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NHA Certified Phlebotomy Technician (CPT) practice questions and answers

20 free questions from our 300-question NHA Certified Phlebotomy Technician (CPT) bank, each with the correct answer, explanation, and source note. Official format: 120 items (100 scored + 20 pretest) · 2-hour limit · 390 scaled score to pass.

Questions last updated September 22, 2026 · Questions written from the NHA CPT Test Plan and the ASCP PBT content guideline; not official or recalled NHA items.

1. Exposure control

   1. A phlebotomist accidentally punctures a finger with a used needle. What is the FIRST action they should take?

   1. AReport the incident to a supervisor later
   2. BPlace the needle back in the sharps container
   3. CApply a bandage and continue working
   4. DWash the wound with soap and water immediately

   Answer: D. The correct answer is washing the wound with soap and water immediately. OSHA's Bloodborne Pathogens Standard requires that exposures to infectious materials be reported promptly and that first aid be administered immediately. Washing the puncture site with soap and water is the critical first step to reduce the risk of infection. Applying a bandage without cleaning the wound does not adequately reduce risk. Reporting later delays necessary post-exposure evaluation. Placing the needle back in the sharps container addresses disposal but not the wound itself.

   Source: OSHA Bloodborne Pathogens Standard — 29 CFR 1910.1030

2. Transmission precautions

   2. Which type of precaution requires a healthcare worker to wear a gown, gloves, mask, and eye protection when entering a patient's room?

   1. ATransmission-based precautions
   2. BStandard precautions only
   3. CContact precautions only
   4. DDroplet precautions only

   Answer: A. The correct answer is transmission-based precautions. These are used in addition to standard precautions when a patient is known or suspected to be infected with organisms that are spread via airborne, droplet, or contact routes. Full barrier PPE including gown, gloves, mask, and eye protection may be required depending on the mode of transmission. Standard precautions apply to all patients but do not typically require all four items. Droplet and contact precautions are subsets of transmission-based precautions, not equivalent to the full set.

   Source: CDC/HICPAC — Guideline for Isolation Precautions

3. Sharps disposal

   3. A phlebotomist needs to dispose of a used butterfly needle. Where should it be placed?

   1. AThe utility room sink for later pickup
   2. BA labeled, puncture-resistant sharps container
   3. CA biohazard bag on the counter
   4. DA regular trash can lined with a plastic bag

   Answer: B. The correct answer is a labeled, puncture-resistant sharps container. OSHA mandates that contaminated sharps be discarded immediately into containers that are closable, puncture-resistant, leakproof, and labeled or color-coded. Regular trash bags offer no puncture protection and pose an injury risk. Biohazard bags are for soft contaminated waste, not sharps. Utility room sinks are never appropriate disposal sites. Containers must be replaced when three-quarters full to prevent overflows and needle-stick injuries during use or handling.

   Source: OSHA Bloodborne Pathogens Standard — 29 CFR 1910.1030(d)(4)(iii)(A)

4. Hipaa privacy

   4. Under HIPAA, a patient's blood test results can be shared with which of the following without additional patient authorization?

   1. AA coworker not involved in the patient's care
   2. BA friend of the patient who asks at the front desk
   3. CThe patient's employer
   4. DThe patient's treating physician

   Answer: D. The correct answer is the patient's treating physician. HIPAA's Privacy Rule permits covered entities to use and disclose protected health information for treatment, payment, and healthcare operations without separate patient authorization. The treating physician falls under the treatment exception. Sharing results with coworkers not involved in care violates minimum necessary standards. The patient's employer and friends have no treatment relationship and require explicit written authorization from the patient to receive any health information.

   Source: HIPAA Privacy Rule — 45 CFR 164.506

5. Patient identification

   5. Before performing a venipuncture, a phlebotomist must verify the patient's identity using how many patient identifiers?

   1. AOnly the patient's name on the wristband
   2. BThe patient's Social Security number
   3. CTwo identifiers, such as name and date of birth
   4. DThe medical record number alone

   Answer: C. The correct answer is two identifiers, such as name and date of birth. The Joint Commission's National Patient Safety Goal NPSG.01.01.01 requires the use of at least two patient identifiers when collecting specimens. This prevents mislabeling and ensures the specimen matches the correct patient. Relying only on name is insufficient since patients may share names. Medical record number alone is one identifier and needs pairing. Social Security numbers are not recommended identifiers and are rarely used at bedside for specimen collection.

