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Quizzes > Health & Medicine > Human Anatomy & Medicine

Free NHA Phlebotomy Practice Test - Test Your Skills

Ready for an NHA phlebotomy exam practice test? Take the free challenge now!

Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art phlebotomy quiz on sky blue background with test tube syringe icons exam questions confidence boost

Use this NHA phlebotomy practice test to prep for the exam with realistic questions and instant feedback so you can spot gaps before test day. You'll review venipuncture, specimen handling, safety, patient communication, and equipment. Want a quicker warm-up? Try our short practice quiz to drill key skills.

What is the primary anticoagulant in a lavender-top blood collection tube?
Sodium citrate
Heparin
Silica
EDTA
Lavender-top tubes contain EDTA, which chelates calcium and prevents clotting by binding calcium ions. EDTA preserves cellular morphology and is ideal for hematology studies. Heparin and citrate are used in other tube colors for different tests.
Which vein is generally considered the first choice for routine venipuncture in the antecubital fossa?
Cephalic vein
Basilic vein
Dorsal hand vein
Median cubital vein
The median cubital vein is the most prominent, well-anchored, and least painful to access, making it the preferred site for venipuncture. The cephalic vein is second choice but can roll more. The basilic vein is close to nerves and arteries, risking complications.
Before performing a blood draw, which identification step is required by NHA standards?
Verify with locker assignment
Check last meal time
Ask patient to state full name and date of birth
Match to ID band color
Correct patient identification requires asking for full name and date of birth, then comparing to the requisition and ID band. This prevents sample mislabeling and medical errors. Other checks like band color are not reliable.
Which additive in a light blue-top tube prevents coagulation by binding calcium reversibly?
EDTA
Sodium citrate
Lithium heparin
Fluoride
Sodium citrate binds calcium reversibly, making light blue tubes ideal for coagulation studies like PT and aPTT. EDTA irreversibly chelates calcium for hematology. Heparin and fluoride serve other functions.
What is the minimum patient preparation time for fasting blood glucose tests?
24 hours
30 minutes
2 hours
8 hours
An 8-hour fast ensures accurate blood glucose measurements by eliminating recent dietary influences. Shorter periods can lead to elevated results, and longer fasting isn't necessary.
Which piece of equipment is essential for avoiding needlestick injuries during venipuncture?
Sharps container
Tourniquet
Safety-engineered syringe or holder
Alcohol pad
Safety-engineered devices have built-in shields to minimize needlestick risk. While sharps containers are important, they don't prevent the initial injury. Alcohol pads and tourniquets are for site prep and vein prominence.
What is the recommended maximum time a tourniquet should remain on a patient before drawing blood?
30 seconds
1 minute
Unlimited if vein is good
5 minutes
Leaving a tourniquet on longer than one minute can cause hemoconcentration, affecting test results. Releasing and reapplying if needed helps maintain specimen integrity.
Which color-top tube is used for collecting serum for chemistry panels?
Lavender-top
Blue-top
Green-top
Red-top
Red-top tubes are plain and contain no anticoagulant, allowing blood to clot and serum to be separated for chemistry assays. Green and lavender contain heparin and EDTA, respectively.
Which antiseptic is most appropriate for routine venipuncture skin cleaning?
70% isopropyl alcohol
Chlorhexidine gluconate
Hydrogen peroxide
Povidone-iodine
70% isopropyl alcohol effectively reduces skin flora and evaporates quickly, making it ideal for routine draws. Chlorhexidine is reserved for special cultures; iodine and peroxide are not standard.
When the patient's skin is broken, the procedure is called:
Analytical
Invasive
Non-invasive
Aseptic
Breaking the skin barrier classifies a procedure as invasive because it can introduce pathogens. Non-invasive procedures do not breach the skin.
Which gauge needle is most commonly used for adult routine blood draws?
25 gauge
18 gauge
21 gauge
16 gauge
A 21-gauge needle balances patient comfort and efficient flow rate for most adult draws. Larger gauges can damage cells; smaller ones slow collection and increase hemolysis risk.
What should you do immediately after withdrawing the needle and before removing the tourniquet?
Label the tube
Invert the tube
Mix the tube
Apply gauze and pressure
Applying gauze and pressure controls bleeding and prevents hematoma formation. Tourniquet removal happens just before or right after needle withdrawal, but site pressure is immediate.
Which component of blood carries oxygen to tissues?
Platelets
Plasma proteins
White blood cells
Red blood cells
Red blood cells contain hemoglobin, which binds and transports oxygen to body tissues. White cells fight infection; platelets aid clotting. Blood cell functions
What is the correct order of draw for serum (red), EDTA (lavender), and sodium citrate (blue) tubes?
Red, blue, lavender
Blue, red, lavender
Lavender, blue, red
Blue, lavender, red
The correct CLSI order is light blue first (coagulation), then red (serum), then lavender (EDTA). This avoids cross-contamination of additives.
If a patient has an IV in the right arm, where should you draw blood?
