Phlebotomy Practice Test

1. A patient who speaks limited English nods but appears confused when asked to confirm identity before a draw. What is the most culturally appropriate next step?

• A. Arrange a qualified interpreter or approved language-access resource before proceeding.
• B. Assume the nod means yes and proceed with the draw.
• C. Speak louder and use the same words again.
• D. Ask another patient in the waiting room to translate the identification questions before starting the draw

2. Which method is the acceptable standard for confirming a patient's identity before a blood draw in an inpatient setting?

• A. Ask the patient to confirm the name the phlebotomist reads aloud from the wristband without checking a second identifier such as date of birth
• B. Confirm identity with a family member at the bedside
• C. Rely on the room number and bed position
• D. Use at least two independent identifiers, such as the patient stating their name and date of birth matched to the requisition and armband

3. Which specimen must be collected before the patient ambulates or becomes active in the morning?

• A. A random glucose, drawn at any time without regard to fasting, activity, or basal-state timing
• B. A basal state specimen, drawn after fasting and before activity
• C. A blood culture set
• D. A type and screen

4. A fasting specimen is ordered. What is the patient generally permitted to consume beforehand?

• A. Black coffee
• B. Chewing gum
• C. Water
• D. Fruit juice

5. A specimen is required for type and crossmatch before a transfusion. What identification step is critical?

• A. Positively identify the patient and label the tube at the bedside per the blood bank's identification protocol
• B. Label the tube at the nurses' station after collection, once the paperwork has been matched to the room number
• C. Use the room number as the primary identifier
• D. Have a family member confirm the patient's identity

6. A physician orders a trough level for a therapeutic drug. When is the specimen collected?

• A. Immediately after the dose is administered
• B. At the point of highest expected concentration
• C. Immediately before the next scheduled dose
• D. At any point during the dosing interval

7. A patient reports taking an anticoagulant. What is the practical implication for the phlebotomist?

• A. The draw must be refused entirely, since any anticoagulant therapy makes venipuncture unsafe to perform on that patient
• B. A tourniquet may not be used
• C. The specimen will always be hemolyzed
• D. Bleeding at the site may take longer to stop, so pressure is held longer and the site is checked before bandaging

8. A patient has an intravenous line running in the left arm. Where should the phlebotomist draw?

• A. From the opposite arm whenever possible
• B. Directly above the IV site in the same arm
• C. From the IV tubing without stopping the infusion
• D. From any site, since IV fluid does not affect results

9. Which condition in a patient's history most directly increases the risk of prolonged bleeding after venipuncture?

• A. Leukocytosis
• B. Polycythemia
• C. Thrombocytopenia
• D. Hyperglycemia, since persistently elevated glucose thickens the blood enough to slow clot formation at the site

10. A phlebotomist is asked to collect a specimen but the requisition lacks the ordering provider's name. What should be done?

• A. Resolve the incomplete requisition before collecting
• B. Collect and let the laboratory sort out the missing information
• C. Enter a supervisor's name in the blank field
• D. Collect and add the provider name later from memory

11. A patient refuses to have blood drawn after the phlebotomist explains the procedure. What is the correct action?

• A. Proceed because the physician ordered the test, since a signed order overrides the patient's right to refuse
• B. Respect the refusal, document it, and notify the ordering provider or nurse
• C. Ask a family member to authorize the draw
• D. Leave without documenting anything

12. Which situation calls for collecting a specimen from a hand vein rather than the antecubital fossa?

• A. Whenever the patient prefers it for comfort
• B. For every pediatric patient, since children's antecubital veins are considered too fragile to access safely
• C. When both antecubital areas are unsuitable due to IV lines, scarring or prior surgery
• D. For all coagulation specimens

13. A phlebotomist is selecting a venipuncture site and notices the patient's usual arm has visible scarring and hardened tissue from prior IV therapy. What is the best approach?

• A. Apply extra antiseptic to the scarred area and proceed as usual.
• B. Draw through the scarred tissue since scarring does not affect specimen quality or venous blood flow at all
• C. Use a larger gauge needle to compensate for the scarred tissue.
• D. Select an alternative site with healthy, palpable vein tissue rather than drawing through the scarred area.

14. A patient has significant edema in both arms due to a medical condition. Why does this complicate venipuncture site selection?

• A. Edema causes veins to become more prominent and easier to access.
• B. Excess fluid in the tissue makes veins difficult to palpate and can dilute or contaminate the specimen if punctured through edematous tissue.
• C. Edema has no impact on venipuncture and only affects capillary punctures.
• D. Edema increases the risk of the patient fainting but does not affect the vein itself or the accuracy of the specimen drawn, since edema is only a cosmetic skin change

15. A patient reports having had a mastectomy with lymph node removal on their right side. How should this affect venipuncture site selection?

