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

Question 1: What is the primary reason for avoiding vigorous shaking of blood collection tubes?

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

Correct answer: It causes hemolysis by rupturing red blood cells

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

Question 2: When a chemical spill occurs in the phlebotomy area, what should the phlebotomist consult FIRST?

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

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

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

Question 3: What is the recommended practice for labeling a blood specimen tube?

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

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

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

Question 4: Which of the following is the correct angle of needle insertion for a standard venipuncture?

45–60 degrees
5–10 degrees
75–90 degrees
15–30 degrees (Correct answer)

Correct answer: 15–30 degrees

A needle angle of 15–30 degrees is recommended for venipuncture to allow entry into the vein without going through the posterior wall.

Question 5: Which body fluid is NOT covered under OSHA's Bloodborne Pathogens Standard for routine precautions?

Blood
Semen
Cerebrospinal fluid
Sweat (Correct answer)

Correct answer: Sweat

Sweat is not considered a potentially infectious material under OSHA's Bloodborne Pathogens Standard unless it is visibly contaminated with blood.

Question 6: A requisition order shows two different patient last names (maiden vs. married). How should the phlebotomist proceed?

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

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

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

Question 7: Which gauge needle is most commonly used for routine venipuncture in adults?

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

Correct answer: 21 gauge

A 21-gauge needle is the standard for routine adult venipuncture, balancing adequate flow with patient comfort.

Question 8: Which type of fire extinguisher is appropriate for electrical equipment fires in a lab?

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

Correct answer: Class C

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

Question 9: A patient has had a mastectomy on the right side. Which arm should be used for venipuncture?

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

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

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

Question 10: What does the RACE acronym stand for in fire safety response?

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

Correct answer: Rescue, Activate, Contain, Extinguish

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

Question 11: A patient arrives for a draw and appears confused and cannot state their name. What is the BEST patient identification approach?

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

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

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

Question 12: Which specimen requires protection from light during transport and processing?

Serum potassium
Sodium
Bilirubin (Correct answer)
Whole blood CBC

Correct answer: Bilirubin

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

Question 13: Which of the following is the best way for a phlebotomist to verify the identity of an outpatient who is conscious and alert?

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

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

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

Question 14: Which federal regulation governs bloodborne pathogen exposure control in the workplace?

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

Correct answer: OSHA 29 CFR 1910.1030

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

Question 15: A patient taking diuretics has been asked to collect a 24-hour urine specimen. What instruction is most important?

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

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

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

Question 16: Which ergonomic measure best reduces repetitive strain injury risk for phlebotomists?

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

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

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

Question 17: A specimen for ammonia testing must be:

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

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

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

Question 18: When preparing a patient for a blood draw, which of the following is a key element of obtaining informed consent?

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

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

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

Question 19: A phlebotomist is tasked with collecting blood for a coagulation test, a complete blood count (CBC), and a blood culture. According to CLSI guidelines, what is the correct order of draw for these tests?

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

Correct answer: Blood culture, Coagulation tube, CBC tube

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

Question 20: What does CLSI (Clinical and Laboratory Standards Institute) recommend as the correct number of times to invert an EDTA tube after collection?

15–20 times
3–4 times
8–10 times (Correct answer)
1–2 times

Correct answer: 8–10 times

CLSI recommends gently inverting EDTA (lavender-top) tubes 8–10 times to ensure complete mixing of the anticoagulant with the blood.

Question 21: Which of the following specimens requires protection from light during transport?

Basic metabolic panel specimen
Bilirubin specimen (Correct answer)
Hemoglobin A1c sample
Prothrombin time sample

Correct answer: Bilirubin specimen

Bilirubin is photosensitive and degrades rapidly when exposed to light, so specimens must be wrapped in foil or placed in an amber bag.

Question 22: How should a phlebotomist properly dispose of a full, sealed sharps container?

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

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

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

Question 23: A pediatric patient is brought in with a parent. The child's wristband has fallen off. Who can verbally confirm the child's identity?

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

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

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

Question 24: What does the term 'antecubital fossa' refer to in phlebotomy?

The bend of the elbow (Correct answer)
The inner wrist
The upper arm
The back of the hand

Correct answer: The bend of the elbow

The antecubital fossa is the triangular area on the anterior surface of the elbow, the most common site for venipuncture.

