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

Question 1: A patient identifies themselves, but the name on the tube label doesn't match the requisition. The phlebotomist should:

Stop the procedure and resolve the discrepancy before drawing blood (Correct answer)
Use the name the patient stated and cross out the label name
Draw the blood and inform the nurse after collection
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 2: The saphenous vein is used as a venipuncture site primarily in which pediatric patient?

Neonates when heelstick volume is insufficient
Adolescents as an alternative to antecubital veins
School-age children as the first-choice site
Infants when limb veins are inaccessible and scalp veins are not appropriate (Correct answer)

Correct answer: Infants when limb veins are inaccessible and scalp veins are not appropriate

The great saphenous vein at the ankle/foot is used in infants when other peripheral sites are exhausted, providing a large, consistently located vein accessible for venipuncture.

Question 3: When processing a urine culture specimen, the preferred storage condition before transport is:

Frozen at −20°C
Room temperature up to 24 hours
Refrigeration at 2–8°C up to 24 hours (Correct answer)
37°C incubator to preserve organisms

Correct answer: Refrigeration at 2–8°C up to 24 hours

Urine for culture should be refrigerated at 2–8°C if not processed within 30 minutes to prevent bacterial overgrowth that would skew colony counts.

Question 4: Which of the following is a core responsibility of a certified phlebotomy technician?

Administering medications intravenously
Drawing blood and ensuring safe specimen transportation (Correct answer)
Prescribing lab tests for patients
Conducting diagnostic imaging tests

Correct answer: Drawing blood and ensuring safe specimen transportation

A core responsibility of a certified phlebotomy technician is to accurately and safely draw blood samples from patients. Equally important is ensuring that these collected specimens are properly prepared, stored, and transported to the laboratory under conditions that maintain their integrity. This prevents contamination or degradation that could affect test results and patient diagnoses.

Question 5: What is the term for the deliberate reduction of microbial contamination on inanimate surfaces using chemical or physical methods?

Sanitization
Sterilization
Antisepsis
Disinfection (Correct answer)

Correct answer: Disinfection

Disinfection reduces or eliminates pathogenic microorganisms on inanimate objects; unlike sterilization, it does not necessarily destroy all microbial life.

Question 6: The correct order of draw for capillary specimens collected in micro-collection tubes is:

Blood gases → EDTA → other additive tubes → serum tube (Correct answer)
EDTA → other additive tubes → serum tube
Serum tube → EDTA → other additive tubes
Other additive tubes → EDTA → serum tube

Correct answer: Blood gases → EDTA → other additive tubes → serum tube

Capillary order of draw begins with blood gas specimens (if collected), then EDTA (lavender/pink) first to ensure accurate hematology results, then other additive tubes, then serum tubes last.

Question 7: In a laboratory with multiple analyzers running the same test, which QA practice ensures consistency of results across instruments?

Running QC only on the primary analyzer
Calibrating each analyzer with different calibrator lots
Using different reference ranges for each analyzer
Correlation studies comparing patient or QC results between instruments (Correct answer)

Correct answer: Correlation studies comparing patient or QC results between instruments

Instrument correlation studies compare results from multiple analyzers to verify they produce equivalent results; significant differences must be investigated and resolved before using both instruments simultaneously.

Question 8: A phlebotomist draws a sample in a lavender-top tube for CBC, but discovers the tube was only three-quarters full. What is the PRIMARY concern?

The tube will not clot properly for the CBC
The sample cannot be centrifuged at the correct speed
Insufficient blood volume may cause the analyzer to not recognize the sample
EDTA will be in excess relative to blood volume, causing cell shrinkage and altered CBC values (Correct answer)

Correct answer: EDTA will be in excess relative to blood volume, causing cell shrinkage and altered CBC values

Underfilling an EDTA tube causes excess EDTA relative to blood volume, leading to osmotic shrinkage of red blood cells and falsely altered CBC parameters including decreased MCV and hematocrit.

Question 9: What is the purpose of a 'delta check' in laboratory quality assurance?

To verify the calibration of an analyzer before each run
To check the difference between high and low QC control values
To compare results from two different analyzers
To compare a patient's current result with their previous result to detect implausible changes (Correct answer)

Correct answer: To compare a patient's current result with their previous result to detect implausible changes

Delta checks compare a patient's current result to their previous result; implausible differences flag potential sample mislabeling, wrong patient, or hemolysis errors.

Question 10: When performing a capillary blood gas collection from a neonate's heel, what must be done to the heel before puncture?

Clean with povidone-iodine only
Apply a tourniquet above the ankle
Apply ice to constrict capillaries
Warm the heel to 42°C (107.6°F) for at least 3–5 minutes (Correct answer)

Correct answer: Warm the heel to 42°C (107.6°F) for at least 3–5 minutes

Warming arterializes the capillary blood by causing vasodilation, which improves the accuracy of blood gas values.

Question 11: What does 'aliquoting' a specimen mean in the laboratory context?

