NHA Phlebotomy Technician (CPT) — All Questions

Which labeling is required on a container used to transport blood specimens off the collection floor?

• a.The phlebotomist's name only
• b.A biohazard symbol or red color coding identifying the contents as infectious✓
• c.A handwritten note that says fragile
• d.No labeling is required if the lid is closed

Containers holding blood or other potentially infectious material must carry the biohazard label or be red color coded so anyone handling them knows the risk. A fragile note or a staff name conveys nothing about infectious hazard. A closed lid contains the specimen but does not warn the next handler.OSHA 29 CFR 1910.1030

Which item is an example of an engineering control rather than a work practice control?

• a.Washing hands after glove removal
• b.Not recapping used needles
• c.Prohibiting eating in the specimen processing area
• d.A needle with a retractable safety shield✓

Engineering controls are devices that isolate or remove the hazard, such as self-sheathing needles, sharps containers and splash guards. Work practice controls change how a task is performed, which is what not recapping, hand washing and food restrictions do. Both categories are required, but only the device itself is an engineering control.OSHA 29 CFR 1910.1030

Which statement best describes standard precautions?

• a.They apply only to patients with a known bloodborne infection
• b.They apply only in the emergency department
• c.They replace the need for transmission-based precautions
• d.They apply to every patient because infection status may be unknown✓

Standard precautions treat blood and body fluids from every patient as potentially infectious, because many infections are undiagnosed at the time of care. Transmission-based precautions such as contact, droplet and airborne are added on top of standard precautions, not substituted for them. The approach applies in every care setting, not just high-acuity areas.CDC Guideline for Isolation Precautions

A tube of blood breaks on the floor. What is the correct decontamination sequence?

• a.Mop the area immediately with plain water
• b.Put on gloves, cover and absorb the spill, then apply an appropriate disinfectant such as 1:10 bleach and allow the required contact time✓
• c.Spray disinfectant and wipe it up right away with a paper towel
• d.Leave it for housekeeping and mark the area with a chair

The spill is contained and absorbed while wearing appropriate PPE, then treated with an EPA-registered disinfectant or a freshly prepared 1:10 bleach solution left in place for the required contact time before final cleanup, with any glass picked up mechanically. Water does not disinfect and wiping immediately gives no contact time. Abandoning a biohazard spill leaves others exposed.OSHA 29 CFR 1910.1030

Which activity is prohibited in an area where blood specimens are handled?

• a.Wearing a buttoned lab coat
• b.Documenting collection times in the log
• c.Storing labeled specimens in a designated refrigerator
• d.Applying lip balm or eating a snack at the bench✓

Eating, drinking, smoking, applying cosmetics or lip balm and handling contact lenses are prohibited where there is a reasonable likelihood of occupational exposure, because they create a hand-to-mucous-membrane route. Wearing appropriate protective clothing and documenting collections are expected practices. Specimens may be stored in a refrigerator designated for that purpose, but food may never be stored there.OSHA 29 CFR 1910.1030

After a reported needlestick, what must the employer provide?

• a.Reassignment away from patient care for six months
• b.A written warning documenting the employee's technique error
• c.A confidential medical evaluation, source testing when permitted by law, and follow-up at no cost to the employee✓
• d.A requirement that the employee use personal insurance for follow-up

The standard requires a confidential post-exposure medical evaluation and follow-up at no cost, including source individual testing where legally permitted, prophylaxis when indicated and counseling. Disciplining the employee discourages reporting and is not a required response. Shifting cost to the employee or automatically removing them from duty is not part of the requirement.OSHA 29 CFR 1910.1030

A patient's adult daughter asks the phlebotomist for her mother's lab results. What is the appropriate response?

• a.Print the results and hand them over if the patient is in the room
• b.Read the results aloud since she is immediate family
• c.Give a general summary without naming specific values
• d.Explain that results are released by the ordering provider and refer her to the care team✓

Phlebotomists do not release results, and protected health information may not be disclosed to family members without proper authorization. Referring the request to the ordering provider respects both privacy rules and scope of practice. Being related, being present in the room or softening the disclosure into a summary does not create authorization.HIPAA

Which set of elements must appear on a blood specimen label?

