Try 100% Updated Phlebotomy-Technician Exam Questions [2026]
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NEW QUESTION # 54
A phlebotomist should identify which of the following as the best site for phenylketonuria collection on an infant?
- A. Central area of the fingertip
- B. Medial or lateral area of the fingertip
- C. Medial or lateral areas of the heel
- D. Central area of the heel
Answer: C
Explanation:
The best site for phenylketonuria, or PKU, collection on an infant is the medial or lateral plantar surface of the heel. PKU screening is a newborn metabolic screening test commonly collected by heel stick onto filter paper. The medial and lateral heel areas are selected because they provide adequate capillary blood flow while reducing the risk of puncturing bone. The central area of the heel is unsafe because the calcaneus may be closer to the puncture site, increasing the risk of bone injury or osteomyelitis. Fingertip puncture is inappropriate for infants because the tissue is small, bone is close to the surface, and the site does not provide the recommended specimen collection area for newborn screening. Proper PKU collection also requires warming the heel when indicated, allowing blood to flow freely, filling filter-paper circles completely from one side, avoiding layering, and allowing the specimen to dry properly before transport. NHA CPT special collection content includes collecting blood for metabolic syndromes such as PKU, filter-paper collection techniques, pediatric considerations, and minimum/maximum volume requirements. Reference topics: Special Collections; PKU collection; infant heel puncture; filter-paper specimen collection.
NEW QUESTION # 55
Which of the following collection sites is appropriate for a dermal puncture on an infant?
- A. Tip of the index finger
- B. Arch of the foot
- C. Posterior curvature of the heel
- D. Medial or lateral plantar surface of the heel
Answer: D
Explanation:
The appropriate dermal puncture site on an infant is the medial or lateral plantar surface of the heel. These areas reduce the risk of puncturing bone and provide suitable capillary blood flow for neonatal testing. The posterior curvature of the heel should be avoided because the bone may be close to the surface, increasing risk of osteomyelitis or injury. The arch of the foot is not an approved puncture site and may damage nerves, tendons, or deeper structures. The tip of the index finger is inappropriate for infants because there is insufficient tissue depth and greater risk of bone injury. Correct infant dermal puncture also requires using an age-appropriate lancet depth, warming the site if needed, cleaning and drying the skin, wiping away the first drop when required, avoiding excessive squeezing, and collecting specimens in the correct order. Infant blood volume is limited, so collection volume must be minimized. Reference topics: Special Collections; infant heel puncture; dermal puncture sites; neonatal safety; osteomyelitis prevention.
NEW QUESTION # 56
Which of the following tube colors is commonly used for coagulation testing?
- A. Gray
- B. Lavender
- C. Red
- D. Light blue
Answer: D
Explanation:
Light-blue tubes are commonly used for coagulation testing because they contain sodium citrate. Citrate binds calcium reversibly, preventing clotting while preserving the specimen for coagulation analysis such as PT, INR, and aPTT. The tube must be filled to the required level because coagulation testing depends on a precise blood-to-anticoagulant ratio. Underfilling a light-blue tube can falsely prolong clotting results and cause specimen rejection. Lavender tubes contain EDTA and are commonly used for hematology tests such as CBC. Gray tubes often contain sodium fluoride and potassium oxalate and are used for glucose or lactate testing depending on facility protocol. Red tubes are generally serum tubes without anticoagulant or with clot activator depending on manufacturer. The phlebotomist must collect light-blue tubes in the correct order of draw and inspect for proper fill. This is a high-yield NHA-style concept because it combines tube color, additive, test department, and specimen acceptability. Reference topics: Routine Blood Collections; coagulation tubes; sodium citrate; fill volume; order of draw.
NEW QUESTION # 57
Which of the following methods should a phlebotomist use to anchor a vein?
- A. Use the thumb of the free hand above the puncture site.
- B. Use the first two fingers of the nondominant hand above the puncture site.
- C. Use the first two fingers of the nondominant hand below the puncture site.
- D. Use the thumb of the free hand below the puncture site.
