NHA CPT Practice Test: 30 Free Phlebotomy Questions
30 NHA CPT-style questions with answers and explanations, weighted to the National Healthcareer Association's Certified Phlebotomy Technician exam. The real exam has 120 questions: 100 scored and 20 unscored pretest items in 2 hours, and you need a scaled score of 390 to pass. No account needed: tap an answer to see why, and get your score and weakest area at the end.
Written by Benjamin Tibbs, a phlebotomy studentChecked against CLSI, OSHA, CDC and The Joint CommissionUpdated October 2026
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Answer: C. Keep people away, notify the supervisor, and use a mercury spill kit
Mercury is a hazardous chemical, not a biohazard, so it is handled under the facility's chemical spill procedure with a mercury spill kit, as the Safety Data Sheet directs. It must never be swept, vacuumed, or thrown in the regular or biohazard trash, because that spreads the droplets and vapor. Specimens near the spill should be checked for contamination.
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Answer: D. Drop the entire assembly into the sharps container without recapping
When a safety device fails and a sharps container is available, discard the whole assembly immediately without recapping. OSHA's Bloodborne Pathogens Standard allows recapping only when no alternative is feasible, and forcing a jammed mechanism invites a needlestick. Report the device failure so it can be evaluated.
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Answer: B. Explain that OSHA bans bending used needles and tell the supervisor
OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030) prohibits bending or recapping contaminated needles unless the employer can show no alternative is feasible or a specific medical procedure requires it, and bans shearing or breaking them outright. Every employee has a duty to address unsafe practice. Speaking to the coworker and reporting it to the supervisor uses the facility's safety process; going straight to OSHA skips the internal steps that should come first.
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Answer: A. Wait until a temporary ID band with a unique number is applied, then verify it
The Joint Commission requires two patient identifiers before collection, and a room number never counts. Unconscious or unidentified emergency patients receive a temporary identification band with a unique number under the facility's protocol, and specimens are labeled to match it. A nurse's verbal statement alone does not meet the requirement.
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Answer: C. Proceed, because water and prescribed medications generally do not break a fast
Fasting for glucose and lipid testing means no food or caloric drinks; plain water is allowed. Routine medications are usually taken as prescribed unless the provider gave other instructions. Canceling or splitting the tests would delay care for no reason.
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Answer: B. Do not draw until the nurse resolves the discrepancy
Any mismatch between identifiers, even one digit, must be resolved before collection. The phlebotomist cannot decide which record is right; the nurse or registration staff must confirm the patient's identity and correct the band. Drawing first risks a wrong-patient specimen.
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Answer: C. Discard tube, then light blue, green, lavender
Butterfly tubing holds air that would underfill the first tube. When a light blue citrate tube is first, CLSI calls for a discard tube (a non-additive or another citrate tube) to fill that dead space, so the citrate tube gets the correct 9:1 blood-to-additive ratio. After the discard, the order is light blue, green, then lavender.
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Answer: A. Treat it as an artery: do not puncture it, and find another vein
Veins do not pulsate, so a pulse means the vessel is an artery, most often the brachial artery, which runs near the basilic vein on the inner side of the antecubital area. Puncturing it during venipuncture can cause bleeding, a hematoma, and nerve compression. Choose a vein that does not pulsate, preferably the median cubital.
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Answer: D. Recollect, because an underfilled citrate tube has too much anticoagulant
Light blue tubes depend on a 9:1 ratio of blood to sodium citrate, and most labs require them to be at least 90% full. An underfilled tube has excess citrate, which falsely prolongs PT/INR and PTT, so the specimen is rejected and redrawn. Adding saline would only dilute it further.
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Answer: B. The tube has lost its vacuum, so try a new tube
A flash shows the needle is in the vein, so the first thing to rule out is a tube that has lost its vacuum, which happens with damaged or expired tubes. Try a new tube before moving the needle. If that also fails, adjust the needle position gently; twisting the needle is painful, and a second tourniquet is never used.