• A. It has no bearing on site selection since lymph node removal only affects the surgical scar area and heals completely within a few weeks
• B. The right arm should still be used first because it is typically the dominant arm.
• C. Either arm may be used interchangeably as long as a tourniquet is applied briefly.
• D. The right arm should generally be avoided in favor of the unaffected arm due to increased risk of complications such as lymphedema.

16. A patient with cognitive impairment becomes agitated and pulls away when the tourniquet is applied. Which approach best supports the patient?

• A. Restrain the arm firmly and complete the draw quickly.
• B. Raise your voice so the patient clearly understands the instructions being given during the draw and cooperates more quickly
• C. Tell the patient that the behavior is making the job harder.
• D. Speak softly, use simple reassuring language, and allow extra time or a support person as needed.

17. A teenage patient asks the technician not to tell their parent about the reason for a blood test. Which response best balances respect for the patient with professional boundaries?

• A. Promise to keep everything secret regardless of policy.
• B. Reassure the patient about confidentiality practices and refer disclosure questions to the ordering provider.
• C. Tell the parent immediately without responding to the patient's request for privacy or explaining why confidentiality applies
• D. Refuse to perform the draw until the patient explains why.

18. A regular donor at a mobile blood drive mentions they feel fatigued lately but still want to donate today. Which action best reflects the phlebotomist's role in supporting the donor's health?

• A. Proceed with the draw without comment since fatigue is a common and expected symptom for donors giving blood regularly
• B. Recommend the donor take an over-the-counter iron supplement immediately before donating.
• C. Note the fatigue and refer the donor to the screening staff or a supervisor to evaluate eligibility before proceeding.
• D. Ask the donor to sign a waiver acknowledging the fatigue and continue with collection.

19. A phlebotomist is collecting blood cultures along with other tubes. Where do the blood culture bottles fall in the order of draw?

• A. Last, after all additive tubes are filled
• B. Immediately after the light blue citrate tube
• C. Anywhere in the sequence, since bottles are sterile and their stoppers resist contamination from prior tubes
• D. First, before any other tube, to minimize contamination risk

20. Which skin antisepsis approach is required before collecting a blood culture, as distinct from a routine venipuncture?

• A. A more rigorous antiseptic with a required contact and drying time, rather than a simple alcohol wipe
• B. The same single alcohol wipe used for routine draws, applied once and allowed only a few seconds to air-dry
• C. No antisepsis, since the bottles contain preservative
• D. Soap and water scrubbing only

21. A glucose tolerance test is ordered. What determines the timing of each specimen?

• A. The clock starts when the patient arrives at the laboratory
• B. The clock starts when the patient finishes the glucose beverage, and draws occur at the ordered intervals from that point
• C. Draws may occur at any convenient time within the test window, since the glucose load stays constant in the blood throughout the interval
• D. Only the fasting specimen matters

22. A phlebotomist is collecting multiple tubes from a pediatric patient for several ordered tests. Which practice best reduces the risk of iatrogenic anemia in this patient?

• A. Combine several ordered tests into a single larger adult-sized tube to reduce the number of sticks, regardless of pediatric volume limits
• B. Use pediatric or micro-volume tubes when available and collect only the minimum volume needed for the ordered tests.
• C. Draw the maximum volume each tube can hold regardless of the patient's size.
• D. Repeat the draw on a separate day for each individual test ordered.

23. When educating a nervous first-time donor about the value of routine preventive lab work, which approach is most consistent with promoting patient wellness?

• A. Recommending the patient stop taking prescribed medications before testing
• B. Explaining that routine testing can help detect changes early and reassuring the patient
• C. Telling the patient the specific disease their results will confirm before testing is even complete
• D. Warning the patient that skipping the draw will make them seriously ill

24. A patient asks the phlebotomist why their physician ordered a fasting lipid panel. What is the most appropriate health-promotion response?

