20 free NHA Phlebotomy Technician (CPT) practice questions

Correct answer: B · Wash the site with soap and water, then report the exposure right away

CDC's NIOSH guidance says to wash needlestick punctures with soap and water, report the incident to a supervisor, and seek medical care immediately to assess the exposure. The 2001 U.S. Public Health Service exposure guidelines add that no evidence shows squeezing the wound reduces transmission risk, and that caustic agents such as bleach are not recommended. A bandage and a full draw list delay the evaluation and any follow-up the exposure needs. An alcohol wipe is not harmful in itself, since antiseptics are not contraindicated, but waiting until the end of the shift to report is the error. The facility's exposure control plan, required by OSHA's Bloodborne Pathogens Standard, sets the local reporting steps.

Look for this next time: After a needlestick, wash with soap and water and report it at once so post-exposure evaluation can start promptly.

Correct answer: C · Engage the shield and drop needle and holder into the container together

OSHA's Bloodborne Pathogens Standard, 29 CFR 1910.1030(d)(2)(vii), says contaminated needles shall not be bent, recapped, or removed unless no alternative is feasible or a specific procedure requires it, and then only with a mechanical device or a one-handed technique. It also bans shearing or breaking them, and (d)(4)(iii) requires contaminated sharps to be discarded immediately or as soon as feasible in a closable, puncture-resistant container. With a safety device and a container in reach, there is a feasible alternative, so the needle stays on the holder and both go in together. Unscrewing the needle removes it from the holder. One-handed recapping is reserved for situations without an alternative. Bending a contaminated needle is prohibited.

Look for this next time: Engage the safety device and discard needle and holder as one unit; OSHA bars bending, recapping, or removing needles when an alternative exists.

Correct answer: A · At least a fit-tested N95 respirator

CDC's 2005 guidelines for preventing transmission of tuberculosis in health-care settings state that all health care workers who enter an airborne infection isolation room should wear at least N95 disposable respirators, and they build fit testing into the respiratory protection program. A surgical mask is used on a coughing patient to contain droplets, not as the worker's protection against airborne droplet nuclei. A face shield protects against splashes but does not filter inhaled air. A mask on the patient helps during transport or in settings without isolation rooms, but it does not replace the worker's respirator inside the isolation room. The short length of a draw does not change the requirement.

Look for this next time: Before entering an airborne isolation room for suspected infectious TB, put on at least a fit-tested N95 respirator.

Correct answer: D · Decline, because neither of them has a work reason to know

The HIPAA Privacy Rule's minimum necessary standard, 45 CFR 164.502(b), requires reasonable efforts to limit any use or disclosure of protected health information to what the purpose needs, and 45 CFR 164.514(d) ties workforce access to the people who need it to carry out their duties. Curiosity about a public figure is not a job duty, so there is nothing to look up or share. Sharing with one coworker is still an unauthorized disclosure. Having system access is not permission to use it for this purpose. Asking the nurse simply moves the improper request to someone else. The NHA CPT test plan lists HIPAA and patient privacy among its safety and compliance tasks.

Look for this next time: Use or share a patient's information only when your job duties require it; curiosity is never a permitted purpose.

Correct answer: B · Hold patient testing, troubleshoot the cause, and repeat QC

CDC's Ready? Set? Test! booklet for sites with a CLIA Certificate of Waiver says that when controls do not give the expected results, staff should wait until the problem is identified and corrected before reporting patient results. It lists the checks: whether the manufacturer's instructions were followed, outdated reagents, test strips or control materials, improper storage, and switched caps, followed by the manufacturer's troubleshooting steps. After the fix, QC is repeated, and patient testing resumes only if it passes. Flagging results does not make them reliable. One passing level does not cancel a failed level. Changing the acceptable range to match a bad reading falsifies the quality record.

Look for this next time: When waived-test QC fails, stop patient testing until the cause is found and repeat QC passes.