From the left arm
Below the IV site
Above the IV site
From the same arm after stopping IV
Drawing on the opposite arm prevents dilution or contamination from IV fluids. Below or above an IV can alter analyte concentrations.
Which protective barrier must be worn whenever there is risk of blood splatter?
Bouffant cap
Face shield or goggles
Apron only
Shoe covers
Face shields or goggles protect mucous membranes from splashes. Gloves and gowns protect skin and clothing, but eye protection is needed for splatter risks.
What is the purpose of inverting tubes after collection?
Label tubes properly
Prevent clotting in serum tubes
Mix blood with additives
Remove air bubbles
Gentle inversion ensures even mixing of blood with anticoagulants or clot activators. Vigorous shaking can cause hemolysis. Labeling and air removal are separate steps.
Which condition can cause pseudohyperkalemia if blood is hemolyzed?
Released intracellular potassium
Decreased platelet count
Dilution with IV fluids
Loss of plasma proteins
Hemolysis releases potassium from red cells into the serum, artificially elevating measured levels. Plasma proteins and platelets don't account for high potassium.
For a cold agglutinin test, how should you handle the specimen after collection?
Keep it at 37°C until centrifuged
Place it in an ice-water slurry
Freeze it
Refrigerate immediately
Cold agglutinins can clump at room temperature; warming to body temperature preserves sample integrity for accurate testing. Cooling or freezing would activate the antibodies.
Which layer contains leukocytes and platelets after centrifuging anticoagulated blood?
Serum
Red cell layer
Buffy coat
Plasma
The buffy coat is the thin white layer between plasma and red cells, rich in leukocytes and platelets. Plasma is above and red cells below.
Which test requires a dark tube to protect specimen from light exposure?
Complete blood count
Blood culture
Bilirubin
Prothrombin time
Bilirubin is light-sensitive and degrades on exposure, requiring amber or foil-wrapped tubes. Coagulation and hematology tests are not photosensitive.
What is the correct action if a tube's vacuum fails during collection?
Replace with a new tube
Use smaller gauge needle
Wait and reattempt
Fill thêm slowly
A failed vacuum means the tube cannot draw blood properly; swapping for a fresh tube ensures correct fill and additive ratio. Slower draw won't correct vacuum loss.
Which phenomenon causes platelets to clump when blood is drawn through too-small a needle?
Shear-induced activation
Agglutination
Clot retraction
Hemolysis
High shear stress in narrow needles activates platelets, causing clumping and erroneous counts. Agglutination is antibody-mediated. Hemolysis breaks RBCs not platelets.
Which blood specimen is required for blood culture collection?
Gel separator tube
Aerobic and anaerobic bottles
Citrate tube
EDTA tube
Blood cultures require both aerobic and anaerobic bottles to detect a broad spectrum of organisms. EDTA and citrate tubes are for hematology and coagulation, respectively.
How long should a tourniquet be left on when drawing blood for a lactic acid level?
Until collection is complete
2 minutes
1 minute
No tourniquet or less than 15 seconds
Lactic acid levels can rise with stasis; minimizing or omitting tourniquet time prevents false elevations. Standard draws allow up to one minute.
Which lab value is most affected by prolonged fist clenching during draw?
Glucose
Potassium
Calcium
Chloride
Fist clenching releases potassium from muscle into blood, raising measured levels. Calcium and chloride are less influenced by stasis.
What is the proper depth for a heel stick on an infant?
5.0 mm
3.5 mm
2.0 mm
0.5 mm
A 2.0 mm depth is recommended to avoid bone injury while obtaining adequate blood flow. Deeper punctures risk bone damage; shallower may not yield enough specimen.
Which best practice prevents specimen clotting in a heparin tube?
Refrigerate before mixing
Let it sit 5 minutes first
Shake vigorously
Invert gently 8 - 10 times immediately
Gentle inversion uniformly mixes heparin with blood to prevent clot formation. Vigorous shaking causes hemolysis and artifacts.
Which specimen transport condition is necessary for ammonia testing?
Keep at room temperature
Warm at 37°C
Freeze at - 20°C
Place on ice immediately
Ammonia levels rise post-collection; chilling the specimen slows metabolic processes. Room temperature or warming would artificially increase levels.
When labeling tubes at bedside, what information must be included immediately after collection?
Collector initials only
Patient name, date of birth, date/time, collector initials
Date/time and test code only
Patient name and ward only
Complete labels ensure sample traceability: full patient ID, collection date/time, and collector. Partial labels risk misidentification and sample rejection.
Which factor increases the risk of hemolysis during blood collection?
Using a small-gauge needle
Allowing alcohol to dry fully
Proper tourniquet time
Gentle tube inversion
Small-gauge needles create high shear forces, leading to RBC rupture. Proper alcohol drying and gentle mixing reduce hemolysis risk.
Which test requires chilling and plating within 30 minutes of collection?
Stat ammonia
Electrolytes
Glucose
CBC
Ammonia is unstable; immediate chilling and prompt processing preserve result accuracy. Electrolytes and CBC are stable at room temperature for longer.
A patient has sclerotic veins. Which technique may improve vein access?
Use a warm compress