• A. Explaining generally that the test helps the provider assess certain health markers and encouraging the patient to ask their provider for details
• B. Interpreting the likely results and telling the patient whether they have heart disease based on family history alone, without waiting for actual values
• C. Refusing to answer and instructing the patient not to ask questions
• D. Telling the patient the test is unnecessary and they should decline it

25. A patient becomes unresponsive during a blood draw. What is the phlebotomist's priority?

• A. Complete the draw before addressing the patient, since interrupting a venipuncture midstream risks a second puncture
• B. Leave the patient to find help
• C. Remove the needle, ensure the patient's safety and airway, and call for emergency assistance
• D. Attempt to give the patient fluids by mouth

26. Under OSHA requirements, what feature must a compliant phlebotomy needle device include?

• A. A recapping sleeve for two-handed recapping
• B. A reusable holder for multiple patients, provided the holder is wiped with an alcohol pad between each patient
• C. A larger bore to reduce draw time
• D. An engineered sharps injury protection mechanism, such as a retractable or shielded needle

27. A phlebotomist must collect a specimen from a patient in an airborne isolation room. What personal protective equipment is required?

• A. A fit-tested N95 or higher respirator, along with gloves and other PPE as indicated
• B. A surgical mask only
• C. Gloves only
• D. No PPE if the visit is brief, since airborne precautions apply only to encounters lasting more than fifteen minutes

28. A blood-containing tube breaks and spills on the counter. What is the correct cleanup approach?

• A. Wipe it up with paper towels and discard them in regular trash
• B. Don gloves, cover and absorb the spill, disinfect with an appropriate agent, and dispose of materials as regulated waste
• C. Pick up broken glass with gloved hands, since standard exam gloves provide adequate puncture protection for sharp fragments
• D. Leave it for environmental services without containment

29. Under HIPAA, may a phlebotomist discuss a patient's ordered tests with a coworker who is not involved in that patient's care?

• A. Yes, since both are employees of the same facility and share the same general duty of confidentiality
• B. No, disclosure must be limited to those with a treatment, payment or operations need
• C. Yes, if the conversation occurs in a staff area
• D. Yes, provided the patient's name is not spoken aloud

30. Which quality assurance practice most directly reduces preanalytical error in phlebotomy?

• A. Increasing the number of tubes collected per patient
• B. Reducing the time spent verifying orders, which speeds turnaround without changing preanalytical accuracy
• C. Allowing each phlebotomist to use a personal technique
• D. Standardized patient identification and labeling procedures with routine competency assessment

31. What distinguishes point-of-care testing from central laboratory testing?

• A. It is exempt from quality control requirements
• B. Results do not need to be documented in the record
• C. Testing occurs at or near the patient, giving rapid results, but still requires quality control and documented competency
• D. It may be performed by anyone without training, since the testing device itself performs all required quality checks automatically

32. Which of the following is the best example of a phlebotomist reinforcing preventive-care behavior during a patient encounter?

• A. Guaranteeing the patient will never become ill if they eat well
• B. Reminding the patient to keep scheduled follow-up appointments with their provider
• C. Offering a personal opinion on which prescription drug the patient should take instead of their provider's choice
• D. Sharing another patient's lab results as a comparison

33. When promoting patient health, why is it important for a phlebotomist to communicate within their defined scope of practice?

• A. Because phlebotomists are legally required to diagnose all patients they encounter during a shift, regardless of the ordering provider
• B. Because scope of practice has no effect on patient outcomes
• C. Because patients prefer that phlebotomists prescribe their medications
• D. Because staying within scope protects patient safety and directs clinical questions to qualified providers

34. Which item is an example of regulated medical waste that must be disposed of in a biohazard-labeled container rather than regular trash?

• A. A patient information sheet used during the visit.
• B. A gauze pad saturated with blood from a venipuncture site.
• C. An empty, unused tube wrapper.
• D. A used alcohol prep pad wrapper with no blood contact, discarded per facility policy

35. Between each patient encounter, what infection-control practice must a phlebotomist follow regarding gloves?

• A. Gloves only need to be changed after every third patient.
• B. Gloves must be removed and replaced with a new pair for each patient encounter.
• C. The same pair of gloves may be used for multiple patients if visibly clean and free of tears
• D. Gloves may be reused after being wiped with antiseptic between patients.

36. A phlebotomist's workstation surface becomes visibly contaminated with a small amount of blood during specimen processing. What is the correct action before continuing to work at that surface?

• A. Wipe the surface with a dry paper towel and continue working.
• B. Continue working since the contamination is minor and will dry on its own without any further intervention needed
• C. Clean and disinfect the surface using an appropriate EPA-registered disinfectant before resuming work.
• D. Cover the contaminated area with a clean paper towel and work around it.

37. Which statement best describes the purpose of an exposure control plan in a facility where phlebotomy is performed?

• A. It applies only to laboratory management and not to phlebotomists performing direct patient care or specimen handling on any shift
• B. It outlines procedures to minimize employee exposure to bloodborne pathogens and the steps to take if exposure occurs.
• C. It is a voluntary document used only for new-employee orientation.
• D. It replaces the need for personal protective equipment during specimen collection.

