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

Question 1: What is the primary purpose of the 'transitional hold' or 'kangaroo care' position during neonatal blood collection?

To improve vein visibility by warming the skin through skin-to-skin contact
To prevent the neonate from moving and causing accidental needlestick
To allow gravity to fill micro-collection tubes more efficiently
To use skin-to-skin contact for pain relief and calming during the procedure (Correct answer)

Correct answer: To use skin-to-skin contact for pain relief and calming during the procedure

Skin-to-skin (kangaroo care) contact between parent and neonate significantly reduces pain responses (heart rate, crying, cortisol) during blood collection procedures.

Question 2: Which specimen type is required for a fingerstick HbA1c test at the point of care?

Urine sample
Serum from a red-top tube
Plasma from a lavender-top tube
Capillary whole blood (Correct answer)

Correct answer: Capillary whole blood

POCT HbA1c analyzers use capillary whole blood obtained via fingerstick, which contains the red blood cells needed to measure glycated hemoglobin.

Question 3: 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)
10 minutes
Immediately

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 4: What does SST stand for in phlebotomy, and which color is it typically associated with?

Standard Serum Tube; red
Sodium Sulfate Tube; green
Sterile Specimen Tube; white
Serum Separator Tube; gold or tiger-top (Correct answer)

Correct answer: Serum Separator Tube; gold or tiger-top

SST stands for Serum Separator Tube; it contains a thixotropic gel and a clot activator, and after centrifugation the gel forms a barrier between serum and the clot for easy serum harvest.

Question 5: A phlebotomist needs to collect a capillary specimen from a patient with severe bilateral hand edema. The BEST alternative site would be:

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

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 6: 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
20-gauge straight needle
23-gauge butterfly needle (Correct answer)

Correct answer: 23-gauge butterfly needle

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

Question 7: What is a primary eligibility requirement for the AMCA Phlebotomy Technician Certification exam?

One year of work experience in a non-medical role
Supervisory experience in a clinical laboratory
Bachelor’s degree in a medical-related field
Completion of a formal phlebotomy training program (Correct answer)

Correct answer: Completion of a formal phlebotomy training program

To be eligible for the AMCA Phlebotomy Technician Certification exam, candidates must typically complete a formal phlebotomy training program. This requirement ensures they have received comprehensive instruction and practical experience in venipuncture techniques, safety protocols, and specimen handling. This foundational training is crucial for safe and effective practice.

Question 8: How long is the AMT’s RPT certification valid before requiring renewal?

1 year
2 years
3 years (Correct answer)
Certification does not expire

Correct answer: 3 years

The AMT’s Registered Phlebotomy Technician (RPT) certification is valid for three years before requiring renewal. To maintain their credential, RPTs must participate in AMT's Certification Continuation Program (CCP), which involves earning continuing education credits. This ensures ongoing professional development and adherence to current standards in phlebotomy.

Question 9: According to ASCP standards, which tube must NEVER be used for glucose tolerance testing?

Red-top (no additive) tube
Gold-top (SST) tube (Correct answer)
Green-top (heparin) tube
Gray-top (sodium fluoride) tube

Correct answer: Gold-top (SST) tube

Gold-top SST tubes contain a clot activator and gel separator that can interfere with glucose measurements in GTT protocols.

Question 10: A laboratory's QA program identifies that STAT order turnaround times frequently exceed the 60-minute target. The MOST effective initial intervention is to:

Map the current STAT process to identify the specific step causing delay (Correct answer)
Purchase additional laboratory analyzers immediately
Increase the STAT TAT target to 90 minutes to reduce perceived failures
Mandate that all STAT specimens be run before routine tests without exception

Correct answer: Map the current STAT process to identify the specific step causing delay

Process mapping visualizes each step in the STAT workflow, identifying the specific bottleneck causing delays before implementing targeted, effective interventions.

Question 11: For a neonatal PKU screening (newborn screening), the blood specimen is collected on which type of collection device?

Blood spot filter paper card (Guthrie card) (Correct answer)
Micro-collection tube (Microtainer)
Heparinized capillary tube
Standard EDTA tube (lavender top)

Correct answer: Blood spot filter paper card (Guthrie card)

Newborn metabolic screening uses filter paper blood spot cards (Guthrie cards), where blood drops are applied to designated circles and dried for analysis.

