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Quizzes > Health & Medicine > Human Anatomy & Medicine

Ready to Ace Your NHA Phlebotomy Practice Exam?

Download the free NHA phlebotomy practice test PDF and master real exam questions now!

Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art coral background with syringe test tube gloves and clipboard promoting free NHA phlebotomy practice exam

Use this free NHA phlebotomy practice exam to build your skills in patient ID, venipuncture, and specimen handling. Finish in minutes and spot study gaps before the real exam. Want more items? Try another practice set when you're done.

What is the minimum number of patient identifiers required to confirm before collecting a blood specimen?
One identifier
Two identifiers
Four identifiers
Three identifiers
Phlebotomy standards require the use of two patient identifiers, such as name and date of birth, to ensure correct patient matching and avoid specimen errors. This reduces the risk of patient misidentification and improves overall safety. The Joint Commission and NHA both endorse this practice.
Which of the following is NOT considered an acceptable patient identifier?
Social Security number
Full name
Medical record number
Date of birth
Social Security numbers are protected for privacy and are not used as primary identifiers due to risk of identity theft. Acceptable identifiers include full name, date of birth, and medical record number. Always follow facility policy for identification.
Which antiseptic is most commonly used to clean the venipuncture site before needle insertion?
Isopropyl alcohol 70%
Hydrogen peroxide
Povidone-iodine
Chlorhexidine gluconate 2%
A 70% isopropyl alcohol wipe is the standard for most routine venipunctures due to its rapid antimicrobial action. It should be allowed to air dry completely to maximize efficacy. Other antiseptics are reserved for special circumstances.
For how long should a tourniquet be applied to the patient's arm during venipuncture?
No more than 30 seconds
No more than 5 minutes
No more than 1 minute
No more than 2 minutes
A tourniquet should be applied for no more than one minute to prevent hemoconcentration and altered test results. If more time is needed, release and reapply after a short break. This practice aligns with CLSI guidelines.
Which vein is most commonly used for routine venipuncture?
Dorsal hand vein
Cephalic vein
Basilic vein
Median cubital vein
The median cubital vein is preferred because it is large, well-anchored, and less painful to access. It also has fewer nearby nerves and arteries, reducing complication risks. This makes it the first choice for most phlebotomists.
What color tube is used first when performing a blood draw in the standard order of draw?
Lavender
Red
Green
Light blue
The light blue top tube (sodium citrate) must be drawn first to avoid contamination from additives in other tubes. This preserves accurate clotting time tests like PT/INR. Adhering to the order of draw is critical.
Which information is essential to label on a blood specimen tube at the patient's bedside?
Patient name and test type only
Patient name, date of birth, date and time of collection, collector's initials
Collector's signature only
Patient room number and test type
Proper tube labeling includes patient name, date of birth, collection date and time, and collector initials to ensure traceability and reduce errors. Labeling at the bedside prevents mix-ups. Always follow facility policy.
Which finger is commonly used for capillary puncture in an adult?
Thumb
Middle or ring finger
Index finger
Little finger
The middle or ring finger is preferred for adult capillary punctures due to the larger blood flow and lower risk of nerve injury. The thumb and little finger have more nerve endings, making them less suitable. This minimizes discomfort for the patient.
Which personal protective equipment (PPE) is mandatory when performing a blood draw?
Mask only
Gloves
Face shield only
Gown only
Gloves are mandatory for all venipunctures to protect both the patient and phlebotomist from bloodborne pathogens. Other PPE may be needed based on exposure risk. Changing gloves between patients is required.
What additive is in the lavender-top tube and what test is it primarily used for?
Sodium citrate; coagulation tests
Heparin; chemistry panel
Sodium fluoride; glucose test
EDTA; complete blood count (CBC)
The lavender-top tube contains EDTA, which chelates calcium and preserves cellular elements for a complete blood count (CBC). EDTA prevents clotting without hemolysis. It's critical for hematology tests.
How many gentle inversions are recommended immediately after drawing a blood culture bottle?
5 - 6 inversions