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Answer: A. Release the tourniquet, remove the needle, and lower the patient's head
These are warning signs of vasovagal syncope (fainting). Stop the draw at once: release the tourniquet, withdraw the needle and activate the safety device, apply pressure, and have the patient lower their head or lie down while you call for help. A cold compress on the forehead or back of the neck can help. Never keep drawing from a patient who may faint.
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Answer: A. Make a new puncture at a different heel site and fill the remaining circles
Each circle must be filled from one side with a single application of blood. Layering, or adding blood to a partly filled circle, makes the spot uneven and can give inaccurate results, and squeezing adds tissue fluid. If flow stops, warm the heel if needed, make a new puncture at a different spot on the medial or lateral plantar surface, and fill the remaining circles.
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Answer: B. Keep the specimen at 37°C until the serum is separated from the cells
Cold agglutinins are antibodies that attach to red cells below body temperature. If the specimen cools before the serum is separated, they bind to the cells and are removed with the clot, giving a falsely low titer. Collect into a prewarmed tube and keep it at 37°C, for example in a heat block, until it is processed.
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Answer: D. Fist pumping and a long tourniquet time released potassium from the forearm muscles
Repeated fist clenching makes the forearm muscles release potassium, and a prolonged tourniquet adds hemoconcentration; together they are a well-known cause of falsely high potassium. CLSI advises keeping the tourniquet on no more than 1 minute and asking the patient to make a fist without pumping. The test should be recollected with correct technique before anyone acts on the result.
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Answer: D. At least 30 minutes
Serum tubes must clot completely before centrifugation, which takes about 30 minutes in a clot-activator tube for a patient with normal clotting (longer for patients on anticoagulants). Spinning too early leaves fibrin strands in the serum that can clog analyzers. After centrifugation, serum should be separated from the cells within 2 hours of collection.
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Answer: A. It is prohibited in work areas where exposure is reasonably likely
OSHA 29 CFR 1910.1030(d)(2)(ix) prohibits eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses in work areas where there is a reasonable likelihood of occupational exposure. A bench where blood is centrifuged is such an area, so lip balm waits for the break room, after hand hygiene.
Why the other choices are wrong
- B. Clean hands do not make the work area safe. The rule bans the activity in the area itself.
- C. Closed tubes can leak or break, and bench surfaces may be contaminated. The ban covers the whole work area, not only moments when tubes are open.
- D. Laboratory processing areas are exactly where blood is handled. The ban applies to any work area with a reasonable likelihood of exposure.
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Answer: B. Close and lock the container and replace it with a new one
OSHA 29 CFR 1910.1030(d)(4)(iii)(A)(2)(iii) requires sharps containers to be replaced routinely and never allowed to overfill. Once the contents reach the manufacturer's fill line, the lid is closed and locked and a new container is put in place. Reaching into or compressing used sharps is how needlesticks happen.
Why the other choices are wrong
- A. Pushing sharps down by hand invites a needlestick through the glove. Nothing is ever pressed into a sharps container.
- C. Overfilling is exactly what OSHA forbids: needles sticking out of the opening are a stick risk for the next person.
- D. Sharps are never moved out of a container. A bag is not puncture resistant, and opening a used container exposes everything in it.
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Answer: C. Section 4 of the chemical's Safety Data Sheet
Under OSHA's Hazard Communication Standard (29 CFR 1910.1200 and Appendix D), every hazardous chemical has a Safety Data Sheet in a standard 16-section format, and Section 4 gives first-aid measures. Employers must keep SDSs readily accessible in the work area. Rinse the skin with water and report the exposure as well.
Why the other choices are wrong
- A. The exposure control plan covers blood and other potentially infectious materials, not chemical hazards.
- B. A test procedure explains how to run the test. The hazards and first aid for each chemical are on its SDS.
- D. An NFPA 704 diamond rates health, flammability and instability hazards with numbers. It gives no first-aid instructions.
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Answer: D. Move the patient away from the fire
RACE, the fire response taught in most US healthcare facilities, stands for Rescue, Alarm, Contain, Extinguish (or Evacuate). Anyone in immediate danger is moved first, then the alarm is activated, the fire is confined by closing doors, and it is fought only if it is small and you are trained. Follow your facility's fire plan.