Question 12: A 6-year-old patient with a known diagnosis of hemophilia A requires a blood draw. What special consideration applies?

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

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

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

Question 13: A phlebotomist sustains a needlestick injury while drawing blood from an HCV-positive patient. What is the first action to take?

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

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 14: Which of the following is NOT an acceptable reason to reject a specimen in the laboratory?

Hemolyzed specimen for potassium assay
Expired collection tube used for specimen draw
Tube filled to only 70% of required volume for coagulation testing
Specimen collected 45 minutes before transport for routine chemistry (Correct answer)

Correct answer: Specimen collected 45 minutes before transport for routine chemistry

A 45-minute pre-transport interval for routine chemistry is within acceptable limits and does not constitute grounds for rejection, unlike underfilled coagulation tubes, hemolysis for potassium, or expired tubes.

Question 15: Why should a capillary blood gas specimen be collected in a heparinized capillary tube and immediately sealed at both ends?

To prevent clotting before analysis
To prevent evaporation of the liquid sample
To prevent exposure to atmospheric air that would alter CO2 and O2 levels (Correct answer)
To keep the specimen at body temperature during transport

Correct answer: To prevent exposure to atmospheric air that would alter CO2 and O2 levels

Sealing the capillary tube immediately prevents atmospheric oxygen from entering and CO2 from escaping, which would alter blood gas values and render the specimen invalid.

Question 16: When performing a fingerstick on an adult patient, which finger is the PREFERRED site?

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

Correct answer: Middle or ring finger

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

Question 17: Under HIPAA, a 'minimum necessary' standard means:

Only the bare minimum staff should perform blood draws
Documentation should be kept as brief as possible
Only the least amount of health information needed for the task should be accessed or shared (Correct answer)
Facilities must employ the fewest number of phlebotomists possible

Correct answer: Only the least amount of health information needed for the task should be accessed or shared

The minimum necessary standard requires that access to PHI be limited to what is reasonably needed to accomplish the intended purpose.

Question 18: Which lancet depth is recommended for an adult fingerstick to ensure adequate blood collection without causing undue pain?

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

Correct answer: 1.5–2.0 mm

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

Question 19: According to ASCP standards, the maximum time a tourniquet should remain applied before venipuncture is performed is:

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

Correct answer: 1 minute

Tourniquet application should not exceed 1 minute to prevent hemoconcentration and erroneous lab results.

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

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 21: When using an evacuated tube system, which tube should be filled LAST to avoid carryover contamination?

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

Correct answer: Lavender EDTA

EDTA in the lavender tube can contaminate other tubes and is drawn last among additive tubes to protect coagulation and chemistry results.

Question 22: What is the primary function of thrombin as a tube additive?

Prevents platelet clumping by chelating calcium
Inhibits glycolysis to stabilize glucose
Rapidly accelerates clot formation for fast serum turnaround (Correct answer)
Acts as a preservative for red blood cell antigens

Correct answer: Rapidly accelerates clot formation for fast serum turnaround

Thrombin-containing tubes (often clear or white top) rapidly clot blood within about 5 minutes, producing serum quickly for stat testing.

Question 23: Which specimen type is MOST sensitive to temperature fluctuations and must be processed within 30 minutes without exception?

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

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

Fill out an incident report.
Report the incident to a supervisor.
Wash the wound with soap and water. (Correct answer)
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 25: Which condition is a contraindication to using the antecubital vein on the same side as a mastectomy?

Anemia
Dehydration
Thrombocytopenia
Lymphedema risk (Correct answer)

Correct answer: Lymphedema risk

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

Question 26: In capillary puncture, the lancet should be positioned perpendicular to the fingerprint lines. Why?

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

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

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

Question 27: A phlebotomist notices the needle bevel is facing downward during insertion. What problem will likely occur?

Air bubbles in the tube
Hemolysis of the sample
Failure to enter the vein or poor blood flow (Correct answer)
Petechiae at the site

Correct answer: Failure to enter the vein or poor blood flow

The bevel must face upward to allow smooth entry into the vein; a downward bevel causes the needle tip to press against the vein wall, impeding flow.

Question 28: What is the primary reason sodium fluoride (gray-top) tubes are used for glucose testing?

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

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

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

Question 29: When a blood culture is ordered, the skin must be disinfected with 70% isopropyl alcohol followed by which agent to achieve the highest level of antisepsis?

