
8 Liters

Correct answer: 5 Liters

The average adult human body typically contains approximately 4.5 to 5.5 liters of blood. This volume constitutes about 7-8% of total body weight and is essential for maintaining blood pressure, transporting substances like oxygen and nutrients, and regulating body temperature.

Question 55: The description of each sort of blood draw is different. What word best sums up a Venus blood test?

Flow is slow and even, easily controlled.
Blood is dark red, flow is steady and easily controlled. (Correct answer)
Blood is bright red, flow is pulsating, and easily controlled.
Blood is bright red, pulsating flow, and harder to control.

Correct answer: Blood is dark red, flow is steady and easily controlled.

Venous blood is deoxygenated, giving it a darker red color compared to arterial blood. When a vein is punctured, the blood flow is typically steady and even, not pulsating, and is generally easy to control. This contrasts with arterial blood, which is bright red, pulsates, and is harder to control due to higher pressure.

Question 56: Which type of blood vessel carries oxygenated blood away from the heart to body tissues?

Veins
Capillaries
Arteries (Correct answer)
Venules

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 57: 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)
Applying the tourniquet for less than one minute.
Inoculating the anaerobic bottle before the aerobic bottle.
Using a winged infusion set with a discard tube.

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 58: When centrifuging blood specimens, what is the typical relative centrifugal force (RCF) range used for routine separation?

1,000–2,000 × g (Correct answer)
100–200 × g
10,000–15,000 × g
50,000–100,000 × g

Correct answer: 1,000–2,000 × g

Routine blood specimen centrifugation uses approximately 1,000–2,000 × g (RCF) to separate cells from serum or plasma without damaging cells.

Question 59: Which additive is found in a light blue (sodium citrate) tube and why is underfilling critical?

EDTA; affects cell morphology
SST gel; disrupts fibrin formation
Heparin; causes clotting
Sodium citrate; incorrect blood-to-anticoagulant ratio affects coagulation results (Correct answer)

Correct answer: Sodium citrate; incorrect blood-to-anticoagulant ratio affects coagulation results

Light blue tubes use sodium citrate at a precise 9:1 blood-to-anticoagulant ratio; underfilling dilutes the specimen and falsely prolongs PT/aPTT.

Question 60: A patient's arm veins are difficult to locate. Which technique should the phlebotomist try FIRST?

Apply a warm compress to the site for 3-5 minutes (Correct answer)
Ask the patient to pump their fist rapidly
Use a 23-gauge needle to reduce patient discomfort
Immediately attempt the antecubital fossa on the other arm

Correct answer: Apply a warm compress to the site for 3-5 minutes

Applying a warm compress dilates blood vessels, making veins more visible and palpable.

Question 61: Which of the following is the best way for a phlebotomist to verify the identity of an outpatient who is conscious and alert?

Ask, "Are you Jane Doe?"
Ask the patient to state their full name and date of birth. (Correct answer)
Call the patient's name in the waiting room and have them confirm.
Match the name on the requisition to the patient's insurance card.

Correct answer: Ask the patient to state their full name and date of birth.

The Clinical and Laboratory Standards Institute (CLSI) mandates using at least two patient identifiers for verification. The best practice is to ask the patient to actively state their full name and date of birth, which can then be compared to the requisition form. Asking a leading question like "Are you Jane Doe?" can lead to errors if the patient is distracted or hard of hearing.

Question 62: What information is required on a properly labeled specimen tube according to CLSI standards?

Patient name, DOB, and collection date/time only
Patient name, date, tube type
Room number and diagnosis
Patient full name, date of birth, collection date and time, and collector ID (Correct answer)

Correct answer: Patient full name, date of birth, collection date and time, and collector ID

CLSI requires patient full name, date of birth, collection date and time, and the collector's identification on every labeled tube.

Question 63: A lavender-top tube is received in the lab without a label. What is the correct action?

Process it immediately to avoid delays
Label it from memory based on the requisition
Discard it and request a redraw (Correct answer)
Store it in the refrigerator until the patient is located

Correct answer: Discard it and request a redraw

Unlabeled specimens must be discarded and a redraw requested because mislabeled or unlabeled specimens are a critical patient safety risk.

Question 64: A patient reports feeling faint during venipuncture. What is the FIRST action the phlebotomist should take?

Complete the draw as quickly as possible before the patient faints
Remove the needle and have the patient lower their head (Correct answer)
Call a code blue
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 65: Which of the following sums up hemodialysis the best?

