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

Question 1: Which two of the following are the circulatory system's primary purposes?

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

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

Serum potassium
Whole blood CBC
Sodium
Bilirubin (Correct answer)

Correct answer: Bilirubin

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

Question 3: The body's covering and defense is made of _________ tissue.

Connective
Epithelial (Correct answer)
Nerve
Muscle

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

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)
Photograph the patient for visual verification in the record

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 5: The three arm veins that phlebotomists typically use:

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

Correct answer: Cephalic, median cubital and basilic veins

The median cubital, cephalic, and basilic veins are the three primary veins phlebotomists typically use for venipuncture in the antecubital fossa. The median cubital vein is generally preferred due to its superficial location, size, and stability. The cephalic and basilic veins serve as alternative sites, with the cephalic often being more accessible on the thumb side and the basilic on the pinky side.

Question 6: Which gauge needle is most commonly used for routine venipuncture in adults?

21 gauge (Correct answer)
25 gauge
18 gauge
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 7: When centrifuging blood specimens, what is the typical relative centrifugal force (RCF) range used for routine separation?

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

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 8: There are various techniques for drawing blood from a patient. What kind of blood collection procedure is most typical?

Venous (Correct answer)
Foot
Hand
Arterial

Correct answer: Venous

Venous blood collection, or venipuncture, is the most common and typical method for drawing blood samples for diagnostic testing. It involves drawing blood from a vein, usually in the arm, because veins are easily accessible, have lower pressure than arteries, and provide sufficient blood volume for most laboratory tests.

Question 9: When collecting a specimen for a prothrombin time (PT) or aPTT, what is the critical fill requirement for the sodium citrate (blue-top) tube?

Fill to at least 50% of tube capacity
Fill no more than 75% to prevent clotting
Fill exactly to the line — the 9:1 blood-to-citrate ratio must be maintained (Correct answer)
Fill level does not affect coagulation results

Correct answer: Fill exactly to the line — the 9:1 blood-to-citrate ratio must be maintained

The 9:1 blood-to-anticoagulant ratio is critical for coagulation testing; under- or overfilling alters the ratio and produces inaccurate PT/aPTT results.

Question 10: A phlebotomist is sending a frozen plasma specimen to a reference laboratory. Which of the following is the correct procedure for transport?

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

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 11: A requisition calls for a stat potassium level. The collected specimen is hemolyzed. What should the phlebotomist do?

Collect a new specimen and notify the nurse or ordering provider of the delay (Correct answer)
Centrifuge immediately to salvage the specimen
Add saline to dilute the hemolysis
Report the result with a note that specimen was hemolyzed

Correct answer: Collect a new specimen and notify the nurse or ordering provider of the delay

Hemolysis falsely elevates potassium (K+ leaks from cells), making the result unreliable; a new specimen must be collected.

Question 12: What happens to the urine collected on the first day at 7 a.m. of a 24-hour urine sample?

Scale
None of the above
Discard (Correct answer)
Saved

Correct answer: Discard

When collecting a 24-hour urine sample, the first urine voided at the start of the collection period (e.g., 7 a.m. on day one) is discarded. This ensures that the collection begins with an empty bladder, and all subsequent urine produced over the next 24 hours is included. Discarding the initial void provides an accurate measure of substances excreted over that specific timeframe.

Question 13: 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 protected from light by wrapping it in foil.
The specimen must be placed in an ice slurry immediately after collection. (Correct answer)
The specimen must be kept at body temperature (37°C) until centrifugation.
The specimen must be allowed to clot for at least 60 minutes before processing.

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 14: When performing a capillary puncture on an adult finger, which area should be avoided?

Medial aspect of the index finger
Lateral aspect of the middle finger
Lateral aspect of the ring finger
The very tip and center of the finger (Correct answer)

Correct answer: The very tip and center of the finger

The tip and center of the finger should be avoided because they have more nerve endings and the skin is thinner, increasing pain and risk of bone puncture.

Question 15: Which of the following tasks is not within the phlebotomist's purview of practice?

Identifying patients properly
Labeling samples correctly
Drawing blood using the appropriate equipment
Collecting a tissue sample (Correct answer)

Correct answer: Collecting a tissue sample

A phlebotomist's primary role is to collect blood samples for diagnostic testing. Collecting tissue samples, such as biopsies, is a more invasive procedure that falls under the purview of physicians or other specialized medical personnel. This task requires advanced medical training and expertise beyond the scope of phlebotomy practice.