Question 25: A patient is scheduled for a glucose tolerance test (GTT). After the fasting blood sample is collected, the patient is given a glucose beverage and instructed to finish it within 5 minutes. What is the phlebotomist's MOST important responsibility regarding the timing of the subsequent draws?

Adjust the collection times based on how quickly the patient feels the effects of the glucose.
Collect the next sample exactly one hour after the fasting draw was completed.
Start the timer as soon as the patient begins drinking the glucose beverage.
Record the time the patient finishes the beverage and collect subsequent samples at the specified intervals from that time. (Correct answer)

Correct answer: Record the time the patient finishes the beverage and collect subsequent samples at the specified intervals from that time.

For a glucose tolerance test, timing is critical for accurate interpretation. The test timing begins precisely when the patient finishes consuming the glucose beverage. The phlebotomist must accurately document this time and use it as the baseline for collecting all subsequent specimens at the required intervals (e.g., 1-hour, 2-hour).

Question 26: What concentration of sodium hypochlorite (bleach) solution is recommended for decontaminating blood spills?

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

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

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

Question 27: A patient reports feeling faint during venipuncture. What is the FIRST action the phlebotomist should take?

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

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

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

Question 28: Which term describes a specimen collected at the wrong time relative to medication administration?

Clotted specimen
Timing error (trough/peak mislabel) (Correct answer)
Hemolyzed specimen
Icteric specimen

Correct answer: Timing error (trough/peak mislabel)

Collecting a drug-level specimen at the wrong time (e.g., confusing trough and peak draws) is a timing error that renders therapeutic drug monitoring results invalid.

Question 29: Where can you quickly and accurately find the information you need about a dangerous chemical if you come across one?

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

Correct answer: Material Safety Data Sheet (MSDS)

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

Question 30: A plasma separator tube (PST) contains which anticoagulant?

Potassium oxalate
EDTA
Sodium citrate
Lithium heparin (Correct answer)

Correct answer: Lithium heparin

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

Question 31: What is the correct angle of needle insertion for routine venipuncture?

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

Correct answer: 15-30 degrees

A 15-30 degree angle allows proper vein entry without going through the posterior wall.

Question 32: What is the maximum recommended time a tourniquet should remain applied before venipuncture?

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

Correct answer: 1 minute

A tourniquet should not remain in place for more than 1 minute, as prolonged application causes hemoconcentration and can alter test results.

Question 33: What is the maximum number of venipuncture attempts recommended per phlebotomist per patient per CLSI guidelines?

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

Correct answer: 2 attempts

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

Question 34: What is the purpose of an Exposure Control Plan (ECP) in a phlebotomy setting?

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

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

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

Question 35: When disposing of a used lancet, which container should be used?

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

Correct answer: Puncture-resistant sharps container

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

Question 36: Which of the following is NOT an acceptable patient identifier according to CLSI GP33?

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

Correct answer: Patient's room number

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

Question 37: A phlebotomist is preparing to draw blood from an inpatient. Which of the following is the most critical first step in the routine collection procedure?

Washing hands and putting on gloves.
Applying the tourniquet to locate a suitable vein.
Assembling all necessary equipment at the bedside.
Verifying the patient's identity using at least two identifiers. (Correct answer)

Correct answer: Verifying the patient's identity using at least two identifiers.

Proper patient identification is mandatory before any collection procedure to prevent errors. The standard is to use at least two unique identifiers, such as asking the patient to state their full name and date of birth, and comparing that information with the requisition and the patient's armband.

Question 38: A patient's requisition indicates 'STAT' status. How does this affect patient identification?

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

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

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

Question 39: How long can a serum specimen typically remain at room temperature before centrifugation must occur?

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

Correct answer: Up to 2 hours

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

Question 40: For a urine culture collected by midstream clean-catch, the specimen must be delivered to the lab within what timeframe if not refrigerated?

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

Correct answer: 2 hours

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

Question 41: A laboratory rejects a light blue top tube for a coagulation test. Which of the following is the most likely reason for specimen rejection?

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

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

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

Question 42: Which of the following tasks is not within the phlebotomist's purview of practice?

