Routine Blood Collections represents the most critical and heavily tested domain on the NHA Certified Phlebotomy Technician (CPT) examination, comprising approximately 40% of all exam questions. This domain encompasses the fundamental technical skills that define phlebotomy practice, including venipuncture techniques, capillary collections, equipment selection, and specimen handling procedures. Mastery of routine blood collection procedures is essential for patient safety, diagnostic accuracy, and professional competency in healthcare settings. The domain covers 22 knowledge statements and 16 task statements, reflecting the comprehensive nature of blood collection responsibilities that phlebotomy technicians encounter daily. Understanding proper tourniquet application, antiseptic techniques, order of draw protocols, and specimen labeling requirements forms the foundation of safe phlebotomy practice. This content area frequently integrates core knowledge topics such as vascular anatomy, pre-analytical variables, and infection control principles, making it a high-yield study focus. The NHA CPT exam emphasizes practical application of these skills through scenario-based questions that mirror real-world clinical situations. Competency in routine blood collections directly impacts patient comfort, specimen quality, and laboratory result accuracy, making this domain crucial for certification success. Questions in this area often test decision-making skills regarding equipment selection, site preparation, and complication management during blood collection procedures. Strong performance in this domain correlates with overall exam success and demonstrates readiness for entry-level phlebotomy practice in hospitals, laboratories, and outpatient facilities.
Practice Questions
Question 1:
When performing venipuncture, what is the maximum time a tourniquet should remain on a patient’s arm?
A) 30 seconds
B) 1 minute
C) 2 minutes
D) 3 minutes
Correct Answer: B) 1 minute
Explanation: A tourniquet should not remain on for more than 1 minute to prevent hemoconcentration, which can alter test results. If the draw takes longer, the tourniquet should be released and reapplied after 2 minutes.
Question 2:
What is the correct order of draw for the following tubes: red top, lavender top, light blue top, and green top?
A) Red, lavender, light blue, green
B) Light blue, red, green, lavender
C) Red, light blue, green, lavender
D) Light blue, green, red, lavender
Correct Answer: B) Light blue, red, green, lavender
Explanation: The correct order of draw follows CLSI guidelines: blood culture bottles first (if applicable), then light blue (coagulation), red (serum), green (heparin), and lavender (EDTA) last to prevent cross-contamination.
Question 3:
Which needle gauge is most commonly used for routine venipuncture in adults?
A) 18 gauge
B) 20 gauge
C) 21 gauge
D) 23 gauge
Correct Answer: C) 21 gauge
Explanation: A 21-gauge needle is the standard size for routine adult venipuncture, providing adequate blood flow while minimizing patient discomfort and hemolysis risk.
Question 4:
When selecting a venipuncture site, which vein is the first choice in the antecubital fossa?
A) Basilic vein
B) Cephalic vein
C) Median cubital vein
D) Brachial vein
Correct Answer: C) Median cubital vein
Explanation: The median cubital vein is the preferred choice because it is typically the largest, most stable, and least likely to roll. It also has fewer nerve endings, making it less painful for the patient.
Question 5:
What should a phlebotomist do if a hematoma begins to form during venipuncture?
A) Continue the draw and apply pressure afterward
B) Immediately remove the needle and apply pressure
C) Reposition the needle and continue
D) Switch to a smaller gauge needle
Correct Answer: B) Immediately remove the needle and apply pressure
Explanation: When a hematoma forms, the needle should be removed immediately to prevent further bleeding into the tissue. Direct pressure should be applied to minimize hematoma size.
Question 6:
How many times should a lavender top tube be inverted after collection?
A) 3-4 times
B) 5-6 times
C) 8-10 times
D) 12-15 times
Correct Answer: C) 8-10 times
Explanation: Lavender top tubes containing EDTA should be inverted 8-10 times to ensure proper mixing of the anticoagulant with blood and prevent clotting.
Question 7:
What is the appropriate antiseptic for routine venipuncture site preparation?
A) Betadine
B) 70% isopropyl alcohol
C) Hydrogen peroxide
D) Chlorhexidine
Correct Answer: B) 70% isopropyl alcohol
Explanation: 70% isopropyl alcohol is the standard antiseptic for routine venipuncture. It should be applied in a circular motion from the center outward and allowed to air dry.
Question 8:
When performing a capillary puncture on an infant’s heel, which area should be avoided?
A) Medial plantar surface
B) Lateral plantar surface
C) Central area of the heel
D) Posterior curve of the heel
Correct Answer: D) Posterior curve of the heel
Explanation: The posterior curve of the heel should be avoided as it may damage the calcaneus bone. Punctures should be made on the medial or lateral plantar surfaces of the heel.
Question 9:
What is the maximum depth for a capillary puncture on an adult finger?
A) 1.5 mm
B) 2.0 mm
C) 2.4 mm
D) 3.1 mm
Correct Answer: D) 3.1 mm
Explanation: The maximum depth for an adult finger stick is 3.1 mm to ensure adequate blood flow while avoiding injury to bone or deep tissues.
Question 10:
Which action should be taken if a patient faints during blood collection?
A) Continue the procedure quickly
B) Remove the needle and lower the patient’s head
C) Apply ammonia capsules immediately
D) Call for emergency assistance first
Correct Answer: B) Remove the needle and lower the patient’s head
Explanation: If a patient faints, immediately remove the needle, apply pressure to the site, and lower the patient’s head below heart level to restore blood flow to the brain.
Question 11:
What information must be included on a specimen label?
A) Patient name and date of birth only
B) Patient name, ID number, and collection date/time
C) Collection date and phlebotomist initials only
D) Patient name and room number only
Correct Answer: B) Patient name, ID number, and collection date/time
Explanation: Proper specimen labeling requires patient name, unique identifier (ID number), collection date and time, and phlebotomist identification to ensure accurate patient identification and specimen tracking.
Question 12:
When should specimens be labeled?
A) Before collection begins
B) During the collection process
C) Immediately after collection at the patient’s bedside
D) When returning to the laboratory
Correct Answer: C) Immediately after collection at the patient’s bedside
Explanation: Specimens must be labeled immediately after collection while still at the patient’s bedside to prevent mislabeling and ensure proper patient identification.
Question 13:
What is the proper angle for needle insertion during venipuncture?
A) 10-15 degrees
B) 15-30 degrees
C) 30-45 degrees
D) 45-60 degrees
Correct Answer: B) 15-30 degrees
Explanation: The needle should be inserted at a 15-30 degree angle with the bevel up to ensure proper entry into the vein and minimize patient discomfort.
Question 14:
Which tube should be collected first when drawing blood cultures and other tests?
A) Blood culture bottles
B) Light blue top tube
C) Red top tube
D) Lavender top tube
Correct Answer: A) Blood culture bottles
Explanation: Blood culture bottles are always collected first to minimize contamination risk, followed by other tubes according to the standard order of draw.
Question 15:
What should be done if blood stops flowing during venipuncture?
A) Immediately remove the needle
B) Push the needle in deeper
C) Gently adjust the needle position
D) Apply more tourniquet pressure
Correct Answer: C) Gently adjust the needle position
Explanation: If blood flow stops, gently adjust the needle position by slightly advancing, withdrawing, or rotating it. Avoid excessive manipulation that could cause patient discomfort or vein damage.