Why the other choices are wrong
- A. Alarm comes second. A person in immediate danger is moved first.
- B. Extinguishing comes last, and only for a small fire and a trained user. The patient must be out of danger first.
- C. Containing the fire comes after rescue and alarm. Closing the door with the patient still inside would trap them.
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Answer: A. Lock the screen or log off before walking away
The HIPAA Privacy Rule requires reasonable safeguards against incidental disclosure (45 CFR 164.530(c)), and the Security Rule requires workstation safeguards (45 CFR 164.310). A draw list with names and tests is protected health information, so the screen is locked or the user logs off whenever the workstation is left unattended.
Why the other choices are wrong
- B. An angled screen is still readable by anyone who walks up to it. An unattended workstation is locked.
- C. Patients and visitors use hallways too, and staff without a job-related need to know are not entitled to the list either.
- D. Asking a visitor to watch protected information is itself a disclosure risk, and it stops no one from reading the screen.
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Answer: B. Wake the patient gently, identify them, and explain before drawing
A sleeping patient is never drawn. Identification needs the patient to state their name and date of birth where possible (The Joint Commission requires two identifiers), and a patient who wakes with a needle in the arm may move suddenly and be injured. Wake them gently, identify them, explain the procedure, then draw.
Review: Patient Identification
Why the other choices are wrong
- A. Identification comes before the draw, not after, and a patient startled awake with a needle in place can be hurt.
- C. Routine morning draws are expected to wake patients. Skipping the draw delays care for no reason.
- D. A roommate is not an acceptable identifier. Identity is confirmed with the patient and the wristband.
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Answer: C. Have him lie down for the draw
A patient who has fainted during earlier draws should be drawn lying down, so a vasovagal reaction cannot turn into a fall. Watch him throughout and stop the draw at the first sign of fainting: pallor, sweating, lightheadedness.
Review: Patient Identification
Why the other choices are wrong
- A. A history of fainting during draws makes another episode more likely. Seating him as usual risks a fall.
- B. Standing is the worst position: a patient who faints while standing falls from full height.
- D. Going without food does not prevent fainting and can make it more likely. Unless the test requires fasting, he should eat normally.
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Answer: A. Hold pressure longer and check that bleeding has stopped
Anticoagulants such as warfarin prolong bleeding at the puncture site. The draw proceeds normally, but pressure is held longer and the site is checked to be sure bleeding has stopped before the bandage goes on. If bleeding continues, keep pressure on it and notify the nurse or provider.
Review: Patient Identification
Why the other choices are wrong
- B. Warfarin is not a reason to refuse a draw, and the phlebotomist does not manage medication. Many of these patients are drawn precisely to monitor their PT/INR.
- C. Tourniquet time should not exceed 1 minute for any patient. Longer causes hemoconcentration and does nothing about bleeding.
- D. The site must stop bleeding before the patient leaves. Sending her off still bleeding risks a hematoma.
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Answer: B. About 3 to 4 inches (7.5 to 10 cm) above the site
The tourniquet goes about 3 to 4 inches above the intended site. It slows venous return to the heart so the veins below it fill, and at that distance it is out of the needle's way. It should be snug but never tight enough to stop arterial flow: the radial pulse must still be felt.
Why the other choices are wrong
- A. A tourniquet over the site is in the needle's way and can compress the very vein you need to fill.
- C. Veins fill below (distal to) a tourniquet. Placed below the site, it does nothing for the vein you puncture.
- D. A tourniquet slows venous return without stopping arterial flow. If the radial pulse disappears, it is too tight.
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Answer: C. The right arm
Edematous tissue holds excess fluid that can dilute and contaminate the specimen, and the veins in it are hard to find and slow to heal. Sites with edema are avoided, so the draw is done on the unaffected right arm.
Why the other choices are wrong
- A. Edema hides veins rather than showing them, and tissue fluid can dilute the specimen.
- B. The hand on the swollen side is still part of the edematous limb. Use the unaffected arm.
- D. Massaging the site pushes tissue fluid around and can alter results. It does not remove the edema.
