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

Question 1: A laboratory implements a new centrifuge protocol and notices gel separator tubes processed under the new protocol have serum with red cell contamination visible above the gel barrier. This is MOST likely due to:

Centrifugation at insufficient speed or time, preventing complete separation (Correct answer)
Tubes being centrifuged at too high a speed for too long
Tubes being stored upright instead of inverted during centrifugation
An error in the QC of the tube itself

Correct answer: Centrifugation at insufficient speed or time, preventing complete separation

Inadequate centrifuge speed (g-force) or insufficient time fails to drive cells through the gel barrier, leaving them in the serum layer above the gel.

Question 2: A specimen labeled 'STAT' must be delivered to the laboratory within what general timeframe?

Within 2 hours
Immediately or within 30–60 minutes (Correct answer)
By end of shift
Within 4 hours

Correct answer: Immediately or within 30–60 minutes

STAT specimens require immediate priority handling and are typically delivered to the lab within 30–60 minutes to support urgent clinical decisions.

Question 3: What information is REQUIRED on a properly labeled specimen tube at the time of collection?

Patient name, date of birth, collection date and time, and collector ID (Correct answer)
Patient name, test name, and phlebotomist's phone number
Patient name and room number only
Physician name, diagnosis, and patient insurance ID

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

CLSI and most accreditation standards require at minimum the patient's full name, date of birth, date and time of collection, and the collector's identifier.

Question 4: Which finding at the venipuncture site indicates accidental arterial puncture?

Bright red blood pulsating into the tube (Correct answer)
Visible bruising immediately
Absence of blood return
Dark, slowly draining blood

Correct answer: Bright red blood pulsating into the tube

Arterial blood is bright red and may enter the tube rapidly in a pulsatile manner due to the higher pressure in arteries.

Question 5: What is the CORRECT action if a patient has a dialysis fistula in one arm?

Avoid drawing blood from the fistula arm entirely (Correct answer)
Draw from the fistula arm using a small-gauge needle
Use the fistula arm only for STAT labs
Check blood pressure in the fistula arm first, then draw

Correct answer: Avoid drawing blood from the fistula arm entirely

The fistula arm must never be used for venipuncture, blood pressure, or IV access, as damage can destroy the fistula and eliminate dialysis access.

Question 6: After a fingerstick, the patient should be instructed to hold their finger:

In a fist to promote blood flow
Submerged in cold water to stop bleeding
Elevated above heart level with pressure applied (Correct answer)
Dependent (hanging down) with gentle pressure applied

Correct answer: Elevated above heart level with pressure applied

Elevating the puncture site above heart level reduces blood flow and promotes hemostasis while applying gentle pressure; dependent positioning increases bleeding.

Question 7: What does the acronym 'RACE' stand for in a fire emergency response?

Run, Alarm, Close doors, Exit
Report, Activate, Call, Escape
Rescue, Alert, Cover, Evacuate
Remove, Alarm, Contain, Extinguish (Correct answer)

Correct answer: Remove, Alarm, Contain, Extinguish

RACE stands for Rescue patients in immediate danger, Alarm (activate the fire alarm), Contain the fire by closing doors, and Extinguish if safe to do so.

Question 8: A POCT INR result of 5.8 is obtained on a patient taking warfarin. This result is considered:

A critical value requiring immediate provider notification (Correct answer)
Subtherapeutic—the warfarin dose needs increasing
Within acceptable range for mechanical heart valves
Normal therapeutic range for warfarin

Correct answer: A critical value requiring immediate provider notification

An INR of 5.8 is dangerously elevated and represents a critical value; the patient is at high risk for serious bleeding and requires immediate clinical intervention.

Question 9: When accessioning a specimen, which piece of information is MOST critical to verify first?

The tube's expiration date
The color of the tube top
Patient identifiers matching the label and requisition (Correct answer)
The physician's name on the requisition

Correct answer: Patient identifiers matching the label and requisition

Patient identification — confirming that the label information matches the requisition — is the most critical step to prevent specimen mix-ups that could lead to dangerous misdiagnoses.

Question 10: Which of the following best describes the phlebotomist's responsibility when a patient asks what the blood test is for?

Explain the test in general terms and refer detailed medical questions to the physician (Correct answer)
Ignore the question and proceed
Refuse to answer any questions
Provide a full diagnosis based on the requisition

Correct answer: Explain the test in general terms and refer detailed medical questions to the physician

Phlebotomists should provide basic information in a reassuring manner but refer clinical interpretation and diagnosis questions to the ordering physician.

Question 11: The 'rule of four' regarding pre-analytical errors states that approximately how many laboratory errors occur in the pre-analytical phase?

20% of all errors
40% of all errors
60–70% of all errors (Correct answer)
Less than 10% of all errors

Correct answer: 60–70% of all errors

Studies consistently show that 60–70% of all laboratory errors are pre-analytical, underscoring the critical importance of proper specimen collection and handling.

Question 12: Which of the following patient conditions requires special identification verification procedures per NCCT standards?

Patients wearing glasses
Ambulatory outpatients
Unconscious or sedated patients (Correct answer)
Patients with type 2 diabetes

Correct answer: Unconscious or sedated patients

Unconscious or sedated patients cannot verbally confirm their identity, requiring staff or armband verification to ensure correct specimen labeling.

Question 13: A timed glucose tolerance test (GTT) requires multiple draws. If the 2-hour post-glucose draw is collected at 2 hours 15 minutes, this is considered:

A pre-analytical error that should be documented (Correct answer)
A post-analytical error requiring repeat testing
Within the 15-minute grace period allowed by all labs
Acceptable within the standard 30-minute tolerance window

Correct answer: A pre-analytical error that should be documented

Draws outside the specified collection window in timed tests constitute a pre-analytical error that must be documented so clinicians can interpret results correctly.

Question 14: Which of the following actions violates standard precautions when drawing blood?

Disposing of sharps immediately in a puncture-resistant container
Recapping a used needle using the one-handed scoop technique
Recapping a used needle by holding the cap with the other hand (Correct answer)
Wearing gloves for every venipuncture

Correct answer: Recapping a used needle by holding the cap with the other hand

Two-handed recapping is prohibited under standard precautions because it significantly increases the risk of needlestick injury.

Question 15: What angle of needle insertion is recommended for radial artery puncture for ABG collection?

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

Correct answer: 45–60 degrees

A needle insertion angle of 45–60 degrees is recommended for radial artery puncture, providing the optimal approach to enter the artery at its depth without excessive angulation.

Question 16: A phlebotomist accidentally mislabels a specimen, leading to an incorrect diagnosis. This is an example of:

Battery
Fraud
Negligence (Correct answer)
Assault

Correct answer: Negligence

Negligence occurs when a healthcare professional fails to meet the standard of care, causing patient harm.