Question 16: A patient has a mastectomy on her left side. Where should the phlebotomist draw blood?

Hand veins on the left side only
Right arm or non-affected extremity (Correct answer)
Either arm with double tourniquet
Left arm antecubital only

Correct answer: Right arm or non-affected extremity

Drawing from the same side as a mastectomy risks lymphedema and unreliable results due to compromised lymphatic drainage.

Question 17: A phlebotomy technician used a syringe to execute their first venipuncture. He was careful when taking the sample not to draw up on the plunger too quickly or push it too hard when transferring the blood from the syringe to the specimen container. The extra safety measures protect against:

A needle stick accident
Bacterial contamination
Hemolysis (Correct answer)
Adulteration of the specimen

Correct answer: Hemolysis

Drawing the plunger too quickly during a syringe draw or pushing the blood too forcefully when transferring it can cause the red blood cells to rupture, a process known as hemolysis. This mechanical trauma releases hemoglobin into the plasma, which can alter test results and make the specimen unsuitable for analysis. Gentle handling of the syringe and careful transfer of the blood are crucial to prevent hemolysis and ensure specimen integrity.

Question 18: Being unfit, either physically or mentally, is _________.

Obesity
Malpractice
Negligence
Incompetence (Correct answer)

Correct answer: Incompetence

Incompetence refers to the lack of ability, skill, or fitness to perform a task or fulfill a role effectively, whether due to physical or mental limitations. In a healthcare context, this means a professional is unable to meet the required standards of practice. This differs from negligence (failure to exercise reasonable care) or malpractice (professional negligence causing injury), as it describes the inherent unfitness rather than a specific act or omission.

Question 19: 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 not protected from light.
The tube was transported at room temperature.

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 20: Which of the following is NOT an acceptable patient identifier according to CLSI GP33?

Patient's date of birth
Patient's room number (Correct answer)
Patient's full name
Patient's assigned medical record number

Correct answer: Patient's room number

Room number is not an acceptable identifier because patients can be moved; name, DOB, and MRN are acceptable.

Question 21: Which of the following is a contraindication for drawing blood from a specific arm site?

The patient is right-handed
The patient has tattoos on the arm
The vein is visible without palpation
The site has an AV fistula for dialysis (Correct answer)

Correct answer: The site has an AV fistula for dialysis

Drawing from an arm with an AV fistula risks damaging the fistula, introducing infection, and producing inaccurate results due to altered hemodynamics.

Question 22: Where the antecubital fossa is located?

The bend of the elbow, back of the arm
The bend of the elbow, the front of the arm (Correct answer)
The bend of the elbow, the inner side of the arm
The bend of the elbow, the outer side of the arm

Correct answer: The bend of the elbow, the front of the arm

The antecubital fossa is the triangular depression located on the anterior (front) aspect of the elbow joint. This area is crucial for phlebotomy because it contains the most commonly used veins for venipuncture. Its accessibility and the superficial nature of these veins make it an ideal site for blood collection.

Question 23: Which action should be taken if a specimen arrives in the lab with visible clots in a tube that requires whole blood (e.g., EDTA)?

Centrifuge and use the plasma
Reject the specimen and request a recollection (Correct answer)
Process normally since clots are common
Warm the specimen to dissolve the clot

Correct answer: Reject the specimen and request a recollection

A clotted EDTA specimen must be rejected because clot formation means the anticoagulant failed to work, and results (especially CBC and coagulation-related tests) will be inaccurate.

Question 24: Which action should be taken if a patient experiences nausea immediately before venipuncture?

Proceed quickly to minimize discomfort duration
Have the patient lie down, apply a cool cloth, and postpone the draw until they recover (Correct answer)
Collect only the highest-priority tubes and stop
Administer oral fluids to stabilize the patient before drawing

Correct answer: Have the patient lie down, apply a cool cloth, and postpone the draw until they recover

Nausea can be a vasovagal prodrome; the patient should be positioned safely and the draw delayed until they are stable.

Question 25: A patient arrives for a draw and appears confused and cannot state their name. What is the BEST patient identification approach?

Skip the draw and reschedule when the patient is alert
Proceed based on the requisition form details
Compare the patient's face to their ID photo
Ask a family member or nurse to verify identity using the patient's ID band (Correct answer)

Correct answer: Ask a family member or nurse to verify identity using the patient's ID band

For patients unable to self-identify, a family member or nurse should verify identity using at least two identifiers, including the ID band.