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

Correct answer: Povidone-iodine or chlorhexidine gluconate

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

Question 30: A specimen tube that should be kept on ice during transport is a(n):

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

Correct answer: Arterial blood gas (ABG) syringe

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

Question 31: Which plasma protein is essential for maintaining oncotic pressure and transporting substances in the blood?

Prothrombin
Albumin (Correct answer)
Fibrinogen
Globulin

Correct answer: Albumin

Albumin is the most abundant plasma protein and is critical for maintaining osmotic pressure and transporting hormones, fatty acids, and drugs.

Question 32: A heelstick is performed on a 3-day-old full-term newborn. Which of the following actions is INCORRECT?

Collecting the specimen in the medial plantar area
Using a blade depth no greater than 2.0 mm
Warming the heel for 3–5 minutes before puncture
Puncturing the posterior curve (back) of the heel (Correct answer)

Correct answer: Puncturing the posterior curve (back) of the heel

The posterior curve of the heel is an unacceptable site because the calcaneus is very close to the skin surface there, posing a high risk of bone puncture and osteomyelitis.

Question 33: Which ASCP-recognized principle requires that patient laboratory results be shared only with authorized healthcare personnel?

Informed consent
HIPAA confidentiality (Correct answer)
Chain of custody
Standard precautions

Correct answer: HIPAA confidentiality

HIPAA (Health Insurance Portability and Accountability Act) protects patient health information and restricts unauthorized disclosure.

Question 34: For a rapid strep test performed at the point of care, a negative result in a symptomatic patient should typically be followed by:

Throat culture to confirm the negative result (Correct answer)
Immediate antibiotic prescription
Repeating the rapid strep test on a second swab
No further testing—a negative result rules out strep

Correct answer: Throat culture to confirm the negative result

Rapid strep tests have lower sensitivity than cultures; a negative result in a symptomatic patient should be confirmed by throat culture.

Question 35: Which vein is considered the FIRST choice for routine venipuncture in most patients?

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

Correct answer: Median cubital vein

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

Question 36: A laboratory QA review finds that the specimen rejection rate for hemolysis has increased from 2% to 8% over the past month. The FIRST step in the quality improvement process is to:

Report the increase to the medical director and close the investigation
Investigate the root cause by analyzing rejection data by phlebotomist, time of day, and patient unit (Correct answer)
Immediately retrain all phlebotomists on hemolysis prevention
Accept the new rate as reflective of sicker patients in the hospital

Correct answer: Investigate the root cause by analyzing rejection data by phlebotomist, time of day, and patient unit

Root cause analysis must precede intervention—the rejection rate data must be stratified to identify where and why the increase is occurring before choosing the appropriate corrective action.

Question 37: What is the purpose of the separator gel found in SST (serum separator) tubes?

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

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

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

Question 38: 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?

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

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

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

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

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

Correct answer: Airborne precautions

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

Question 41: What is the primary purpose of the Exposure Control Plan mandated by OSHA's Bloodborne Pathogens Standard?

To document all patients' infectious disease status
To schedule annual hepatitis B vaccinations
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 42: Which condition causes a specimen to appear lipemic, and how does it affect test results?

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

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

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

Question 43: Which OSHA standard specifically mandates the use of engineered sharps injury protections and a sharps injury log in healthcare settings?

OSHA Respiratory Protection Standard
OSHA Personal Protective Equipment Standard
OSHA Hazard Communication Standard (HazCom)
OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030) (Correct answer)

Correct answer: OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030)

The OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030) requires exposure control plans, engineering controls, PPE, and maintenance of a sharps injury log.

Question 44: A requisition slip lists a 'STAT' order. In a clinical laboratory context, STAT means:

Scheduled for the next routine run
Standard turnaround time
Send to tertiary analysis testing
Immediate processing — results needed urgently (Correct answer)

Correct answer: Immediate processing — results needed urgently

STAT (from Latin statim) signals that the specimen must be collected and results returned as quickly as possible.

Question 45: What is the AMT's primary credential for phlebotomists?

PBT(ASCP)
CPT
RPT (Correct answer)
RMA

Correct answer: RPT

The AMT awards the Registered Phlebotomy Technician (RPT) credential to qualified phlebotomists.

Question 46: When drawing blood from a pediatric patient, which communication approach is most appropriate?

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

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

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

Question 47: What is the recommended angle of needle insertion for routine adult venipuncture?