Discarding the primary tube after testing
Dividing the specimen into smaller portions for separate tests or storage (Correct answer)
Labeling a specimen with a secondary barcode
Centrifuging the specimen twice

Correct answer: Dividing the specimen into smaller portions for separate tests or storage

Aliquoting is the process of dividing a primary specimen into smaller sub-samples so multiple departments can test the same collection without re-drawing the patient.

Question 12: Which of the following is a sign that a venipuncture needle has been inserted too deeply?

Blood flows freely into the tube
No blood return despite correct technique, and the patient feels sharp deep pain (Correct answer)
The needle bevel is partially visible above the skin
The tourniquet loosens automatically

Correct answer: No blood return despite correct technique, and the patient feels sharp deep pain

Inserting the needle too deeply can pierce the posterior vein wall, causing no blood return and sharp pain as tissue beyond the vein is punctured.

Question 13: Which laboratory test requires the specimen to be kept warm (37°C) during transport to the laboratory?

Basic metabolic panel (BMP)
Prothrombin time (PT)
Cold agglutinin titer (Correct answer)
Complete blood count (CBC)

Correct answer: Cold agglutinin titer

Cold agglutinins precipitate at low temperatures, so the specimen must be maintained at body temperature to prevent false results.

Question 14: What is the correct action when a needle accidentally punctures a phlebotomist's skin after drawing blood?

Squeeze the wound to expel blood and then seal it with a bandage
Report the needlestick immediately, wash the wound, and follow the employer's exposure protocol (Correct answer)
Wait 24 hours to see if symptoms develop before reporting
Apply antiseptic cream and continue working

Correct answer: Report the needlestick immediately, wash the wound, and follow the employer's exposure protocol

Needlestick injuries require immediate washing, reporting to occupational health, and following the employer's post-exposure prophylaxis protocol.

Question 15: A phlebotomist must prepare a specimen for transport to a reference lab that requires chilled handling. What is the proper technique for chilling the specimen?

Placing the tube directly on a large block of ice.
Submerging the tube in a mixture of crushed ice and water. (Correct answer)
Attaching a cold pack to the outside of the transport bag.
Storing the tube in the refrigerator for 30 minutes before transport.

Correct answer: Submerging the tube in a mixture of crushed ice and water.

For proper chilling, the specimen tube must be fully surrounded by the cooling medium to ensure rapid and consistent temperature reduction. A slurry of crushed ice and water provides the most effective contact with the entire surface of the tube.

Question 16: What does the term 'fomite' refer to in the context of infection control?

An inanimate object that can harbor and transmit pathogens (Correct answer)
A vector such as a mosquito
An airborne pathogen
A blood-borne virus

Correct answer: An inanimate object that can harbor and transmit pathogens

A fomite is any inanimate object (e.g., doorknob, phlebotomy tray) that can carry infectious agents and facilitate their transfer.

Question 17: Why is the first drop of blood wiped away during a capillary puncture?

To remove tissue fluid that could dilute or contaminate the sample (Correct answer)
To allow the lancet wound to seal partially
To sterilize the puncture site
To ensure adequate blood flow by removing the clot

Correct answer: To remove tissue fluid that could dilute or contaminate the sample

The first drop contains tissue fluid released when the skin is punctured, which dilutes the blood sample and can alter test results; it must be discarded.

Question 18: A urine dipstick test shows a positive nitrite result. This finding is MOST indicative of:

Dehydration
Diabetes mellitus
Kidney stones
Bacterial infection (Correct answer)

Correct answer: Bacterial infection

Nitrites on a urine dipstick indicate the presence of nitrite-producing bacteria, which convert urinary nitrates to nitrites, suggesting a urinary tract infection.

Question 19: Which tube additive and color is used for blood culture collection, designed to support bacterial viability?

No additive; plain red top
SPS (Sodium Polyanethol Sulfonate); yellow top (Correct answer)
EDTA; lavender top
Sodium citrate; light blue 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 20: A phlebotomist sustains a needlestick injury while drawing blood from an HCV-positive patient. What is the first action to take?

Apply a tourniquet above the wound
Report to the supervisor before doing anything
Immediately wash the site with soap and water (Correct answer)
Apply betadine to the puncture site

Correct answer: Immediately wash the site with soap and water

Immediate washing with soap and water for at least 15 seconds is the first response to a needlestick to reduce pathogen load.

Question 21: What is the function of platelets (thrombocytes) in the blood?

Produce antibodies
Fight bacterial infections
Transport oxygen
Assist in blood clotting (Correct answer)

Correct answer: Assist in blood clotting

Platelets are cell fragments that aggregate at sites of vessel injury to form a plug and initiate the clotting cascade to stop bleeding.

Question 22: When drawing blood cultures, the phlebotomist must inoculate which bottle FIRST when using a winged infusion set?

Sodium citrate tube first
Either order is acceptable
Anaerobic bottle (Correct answer)
Aerobic bottle

Correct answer: Anaerobic bottle

With a winged set, the anaerobic bottle is inoculated first to prevent air from the tubing from entering it and killing anaerobic organisms.

Question 23: Which of the following describes the CORRECT skin antiseptic technique before venipuncture?