Question 26: Which statement about patient education before blood collection is CORRECT?

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

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 27: For PTT, which tube is utilized?

Light Blue (Correct answer)
Red
Gray
Green

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 28: During an oral glucose tolerance test (OGTT), which of the following actions by the patient would invalidate the test?

Sitting quietly in the waiting room
Smoking a cigarette during the test (Correct answer)
Having the blood drawn 5 minutes late
Drinking required water between draws

Correct answer: Smoking a cigarette during the test

Smoking during an OGTT stimulates catecholamine release, which raises blood glucose and can falsely elevate results.

Question 29: 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 30: 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 a family member requests the results over the phone
When the patient has been discharged from the hospital

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 31: What exactly are antiseptics?

Chemicals used to clean human skin by inhibiting the growth of microorganisms (e.g., 70% isopropyl alcohol, iodine, chlorhexidine, chlorine, hexachlorophene, chloroxylenol, quaternary ammonium compounds, and triclosan) (Correct answer)
Chemicals used to make the skin dry and make venipunctures more safe (e.g., hand sanitizer)
Chemicals used to make the vein easier to palpate and select (e.g., heel warmer)
Chemicals used only on infants to decontaminate areas of the skin (e.g., water)

Correct answer: Chemicals used to clean human skin by inhibiting the growth of microorganisms (e.g., 70% isopropyl alcohol, iodine, chlorhexidine, chlorine, hexachlorophene, chloroxylenol, quaternary ammonium compounds, and triclosan)

Antiseptics are chemical agents specifically formulated to be safe for use on living tissues, such as human skin. Their primary function is to inhibit the growth and reproduction of microorganisms, thereby reducing the risk of infection. Common examples like 70% isopropyl alcohol and iodine are routinely used by phlebotomists to prepare a patient's skin before venipuncture.

Question 32: What is the maximum recommended angle for needle insertion during a routine venipuncture?

15 degrees
30 degrees (Correct answer)
60 degrees
45 degrees

Correct answer: 30 degrees

A 15–30 degree angle is recommended for venipuncture; 30 degrees is the maximum to avoid passing through the vein.

Question 33: An irate patient grabs a phlebotomist's arm during a blood draw. This is an example of which type of workplace hazard?

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

Correct answer: Psychosocial/workplace violence hazard

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

Question 34: What unique handling is needed for an ABG?

Shaking
Chilling (Correct answer)
Warming
Pre-warmed tubes

Correct answer: Chilling

Arterial Blood Gas (ABG) samples are highly sensitive to temperature and cellular metabolism, which can rapidly alter oxygen, carbon dioxide, and pH levels. Chilling the sample immediately after collection slows down the metabolic processes of blood cells. This crucial step prevents changes in gas levels and pH, ensuring the accuracy and reliability of the ABG results.

Question 35: Employees must get bloodborne pathogen education and training, according to OSHA, at __________.

None of the above
For a pre-agreed fee
At a reasonable cost
At no cost (Correct answer)

Correct answer: At no cost

OSHA (Occupational Safety and Health Administration) regulations mandate that employers provide bloodborne pathogen education and training to employees at no cost to the employee. This ensures that all workers potentially exposed to bloodborne pathogens receive the necessary information and training to protect themselves, regardless of their ability to pay.

Question 36: A patient experiences a sharp, radiating pain down their arm as the needle is inserted. This is a potential sign of:

Hemoconcentration.
An arterial puncture.
Nerve contact. (Correct answer)
A collapsing vein.

Correct answer: Nerve contact.

A sharp, electric, or radiating pain is a classic sign that the needle has come into contact with a nerve. If this occurs, the phlebotomist should immediately withdraw the needle and terminate the venipuncture to prevent potential nerve damage.

Question 37: What does the RACE acronym stand for in fire safety response?

Remove, Alarm, Confine, Extinguish
Rescue, Activate, Contain, Extinguish (Correct answer)
Remove, Activate, Contain, 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 38: When labeling a blood culture bottle at the bedside, which information is MOST critical to include?

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

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 39: When processing a blood sample in a serum separator tube (SST), which step is critical for proper specimen quality?

Allowing the tube to clot fully before centrifugation. (Correct answer)
Inverting the tube vigorously 15-20 times.
Placing the tube on ice as soon as it is filled.
Centrifuging the tube immediately after collection.