38. During a draw, a patient discloses that they feel unsafe at home. What is the technician's most appropriate action within scope?

• A. Advise the patient on exactly what legal steps to take.
• B. Investigate the situation by asking detailed questions about the home.
• C. Keep the information private to respect the patient's confidentiality and say nothing to anyone else on the care team
• D. Acknowledge the disclosure supportively and report it to the appropriate provider or supervisor per protocol.

39. After completing a venipuncture, what is the most appropriate way for a phlebotomist to handle the used needle?

• A. Set it on the tray until the end of the shift, then discard it
• B. Recap it with two hands before disposal
• C. Activate its safety device and place it directly in a sharps container
• D. Bend the needle to prevent reuse before disposing of it in the regular trash

40. Which sequence best represents the correct order for donning personal protective equipment (PPE) before entering an isolation room?

• A. Goggles, gloves, gown, mask
• B. Mask, gloves, gown, goggles
• C. Gown, mask, goggles, gloves
• D. Gloves, gown, mask, goggles

41. Under standard precautions, how should a phlebotomist treat every patient's blood and body fluids?

• A. As safe once the patient has tested negative once
• B. As infectious only when the patient has a documented diagnosis of a bloodborne pathogen
• C. As potentially infectious regardless of the patient's known status
• D. As requiring precautions only in the emergency department

42. A patient becomes verbally hostile, raising their voice about a long wait. Which de-escalation approach is most appropriate for the technician?

• A. Match the patient's tone to show the concern is being taken seriously.
• B. Remain calm, listen without interrupting, and acknowledge the frustration.
• C. Warn the patient that the draw will be refused if the behavior continues without any further explanation
• D. Ignore the complaint and begin the procedure.

43. A patient scheduled for a two-hour certification-style testing accommodation asks the technician why a blood draw takes so much less time than an exam. Which reply is most professionally appropriate?

• A. "Because the exam is 100 questions and this is just one stick, so naturally it's much quicker to complete."
• B. "I have no idea how long anything takes."
• C. "A venipuncture usually takes only a few minutes; I'll explain each step so you know what to expect."
• D. "Please don't ask questions during the procedure."

44. A phlebotomist is asked by a community-health coordinator to help promote a wellness screening event. Which action best aligns with the phlebotomist's professional role?

• A. Providing accurate general information about what the screening involves and who may benefit
• B. Promising attendees that screening will cure existing conditions they may already have, without any further treatment
• C. Collecting specimens without any patient consent to save time
• D. Telling attendees they do not need to see a provider afterward

45. During a draw, a patient expresses anxiety about needles and says they may avoid future blood work. Which response best promotes ongoing patient health?

• A. Acknowledging the patient's concern and explaining comfort techniques that can make future draws easier
• B. Advising the patient to permanently avoid all future lab testing
• C. Telling the patient their fear is irrational and they should get over it before the next scheduled blood draw
• D. Diagnosing the patient with a phobia and recommending medication

46. A patient asks the phlebotomist for lifestyle advice to improve their cholesterol. What is the most appropriate way to promote the patient's health?

• A. Prescribing a specific low-fat diet and daily exercise regimen tailored to the patient's cholesterol numbers
• B. Telling the patient exactly which supplements to purchase
• C. Encouraging the patient to discuss lifestyle goals with their provider or a dietitian
• D. Assuring the patient that lab results do not matter

47. Which behavior best demonstrates a phlebotomist modeling healthy practices that support a culture of wellness in the workplace?

• A. Reusing single-use supplies to reduce cost
• B. Encouraging coworkers to ignore safety guidelines whenever the daily workload becomes heavy
• C. Consistently following hand hygiene and infection-control practices
• D. Skipping protective equipment to work faster

48. A patient mentions they rarely get routine checkups because they feel healthy. How can the phlebotomist best promote preventive health within their role?

• A. Gently noting that routine visits can help identify concerns early and encouraging the patient to talk with their provider
• B. Telling the patient that feeling healthy means checkups are unnecessary until symptoms actually appear and become impossible to ignore
• C. Ordering additional tests independently to prove a point
• D. Insisting the patient is definitely ill without any evidence

49. Which layer of a blood vessel does the needle bevel pass through last before entering the lumen?

• A. The tunica adventitia
• B. The tunica intima
• C. The tunica media
• D. The endosteum

50. Which tube additive works by inhibiting glycolysis to preserve glucose in the specimen?

• A. EDTA, in the lavender-topped tube
• B. Sodium heparin, in the green-topped tube
• C. A clot activator, in the red-topped tube
• D. Sodium fluoride, in the gray-topped tube

51. Which term describes the liquid portion of blood obtained from a tube containing an anticoagulant?

• A. Plasma, from which fibrinogen has been removed by clotting
• B. Plasma, which still contains fibrinogen
• C. Whole blood
• D. Serum, which still contains fibrinogen

52. A light blue sodium citrate tube must be filled to the indicated fill line. Why is the fill volume critical for this tube specifically?