3 - 4 inversions
8 - 10 inversions
0 - 2 inversions (no mixing)
Blood culture bottles should not be inverted repeatedly; inverting once or twice is sufficient to mix with anticoagulant. Excessive mixing can damage organisms and hinder detection. Follow the manufacturer's instructions.
Which needle gauge is most appropriate for routine adult venipuncture?
21-gauge
25-gauge
18-gauge
23-gauge
A 21-gauge needle is standard for adult venipuncture because it balances flow rate and patient comfort. Larger needles may cause more discomfort; smaller ones can cause hemolysis. It's widely recommended in phlebotomy guidelines.
If a patient begins to feel faint during a draw, what is the first action you should take?
Apply pressure immediately
Continue to draw quickly
Call for security
Remove the tourniquet and needle and have patient lower head
If a patient feels faint, stop the draw, remove the tourniquet and needle, and have them lower their head between their knees or lie flat. This prevents injury from fainting. Monitor vital signs and provide assistance.
Prolonged tourniquet application can lead to which pre-analytical error?
Hemoconcentration
Lipemia
Clotting
Hemolysis
Hemoconcentration occurs when plasma fluid leaks into tissues from prolonged stasis, concentrating analytes. This can falsely elevate potassium, proteins, and other results. Always release the tourniquet within one minute.
What should you do if a light blue top tube is underfilled?
Reject the specimen and recollect
Proceed; ratio adjustment is automatic
Invert it more times
Label it as partial and send
Underfilling a sodium citrate tube alters the blood-to-additive ratio, invalidating coagulation tests like PT/INR. The specimen must be recollected to ensure accuracy. Partial tubes are rejected.
Which action is correct when collecting blood cultures?
Use a single bottle only
Label after leaving the patient room
Discard the first 5 mL and collect only one bottle
Draw aerobic then anaerobic bottles
Blood cultures require both aerobic and anaerobic bottles to detect a broad range of organisms. Drawing aerobic first helps reduce oxygen contamination. Label at the bedside immediately after draw.
After drawing an additive tube, how many times should it be inverted to mix the blood properly?
1 - 2 gentle inversions
3 - 4 gentle inversions
15 - 20 vigorous inversions
5 - 10 gentle inversions
Most additive tubes require 5 - 10 gentle inversions to mix blood with anticoagulant without causing hemolysis. Vigorous or excessive shaking can cause cell damage. Gentle mixing ensures accurate test results.
Which antiseptic is preferred for blood cultures due to its persistent activity?
Chlorhexidine gluconate 2% with alcohol
Hydrogen peroxide
70% isopropyl alcohol
Povidone-iodine alone
Chlorhexidine gluconate with alcohol provides rapid kill and persistent antimicrobial action, making it the first choice for blood culture site prep. It reduces contamination rates significantly. Follow product instructions for contact time.
What color tube is used for microbiology blood culture specimens?
Lavender
Red
Green
Yellow (SPS)
Yellow-top tubes containing SPS (sodium polyanethol sulfonate) inhibit complement and phagocytosis, preserving pathogens for blood culture testing. They are used specifically for microbiology culture draws. Label appropriately.
Which pre-analytical error is most commonly caused by using too small a needle?
Lipemia
Hemoconcentration
Hemolysis
Clot formation
Using a needle that's too small can cause red blood cells to rupture as they pass through, leading to hemolysis. Hemolyzed specimens can yield falsely elevated potassium and LDH levels. Choose the appropriate gauge to prevent this.
Which condition can develop if a tourniquet is left on too long, causing tiny skin hemorrhages?
Hematoma
Thrombosis
Petechiae
Edema
Prolonged tourniquet application can increase capillary pressure, causing petechiae - small red or purple spots on the skin. This indicates microvascular damage. Release the tourniquet promptly to avoid it.
What is the recommended site for a newborn heel stick specimen?
Medial arch of the heel
Lateral plantar surface of the heel
Posterior aspect of the heel
Center of the heel
The lateral plantar surface of the heel has fewer nerves and more capillary beds, making it the safest site for neonatal heel punctures. Avoid the medial heel to prevent nerve damage. Follow depth guidelines to avoid bone injury.
What device can be used to transfer blood from a syringe into vacuum tubes without needlestick risk?
Hypodermic connector
Needle-manifold
Tube adapter (transfer device)
Butterfly needle
