NHA Phlebotomy CPT 2026 Exam - Venipuncture
Procedures (Chapter Test) 50 Tricky Questions
with Answers
Question 1
During venipuncture, a phlebotomist palpates a vein that feels bouncy but rolls laterally when
pressure is applied. What is the most appropriate technique adjustment to prevent vein
movement during needle insertion?
A. Apply the tourniquet tighter.
B. Anchor the vein firmly 1 to 2 in below the site.
C. Insert the needle at a 45 degree angle.
D. Release the tourniquet before insertion.
Answer. B.
A rolling vein requires proper anchoring to stabilize it. Placing the thumb firmly one to two in
below the puncture site and pulling the skin top prevents lateral movement during insertion.
Increasing tourniquet pressure may cause high concentration and a 45° angle is excessive for
routine venopuncture. Releasing the tourniquet before insertion would reduce vein prominence
and complicate access.
Question 2
A patient has been fasting for 12 hours and appears dehydrated. Which venipuncture
complication is most likely if the tourniquet is left on for more than 1 minute?
A. Heme concentration.
B. Hemolysis from alcohol contamination.
C. Vein collapse.
D. Additive carryover.
Answer A.
Prolonged tourniquet application especially in a dehydrated patient leads to heme
concentration. This causes increased concentration of protein cells and protein-bound analytes
such as potassium and calcium. The effect can falsely elevate laboratory results and
compromise specimen accuracy. Tourniquette time should be limited to under one minute.
,Question 3
When performing venipuncture using a butterfly system, blood enters the tubing but stops
flowing into the tube. What is the most likely cause?
A. The bevel is facing downward.
B. The needle has penetrated through the vein.
C. The tube vacuum is too strong.
D. The alcohol was not dry.
Answer B.
If blood initially appears but then stops, it may indicate the needle has gone through the back
wall of the vein. This is common with shallow veins and butterfly needles. Slightly withdrawing
the needle may reestablish blood flow. A downward bevel would prevent initial flow and alcohol
drying does not affect ongoing flow once blood is present.
Question 4
Which angle of insertion is most appropriate for routine antecubital venipuncture?
A. 5 to 10°
B. 15 to 30°
C. 30 to 45°
D. 45 to 60°.
Answer B.
The recommended insertion angle for routine venopuncture is 15 to 30°. This angle allows safe
entry into the vein lumen without puncturing through the opposite wall. Smaller angles are used
for superficial veins while larger angles increase the risk of vein transfixation and tissue trauma.
Question 5
A patient reports a sudden sharp electric-like pain radiating down the arm during needle
insertion. What should the phlebotomist do immediately?
A. Continue collection quickly.
B. Rotate the needle slightly.
C. Remove the needle immediately.
D. Ask the patient to relax.
Answer C.
, Sudden sharp radiating pain may indicate nerve involvement. The needle must be removed
immediately to prevent nerve damage. Continuing or adjusting the needle could worsen injury.
Proper sight selection and awareness of anatomical landmarks reduce this risk.
Question 6
Which vein is generally the first choice for venipuncture due to stability and lower complication
risk?
A. Basilic vein.
B. Median cubital vein.
C. Syphilitic vein.
D. Dorsal hand vein.
Answer B.
The median cubital vein is preferred because it is usually well anchored, large, and less likely to
roll. It is also located away from major nerves and arteries compared to the basilic vein. Its
stability reduces risk of complications such as hematoma and nerve injury.
Question 7
A phlebotomist notices swelling forming at the puncture site during collection. What is the most
likely cause?
A. Hemolysis.
B. Hematoma formation.
C. Heme concentration.
D. Vein sclerosis.
Answer. B.
Swelling during blood draw indicates blood leaking into surrounding tissue forming a hematoma.
This can occur if the needle penetrates through the vein or if insufficient pressure is applied after
removal. Collection should be stopped immediately and pressure applied to prevent further
bleeding.
Question 8
When drawing multiple tubes, why is the order of draw critical?