Correct answer: C · Have nursing identify and band the patient per policy before drawing

The Joint Commission's 2026 goals call for at least two patient identifiers (NPSG.01.01.01 for laboratories, NPG.01.01.01 for hospitals) and state that a room number or physical location is not an identifier. The hospital goal also requires specimen containers to be labeled in the patient's presence. With no band, the phlebotomist cannot confirm two identifiers against the requisition, so the patient's nurse must identify the patient and attach a band under the facility's procedure first. The room number and door sign are locations, not identifiers. A name alone is one identifier, and asking a drowsy patient to confirm it is weak. Writing the room number on the tubes repeats the same error on the label.

Look for this next time: Every draw needs at least two patient identifiers; a room number never counts, so the patient must be identified and banded first.

Correct answer: A · Explain the 8-hour fast, then notify the provider or reschedule per policy

NIDDK explains that the fasting plasma glucose test is done after a fast of at least 8 hours, and that fasting means nothing to eat or drink except sips of water. Coffee with sugar and cream ended her fast 90 minutes ago, so a specimen drawn now is not a fasting specimen. The phlebotomist should explain the requirement and follow the lab's procedure, which typically means telling the ordering provider or rescheduling. Labeling it fasting would misreport the conditions of the test. Waiting 30 minutes does not create an 8-hour fast. A sodium fluoride tube slows glycolysis after collection, but it cannot remove sugar the patient has already absorbed. The NHA CPT test plan lists verifying fasting and other testing requirements under task 2K.

Look for this next time: A fasting glucose needs at least 8 hours with nothing but water; report a broken fast instead of labeling the specimen fasting.

Correct answer: A · Use the right arm, with no tourniquet or puncture on the fistula arm

The National Kidney Foundation tells dialysis patients not to let anyone draw blood or place an IV in the access arm unless the dialysis team says it is okay, and not to let anyone put a blood pressure cuff on that arm. A tourniquet squeezes the arm in the same way. The NHA CPT test plan lists the presence of fistulas among special considerations that affect collection (k49). The right arm has good veins, so it is the site to use. Puncturing the fistula itself risks damaging the patient's dialysis access. The left hand is still part of the access arm. Patient preference does not override the rule that protects the access.

Look for this next time: Never draw from, or put a tourniquet on, a dialysis access arm unless the dialysis team approves; use the other arm.

Correct answer: D · Not draw, tell his nurse or provider promptly, and document the refusal

The CMS hospital Conditions of Participation, 42 CFR 482.13(b)(2), state that a patient's rights include being able to request or refuse treatment. A competent adult who has heard the reason for the test may decline it, and drawing anyway would mean collecting without consent. Because the test is STAT, the refusal must reach the nurse or ordering provider promptly so they can talk with the patient, and it is documented according to policy. A family member cannot override the decision of a patient who can make his own choices. Telling him that STAT orders cannot be refused is false and pressures him. The NHA CPT test plan covers consent under tasks 2F and 2G.

Look for this next time: A competent adult may refuse a draw; do not proceed, and notify the nurse or provider promptly.

Correct answer: A · Light blue, gold, lavender, gray

The order of draw CLSI publishes for its venous collection standard (GP41, 7th edition, 2017, which CLSI replaced in February 2025 with PRE02, 8th edition) runs: blood culture, sodium citrate, serum tubes with or without clot activator or gel, heparin, EDTA, then sodium fluoride/potassium oxalate. That makes the sequence light blue, gold, lavender, gray. CLSI notes that a plastic serum tube with clot activator drawn before the citrate tube can interfere with coagulation testing, which rules out starting with gold. EDTA binds calcium and is a potassium salt, so carryover into a later serum tube can distort chemistry results; both other options put lavender ahead of gold. CLSI states the same order applies to syringe, tube holder, and evacuated tube collections.

Look for this next time: CLSI order: blood cultures, citrate, serum, heparin, EDTA, then fluoride; EDTA never goes before serum or heparin tubes.