A tube transfer device safely attaches to the syringe, allowing direct transfer to vacuum tubes without re-capping needles. This reduces needlestick injuries and protects phlebotomists. Always use an approved safety transfer device.
Which specimen requires protection from light during transport and storage?
Glucose
Serum potassium
Bilirubin
Lipid panel
Bilirubin is light-sensitive and can degrade when exposed, causing falsely low results. Specimens should be wrapped in foil or placed in amber tubes. Proper handling preserves analyte stability.
For cold agglutinin testing, how should the specimen be transported?
On ice immediately
Frozen
At room temperature
Pre-warmed to 37°C and kept warm
Cold agglutinins can clump at low temperatures, so specimens must be kept at 37°C from collection through testing. Pre-warm collection tubes and transport containers to preserve sample integrity. This prevents aggregation of red cells.
How long should a patient fast before a lipid panel blood draw?
6 - 8 hours
2 - 4 hours
8 - 12 hours
24 hours
Patients should fast for 8 - 12 hours before a lipid panel to stabilize triglyceride levels and provide accurate cholesterol measurements. Shorter fasting periods can lead to variable results. Confirm fasting status before the draw.
When collecting peak and trough levels for therapeutic drug monitoring, when should the trough level be drawn?
Immediately after dose
30 minutes before next dose
At the time of peak concentration
1 hour after dose
Trough levels are drawn immediately before the next scheduled dose, typically within 30 minutes, to measure the lowest drug concentration. This helps assess proper dosing. Timing accuracy is crucial for therapeutic monitoring.
How long should direct pressure be applied after a heel puncture on a newborn?
30 seconds
1 minute
2 - 3 minutes
5 minutes
Direct pressure for 2 - 3 minutes ensures hemostasis in neonates due to their delicate capillary beds. Shorter times may cause bleeding; longer times risk tissue damage. Follow facility protocol.
Which device is best for routine blood draws in patients with small or fragile veins?
Hypodermic syringe only
Straight needle
Butterfly (winged) needle
21-gauge straight
Butterfly needles (winged infusion sets) offer better control and less vein trauma, ideal for small or fragile veins. They allow for gentle angle entry and easy handling. This reduces hemolysis and discomfort.
According to CLSI guidelines, what is the maximum depth for a skin puncture in an adult?
2.0 mm
1.0 mm
2.5 mm
1.8 mm
CLSI recommends a maximum puncture depth of 2.0 mm for adults to avoid bone injury. Staying within this limit ensures patient safety and adequate sample. Use a standardized lancet device.
What is the best practice when encountering a rolling vein during venipuncture?
Anchor the vein firmly below the puncture site
Withdraw and retry on the other arm without anchoring
Apply more tourniquet pressure
Use a smaller gauge needle immediately
Anchoring the vein by firmly holding the skin below the site stabilizes it and prevents rolling. This improves needle insertion success. Retrying without anchoring increases risk of missing the vein.
Which patient condition increases the risk of hemolysis during venipuncture?
Diabetes
Anemia
Hypertension
Use of a small-gauge needle
Small-gauge needles create high shear forces that can rupture red blood cells, causing hemolysis. Hemolyzed samples yield inaccurate potassium and LDH readings. Use the recommended gauge to minimize this risk.
Which type of specimen is most likely to be lipemic and why?
Sample from dehydrated patient; due to high concentration
Morning sample; due to overnight fasting
Fasting blood sample; due to low lipids
Postprandial blood sample; due to recent fatty meal
Lipemic samples result from high blood lipid content, often after consuming a fatty meal. These cloudy or milky specimens can interfere with photometric assays. Patients should fast 8 - 12 hours to prevent lipemia.
What protective measure is required for specimens tested for bilirubin levels?
Freeze immediately
Protect from light
Heat to 37°C
Expose to ambient air
Bilirubin is photosensitive and degrades when exposed to light, leading to falsely low results. Specimens must be wrapped in foil or placed in amber tubes. Proper handling ensures accurate bilirubin measurement.
Which CLSI guideline document covers venipuncture procedures?
C28-A3
H18-A4
GP41-A7
H3-A6
CLSI GP41-A7 provides standards for blood collection by venipuncture and capillary puncture. It covers patient identification, site preparation, order of draw, and safety. Compliance with this guideline improves pre-analytical quality.
How should a phlebotomist proceed if a patient's vein is inaccessible and a syringe draw is needed?
Perform a capillary stick instead
Use a larger gauge needle