Question 17: After collecting an ABG sample, the syringe should be gently rotated/rolled for at least 5 seconds before capping. This step ensures:

The sample clots before being placed on ice
Air bubbles rise to the top for easier removal
The sample cools to room temperature before analysis
The heparin anticoagulant is thoroughly mixed with the blood (Correct answer)

Correct answer: The heparin anticoagulant is thoroughly mixed with the blood

Rolling the syringe mixes the heparin anticoagulant throughout the blood sample, preventing clot formation that would interfere with blood gas analysis.

Question 18: After a successful venipuncture, tubes should be mixed by:

Vigorous shaking for 30 seconds to fully dissolve additives
Gentle inversion 8–10 times immediately after collection (Correct answer)
Placing on a mechanical tube rocker for 5 minutes
No mixing is needed for tubes with additive

Correct answer: Gentle inversion 8–10 times immediately after collection

Tubes must be gently inverted 8–10 times immediately after collection to mix blood with additives; vigorous shaking causes hemolysis and excessive foam, while inadequate mixing causes clotting in anticoagulant tubes.

Question 19: The AMT RPT recertification requires:

Retaking the full examination every year
Continuing education units (CEUs) on a defined renewal cycle (Correct answer)
A letter of recommendation from a physician
Proof of 500 venipunctures annually

Correct answer: Continuing education units (CEUs) on a defined renewal cycle

AMT RPT holders must earn CEUs and pay renewal fees on the AMT's recertification cycle to maintain active credentialed status.

Question 20: Which disinfectant concentration of sodium hypochlorite (bleach) is recommended by the CDC for decontaminating blood spills?

1:50 dilution (approximately 1,000 ppm)
1:100 dilution (approximately 500 ppm)
Undiluted household bleach
1:10 dilution (approximately 5,000 ppm) (Correct answer)

Correct answer: 1:10 dilution (approximately 5,000 ppm)

A 1:10 dilution of household bleach provides approximately 5,000 ppm of available chlorine, which is effective for blood spill decontamination.

Question 21: Which gauge needle is most commonly used for routine adult venipuncture?

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

Correct answer: 21-gauge

21-gauge needles are the standard choice for routine adult venipuncture, balancing patient comfort and adequate blood flow.

Question 22: Which vein is considered the FIRST choice for routine venipuncture in most patients?

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

Correct answer: Median cubital vein

The median cubital vein is the preferred first choice because it is large, well-anchored, and less painful to puncture.

Question 23: Which specimen is typically collected in a grey-top tube containing sodium fluoride?

Complete blood count (CBC)
Thyroid function tests
Coagulation studies
Glucose and lactate testing (Correct answer)

Correct answer: Glucose and lactate testing

Grey-top tubes with sodium fluoride inhibit glycolysis, preserving glucose levels for accurate glucose and lactate measurements.

Question 24: A phlebotomist notices a patient's armband is missing. What is the correct next step?

Ask the nurse at the station to confirm the patient's identity
Obtain a new armband and verify two identifiers before drawing (Correct answer)
Ask the patient to verbally confirm their name and proceed
Draw the blood and label it with information from the requisition form

Correct answer: Obtain a new armband and verify two identifiers before drawing

A patient must have a proper armband with verified two-identifier confirmation before any specimen is collected to prevent misidentification.

Question 25: A patient on warfarin therapy requires venipuncture. What extra precaution is MOST important post-draw?

Use a smaller gauge needle
Avoid the antecubital fossa entirely
Draw blood only from the hand veins
Apply firm pressure for an extended period until bleeding stops (Correct answer)

Correct answer: Apply firm pressure for an extended period until bleeding stops

Anticoagulated patients have prolonged clotting times and require extended pressure application—often 5 minutes or more—to achieve hemostasis.

Question 26: A Levey-Jennings chart plots control values over time against which reference points?

The manufacturer's stated acceptable QC ranges
The patient's normal range for each analyte
The mean and standard deviations (±1SD, ±2SD, ±3SD) of the control material (Correct answer)
The previous day's QC values as a baseline

Correct answer: The mean and standard deviations (±1SD, ±2SD, ±3SD) of the control material

Levey-Jennings charts plot consecutive control values against established mean ±1, 2, and 3 standard deviation (SD) lines, allowing visual detection of trends and rule violations.

Question 27: Which of the following veins is considered the FIRST choice for routine adult venipuncture according to standard phlebotomy guidelines?

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

Correct answer: Median cubital vein

The median cubital vein in the antecubital fossa is the preferred site because it is large, well-anchored, and least painful.

Question 28: What is the correct centrifuge speed and time for most routine serum separation in a standard clinical laboratory?

2,000–3,000 × g for 10 minutes (Correct answer)
5,000 × g for 20 minutes
500 × g for 2 minutes
1,000–1,500 × g for 5 minutes

Correct answer: 2,000–3,000 × g for 10 minutes

Most clinical laboratories centrifuge routine serum or plasma specimens at 2,000–3,000 × g for approximately 10 minutes to achieve complete separation without damaging cells.

Question 29: Which of the following would be a valid reason for a laboratory to reject a blood specimen?

The phlebotomist's initials are on the label.
The patient's name is written in pen on the label.
The specimen was transported at room temperature.
The specimen was collected in a tube with an expired date. (Correct answer)

Correct answer: The specimen was collected in a tube with an expired date.

Laboratories have strict criteria for specimen acceptance to ensure test accuracy. Using an expired collection tube is a reason for rejection because the vacuum may be insufficient and the additives may have degraded, compromising the specimen's integrity.

Question 30: What is the primary reason that EDTA tubes are collected FIRST in the capillary order of draw?

Lab policy requires EDTA first regardless of clinical rationale
To ensure the hematology specimen is collected before platelet clumping and activation occur (Correct answer)
EDTA stabilizes glucose levels in the sample
EDTA prevents clotting of the entire collection

Correct answer: To ensure the hematology specimen is collected before platelet clumping and activation occur

In capillary collection, EDTA tubes are first because the trauma of skin puncture activates platelets immediately; early collection captures the most representative sample before significant platelet clumping occurs.

Question 31: A 6-year-old patient with a known diagnosis of hemophilia A requires a blood draw. What special consideration applies?

Hemophilia A does not affect phlebotomy procedures
Use a small butterfly needle with careful technique and apply prolonged pressure afterward (Correct answer)
Use a larger gauge needle to minimize the number of attempts
Avoid venipuncture entirely and use only capillary collection

Correct answer: Use a small butterfly needle with careful technique and apply prolonged pressure afterward

Hemophilia A (factor VIII deficiency) impairs clotting; careful technique to minimize trauma and prolonged post-draw pressure are essential to prevent hematoma.

Question 32: A capillary blood glucose result is typically considered to be which of the following compared to a venous plasma glucose?

