Certified Phlebotomy Technician (NHA) Exam Study Guide

100 scored questions.

120 minutes (a two-hour exam).

A scaled score of 390.

Roughly 1.2 minutes per question — 120 minutes divided across 100 scored questions leaves little slack, so don't linger.

Blood culture (sterile) → light blue (sodium citrate) → red/gold (serum) → green (heparin) → lavender (EDTA) → gray (fluoride/oxalate).

It prevents cross-contamination of additives between tubes, which would otherwise skew test results (e.g., EDTA carryover falsely elevating potassium).

EDTA, an anticoagulant that binds calcium; used for hematology tests like the CBC.

The median cubital vein — it is well-anchored, close to the surface, and away from major nerves and arteries.

No longer than one minute — prolonged application causes hemoconcentration, falsely elevating analytes like proteins and cells.

The rupture of red blood cells, releasing contents into serum/plasma; common causes include vigorous mixing, using too small a needle, or drawing too forcefully.

On the medial or lateral plantar surface of the heel; the center is avoided to prevent bone (calcaneus) injury.

Two unique identifiers, typically full name and date of birth, verified against the requisition and ID band.

Draw below the IV site (distal to it) after the IV has been paused per policy, and note it; never draw above/proximal to a running IV, as it dilutes and contaminates the sample.

EDTA is an anticoagulant that binds calcium ions, preventing blood from clotting. It is primarily used for hematology testing such as complete blood counts (CBC).

Centrifugation causes the separator gel to form a barrier between the serum and clotted cells. This allows the serum to be separated cleanly from the cellular material without contamination.

A 20-gauge needle is the standard for most routine adult venipuncture. Larger gauges (18) are used for donors and difficult veins; smaller gauges (22-23) are used for geriatric or pediatric patients.

CLIA stands for Clinical Laboratory Improvement Amendments. It is federal legislation that regulates clinical laboratory testing to ensure accuracy and reliability of test results.

Low albumin and electrolyte imbalances (especially low sodium or potassium) can cause edema. Edematous limbs should be avoided for venipuncture since fluids in the tissues can dilute blood specimens.

A hematoma is blood that leaks into surrounding tissues, causing swelling and bruising. You should immediately remove the needle and apply gentle pressure for 3-5 minutes, then apply ice to reduce swelling.

Avoid: areas with bruising or hematomas, edematous limbs, arms with mastectomy or dialysis fistula, scar tissue, and the inner wrist or near the artery. Also avoid drawing above an active IV line.

After two unsuccessful attempts, you should stop and ask another phlebotomist to try. Document the difficulty and notify the patient's nurse or physician. Never make more than two unsuccessful attempts on a single patient.

Butterfly needles (winged infusion sets) are preferred for pediatric patients, geriatric patients with fragile veins, and patients with difficult venipuncture due to their small size and maneuverability.

Chain of custody is the documented record of specimen handling from collection through analysis. It ensures specimen integrity and legal admissibility, particularly important for forensic, legal, and paternity testing.

Handwashing is the most effective method to prevent the transmission of pathogens. It removes microorganisms and breaks the chain of infection, protecting both the phlebotomist and the patient.

Immediately wash the site with soap and water, encourage bleeding by gently squeezing the wound, apply an antiseptic, and cover with a bandage. Report the incident to your supervisor and follow your facility's exposure protocol and bloodborne pathogen procedures.

Discard the specimen immediately. Clean up any spill with appropriate disinfectant (typically 10% bleach solution or facility-approved sanitizer). Do not attempt to re-collect into the same tube; use a new tube and re-identify the specimen with the patient.

Serum is the liquid portion of clotted blood with no anticoagulant. Plasma is the liquid portion of blood when an anticoagulant is present and prevents clotting. Different tests require different specimens depending on whether anticoagulation is needed.

Key responsibilities include: following proper identification procedures to ensure correct patient and specimen, preventing infection through hand hygiene and aseptic technique, and maintaining patient confidentiality and privacy according to HIPAA regulations.

The three routes are: percutaneous (needle stick or puncture wound), mucous membrane exposure (eyes, nose, mouth), and contact with non-intact skin (cuts, dermatitis, or other breaks in the skin).

A 24-hour urine collection is used to measure substances like creatinine clearance, cortisol, or protein. The patient must discard the first morning void, then collect all urine for exactly 24 hours into a provided container, keeping it refrigerated or on ice.

POL stands for Point-of-Care Laboratory Testing (also called POCT). These are simple tests performed near the patient, such as blood glucose, urinalysis, or rapid strep tests, rather than in the main laboratory.

Proper labeling prevents wrong-patient errors and specimen misidentification. Labels must include: patient name, patient ID or medical record number, date and time of collection, and phlebotomist's initials or identifier.

Syncope is fainting caused by vasovagal response or anxiety. If a patient appears faint: remove the needle immediately, have them lie down or lower their head, loosen tight clothing, and apply a cold compress. Never leave the patient unattended; alert medical personnel.

Quality control involves testing known samples with expected results to verify that laboratory equipment and reagents are functioning correctly. It ensures the accuracy and reliability of patient test results and detects problems before patient specimens are tested.