• a.Patient full name, a second unique identifier, date and time of collection, and the collector's identification✓
• b.Patient room number and diagnosis
• c.Ordering provider and insurance number
• d.Patient last name and the test name only

A compliant label carries the patient's full name plus a second unique identifier such as the medical record number or date of birth, the date and time of collection and the identity of the person who collected it. Room numbers and diagnoses change and are not unique identifiers. Test names and billing information belong on the requisition, not in place of patient identification.CLIA

When and where should blood tubes be labeled?

• a.At the patient's side immediately after collection, before leaving the patient✓
• b.At the nurses' station after all patients on the floor are collected
• c.Before the draw, so the tubes are ready
• d.In the laboratory after delivery, using the requisition

Tubes are labeled at the bedside immediately after collection and before leaving the patient, which is the only point at which identity can still be verified against the patient. Pre-labeling risks putting the wrong patient's blood in an already labeled tube. Labeling later in the laboratory or at a workstation makes mislabeling likely and is a leading cause of transfusion and diagnostic errors.CLIA

Which specimen must be transported chilled in an ice slurry?

• a.Bilirubin
• b.Cold agglutinins
• c.Complete blood count
• d.Ammonia✓

Ammonia rises rapidly at room temperature as cells continue to metabolize, so the tube is chilled in an ice and water slurry and delivered immediately. Bilirubin is protected from light rather than chilled, and cold agglutinins must be kept at body temperature because cooling causes the antibody to bind red cells. A CBC is transported at room temperature.CLSI GP44

A neonatal bilirubin is collected. How must the specimen be handled during transport?

• a.Protected from light, for example with an amber tube or foil wrap✓
• b.Kept in an ice slurry for at least 30 minutes
• c.Left uncovered at room temperature to allow clotting
• d.Frozen immediately at minus 20 degrees Celsius

Bilirubin is photosensitive and degrades within minutes of light exposure, so an amber microtube or foil wrapping is used. Vitamin B12, folate, carotene and vitamin A require the same protection. Freezing whole blood hemolyzes it, chilling is not the required protection here, and leaving the tube exposed causes falsely low results.CLSI GP44

A cryofibrinogen test is ordered. What handling is required?

• a.Transport on ice
• b.Refrigerate at 4 degrees Celsius for one hour before centrifuging
• c.Keep the specimen at 37 degrees Celsius until processed✓
• d.Freeze the whole blood immediately

Cryofibrinogen, cryoglobulins and cold agglutinins precipitate or bind when cooled, so the specimen is kept warm at body temperature from collection through processing, often using a prewarmed tube and a 37 degree carrier. Icing or refrigerating causes the target protein to drop out of solution and gives falsely low results. Freezing whole blood destroys the cells entirely.CLSI GP44

Within what time should serum or plasma be separated from cells for routine chemistry testing?

• a.Within 8 hours of collection
• b.Only after the specimen has been refrigerated overnight
• c.Within 2 hours of collection✓
• d.Within 24 hours if refrigerated

Serum or plasma should be physically separated from the cells within two hours of collection, because continued cellular metabolism lowers glucose and raises potassium, LDH and phosphorus. Holding the tube for 8 or 24 hours before separation produces clinically misleading results. Refrigerating an unseparated tube actually accelerates potassium leakage from red cells.CLSI GP44

Which collection practice is most likely to hemolyze a specimen?

• a.Letting the alcohol dry fully before puncture
• b.Forcing blood from a syringe through the needle into an evacuated tube✓
• c.Using a 21 gauge needle on a good antecubital vein
• d.Inverting an EDTA tube gently eight times

Pushing blood through a narrow needle under pressure shears red cells and is a classic cause of hemolysis, which is why a transfer device is used instead. Gentle inversion, an appropriately sized needle and fully dried alcohol all reduce hemolysis. Hemolysis falsely raises potassium, LDH, AST and magnesium and often forces a redraw.CLSI GP41

A chemistry specimen arrives visibly hemolyzed. Which result is most likely to be falsely elevated?

