Phlebotomy Practice Test

1. 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

2. 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

3. 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

4. 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.

5. 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

6. 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.

7. 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

8. A phlebotomist prepares to clean a venipuncture site with an antiseptic. What technique is generally recommended for applying the antiseptic to routine venipuncture sites?

• A. Wipe repeatedly back and forth across the site
• B. Blow on the site to speed drying
• C. Cleanse the site and allow the antiseptic to air-dry before puncture
• D. Wipe the site once and puncture immediately while still wet with antiseptic

9. 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.

10. 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

11. 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

12. 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

13. 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

14. 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.

15. 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

16. 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

17. 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

18. 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.

19. 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

20. 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

21. 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

22. 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

23. 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.

24. 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

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. 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.

27. 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

28. 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

29. 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

30. 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

31. While drawing blood, a patient offhandedly says, 'Sometimes I feel like nothing matters anymore.' Which response best reflects appropriate psychosocial support within the phlebotomist's role?

• A. Acknowledge the comment with concern, and alert the appropriate clinical staff so the patient can be further evaluated.
• B. Change the subject quickly to keep the patient's mood light during the draw.
• C. Tell the patient that everyone feels that way sometimes and it is not a concern.
• D. Ask the patient detailed questions about their mental health history to better understand the comment before continuing with the draw

32. 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

33. A phlebotomist is about to collect a blood specimen from a patient. According to standard infection-control principles, when should hand hygiene be performed?

• A. Only after removing gloves at the end of the procedure
• B. Both before donning gloves and after removing them
• C. Only if the phlebotomist's hands appear visibly soiled
• D. Only before the first patient of the day

34. A phlebotomist working in a pediatric clinic notices a poster campaign about childhood immunization schedules. A parent asks the phlebotomist whether their child's blood draw today is related to vaccines. Which response is most appropriate?

• A. Suggest the parent look at the poster later since the phlebotomist cannot discuss immunizations at all, even in general educational terms with a parent
• B. Clarify that today's blood draw was ordered for a different reason, and direct specific questions about immunizations to the child's provider.
• C. Tell the parent the draw is definitely connected to the vaccine schedule since both involve needles.
• D. Explain to the parent exactly which antibody titers will be tested and what the results will mean.

35. 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.

36. 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

37. 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

38. 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

39. A phlebotomist accidentally sustains a needlestick injury while collecting a specimen. What should be the FIRST action?

• A. Complete the current draw so the specimen is not wasted
• B. Apply a tourniquet above the injury site
• C. Wait until the end of the shift to report the incident
• D. Wash the wound with soap and running water

40. 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

41. 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."

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 with moderate dementia repeatedly asks the same question about why blood is being drawn, each time as if hearing it for the first time. Which approach best supports the patient's psychosocial needs?

• A. Skip the explanation altogether since the patient will not remember it regardless.
• B. Ask a family member to explain the procedure instead so the technician can proceed more quickly.
• C. Explain the procedure once at the start and decline to repeat it further to avoid confusing the patient.
• D. Calmly and patiently re-explain the procedure each time it is asked, using simple, consistent language.

44. A patient states that their religious beliefs require a family member to be present during any medical procedure. How should the technician respond?

• A. Accommodate the request when feasible within facility policy and patient safety.
• B. Explain that visitors are not allowed and proceed alone.
• C. Tell the patient that beliefs have no role in a simple blood draw and cannot be accommodated
• D. Delay the draw indefinitely without further action.

45. 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

46. 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

47. A patient who is deaf and communicates primarily through sign language arrives for a scheduled draw without an interpreter present. Which action is most appropriate?

• A. Proceed with the draw using written notes only, since the procedure itself does not require verbal communication or a consent explanation
• B. Arrange for a qualified interpreter or approved communication service before proceeding with the explanation and consent process.
• C. Ask a family member who happens to be present to interpret all medical information.
• D. Reschedule the appointment indefinitely until the patient arranges their own interpreter.

48. 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

49. 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

50. An older adult appears embarrassed about needing help rolling up a sleeve and apologizes repeatedly. Which technician behavior best supports the patient's dignity?

• A. Point out that many older patients struggle with this.
• B. Ask a coworker to take over so the patient feels less watched during the procedure and less embarrassed overall
• C. Complete the task quickly without comment to avoid awkwardness.
• D. Offer assistance matter-of-factly and reassure the patient that helping is routine.

51. 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

52. 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.

53. A patient from a cultural background where direct eye contact is considered disrespectful avoids looking at the phlebotomist throughout the interaction. Which interpretation and response is most appropriate?

• A. Document the behavior as a concern for the care team to investigate.
• B. Interpret the behavior as a sign the patient does not trust the technician and address it directly before proceeding with the venipuncture
• C. Insist on eye contact to confirm the patient is engaged and understands the instructions.
• D. Recognize that eye-contact norms vary by culture and continue communicating respectfully through verbal cues and tone.