Answer: D
Explanation:
The vein is anchored by placing the thumb of the free hand below the intended puncture site and gently pulling the skin taut. This stabilizes the vein, reduces rolling, creates a firmer puncture surface, and supports accurate needle entry. Anchoring above the site is unsafe because it places the phlebotomist's hand in the direction of needle travel and increases needlestick risk. Using two fingers instead of the thumb provides less controlled traction and may interfere with the venipuncture angle or contaminate the prepared site. The phlebotomist should avoid touching the cleansed puncture site after antisepsis unless the site is re-cleansed. Proper anchoring is especially important for superficial or mobile veins because failure to stabilize the vein can cause missed access, hematoma formation, probing, patient discomfort, or specimen collection failure. The NHA CPT outline identifies anchoring the vein below the venipuncture site and knowledge of anchoring techniques as routine venipuncture competencies. Reference topics: Routine Blood Collections; site selection; anchoring below venipuncture site; venous anatomy and safe insertion technique.
NEW QUESTION # 58
A phlebotomist enters a patient's room and finds the patient motionless and cyanotic. Which of the following actions should the phlebotomist take?
- A. Ask the patient if they are okay in a loud voice.
- B. Apply an automated external defibrillator.
- C. Perform the head-tilt/chin-lift maneuver.
- D. Administer three rescue breaths.
Answer: A
Explanation:
The first action is to assess responsiveness by speaking loudly and directly to the patient, such as asking whether they are okay. A motionless, cyanotic patient may be in respiratory or cardiac arrest, but the phlebotomist must follow the emergency response sequence rather than jumping to airway maneuvers, rescue breaths, or AED use before confirming responsiveness and activating help according to facility protocol. The head-tilt/chin-lift maneuver is an airway-opening step, but it follows initial responsiveness assessment and emergency activation. Rescue breaths are not the first step and are performed only within the appropriate CPR sequence and training level. Applying an AED is appropriate when cardiac arrest is suspected and the emergency response process has been initiated, but the first immediate action from the options is responsiveness assessment. NHA CPT safety content includes recognizing emergencies, initiating first aid, responding to codes, and CPR-related guidelines. Reference topics: Safety and Compliance; emergency recognition; CPR sequence; first aid response.
NEW QUESTION # 59
Which of the following is the correct method for cleaning a small blood spill?
- A. Wipe with dry gauze only.
- B. Spray air freshener over the area.
- C. Cover the spill with paper and leave it to dry.
- D. Use an approved disinfectant according to facility policy.
Answer: D
Explanation:
A small blood spill should be cleaned using an approved disinfectant according to facility policy. Blood is treated as potentially infectious, so spill response requires gloves, appropriate PPE, containment, removal of visible material, disinfection with correct contact time, and proper disposal of contaminated materials. Dry gauze alone does not disinfect the surface and can spread contamination. Air freshener has no disinfection role. Covering the spill and leaving it to dry is unsafe because dried blood may still represent a contamination hazard and creates exposure risk for staff and patients. The specific disinfectant may vary by facility, but it must be appropriate for bloodborne pathogens and used as directed. The phlebotomist must also avoid direct hand contact, dispose of materials in designated biohazard waste when required, and perform hand hygiene after glove removal. This question tests standard precautions, environmental safety, and infection-control discipline. Reference topics: Safety and Compliance; blood spill cleanup; disinfectants; standard precautions; biohazard waste.
NEW QUESTION # 60
Which of the following actions should a phlebotomist take if a patient develops a rapidly forming hematoma during venipuncture?
- A. Ask the patient to pump their fist.
- B. Remove the needle and apply pressure.
- C. Insert the needle deeper into the vein.
- D. Continue collecting until all tubes are filled.
Answer: B
Explanation:
If a rapidly forming hematoma develops, the phlebotomist should remove the needle and apply pressure. A hematoma occurs when blood leaks into surrounding tissue, often because the needle has gone through the vein, partially exited the vein, or the vein wall has been injured. Continuing the collection can worsen bleeding, increase pain, and compromise the specimen. Asking the patient to pump their fist increases venous pressure and can worsen leakage or alter some test results. Inserting the needle deeper is unsafe because it may worsen vessel injury or strike nearby structures. The correct response is to release the tourniquet, remove the needle, activate the safety device, apply firm pressure, and monitor the site. A bandage should be applied only after bleeding has stopped. The phlebotomist should document or report the complication according to facility policy and avoid recollecting from the affected site. Reference topics: Routine Blood Collections; hematoma; venipuncture complications; needle removal; post-procedure care.
NEW QUESTION # 61
Which of the following types of consent provides a patient with information about the methods, risks, and consequences of a procedure?