Apply antiseptic and wipe immediately
Clean in a concentric circle moving outward from the center (Correct answer)
Wipe in a back-and-forth scrubbing motion
Use soap and water only

Correct answer: Clean in a concentric circle moving outward from the center

Cleaning from the center outward in a spiral motion prevents reintroducing contaminants from the surrounding skin back to the puncture site.

Question 24: What is the maximum recommended time a tourniquet should remain applied before venipuncture?

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

Correct answer: 1 minute

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

Question 25: A patient's arm shows a hematoma forming during venipuncture. What is the FIRST action to take?

Redirect the needle to another vein
Inform the nurse before stopping
Remove the needle and apply firm pressure (Correct answer)
Apply a warm compress immediately

Correct answer: Remove the needle and apply firm pressure

When a hematoma forms, the phlebotomist must immediately remove the needle and apply firm pressure to stop bleeding and limit bruising.

Question 26: The AMCA phlebotomy exam requires candidates to demonstrate competency in which primary area?

Specimen collection, processing, and patient safety (Correct answer)
Medical coding and insurance billing
Surgical assisting and sterile technique
Pharmacology and medication administration

Correct answer: Specimen collection, processing, and patient safety

The AMCA Phlebotomy Technician exam focuses on specimen collection procedures, processing protocols, and maintaining patient safety throughout.

Question 27: What is the recommended alcohol drying time before performing venipuncture?

Immediately after wiping
5 minutes
30–60 seconds (Correct answer)
Until the patient says it feels dry

Correct answer: 30–60 seconds

Allowing isopropyl alcohol 30–60 seconds to air-dry ensures full antiseptic effect and prevents specimen contamination or patient stinging.

Question 28: A patient in respiratory isolation sneezes directly toward the phlebotomist who is not wearing a mask. Which link in the chain of infection has been exploited?

Mode of transmission (Correct answer)
Portal of entry
Reservoir
Susceptible host

Correct answer: Mode of transmission

The sneeze represents the mode of transmission—the mechanism by which the pathogen traveled from the source to the potential host.

Question 29: Which of the following is TRUE regarding the use of topical anesthetic (EMLA cream) for pediatric venipuncture?

It eliminates all pain from venipuncture
It is contraindicated in children under 12 years of age
It must be applied immediately before the procedure for maximum effect
It requires application 45–60 minutes before the procedure under an occlusive dressing (Correct answer)

Correct answer: It requires application 45–60 minutes before the procedure under an occlusive dressing

EMLA cream requires 45–60 minutes under occlusive dressing to achieve adequate dermal anesthesia; immediate application provides no benefit.

Question 30: A patient has a PaO2 of 58 mmHg while breathing room air. This finding indicates:

The patient needs immediate intubation
Hypoxemia requiring clinical intervention (Correct answer)
Adequate oxygenation—above the critical threshold of 55 mmHg
Normal oxygenation for an elderly patient

Correct answer: Hypoxemia requiring clinical intervention

PaO2 of 58 mmHg is below the normal range (80–100 mmHg on room air) and represents clinically significant hypoxemia requiring assessment and potential supplemental oxygen.

Question 31: The Westgard 10x̄ rule is used to detect which type of QC error?

Random error
Gross error
Systematic error (bias) (Correct answer)
Precision error

Correct answer: Systematic error (bias)

The 10x̄ rule detects systematic bias: when 10 consecutive control values fall on the same side of the mean, it indicates the method has shifted from its calibrated target.

Question 32: A patient presents with uncontrolled hypertension and is on anticoagulation therapy. When preparing to collect an ABG, the phlebotomist should recognize that anticoagulation therapy requires:

No special precautions—the procedure is unchanged
Applying pressure for an extended period (5–10 minutes or more) after collection (Correct answer)
Avoiding the radial artery and using femoral access only
Using a larger bore needle to ensure adequate sample

Correct answer: Applying pressure for an extended period (5–10 minutes or more) after collection

Patients on anticoagulants have impaired clotting; pressure must be held for a prolonged time (at least 5 minutes, often 10+ minutes) at the arterial puncture site to achieve hemostasis.

Question 33: What is the correct centrifuge speed and time for most routine serum separation in a standard clinical laboratory?

1,000–1,500 × g for 5 minutes
2,000–3,000 × g for 10 minutes (Correct answer)
500 × g for 2 minutes
5,000 × g for 20 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 34: What is the maximum recommended blood volume to collect from a neonate weighing 3 kg in a single day?

1–3 mL
15 mL
30 mL
5–10 mL (Correct answer)

Correct answer: 5–10 mL

For neonates, blood volume is approximately 85–90 mL/kg; daily blood draws should not exceed 5–10% of total blood volume to avoid iatrogenic anemia.

Question 35: In workplace drug testing phlebotomy, the collector must verify the specimen temperature within how many minutes of collection?

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

Correct answer: 4 minutes

Federal workplace drug testing guidelines (DOT) require temperature verification within 4 minutes to detect specimen tampering.

Question 36: A lavender (purple) top tube is used PRIMARILY for:

Blood culture collection
Coagulation studies
Blood glucose testing
Complete blood count (CBC) (Correct answer)

Correct answer: Complete blood count (CBC)

Lavender/purple top tubes contain EDTA, which preserves cellular morphology, making them ideal for CBC and differential count testing.