A. To prevent hemolysis.
B. To reduce patient discomfort.
Procedures (Chapter Test) 50 Tricky Questions
with Answers
Question 1
During venipuncture, a phlebotomist palpates a vein that feels bouncy but rolls laterally when
pressure is applied. What is the most appropriate technique adjustment to prevent vein
movement during needle insertion?
A. Apply the tourniquet tighter.
B. Anchor the vein firmly 1 to 2 in below the site.
C. Insert the needle at a 45 degree angle.
D. Release the tourniquet before insertion.
Answer. B.
A rolling vein requires proper anchoring to stabilize it. Placing the thumb firmly one to two in
below the puncture site and pulling the skin top prevents lateral movement during insertion.
Increasing tourniquet pressure may cause high concentration and a 45° angle is excessive for
routine venopuncture. Releasing the tourniquet before insertion would reduce vein prominence
and complicate access.
Question 2
A patient has been fasting for 12 hours and appears dehydrated. Which venipuncture
complication is most likely if the tourniquet is left on for more than 1 minute?
A. Heme concentration.
B. Hemolysis from alcohol contamination.
C. Vein collapse.
D. Additive carryover.
Answer A.
Prolonged tourniquet application especially in a dehydrated patient leads to heme
concentration. This causes increased concentration of protein cells and protein-bound analytes
such as potassium and calcium. The effect can falsely elevate laboratory results and
compromise specimen accuracy. Tourniquette time should be limited to under one minute.
,Question 3
When performing venipuncture using a butterfly system, blood enters the tubing but stops
flowing into the tube. What is the most likely cause?
A. The bevel is facing downward.
B. The needle has penetrated through the vein.
C. The tube vacuum is too strong.
D. The alcohol was not dry.
Answer B.
If blood initially appears but then stops, it may indicate the needle has gone through the back
wall of the vein. This is common with shallow veins and butterfly needles. Slightly withdrawing
the needle may reestablish blood flow. A downward bevel would prevent initial flow and alcohol
drying does not affect ongoing flow once blood is present.
Question 4
Which angle of insertion is most appropriate for routine antecubital venipuncture?
A. 5 to 10°
B. 15 to 30°
C. 30 to 45°
D. 45 to 60°.
Answer B.
The recommended insertion angle for routine venopuncture is 15 to 30°. This angle allows safe
entry into the vein lumen without puncturing through the opposite wall. Smaller angles are used
for superficial veins while larger angles increase the risk of vein transfixation and tissue trauma.
Question 5
A patient reports a sudden sharp electric-like pain radiating down the arm during needle
insertion. What should the phlebotomist do immediately?
A. Continue collection quickly.
B. Rotate the needle slightly.
C. Remove the needle immediately.
D. Ask the patient to relax.
Answer C.
, Sudden sharp radiating pain may indicate nerve involvement. The needle must be removed
immediately to prevent nerve damage. Continuing or adjusting the needle could worsen injury.
Proper sight selection and awareness of anatomical landmarks reduce this risk.
Question 6
Which vein is generally the first choice for venipuncture due to stability and lower complication
risk?
A. Basilic vein.
B. Median cubital vein.
C. Syphilitic vein.
D. Dorsal hand vein.
Answer B.
The median cubital vein is preferred because it is usually well anchored, large, and less likely to
roll. It is also located away from major nerves and arteries compared to the basilic vein. Its
stability reduces risk of complications such as hematoma and nerve injury.
Question 7
A phlebotomist notices swelling forming at the puncture site during collection. What is the most
likely cause?
A. Hemolysis.
B. Hematoma formation.
C. Heme concentration.
D. Vein sclerosis.
Answer. B.
Swelling during blood draw indicates blood leaking into surrounding tissue forming a hematoma.
This can occur if the needle penetrates through the vein or if insufficient pressure is applied after
removal. Collection should be stopped immediately and pressure applied to prevent further
bleeding.
Question 8
When drawing multiple tubes, why is the order of draw critical?
A. To prevent hemolysis.
B. To reduce patient discomfort.