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

Correct answer: 15–30 degrees

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

Question 48: Why must lithium heparin tubes NOT be used for lithium level tests?

The additive lithium will falsely elevate the patient's lithium result (Correct answer)
Lithium levels require serum, not plasma
Heparin destroys lithium ions
Heparin causes lithium to precipitate

Correct answer: The additive lithium will falsely elevate the patient's lithium result

The lithium in lithium heparin additive would be added to the patient's own lithium, causing a falsely elevated serum lithium measurement.

Question 49: What is the primary purpose of the Association of Phlebotomy Technicians (APT)?

To provide hospital accreditation services
To advocate for nurses in clinical settings
To regulate medical laboratories
To support and certify phlebotomy professionals (Correct answer)

Correct answer: To support and certify phlebotomy professionals

The primary purpose of the Association of Phlebotomy Technicians (APT) is to support and certify phlebotomy professionals. It aims to elevate the standards of phlebotomy practice through education, credentialing, and advocacy. This ensures that phlebotomists are well-trained and competent in their critical role in healthcare.

Question 50: What is a significant benefit of earning the NHA CPT certification?

Eligibility for management positions in laboratories
Increased job opportunities in phlebotomy (Correct answer)
Exemption from state licensure requirements
Automatic renewal of certification every two years

Correct answer: Increased job opportunities in phlebotomy

Earning the NHA CPT certification validates a phlebotomist's skills and knowledge, making them more attractive to potential employers. Many healthcare facilities prefer or require certified phlebotomists, thus increasing job opportunities for those holding the credential. It demonstrates a commitment to professional standards and competency in the field, opening more doors for employment.

Question 51: During a capillary puncture on an adult, which site is preferred?

Lateral aspect of the fingertip (Correct answer)
Fingertip center
Earlobe
Medial aspect of the heel

Correct answer: Lateral aspect of the fingertip

The lateral (side) aspect of the fingertip is preferred because it is less sensitive and has a better capillary bed than the center, which has dense nerve endings.

Question 52: What is the primary purpose of labeling blood collection tubes at the bedside immediately after collection?

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

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 53: According to CLSI standards, which two patient identifiers must be used before performing a blood draw?

Floor number and diagnosis
Physician name and insurance ID
Full name and date of birth (or medical record number) (Correct answer)
Room number and date of birth

Correct answer: Full name and date of birth (or medical record number)

CLSI and TJC require at least two patient identifiers — most commonly full name and date of birth or medical record number — before any specimen collection.

Question 54: Which minimum information must be on a properly labeled blood specimen tube?

Nurse name and tube color
Patient name, date of birth, and collection date/time (Correct answer)
Room number and diagnosis
Physician name and insurance number

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

At minimum, a specimen label must include the patient's full name, date of birth (or medical record number), and the date and time of collection to ensure traceability.

Question 55: After removing the needle from the patient's arm, what is the correct immediate post-venipuncture instruction for the patient?

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

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

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

Question 56: When performing a venipuncture, the bevel of the needle should be positioned:

Facing sideways at a 90° angle
Facing up (bevel up) at a 15–30° angle (Correct answer)
Facing down (bevel down) at a 45° angle
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 57: 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:

1,350 defects per million
3.4 defects per million (Correct answer)
6,000 defects per million
66,800 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 58: Light-sensitive specimens such as bilirubin or vitamin B12 should be:

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

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

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

Question 59: For an ABG specimen, which anticoagulant is used in the collection syringe?

Sodium citrate
Sodium fluoride
Heparin (liquid or lyophilized) (Correct answer)
EDTA (ethylenediaminetetraacetic acid)

Correct answer: Heparin (liquid or lyophilized)

Heparin (as liquid sodium heparin or dry/lyophilized heparin) is the anticoagulant used in ABG syringes because it does not affect blood gas values when used in proper amounts.

Question 60: 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 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)
The tube will not clot properly for the CBC

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 61: Ethical non-maleficence in phlebotomy practice means:

Avoiding actions that cause unnecessary harm to the patient (Correct answer)
Maximizing the number of draws performed per shift
Following only institutional rules regardless of patient impact
Treating all patients equally under the law

Correct answer: Avoiding actions that cause unnecessary harm to the patient

Non-maleficence obligates healthcare workers to avoid causing harm, including unnecessary pain or risk during procedures.