   Source: The Joint Commission — NPSG.01.01.01

6. Patient communication

   6. A patient tells the phlebotomist they have a fear of needles and feel dizzy. What is the BEST approach?

   1. AAsk a nurse to restrain the patient for the draw
   2. BIgnore the comments and focus on locating a vein
   3. CTell them the draw will be quick and begin immediately
   4. DHave the patient lie down, speak calmly, and proceed only when stable

   Answer: D. The correct answer is to have the patient lie down, speak calmly, and proceed only when stable. A patient experiencing a vasovagal response or anxiety needs to be placed in a supine or Trendelenburg position to prevent fainting and injury. Calm reassurance helps reduce anxiety. Rushing the procedure increases the risk of a syncopal episode. Ignoring the patient's concerns violates standards of care. Restraining a patient is never appropriate and could constitute assault or battery.

   Source: NHA CPT Test Plan — Section 2C: Communication

7. Order of draw

   7. Which order of draw is correct for a routine venipuncture using evacuated tubes?

   1. ABlood culture, coagulation tube, SST, heparin, EDTA, glycolytic inhibitor
   2. BEDTA, SST, coagulation tube, blood culture, heparin
   3. CSST, EDTA, blood culture, glycolytic inhibitor, heparin
   4. DCoagulation tube, EDTA, blood culture, SST, glycolytic inhibitor

   Answer: A. The correct answer is blood culture, coagulation tube, SST, heparin, EDTA, glycolytic inhibitor. The order of draw prevents cross-contamination of additives between tubes. Blood cultures are drawn first to minimize contamination risk. Coagulation tubes must follow blood cultures because tissue thromboplastin can affect clotting times. SST comes before heparin and EDTA. EDTA is drawn before glycolytic inhibitors because potassium EDTA can interfere with certain tests. Incorrect order can cause erroneous results due to additive carryover between tubes.

   Source: CLSI GP41-A7 — Order of Draw

8. Tube additives

   8. What color top does a tube containing EDTA have?

   1. ALavender or purple
   2. BBlue
   3. CGreen
   4. DRed

   Answer: A. The correct answer is lavender or purple. EDTA (ethylenediaminetetraacetic acid) tubes have a lavender or purple stopper and are used for hematology tests such as complete blood counts and hemoglobin A1c. EDTA binds calcium to prevent clotting while preserving cell morphology. Red-top tubes contain no additive or a clot activator. Blue-top tubes contain sodium citrate for coagulation studies. Green-top tubes contain heparin for chemistry tests. Knowing tube colors is essential for correct test ordering and specimen collection.

   Source: NHA CPT Test Plan — Section 3B: Tube Additives

9. Adverse reactions

   9. A patient begins to feel faint during a venipuncture. What position should the patient be placed in?

   1. ASupine or Trendelenburg with legs elevated
   2. BStanding with arms above head
   3. CSitting upright in a chair
   4. DUpright with head between knees

   Answer: A. The correct answer is supine or Trendelenburg with legs elevated. When a patient experiences a vasovagal reaction during or after venipuncture, blood pressure drops and cerebral perfusion decreases. Placing the patient supine or in Trendelenburg with legs elevated promotes venous return to the heart and brain. Sitting upright worsens hypotension by allowing blood to pool in the legs. Standing increases the risk of syncope and injury. Head between knees while sitting is an alternative but is less effective than full supine positioning.

   Source: NHA CPT Test Plan — Section 3G: Adverse Reactions

10. Venipuncture technique

    10. What is the primary purpose of applying a tourniquet before venipuncture?

    1. ATo numb the skin around the puncture site
    2. BTo clean the skin before needle insertion
    3. CTo increase arterial blood flow to the area
    4. DTo distend the veins by restricting venous blood flow

    Answer: D. The correct answer is to distend the veins by restricting venous blood flow. A tourniquet is applied 3-4 inches above the venipuncture site to impede venous return while allowing arterial flow to continue. This causes veins to fill and become more visible and palpable for needle insertion. Numbing the skin is not a function of the tourniquet. Increasing arterial flow is the opposite of what occurs. Cleaning the skin is performed with an antiseptic swab, not a tourniquet. The tourniquet should not remain in place longer than one minute.

    Source: NHA CPT Test Plan — Section 3C: Venipuncture Procedure

11. Patient preparation

    11. A phlebotomist finds that the physician's order is for a fasting lipid panel, but the patient ate breakfast. What should the phlebotomist do?