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Answer: D. Attach a safety transfer device and let each tube fill by its vacuum
Syringe blood goes into tubes through a safety transfer device, not a needle pushed through stoppers by hand. OSHA's Bloodborne Pathogens Standard requires engineering controls that remove the hazard, and the device keeps fingers away from the needle. Tubes fill by their own vacuum, in the order of draw; forcing the plunger hemolyzes the cells and can pop the stopper.
Why the other choices are wrong
- A. Opening the tubes exposes the blood to splashes and upsets each tube's blood-to-additive ratio.
- B. Pushing a needle through stoppers by hand risks a needlestick, and pressing the plunger hemolyzes the cells.
- C. Recapping is prohibited except where no alternative is feasible, and the delay lets the blood start clotting in the syringe.
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Answer: A. The aerobic bottle
Butterfly tubing holds air. Filling the aerobic bottle first sends that air into the bottle meant for organisms that use oxygen, instead of into the anaerobic bottle, as blood culture manufacturers (BD BACTEC) and laboratory collection guides direct for winged sets.
Why the other choices are wrong
- B. The air in the butterfly tubing would go into the anaerobic bottle and can hinder the growth of anaerobes.
- C. With a butterfly the order matters, because of the air in the tubing.
- D. A discard tube before the cultures would add a stopper puncture ahead of the sterile collection. Blood cultures come first in the order of draw.
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Answer: B. He should stay seated, and not smoke or eat until the last draw
During a glucose tolerance test the patient may not eat, smoke or chew gum, and stays at rest in the waiting area until the final specimen, because food, smoking and activity all change glucose levels. Water is usually allowed, per the laboratory's instructions.
Why the other choices are wrong
- A. Smoking changes glucose metabolism and is not allowed during the test.
- C. Eating invalidates the test outright, and walking around and smoking also change the results.
- D. No food of any kind until the last draw; only water, where the laboratory allows it.
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Answer: C. Falsely low, because cells keep using glucose until serum is separated
Red and white cells keep consuming glucose (glycolysis) until the serum is separated from them, lowering glucose by roughly 5% to 7% an hour. CLSI recommends separating serum or plasma from cells within 2 hours of collection, so a tube left unspun for 4 hours gives a falsely low glucose (a fluoride tube is used when a delay is unavoidable).
Why the other choices are wrong
- A. The gel forms its barrier only during centrifugation. Before spinning, the serum is still in contact with the cells.
- B. Glucose goes down, not up: the cells consume it.
- D. Refrigeration slows glycolysis, but it cannot restore glucose the cells have already used.
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Answer: D. Cover it with gauze and twist it off behind a splash shield
OSHA's Bloodborne Pathogens Standard requires procedures involving blood to be done in a way that minimizes splashing and spraying (29 CFR 1910.1030(d)(2)(xi)). Opening a tube behind a splash shield, with gauze over the stopper and a slow twist away from the body, contains the droplets and aerosol a popped stopper releases. Gloves are worn throughout.
Why the other choices are wrong
- A. Popping a stopper sprays droplets and aerosol; aiming it away does not contain them.
- B. Blood specimens are never handled with bare hands. Gloves are required.
- C. An open tube at eye level puts the face in the path of any splash. Open it below face level, behind a shield.
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Question counts, time limits and passing scores from each certifying body's own documents, checked October 6, 2026.
| Exam | Questions | Time | Passing score | Practice |
|---|---|---|---|---|
| NHA CPTNational Healthcareer Association | 120 questions: 100 scored and 20 unscored pretest items | 2 hours | 390 (scaled score from 200 to 500) | This page |
| ASCP PBTAmerican Society for Clinical Pathology Board of Certification | 80 multiple-choice questions | 2 hours | 400 (scaled score) | ASCP PBT practice exam |
| AMT RPTAmerican Medical Technologists | 200 scored questions (AMT exams may also include unscored pretest items) | 2.5 hours | 70 (scaled score from 0 to 100) | AMT RPT practice exam |
More detail: how each exam is scored · retake rules · NHA vs ASCP vs AMT · all exam facts with sources · general phlebotomy practice test