Always 20% higher due to arterial mixing
Identical—there is no difference
10–15% lower than venous plasma glucose
Approximately equal to or slightly higher than venous plasma glucose (Correct answer)

Correct answer: Approximately equal to or slightly higher than venous plasma glucose

Capillary blood glucose is approximately equal to or slightly higher (up to 10–15% higher) than venous blood glucose because capillary blood contains more arterial blood with higher glucose.

Question 33: What is the primary purpose of the Exposure Control Plan mandated by OSHA's Bloodborne Pathogens Standard?

To eliminate or minimize employee exposure to blood and other potentially infectious materials (Correct answer)
To outline disciplinary actions for PPE non-compliance
To document all patients' infectious disease status
To schedule annual hepatitis B vaccinations

Correct answer: To eliminate or minimize employee exposure to blood and other potentially infectious materials

The Exposure Control Plan is a written document outlining procedures to eliminate or minimize occupational exposure to bloodborne pathogens.

Question 34: What is the maximum number of venipuncture attempts a phlebotomist should make on a single patient before seeking assistance?

1
3
4
2 (Correct answer)

Correct answer: 2

Standard practice limits phlebotomists to two venipuncture attempts per patient before asking a colleague to attempt the collection.

Question 35: During a blood draw, gloves become visibly contaminated with blood. What is the appropriate action?

Stop, remove gloves, perform hand hygiene, and re-glove before continuing (Correct answer)
Wipe gloves with an alcohol swab and continue
Continue the draw and change gloves after completing the collection
Remove gloves, complete the draw barehanded, then perform hand hygiene

Correct answer: Stop, remove gloves, perform hand hygiene, and re-glove before continuing

Visibly contaminated gloves must be removed immediately; hands must be sanitized before donning new gloves to prevent cross-contamination.

Question 36: A phlebotomist notices a patient's ID band is missing. What should they do?

Ask a nearby visitor to confirm the patient's identity
Ask the patient to verbally state their name and date of birth only
Refuse to draw until proper identification is confirmed per facility protocol (Correct answer)
Proceed using the requisition form alone

Correct answer: Refuse to draw until proper identification is confirmed per facility protocol

Proper patient identification is mandatory before specimen collection; the phlebotomist must follow facility protocol to obtain verified ID before proceeding.

Question 37: Potassium EDTA (K2EDTA) is preferred over sodium EDTA for hematology specimens because:

K2EDTA prevents hemolysis more effectively
It adds less volume and dilutes the sample less
Sodium EDTA causes red cell shrinkage while K2EDTA better preserves cell morphology (Correct answer)
Sodium EDTA is no longer manufactured in the United States

Correct answer: Sodium EDTA causes red cell shrinkage while K2EDTA better preserves cell morphology

K2EDTA is the CLSI-recommended anticoagulant for hematology because it preserves cell morphology and size better than sodium EDTA, which can cause red cell shrinkage.

Question 38: Which hepatitis virus is primarily transmitted through the fecal-oral route and poses the least occupational risk to phlebotomists?

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

Correct answer: Hepatitis A

Hepatitis A is transmitted via the fecal-oral route, not blood, so it poses minimal occupational risk during routine phlebotomy.

Question 39: Which vein is most commonly selected for routine venipuncture according to ASCP phlebotomy guidelines?

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

Correct answer: Median cubital vein

The median cubital vein is the preferred first choice for venipuncture because it is large, well-anchored, and typically less painful.

Question 40: Microtainer tubes are color-coded the same as adult venipuncture tubes. Which Microtainer tube would be used for a neonatal chemistry panel (BMP)?

Gray (sodium fluoride)
Green (lithium heparin)
Lavender (EDTA)
Gold (serum separator with clot activator) (Correct answer)

Correct answer: Gold (serum separator with clot activator)

Gold-top Microtainer tubes (serum separator with clot activator) are used for chemistry panels, just as gold/SST tubes are used in adult venipuncture for chemistry testing.

Question 41: A phlebotomist must draw blood for a coagulation test, a complete blood count (CBC), and a serum chemistry panel. Which is the correct order of draw using the evacuated tube system?

Lavender top (EDTA), Light Blue top (sodium citrate), Red top (serum)
Red top (serum), Light Blue top (sodium citrate), Lavender top (EDTA)
Light Blue top (sodium citrate), Red top (serum), Lavender top (EDTA) (Correct answer)
Red top (serum), Lavender top (EDTA), Light Blue top (sodium citrate)

Correct answer: Light Blue top (sodium citrate), Red top (serum), Lavender top (EDTA)

The correct order of draw is critical to prevent cross-contamination of additives between tubes. For these tests, the Light Blue top (sodium citrate for coagulation) must be drawn first. The Red top (serum tube, which may have a clot activator but no anticoagulant) comes next. Finally, the Lavender top (EDTA) is drawn for the CBC.

Question 42: A phlebotomist is asked by a law enforcement officer to draw blood from an unconscious DUI suspect without a warrant. The phlebotomist should:

Comply because law enforcement always supersedes consent requirements
Draw blood only after calling the patient's next of kin
Proceed since the patient is unconscious and cannot object
Decline unless a valid warrant or applicable legal exception is presented, and consult with a supervisor (Correct answer)

Correct answer: Decline unless a valid warrant or applicable legal exception is presented, and consult with a supervisor

Following the Missouri v. McNeely Supreme Court ruling, warrantless blood draws generally require patient consent or a recognized legal exception; consult institutional policy and supervision.

Question 43: When a blood culture is ordered, the skin must be disinfected with 70% isopropyl alcohol followed by which agent to achieve the highest level of antisepsis?

Hydrogen peroxide
Benzalkonium chloride
Povidone-iodine or chlorhexidine gluconate (Correct answer)
Saline solution

Correct answer: Povidone-iodine or chlorhexidine gluconate

Blood culture sites require a two-step prep using alcohol followed by povidone-iodine or chlorhexidine to reduce skin flora and minimize contamination.

Question 44: What condition can result from excessive fist pumping by a patient during venipuncture?

Thrombocytopenia
Hypoglycemia
Pseudohyperkalemia (Correct answer)
Hemodilution

Correct answer: Pseudohyperkalemia

Repeated fist pumping causes potassium to leak from muscle cells, falsely elevating serum potassium (pseudohyperkalemia).

Question 45: A patient identifies themselves, but the name on the tube label doesn't match the requisition. The phlebotomist should:

Draw the blood and inform the nurse after collection
Use the name the patient stated and cross out the label name
Stop the procedure and resolve the discrepancy before drawing blood (Correct answer)
Draw the blood using the tube that's already labeled and correct it later

Correct answer: Stop the procedure and resolve the discrepancy before drawing blood

Any patient identification discrepancy must be resolved BEFORE drawing blood; collecting on a mislabeled specimen is a serious patient safety error that can cause wrong-patient results.