Question 37: When performing venipuncture on a patient with small or fragile veins, which needle is most appropriate?

18-gauge straight needle
21-gauge multi-sample needle
23-gauge butterfly needle (Correct answer)
20-gauge straight needle

Correct answer: 23-gauge butterfly needle

A 23-gauge butterfly (winged infusion) set allows better control and flexibility for difficult or fragile veins.

Question 38: What angle of needle insertion is recommended for standard adult venipuncture?

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

Correct answer: 15–30 degrees

A 15–30 degree angle allows the needle to enter the vein cleanly without going through the back wall.

Question 39: 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 40: For a bleeding time test, where is the standardized incision typically made?

The earlobe
The forearm, 5 cm below the antecubital crease (Correct answer)
The dorsum of the hand
The fingertip of the fourth finger

Correct answer: The forearm, 5 cm below the antecubital crease

The modified Ivy method uses a standardized incision on the forearm, with a blood pressure cuff inflated to 40 mmHg to standardize pressure.

Question 41: Which condition causes a specimen to appear lipemic, and how does it affect test results?

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

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 42: After centrifugation, a serum specimen should ideally be transferred off the clot within:

5 minutes
2 hours (Correct answer)
30 minutes
No time limit if kept refrigerated on the clot

Correct answer: 2 hours

Serum should be transferred to a secondary aliquot tube within 2 hours of centrifugation; prolonged contact with the clot allows metabolic processes and cellular release to alter analyte concentrations.

Question 43: 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?

60 minutes
30 minutes (Correct answer)
Immediately
10 minutes

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

1 minute (Correct answer)
3 minutes
10 minutes
5 minutes

Correct answer: 1 minute

Tourniquets should not remain on longer than 1 minute to prevent hemoconcentration, which skews test results.

Question 45: Which vein is most commonly used for venipuncture in the antecubital fossa?

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

Correct answer: Median cubital vein

The median cubital vein is the preferred site for venipuncture because it is large, well-anchored, and least painful.

Question 46: Specimens for cold agglutinins must be transported to the lab:

On ice to prevent agglutination
Frozen at −20°C immediately
At room temperature with gentle rocking
At 37°C to prevent premature cold agglutination (Correct answer)

Correct answer: At 37°C to prevent premature cold agglutination

Cold agglutinin specimens must be kept at 37°C during transport because the antibodies react at lower temperatures, causing red cell clumping that would interfere with testing.

Question 47: According to OSHA and CDC guidelines, a sharps container should be sealed and disposed of when it is how full?

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

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 48: Which specimen type is MOST sensitive to temperature fluctuations and must be processed within 30 minutes without exception?

Ammonia (plasma) (Correct answer)
TSH (thyroid-stimulating hormone)
Serum electrolytes in SST
Lipid panel (fasting plasma)

Correct answer: Ammonia (plasma)

Ammonia levels rise rapidly in unprocessed whole blood because red blood cells continuously produce ammonia; the specimen must be placed on ice and centrifuged within 15–30 minutes.

Question 49: What angle should the needle be inserted for routine antecubital venipuncture?

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

Correct answer: 15–30 degrees

A 15–30 degree angle (bevel up) allows smooth entry into the vein without passing through the posterior wall.

Question 50: Potassium EDTA (K2EDTA) is preferred over sodium EDTA for hematology specimens because:

Sodium EDTA causes red cell shrinkage while K2EDTA better preserves cell morphology (Correct answer)
It adds less volume and dilutes the sample less
K2EDTA prevents hemolysis more effectively
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 51: A serum specimen appears hemolyzed. Which analyte result is MOST likely to be falsely elevated?

Glucose
Calcium
Potassium (Correct answer)
Sodium

Correct answer: Potassium

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

Question 52: What is the maximum time a whole blood specimen should remain at room temperature before centrifugation?

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

Correct answer: 60 minutes

Whole blood specimens should be centrifuged within 60 minutes of collection to prevent cellular metabolism from altering analyte levels.

Question 53: What is the purpose of mixing the arterial blood gas syringe gently by rolling it between the palms after collection?

To warm the specimen to body temperature
To eliminate air bubbles from the syringe
To activate clotting factors
To mix heparin evenly with blood and prevent clot formation (Correct answer)

Correct answer: To mix heparin evenly with blood and prevent clot formation

Rolling the syringe ensures heparin is uniformly distributed throughout the blood, preventing micro-clots that would invalidate the ABG result.

Question 54: 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
Eye protection and gloves only
Gown and gloves (Correct answer)
N95 respirator and gloves

Correct answer: Gown and gloves

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

Question 55: A phlebotomist uses a butterfly needle to collect only a light blue top tube for a coagulation study. Which of the following is a necessary step to ensure an accurate result?

Invert the tube vigorously 15 times.
Slightly underfill the light blue tube.
Draw a discard tube before the light blue tube. (Correct answer)
Warm the tube in an incubator before the draw.

Correct answer: Draw a discard tube before the light blue tube.