Convert to a syringe draw using a safety transfer device
Refer the patient for arterial draw
When vacuum tubes will not fill, switching to a syringe draw with a safety transfer device allows better control of flow and reduces collapsing fragile veins. It maintains sample integrity and safety. Always follow facility policy.
When is the most appropriate time to check a patient's identification against the requisition?
Before leaving the patient's side
After drawing the blood
After labeling the tubes
Once the tubes are delivered to the lab
Patient ID should be confirmed and labels applied before leaving the bedside to prevent specimen mislabeling. This final check ensures accuracy and traceability. Post-collection checks significantly reduce errors.
How should an EDTA tube be handled if the patient is on anticoagulant therapy and the CBC is critical?
Mix gently and fill tube completely
Use heparin tube instead
Draw an extra tube without additive
Increase tourniquet time
A completely filled EDTA tube mixed gently prevents clot formation and ensures accurate cell counts, especially for patients on anticoagulants. Underfilling can lead to incorrect ratios and unreliable CBC results. Heparin tubes are not appropriate for CBC.
What is the recommended action if a hemolytic sample is identified in the lab?
Reject and request a redraw
Dilute the sample before testing
Use half the volume for testing
Proceed with testing; note the hemolysis
Hemolyzed samples can produce inaccurate test results for potassium, AST, and LDH and should be rejected. A redraw reduces the risk of reporting erroneous values. Always follow laboratory rejection policies.
Which patient position reduces the risk of postural hypotension during venipuncture?
Standing with arm elevated
Sitting with back support
Supine without a headrest
Leaning forward over table
A seated position with back support maintains stable blood pressure and reduces orthostatic hypotension risk. Standing can cause fainting or dizziness. This is especially important in elderly or hypovolemic patients.
What quality indicator monitors the rate of specimen recolLECTION due to hemolysis?
Labeling compliance
Order-to-collect ratio
Turnaround time
Rejection rate
The rejection rate measures how often samples are rejected, often due to hemolysis, clotting, or labeling errors. Tracking this indicator identifies training needs. Lower rejection rates reflect higher pre-analytical quality.
Which medication level requires peak and trough samples at specific times post-dose?
Metformin
Vancomycin
Heparin
Aspirin
Vancomycin requires peak (30 - 60 minutes post-infusion) and trough (just before next dose) levels to ensure efficacy and avoid toxicity. Proper timing optimizes therapy. Incorrect timing invalidates results.
Which CLSI guideline addresses pre-analytical quality indicators and specimen acceptance criteria?
H3-A6
C28-A3
GP41-A7
QMS01-A
CLSI QMS01-A covers quality management systems and pre-analytical quality indicators including specimen acceptance and rejection criteria. It guides labs in monitoring and improving pre-analytical processes. Use it to establish performance metrics.
For gene-based testing requiring DNA preservation, which tube additive is recommended?
Heparin
Sodium fluoride
Sodium citrate
EDTA
EDTA preserves nucleated cells and inhibits DNases, making it ideal for DNA-based testing. Heparin can inhibit PCR reactions. Use EDTA tubes for molecular diagnostics.
How does tube expiration impact vacuum draw volume and test accuracy?
Vacuum loss leads to underfilled tubes and ratio errors
Only label legibility is impacted
Only additive potency is affected
Expired tubes maintain vacuum
Expired tubes can lose vacuum over time, leading to underfilled specimens and incorrect blood-to-additive ratios. This affects coagulation and chemistry tests. Always check expiration dates before use.
Which pre-analytical factor contributes most to spurious thrombocytosis?
Excessive anticoagulant
Hemolysis
Lipemia
Prolonged tourniquet
Excess anticoagulant from underfilled EDTA tubes can shrink cells and artifactually elevate platelet counts, leading to spurious thrombocytosis. Proper fill volume prevents this. Monitor fill levels closely.
Which advanced quality metric tracks specimen transport time from collection to laboratory receipt?
Rejection rate
Transport delta
TAT (Turnaround Time)
Pre-analytical error rate
Transport delta measures the interval between specimen collection and laboratory receipt, highlighting delays that may compromise sample integrity. Monitoring it allows labs to improve logistics and reduce degradation. It's critical for time-sensitive tests.
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Study Outcomes