• a.Chloride
• b.Sodium
• c.Albumin
• d.Potassium✓

Potassium is far more concentrated inside red cells than in plasma, so cell rupture releases it and drives the measured value up sharply. LDH, AST and magnesium rise for the same reason. Sodium and chloride are higher outside the cells, and albumin is a plasma protein unaffected by red cell lysis.CLSI GP44

A lavender tube submitted for a CBC contains visible small clots. What should happen?

• a.Reject the specimen and recollect, because clotting invalidates cell counts✓
• b.Filter the specimen and then run it
• c.Run the CBC and add a comment about clots
• d.Add extra EDTA and mix again

Clots consume platelets and trap white and red cells, so counts are falsely low and the specimen must be rejected and recollected with prompt, adequate mixing. Commenting on a clotted CBC still reports unreliable numbers. Filtering removes cells that should be counted, and adding anticoagulant after the fact cannot reverse clot formation.CLIA

An unlabeled tube arrives in the laboratory with a completed requisition attached. What is the correct action?

• a.Ask the phlebotomist who drew it to label it now
• b.Label it from the requisition and process it
• c.Process it and hold the result until labeling is confirmed
• d.Reject the specimen and request recollection✓

An unlabeled specimen cannot be positively linked to a patient, so it is rejected and recollected, and the event is documented. Labeling after the fact from a requisition or from memory is exactly how patients receive another patient's results. Only irreplaceable specimens such as cerebrospinal fluid have a special resolution process, and whole blood is not in that category.CLIA

An EDTA specimen is collected for a CBC with a manual differential. What time limit applies to making the blood smear?

• a.Timing does not matter because EDTA preserves morphology indefinitely
• b.Smears must be made after refrigerating the tube overnight
• c.Smears may be made up to 24 hours later at room temperature
• d.Smears should be prepared within about one hour of collection✓

EDTA preserves cells for automated counting for roughly 24 hours, but white cell and platelet morphology begins to distort within a few hours, so smears are made within about one hour. Waiting a day produces artifacts that mimic disease. Refrigeration does not restore morphology, and no anticoagulant preserves cell shape indefinitely.CLSI GP44

A gel serum separator tube has already been centrifuged and the serum is above the gel. A repeat test is requested. What should be done?

• a.Test from the serum already above the gel, or aliquot it into a labeled tube✓
• b.Freeze the whole tube and thaw it before testing
• c.Shake the tube to remix the serum with the cells
• d.Recentrifuge the original tube to obtain more serum

Once the gel barrier has formed, the serum above it is stable and can be tested or aliquotted into a properly labeled tube. Recentrifuging a gel tube can force cellular contents into the serum and falsely raise potassium. Remixing serum with cells or freezing the tube with cells still present destroys specimen integrity.CLSI GP44

Which specimen requirement applies to an erythrocyte sedimentation rate?

• a.It should be tested within about four hours at room temperature✓
• b.It requires a serum separator tube
• c.It must be protected from light
• d.It must be frozen if not tested within one hour

An ESR is performed on a well-mixed EDTA specimen and should be set up within about four hours at room temperature, because red cells lose their normal shape over time and settle differently. Freezing destroys the cells, and light does not affect sedimentation. A serum tube is unusable because the test requires anticoagulated whole blood.CLSI GP44

Unless a test specifies otherwise, at what temperature are routine blood specimens transported?

• a.At ambient room temperature, roughly 15 to 30 degrees Celsius✓
• b.Frozen at minus 20 degrees Celsius
• c.Refrigerated at 2 to 8 degrees Celsius
• d.Warmed to 37 degrees Celsius

Most routine specimens travel at ambient room temperature unless the test specifically calls for chilling, freezing or warming. Routine refrigeration of unseparated blood raises potassium as it leaks from red cells. Freezing whole blood causes hemolysis, and warming is reserved for cold-sensitive analytes such as cryoglobulins.CLSI GP44

A tube is submitted with far less blood than the test requires. How is this documented as a rejection reason?

• a.Chain of custody break
• b.Quantity not sufficient✓
• c.Delayed transport
• d.Improper additive

An underfilled specimen that cannot support the ordered testing is reported as quantity not sufficient, and the laboratory requests recollection. A chain of custody break involves lost documentation of handling, an improper additive means the wrong tube was used, and delayed transport refers to exceeding time limits. Each of these is a distinct rejection category with a different corrective action.CLIA

A routine urinalysis cannot be tested for 90 minutes. What is the correct interim handling?