Question 46: Which tube additive is matched CORRECTLY with its function?

Sodium citrate – binds calcium to prevent coagulation (Correct answer)
Sodium fluoride – prevents hemolysis
EDTA – promotes clotting
Heparin – causes platelet aggregation

Correct answer: Sodium citrate – binds calcium to prevent coagulation

Sodium citrate reversibly binds calcium ions, preventing the coagulation cascade and preserving the sample for coagulation studies.

Question 47: A test for bilirubin levels has been ordered. What is the most critical handling requirement for this specimen immediately after collection?

Place the tube in an ice slurry.
Keep the tube at body temperature (37°C).
Centrifuge the tube immediately.
Protect the tube from light. (Correct answer)

Correct answer: Protect the tube from light.

Bilirubin is a photosensitive analyte, meaning it breaks down when exposed to light. To ensure accurate test results, the specimen must be protected from light by wrapping it in aluminum foil or placing it in an amber-colored tube immediately after collection.

Question 48: A sharps container is three-quarters full. What is the correct action?

Transfer needles to a new container using forceps
Continue using it until it is completely full
Seal and replace the container according to facility policy (Correct answer)
Press the contents down to create more space

Correct answer: Seal and replace the container according to facility policy

OSHA and most facility policies require sharps containers to be replaced when they reach the designated fill line (usually three-quarters full) to prevent overfilling and injury.

Question 49: A phlebotomist enters a patient's room and explains they need to draw blood. The patient, who appears competent, silently extends their arm. This is an example of which type of consent?

Expressed Consent
Minor Consent
Implied Consent (Correct answer)
Informed Consent

Correct answer: Implied Consent

Implied consent is demonstrated by the patient's actions, such as extending an arm for venipuncture, which indicates a voluntary agreement to the procedure without verbal or written confirmation. While the procedure was explained (an element of informed consent), the patient's non-verbal action is the key to this scenario.

Question 50: Westgard's 1₃ₛ rule states that a QC run is rejected when:

One control value exceeds ±3SD (Correct answer)
Two consecutive controls exceed ±2SD
Ten consecutive controls fall on the same side of the mean
The range between two controls exceeds 4SD

Correct answer: One control value exceeds ±3SD

The 1₃s (one-three-sigma) Westgard rule rejects a run when any single control value exceeds 3 standard deviations from the mean, indicating a probable random error.

Question 51: Which of the following represents a POST-ANALYTICAL quality concern in phlebotomy and laboratory practice?

Using the wrong vacuum tube for the ordered test
Centrifuging a specimen at the wrong speed
Mislabeling a specimen tube at the bedside
Failing to notify the provider of a critical value within the required timeframe (Correct answer)

Correct answer: Failing to notify the provider of a critical value within the required timeframe

Critical value notification failure is a post-analytical error—it occurs after the result is generated, in the communication/reporting phase.

Question 52: A patient has a normal adult hematocrit. Which range best represents this value for males?

28–34%
38–50% (Correct answer)
70–80%
55–65%

Correct answer: 38–50%

Normal hematocrit for adult males is approximately 41–53%, so the range 38–50% is the closest correct answer among the choices.

Question 53: When drawing blood from a pediatric patient, which communication approach is most appropriate?

Perform the draw as quickly as possible without any explanation
Speak only to the parent and ignore the child
Tell the child it will not hurt at all
Use age-appropriate language and explain what will happen in simple terms (Correct answer)

Correct answer: Use age-appropriate language and explain what will happen in simple terms

Age-appropriate communication helps reduce fear and gain cooperation; honest explanations build trust while giving false reassurances can harm the therapeutic relationship.

Question 54: Which vein in the antecubital area is considered the least preferred due to its proximity to the brachial artery?

Cephalic
Dorsal hand vein
Median cubital
Basilic (Correct answer)

Correct answer: Basilic

The basilic vein is least preferred because it lies near the brachial artery and median nerve, increasing the risk of accidental arterial puncture or nerve injury.

Question 55: Which lancet depth is recommended for an adult fingerstick to ensure adequate blood collection without causing undue pain?

3.5–4.0 mm
2.4–3.0 mm
1.5–2.0 mm (Correct answer)
0.5–1.0 mm

Correct answer: 1.5–2.0 mm

A lancet depth of 1.5–2.0 mm is typically sufficient for adult fingerstick collection, providing adequate blood flow while minimizing pain and avoiding deep tissue.

Question 56: A specimen tube that should be kept on ice during transport is a(n):

Coagulation (PT/INR) tube
CBC (complete blood count) tube
Arterial blood gas (ABG) syringe (Correct answer)
Blood culture bottle

Correct answer: Arterial blood gas (ABG) syringe

ABG samples must be kept on ice to slow cellular metabolism and prevent gas exchange that would alter pH, pO₂, and pCO₂ values.

Question 57: When performing a fingerstick on an adult patient, which finger is the PREFERRED site?

Thumb
Little finger
Index finger
Middle or ring finger (Correct answer)

Correct answer: Middle or ring finger

The middle (third) and ring (fourth) fingers are preferred for adult fingersticks because they have adequate tissue depth and fewer nerve endings than the index finger.

Question 58: What is the correct order of donning (putting on) PPE before entering an isolation room?

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

Correct answer: Gown, mask, eye protection, gloves

CDC guidelines specify gown first, then mask/respirator, then eye protection, then gloves last so gloves cover the gown cuffs.

Question 59: What is the primary purpose of applying a tourniquet during venipuncture?

To sterilize the puncture site
To distend veins by restricting venous blood flow (Correct answer)
To prevent arterial blood from entering the tube
To reduce patient movement

Correct answer: To distend veins by restricting venous blood flow

A tourniquet restricts venous return, causing veins to distend and become more visible and palpable for easier needle access.

Question 60: If a phlebotomist's eye is splashed with blood, which action should be taken immediately?

Flush the eye with clean water or saline for 15 minutes (Correct answer)
Pat the eye dry with a sterile gauze pad
Apply an antibiotic eye drop
Close the eye tightly and report to occupational health

Correct answer: Flush the eye with clean water or saline for 15 minutes

Immediate and prolonged flushing of the eye with water or saline for at least 15 minutes is the first response to a mucous membrane blood splash.

Question 61: When reconstituting a lyophilized (freeze-dried) control or reagent, which technique ensures the most accurate result?

Heat the vial at 56°C for 5 minutes
Gently swirl and roll the vial until fully dissolved without introducing bubbles (Correct answer)
Shake the vial vigorously to dissolve quickly
Add double the specified diluent volume to ensure complete dissolution

Correct answer: Gently swirl and roll the vial until fully dissolved without introducing bubbles

Gentle swirling prevents foaming and bubble formation that can trap undissolved material, ensuring complete reconstitution and accurate analyte concentrations.