Question 62: What is the primary purpose of a syringe blood transfer device (blood transfer device)?

To mix the blood with tube additives by inversion
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)
To measure the exact volume of blood collected in the syringe

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 63: Which of the following is an example of an engineering control used to prevent needlestick injuries in phlebotomy?

Wearing double gloves
Using a self-sheathing safety needle (Correct answer)
Performing hand hygiene after every collection
Placing biohazard labels on specimen bags

Correct answer: Using a self-sheathing safety needle

A self-sheathing safety needle is an engineering control—a device designed to isolate or remove the hazard from the worker.

Question 64: Which of the following is considered a 'reservoir' in the chain of infection?

A susceptible host
An infected patient's bloodstream (Correct answer)
A needle used for venipuncture
The phlebotomist's ungloved hands

Correct answer: An infected patient's bloodstream

A reservoir is the habitat where a pathogen lives and multiplies; an infected patient's bloodstream serves as a reservoir for blood-borne pathogens.

Question 65: During a blood draw, gloves become visibly contaminated with blood. What is the appropriate action?

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

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 66: In a 2-bottle blood culture set, which bottle should be inoculated first when using a winged blood collection set (butterfly needle)?

Aerobic bottle first (Correct answer)
The bottle with the smaller volume requirement first
Anaerobic bottle first
Either bottle; order does not matter

Correct answer: Aerobic bottle first

When using a butterfly set, the tubing contains air; inoculating the aerobic bottle first prevents that air from entering the anaerobic bottle.

Question 67: Which laboratory test requires the specimen to be kept warm (37°C) during transport to the laboratory?

Cold agglutinin titer (Correct answer)
Basic metabolic panel (BMP)
Prothrombin time (PT)
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 68: A laboratory is investigating a systematic positive bias in sodium results compared to proficiency testing. Which of the following is MOST likely to be the cause?

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

Correct answer: Calibrator drift or incorrect calibration assignment

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

Question 69: What organization accredits phlebotomy training programs recognized by the ASCP Board of Certification?

CAP
CLIA
JCAHO
NAACLS (Correct answer)

Correct answer: NAACLS

NAACLS (National Accrediting Agency for Clinical Laboratory Sciences) accredits programs accepted by ASCP BOC.

Question 70: Which of the following is an absolute contraindication for a fingerstick on a specific finger?

Dominant hand fingers
Cold fingers
Fingers with edema or poor circulation (Correct answer)
Fingers with nail polish

Correct answer: Fingers with edema or poor circulation

Fingers with edema have excess interstitial fluid that will dilute the blood sample, and poor circulation means inadequate blood flow for collection—both are contraindications.

Question 71: If a phlebotomist's eye is splashed with blood, which action should be taken immediately?

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

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

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

Question 72: A sharps container is three-quarters full. What is the correct action?

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

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

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

Question 73: What does a haemolysed sample look like, and what is a common cause?

Cloudy white; caused by high lipid content
Yellow-green; caused by bilirubin contamination
Pink or red serum/plasma; caused by red cell destruction (Correct answer)
Dark brown; caused by oxidation of hemoglobin

Correct answer: Pink or red serum/plasma; caused by red cell destruction

Hemolysis causes red blood cells to rupture, releasing hemoglobin and turning serum/plasma pink to red.

Question 74: What is the maximum time a tourniquet should remain on a patient's arm before venipuncture?

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

Correct answer: 1 minute

Tourniquets should not remain in place longer than 1 minute to avoid hemoconcentration and altered laboratory values.

Question 75: A phlebotomist is preparing for a routine venipuncture on an adult patient. Which of the following is the most critical first step in this procedure?

Positively identifying the patient (Correct answer)
Palpating for a suitable vein
Applying the tourniquet
Selecting the appropriate gauge needle

Correct answer: Positively identifying the patient

The most critical initial step in any patient procedure, including venipuncture, is to ensure the correct patient is being treated. The Joint Commission mandates using at least two patient identifiers to prevent errors. All other steps follow after the patient's identity has been confirmed.

Question 76: Why must blood culture tubes be drawn first in the order of draw?

To allow the anticoagulant in the culture media to work immediately.
To prevent contamination of the culture with skin flora.
To ensure the tube's vacuum is at its strongest.
To prevent contamination of the culture with additives from other tubes. (Correct answer)

Correct answer: To prevent contamination of the culture with additives from other tubes.