• a.Refrigerate the specimen or use a chemical preservative tube✓
• b.Add a small amount of bleach to prevent bacterial growth
• c.Freeze the specimen
• d.Leave it at room temperature and test when convenient

Urine should be tested within about two hours or refrigerated, because bacteria multiply and cells and casts break down at room temperature. A preservative transport tube is an accepted alternative. Freezing destroys formed elements, and adding a disinfectant contaminates the specimen and invalidates chemical testing.CLSI GP44

Serum is transferred into a secondary aliquot tube for send-out testing. What must be done?

• a.Combine aliquots from the same patient collected on different days
• b.Leave it unlabeled because the parent tube is labeled
• c.Label the aliquot with the same patient identifiers as the original tube✓
• d.Write only the accession number on the cap

Every aliquot is an independent specimen and must carry the same patient identifiers as the parent tube so identity is never lost. Relying on the parent tube or writing an identifier only on a removable cap breaks the chain of identification. Pooling specimens collected at different times mixes results from different clinical moments and is never acceptable.CLIA

A phlebotomist notices the expiration date on a box of lavender tubes passed last month. What is the concern?

• a.Vacuum and additive reactivity decline, so fill volume and results become unreliable✓
• b.Nothing, since expiration applies only to reagents
• c.The tube color will fade and cause misidentification
• d.The stopper will not fit the holder correctly

Evacuated tubes lose vacuum and additive effectiveness over time, so an expired tube may underfill or fail to anticoagulate properly, producing unreliable results. Expired tubes are removed from stock and not used. Color coding and stopper fit are not the reason for the date, and expiration dating applies to collection devices as well as reagents.CLIA

Why must additive tubes be mixed by gentle inversion rather than shaking?

• a.Shaking increases the vacuum inside the tube
• b.Gentle inversion is required only for serum tubes
• c.Shaking causes mechanical hemolysis and foaming that invalidate many tests✓
• d.Shaking dissolves the stopper lubricant into the specimen

Vigorous shaking shears red cells and creates foam, producing hemolysis that falsely raises potassium, LDH and AST and can prevent testing altogether. Gentle inversion distributes the additive without damaging cells and is required for every additive tube, not just serum tubes. Shaking has no effect on stopper lubricant or on the residual vacuum.CLSI GP41

A serum tube is centrifuged five minutes after collection and fibrin strands appear in the serum. What went wrong?

• a.The specimen was spun before the clot had fully formed✓
• b.The serum was exposed to light
• c.The tube contained too much clot activator
• d.The tube was centrifuged at too low a speed

A plain or gel serum tube needs roughly 30 minutes at room temperature to clot completely before centrifugation, and spinning early leaves fibrin that clogs analyzers and skews results. Speed affects separation quality but does not create fibrin. Clot activator quantity is fixed by the manufacturer, and light exposure affects photosensitive analytes rather than clot formation.CLSI GP44

How should an outpatient be identified before venipuncture?

• a.Ask the patient to state full name and date of birth, then match both to the requisition✓
• b.Ask, Are you Mr. Johnson, and proceed if the patient says yes
• c.Confirm the name on the sign-in sheet
• d.Match the room number and the last four digits of the record number

Two independent identifiers must be actively stated by the patient and matched against the requisition, most commonly full name and date of birth. Asking a yes-or-no question invites a confused or hard-of-hearing patient to agree incorrectly. A sign-in sheet is not a verified identifier and outpatients have no room number, which is never an acceptable identifier in any setting.CLIA

An inpatient scheduled for a type and screen has no identification wristband. What should the phlebotomist do?

• a.Ask the roommate to confirm the patient's identity
• b.Draw the specimen and note the missing band on the label
• c.Ask the nurse to verify identity and apply a new wristband before collecting✓
• d.Use the name on the door and the chart at the bedside

An inpatient must wear an attached identification band, and blood bank specimens have the strictest identification requirements because a mismatch can cause a fatal transfusion reaction. The nurse verifies identity and applies a new band before collection proceeds. Roommates, door signs and bedside charts are not verified patient identifiers and can be wrong after a room change.CLIA

A patient scheduled for a fasting lipid panel reports drinking black coffee two hours ago. What should the phlebotomist do?