Question 62: What is the primary reason sodium fluoride (gray-top) tubes are used for glucose testing?

Sodium fluoride inhibits glycolysis, preventing cells from consuming glucose (Correct answer)
Fluoride activates enzymes that stabilize glucose molecules
Fluoride enhances colorimetric glucose reactions for more accurate readings
It anticoagulates the specimen better than EDTA

Correct answer: Sodium fluoride inhibits glycolysis, preventing cells from consuming glucose

Sodium fluoride is a glycolytic inhibitor that blocks red blood cell glycolysis, preventing the breakdown of glucose and preserving the specimen's glucose concentration for up to 24 hours.

Question 63: A phlebotomist has just drawn a serum separator tube (SST) for a chemistry panel. What is the correct minimum time the tube should be allowed to clot before centrifugation?

Immediately
10 minutes
60 minutes
30 minutes (Correct answer)

Correct answer: 30 minutes

Serum separator tubes require adequate time for complete clot formation to ensure proper separation of serum from cellular components during centrifugation. The standard recommended minimum clotting time is 30 minutes at room temperature.

Question 64: A serum specimen appears hemolyzed. Which analyte result is MOST likely to be falsely elevated?

Sodium
Potassium (Correct answer)
Glucose
Calcium

Correct answer: Potassium

Potassium is highly concentrated inside red blood cells, so hemolysis releases it into the serum, causing falsely elevated potassium values.

Question 65: What is the recommended angle of needle insertion for routine adult venipuncture?

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

Correct answer: 15–30 degrees

A 15–30 degree angle is standard for venipuncture, allowing the needle to enter the vein without piercing the posterior wall.

Question 66: Which sharps disposal container characteristic is required under OSHA's Bloodborne Pathogens Standard?

Red-colored only
Must be emptied daily regardless of fill level
Transparent so fill level is visible
Closable, puncture-resistant, leak-proof on sides and bottom, and labeled with a biohazard symbol (Correct answer)

Correct answer: Closable, puncture-resistant, leak-proof on sides and bottom, and labeled with a biohazard symbol

OSHA requires sharps containers to be closable, puncture-resistant, leak-proof on sides and bottom, and properly labeled or color-coded.

Question 67: The AMT RPT examination is administered by:

The National Phlebotomy Association
The National Healthcareer Association
The American Society for Clinical Pathology
American Medical Technologists (Correct answer)

Correct answer: American Medical Technologists

AMT (American Medical Technologists) administers the RPT exam and credential for phlebotomy technicians.

Question 68: After removing the needle from the patient's arm, what is the correct immediate post-venipuncture instruction for the patient?

Remove the gauze immediately to check if bleeding has stopped.
Bend the arm at the elbow to hold the gauze in place.
Apply firm pressure to the gauze over the site without bending the arm. (Correct answer)
Pump their fist several times to restore circulation.

Correct answer: Apply firm pressure to the gauze over the site without bending the arm.

Immediately after needle withdrawal, the patient should be instructed to apply firm pressure with gauze over the puncture site while keeping the arm extended. Bending the arm at the elbow can cause a hematoma by pushing the vein against the puncture site in the skin, allowing blood to leak into the tissue.

Question 69: A specimen labeled 'STAT' arrives at the lab. According to standard processing guidelines, it should be processed within:

15 minutes
30 minutes (Correct answer)
5 minutes
60 minutes

Correct answer: 30 minutes

STAT specimens should generally be processed and resulted within 30 minutes of receipt to meet critical turnaround time expectations.

Question 70: Which type of specimen is collected for a PKU (phenylketonuria) newborn screening test?

Cerebrospinal fluid
Capillary blood on filter paper (Correct answer)
Urine midstream sample
Venous blood in a lavender tube

Correct answer: Capillary blood on filter paper

PKU screening uses a heel stick to collect capillary blood spotted onto a Guthrie filter paper card.

Question 71: Which certification is offered by the ASCP for laboratory professionals?

Medical Laboratory Scientist (MLS) (Correct answer)
Registered Health Information Technician (RHIT)
Certified Nursing Assistant (CNA)
Certified Professional Coder (CPC)

Correct answer: Medical Laboratory Scientist (MLS)

The American Society for Clinical Pathology (ASCP) offers a range of certifications for laboratory professionals, including the Medical Laboratory Scientist (MLS) certification. This certification signifies a high level of competency and knowledge in clinical laboratory science. It is a widely recognized credential for those working in medical laboratories.

Question 72: Which tube additive works by binding calcium ions to prevent coagulation?

Thrombin
Sodium fluoride
Silica particles
EDTA (Correct answer)

Correct answer: EDTA

EDTA chelates (binds) calcium ions, which are essential for the coagulation cascade, thereby preventing clotting.

Question 73: Which condition causes a specimen to appear lipemic, and how does it affect test results?

Excessive bilirubin causing orange discoloration; falsely lowers hemoglobin
Prolonged storage causing yellow serum; falsely lowers albumin
High lipid content causing milky turbidity; can interfere with photometric assays (Correct answer)
Hemolysis causing red discoloration; falsely elevates glucose

Correct answer: High lipid content causing milky turbidity; can interfere with photometric assays

Lipemia from elevated triglycerides creates turbid, milky plasma or serum that scatters light and can interfere with spectrophotometric laboratory measurements.

Question 74: According to ASCP standards, how many hours of clinical phlebotomy experience (venipunctures) are required for examination eligibility under Route 2?

200 venipunctures
100 venipunctures
1,040 hours of work experience (Correct answer)
50 venipunctures

Correct answer: 1,040 hours of work experience

Route 2 for PBT(ASCP) requires 1,040 hours of acceptable clinical work experience in the US.

Question 75: A toddler requires venipuncture but is extremely uncooperative. Which approach is BEST?

Reschedule the collection for another day when the child may be calmer
Involve the parent in positioning and comforting while a second person assists in immobilization as needed (Correct answer)
Attempt the draw up to 5 times until successful
Restrain the child completely without explanation to complete the draw quickly

Correct answer: Involve the parent in positioning and comforting while a second person assists in immobilization as needed

Involving the parent for comfort and having a trained assistant for safe immobilization is the recommended approach, minimizing trauma while safely completing the collection.

Question 76: Which tube additive and color is used for blood culture collection, designed to support bacterial viability?

SPS (Sodium Polyanethol Sulfonate); yellow top (Correct answer)
Sodium citrate; light blue top
EDTA; lavender top
No additive; plain red top

Correct answer: SPS (Sodium Polyanethol Sulfonate); yellow top

Yellow top tubes containing SPS are used for blood cultures; SPS inhibits complement, phagocytosis, and certain antibiotics while preserving bacterial viability for accurate microbiological detection.

Question 77: In the order of draw, which color tube should be collected IMMEDIATELY after the blood culture bottles?