• A. Underfilling causes the tube to clot immediately
• B. The anticoagulant-to-blood ratio is fixed, so underfilling dilutes the sample and falsely prolongs coagulation results
• C. The laboratory cannot centrifuge a partially filled tube, so any short draw is simply spun for a longer cycle to compensate
• D. Fill volume affects only the appearance of the specimen

53. After filling an additive tube, how should it be mixed?

• A. By shaking briskly for several seconds
• B. By rolling it rapidly between the palms
• C. It does not require mixing if drawn promptly and delivered to the laboratory within a few minutes of collection
• D. By gentle inversion the number of times the manufacturer specifies

54. A phlebotomist is selecting a needle for a patient with small fragile veins. Which gauge consideration applies?

• A. A higher gauge number indicates a larger bore
• B. A higher gauge number indicates a smaller bore, and an excessively small bore increases hemolysis risk
• C. Gauge has no relationship to hemolysis, since shear damage to red cells depends only on centrifuge speed
• D. The largest available bore should always be used

55. During venipuncture the needle is inserted and no blood flows into the tube. Which corrective action is appropriate?

• A. Probe laterally with the needle until the vein is located
• B. Withdraw the needle completely and reinsert at the same site immediately
• C. Slightly adjust needle depth or angle, or try a new tube, without probing laterally
• D. Increase the vacuum by pressing harder on the tube, which restores flow when a vein has partially collapsed

56. A patient reports sudden severe shooting pain radiating down the arm during needle insertion. What is the immediate action?

• A. Complete the draw quickly to minimize the duration of pain
• B. Reposition the needle deeper to bypass the painful area
• C. Continue and document the complaint afterward, since transient nerve sensations resolve on their own quickly
• D. Discontinue the draw immediately and remove the needle, then report the event

57. Blood entering the tube appears bright red and pulsating, and the tube fills unusually quickly. What has most likely occurred?

• A. Arterial puncture, requiring immediate needle removal and firm prolonged pressure
• B. A normal venous draw in a well-oxygenated patient, since pulse oximetry above 95 percent can redden venous blood
• C. Hemolysis of the specimen
• D. Vacuum failure in the tube

58. A hematoma begins forming during venipuncture. What is the correct response?

• A. Continue the draw and apply pressure afterward
• B. Discontinue the draw, remove the needle and apply firm pressure to the site
• C. Massage the area to disperse the collected blood back into circulation before it can organize into a bruise
• D. Apply a heat pack immediately

59. A heel stick is performed on a newborn. Which area of the heel is appropriate?

• A. The center of the heel pad for maximum blood flow, since the fat pad there is thickest in a full-term newborn
• B. The posterior curvature of the heel
• C. The medial or lateral plantar surface, avoiding the center and the posterior curvature
• D. The arch of the foot

60. Why is a capillary puncture site sometimes warmed before collection?

• A. Warming sterilizes the skin
• B. Warming prevents hemolysis in the collection device by keeping the lancet and capillary tube above body temperature
• C. Warming is required to activate the lancet
• D. Warming increases blood flow to the site, improving collection and reducing the need to squeeze

61. In capillary collection, what is the order of draw and why does it differ from venipuncture?

• A. Hematology specimens are collected first because platelets begin aggregating at the puncture site
• B. The order is identical to venipuncture
• C. Order does not matter in capillary collection
• D. Serum specimens are collected first, as in venipuncture, because clot activator works fastest on capillary blood

62. A phlebotomist is using a winged infusion set to draw a coagulation specimen as the first tube. What additional step is required?