Correct answer: Allowing the tube to clot fully before centrifugation.

For a serum separator tube (SST), the blood must be allowed to clot completely before being placed in a centrifuge. This usually takes about 30 minutes at room temperature. Centrifuging too early can result in a fibrin-rich serum or incomplete separation, compromising the specimen's integrity.

Question 40: During a venipuncture, the phlebotomist notices a hematoma forming at the site. Which of the following is the most appropriate immediate action?

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

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

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

Correct answer: Potassium oxalate and sodium fluoride

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

Question 42: Which of the following situations would require a phlebotomist to draw a 'discard' tube before collecting a specimen for a coagulation test in a light blue top tube?

When the patient has been fasting for more than 12 hours.
When using a winged infusion set (butterfly needle). (Correct answer)
When collecting from a patient with a high hematocrit.
When it is the first tube drawn using a standard evacuated tube system.

Correct answer: When using a winged infusion set (butterfly needle).

When using a winged infusion set, the air in the tubing will displace blood, leading to an underfilled tube. For coagulation tests (light blue top), the 9:1 blood-to-anticoagulant ratio is critical. Drawing a discard tube first purges the air from the tubing, ensuring the light blue top tube fills to the correct volume.

Question 43: Which of the following is the best way for a phlebotomist to verify the identity of an outpatient who is conscious and alert?

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

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 44: A phlebotomist enters a room and finds two patients sharing the same room with very similar names. What is the SAFEST approach?

Call the nursing station to determine which bed is correct
Ask the roommate to point out the correct patient
Draw from the patient closest to the door, as listed first on the requisition
Confirm ID band and second identifier for each patient independently before any draw (Correct answer)

Correct answer: Confirm ID band and second identifier for each patient independently before any draw

Each patient must be independently verified using their ID band and a second identifier regardless of room sharing or similar names.

Question 45: A requisition order shows two different patient last names (maiden vs. married). How should the phlebotomist proceed?

Draw the specimen and flag the discrepancy on the label
Clarify the discrepancy with nursing or the ordering physician before drawing (Correct answer)
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 46: Why must the first drop of blood be wiped away during a capillary puncture?

It contains excess red blood cells
It is needed to prime the lancet
It contains excess platelets
It may be contaminated with tissue fluid and alcohol residue (Correct answer)

Correct answer: It may be contaminated with tissue fluid and alcohol residue

The first drop is discarded because it may be diluted with tissue fluid and contaminated with residual alcohol, skewing results.

Question 47: A patient reports feeling faint during venipuncture. What is the FIRST action to take?

Complete the draw as quickly as possible
Remove the needle and have the patient lower their head or lie down (Correct answer)
Apply a cold compress to the puncture site
Offer the patient a glass of water

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

Removing the needle immediately and positioning the patient to improve cerebral blood flow prevents injury from a vasovagal syncope episode.

Question 48: What is the correct temperature range for storing most routine blood specimens awaiting transport?

Body temperature at 37°C in a water bath
Room temperature at 37°C
Refrigerated at 2–8°C (Correct answer)
Frozen at –20°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 49: Which of the following will happen if tubes are chilled?

Stagnation of gel flow
Faster gel flow
None of the above
Slowed gel flow (Correct answer)

Correct answer: Slowed gel flow

Many blood collection tubes contain a thixotropic gel separator that forms a barrier between serum/plasma and blood cells after centrifugation. If these tubes are chilled, the viscosity of the gel increases significantly. This increased viscosity can impede the gel's ability to properly move and form a clean barrier during centrifugation, leading to slowed or incomplete gel flow and potentially affecting specimen separation and integrity.

Question 50: A specimen for lactic acid testing should be transported:

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

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 51: A patient scheduled for a lipid panel says they ate a small snack 4 hours ago. What should the phlebotomist do?

Draw the specimen and note the fasting deviation on the requisition
Draw immediately; 4 hours is sufficient fasting for a lipid panel
Reschedule and instruct the patient to fast for 9–12 hours (Correct answer)
Collect the specimen since triglycerides are unaffected by food

Correct answer: Reschedule and instruct the patient to fast for 9–12 hours

A lipid panel requires 9–12 hours of fasting; a 4-hour fast is inadequate and the test should be rescheduled.

Question 52: How often must phlebotomists receive bloodborne pathogen training per OSHA requirements?