  1. Understand the NHA phlebotomy practice exam format -

    Learn about the quiz structure, question types, and timing to replicate the real exam environment and boost your confidence.

  2. Demonstrate proper patient identification techniques -

    Master the use of two unique identifiers and verify patient information accurately to ensure safety and compliance.

  3. Apply correct venipuncture procedures -

    Practice selecting appropriate sites, preparing equipment, and performing draws with the proper angle, order of draw, and safety measures.

  4. Identify best practices for specimen handling and labeling -

    Understand tube selection, labeling conventions, and transport protocols to maintain sample integrity and prevent errors.

  5. Analyze quiz feedback to target knowledge gaps -

    Use instant results to pinpoint strengths and weaknesses, guiding focused review and individualized study plans.

  6. Utilize the free NHA phlebotomy practice test PDF -

    Download and integrate detailed explanations and additional questions to reinforce learning and enhance exam readiness.

Cheat Sheet

  1. Accurate Patient Identification -

    Mastering accurate patient identification not only enhances safety but also boosts your performance on the nha phlebotomy practice exam. Use two identifiers - full name and date of birth - and ask patients to spell their last name for confirmation, per Joint Commission guidelines. This simple verification step prevents labeling errors and is a common focus of nha phlebotomy questions.

  2. Venipuncture Site Selection & Order of Draw -

    Identify the median cubital vein as your first choice and follow CLSI H3-A6 standards to avoid additive carryover. Remember the mnemonic "Boys Love Ravishing Girls But Prefer Pretty Girls" (Blood cultures, Light blue, Red, Gold, PST, Green, Lavender, Pink, Gray) to nail this on any free nha phlebotomy practice test. Proper sequencing reduces hemolysis and ensures accurate test results.

  3. Needle Gauge & Equipment Choice -

    Select a 21-gauge straight needle for routine draws, a 23-gauge butterfly set for small veins, and an 18-gauge for donor collection to maintain proper flow and patient comfort. Matching gauge size to vein durability minimizes bruising and hemolysis - key skills tested on the nha cpt practice exam. Always inspect equipment for sterility and expiration dates before use.

  4. Specimen Handling & Mixing -

    Invert tubes gently but thoroughly: 3 - 4 times for citrate, 5 - 6 for heparin, and 8 - 10 for EDTA to mix additives without causing bubbles. Label tubes immediately using a two-step check, then transport specimens at recommended temps (e.g., glucose on ice within 30 minutes) as outlined in the nha phlebotomy practice test pdf. Proper handling prevents clotting, glycolysis, and contamination.

  5. Infection Control & PPE -

    Adhere to CDC's Standard Precautions: perform hand hygiene before and after phlebotomy, don gown, mask, goggles, then gloves, and use the one-handed scoop method for needle recapping avoidance. Dispose of sharps immediately into approved containers to prevent needlestick injuries - an area emphasized in nha phlebotomy practice questions. Consistent PPE use protects both you and your patients.

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