Correct answer: B · Release the tourniquet, then withdraw the needle and apply gauze

The WHO guidelines on drawing blood (2010) say to release the tourniquet before withdrawing the needle, and note that many guidelines remove it as soon as blood flow is established and always before it has been on for two minutes. Withdrawing the needle while the tourniquet still compresses the arm keeps pressure in the vein, so blood leaks from the puncture into the tissue, which is how a hematoma starts. Pumping the fist does not make withdrawal under a tourniquet safe. Leaving the tourniquet on during pressure works against the gauze rather than with it. After the needle is out, the safety device is engaged and gentle pressure is applied. The NHA CPT test plan lists tourniquet application and removal steps under tasks 3E and k70.

Look for this next time: Release the tourniquet before withdrawing the needle, and never leave it on for two minutes or more.

Correct answer: C · After the site air-dries completely, about 30 seconds, untouched

The WHO guidelines on drawing blood (2010) say to clean the site with 70% alcohol for 30 seconds and allow it to dry completely, about another 30 seconds. They list failing to let the alcohol or disinfectant dry among the causes of hemolysis, and note that too little contact time increases the risk of contamination. They also say not to touch the cleaned site, and to repeat the disinfection if it is touched. Puncturing through wet alcohol stings and risks a hemolyzed specimen. Blowing or fanning brings breath and air contaminants onto the prepared skin. Blotting with gauze removes the antiseptic before it has had its contact time.

Look for this next time: Let alcohol air-dry completely, about 30 seconds, and do not touch the cleaned site before the puncture.

Correct answer: B · Keep the arm straight and hold steady pressure until bleeding stops

The WHO guidelines on drawing blood (2010) say to apply gentle pressure with clean gauze and ask the patient to hold it with the arm extended and raised, and specifically ask the patient not to bend the arm, because doing so causes a hematoma. Bending the elbow over the gauze is a common habit, but it squeezes the vein unevenly and lets blood seep into the tissue. Rubbing the site disturbs the forming clot. Letting the arm hang raises venous pressure at the puncture, and lifting the gauze after 10 seconds checks too early. The phlebotomist confirms that bleeding has stopped before bandaging. The NHA CPT test plan lists hematoma among the complications to recognize and respond to (task 3L).

Look for this next time: After venipuncture, keep the arm straight with steady pressure; bending the elbow over the gauze promotes a hematoma.

Correct answer: C · Release the tourniquet, withdraw the needle, apply pressure, and get help

Pallor, sweating, and feeling faint are early signs of a vasovagal reaction. In their table of donor reactions, the WHO guidelines on drawing blood (2010) list stopping the collection as the first step for a mild vasovagal reaction, followed by reclining the person, loosening clothing, and monitoring, with a physician called for a severe reaction and the recovery position used if the person loses consciousness. The NHA CPT test plan's task 3K says to discontinue the draw when a patient shows problematic signs and symptoms. Ending the draw safely means tourniquet off, needle out, safety device engaged, and pressure on the site, while keeping her from falling. Finishing the tubes risks a fall with a needle in her arm. An inhalant does not address the risk, and the draw still needs to stop. Walking away leaves her alone and unprotected.

Look for this next time: At the first signs of fainting, stop the draw: tourniquet off, needle out, pressure on, protect the patient from falling, and call for help.

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

The WHO guidelines on drawing blood (2010) recommend heel-pricks for infants from birth to about 6 months and place the lancet on the medial or lateral plantar surface of the heel. In a 3 kg baby, they give the skin-to-bone distance as 3.32 mm at the medial and lateral heel but 2.33 mm at the posterior heel, which should be avoided to reduce the risk of hitting bone; puncturing the calcaneus can lead to osteomyelitis. The toe is even shallower, at 2.19 mm. The arch is not one of the recommended sites. Choosing the correct site, together with a lancet of suitable depth, is what keeps an infant heel stick safe.

Look for this next time: For infant heel sticks, puncture the medial or lateral plantar surface and avoid the back curve of the heel.