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

Correct answer: Annually

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

Question 53: 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?

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

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

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

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

On ice at 4°C
Frozen at -20°C
Body temperature at 37°C (Correct answer)
Room temperature at 22°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 56: A patient's arm is edematous at the antecubital fossa. What is the best action?

Collect from a finger stick instead
Proceed with venipuncture at the same site
Apply extra pressure and draw from the edematous area
Select an alternate site such as the forearm or hand (Correct answer)

Correct answer: Select an alternate site such as the forearm or hand

Edematous tissue traps interstitial fluid that can dilute the specimen, so an alternate unaffected site must be chosen.

Question 57: Which specimen type is required for coagulation tests such as PT and aPTT?

Whole blood from a lavender-top tube
Plasma from a green-top heparin tube
Serum from a red-top tube
Plasma from a light-blue (sodium citrate) tube (Correct answer)

Correct answer: Plasma from a light-blue (sodium citrate) tube

Sodium citrate binds calcium to prevent clotting, and the correct 9:1 blood-to-additive ratio is critical for accurate coagulation results.

Question 58: 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
Blood culture, Coagulation tube, CBC tube (Correct answer)
CBC tube, Blood culture, Coagulation tube
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 59: Which label color indicates a biohazardous specimen bag?

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

Correct answer: Orange with black biohazard symbol

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

Question 60: After applying pressure to a venipuncture site, how should the phlebotomist dispose of the used needle?

Break the needle off the holder before discarding
Place the needle on the tray temporarily until the labeling is done
Immediately discard the uncapped needle directly into a puncture-resistant sharps container (Correct answer)
Recap the needle and place it in a regular trash can

Correct answer: Immediately discard the uncapped needle directly into a puncture-resistant sharps container

Needles must never be recapped and must be discarded immediately into a puncture-resistant sharps container to prevent needlestick injuries.

Question 61: A 24-hour urine collection is ordered. Which instruction to the patient is CORRECT?

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

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

Gloves and eye protection
Gloves and surgical mask
Gloves only (Correct answer)
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 63: What is the primary reason for avoiding vigorous shaking of blood collection tubes?

It increases glycolysis
It deactivates tube additives
It activates coagulation factors
It causes hemolysis by rupturing red blood cells (Correct answer)

Correct answer: It causes hemolysis by rupturing red blood cells

Vigorous shaking causes mechanical hemolysis by rupturing red blood cells, releasing intracellular contents that interfere with test results.

Question 64: A patient reports feeling dizzy and lightheaded during a venipuncture. What is the FIRST action the phlebotomist should take?

Remove the needle and have the patient lie down (Correct answer)
Ask the patient to take deep breaths while drawing continues
Call the nurse before removing the needle
Continue drawing to finish quickly

Correct answer: Remove the needle and have the patient lie down

If a patient shows signs of syncope, immediately remove the needle and position the patient safely (lying down or head between knees) to restore blood flow to the brain.

Question 65: The pressure is highest when the heart is contracting. The term for this pressure is the ______.

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

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

Blood (Correct answer)
Semen
Pleural fluid
Saliva

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 67: Specimens labeled with a 'STAT' priority should be delivered to the laboratory within:

2 hours
60 minutes
30 minutes (Correct answer)
5 minutes

Correct answer: 30 minutes

STAT specimens are urgent and most facilities require delivery and initial processing within 30 minutes of collection.

Question 68: Which tube additive is found in a red-top (no additive) tube?

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

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

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

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

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

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 71: What is the primary vein of choice for routine venipuncture in adults?

Basilic vein
Cephalic vein
Median antebrachial vein
Median cubital vein (Correct answer)

Correct answer: Median cubital vein

The median cubital vein is the preferred site because it is large, well-anchored, and least likely to roll or cause complications.

Question 72: Which description best defines the function and structure of capillaries?

Large valved vessels that return deoxygenated blood to the heart
Microscopic, single-cell-thick vessels where gas and nutrient exchange occurs between blood and tissues (Correct answer)
Thick-walled vessels that carry blood away from the heart under high pressure
Elastic vessels that absorb pressure changes generated by the heart

Correct answer: Microscopic, single-cell-thick vessels where gas and nutrient exchange occurs between blood and tissues

Capillaries are the smallest blood vessels, with walls only one endothelial cell thick, allowing efficient diffusion of oxygen, carbon dioxide, nutrients, and waste products between blood and surrounding tissues.