Red/SST
Green (lithium heparin)
Light blue (sodium citrate) (Correct answer)
Lavender (EDTA)

Correct answer: Light blue (sodium citrate)

The light blue sodium citrate tube is the first additive tube collected after blood cultures to prevent contamination from other additives.

Question 78: A phlebotomist is tasked with cleaning a small blood spill on a laboratory countertop. Which of the following is an appropriate disinfectant?

Sterile saline solution
Soap and water
70% isopropyl alcohol
A 1:10 dilution of household bleach (Correct answer)

Correct answer: A 1:10 dilution of household bleach

A 1:10 dilution of household bleach (sodium hypochlorite) is a commonly used and effective disinfectant for cleaning up blood spills in a healthcare setting. Soap and water can clean but not disinfect. 70% isopropyl alcohol is not recommended for blood spills as it can cause proteins to coagulate, potentially trapping infectious particles. Saline is not a disinfectant.

Question 79: How much pressure must be applied to a radial artery puncture site to achieve hemostasis in a patient with normal coagulation?

At least 3–5 minutes of continuous firm pressure (Correct answer)
30 seconds of firm pressure
Until a clot is visibly formed at the surface
1–2 minutes of light pressure

Correct answer: At least 3–5 minutes of continuous firm pressure

A minimum of 3–5 minutes of continuous, firm pressure is required at an arterial puncture site in a normally coagulating patient; less time risks hematoma formation.

Question 80: Which needle gauge is most appropriate for a blood culture collection to minimize contamination risk while maintaining adequate flow?

18 gauge
25 gauge
16 gauge
21–22 gauge (Correct answer)

Correct answer: 21–22 gauge

A 21–22 gauge needle provides adequate flow for blood culture volumes while reducing hemolysis and patient discomfort.

Question 81: A phlebotomist needs to collect a specimen from a patient with only one usable arm that has an IV line running. What is the BEST approach?

Refuse to collect and notify the nurse
Draw from above the IV site
Turn off the IV for 2 minutes, then draw below the IV site (Correct answer)
Draw from the IV catheter directly

Correct answer: Turn off the IV for 2 minutes, then draw below the IV site

Turning off the IV for at least 2 minutes and drawing distal to (below) the infusion site minimizes IV fluid dilution of the blood sample.

Question 82: A phlebotomist is preparing to draw blood from a patient in an isolation room. Which of the following pieces of Personal Protective Equipment (PPE) is the minimum requirement before entering the room?

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

Correct answer: Gloves and gown

Standard Precautions require gloves for all phlebotomy procedures. However, when a patient is in an isolation room, there is a higher risk of exposure to infectious agents. Therefore, a gown is also required to protect the phlebotomist's clothing and skin from potential contamination. Masks and face shields are required when there is a risk of splashing or aerosol generation, but a gown and gloves are the minimum for entering an isolation setting.

Question 83: A patient tells the phlebotomist they have a latex allergy. What should the phlebotomist do?

Decline to perform the draw
Switch to latex-free gloves and supplies immediately (Correct answer)
Proceed normally as latex is rarely used in blood draws
Document it but continue with standard equipment

Correct answer: Switch to latex-free gloves and supplies immediately

Latex allergies require immediate substitution of all latex-containing equipment (gloves, tourniquets) with latex-free alternatives to prevent potentially life-threatening reactions.

Question 84: Which additive tube must NEVER be inverted after collection?

EDTA (lavender)
Red/gold serum separator
None — all tubes require inversion (Correct answer)
Sodium citrate (light blue)

Correct answer: None — all tubes require inversion

All additive tubes require gentle inversion immediately after collection to mix the additive thoroughly with the blood.

Question 85: After performing a venipuncture, a phlebotomist accidentally sustains a needlestick injury. What is the IMMEDIATE first step the phlebotomist should take?

Report the incident to a supervisor.
Fill out an incident report.
Seek post-exposure prophylaxis (PEP).
Wash the wound with soap and water. (Correct answer)

Correct answer: Wash the wound with soap and water.

The immediate priority after a needlestick injury is to decontaminate the site to reduce the risk of infection. The wound should be immediately and thoroughly washed with soap and running water. Reporting the incident, filling out a report, and seeking medical evaluation are all crucial subsequent steps, but the first action is to clean the injury.

Question 86: Which of the following BEST describes the purpose of a quality assurance (QA) program in a laboratory?

To conduct random audits of phlebotomy technique only
To ensure all laboratory equipment is calibrated monthly
To monitor and improve all processes affecting the quality and accuracy of patient test results (Correct answer)
To train new laboratory staff on equipment operation

Correct answer: To monitor and improve all processes affecting the quality and accuracy of patient test results

QA encompasses the entire system of monitoring, evaluating, and improving all laboratory processes—pre-analytical, analytical, and post-analytical—to ensure accurate, reliable results.

Question 87: A 24-hour urine collection must be preserved with hydrochloric acid (HCl). Which test most commonly requires this preservative?

Urine culture and sensitivity
Urinalysis with microscopy
Urine catecholamines or metanephrines (Correct answer)
Urine pregnancy test (hCG)

Correct answer: Urine catecholamines or metanephrines

Acid preservatives like HCl are required for 24-hour catecholamine and metanephrine collections to prevent oxidative breakdown of these compounds.

Question 88: When a specimen is hemolyzed, which of the following test results is MOST likely to be falsely elevated?

Sodium (Na+)
Potassium (K+) (Correct answer)
Calcium
Glucose

Correct answer: Potassium (K+)

Potassium is highly concentrated inside red blood cells; hemolysis releases intracellular potassium, causing falsely elevated serum potassium levels.

Question 89: Which type of isolation precaution is required for a patient diagnosed with active pulmonary tuberculosis?

Airborne precautions (Correct answer)
Droplet precautions
Contact precautions
Reverse isolation

Correct answer: Airborne precautions

Airborne precautions are required for TB because the bacteria are transmitted via tiny droplet nuclei that remain suspended in the air.

Question 90: Which federal agency regulates occupational exposure to bloodborne pathogens for healthcare workers?

CDC
FDA
CMS
OSHA (Correct answer)

Correct answer: OSHA

OSHA's Bloodborne Pathogen Standard (29 CFR 1910.1030) mandates exposure control plans, PPE use, and training for healthcare workers.

Question 91: When labeling a blood specimen tube, which piece of information is NOT typically required on the tube label?

Patient's insurance information (Correct answer)
Patient's full name
Phlebotomist's initials or ID
Date and time of collection

Correct answer: Patient's insurance information

Insurance information is an administrative/billing detail and is not required on the specimen label itself; specimen labels require patient identifiers, collection time, and collector ID.

Question 92: Which vaccine is offered free of charge to all employees with potential occupational exposure to blood under OSHA's Bloodborne Pathogens Standard?