• a.Notify the laboratory or provider and document the non-fasting status before collecting or rescheduling✓
• b.Send the patient home for a full 24 hour fast
• c.Draw the specimen and say nothing since coffee has no calories
• d.Collect the specimen and label it as fasting anyway

A fasting specimen typically requires 9 to 12 hours with only water, and coffee stimulates metabolism and can alter results, so the deviation must be reported and documented. Recording a non-fasting sample as fasting falsifies the record and misleads interpretation. Fasting longer than about 12 hours can itself distort results, so a 24 hour fast is not appropriate.

During a 3-hour glucose tolerance test the patient vomits 20 minutes after drinking the glucose solution. What is the correct action?

• a.Give a second glucose drink and restart the timing
• b.Shorten the test to one hour
• c.Continue the collections and note the vomiting on the last tube
• d.Notify the provider or laboratory immediately, since the test usually must be discontinued and rescheduled✓

Vomiting means the glucose load was not absorbed, so the remaining timed results are meaningless and the provider or laboratory decides whether to stop and reschedule. Repeating the drink is not the phlebotomist's decision and doubles the dose risk. Continuing the draws or arbitrarily shortening the protocol produces uninterpretable data.

A 9-year-old is brought for a blood draw by an adult neighbor with no documented authorization. What should the phlebotomist do?

• a.Verify legal authorization from a parent or guardian before collecting✓
• b.Proceed because any adult present may consent
• c.Proceed because the child agrees to the draw
• d.Ask the child to sign the consent form

A minor cannot give legal consent for a procedure, so authorization must come from a parent, legal guardian or a documented designee. A neighbor without documented authority cannot supply it, and a child's agreement is assent rather than consent. Having the child sign a form creates a record with no legal standing.

A competent adult inpatient refuses the ordered blood draw. What is the correct response?

• a.Draw anyway because a provider ordered it
• b.Tell the patient that refusing will delay discharge
• c.Have a family member hold the arm still
• d.Respect the refusal, notify the nurse or provider, and document it✓

A competent adult has the right to refuse any procedure, and proceeding without consent may constitute battery. The correct steps are to stop, explain the purpose of the test respectfully, notify the nurse or ordering provider and document the refusal. Coercing the patient or restraining an arm is never acceptable regardless of the order.

Midway through a draw an outpatient becomes pale, sweaty and says the room is spinning. What is the first action?

• a.Leave the patient to get help from the front desk
• b.Continue the draw quickly before the patient faints
• c.Hold an ammonia inhalant under the patient's nose
• d.Release the tourniquet, remove the needle, and lower the patient's head while keeping the patient seated or supine✓

Presyncope is managed by immediately stopping the draw and removing the needle so an unconscious patient is not injured, then lowering the head or laying the patient flat to restore cerebral perfusion. Continuing the collection risks a fall with the needle in place. Ammonia inhalants are discouraged because they can trigger bronchospasm, and the patient must never be left alone.

A swelling appears rapidly at the site while the tube is filling. What should the phlebotomist do?

• a.Massage the area to disperse the blood
• b.Release the tourniquet, remove the needle, and apply firm direct pressure for several minutes✓
• c.Tighten the tourniquet to slow the swelling
• d.Continue until the tube is full, then apply a bandage

Rapid swelling indicates a hematoma from blood leaking into tissue, so the draw is stopped and firm direct pressure is applied for several minutes, longer if the patient takes anticoagulants. Tightening the tourniquet increases venous pressure and worsens the leak. Continuing the draw enlarges the hematoma, and massaging spreads blood through the tissue and increases bruising.

On needle insertion the patient reports sudden shooting, electric pain radiating to the hand. What should be done?