Question 73: A specimen for prothrombin time (PT) testing requires a light blue-top tube. What is the correct blood-to-additive ratio?

4:1
1:1
1:10
9:1 (Correct answer)

Correct answer: 9:1

Light blue-top tubes contain sodium citrate and require a 9:1 blood-to-anticoagulant ratio to ensure accurate coagulation results.

Question 74: What does the term 'chain of custody' mean in phlebotomy?

The order in which tubes are drawn
The hospital's policy for patient identification
The process of transporting specimens in a locked cooler
A documented, unbroken record tracking specimen handling from collection to result reporting (Correct answer)

Correct answer: A documented, unbroken record tracking specimen handling from collection to result reporting

Chain of custody is a documented process ensuring specimen integrity and accountability at every step from collection through analysis.

Question 75: A blood culture specimen should be inoculated in which order?

Anaerobic bottle first, then aerobic
Only one bottle is needed per draw
Either order is acceptable
Aerobic bottle first, then anaerobic (Correct answer)

Correct answer: Aerobic bottle first, then anaerobic

When collecting blood cultures via syringe, the aerobic bottle is inoculated first to prevent air from the syringe from entering the anaerobic bottle and inhibiting anaerobic organism growth.

Question 76: A patient taking diuretics has been asked to collect a 24-hour urine specimen. What instruction is most important?

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

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 77: What is the maximum recommended tourniquet application time before venipuncture?

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

Correct answer: 1 minute

Tourniquet application beyond one minute causes hemoconcentration, which can falsely elevate some analyte results.

Question 78: A specimen for ammonia testing must be:

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

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 79: Where exactly is the antecubital fossa?

The bend of the elbow, front of the arm (Correct answer)
The bend of the elbow, outer side of arm
The bend of the elbow, inner side of arm
The bend of the elbow, back of the arm

Correct answer: The bend of the elbow, front of the arm

The antecubital fossa is the triangular hollow area located on the anterior (front) aspect of the elbow joint. This region is anatomically significant in phlebotomy because it contains the major superficial veins (median cubital, cephalic, and basilic) that are commonly accessed for blood draws.

Question 80: Which specimen type is required for a prothrombin time (PT) test?

Whole blood in an EDTA tube
Serum in a red-top tube
Urine in a sterile cup
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 81: An inpatient's ID band is missing. What should the phlebotomist do?

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
Draw the specimen and note 'ID band absent' on the tube
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 82: Hemolysis in a specimen is MOST likely caused by which phlebotomy error?

Collecting in the correct order of draw
Using an evacuated tube that is too large
Drawing blood too slowly through a small-gauge needle (Correct answer)
Allowing the tourniquet on for less than one minute

Correct answer: Drawing blood too slowly through a small-gauge needle

Slow, forceful aspiration through a small-gauge needle creates turbulence and shear forces that lyse red blood cells.

Question 83: Which additive in a light blue (sodium citrate) tube prevents clotting by binding calcium?

Potassium oxalate
Lithium heparin
EDTA
Sodium citrate (Correct answer)

Correct answer: Sodium citrate

Sodium citrate chelates calcium ions, which are necessary for the clotting cascade, thereby preventing coagulation.

Question 84: Which federal regulation governs bloodborne pathogen exposure control in the workplace?

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

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 85: A phlebotomist accidentally needlesticks themselves after drawing blood from an HCV-positive patient. What is the FIRST action?

Request a blood transfusion
Wash the wound vigorously with soap and water, then report to employee health immediately (Correct answer)
Immediately notify the supervisor and file an incident report
Apply a bandage and monitor for symptoms over 6 months

Correct answer: Wash the wound vigorously with soap and water, then report to employee health immediately

Immediate thorough washing of the wound with soap and water, followed by prompt reporting to employee health, is the standard first response to a needlestick.

Question 86: 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.
Discard the needle in the regular trash.
Ask the patient about their medical history.
Complete an incident report and inform their supervisor. (Correct answer)

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

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

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

From the IV catheter directly
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 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 89: A patient's requisition indicates 'STAT' status. How does this affect patient identification?

The ordering physician's presence substitutes for ID verification
Identification steps may be abbreviated to save time
Only the patient's room number is needed for STAT draws
Standard two-identifier verification is still required regardless of urgency (Correct answer)

Correct answer: Standard two-identifier verification is still required regardless of urgency

STAT urgency does not waive identification requirements; two patient identifiers must always be confirmed.