• A. No additional step is needed
• B. Draw a discard tube first to fill the tubing dead space
• C. Overfill the citrate tube to compensate, since extra blood offsets the volume held in the winged set's tubing
• D. Use a larger gauge needle

63. At what angle should the needle be inserted for a routine venipuncture?

• A. Approximately 45 to 60 degrees, bevel down
• B. 90 degrees, perpendicular to the skin
• C. Approximately 15 to 30 degrees, bevel up
• D. Parallel to the skin surface

64. After the needle is withdrawn, what is the correct immediate action at the puncture site?

• A. Have the patient bend the arm up at the elbow to hold the gauze, which seats pressure directly over the puncture
• B. Apply a bandage immediately without pressure
• C. Ask the patient to rub the site
• D. Apply pressure with gauze and keep the arm straight until bleeding stops

65. Which vein lies closest to the brachial artery and the median nerve, making it the last choice in the antecubital fossa?

• A. The basilic vein
• B. The median cubital vein
• C. The cephalic vein
• D. The subclavian vein

66. Which formed element of blood is primarily responsible for hemostasis?

• A. Plasma proteins alone, since fibrinogen circulating in plasma forms the entire clot without cellular involvement
• B. Platelets, also called thrombocytes
• C. Erythrocytes
• D. Neutrophils

67. Which tube type is generally used for a complete blood count?

• A. Lavender EDTA
• B. Gray sodium fluoride
• C. Gold serum separator
• D. Light blue sodium citrate

68. Which information must appear on a specimen label at minimum?

• A. Patient identifiers, date and time of collection, and the collector's identification
• B. The ordering provider's home contact information, listed so the laboratory can reach them after hours
• C. The expected result range
• D. The patient's diagnosis and insurance carrier

69. A phlebotomist has made two unsuccessful attempts on a patient. What is the appropriate next step?

• A. Continue attempting until successful
• B. Cancel the order and document that the test is not needed, since two failed attempts usually means the test was unnecessary
• C. Attempt a third time at the same site
• D. Stop and ask another qualified phlebotomist to attempt the collection

70. Why is the needle typically inserted with the bevel facing upward during routine venipuncture?

• A. It has no effect on the procedure and is done purely by convention, since needle orientation cannot influence flow through the lumen
• B. It reduces the total volume of blood needed for testing.
• C. It causes the vein to dilate more quickly.
• D. It allows smoother entry into the vein and helps ensure efficient blood flow into the tube.

71. Which explanation best describes why the standard order of draw begins with blood culture bottles and coagulation tubes before other additive tubes?

• A. They must be drawn first because they require the largest blood volume of any tube type.
• B. Culture bottles and coagulation tubes contain no additives, so order does not actually matter for them as long as they are drawn within the same overall venipuncture encounter and mixed promptly afterward
• C. They are drawn first purely due to their color-coding placement on the collection tray.
• D. Drawing blood cultures first preserves specimen sterility, and drawing coagulation tubes early avoids additive carryover from other tubes that could interfere with clotting results.

72. A phlebotomist applies a tourniquet to locate a vein but has difficulty finding a suitable site. What is the recommended maximum time to leave a single tourniquet application in place before releasing and reapplying?

• A. There is no time limit as long as the patient does not complain.
• B. About one minute.
• C. Ten minutes.
• D. Five minutes.

73. A phlebotomist collects blood using a syringe and must transfer it into multiple evacuated tubes. Which practice is correct?

• A. Transfer the blood by removing tube stoppers and pouring the specimen in directly.
• B. Push the plunger forcefully to speed the transfer process into each tube.
• C. Fill the tubes in any convenient order since the syringe method is not affected by additive carryover between tube types or exposure time before transfer
• D. Use a safety transfer device and fill the tubes following the same standard order of draw used for direct tube collection.

74. A phlebotomist inserts the needle but does not obtain blood flow, and probing is not achieving results. What is the correct next step?

• A. Withdraw the needle completely and, if permitted, attempt a new site with a fresh needle.
• B. Leave the needle in place and ask a colleague to attempt the draw from the same needle without repositioning it first
• C. Insert a second needle alongside the first without withdrawing it.
• D. Continue probing at different angles until blood flow is achieved.

75. Which mechanism describes how the anticoagulant in a lavender-top tube prevents blood from clotting for CBC testing?

• A. It coats the tube interior to physically block platelet activity.
• B. It dissolves the fibrin clot after it forms.
• C. It chelates calcium, which is required for the coagulation cascade to proceed.
• D. It raises the pH of the specimen to inhibit clotting enzymes for the entire duration of the tube's shelf life

76. A phlebotomist accidentally draws tubes out of the standard order of draw sequence. What is the primary concern with this deviation?

• A. The patient is more likely to develop a hematoma.
• B. The blood may change color, making visual inspection difficult for the laboratory technologist reviewing it
• C. The tubes will take longer to reach the laboratory.
• D. Additive from an earlier tube can carry over into a later tube and alter that specimen's results.