None of the above
It's the process of purifying the blood of a person whose kidneys aren't functioning normally (Correct answer)
It's the process through which the blood in the kidney is drained
It's a process of collecting blood from a person whose kidneys are faulty

Correct answer: It's the process of purifying the blood of a person whose kidneys aren't functioning normally

Hemodialysis is a medical procedure used to remove waste products, excess fluid, and toxins from the blood when a person's kidneys are no longer able to perform these functions adequately. It acts as an artificial kidney, filtering the blood outside the body through a machine. This process purifies the blood and helps maintain the body's fluid and electrolyte balance.

Question 66: Before collecting a timed specimen (e.g., 2-hour postprandial glucose), what is most important to confirm?

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

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 67: Which tube should be collected first when using the correct order of draw with an ETS?

Sodium citrate (light blue)
EDTA (lavender)
Blood culture bottles (Correct answer)
SST (gold)

Correct answer: Blood culture bottles

Blood culture bottles are drawn first to minimize the risk of microbial contamination from skin flora.

Question 68: What does a 'short draw' in a coagulation tube cause?

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

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 69: What is the maximum recommended time a centrifuged specimen should sit before aliquoting to prevent result changes?

30 minutes
4 hours
2 hours (Correct answer)
8 hours

Correct answer: 2 hours

Serum or plasma should be aliquoted within 2 hours of centrifugation to prevent analyte degradation and cellular metabolism changes.

Question 70: A 24-hour urine collection is ordered. Which instruction to the patient is CORRECT?

Discard the first morning void, then collect all urine for 24 hours ending with the next morning void (Correct answer)
Collect only the final void of the day
Refrigerate urine only if a preservative is not provided
Include the first morning void in the collection

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

The standard 24-hour protocol discards the first morning void to establish a start time, then collects all urine through and including the next morning void.

Question 71: What is the Allen test used for before an ABG draw?

To confirm adequate collateral circulation in the hand before radial artery puncture (Correct answer)
To assess pain tolerance
To locate the median cubital vein
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 72: When performing phlebotomy, _________ is the one and only method that is absolutely essential for preventing the spread of infection.

Washing hands (Correct answer)
Wearing a mask
Burning waste
Cleaning spills

Correct answer: Washing hands

Handwashing is universally recognized as the single most effective method for preventing the spread of infection in healthcare settings, including phlebotomy. It physically removes transient microorganisms from the hands, significantly reducing the risk of transmitting pathogens between patients and healthcare workers. While other measures are important, proper hand hygiene is the foundational practice for infection control.

Question 73: In order to create a specimen, _______________ of stool is required.

2 g
1-2 tbsp (Correct answer)
2 ml
2 kg

Correct answer: 1-2 tbsp

For most stool specimens, a sufficient amount for laboratory analysis is typically 1-2 tablespoons, or approximately 30-60 mL if liquid. This quantity allows for adequate testing to be performed by the laboratory while not requiring an excessively large or inconvenient sample from the patient.

Question 74: What is the correct action if a phlebotomist accidentally needlesticks themselves during a draw?

Immediately wash the site, report to supervisor, and follow exposure protocol (Correct answer)
Squeeze the wound to remove any contaminated blood
Apply a bandage and continue the procedure
Apply antiseptic and monitor for symptoms over 24 hours

Correct answer: Immediately wash the site, report to supervisor, and follow exposure protocol

Immediate washing, reporting, and following the facility's exposure control plan are required by OSHA bloodborne pathogen standards.

Question 75: Which three arm veins are most frequently used in phlebotomy?

Cephalic, median cubital and basilic veins (Correct answer)
Median cubital, basalmic, and radial veins
Antecubital, median cubital and basilic veins
Antecubital fossa, median cubital and cephalic veins

Correct answer: Cephalic, median cubital and basilic veins

The cephalic, median cubital, and basilic veins are the three most commonly used veins for venipuncture in the antecubital fossa (the bend of the elbow). The median cubital vein is generally preferred due to its size, stability, and superficial location, followed by the cephalic and then the basilic vein.

Question 76: A patient has an IV running in the right antecubital vein. Where should the phlebotomist draw blood?

Above the IV site on the same arm
From the left arm or a site below the IV on the same arm only if no other option exists (Correct answer)
From the IV catheter directly
From any site on the right arm

Correct answer: From the left arm or a site below the IV on the same arm only if no other option exists

Drawing from the arm with an active IV risks dilution and contamination; use the opposite arm or, as a last resort, below the IV site on the same arm.