When using a butterfly collection set, the air in the tubing will displace blood, leading to an underfilled tube. Coagulation tubes (light blue) require a precise 9:1 ratio of blood to anticoagulant. Drawing a discard tube first purges the air from the tubing, ensuring the light blue tube fills to the correct volume.

Question 56: Which condition is a contraindication to using the antecubital vein on the same side as a mastectomy?

Lymphedema risk (Correct answer)
Dehydration
Thrombocytopenia
Anemia

Correct answer: Lymphedema risk

Venipuncture on the same side as a mastectomy risks introducing infection or worsening lymphedema due to compromised lymphatic drainage.

Question 57: After ABG collection, the phlebotomist must label the syringe with which of the following patient information immediately at the bedside?

The phlebotomist's name only—the nurse documents the rest
Only the patient's name and date of birth
Patient name, date of birth (or ID number), date and time of collection, and FiO2 or oxygen delivery information (Correct answer)
Room number and collection time only

Correct answer: Patient name, date of birth (or ID number), date and time of collection, and FiO2 or oxygen delivery information

ABG labels require full patient ID plus FiO2/oxygen status because gas values are meaningless without knowing what oxygen concentration the patient was breathing at collection.

Question 58: Which tube color is used for plasma protein electrophoresis requiring heparin anticoagulant?

Gray (potassium oxalate/sodium fluoride)
Light blue (sodium citrate)
Green (lithium or sodium heparin) (Correct answer)
Lavender (EDTA)

Correct answer: Green (lithium or sodium heparin)

Green-top tubes contain heparin anticoagulant and are used for plasma specimens including some chemistry and special tests requiring heparinized plasma.

Question 59: Six Sigma methodology in a laboratory quality program uses 'defects per million opportunities' (DPMO). A process operating at Six Sigma quality has a DPMO of approximately:

3.4 defects per million (Correct answer)
66,800 defects per million
1,350 defects per million
6,000 defects per million

Correct answer: 3.4 defects per million

Six Sigma quality is defined as 3.4 defects per million opportunities, representing near-perfect performance and the highest achievable quality level in the Six Sigma framework.

Question 60: How often must most ASCP certifications be renewed?

Every 5 years (Correct answer)
Every 3 years
Every 10 years
They do not require renewal

Correct answer: Every 5 years

Most certifications offered by the American Society for Clinical Pathology (ASCP) require renewal every five years. This renewal process, often through the Credential Maintenance Program (CMP), ensures that laboratory professionals stay current with advancements in the field. It typically involves completing continuing education activities to maintain competency.

Question 61: Which disinfectant concentration of sodium hypochlorite (bleach) is recommended by the CDC for decontaminating blood spills?

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

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 62: How should a phlebotomist dispose of a used needle after venipuncture?

Place uncapped needle directly into a puncture-resistant sharps container (Correct answer)
Break the needle off and discard separately
Recap using two hands and place in a sharps container
Recap the needle, then place in a regular trash bin

Correct answer: Place uncapped needle directly into a puncture-resistant sharps container

Needles must be immediately discarded uncapped into a puncture-resistant sharps container to prevent needlestick injuries.

Question 63: When a patient refuses to confirm their identity before blood collection, what should the phlebotomist do?

Ask a colleague to confirm the patient's identity and proceed
Collect an unlabeled sample and label it after leaving the room
Collect the sample using the ward list name and label later
Do not collect the sample and document the refusal; escalate to the nurse in charge (Correct answer)

Correct answer: Do not collect the sample and document the refusal; escalate to the nurse in charge

Without confirmed patient identity, the sample cannot be safely collected; the refusal must be documented and escalated to prevent a misidentification event.

Question 64: When using the evacuated tube system, what confirms proper needle placement in the vein?

Blood flows back into the collection tube (Correct answer)
The patient reports feeling pressure at the site
The needle hub turns pale when inserted
The tourniquet automatically releases

Correct answer: Blood flows back into the collection tube

Blood filling the evacuated tube confirms the needle is correctly positioned in the vein and the vacuum is drawing the specimen.

Question 65: Capillary blood specimens are most often collected from which site in adult patients?

Toe
Earlobe
Fingertip (finger stick) (Correct answer)
Heel

Correct answer: Fingertip (finger stick)

In adults, the capillary puncture is most commonly performed on the fleshy tip of the third or fourth finger (ring or middle finger).

Question 66: What information is REQUIRED on a properly labeled specimen tube at the time of collection?

Patient name, test name, and phlebotomist's phone number
Patient name and room number only
Patient name, date of birth, collection date and time, and collector ID (Correct answer)
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 67: Light-sensitive specimens such as bilirubin or vitamin B12 should be:

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

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 68: The term 'arterialized capillary blood' refers to blood obtained after:

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

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.

Question 69: 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?

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

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

Influenza vaccine
Varicella vaccine
Hepatitis B vaccine (Correct answer)
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 71: 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?

Antimicrobial soap and water
Chlorhexidine scrub solution
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 72: 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, gown, and mask
Gloves only
Gloves and gown (Correct answer)
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 73: Which finding at the venipuncture site indicates accidental arterial puncture?