- A. Expressed
- B. Implied
- C. Verbal
- D. Informed
Answer: D
Explanation:
Informed consent means the patient receives enough information to understand the nature of the procedure, including the method, purpose, risks, benefits, alternatives, and possible consequences, before agreeing. Therefore, informed consent is the correct answer. Expressed consent means the patient clearly agrees, either verbally or in writing, but the term does not by itself prove that the patient received a full explanation of risks and consequences. Implied consent occurs through the patient's actions, such as extending an arm for venipuncture after identification and explanation. Verbal consent is simply the spoken form of agreement and may be expressed, but again it does not specifically define the full disclosure requirement. In phlebotomy, routine blood collection often proceeds with implied or expressed consent after proper identification and explanation, but higher-risk or special procedures may require more formal informed consent depending on policy. The NHA CPT outline includes receiving implied, informed, or expressed consent and understanding the components required for consent. Reference topics: Patient Preparation; patient rights; consent types; communication before collection.
NEW QUESTION # 62
A phlebotomist centrifuges a serum specimen before it has fully clotted. Which of the following is most likely to occur?
- A. The specimen volume will increase.
- B. The specimen will become sterile.
- C. Fibrin strands can form in the serum.
- D. The tube additive will be neutralized.
Answer: C
Explanation:
If a serum specimen is centrifuged before it has fully clotted, fibrin strands can form in the serum. These strands can interfere with testing instruments, cause sample aspiration problems, and lead to inaccurate results or specimen rejection. Serum specimens must be allowed to clot for the required time before centrifugation. Centrifugation does not increase specimen volume, neutralize additives, or sterilize blood. Blood specimens remain potentially infectious regardless of processing. This question tests the difference between serum and plasma. Serum is the liquid portion after clotting; plasma is the liquid portion of anticoagulated blood. If the phlebotomist rushes serum processing, the specimen may look separated but still contain fibrin. The correct workflow includes observing required clot time, balancing centrifuge tubes, using the correct speed and duration, and removing specimens promptly after centrifugation when required. Speed is not quality; specimen integrity is quality. Reference topics: Processing Specimens; clotting time; serum processing; centrifugation; fibrin formation.
NEW QUESTION # 63
A phlebotomist notices that a serum separator tube has not clotted before centrifugation. Which of the following actions should the phlebotomist take?
- A. Allow the tube to clot completely before centrifuging.
- B. Shake the tube vigorously to accelerate clotting.
- C. Transfer the specimen into a plasma tube.
- D. Centrifuge the tube immediately.
Answer: A
Explanation:
The phlebotomist should allow the serum separator tube to clot completely before centrifugation. Serum specimens require clot formation before centrifugation so the liquid serum can separate properly from the clot. Centrifuging before clotting is complete can cause fibrin strands, incomplete separation, instrument issues, and possible specimen rejection. Shaking the tube vigorously is incorrect because it can hemolyze the specimen and disrupt cellular integrity. Transferring the specimen into a plasma tube is unsafe and invalid because the specimen was not collected with the correct anticoagulant at the correct blood-to-additive ratio. Proper processing means respecting the requirements of the tube collected: serum tubes must clot for the required time, additive tubes must be gently inverted, and specimens must be centrifuged according to time, speed, and temperature requirements. This item tests processing discipline, not speed. A phlebotomist must protect specimen integrity from collection through transport and processing. Reference topics: Processing Specimens; serum separation; clotting time; centrifugation; specimen rejection.
NEW QUESTION # 64
A phlebotomist is collecting a blood culture from a 6-month-old infant who has no known allergies. Which of the following disinfectants should the phlebotomist use?
- A. Sodium polyanethol sulfonate
- B. Hydrogen peroxide
- C. Chlorhexidine gluconate
- D. Sodium hypochlorite
Answer: C
Explanation:
Chlorhexidine gluconate is the best answer for blood culture skin antisepsis in this 6-month-old infant with no known allergies. Blood cultures require stricter skin disinfection than routine venipuncture because contamination can produce false-positive culture results, unnecessary antibiotics, repeat testing, and delayed diagnosis. Sodium polyanethol sulfonate is not a skin disinfectant; it is an anticoagulant/additive used in blood culture media to support organism recovery. Sodium hypochlorite is a bleach-type disinfectant used for environmental decontamination, not patient skin preparation for venipuncture. Hydrogen peroxide is not the standard blood culture skin antiseptic. Chlorhexidine is widely used for effective skin antisepsis, and CDC guidance recognizes chlorhexidine-containing agents in healthcare infection-control contexts when age, skin maturity, and clinical risk are considered. For collection technique, the phlebotomist should cleanse the site properly, allow the antiseptic to dry, avoid repalpating unless sterile technique is used, collect adequate volume, and label/document accurately. Reference topics: Special Collections; blood culture collection; pediatric skin preparation; contamination prevention.