Blood culture tubes are drawn first to maintain the sterility of the sample and prevent contamination from additives in other tubes, which could inhibit bacterial growth and lead to false-negative results. While proper site cleaning is crucial to prevent skin flora contamination, the order of draw specifically addresses cross-contamination from other tubes.

Question 77: The 'rule of four' regarding pre-analytical errors states that approximately how many laboratory errors occur in the pre-analytical phase?

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

Correct answer: 60–70% of all errors

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

Question 78: A phlebotomist notices a pediatric patient's arm has an IV infusion running. Where should blood be drawn?

From the IV line itself by stopping the infusion briefly
From the same arm, above the IV site
From the opposite arm or below the IV site in the same arm only as a last resort (Correct answer)
It doesn't matter—IV infusion doesn't affect blood test results

Correct answer: From the opposite arm or below the IV site in the same arm only as a last resort

Drawing from the opposite arm avoids IV fluid dilution of the specimen; if only one arm is available, draw below the IV site with the infusion stopped for 2 minutes.

Question 79: A phlebotomist accidentally sustains a needlestick injury. What is the FIRST action to take?

Apply a tourniquet above the injury site
Squeeze the wound to expel as much blood as possible
Wash the wound thoroughly with soap and water (Correct answer)
Immediately report to a supervisor without treating the wound

Correct answer: Wash the wound thoroughly with soap and water

Immediate washing with soap and water is the first and most important step in reducing infection risk after a needlestick.

Question 80: What is the recommended alcohol drying time before performing venipuncture?

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

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 81: 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?

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

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

Petechiae
Hematoma
Phlebitis
Vein collapse (Correct answer)

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

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

Correct answer: Protect the tube from light.

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

Question 84: When a laboratory documents QC results, which of the following is the MINIMUM information that must be recorded?

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

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

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

Question 85: To break the chain of infection, what is the single most effective means of preventing the spread of pathogens?

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

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 86: Normal arterial blood gas values at sea level breathing room air include which of the following pH ranges?

7.45–7.55
7.35–7.45 (Correct answer)
7.25–7.35
7.30–7.40

Correct answer: 7.35–7.45

Normal arterial pH is 7.35–7.45; values below this range indicate acidosis and above indicate alkalosis.

Question 87: What is the purpose of a biohazard label on a specimen bag?

To identify the ordering physician
To indicate the specimen requires refrigeration
To indicate the specimen is for STAT processing
To warn handlers that the contents may contain infectious material (Correct answer)

Correct answer: To warn handlers that the contents may contain infectious material

Biohazard labels warn all personnel who handle the bag that the contents may be infectious and that PPE should be used.

Question 88: Which venipuncture complication involves blood leaking into surrounding tissue during or after a draw?

Hemolysis
Hematoma (Correct answer)
Syncope
Petechiae

Correct answer: Hematoma

A hematoma occurs when blood leaks from the vein into surrounding tissue, causing a visible bruise or swelling.

Question 89: After implementing corrective action for a QC failure, what step is REQUIRED before releasing patient results?

Release results for specimens collected before the QC failure only
Run QC again to confirm the corrective action resolved the problem before releasing results (Correct answer)
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 90: Which evacuated tube color contains EDTA as its anticoagulant and is most commonly used for CBC testing?

Light blue
Lavender/purple (Correct answer)
Green
Red

Correct answer: Lavender/purple

Lavender/purple top tubes contain EDTA, which chelates calcium to prevent clotting and is the additive of choice for hematology tests like CBCs.

Question 91: Which anatomical structure runs parallel and medial to the median cubital vein and must be avoided during antecubital venipuncture?

Brachial artery (Correct answer)
Median nerve at the wrist
Radial nerve
Ulnar artery

Correct answer: Brachial artery

The brachial artery runs medial to the antecubital fossa; accidental arterial puncture causes pulsatile bright red blood, hematoma, and pain—it must be avoided.

Question 92: If a phlebotomist accidentally draws a lavender tube before the light blue tube, what should be done?

Invert the light blue tube 10 extra times to correct for contamination
Send the light blue tube anyway and note the error on the requisition
Relabel the tubes and send them both to the lab
Discard both tubes and collect a fresh light blue tube with a new venipuncture (Correct answer)

Correct answer: Discard both tubes and collect a fresh light blue tube with a new venipuncture

EDTA contamination from the lavender tube invalidates the coagulation sample; both tubes should be discarded and recollected in the correct order.