Question 77: Under HIPAA, a phlebotomist may share a patient's test results with:

Anyone in the phlebotomy department
Any hospital employee who asks
Only individuals authorized by the patient or directly involved in their care (Correct answer)
The patient's family unless the patient has objected

Correct answer: Only individuals authorized by the patient or directly involved in their care

HIPAA restricts disclosure of protected health information (PHI) to only those authorized by the patient or directly involved in their care.

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

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

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: What is lipemia, and how does it affect laboratory specimens?

Low platelet count; causes clotting issues
High glucose causing crystallization in the tube
Excess bilirubin causing yellow serum; interferes with optical assays
Excess lipids (triglycerides) causing cloudy serum; interferes with many chemistry tests (Correct answer)

Correct answer: Excess lipids (triglycerides) causing cloudy serum; interferes with many chemistry tests

Lipemia is excess lipids in the blood producing turbid/cloudy serum that can interfere with spectrophotometric assays and many automated chemistry tests.

Question 80: Which specimen type requires the patient to fast for 8–12 hours before collection?

Prothrombin time (PT)
Fasting blood glucose (Correct answer)
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 81: A patient's arm shows a hematoma at a previous venipuncture site. What is the best action?

Draw from the same site to avoid additional sticks
Warm the hematoma with a heat pack before drawing
Select a different vein, avoiding the hematoma area (Correct answer)
Apply a tourniquet directly over the hematoma

Correct answer: Select a different vein, avoiding the hematoma area

Drawing through or near a hematoma can cause specimen contamination and increased patient discomfort.

Question 82: Which site is CONTRAINDICATED for venipuncture in a patient who has had a mastectomy on the left side?

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

Correct answer: Left antecubital fossa

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

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

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

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: The _________ contains the heart, lymphatic system, and blood vessels.

Respiratory system
Urinary system
Digestive system
Cardiovascular system (Correct answer)

Correct answer: Cardiovascular system

The cardiovascular system, also known as the circulatory system, is responsible for transporting blood throughout the body. Its core components include the heart, which acts as a pump, and a vast network of blood vessels (arteries, veins, and capillaries) that carry blood. While the lymphatic system is related to fluid transport, the listed components directly define the cardiovascular system.

Question 85: What is the correct temperature range for storing most routine blood specimens awaiting transport?

Body temperature at 37°C in a water bath
Frozen at –20°C
Refrigerated at 2–8°C (Correct answer)
Room temperature at 37°C

Correct answer: Refrigerated at 2–8°C

Most routine specimens should be stored at 2–8°C to slow cellular metabolism and analyte degradation while awaiting transport or analysis.

Question 86: Which type of fire extinguisher is appropriate for electrical equipment fires in a lab?

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

Correct answer: Class C

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

Question 87: 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)
Having the patient sign a detailed legal document before every routine draw.
Telling the patient that the doctor ordered the test and they must comply.

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 88: A phlebotomist is called to an inpatient's room. The patient's identification band is not on their wrist but is taped to the bedrail. The information on the band matches the requisition form. What is the appropriate course of action?

Proceed with the draw since the information matches the requisition.
Document the location of the ID band and proceed with the collection.
Ask the patient to state their full name and date of birth before proceeding.
Do not draw the blood and ask the nurse to place a new ID band on the patient. (Correct answer)

Correct answer: Do not draw the blood and ask the nurse to place a new ID band on the patient.

According to safety standards, an identification band must be physically attached to the patient. An ID band on a bedrail or nightstand does not ensure it belongs to the correct patient. The phlebotomist must not proceed until the patient is properly identified by having a nurse re-band them.

Question 89: A conscious patient in the ED cannot speak. Which identification method is most appropriate?

Ask a bystander who arrived with the patient
Postpone the draw until the patient can verbally identify themselves
Use only the requisition slip as identification
Check the temporary ID band placed by the ED staff (Correct answer)

Correct answer: Check the temporary ID band placed by the ED staff

Emergency departments assign temporary ID bands for unresponsive or non-verbal patients, which serve as the authoritative identifier.

Question 90: Which federal agency requires healthcare workers to follow Standard Precautions to prevent bloodborne pathogen transmission?