• a.Loosen the tourniquet and continue
• b.Redirect the needle deeper to find the vein
• c.Discontinue immediately, remove the needle, and report the event✓
• d.Reassure the patient and finish the draw quickly

Shooting, electric or radiating pain and tingling suggest nerve involvement, and the needle must be removed at once to prevent lasting injury, with the event reported and documented. Continuing or redirecting the needle deepens the contact and increases the risk of permanent damage. Loosening the tourniquet does nothing about the nerve contact itself.

Small red pinpoint spots appear on the arm under the tourniquet. What do they indicate?

• a.The beginning of a hematoma
• b.Contamination of the site
• c.Petechiae, suggesting capillary fragility or a platelet problem, and a tendency to bleed at the site✓
• d.An allergic reaction to the tourniquet latex

Petechiae are tiny non-raised red spots from capillary leakage and often warn that the patient may bleed longer after the draw. They are not an allergic reaction, which appears as raised itchy welts, and not a hematoma, which is a diffuse swelling and bruise. They do not indicate contamination, but they do mean pressure should be held longer after needle removal.

During a draw the blood is bright red and pulses into the tube, filling it very quickly. What should the phlebotomist do?

• a.Continue since fast filling means a good draw
• b.Reposition the needle and collect the remaining tubes
• c.Apply a bandage without pressure and send the patient on
• d.Suspect arterial puncture, remove the needle at once, and apply firm pressure for at least five minutes✓

Bright red blood that pulsates and fills rapidly suggests an artery was entered, so the needle is withdrawn immediately and firm pressure is held at least five minutes, with the patient observed and the event reported and noted for the laboratory. Continuing or repositioning risks significant bleeding. A bandage without sustained pressure will not control arterial bleeding.

A frightened 6-year-old is scheduled for a venipuncture. Which approach is most appropriate?

• a.Tell the child that the draw will be canceled if the crying continues
• b.Show the child the needle in detail so there are no surprises
• c.Explain the steps in simple honest words, offer a comfort position with the caregiver, and work efficiently✓
• d.Promise the child that it will not hurt at all

Honest, simple explanations paired with a caregiver comfort hold reduce anxiety and improve first-attempt success, and working efficiently shortens the stressful period. Promising no pain destroys trust as soon as the needle enters. Threats increase distress, and displaying the needle usually escalates fear rather than reducing it.

Before beginning a draw, what should the phlebotomist explain to the patient?

• a.Who the phlebotomist is, that blood will be collected, and roughly what will happen✓
• b.The reference ranges the results will be compared against
• c.The likely diagnosis based on the tests ordered
• d.The cost of each test and the insurance coverage

Introducing oneself, stating that a blood specimen will be collected and briefly describing the procedure supports implied consent and reduces anxiety. Interpreting test results or offering a diagnosis is outside the phlebotomist's scope of practice. Billing questions belong to the business office, and reference ranges are part of the physician's interpretation.HIPAA

Which description of antecubital vein anatomy is correct?

• a.The median cubital vein lies deep to the brachial artery
• b.The basilic vein lies on the lateral or thumb side of the arm
• c.The cephalic vein lies on the medial or little finger side
• d.The cephalic vein lies laterally and the basilic vein medially, with the median cubital between them✓

In the antecubital fossa the cephalic vein runs along the lateral thumb side, the basilic vein along the medial little finger side, and the median cubital connects them across the middle. The median cubital is superficial and lies above, not beneath, the brachial artery. Reversing the cephalic and basilic positions would put the phlebotomist next to the artery and nerve without realizing it.

Which statement about arterial, venous and capillary blood is correct?

• a.Arterial blood is bright red and oxygen rich, venous blood is darker, and capillary blood is a mixture of both plus interstitial fluid✓
• b.Arterial blood is collected routinely for a CBC
• c.Venous blood is bright red because it carries nutrients
• d.Capillary blood is identical in composition to venous blood

Oxygenated arterial blood appears bright red, deoxygenated venous blood appears darker, and capillary blood collected by dermal puncture mixes arterial and venous blood with interstitial and intracellular fluid. Because of that mixture, capillary glucose tends to run higher and capillary potassium and total protein lower than venous values. Routine hematology and chemistry use venous blood; arterial puncture is reserved for blood gases and is outside the entry-level phlebotomy scope.