Question 93: When a requisition shows 'QNS,' what does this mean and what action is taken?

Quantity not sufficient — the specimen volume is inadequate and the test cannot be performed; recollection is required (Correct answer)
Quality not satisfactory — the specimen is hemolyzed and must be retested
Quick notification sent — results are telephoned to the provider
Queue not started — the specimen is pending centrifugation

Correct answer: Quantity not sufficient — the specimen volume is inadequate and the test cannot be performed; recollection is required

QNS (quantity not sufficient) means there is not enough specimen to run the requested test, requiring a new collection from the patient.

Question 94: Which of the following patient conditions requires special identification verification procedures per NCCT standards?

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

Correct answer: Unconscious or sedated patients

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

Question 95: A serum specimen appears hemolyzed. Which analyte result is MOST likely to be falsely elevated?

Potassium (Correct answer)
Glucose
Sodium
Calcium

Correct answer: Potassium

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

Question 96: Which sharps disposal container characteristic is required under OSHA's Bloodborne Pathogens Standard?

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

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 97: What gauge needle is most commonly used with a butterfly (winged infusion) set for small or fragile hand veins?

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

Correct answer: 23 gauge

A 23-gauge butterfly needle is preferred for small, fragile, or difficult veins such as hand veins because its smaller diameter causes less trauma to delicate vessels.

Question 98: After centrifugation, a serum specimen should ideally be transferred off the clot within:

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

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 99: A phlebotomist selects a vein in the antecubital fossa but cannot see it—only palpate it. The correct approach is to:

Request a nurse perform the draw since it cannot be visualized
Palpate carefully to confirm vein location, depth, and direction, then proceed with the draw (Correct answer)
Apply the tourniquet and wait 5 minutes for the vein to become visible
Avoid using any vein that cannot be seen; only draw from visible veins

Correct answer: Palpate carefully to confirm vein location, depth, and direction, then proceed with the draw

Palpation is an essential venipuncture skill; a vein that is palpable but not visible can be safely accessed by an experienced phlebotomist using tactile guidance.

Question 100: A phlebotomist observes petechiae on a child's arm after applying a tourniquet. This finding suggests:

Normal tourniquet-related skin color change
The tourniquet was applied correctly and hemostasis is good
The child has an allergy to latex
Possible thrombocytopenia (low platelet count) or capillary fragility (Correct answer)

Correct answer: Possible thrombocytopenia (low platelet count) or capillary fragility

Petechiae (tiny red/purple pinpoint hemorrhages) appearing under a tourniquet indicate thrombocytopenia or capillary fragility—this is a clinically significant unexpected finding.

Question 101: When accessioning a specimen, which piece of information is MOST critical to verify first?

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

Correct answer: Patient identifiers matching the label and requisition

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

Question 102: What angle of needle insertion is recommended for radial artery puncture for ABG collection?

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

Correct answer: 45–60 degrees

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

Question 103: 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 104: According to OSHA and CDC guidelines, a sharps container should be sealed and disposed of when it is how full?

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

Correct answer: 3/4 full

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

Question 105: When is a phlebotomist required to recertify their PBT(ASCP) credential?

Every 3 years
Every 5 years (Correct answer)
Every 2 years
Every 10 years

Correct answer: Every 5 years

ASCP requires renewal of the PBT credential every 5 years through continuing education or re-examination.

Question 106: Which of the following is a critical step in preparing a thick blood smear for malaria diagnosis?

Creating a feathered edge by pushing a spreader slide rapidly and smoothly
Using the corner of a clean slide to spread the blood into a dime-sized circle (Correct answer)
Ensuring the smear is thick enough to obscure newsprint placed underneath it
Fixing the smear with methanol before it air dries

Correct answer: Using the corner of a clean slide to spread the blood into a dime-sized circle

For a thick smear, a large drop of blood is spread in a circular motion to create a smear about the size of a dime. This technique concentrates the parasites, making them easier to find. Unlike thin smears, thick smears are not fixed with methanol, as this would prevent the red blood cells from lysing, which is necessary for proper examination.