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

Correct answer: Collecting a tissue sample

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

Question 43: What is the PRIMARY reason phlebotomists verify dietary restrictions before collection?

To prevent pre-analytical errors that alter test results (Correct answer)
To comply with hospital food service scheduling
To document the patient's nutritional status for the nurse
To ensure the patient has taken required medications with food

Correct answer: To prevent pre-analytical errors that alter test results

Pre-analytical variables like fasting status directly impact the accuracy of many analyte measurements.

Question 44: Which test requires a fasting specimen for accurate results?

Blood culture
Urinalysis
Complete blood count (CBC)
Fasting lipid panel (Correct answer)

Correct answer: Fasting lipid panel

A fasting lipid panel requires the patient to fast for 9–12 hours before collection because dietary fat raises triglycerides and affects calculated LDL values.

Question 45: An irate patient grabs a phlebotomist's arm during a blood draw. This is an example of which type of workplace hazard?

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

Correct answer: Psychosocial/workplace violence hazard

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

Question 46: What is the purpose of inverting collection tubes after blood collection?

To prevent hemolysis
To mix blood with the tube additive (Correct answer)
To separate serum from plasma
To activate the clotting process in serum tubes

Correct answer: To mix blood with the tube additive

Gentle inversions ensure the blood mixes thoroughly with the additive (anticoagulant, clot activator, or preservative) to achieve the intended effect.

Question 47: A patient scheduled for a routine venipuncture expresses extreme anxiety about needles and reports a history of fainting during blood draws. Which action should the phlebotomist take to prepare the patient?

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

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

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

Question 48: What color tube top is used when no additive is present (plain glass tube for serum)?

Green
Yellow
Red (plain/no additive) (Correct answer)
Lavender

Correct answer: Red (plain/no additive)

A plain red-top tube contains no additives and allows blood to clot naturally to produce serum after centrifugation.

Question 49: Phlebotomists are required to wear gloves primarily to protect against:

Chemical burns from alcohol swabs
Patient discomfort during the procedure
Bloodborne pathogen exposure for both phlebotomist and patient (Correct answer)
Needle contamination during packaging

Correct answer: Bloodborne pathogen exposure for both phlebotomist and patient

Gloves are a PPE barrier required by OSHA Bloodborne Pathogens Standard to protect against exposure to blood and other potentially infectious materials.

Question 50: A potential factor that could lead to tube rupture during centrifugation is _______.

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

Correct answer: Unbalanced centrifuge

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

Question 51: When aliquoting a specimen, which technique prevents cross-contamination between aliquots?

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

Correct answer: Changing pipette tips between each aliquot transfer

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

Question 52: You should _________ when you enter a room that has isolation signs.

Read isolation signs to determine what PPE is appropriate (Correct answer)
Go on it, as short visits in isolation do not matter
Ask a nurse if gown, mask or gloves are needed
Ask the patient what the nurses wear

Correct answer: Read isolation signs to determine what PPE is appropriate

Isolation signs provide vital information regarding the type of precautions required (e.g., contact, droplet, airborne) and the specific Personal Protective Equipment (PPE) needed before entering a patient's room. Reading these signs ensures healthcare workers protect themselves and prevent the spread of infection to others. This adherence to protocols is crucial for maintaining a safe healthcare environment.

Question 53: Which of the following veins is considered the safest first choice for routine venipuncture?

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

Correct answer: Median cubital vein

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

Question 54: An inpatient's ID band is missing. What should the phlebotomist do?

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

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

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

Question 55: What is the purpose of the gel separator in SST and PST tubes?

To form a physical barrier between cells and serum/plasma after centrifugation (Correct answer)
To lyse red blood cells for plasma testing
To neutralize tube additives
To anticoagulate the specimen

Correct answer: To form a physical barrier between cells and serum/plasma after centrifugation

The thixotropic gel in separator tubes migrates during centrifugation to form a stable physical barrier between the cellular layer and the serum or plasma layer.

Question 56: Which organization accredits phlebotomy training programs and certifies phlebotomy technicians in the US?