    1. AAsk the patient to come back tomorrow without giving any notice to the physician
    2. BProceed with the draw since the lab can adjust for fasting status
    3. CNotify the ordering physician and do not draw the fasting specimen
    4. DDraw the specimen anyway and note the non-fasting status on the tube

    Answer: C. The correct answer is to notify the ordering physician and not draw the fasting specimen. A fasting lipid panel requires 8-12 hours of fasting for accurate triglyceride and cholesterol results. Drawing a non-fasting specimen without physician notification could lead to incorrect diagnosis or treatment. The phlebotomist should contact the physician to determine whether to proceed, reschedule, or modify the order. Noting non-fasting status does not make the results clinically valid. The lab cannot retroactively adjust for fasting status on a lipid panel.

    Source: NHA CPT Test Plan — Section 2D: Patient Preparation and Assessment

12. Blood culture collection

    12. When collecting a blood culture, approximately how much blood should be drawn into each culture bottle?

    1. A1-2 mL per bottle to avoid overfilling
    2. B20-30 mL for adults, divided between aerobic and anaerobic bottles
    3. C5-10 mL total, all into the aerobic bottle
    4. DAs much as possible regardless of bottle capacity

    Answer: B. The correct answer is 20-30 mL for adults, divided between aerobic and anaerobic bottles. Adequate blood volume is critical for blood culture sensitivity. The recommended volume is 20-30 mL for adults, typically split 10-15 mL per bottle (aerobic and anaerobic). Insufficient volume reduces the likelihood of detecting bacteremia. Drawing only 5-10 mL total halves the sensitivity. One to two milliliters is far too low for reliable detection. Overfilling bottles can cause false positives or processing errors. Pediatric volumes differ based on the child's weight.

    Source: NHA CPT Test Plan — Section 4A: Blood Cultures

13. Specimen inversion

    13. An SST tube was collected for a chemistry panel but was not inverted after collection. What is the likely consequence?

    1. AThe additive will destroy the red blood cells prematurely
    2. BThe serum will separate too quickly during centrifugation
    3. CMicro-clots may form, leading to inaccurate or rejected results
    4. DThe tube will not clot and the specimen will be unusable

    Answer: C. The correct answer is that micro-clots may form, leading to inaccurate or rejected results. SST tubes contain a clot activator that requires mixing with the blood by gentle inversion (typically 5-10 times). Failure to invert means the clot activator does not distribute evenly throughout the specimen, causing incomplete clotting and micro-clot formation. These micro-clots can interfere with laboratory analyzers and produce erroneous results. The additive will not destroy red blood cells. The tube will partially clot, but not properly. Serum separation depends on complete clotting first.

    Source: NHA CPT Test Plan — Section 5A: Specimen Handling

14. Specimen rejection

    14. Which of the following is an acceptable reason to reject a specimen?

    1. AThe collection time was recorded in 24-hour format
    2. BThe tube was filled to the minimum fill line
    3. CThe specimen was collected two hours before processing
    4. DThe specimen label does not match the requisition form information

    Answer: D. The correct answer is that the specimen label does not match the requisition form. Mismatched information between the specimen label and the requisition is a critical rejection criterion because it creates a patient identification error. If the specimen cannot be positively linked to the correct patient and test order, results are unreliable and potentially dangerous. Most specimens can be processed within a reasonable window if properly stored. Minimum fill lines ensure adequate volume. Twenty-four-hour time format is standard and acceptable.

    Source: NHA CPT Test Plan — Section 5D: Specimen Rejection

15. Hepatitis b vaccination

    15. OSHA requires employers to offer the Hepatitis B vaccine to employees with occupational exposure. Within what timeframe must the vaccine be offered?

    1. AWithin 24 hours of hire
    2. BOnce per year during annual health screenings
    3. CWithin 10 business days of initial assignment
    4. DOnly after an exposure incident occurs

    Answer: C. The correct answer is within 10 business days of initial assignment to tasks where occupational exposure may occur. The OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030(f)(1)(ii)(A)) mandates that the hepatitis B vaccine series be made available to all employees with occupational exposure within 10 business days. This proactive requirement helps protect phlebotomists and other at-risk healthcare workers. Offering it only after an exposure is reactive and violates the standard. Annual screening is not a substitute for the initial vaccine offer. The 24-hour timeframe is not specified by OSHA.