Apply cold pack
Ask patient to hyperextend
Use a smaller tourniquet
A warm compress dilates sclerotic veins, improving palpability and access. Cold constricts vessels. Tourniquet size and positioning alone won't correct sclerosis.
Which scenario represents a preanalytical error affecting potassium levels?
Tourniquet left on >2 minutes
Sample shipped on ice
Proper EDTA tube used
Immediate centrifugation
Prolonged tourniquet time causes hemoconcentration, falsely elevating potassium. Chilling, EDTA, and quick centrifugation prevent but do not raise levels.
Which procedure is required for chain-of-custody specimens?
Document every handoff
Use EDTA tube
Refrigerate only
Label with patient initials
Chain-of-custody requires detailed logs of each person handling the specimen to maintain legal integrity. Tube type and temperature alone are insufficient.
During capillary sampling, which action prevents hemolysis?
Wipe away first drop
Use warm water
Squeeze the site heavily
Draw deep puncture
The first drop often contains tissue fluid and debris; wiping it away yields a cleaner sample. Excessive squeezing induces hemolysis.
What is the maximum angle of needle insertion for dorsal hand venipuncture?
45 degrees
10 degrees
30 degrees
20 degrees
A shallow angle (around 10 degrees) reduces the risk of penetrating through the vein in the hand, which has smaller and more fragile veins. Higher angles increase trauma.
A lipemic sample most affects which lab value?
PT/INR
CBC
Triglycerides
Ammonia
Lipemia (high lipid content) causes turbidity affecting triglyceride assays and other spectrophotometric tests. Coagulation, cell counts, and ammonia are less impacted.
Which blood culture collection practice reduces contamination?
Draw immediately after venipuncture
Use chlorhexidine for site prep
Skip gloves to improve dexterity
Label before cleaning
Chlorhexidine gluconate reduces skin flora more effectively than alcohol alone, lowering contamination rates. Gloves and proper labeling come after site prep.
When collecting for a potassium EDTA plasma specimen, what tube fill ratio is critical?
9 parts blood to 1 part EDTA
4:1
6:4
1 part blood to 9 parts EDTA
A 9:1 ratio ensures optimal anticoagulation without over-chelation. Incorrect ratios cause clotting or excessive additive effects.
Which action is required for a specimen that cannot be processed immediately and requires freezing?
Store at 4°C for 24 hours
Dry out before freezing
Keep at room temperature
Freeze at - 20°C or lower with proper aliquot
Certain analytes require freezing at - 20°C or colder in sealed aliquots to preserve stability. Refrigeration or room temperature leads to degradation.
A diabetic patient has difficult veins. Which specimen type may be preferred for point-of-care glucose testing?
Heparinized arterial sample
Capillary blood via fingerstick
Serum from red-top tube
Venous EDTA plasma
Capillary fingerstick is less invasive, quicker, and appropriate for immediate glucose measurement. Venous draws are used for lab analysis but aren't point-of-care.
Which regulation classifies a blood glucose meter as a waived test?
HIPAA
CLIA '88
CAP
OSHA BBP
Under CLIA '88, certain simple tests like point-of-care glucose are waived, meaning minimal regulatory requirements. HIPAA covers privacy, OSHA addresses safety, CAP is accreditor.
Which factor is most likely to produce a hemolyzed sample during transport?
Prompt transport
Room temperature storage
Using gel separators
Excessive centrifugal force
Overly high-speed centrifugation can rupture RBCs, causing hemolysis. Room temperature or prompt transport alone don't induce it.
Which condition requires a discard tube before collecting an ethylenediaminetetraacetic acid (EDTA) sample?
Blood cultures
Serum chemistry
CBC
Coagulation studies
Coagulation studies use citrate tubes and require a discard tube to clear tissue thromboplastin. EDTA is for hematology and doesn't need a discard.
Under CAP inspection, which quality indicator is evaluated for phlebotomy?
Specimen rejection rate
Number of tubes used
Staff turnover
Patient scheduling
CAP inspects laboratories on specimen rejection rates as a measure of preanalytical quality. Tube count and scheduling are not direct CAP quality indicators.
Which CLIA classification applies to a mid-complexity molecular assay performed after phlebotomy?
Moderate complexity
High complexity
Provider-performed microscopy
Waived
Molecular assays like PCR are classified as moderate complexity under CLIA. Waived tests are simple; high complexity covers cytogenetics.
What is the acceptable temperature range for transporting urine specimens for drug screening?
Below 0°C
32 - 38°C
15 - 25°C
4 - 8°C
Drug-screening labs check that fresh urine is 32 - 38°C to detect tampering. Cooler or warmer indicates possible adulteration.
Which federal regulation mandates exposure control plans in phlebotomy?
HIPAA Privacy Rule
CLIA '88
OSHA Bloodborne Pathogens Standard
FDA 510(k)
OSHA's Bloodborne Pathogens Standard requires written exposure control plans to protect against needle-stick injuries. CLIA regulates testing, FDA regulates devices, HIPAA covers privacy.
Which specialized tube is required for DNA PCR testing in forensic serology?
Citrate tube
Heparin tube
Serum separator tube
EDTA tube
EDTA preserves nucleated cells and DNA integrity, making it preferred for forensic PCR. Heparin and citrate can inhibit downstream enzymatic reactions.
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Study Outcomes