Question 107: Warming the fingertip or heel before a capillary puncture primarily serves to:

Sterilize the skin surface
Increase local blood flow (arterialization) for adequate sample collection (Correct answer)
Reduce patient pain during puncture
Prevent the sample from clotting in the tube

Correct answer: Increase local blood flow (arterialization) for adequate sample collection

Warming vasodilates local capillaries and increases blood flow up to 7-fold, making sample collection easier and improving the quality of arterialized capillary blood.

Question 108: When labeling a blood specimen tube, which piece of information is NOT typically required on the tube label?

Patient's insurance information (Correct answer)
Date and time of collection
Phlebotomist's initials or ID
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 109: A patient with MRSA is placed on contact precautions. Which PPE is minimally required when entering the room to perform a blood draw?

Gown and gloves (Correct answer)
N95 respirator and gloves
Eye protection and gloves only
Surgical mask 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 110: Which cellular component of blood is primarily responsible for oxygen transport?

Leukocytes
Monocytes
Erythrocytes (Correct answer)
Platelets

Correct answer: Erythrocytes

Erythrocytes (red blood cells) contain hemoglobin, which binds and transports oxygen from the lungs to tissues throughout the body.

Question 111: A phlebotomist notices a centrifuged SST tube has a very thin serum layer. This is MOST consistent with:

Lipemia causing density changes
Specimen was spun at too high a speed
Diluted specimen from excessive saline flush
Polycythemia (elevated hematocrit) (Correct answer)

Correct answer: Polycythemia (elevated hematocrit)

Polycythemia results in a higher proportion of red blood cells relative to plasma, producing a thin serum layer after centrifugation of a clotted specimen.

Question 112: What gauge needle is typically used for whole blood donation collection to allow rapid collection of the required volume?

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

Correct answer: 16 gauge

Blood donation uses a 16-gauge needle to allow approximately 450–500 mL of blood to be collected efficiently within the required timeframe without excessive hemolysis.

Question 113: Turnaround time (TAT) monitoring is classified as which type of quality indicator?

Pre-analytical quality indicator
Analytical quality indicator
Post-analytical quality indicator
Process quality indicator covering all phases (Correct answer)

Correct answer: Process quality indicator covering all phases

TAT spans all phases—from order to specimen collection (pre-analytical), analysis (analytical), and result reporting (post-analytical)—making it a comprehensive process quality indicator.

Question 114: A phlebotomist is preparing to draw blood from a 5-year-old child. Which communication strategy is MOST effective?

Ask the parent to leave so the child focuses on the phlebotomist
Tell the child exactly what will hurt and for how long in clinical terms
Do not explain anything to avoid increasing anxiety
Use age-appropriate language, explain what they will feel, and allow them control (e.g., which arm) (Correct answer)

Correct answer: Use age-appropriate language, explain what they will feel, and allow them control (e.g., which arm)

Age-appropriate, honest explanation combined with giving the child choices reduces anxiety and improves cooperation during pediatric blood collection.

Question 115: What is the primary reason that EDTA tubes are collected FIRST in the capillary order of draw?

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

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

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

Question 116: Which hepatitis virus is primarily transmitted through the fecal-oral route and poses the least occupational risk to phlebotomists?

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

Correct answer: Hepatitis A

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

Question 117: What is the purpose of a 'delta check' in laboratory quality assurance?

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

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

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

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 119: What precaution must be taken when drawing blood from a patient receiving thrombolytic therapy (e.g., tPA)?

Avoid all venipuncture for 24 hours after therapy
Use a 16-gauge needle to ensure rapid collection
Apply prolonged firm pressure after venipuncture to prevent hematoma (Correct answer)
Use only capillary collection methods

Correct answer: Apply prolonged firm pressure after venipuncture to prevent hematoma

Thrombolytics impair normal clotting, so extended manual pressure (5–10 minutes or longer) is required at the puncture site to achieve hemostasis.

Question 120: When is it acceptable for a phlebotomist to draw blood from a site with an IV line running?

Never — IV sites are always off-limits
Whenever veins in the other arm are inaccessible
Only if the IV fluid is normal saline
Only with physician authorization and below the IV site after stopping the infusion for at least 2 minutes (Correct answer)

Correct answer: Only with physician authorization and below the IV site after stopping the infusion for at least 2 minutes

If no alternative site exists, blood may be drawn from the arm with an IV only with physician order, distal to the IV site, after stopping the infusion for 2 minutes and discarding the first 5 mL.

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

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

120

Questions

120 min

Time Limit

70%

To Pass

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