54. 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

55. 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

56. 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

57. 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

58. 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

59. 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.

60. A phlebotomist is about to draw a patient who appears anxious and mentions a prior fainting episode during blood draws. Which action best supports safe and effective care?

• A. Ask the patient to describe every prior medical procedure before continuing.
• B. Proceed with the draw in a standing position to save time.
• C. Delay the draw until the patient's anxiety has completely resolved, even if that takes hours to accomplish before collection
• D. Position the patient in a reclined or seated-with-support position and monitor closely during and after the draw.

61. 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

62. 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.

63. 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.

64. Which specimen requires protection from light during transport?

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

65. 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

66. 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

67. 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.

68. 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.

69. 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

70. 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.

71. 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.

72. 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

73. 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

74. 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

75. 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

76. 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.

77. 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

78. 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

79. 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

80. 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

81. 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.

82. A point-of-care glucose result comes back critically low for a patient. What is the phlebotomist's responsibility regarding this result?

• A. Record the result in the chart and allow the next scheduled provider rounds to catch it, since critical values do not require immediate action beyond standard charting practices.
• B. Repeat the test silently up to three times before reporting anything, regardless of how low the first result was.
• C. Disregard the result if the meter does not display an explicit 'critical' flag on the screen.
• D. Recognize the result as a critical value and report it immediately according to facility protocol, rather than simply filing it with routine results.

83. A laboratory identifies that a specimen collected earlier in the day was hemolyzed and cannot be used for the ordered test. What is an appropriate next step involving the phlebotomy team?

• A. Report the hemolyzed result to the ordering provider as the final value, since redrawing wastes the patient's time and delays care more than an inaccurate result would.
• B. Contact the patient or the ordering unit to arrange recollection of the specimen as soon as practical, per facility protocol.
• C. Wait for the next regularly scheduled draw days later rather than arranging a recollection sooner.
• D. Have the laboratory dilute the hemolyzed specimen with saline to compensate for the affected result.

84. 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

85. 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.

86. 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

87. 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

88. 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.

89. A phlebotomist is preparing to collect a unit from a first-time blood donor at a community blood drive. Before proceeding with the donation, what must be completed?

• A. Confirm only the donor's identity and proceed, since eligibility is assessed solely by a physician after collection, once the unit has already been drawn and sent for testing.
• B. Verify the donor's hemoglobin or hematocrit level, weight, and a complete health-history screening against the collection facility's eligibility criteria.
• C. Skip the health-history screening for first-time donors, since it applies only to repeat donors on later visits.
• D. Collect the unit first and perform the hemoglobin check afterward on the already-collected sample.

90. A physician orders a rapid antigen test requiring a nasal swab from a symptomatic patient. Which technique correctly obtains the specimen?

• A. Insert the swab as deep as possible toward the back of the throat through the nose to reach the nasopharynx for every rapid antigen test, since deeper placement always yields a higher viral load regardless of the manufacturer's instructions.
• B. Wipe the swab only across the outer rim of the nostril without inserting it into the nasal passage.
• C. Use a separate new swab for each nostril and submit them as two entirely separate specimens rather than one.
• D. Insert the swab a short distance into one nostril along the floor of the nasal passage, rotate it against the nasal wall for several seconds, then repeat in the other nostril with the same swab if the test requires it.

91. A physician orders a throat culture to evaluate a patient for possible streptococcal pharyngitis. Which technique correctly obtains the specimen?

• A. Swab the inside of the cheeks and under the tongue, since additional saliva volume improves culture sensitivity for organisms living throughout the entire oral cavity.
• B. Have the patient swab their own tonsils at home and mail the specimen to the laboratory for testing.
• C. Swab only the front teeth and gum line, since streptococcal organisms colonize the gums before the throat.
• D. Swab the posterior pharynx and tonsillar areas, including any areas of visible exudate or inflammation, while avoiding the tongue, cheeks, or teeth.

92. A phlebotomist is preparing to collect a specimen for legal blood alcohol testing. Why must the skin antisepsis agent used for this collection differ from the alcohol-based antiseptic used for routine venipuncture?

• A. Alcohol-based antiseptics simply take longer to dry than non-alcohol alternatives, which is the only reason for the substitution, with no bearing on the accuracy of the alcohol level measured.
• B. An alcohol-based antiseptic could contaminate the site and falsely elevate the specimen's measured alcohol concentration, so a non-alcohol antiseptic is used instead.
• C. Non-alcohol antiseptics are required because alcohol-based products are not effective at reducing skin flora.
• D. The antiseptic choice makes no difference to the result, and a non-alcohol product is used only for patient comfort.