Visible bruising immediately
Absence of blood return
Bright red blood pulsating into the tube (Correct answer)
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 74: A phlebotomist notices a patient's armband is missing. What is the correct next step?

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

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 75: Which of the following describes the concept of 'turnaround time' (TAT) in POCT quality assurance?

Time for the reagent to reach room temperature
Time from specimen collection to result reporting (Correct answer)
Time between QC runs
Time between device maintenance checks

Correct answer: Time from specimen collection to result reporting

Turnaround time (TAT) is the interval from specimen collection (or test ordering) to result availability, and monitoring it is a key QA metric in POCT programs.

Question 76: Which component of blood is responsible for the immune response and fighting infection?

Reticulocytes
Thrombocytes
Leukocytes (Correct answer)
Erythrocytes

Correct answer: Leukocytes

Leukocytes (white blood cells) are the immune cells of the blood that identify and destroy pathogens, foreign substances, and abnormal cells.

Question 77: What is the primary purpose of the Exposure Control Plan mandated by OSHA's Bloodborne Pathogens Standard?

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

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 78: When balancing a centrifuge for spinning blood tubes, which principle must be followed?

Tubes of the same size and fill volume must be placed directly opposite each other. (Correct answer)
All available slots in the centrifuge must be filled before operation.
Heavier tubes should be placed closer to the center of the rotor.
Plasma tubes and serum tubes should never be centrifuged at the same time.

Correct answer: Tubes of the same size and fill volume must be placed directly opposite each other.

To prevent damage to the centrifuge and ensure proper specimen separation, the rotor must be balanced. This is achieved by placing tubes of equal size, shape, and volume in opposite positions to distribute the weight evenly.

Question 79: A conscious patient verbally refuses a blood draw. What is the appropriate response?

Respect the refusal, document it, and notify the nurse or physician (Correct answer)
Call security immediately
Restrain the patient and continue
Proceed anyway to fulfill the physician's order

Correct answer: Respect the refusal, document it, and notify the nurse or physician

Competent adult patients have the right to refuse medical procedures; the phlebotomist must document the refusal and inform the care team.

Question 80: A patient has a normal adult hematocrit. Which range best represents this value for males?

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

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 81: Which of the following is NOT typically included in a patient's Bill of Rights?

The right to privacy and confidentiality
The right to refuse treatment
The right to receive a detailed itemized bill
The right to know the phlebotomist's personal home address (Correct answer)

Correct answer: The right to know the phlebotomist's personal home address

Patients have rights to privacy, information, and refusal of treatment, but not to staff members' personal information.

Question 82: A phlebotomist performing POCT notices that the QC result is within range but the patient's glucose result seems inconsistent with their clinical presentation (the patient appears diaphoretic and confused but the meter reads 120 mg/dL). The BEST action is to:

Recalibrate the meter and retest the patient
Administer glucose immediately based on clinical signs
Repeat the test or collect a venous sample for lab glucose (Correct answer)
Accept the result and document it

Correct answer: Repeat the test or collect a venous sample for lab glucose

When a POCT result conflicts with clinical presentation, the result should be repeated or confirmed with a laboratory venous glucose, as meters have known sources of error.

Question 83: 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 84: A patient reports feeling faint and breaks into a cold sweat during venipuncture. This is most likely a sign of:

Hematoma
Nerve injury
Anaphylaxis
Vasovagal syncope (Correct answer)

Correct answer: Vasovagal syncope

Vasovagal syncope is a common reaction characterized by fainting, pallor, diaphoresis, and bradycardia triggered by needle anxiety or pain.

Question 85: After implementing corrective action for a QC failure, what step is REQUIRED before releasing patient results?

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

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 86: What term describes the collapse or rolling of a vein during venipuncture?

Phlebitis
Petechiae
Vein collapse (Correct answer)
Hematoma

Correct answer: Vein collapse

Vein collapse occurs when too much suction is applied, causing the vein walls to cave in and obstruct blood flow into the needle.

Question 87: What is the liquid portion of blood that remains after clotting has occurred?

Serum (Correct answer)
Plasma
Buffy coat
Fibrinogen

Correct answer: Serum

Serum is the liquid portion of blood that remains after the clot has formed and been removed, whereas plasma still contains clotting factors.

Question 88: When performing a venipuncture, the bevel of the needle should be positioned:

Facing sideways at a 90° angle
Facing down (bevel down) at a 45° angle
Facing up (bevel up) at a 15–30° angle (Correct answer)
Facing up at a 45° angle

Correct answer: Facing up (bevel up) at a 15–30° angle

Inserting the needle bevel-up at 15–30° allows smooth vein entry and reduces patient discomfort.

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

Airborne precautions (Correct answer)
Contact precautions
Droplet 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: A specimen is received with two different patient names on the label and the requisition. The phlebotomist should:

Use the requisition name and discard the tube label
Process the specimen and note the discrepancy in the results
Reject the specimen and request a recollection with correct labeling (Correct answer)
Call the patient to determine the correct name

Correct answer: Reject the specimen and request a recollection with correct labeling

Mismatched patient identifiers constitute a labeling error; the specimen must be rejected and recollected to prevent potential misidentification and patient harm.