NEW QUESTION # 65
Which of the following specimens should be collected before antibiotics are administered when ordered for suspected bloodstream infection?
- A. Hemoglobin A1c
- B. Lipid panel
- C. Electrolyte panel
- D. Blood culture
Answer: D
Explanation:
Blood cultures should be collected before antibiotics are administered when ordered for suspected bloodstream infection. Antibiotics can reduce or inhibit microbial growth in the specimen, potentially producing false-negative results. Blood cultures are used to detect bacteria or fungi in the bloodstream and require careful timing, strict antisepsis, adequate volume, and correct bottle handling. A lipid panel, hemoglobin A1c, and electrolyte panel do not depend on organism recovery and are not the priority before antibiotic therapy in this context. The phlebotomist must follow facility policy for collection order, number of sets, collection sites, bottle order, skin preparation, and documentation. If antibiotics have already been started, the phlebotomist should not cancel the test independently; they should collect according to order and document or communicate relevant timing if required. Blood culture contamination is a serious quality problem, but delayed collection after antibiotic administration can also reduce diagnostic value. Reference topics: Special Collections; blood cultures; timing before antibiotics; bloodstream infection; aseptic technique.
NEW QUESTION # 66
Which of the following specimens should a phlebotomist protect from light immediately after collection?
- A. Hemoglobin A1c
- B. Bilirubin
- C. Sodium
- D. Blood urea nitrogen
Answer: B
Explanation:
Bilirubin specimens should be protected from light immediately after collection because bilirubin is photosensitive. Exposure to light can degrade bilirubin and produce falsely decreased results. The phlebotomist should follow facility procedure, which may include wrapping the tube in foil or using an amber transport container. Blood urea nitrogen is not classically light-sensitive; it is generally handled as a routine chemistry analyte unless special facility requirements apply. Sodium testing does not require light protection. Hemoglobin A1c reflects long-term glycemic exposure through glycated hemoglobin and is not light-sensitive in the same way bilirubin is. The broader technical principle is that specimen handling requirements are test-specific. Some specimens require chilling, some must remain warm, some require rapid transport, some must avoid light, and some require timed collection. Failure to follow these requirements creates preanalytical error even when the venipuncture itself was performed correctly. Reference topics: Special Collections; Processing Specimens; light-sensitive specimens; bilirubin handling; specimen integrity.
NEW QUESTION # 67
Which of the following can cause a preanalytic error for serum bilirubin?
- A. Population
- B. Pollutants
- C. Light
- D. Location
Answer: C
Explanation:
Light exposure can cause a preanalytic error for serum bilirubin because bilirubin is light-sensitive. If a bilirubin specimen is exposed to light for too long, photodegradation can occur, leading to falsely decreased bilirubin results. This is why bilirubin specimens are commonly protected from light by using an amber container or wrapping the specimen in foil according to facility procedure. "Population" is not a specimen-handling variable that directly causes bilirubin degradation. "Pollutants" is too vague and does not identify the specific preanalytical issue tested here. "Location" may matter for collection site selection in some contexts, but it is not the classic handling error for bilirubin. The phlebotomist must know which specimens require special handling for light, temperature, time, transport, and processing. Failure to protect light-sensitive analytes can compromise specimen integrity before testing even begins, producing inaccurate laboratory results despite correct venipuncture technique. The NHA CPT outline directly includes maintaining specimen integrity based on handling requirements such as temperature, light, and time, as well as recognizing the impact of preanalytical errors on test results. Reference topics: Processing Specimens; bilirubin handling; light protection; preanalytical error.
NEW QUESTION # 68
Which of the following additives is commonly found in a gray-top tube used for glucose testing?