Correct answer: C · If she touches the site, repeat the full antisepsis and let it dry

Skin flora is the main source of blood culture contamination, and the WHO guidelines on drawing blood (2010) note that contaminated cultures can lead to unnecessary antibiotics, delayed diagnosis, and longer hospital stays. WHO recommends one application of 2% chlorhexidine gluconate in 70% isopropyl alcohol with at least 30 seconds of skin contact, then letting the area dry completely. The guidelines say not to touch the cleaned site, and to repeat the disinfection if it is touched. Nonsterile gloves can carry organisms back onto the skin. A quick alcohol wipe is not the full preparation, and drawing at once skips the drying time. Blotting with gauze removes antiseptic and recontaminates the site.

Look for this next time: After blood culture skin antisepsis, do not touch the site; if you must, repeat the full preparation and let it dry.

Correct answer: D · Defer him today, because male donors need at least 13.0 g/dL

FDA's donor eligibility rule, 21 CFR 630.10(f)(3), requires male allogeneic donors to have a hemoglobin of at least 13.0 g/dL or a hematocrit of at least 39%. His 12.8 g/dL is below that, so he cannot donate today. The same paragraph says the sample may come from a fingerstick or venipuncture, and that blood obtained from the earlobe is not acceptable, so retesting there to get a higher number is not allowed. The rule's lower alternative standard of 12.0 to 12.5 g/dL applies only to female donors under an FDA-accepted procedure. A smaller unit is not an option the rule provides. Feeling well does not override the minimum, which exists to protect the donor and the product.

Look for this next time: FDA rules require at least 13.0 g/dL hemoglobin for male allogeneic donors, and earlobe samples are not acceptable for the screen.

Correct answer: A · Gray top with sodium fluoride and potassium oxalate

Blood cells keep consuming glucose after collection, so a specimen that sits unseparated for hours can read falsely low. The WHO guidelines on drawing blood (2010) describe the gray-top sodium fluoride/potassium oxalate tube as an antiglycolytic tube used for glucose, which is why it suits a delayed pickup. A red-top tube left whole for hours keeps its cells in contact with the serum, so glycolysis continues. EDTA is the anticoagulant for hematology testing, and refrigeration alone does not make it a glucose preservative. Sodium citrate is the coagulation tube. The NHA CPT test plan lists maintaining specimen integrity for time and temperature under processing task 5B.

Look for this next time: A sodium fluoride (gray-top) tube slows glycolysis, so it protects glucose when separation or delivery will be delayed.

Correct answer: B · The collector seals and dates the bottles, and the employee initials the seals

Under 49 CFR 40.71(b), the collector takes these steps in the presence of the employee: the collector, not the employee, places the tamper-evident seals over the bottle caps and down the sides and writes the date on them, and then the employee initials the seals to certify that the bottles hold the specimen he or she provided. If the employee refuses to initial, the collector notes it in the Remarks line of the custody and control form and completes the collection. Letting the employee seal, sealing out of the employee's sight, or shipping unsealed bottles each breaks the documented chain of custody that makes a forensic result defensible. The NHA CPT test plan lists chain of custody under processing task 5C.

Look for this next time: In a DOT collection, the collector seals and dates the bottles in front of the donor, and the donor initials the seals.

Correct answer: D · Report it to the provider now under the critical-result policy and document it

The Joint Commission's 2026 laboratory goal NPSG.02.03.01 asks that important test results reach the right staff person on time, and the hospital goal NPG.01.02.01 requires written procedures that define critical results, who reports them to whom, and the acceptable time to report. A clinic's own written critical-result procedure applies the same principle. The NHA CPT test plan's task 5G covers recognizing and reporting critical values for point-of-care and CLIA-waived testing. A glucose of 38 mg/dL in a confused patient needs the provider now, so the phlebotomist reports it immediately and documents who was told and when. Waiting for chart review delays care. Repeating three times and averaging is not a reporting procedure and loses time. Sending the patient home with advice is unsafe and outside a phlebotomist's role.

Look for this next time: Report a critical value to the responsible provider immediately under the written procedure, and document who was told and when.