    Source: OSHA Bloodborne Pathogens Standard — 29 CFR 1910.1030(f)(1)(ii)(A)

16. Specimen evaporation

    16. A potassium EDTA tube is left uncapped on the laboratory bench for 30 minutes. What problem could this cause?

    1. ARed blood cells will lyse and release hemoglobin
    2. BThe EDTA will degrade and allow the blood to clot
    3. CEvaporation may increase potassium concentration, yielding a falsely elevated result
    4. DCarbon dioxide loss will falsely lower blood pH

    Answer: C. The correct answer is evaporation may increase potassium concentration, yielding a falsely elevated result. Leaving EDTA tubes uncapped allows serum or plasma to evaporate, concentrating dissolved analytes including potassium. This can produce a pseudohyperkalemia that may lead to misdiagnosis and inappropriate treatment. EDTA is stable and will not degrade from brief exposure to air. CO2 loss primarily affects arterial blood gas samples in heparin syringes. Red cell lysis requires more extreme conditions than brief air exposure.

    Source: NHA CPT Test Plan — Section 5C: Specimen Storage

17. Difficult venipuncture

    17. A phlebotomist is drawing from an antecubital vein and the patient reports tingling and numbness in the hand. What is the MOST likely cause?

    1. AThe needle has contacted or entered a nerve
    2. BThe tourniquet is too tight and restricting arterial flow
    3. CThe blood is flowing too quickly into the tube
    4. DThe needle gauge is too large for the patient's vein

    Answer: A. The correct answer is the needle has contacted or entered a nerve. Tingling, numbness, or sharp radiating pain during venipuncture strongly suggests nerve contact or penetration. The phlebotomist should immediately withdraw the needle and redirect to a different site. Continuing the draw risks permanent nerve damage and potential litigation. A tight tourniquet would cause pallor and coolness, not tingling. Fast flow into the tube does not cause neurological symptoms. Needle gauge affects comfort but does not typically cause nerve-related sensations.

    Source: NHA CPT Test Plan — Section 3F: Difficult Collections

18. Contaminated cleanup

    18. A phlebotomist discovers a broken vacuum tube with spilled blood on the phlebotomy tray. What is the correct cleanup procedure?

    1. ASpray the area with bleach and leave it to air dry
    2. BDon gloves, carefully pick up glass with forceps, disinfect the surface, and dispose in biohazard sharps
    3. CWipe with a dry cloth and continue with the next patient
    4. DUse paper towels to soak up the blood and place everything in the regular trash

    Answer: B. The correct answer is donning gloves, carefully picking up glass with forceps, disinfecting the surface, and disposing in biohazard sharps. OSHA requires that broken glass contaminated with blood be handled with forceps or other implements, never bare hands, and disposed in a sharps container. The surface must then be disinfected with an EPA-registered disinfectant. Paper towels and regular trash do not address contamination. Bleach alone without PPE is unsafe. Leaving the area contaminated creates an exposure risk for staff and patients.

    Source: OSHA Bloodborne Pathogens Standard — 29 CFR 1910.1030(d)(4)(ii)(A)

19. Vein selection

    19. A patient with a known history of difficult venous access arrives for a prothrombin time draw. What is the BEST initial approach?

    1. AWarm the antecubital area to promote vasodilation and palpate carefully before selecting a site
    2. BImmediately request a nurse to perform an arterial puncture instead
    3. CAttempt the draw on the dorsum of the hand without patient consent
    4. DUse the smallest gauge needle available and proceed without warming

    Answer: A. The correct answer is to warm the antecubital area to promote vasodilation and palpate carefully before selecting a site. Warm packs or warm water applied for 3-5 minutes dilates peripheral veins and improves visualization and palpation. Careful palpation helps identify the best viable vein before needle insertion. Starting on the hand without consent violates patient rights. Using the smallest gauge without assessment may cause hemolysis. Arterial puncture is not indicated for routine coagulation testing and requires separate physician orders.

    Source: NHA CPT Test Plan — Section 2E: Vein Selection

20. Coagulation collection

    20. A blue-top sodium citrate tube is underfilled. How should the phlebotomist handle this situation?

    1. ADiscard the tube, explain the situation to the physician, and recollect using a new tube
    2. BFill the tube the rest of the way with sterile saline
    3. CSend it to the lab and note the underfill on the requisition
    4. DAdd a few drops of EDTA to compensate for the low volume

    Answer: A. The correct answer is to discard the tube, explain the situation to the physician, and recollect using a new tube. Coagulation tests like PT and aPTT are critically dependent on the correct blood-to-anticoagulant ratio (typically 9:1 for sodium citrate). Underfilling shifts this ratio, causing prolonged clotting times and potentially erroneous results. Saline dilution alters test accuracy. Noting the underfill does not correct the ratio error. Adding EDTA changes the anticoagulant chemistry entirely. Only recollection with a properly filled tube ensures accurate results.

    Source: NHA CPT Test Plan — Section 3D: Capillary and Special Procedures