Question 90: Which pre-analytical variable is most likely to affect potassium (K+) results if not controlled?

Time of day of collection
Patient's hydration status
Patient's body mass index
Prolonged tourniquet application causing hemolysis (Correct answer)

Correct answer: Prolonged tourniquet application causing hemolysis

Prolonged tourniquet use can cause hemolysis, releasing intracellular potassium and falsely elevating serum K+ levels.

Question 91: Which of the following is most crucial for a peak and trough sample to be successful and effective?

Timing (Correct answer)
All of the above
Puncturing site
Tubes

Correct answer: Timing

Peak and trough blood samples are collected to monitor the levels of certain medications in a patient's bloodstream, ensuring therapeutic efficacy and preventing toxicity. The 'peak' level is drawn when the drug concentration is highest, and the 'trough' level is drawn when it's lowest, just before the next dose. Precise timing of these collections relative to drug administration is absolutely critical for accurate interpretation of the drug's pharmacokinetics and for guiding dosage adjustments.

Question 92: When disposing of a used lancet, which container should be used?

Regular trash bin
Red biohazard bag
Puncture-resistant sharps container (Correct answer)
Yellow chemotherapy waste container

Correct answer: Puncture-resistant sharps container

Used lancets are sharps and must be disposed of in a puncture-resistant, labeled sharps container to prevent injury.

Question 93: When collecting a specimen for erythrocyte sedimentation rate (ESR), which tube is used and what is the maximum time before testing?

Sodium citrate (blue-top); must test within 2 hours
Heparin (green-top); must test within 1 hour
SST; must test within 4 hours
EDTA (lavender-top); must test within 4 hours of collection (Correct answer)

Correct answer: EDTA (lavender-top); must test within 4 hours of collection

ESR is performed on EDTA whole blood and must be tested within 4 hours of collection (or 12 hours if refrigerated at 4°C) to yield valid results.

Question 94: Which professional organization publishes the CLSI standards used in phlebotomy practice?

Centers for Disease Control and Prevention
American Medical Association
Clinical and Laboratory Standards Institute (Correct answer)
American Society for Clinical Pathology

Correct answer: Clinical and Laboratory Standards Institute

CLSI (Clinical and Laboratory Standards Institute) develops voluntary consensus standards and guidelines for laboratory best practices including phlebotomy.

Question 95: Which of the following is a key requirement of the Needlestick Safety and Prevention Act?

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

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 96: Where can you quickly and accurately find the information you need about a dangerous chemical if you come across one?

Employee Manual
By searching on the internet
Procedural manual
Material Safety Data Sheet (MSDS) (Correct answer)

Correct answer: Material Safety Data Sheet (MSDS)

A Material Safety Data Sheet (MSDS), now often referred to as a Safety Data Sheet (SDS), is a comprehensive document that provides detailed information about a hazardous chemical. It includes data on its properties, potential hazards, safe handling procedures, emergency control measures, and first-aid information. MSDS/SDS sheets are legally required to be readily accessible in workplaces where hazardous chemicals are used, ensuring quick access to critical safety information.

Question 97: Which tube is used to collect a specimen for a fasting blood glucose test?

Red top
Gray top (sodium fluoride) (Correct answer)
Light blue top
Green top

Correct answer: Gray top (sodium fluoride)

The gray top tube contains sodium fluoride, a glycolytic inhibitor that prevents red blood cells from consuming glucose and preserves the sample accurately.

Question 98: Which of the following is considered an engineering control under the OSHA Bloodborne Pathogens Standard?

Using a needle with a retractable safety shield (Correct answer)
Wearing double gloves
Following hand hygiene protocols
Posting biohazard warning signs

Correct answer: Using a needle with a retractable safety shield

Engineering controls are physical or mechanical devices — such as safety-engineered needles — that isolate or remove bloodborne pathogen hazards.

Question 99: What is the primary purpose of the evacuated tube system (ETS) in phlebotomy?

To sterilize the collection site
To warm the blood sample
To mix anticoagulants before collection
To create a vacuum that draws blood directly into the tube (Correct answer)

Correct answer: To create a vacuum that draws blood directly into the tube

The evacuated tube system uses a pre-measured vacuum to draw a precise volume of blood directly into the collection tube.

Question 100: What is the correct order for donning (putting on) PPE?

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

Correct answer: Gown, mask, eye protection, gloves

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

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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