- A. Sodium citrate
- B. EDTA
- C. Sodium fluoride
- D. SPS
Answer: C
Explanation:
Sodium fluoride is commonly found in gray-top tubes used for glucose testing. Sodium fluoride inhibits glycolysis, which helps preserve glucose concentration after collection by slowing cellular glucose consumption. Many gray-top tubes also contain potassium oxalate as an anticoagulant. Sodium citrate is found in light-blue tubes used for coagulation studies because it binds calcium reversibly. EDTA is found in lavender-top tubes and is commonly used for hematology testing such as CBC. SPS is sodium polyanethol sulfonate, an additive used in blood culture bottles or yellow SPS tubes because it supports organism recovery by reducing certain inhibitory effects. Tube additives are not trivia; they determine specimen type and test validity. A glucose specimen collected in the wrong tube or processed late may produce inaccurate results because cells continue metabolizing glucose after collection. The phlebotomist must match test, tube, additive, order of draw, fill volume, and handling requirements. Reference topics: Special Collections; glucose testing; gray-top tube; sodium fluoride; additive function.
NEW QUESTION # 69
Which of the following actions should a phlebotomist take after removing gloves?
- A. Perform hand hygiene.
- B. Touch clean supplies immediately.
- C. Put the same gloves in a lab coat pocket.
- D. Use hand sanitizer on the gloves before reuse.
Answer: A
Explanation:
The phlebotomist should perform hand hygiene after removing gloves. Gloves reduce contamination but do not replace hand hygiene. Hands can become contaminated during glove removal, and gloves may have microscopic defects. Putting used gloves in a lab coat pocket is a contamination hazard. Sanitizing gloves for reuse is incorrect because medical gloves used during patient care are single-use items and should be discarded appropriately. Touching clean supplies immediately after glove removal without hand hygiene can contaminate the clean supply area and spread organisms to future patients. Proper glove workflow includes performing hand hygiene before gloving when indicated, wearing gloves for blood collection, avoiding unnecessary surface contact while gloved, removing gloves without contaminating the hands, discarding them properly, and performing hand hygiene afterward. This question tests routine infection-control behavior. Many healthcare-associated contamination events happen through simple missed hand hygiene after glove removal. Reference topics: Safety and Compliance; hand hygiene; glove removal; standard precautions; contamination prevention.
NEW QUESTION # 70
A phlebotomist is scheduled to perform a venipuncture on a patient who had a bilateral radical mastectomy. Which of the following actions should the phlebotomist take?
- A. Obtain the specimen from the ulnar vein.
- B. Contact to receive the surgical outpatient records.
- C. Contact the provider for approval.
- D. Obtain the specimen from the subclavian vein.
Answer: C
Explanation:
The phlebotomist should contact the provider for approval. After a mastectomy, especially radical mastectomy with lymph node involvement, venipuncture on the affected side is generally avoided because impaired lymphatic drainage can increase risk for lymphedema, infection, delayed healing, and patient complications. With a bilateral radical mastectomy, both arms may be restricted, so the phlebotomist should not independently choose an alternate arm vein. Drawing from an ulnar vein is not a standard solution and could still be in a restricted extremity. Requesting surgical outpatient records is not the immediate collection action and does not provide authorization to proceed. Obtaining a specimen from the subclavian vein is outside the phlebotomist's routine scope and would be a provider-level invasive procedure. The correct approach is to pause, follow facility policy, notify the nurse or provider, and obtain explicit direction for an approved site or alternate collection method. Reference topics: Routine Blood Collections; site contraindications; mastectomy precautions; provider communication; patient safety.
NEW QUESTION # 71
Which of the following situations increases a phlebotomist's risk for a needlestick?
- A. A 22-gauge needle is used for an antecubital draw.
- B. The tourniquet is tied too tightly on a patient's arm.
- C. The sharps container is nearly full.
- D. A transfer device is used with the syringe method.
Answer: C
Explanation:
A nearly full sharps container increases the risk for a needlestick because contaminated needles or other sharps may protrude, rebound, or be difficult to place safely into the container. Sharps containers must be puncture-resistant, leak-resistant, properly labeled or color-coded, kept upright, and replaced before they become overfilled. OSHA specifically warns not to allow sharps containers to overfill and requires routine replacement to reduce sharps injury risk. A tight tourniquet can cause patient discomfort, hemoconcentration, or venous obstruction, but it is not the best answer for needlestick risk. A 22-gauge needle is commonly used for routine venipuncture, especially for smaller veins, and is not inherently unsafe. A transfer device used with the syringe method is actually a safety control because it prevents the phlebotomist from manually pushing blood through a needle into evacuated tubes. NHA CPT safety content includes bloodborne pathogens, sharps safety, OSHA standards, exposure control, and safe disposal of contaminated equipment. Reference topics: Safety and Compliance; OSHA Bloodborne Pathogens Standard; sharps disposal; needlestick prevention.
NEW QUESTION # 72
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