93. A phlebotomist is about to collect several tubes from a small pediatric patient for multiple ordered tests. Before drawing, what should the phlebotomist do to avoid exceeding a safe collection volume for this patient?

• A. Use the same maximum volume guideline applied to adult patients, since draw limits do not vary by patient size.
• B. Estimate the safe volume visually based on the child's general appearance rather than a weight-based reference.
• C. Consult a pediatric maximum-draw volume reference based on the patient's weight and compare it against the total volume of all ordered tubes combined.
• D. Draw the tests in the order received without totaling volume, since individual tube fill lines already account for patient size and cannot be exceeded regardless of how many tubes are ordered.

94. A nurse asks a phlebotomist to assist by receiving a blood specimen drawn from a critically ill patient's non-tunneled central venous line rather than performing a venipuncture. What is the phlebotomist's role in this situation?

• A. Independently access and flush the central line and draw the specimen without nursing involvement.
• B. Refuse to participate at all, since central line specimens fall entirely outside any phlebotomy-related task, even when a nurse has already accessed the line and only needs help with labeling.
• C. Perform a standard peripheral venipuncture instead, disregarding the request to use the existing line.
• D. Assist by preparing labeled tubes and following facility protocol for handling the line-drawn specimen, since accessing the line itself is performed by qualified nursing staff.

95. Immediately after a patient provides a urine specimen for a workplace drug screen, what should the collector do before the patient leaves the collection area?

• A. Check and record the specimen's temperature within the required short window after collection to help detect a substituted or diluted specimen.
• B. Skip a temperature check entirely, since chain-of-custody documentation alone is sufficient to validate the specimen.
• C. Check the specimen's temperature only if the patient specifically requests that it be checked.
• D. Allow the specimen to reach room temperature over the next hour before checking anything, since immediate readings are unreliable and do not reflect the specimen's true temperature at collection.

96. A wound care nurse asks a phlebotomist to obtain a wound culture from a patient's surgical site with visible drainage. Which technique correctly collects a specimen likely to reflect the actual infection?

• A. Cleanse the wound of surface exudate and debris first, then swab the wound bed or margins of viable tissue rather than surface drainage.
• B. Swab the surface drainage directly without cleansing first, since cleansing would remove the organisms causing the infection along with the surrounding contaminating flora.
• C. Swab only the intact skin surrounding the wound, avoiding contact with the wound itself entirely.
• D. Collect the specimen by wringing out the dressing that had been covering the wound.

97. A phlebotomist performs a point-of-care urine pregnancy test and steps away before reading the result. When the phlebotomist returns twenty minutes later, a faint line has appeared in the test window. How should this result be interpreted?

• A. The faint line confirms a positive result regardless of when it was read after the test began.
• B. The result is valid as long as the control line is also visible, no matter how much time has passed.
• C. The result should be considered invalid, since it was not read within the manufacturer's specified time window, and the test should be repeated with a new device.
• D. A delayed reading only affects negative results, so a line appearing late always means the test is positive, regardless of how many minutes have passed since it started.

98. A physician orders blood cultures to evaluate a hospitalized patient for possible bacteremia and requests two sets, each from a separate venipuncture. Why are cultures typically collected from two different sites rather than one?

• A. A single site cannot physically supply enough blood volume for the ordered number of bottles, so a second site is only needed when more than two bottles are requested.
• B. Hospital policy requires two sites purely so each set can be billed as a separate procedure.
• C. Growth in cultures from two separate sites is more likely to represent true bacteremia, while growth from only one site more often reflects skin-flora contamination.
• D. Drawing from two sites allows the laboratory to test each set for a different organism.

99. A physician orders a lactose tolerance test to evaluate a patient for suspected lactose intolerance. How does specimen collection for this test proceed?

• A. A fasting baseline blood glucose is drawn, the patient consumes a measured lactose load, and additional timed blood glucose specimens are drawn at defined intervals afterward, similar in structure to a glucose tolerance test.
• B. A single random blood glucose is drawn at any point in the day, without fasting or any timed intervals.
• C. Only a stool specimen is collected, since this particular test assesses digestion products rather than blood glucose.
• D. Blood glucose is measured once immediately before the lactose load is consumed, and no further specimens are collected, since the single pre-load value alone is always considered fully sufficient to diagnose lactose intolerance.

100. A phlebotomist is filling out a newborn screening filter paper card from a heel stick to test for conditions such as PKU. What technique correctly saturates each printed circle on the card?

• A. Touch one large drop of blood to the center of each circle and let it soak through and fill the circle from a single application, without layering more drops on top.
• B. Apply several small drops to each circle in layers until the circle appears fully filled.
• C. Smear the blood across each circle using the corner edge of the card to spread it evenly.
• D. Press the filter paper card directly against the puncture site to transfer blood onto the circle, which most quickly and evenly saturates the entire printed circle in one motion.