ASCP, NHA, and NCCT among others (Correct answer)
OSHA and the FDA
CMS and the CDC jointly
The Joint Commission exclusively

Correct answer: ASCP, NHA, and NCCT among others

Several organizations — including ASCP (American Society for Clinical Pathology), NHA (National Healthcareer Association), and NCCT — offer nationally recognized phlebotomy certification examinations.

Question 57: The antecubital fossa is located:

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

Correct answer: In the inner bend of the elbow

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

Question 58: According to CLSI guidelines, what is the maximum amount of time that should elapse between the collection of a routine blood specimen for serum testing and the separation of serum from the cells by centrifugation?

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

Correct answer: 2 hours

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

Question 59: Which additive in the green-top tube prevents clotting by binding calcium?

Lithium heparin (Correct answer)
Sodium citrate
EDTA
Sodium fluoride

Correct answer: Lithium heparin

Lithium heparin inhibits thrombin and thromboplastin, preventing clot formation without binding calcium directly, but it is the anticoagulant in green-top tubes.

Question 60: Which vein is generally considered the FIRST choice for routine adult venipuncture?

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

Correct answer: Median cubital vein

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

Question 61: What happens to the urine collected on the first day at 7 a.m. of a 24-hour urine sample?

None of the above
Discard (Correct answer)
Saved
Scale

Correct answer: Discard

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

Question 62: A patient has an IV infusing in the left antecubital vein. Where should the phlebotomist draw?

Below the IV site in the same arm
The right arm or another site distal to the IV (Correct answer)
Turn off the IV for 5 minutes, then draw above the IV site
Draw from the left arm after flushing the IV with saline

Correct answer: The right arm or another site distal to the IV

Drawing from a site ipsilateral to or below an IV infusion risks specimen dilution; the contralateral arm or a distal alternative site is preferred.

Question 63: Which specimen type is required for a prothrombin time (PT) test?

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

Correct answer: Plasma in a sodium citrate tube

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

Question 64: Which label color indicates a biohazardous specimen bag?

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

Correct answer: Orange with black biohazard symbol

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

Question 65: Under HIPAA, a phlebotomist may share a patient's test results with:

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

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

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

Question 66: A patient scheduled for a lipid panel says they ate a small snack 4 hours ago. What should the phlebotomist do?

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

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

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

Question 67: For a therapeutic drug monitoring (TDM) trough level, when should blood be drawn relative to the drug dose?

At any time unrelated to dosing
Immediately before the next scheduled dose (Correct answer)
2 hours after the dose
30 minutes after the dose

Correct answer: Immediately before the next scheduled dose

A trough level is drawn immediately before the next scheduled dose, when the drug concentration is at its lowest point.

Question 68: Which federal law governs the handling and disposal of biohazardous waste and sharps in the clinical laboratory?

OSHA Bloodborne Pathogens Standard (Correct answer)
HIPAA
The Clean Air Act
CLIA '88

Correct answer: OSHA Bloodborne Pathogens Standard

The OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030) mandates proper handling, disposal, and PPE requirements related to blood and other potentially infectious materials.

Question 69: The antecubital fossa, the primary venipuncture site, is located at which anatomical region?

Back of the hand
Inner wrist
Inner elbow (Correct answer)
Upper arm

Correct answer: Inner elbow

The antecubital fossa is the shallow triangular depression located on the anterior (front) surface of the elbow, where the major veins used for routine venipuncture are found.

Question 70: Which of the following is a common cause of pre-analytical error in specimen handling?

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

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

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

Question 71: A specimen labeled 'STAT' should be processed within what timeframe from receipt in the laboratory?

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

Correct answer: Within 30–60 minutes

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

Question 72: An outpatient arrives for a fasting glucose tolerance test. The phlebotomist confirms the patient's name and date of birth against the requisition. Which of the following is the MOST critical next step in patient preparation?

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

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

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

Question 73: A gray-top tube contains sodium fluoride. What is its primary purpose?

To activate clotting factors
To prevent platelet aggregation
To chelate calcium ions
To inhibit glycolysis and preserve glucose levels (Correct answer)

Correct answer: To inhibit glycolysis and preserve glucose levels

Sodium fluoride inhibits the enzymes responsible for glycolysis, preserving glucose concentration in the specimen.

Question 74: When collecting a specimen for ammonia testing, which special handling step is required?