Question 91: A phlebotomist needs to collect a capillary specimen from a patient with severe bilateral hand edema. The BEST alternative site would be:

The forearm
The forehead
The upper arm
The earlobe (Correct answer)

Correct answer: The earlobe

The earlobe is an acceptable alternative capillary puncture site when finger sites are compromised by edema, burns, or inadequate circulation.

Question 92: During a blood draw, gloves become visibly contaminated with blood. What is the appropriate action?

Continue the draw and change gloves after completing the collection
Stop, remove gloves, perform hand hygiene, and re-glove before continuing (Correct answer)
Wipe gloves with an alcohol swab and continue
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 93: Which of the following is a PRE-ANALYTICAL error that can affect laboratory results?

Hemolyzed specimen due to difficult venipuncture (Correct answer)
Analyzer malfunction during measurement
Incorrect reference range in the laboratory information system
Transcription error when entering results

Correct answer: Hemolyzed specimen due to difficult venipuncture

Pre-analytical errors occur before the specimen reaches the analyzer; hemolysis from difficult venipuncture is a classic pre-analytical error that alters multiple analyte values.

Question 94: When collecting a capillary blood specimen from an infant's heel, ASCP guidelines specify the puncture depth should not exceed:

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

Correct answer: 2.0 mm

Heel stick depth must not exceed 2.0 mm to avoid striking the calcaneal bone and causing osteomyelitis.

Question 95: A phlebotomist is collecting a specimen for a legal blood alcohol level test. Which of the following is a key component of the 'chain of custody' process for this specimen?

Having the patient sign a waiver before the draw.
Using a larger gauge needle for the collection.
Documenting every person who handles the specimen. (Correct answer)
Drawing a discard tube before the required gray-top tube.

Correct answer: Documenting every person who handles the specimen.

Chain of custody is a legal and procedural process that tracks a specimen from the moment of collection to its final disposition. It requires meticulous documentation of everyone who handles the specimen to ensure its integrity for legal proceedings.

Question 96: Westgard's 1₃ₛ rule states that a QC run is rejected when:

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

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 97: Which of the following represents the correct order of draw for a set of blood cultures, a coagulation tube (light blue), and a serum tube (red)?

Blood Cultures, Light Blue, Red (Correct answer)
Red, Light Blue, Blood Cultures
Light Blue, Red, Blood Cultures
Blood Cultures, Red, Light Blue

Correct answer: Blood Cultures, Light Blue, Red

The correct order of draw is critical to prevent cross-contamination of additives between tubes. Blood cultures must always be drawn first to maintain sterility and avoid contamination from other tube additives. The coagulation tube (light blue top) is drawn next. Finally, the serum tube (red top) is drawn.

Question 98: The femoral artery is used as an alternative ABG site primarily in which clinical scenario?

When the patient has a bleeding disorder
When radial and brachial sites are inaccessible (e.g., severe peripheral vascular disease, cardiac arrest) (Correct answer)
When the patient is awake and cooperative
When a larger blood volume is needed

Correct answer: When radial and brachial sites are inaccessible (e.g., severe peripheral vascular disease, cardiac arrest)

The femoral artery is reserved for situations where upper extremity access is impossible, such as in severe peripheral vascular disease, bilateral AV fistulas, or cardiac arrest resuscitation.

Question 99: Which site is preferred for neonatal heel stick collection?

The medial or lateral plantar surface of the heel (Correct answer)
The big toe
The arch of the foot
The center of the heel pad

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

The medial or lateral plantar surface of the heel is farthest from the calcaneus bone, reducing the risk of osteomyelitis.

Question 100: What does the acronym 'RACE' stand for in a fire emergency response?

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

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

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
Avoid drawing blood from the fistula arm entirely (Correct answer)

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 102: Which law primarily governs the confidentiality of patient health information in the United States?

OSHA Bloodborne Pathogen Standard
Joint Commission Standards
CLIA '88
HIPAA Privacy Rule (Correct answer)

Correct answer: HIPAA Privacy Rule

The HIPAA Privacy Rule establishes national standards for protecting individually identifiable health information and applies to all healthcare providers and workers.

Question 103: In capillary puncture, which of the following causes the LEAST amount of pain and tissue damage while still providing adequate blood?

A 21-gauge needle for precise puncture
A manual lancet blade for maximum control
A larger gauge lancet with greater depth
An automated spring-loaded safety lancet of appropriate gauge and depth (Correct answer)

Correct answer: An automated spring-loaded safety lancet of appropriate gauge and depth

Automated spring-loaded safety lancets provide a controlled, consistent puncture depth and width, minimize tissue trauma, retract automatically for safety, and produce less pain than manual devices.

Question 104: A STAT arterial blood gas (ABG) sample collected in a heparinized syringe must be transported to the lab within what time frame if kept at room temperature?

30 minutes (Correct answer)
15 minutes
60 minutes
4 hours

Correct answer: 30 minutes

ABG samples must reach the analyzer within 30 minutes at room temperature to prevent continued cellular metabolism from altering pH, PO2, and PCO2 values.

Question 105: 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)
Only the final pass/fail decision
QC values and technologist name only
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 106: When collecting specimens for cold agglutinin titers, how must the specimen be transported to the lab?