  1. Understand Exam Format -

    Identify the structure, question types, and time constraints of the NHA phlebotomy practice test to build exam-day confidence.

  2. Apply Proper Venipuncture Techniques -

    Demonstrate correct needle selection, site preparation, and blood draw procedures in line with NHA standards.

  3. Recognize Key Equipment -

    Distinguish among collection tubes, lancets, tourniquets, and other phlebotomy tools and explain their specific uses.

  4. Implement Safety and Infection Control -

    Practice hand hygiene, personal protective equipment use, and sharps disposal to minimize patient and practitioner risk.

  5. Sequence Tube Order Accurately -

    Follow the correct order of draw to prevent sample contamination and ensure accurate laboratory results.

  6. Assess Knowledge and Improve -

    Analyze practice test scores to pinpoint strengths and weaknesses, then focus study efforts for optimal exam performance.

Cheat Sheet

  1. Selecting Venipuncture Sites & Order of Draw -

    Review site selection on the antecubital fossa based on vein prominence and patient history, following CLSI guidelines (www.clsi.org). Use the mnemonic "Stop Light Red, Green, Best Yellow" to recall blood culture, light blue, red, green, lavender, gray sequence. Practicing this order on an nha phlebotomy practice test free module reinforces proper technique under exam conditions.

  2. Patient Identification & Labeling Accuracy -

    Always verify two patient identifiers (name and DOB) per Joint Commission standards before drawing to prevent mislabeling errors. Label tubes immediately at the bedside, ensuring the phlebotomy test nha scenario mirrors real-world safety. Consistent practice in nha phlebotomy exam practice test simulations builds confidence and reduces specimen rejection.

  3. Equipment & Needle Gauge Selection -

    Select a 21 - 23 gauge needle for most adults; remember that a smaller gauge number means a larger bore. For pediatric or fragile vein cases, switch to a 23 - 25 gauge butterfly set as recommended by Johns Hopkins Medicine. Regularly timed drills on phlebotomy nha practice test questions hone your speed and precision.

  4. Infection Control & PPE Best Practices -

    Follow CDC's Standard Precautions: perform hand hygiene before and after each draw, wear gloves, and change between patients to prevent cross-contamination (www.cdc.gov). Simulating these protocols in nha phlebotomy practice test environments instills disciplined, safe practice habits. Proper PPE donning/doffing drills are vital for exam success and clinical safety.

  5. Specimen Handling & Additive Ratios -

    Memorize the citrate tube ratio (9:1 blood to additive) for coagulation tests to avoid under- or over-filling, referencing Clinical and Laboratory Standards Institute data. Gently invert tubes 5 - 10 times immediately after collection to mix additives evenly. Reviewing these steps in an nha phlebotomy exam practice test setting ensures accurate lab results and top scores.

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