Centrifuge at room temperature before transport
Warm the specimen to 37°C immediately
Place specimen on ice and transport immediately (Correct answer)
Expose specimen to light to prevent degradation

Correct answer: Place specimen on ice and transport immediately

Ammonia specimens must be placed on ice immediately after collection and transported quickly because ammonia levels rise rapidly at room temperature.

Question 75: Under HIPAA, which situation allows a phlebotomist to share a patient's lab results?

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

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

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

Question 76: Which of the following best describes a midstream clean-catch urine collection?

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

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

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

Question 77: What is the purpose of inverting a blood collection tube after filling?

To activate the vacuum
To mix the blood with the tube's additive (Correct answer)
To separate serum from cells
To check for clots

Correct answer: To mix the blood with the tube's additive

Gentle inversions mix the blood thoroughly with the additive (anticoagulant or clot activator) to ensure proper function.

Question 78: Which antiseptic is the standard choice for routine venipuncture site preparation?

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

Correct answer: 70% isopropyl alcohol

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

Question 79: What is the recommended angle of needle insertion for a routine venipuncture?

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

Correct answer: 15–30 degrees

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

Question 80: What is the purpose of the clot activator found in gold or red SST tubes?

To accelerate clot formation for serum collection (Correct answer)
To chelate heavy metals in the specimen
To prevent blood from clotting
To preserve cellular morphology

Correct answer: To accelerate clot formation for serum collection

Clot activators like silica particles trigger faster clot formation so serum can be obtained after centrifugation more efficiently.

Question 81: When performing a capillary puncture on an infant, which part of the heel is the correct puncture site?

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

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

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

Question 82: A phlebotomist recaps a needle using one hand to avoid needlestick injury. This technique is permitted under which circumstances?

Anytime, as long as gloves are worn
Only when a safety device is unavailable and one-hand scoop method is used (Correct answer)
Never; recapping is always prohibited
Only when the patient's blood is known to be HIV-negative

Correct answer: Only when a safety device is unavailable and one-hand scoop method is used

OSHA prohibits two-handed recapping; the one-hand scoop method is acceptable only as an exception when no safer alternative exists.

Question 83: What is the primary purpose of inverting a collection tube after drawing blood?

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

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

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

Question 84: When should a phlebotomist recollect a specimen without consulting the laboratory?

When the tube was not filled to the correct volume for a citrate tube (Correct answer)
When the specimen is slightly hemolyzed
When the serum appears slightly icteric
When the patient is on anticoagulant therapy

Correct answer: When the tube was not filled to the correct volume for a citrate tube

A sodium citrate tube that is underfilled must be recollected because the incorrect blood-to-anticoagulant ratio will invalidate coagulation test results.

Question 85: Which of the following is NOT an acceptable patient identifier when collecting blood?

Full name
Date of birth
Room number (Correct answer)
Medical record number

Correct answer: Room number

Room number is not a reliable identifier because patients can be moved; only patient-specific identifiers are acceptable.

Question 86: When collecting blood cultures, how should the venipuncture site be cleaned to reduce contamination?

With povidone-iodine or chlorhexidine gluconate using a concentric circle technique, then allowed to dry (Correct answer)
With soap and water followed by alcohol
With 70% isopropyl alcohol only
With a dry sterile gauze pad

Correct answer: With povidone-iodine or chlorhexidine gluconate using a concentric circle technique, then allowed to dry

Blood cultures require a two-step antiseptic prep (alcohol followed by chlorhexidine or iodine) using concentric circles and full drying to minimize false-positive contamination.

Question 87: When a requisition form calls for a fasting specimen, what does this typically mean?

The patient should have had nothing by mouth for 8-12 hours (Correct answer)
The patient should avoid fatty foods for 2 hours
The patient must fast for 24 hours
The patient should have had only water for 4 hours

Correct answer: The patient should have had nothing by mouth for 8-12 hours

A standard fasting specimen requires 8-12 hours of no food or drink (except water) to ensure accurate baseline metabolic values.

Question 88: What does the term 'hemoconcentration' refer to in phlebotomy?