Frozen at –20°C immediately after collection
At body temperature (37°C) in a warming device (Correct answer)
On ice in a slurry at 0–4°C
At room temperature with no special handling

Correct answer: At body temperature (37°C) in a warming device

Cold agglutinins bind to red blood cells at low temperatures; keeping the specimen warm prevents premature agglutination before testing.

Question 107: Which of the following actions violates standard precautions when drawing blood?

Recapping a used needle by holding the cap with the other hand (Correct answer)
Recapping a used needle using the one-handed scoop technique
Disposing of sharps immediately in a puncture-resistant container
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 108: Standard precautions in phlebotomy require gloves:

Only when the phlebotomist has cuts on their hands
For every blood draw regardless of patient status (Correct answer)
Only for arterial punctures
Only when the patient has a known infection

Correct answer: For every blood draw regardless of patient status

Standard precautions treat all blood and body fluids as potentially infectious, requiring gloves for every patient contact involving blood.

Question 109: Which of the following blood collection tubes does NOT require mixing after collection?

Plain red top (no additive) (Correct answer)
Gold top (SST with clot activator)
Gray top (sodium fluoride)
Lavender top (EDTA)

Correct answer: Plain red top (no additive)

Plain red-top tubes contain no additives; blood is allowed to clot naturally without mixing. All other tubes with additives require gentle inversion to mix the additive with blood.

Question 110: Which of the following additives is correctly matched with its primary function in a blood collection tube?

Heparin - Glycolysis inhibitor
Sodium Fluoride - Clot activator
EDTA - Anticoagulant that binds calcium (Correct answer)
Thrombin - Anticoagulant that binds thrombin

Correct answer: EDTA - Anticoagulant that binds calcium

EDTA (Ethylenediaminetetraacetic acid) is an anticoagulant that works by chelating (binding) calcium ions, which are essential for the coagulation cascade, thus preventing the blood from clotting. Sodium fluoride is a glycolysis inhibitor, heparin is an anticoagulant that inhibits thrombin, and thrombin is a potent clot activator.

Question 111: To break the chain of infection, what is the single most effective means of preventing the spread of pathogens?

Wearing gloves
Isolating infected patients
Proper hand hygiene (Correct answer)
Using safety-engineered needles

Correct answer: Proper hand hygiene

While all options are important infection control measures, frequent and proper hand hygiene is recognized by the CDC and other health organizations as the single most effective way to prevent the spread of infections in a healthcare setting. It removes or destroys microorganisms picked up from other people, surfaces, or contaminated body fluids.

Question 112: A phlebotomist notices a patient's ID band is missing. What should they do?

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

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 113: A gray top tube contains which additive combination?

Lithium heparin and silica
Sodium fluoride and potassium oxalate (Correct answer)
Sodium citrate and thrombin
EDTA and gel separator

Correct answer: Sodium fluoride and potassium oxalate

Gray top tubes contain sodium fluoride (glycolysis inhibitor) and potassium oxalate (anticoagulant) for glucose and lactate testing.

Question 114: 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.
Wash the wound with soap and water. (Correct answer)
Fill out an incident report.
Seek post-exposure prophylaxis (PEP).

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 115: What is the primary purpose of labeling blood collection tubes at the bedside immediately after collection?

To prevent specimen mislabeling and ensure patient safety (Correct answer)
To satisfy insurance auditing rules
To speed up laboratory processing times
To meet regulatory billing requirements

Correct answer: To prevent specimen mislabeling and ensure patient safety

Bedside labeling immediately after collection is the most critical step to prevent mislabeling errors, which are a leading cause of transfusion reactions and diagnostic mistakes.

Question 116: When labeling a blood specimen tube, which piece of information is NOT typically required on the tube label?

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

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 117: What is the primary purpose of a syringe blood transfer device (blood transfer device)?

To mix the blood with tube additives by inversion
To measure the exact volume of blood collected in the syringe
To cap and seal the syringe barrel after collection
To safely transfer blood from a syringe into evacuated tubes without using an exposed needle (Correct answer)

Correct answer: To safely transfer blood from a syringe into evacuated tubes without using an exposed needle

A blood transfer device attaches to the syringe hub and connects to evacuated tubes, allowing vacuum-assisted, needle-free transfer that reduces needlestick risk and minimizes hemolysis from forced plunger ejection.

Question 118: Which needle gauge is most commonly used for routine adult venipuncture?

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

Correct answer: 21-gauge

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

Question 119: What is the correct way to ask a patient to confirm their identity before a blood draw?

Ask 'Are you John Smith?'
Check the room number and assume correct patient
Ask 'Can you tell me your full name and date of birth?' (Correct answer)
Ask the nurse on duty to confirm

Correct answer: Ask 'Can you tell me your full name and date of birth?'

Open-ended questions requiring the patient to state their name and DOB prevent errors; asking 'Are you Mr. Smith?' allows the patient to agree even if they are not.

Question 120: A patient on warfarin therapy requires venipuncture. What extra precaution is MOST important post-draw?

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

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.

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

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120 min

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70%

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