Varicella vaccine
Hepatitis B vaccine (Correct answer)
Influenza vaccine
Hepatitis A vaccine

Correct answer: Hepatitis B vaccine

OSHA requires employers to offer the hepatitis B vaccine series at no cost to all employees with occupational exposure risk.

Question 93: If blood flow stops after initially starting well during venipuncture, which corrective action should be attempted FIRST?

Remove the needle and try a new site
Gently rotate the needle 180 degrees (Correct answer)
Apply additional tourniquet pressure
Squeeze the patient's fist repeatedly

Correct answer: Gently rotate the needle 180 degrees

Rotating the needle 180 degrees may reposition the bevel away from the vein wall and restore blood flow without restarting the procedure.

Question 94: What is the purpose of the separator gel found in SST (serum separator) tubes?

It keeps the specimen frozen during transport
It forms a stable barrier between serum and clot after centrifugation (Correct answer)
It prevents hemolysis during collection
It acts as a clot activator to speed clotting

Correct answer: It forms a stable barrier between serum and clot after centrifugation

The polyethylene glycol gel migrates during centrifugation to form a physical barrier between the serum layer and the clot, preserving serum integrity.

Question 95: What information is the MINIMUM required on a specimen label according to best practice standards?

Patient name, date of birth, and collection date/time (Correct answer)
Barcode only if computer-generated
Patient name only
Patient name and ward number

Correct answer: Patient name, date of birth, and collection date/time

Minimum labeling requires patient name, date of birth, and collection date/time to ensure accurate patient-sample matching.

Question 96: A QC control value plots at +2.3SD on the Levey-Jennings chart. According to Westgard rules, this result is:

A warning (1₂s violation)—investigate before running patient samples (Correct answer)
An indication of random error requiring instrument recalibration
Within acceptable limits—no action required
A rejection requiring immediate corrective action

Correct answer: A warning (1₂s violation)—investigate before running patient samples

A value between ±2SD and ±3SD triggers the 1₂s warning rule—not an automatic rejection, but a signal to investigate before proceeding with patient testing.

Question 97: Which specimen type is collected in a light blue (sodium citrate) tube?

Blood bank specimens
Chemistry panels
Coagulation studies (PT, aPTT) (Correct answer)
Complete blood counts

Correct answer: Coagulation studies (PT, aPTT)

Sodium citrate tubes (light blue tops) are used for coagulation studies because citrate chelates calcium to prevent clotting.

Question 98: Which laboratory test in a newborn is MOST likely to yield unreliable results from a heelstick specimen compared to a venous sample?

Total bilirubin
Neonatal blood culture (Correct answer)
Complete blood count (CBC)
Blood glucose

Correct answer: Neonatal blood culture

Blood cultures should never be collected via heelstick because the skin's normal flora can contaminate the specimen, leading to false-positive cultures and inappropriate antibiotic treatment.

Question 99: A gray-top tube contains which additives and is primarily used for which test?

Sodium citrate; coagulation studies
Sodium fluoride and potassium oxalate; glucose/lactate testing (Correct answer)
Heparin; plasma chemistry panels
EDTA; complete blood count

Correct answer: Sodium fluoride and potassium oxalate; glucose/lactate testing

Gray-top tubes contain sodium fluoride (glycolysis inhibitor) and potassium oxalate (anticoagulant), making them ideal for glucose and lactate testing.

Question 100: When performing a heelstick on a preterm neonate (born at 28 weeks gestation), the maximum lancet depth should be:

2.0 mm (same as full-term)
No heelstick—always use venipuncture for preterm infants
1.0 mm or less
0.65 mm (the shallowest commercially available device) (Correct answer)

Correct answer: 0.65 mm (the shallowest commercially available device)

Preterm neonates have extremely thin skin and very little subcutaneous tissue; the shallowest commercially available neonatal lancet (0.65–0.85 mm) should be used to avoid bone puncture.

Question 101: What should a phlebotomist do if an evacuated tube fails to fill because it has lost its vacuum mid-draw?

Replace it with a new tube while keeping the needle in the vein (Correct answer)
Remove the needle and restart the venipuncture from scratch
Apply external pressure on the tube to create suction
Push the needle deeper into the vein to improve flow

Correct answer: Replace it with a new tube while keeping the needle in the vein

If a tube has lost its vacuum, the phlebotomist should remove it and immediately insert a new tube while the needle remains in the vein, avoiding an unnecessary second puncture for the patient.

Question 102: What does 'bevel up' mean when inserting a needle for venipuncture?

The needle is angled upward at 90 degrees to the skin
The syringe plunger is fully retracted before insertion
The angled opening of the needle tip faces upward toward the phlebotomist (Correct answer)
The needle cap has been removed prior to insertion

Correct answer: The angled opening of the needle tip faces upward toward the phlebotomist

Bevel up means the slanted, sharp opening of the needle faces upward, which facilitates smooth entry into the vein and reduces vessel wall trauma during puncture.

Question 103: After completing a blood draw, the phlebotomist removes gloves and performs hand hygiene. According to CDC guidelines, which hand hygiene agent is preferred when hands are NOT visibly soiled?

Chlorhexidine scrub solution
Antimicrobial soap and water
Plain soap and running water for at least 20 seconds
Alcohol-based hand rub (ABHR) (Correct answer)

Correct answer: Alcohol-based hand rub (ABHR)

CDC guidelines prefer alcohol-based hand rub when hands are not visibly soiled because it is faster, more effective against most pathogens, and less drying than repeated handwashing.

Question 104: A laboratory monitors the number of specimen recollections due to clotted blood. This metric is BEST categorized as:

A calibration quality indicator
A pre-analytical quality indicator (Correct answer)
An analytical quality indicator
A post-analytical quality indicator

Correct answer: A pre-analytical quality indicator

Clotted specimens result from pre-analytical failures (inadequate mixing, delayed processing) occurring before laboratory analysis, making this a pre-analytical quality indicator.

Question 105: A heparin tube (green top) is positioned in the order of draw after the SST. Why is heparin drawn before EDTA but after SST?

Heparin carryover into EDTA tubes is less harmful than EDTA carryover into heparin tubes (Correct answer)
SST activates clotting that heparin must neutralize before EDTA collection
Heparin must clot before EDTA tubes are drawn
CLSI mandates this order to reduce patient discomfort from multiple sticks

Correct answer: Heparin carryover into EDTA tubes is less harmful than EDTA carryover into heparin tubes

Small amounts of heparin carryover into EDTA tubes have minimal clinical impact, whereas EDTA carryover into heparin tubes would chelate calcium and critically disrupt chemistry results.

Question 106: According to OSHA and CDC guidelines, a sharps container should be sealed and disposed of when it is how full?