Dilution of blood due to excessive fluid intake
Increased concentration of blood cells due to prolonged tourniquet use (Correct answer)
Hemolysis caused by improper needle insertion
Clotting of blood within the collection tube

Correct answer: Increased concentration of blood cells due to prolonged tourniquet use

Hemoconcentration occurs when a tourniquet is left on too long, causing fluid to shift out of capillaries and artificially elevating cell and analyte concentrations.

Question 89: Which additive in a gray-top tube prevents glycolysis in glucose specimens?

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

Correct answer: Potassium oxalate and sodium fluoride

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

Question 90: A specimen is hemolyzed. Which test result is MOST likely to be falsely elevated?

Calcium
Glucose
Potassium (Correct answer)
Sodium

Correct answer: Potassium

Red blood cells contain high concentrations of potassium, so hemolysis releases intracellular potassium and falsely elevates serum potassium levels.

Question 91: Which of the subsequent claims is accurate?

A lancet is very crucial in performing a finger stick (Correct answer)
A syringe isn't needed for a finger stick (Correct answer)
A tourniquet is very essential to effectively perform a finger stick
All of the above

Correct answer: A lancet is very crucial in performing a finger stick

A lancet is a small, sterile, sharp instrument specifically designed to create a controlled, superficial puncture on the skin, which is essential for capillary blood collection procedures like a finger stick. Without a lancet, it would be impossible to safely and effectively obtain the required blood sample from the capillary bed. Its precise design ensures minimal tissue damage while allowing sufficient blood flow for collection.

Question 92: A phlebotomist draws a serum separator tube (SST) and notices it did not fill to the minimum volume. What should be done?

Draw a new full tube if possible; partial fills can affect centrifuged serum yield (Correct answer)
Add saline to bring the tube to the correct volume
Send the tube as-is and note the partial fill on the requisition
Combine it with another SST from the same patient

Correct answer: Draw a new full tube if possible; partial fills can affect centrifuged serum yield

Short-draw SST tubes may yield insufficient serum after centrifugation and can affect gel separator performance.

Question 93: What is the most common cause of hemolysis during venipuncture?

Leaving the tourniquet on too long
Using too large a needle
Pulling back the syringe plunger too forcefully or transferring blood too quickly (Correct answer)
Using a cold alcohol swab

Correct answer: Pulling back the syringe plunger too forcefully or transferring blood too quickly

Excessive mechanical force when aspirating with a syringe or transferring blood through a needle ruptures red blood cells and causes hemolysis.

Question 94: For PTT, which tube is utilized?

Gray
Green
Light Blue (Correct answer)
Red

Correct answer: Light Blue

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

Question 95: A gray-top tube contains sodium fluoride. Its PRIMARY purpose is to:

Preserve glucose by inhibiting glycolysis (Correct answer)
Accelerate clot formation
Bind calcium for coagulation testing
Prevent platelet aggregation

Correct answer: Preserve glucose by inhibiting glycolysis

Sodium fluoride inhibits the enzyme enolase, halting glycolysis and stabilizing glucose levels in the specimen.

Question 96: A serum separator tube (SST) must be inverted how many times after collection?

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

Correct answer: 5 times

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

Question 97: A patient reports they take warfarin daily. How does this affect patient preparation for a venipuncture?

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

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

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

Question 98: Which site is CONTRAINDICATED for venipuncture in a patient who has had a mastectomy on the left side?

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

Correct answer: Left antecubital fossa

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

Question 99: Which term describes the cessation of blood flow from a wound through physiological processes?

Fibrinolysis
Thrombocytopenia
Hemostasis (Correct answer)
Anticoagulation

Correct answer: Hemostasis

Hemostasis is the body's mechanism to stop bleeding through vasoconstriction, platelet plug formation, and the coagulation cascade.

Question 100: Which blood cell is in charge of carrying carbon dioxide and oxygen:

Platelets
Erythrocyte (Correct answer)
None of the above
Leukocyte

Correct answer: Erythrocyte

Erythrocytes, commonly known as red blood cells, are specialized blood cells primarily responsible for transporting oxygen from the lungs to the body's tissues. They also carry carbon dioxide from the tissues back to the lungs for exhalation. This crucial function is facilitated by the hemoglobin protein contained within the erythrocytes.

NHA Certified Phlebotomy Technician (CPT) Exam

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

100

Questions

120 min

Time Limit

70%

To Pass

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