What distinguishes plasma from serum?

• a.Plasma contains fibrinogen and clotting factors, while serum is the fluid left after clotting✓
• b.Serum contains fibrinogen and plasma does not
• c.Serum contains red cells and plasma does not
• d.Plasma is obtained only from a serum separator tube

Plasma comes from an anticoagulated tube and still contains fibrinogen and the clotting factors, while serum is what remains after the blood has clotted and consumed fibrinogen. Neither fraction contains red cells once the specimen is centrifuged. Plasma requires an anticoagulant tube such as heparin or EDTA, not a serum separator tube.

After an EDTA tube is centrifuged, what is the thin layer between the plasma and the packed red cells?

• a.Separator gel
• b.Fibrin clot
• c.Hemolyzed plasma
• d.Buffy coat, containing white blood cells and platelets✓

The buffy coat is the pale layer of leukocytes and platelets that settles between the denser red cells and the lighter plasma. A fibrin clot forms only in a tube without anticoagulant, and separator gel exists only in gel tubes, not in a standard lavender tube. Hemolyzed plasma appears as pink or red discoloration throughout the plasma rather than as a discrete layer.

Which structural feature of veins is most relevant to venipuncture technique?

• a.Veins pulsate under the fingertip
• b.Veins carry blood away from the heart
• c.Veins have thicker muscular walls than arteries
• d.Veins have one-way valves and thinner walls, so they collapse easily under strong vacuum✓

Veins have thin walls and one-way valves that keep blood moving toward the heart, which is why a large vacuum tube or aggressive suction can collapse them and why needles are inserted pointing toward the heart away from valves. Arteries, not veins, have thick muscular walls and a palpable pulse. Arteries carry blood away from the heart while veins return it.

Which blood component makes up roughly 55 percent of whole blood volume?

• a.Erythrocytes
• b.Plasma✓
• c.Leukocytes
• d.Platelets

Plasma accounts for approximately 55 percent of whole blood and is about 90 percent water carrying proteins, electrolytes and waste products. Red cells make up most of the remaining 45 percent, which corresponds to the hematocrit. White cells and platelets together form only a small fraction, visible as the thin buffy coat after centrifugation.

A requisition is marked NPO. What does this abbreviation mean?

• a.Nothing by mouth✓
• b.The specimen is needed post-operatively
• c.Notify provider only
• d.No preservative ordered

NPO comes from the Latin nil per os and means the patient is to take nothing by mouth, a status the phlebotomist must respect by not offering food or fluids. It is distinct from a fasting order, though the two often overlap. Postoperative status, preservative choice and notification instructions are all conveyed by different notations.

In medical terminology, what does the suffix -emia indicate?

• a.Excessive discharge or flow
• b.Inflammation of a structure
• c.A condition of the blood✓
• d.Surgical removal

The suffix -emia refers to a blood condition, as in anemia, bacteremia and hyperkalemia. Inflammation is indicated by -itis, surgical removal by -ectomy, and excessive flow by -rrhea or -rrhage. Recognizing these roots helps a phlebotomist interpret test names and requisitions accurately.

A specimen is marked STAT. What does this require of the phlebotomist?

• a.Collect it only after all fasting patients are done
• b.Collect it with the next scheduled sweep
• c.Collect it at the end of the shift and label the time
• d.Collect and deliver it immediately, ahead of routine work✓

STAT means immediately, and these draws take priority over routine and timed collections so critical results reach the provider quickly. Deferring a STAT to a scheduled sweep or to the end of a shift defeats the purpose and can delay urgent treatment. Fasting patients are a scheduling convenience, not a higher priority than a STAT order.

Which tube and test pairing is correct?

• a.Royal blue tube for trace element studies such as lead and zinc✓
• b.Gray tube for a type and crossmatch
• c.Lavender tube for a prothrombin time
• d.Light blue tube for a complete blood count

Royal blue tubes are manufactured with low background metal contamination for trace element and toxicology testing. A CBC requires the lavender EDTA tube and a prothrombin time requires the light blue citrate tube, so those two pairings are reversed. Type and crossmatch is performed on a pink or red blood bank tube, never on a gray fluoride tube.