3/4 full (Correct answer)
1/2 full
Completely full to maximize space
At the end of each shift

Correct answer: 3/4 full

OSHA regulations and CDC guidelines state that sharps containers should be disposed of when they are approximately 3/4 full. Overfilling a sharps container significantly increases the risk of accidental needlestick injuries and exposure to bloodborne pathogens.

Question 107: What is the maximum recommended depth of a heel puncture in a full-term neonate?

2.4 mm
3.0 mm
2.0 mm (Correct answer)
1.0 mm

Correct answer: 2.0 mm

CLSI recommends a maximum lancet depth of 2.0 mm for full-term neonates to avoid penetrating the calcaneus (heel bone) and causing osteomyelitis.

Question 108: Which of the following best describes why EDTA tubes come AFTER coagulation tubes in the order of draw?

EDTA chelates calcium, which would inhibit the coagulation cascade in subsequent tests (Correct answer)
EDTA tubes must be stored at room temperature and are drawn last for temperature reasons
EDTA degrades fibrinogen if collected before coagulation samples
EDTA activates platelets that would interfere with coagulation tests

Correct answer: EDTA chelates calcium, which would inhibit the coagulation cascade in subsequent tests

EDTA's calcium-chelating action would carry over into coagulation (citrate) tubes and falsely prolong clotting times if drawn first.

Question 109: Which needle gauge is most commonly used for routine adult venipuncture?

16-gauge
18-gauge
25-gauge
21-gauge (Correct answer)

Correct answer: 21-gauge

A 21-gauge needle is the standard for adult venipuncture, balancing adequate blood flow with minimal patient discomfort.

Question 110: Which of the following is the correct order of draw for a serum separator tube (SST) followed by an EDTA tube?

Either order is acceptable
SST first, then EDTA (Correct answer)
EDTA only; SST is obsolete
EDTA first, then SST

Correct answer: SST first, then EDTA

The SST (gold/red-gray top) is drawn before EDTA (lavender top) to prevent anticoagulant carryover that could affect coagulation studies.

Question 111: What is the maximum recommended time a tourniquet should remain applied before venipuncture?

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

Correct answer: 1 minute

A tourniquet should not remain in place for more than 1 minute to prevent hemoconcentration and erroneous lab results.

Question 112: A phlebotomist notices a patient's tourniquet has been on for 3 minutes before the draw begins. What should they do?

Release the tourniquet and reapply after a 2-minute wait (Correct answer)
Document and continue — tourniquet time does not affect results
Proceed immediately to minimize patient discomfort
Switch to the other arm without releasing

Correct answer: Release the tourniquet and reapply after a 2-minute wait

Prolonged tourniquet application causes hemoconcentration; releasing and waiting before reapplying prevents falsely elevated analyte results.

Question 113: Light-sensitive specimens such as bilirubin or vitamin B12 should be:

Frozen within 5 minutes of collection
Refrigerated immediately after centrifugation
Processed at 37°C before analysis
Wrapped in foil or placed in amber containers to block light exposure (Correct answer)

Correct answer: Wrapped in foil or placed in amber containers to block light exposure

Bilirubin and certain vitamins degrade rapidly when exposed to fluorescent or UV light, so wrapping tubes in aluminum foil or using amber containers preserves analyte stability.

Question 114: When a laboratory documents QC results, which of the following is the MINIMUM information that must be recorded?

Date, time, operator ID, lot numbers of controls and reagents, control values, and pass/fail decision (Correct answer)
QC values and technologist name only
Only the final pass/fail decision
Control lot number and expiration date only

Correct answer: Date, time, operator ID, lot numbers of controls and reagents, control values, and pass/fail decision

Comprehensive QC documentation is required for regulatory compliance and includes all identifiers (date, time, operator, lot numbers), values, and decision so that patterns can be retrospectively investigated.

Question 115: In capillary puncture, the lancet should be positioned perpendicular to the fingerprint lines. Why?

To maximize lancet depth penetration
To ensure the wound opens freely and blood flows more easily (Correct answer)
To reduce the risk of nerve damage
To allow the wound to seal faster after collection

Correct answer: To ensure the wound opens freely and blood flows more easily

Puncturing perpendicular (across) the fingerprint lines allows the wound to gape slightly and blood to flow freely; puncturing parallel to the lines tends to seal the wound shut.

Question 116: A patient with MRSA is placed on contact precautions. Which PPE is minimally required when entering the room to perform a blood draw?

Surgical mask and gloves
N95 respirator and gloves
Gown and gloves (Correct answer)
Eye protection and gloves only

Correct answer: Gown and gloves

Contact precautions require a gown and gloves at minimum to prevent skin and clothing contamination with MRSA.

Question 117: A laboratory is investigating a systematic positive bias in sodium results compared to proficiency testing. Which of the following is MOST likely to be the cause?

Expired control material causing erroneous results only in QC
Random pipetting errors in individual samples
Calibrator drift or incorrect calibration assignment (Correct answer)
Hemolysis in patient samples causing elevated sodium

Correct answer: Calibrator drift or incorrect calibration assignment

Systematic bias (consistently too high) in an electrolyte analyzer most commonly results from calibrator drift, where the reference solution's concentration has shifted, causing all results to be offset.

Question 118: After implementing corrective action for a QC failure, what step is REQUIRED before releasing patient results?

Notify the medical director and wait for approval
Release results for specimens collected before the QC failure only
Document the corrective action and release all results on hold
Run QC again to confirm the corrective action resolved the problem before releasing results (Correct answer)

Correct answer: Run QC again to confirm the corrective action resolved the problem before releasing results

QC must be repeated after corrective action to verify the problem is resolved; only after passing QC can patient results be released—this is a fundamental principle of laboratory quality control.

Question 119: How should a phlebotomist introduce themselves when entering a patient's room?

State their name, title, and purpose of the visit (Correct answer)
Enter and begin setup without speaking
Just say 'Blood draw' and wait
Ask the patient to roll up their sleeve immediately

Correct answer: State their name, title, and purpose of the visit

Proper professional introduction includes the phlebotomist's name, role, and reason for the visit to establish trust and comply with patient rights standards.

Question 120: The term 'arterialized capillary blood' refers to blood obtained after:

Using a longer lancet that reaches arterioles
Applying a tourniquet to concentrate arterial blood
Puncturing a capillary adjacent to an artery
Warming the site to increase local arterial blood flow (Correct answer)

Correct answer: Warming the site to increase local arterial blood flow

Warming the site for 3–5 minutes vasodilates local arterioles and increases arterial contribution to capillary blood, making its composition closer to arterial blood.

National Healthcareer Association (NHA) Certified Phlebotomy Technician (CPT) Exam

The NHA Certified Phlebotomy Technician (CPT) exam certifies individuals in the skills and knowledge required to perform phlebotomy procedures safely and effectively.

120

Questions

120 min

Time Limit

70%

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