77. When only a single tube is being collected by direct venipuncture with a standard evacuated tube holder, why is a discard tube generally unnecessary?

• A. There is no prior tube additive present in the system that could contaminate the single specimen being drawn.
• B. Discard tubes are required only when a winged collection set is used, regardless of what is drawn first or which tube follows it
• C. A discard tube is never required under any circumstance in phlebotomy.
• D. Discard tubes are only used for coagulation studies drawn by syringe.

78. Which vein is generally the first choice for routine venipuncture in the antecubital area due to its size, stability, and relatively low risk of nerve or artery involvement?

• A. Cephalic vein.
• B. Median cubital vein.
• C. Radial vein, located near the wrist and easily palpated in most patients.
• D. Basilic vein.

79. During a capillary collection, a phlebotomist repeatedly squeezes the puncture site firmly to increase blood flow. What is a likely consequence of this technique?

• A. It significantly reduces the risk of clot formation in the sample.
• B. It can introduce excess tissue fluid and cause hemolysis, affecting the accuracy of results.
• C. It is required for accurate capillary glucose testing and should always be done regardless of specimen type ordered
• D. It has no effect on the specimen and is an acceptable way to speed collection.

80. When performing a venipuncture using a syringe rather than an evacuated tube system, what technique consideration is unique to the syringe method?

• A. The needle gauge selection becomes irrelevant with a syringe, since plunger control governs flow rate entirely
• B. The order of draw no longer applies once a syringe is used.
• C. Antiseptic site preparation is not required when using a syringe.
• D. The phlebotomist must control plunger withdrawal speed manually to avoid hemolysis or vein collapse.

81. Physiologically, what causes a hematoma to form when a vein is punctured during venipuncture?

• A. Blood leaks from the vein into surrounding tissue, often because the vein wall was not adequately sealed after needle withdrawal.
• B. Blood clots inside the vein and blocks normal flow.
• C. The antiseptic solution reacts with blood at the puncture site, producing a chemical irritation that mimics a hematoma and slows normal clotting
• D. The needle punctures the artery instead of the vein.

82. A phlebotomist notices localized redness, itching, and small raised bumps on a patient's skin immediately after applying an antiseptic wipe, before any needle has touched the skin. What does this most likely indicate?

• A. Early signs of infection at the intended puncture site.
• B. An expected and harmless response to any skin cleansing product.
• C. A possible allergic reaction to the antiseptic, which should be addressed before proceeding.
• D. A normal reaction indicating the site has been adequately prepared and disinfected for the venipuncture

83. A specimen is collected for a chain of custody drug screen. What distinguishes this process?

• A. Faster laboratory turnaround than routine specimens, because forensic requisitions bypass the normal testing queue
• B. Collection by any staff member without documentation
• C. Exemption from patient identification requirements
• D. Documented, unbroken transfer of the specimen with signatures at each handoff and tamper-evident sealing

84. Which specimen requires protection from light during transport?

• A. Basic metabolic panel
• B. Complete blood count
• C. Prothrombin time
• D. Bilirubin

85. A specimen for cold agglutinins requires what special handling?

• A. Transport on ice
• B. Maintenance at body temperature until processing
• C. Freezing immediately after collection, which is the standard handling for most cold-reactive antibody titers
• D. No special handling

86. A serum separator tube is centrifuged before the specimen has fully clotted. What is the likely consequence?

• A. Improved separation of the gel barrier, since spinning breaks up any remaining clot before it can trap serum
• B. Faster and more accurate results
• C. Fibrin formation in the serum, which can interfere with analysis and may require recollection
• D. No effect at all

87. A laboratory rejects a specimen labeled "QNS." What does this indicate?

• A. Quality not standardized, meaning the specimen failed a general appearance check rather than a volume check
• B. Questionable nursing supervision
• C. Quick negative screen
• D. Quantity not sufficient — too little specimen was collected for the ordered testing

88. Which of the following is a valid reason for a laboratory to reject a specimen?

• A. The tube label does not match the requisition
• B. The specimen was collected by a student under supervision
• C. The specimen arrived earlier than expected
• D. The tube was filled to the indicated line

89. A specimen must reach the laboratory within a defined stability window. What happens if the window is exceeded?

• A. The specimen may be rejected because analyte concentrations change over time in the collected sample
• B. The laboratory simply notes the delay and reports the result normally, since most analytes are stable indefinitely at room temperature
• C. The result becomes more accurate with additional settling time
• D. Stability windows apply only to urine specimens