CDC
OSHA (Correct answer)
CMS
FDA

Correct answer: OSHA

OSHA's Bloodborne Pathogen Standard (29 CFR 1910.1030) mandates Standard Precautions, including PPE use and safe needle handling, for all healthcare workers.

Question 91: During a venipuncture, the phlebotomist notices a hematoma forming at the site. Which of the following is the most appropriate immediate action?

Adjust the needle's depth to see if blood flow improves.
Ask the patient to apply pressure while the phlebotomist gathers more supplies.
Release the tourniquet, withdraw the needle, and apply firm pressure. (Correct answer)
Complete the draw as quickly as possible.

Correct answer: Release the tourniquet, withdraw the needle, and apply firm pressure.

If a hematoma begins to form, it indicates that blood is leaking into the tissue surrounding the vein. The correct procedure is to immediately stop the blood draw by releasing the tourniquet, removing the needle, and applying firm, direct pressure to the site to minimize the size of the hematoma and prevent further injury.

Question 92: Royal blue-top tubes are used for which specialized testing category?

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

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 93: Which gauge needle is most commonly used for routine venipuncture in adults?

18 gauge
25 gauge
21 gauge (Correct answer)
23 gauge

Correct answer: 21 gauge

A 21-gauge needle is the standard choice for routine adult venipuncture, balancing flow rate and patient comfort.

Question 94: Which additive in a gray-top tube prevents glycolysis in glucose specimens?

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

Correct answer: Potassium oxalate and sodium fluoride

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

Question 95: Which of the following Personal Protective Equipment (PPE) is most essential for a phlebotomist to wear during a routine venipuncture procedure to comply with standard precautions?

Gloves (Correct answer)
A fluid-resistant gown
A face shield
Shoe covers

Correct answer: Gloves

According to OSHA's Bloodborne Pathogens Standard and the principle of Universal/Standard Precautions, gloves must be worn when it can be reasonably anticipated that the employee may have hand contact with blood or other potentially infectious materials. This makes gloves the most essential and required piece of PPE for a routine venipuncture.

Question 96: Which of the following best describes 'chain of custody' in specimen collection?

The sequence of tube additives in the order of draw
The hospital's policy for transporting specimens
A documented record of every person who handled a specimen from collection to disposal (Correct answer)
The order in which lab tests are resulted

Correct answer: A documented record of every person who handled a specimen from collection to disposal

Chain of custody is an unbroken documentation trail recording every individual who handled the specimen, required for forensic, legal, and drug testing specimens.

Question 97: When should gloves be worn?

None of the above
Before touching bedpan, patient, or specimen (Correct answer)
Before only touching the specimen
Before only touching the patient

Correct answer: Before touching bedpan, patient, or specimen

Gloves are a crucial component of standard precautions and should be worn whenever there is a potential for contact with blood, body fluids, non-intact skin, or contaminated items. This includes before touching a patient, handling a bedpan, or collecting and handling specimens. Wearing gloves protects both the healthcare worker and the patient from pathogen transmission.

Question 98: Which of the following is NOT a component of blood?

Red blood cells
Plasma
Neurons (Correct answer)
Platelets

Correct answer: Neurons

Neurons are specialized nerve cells belonging to the nervous system and are not found in blood; the four main blood components are plasma, red blood cells, white blood cells, and platelets.

Question 99: Upon entering a hospital room, a phlebotomist finds a patient who is unconscious. The requisition form is for a 'John Smith'. What is the first step in patient identification in this scenario?

Ask the visiting family member to confirm the patient's identity.
Check the patient's wristband for two identifiers. (Correct answer)
Proceed with the draw as the patient cannot refuse.
Match the room number on the requisition to the room number on the door.

Correct answer: Check the patient's wristband for two identifiers.

For an unconscious inpatient, the primary method of identification is to compare the information on the requisition form with the patient's wristband. The wristband must contain at least two unique identifiers (e.g., full name and medical record number) that match the form exactly. Relying on a room number is unreliable, and while family can assist, the wristband is the definitive source.

Question 100: What is the correct response when a patient states they have a latex allergy before venipuncture?

Notify the charge nurse but continue using available supplies
Proceed normally because modern gloves are all nitrile
Ask the patient to rate the severity before deciding on precautions
Use latex-free gloves, tourniquets, and supplies throughout the procedure (Correct answer)

Correct answer: Use latex-free gloves, tourniquets, and supplies throughout the procedure

A reported latex allergy requires replacing all latex-containing items with latex-free alternatives to prevent an allergic reaction.

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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