90. Why are specimens transported in a sealed secondary container or biohazard bag?

• A. To contain leaks and protect handlers from exposure during transport
• B. To prevent the specimen from clotting
• C. To satisfy a billing requirement
• D. To keep specimens at exactly body temperature, since the bag's material insulates against ambient temperature swings

91. A centrifuge is unbalanced when loaded with an odd number of tubes. What should the operator do?

• A. Run the centrifuge at a lower speed instead
• B. Run it as loaded; modern centrifuges self-balance regardless of how many tubes are placed in the rotor
• C. Add a balance tube of equal weight opposite the odd specimen
• D. Open the lid during the spin to monitor for vibration

92. A serum specimen appears milky and turbid. What is this called and what is a common cause?

• A. Hemolysis, caused by ruptured red cells releasing hemoglobin that tints serum pink to red rather than milky white
• B. Icterus, caused by elevated bilirubin
• C. Normal serum appearance
• D. Lipemia, commonly caused by recent food intake or elevated triglycerides

93. A phlebotomist collects a specimen requiring chilling. Which handling is correct?

• A. Place the tube directly against solid ice cubes, which chills the specimen fastest and most evenly
• B. Place the specimen in an ice slurry rather than directly on solid ice cubes
• C. Freeze the whole blood specimen immediately
• D. Warm the specimen to counteract cooling

94. A specimen must be sent to the laboratory via a pneumatic tube system. Which factor should the phlebotomist consider before sending certain specimen types this way?

• A. Pneumatic tube systems have no effect on any specimen type and may be used without restriction, since the cushioned carrier fully absorbs any acceleration or deceleration force during transit
• B. The mechanical forces of pneumatic transport can cause hemolysis or affect certain fragile specimens, so facility policy on tube-safe specimen types should be followed.
• C. Only urine specimens are affected by pneumatic tube transport.
• D. Pneumatic tube systems always improve specimen integrity compared to hand delivery.

95. After collection, a tube of whole blood for a CBC is transported to the lab but sits unmixed and unprocessed for several hours before analysis. What is a likely consequence?

• A. The delay has no effect because CBC specimens do not require any stability considerations.
• B. The specimen remains completely stable indefinitely as long as it stays at room temperature, since whole blood cells do not change once collected
• C. The delay will cause the specimen to clot, making it unsuitable for testing.
• D. Cellular changes such as swelling or degradation may occur, potentially affecting the accuracy of the cell counts.

96. A phlebotomist is preparing to send several specimens to an outside reference laboratory. Which practice best supports specimen integrity during this longer transport?

• A. Assume all specimens can be shipped at room temperature regardless of test type.
• B. Ship the specimens without documentation since the reference lab already has the original order and matches results by accession number
• C. Combine all specimen types into a single unlabeled bag to save space.
• D. Follow the reference lab's specific packaging, temperature, and time requirements for each specimen type.

97. A phlebotomist notices that a batch of tubes drawn earlier in the shift is now well past the recommended time-to-centrifugation for serum chemistry testing. What is the appropriate action?

• A. Notify the laboratory of the delay so they can assess whether the results remain valid or a redraw is needed.
• B. Relabel the tubes with a new collection time to reflect when they are finally processed.
• C. Discard the tubes without notifying anyone, since they are no longer usable.
• D. Centrifuge the tubes immediately and send them, since exceeding the window has no measurable effect on chemistry analytes.

98. A phlebotomist is aliquoting a serum specimen into multiple smaller tubes for different testing departments. Which practice is essential to maintain specimen integrity and traceability?

• A. Label the aliquots only after they arrive in each department.
• B. Label each aliquot immediately with patient identifiers and appropriate information before it leaves the original tube's location.
• C. Use a single unlabeled dropper across all aliquots to save supplies, since the original tube's label already documents the source of every aliquot
• D. Combine leftover serum from two different patients if volumes are low.

99. Which of the following is generally the best practice when transporting a filled blood specimen tube from the collection site to the laboratory?

• A. Transport the tube inverted continuously throughout transit.
• B. Transport the tube upright in a rack or holder within a secondary container.
• C. Transport the tube loose in a coat pocket for convenience.
• D. Transport the tube on its side to speed clot formation and reduce transit time to the laboratory

100. A coagulation tube is drawn but only fills to about half of its designated fill line. What should happen to this specimen?

• A. It should be topped off with saline to reach the correct volume.
• B. It should be accepted since coagulation tubes have no minimum fill requirement when the ordered test is a screening assay
• C. It should be rejected and redrawn, since an incorrect blood-to-additive ratio can invalidate coagulation results.
• D. It should be sent with a note that results may be slightly less accurate.