Table of Contents
Chapter 1: Patient Safety & Complication Management ................. Page 1
Chapter 2: Specimen Collection & Handling ................................. Page 9
Chapter 3: Infection Control & Safety ........................................ Page 17
Chapter 4: Equipment & Supplies ................................................ Page 25
Chapter 5: Venipuncture Techniques & Sites .............................. Page 33
Chapter 6: Capillary Collection & Special Populations .............. Page 41
Chapter 7: Laboratory Regulations & Compliance (CLIA, HIPAA) .... Page 49
Chapter 8: Blood Components & Anticoagulants ....................... Page 57
Chapter 9: Order of Draw & Additive Interference .................... Page 65
Chapter 10: Patient Identification & Documentation .................. Page 73
Chapter 11: Transport, Storage & Processing ............................. Page 81
Chapter 12: Quality Assurance & Error Prevention .................... Page 89
,
,NHCO Phlebotomy Exam 2025/2026 –
Chapter 1
Patient Safety & Complication Management
Question 1
A patient begins to faint during venipuncture. The phlebotomist’s first action should be:
A. Finish the blood draw quickly
B. Remove the needle and ensure patient safety
C. Tighten the tourniquet to speed collection
D. Stand the patient up
Correct Answer: B
Rationale:
Immediate removal of the needle and ensuring the patient’s safety prevents injury.
Completing the draw or tightening the tourniquet is unsafe; standing the patient could worsen
syncope.
Question 2
During a difficult venipuncture, blood flow is extremely slow. What is the most appropriate
next step?
A. Withdraw and reattempt in the same vein immediately
B. Adjust the needle slightly and maintain proper angle
C. Apply additional tourniquet pressure
D. Ask the patient to pump their fist rapidly
Correct Answer: B
Rationale:
Slow flow is often caused by needle wall obstruction or angle against the vein. Slight
adjustment can restore flow safely. Re-inserting immediately increases hematoma risk;
tourniquet and fist pumping are inappropriate.
Question 3
A patient on IV therapy in the left arm needs multiple blood tubes. The safest approach is:
, A. Draw below the IV in the same arm
B. Draw from the opposite arm
C. Draw from the same hand
D. Ask the nurse to stop the IV and draw immediately
Correct Answer: B
Rationale:
Drawing from the opposite arm prevents contamination, dilution, or hematoma. Below IV or
same hand draws are not recommended; stopping IV requires nurse protocol.
Question 4
A patient’s sample appears lipemic. What should the phlebotomist do?
A. Repeat the draw immediately
B. Centrifuge and use it for testing
C. Notify the lab to determine acceptability
D. Discard without documentation
Correct Answer: C
Rationale:
Lipemia can interfere with results. Lab must decide if the sample is acceptable. Repeating
immediately or discarding violates safety and protocol. Centrifugation alone does not correct
interference.
Question 5
A tube is underfilled, resulting in clotted blood in an EDTA tube. Likely cause:
A. Tube underfilled
B. Tourniquet left too long
C. Tube inverted too gently
D. Patient dehydration
Correct Answer: A
Rationale:
EDTA tubes require proper additive-to-blood ratio. Underfilling alters the anticoagulant ratio,
causing clotting. Other factors may contribute but are less likely primary causes.
Question 6
Chapter 1: Patient Safety & Complication Management ................. Page 1
Chapter 2: Specimen Collection & Handling ................................. Page 9
Chapter 3: Infection Control & Safety ........................................ Page 17
Chapter 4: Equipment & Supplies ................................................ Page 25
Chapter 5: Venipuncture Techniques & Sites .............................. Page 33
Chapter 6: Capillary Collection & Special Populations .............. Page 41
Chapter 7: Laboratory Regulations & Compliance (CLIA, HIPAA) .... Page 49
Chapter 8: Blood Components & Anticoagulants ....................... Page 57
Chapter 9: Order of Draw & Additive Interference .................... Page 65
Chapter 10: Patient Identification & Documentation .................. Page 73
Chapter 11: Transport, Storage & Processing ............................. Page 81
Chapter 12: Quality Assurance & Error Prevention .................... Page 89
,
,NHCO Phlebotomy Exam 2025/2026 –
Chapter 1
Patient Safety & Complication Management
Question 1
A patient begins to faint during venipuncture. The phlebotomist’s first action should be:
A. Finish the blood draw quickly
B. Remove the needle and ensure patient safety
C. Tighten the tourniquet to speed collection
D. Stand the patient up
Correct Answer: B
Rationale:
Immediate removal of the needle and ensuring the patient’s safety prevents injury.
Completing the draw or tightening the tourniquet is unsafe; standing the patient could worsen
syncope.
Question 2
During a difficult venipuncture, blood flow is extremely slow. What is the most appropriate
next step?
A. Withdraw and reattempt in the same vein immediately
B. Adjust the needle slightly and maintain proper angle
C. Apply additional tourniquet pressure
D. Ask the patient to pump their fist rapidly
Correct Answer: B
Rationale:
Slow flow is often caused by needle wall obstruction or angle against the vein. Slight
adjustment can restore flow safely. Re-inserting immediately increases hematoma risk;
tourniquet and fist pumping are inappropriate.
Question 3
A patient on IV therapy in the left arm needs multiple blood tubes. The safest approach is:
, A. Draw below the IV in the same arm
B. Draw from the opposite arm
C. Draw from the same hand
D. Ask the nurse to stop the IV and draw immediately
Correct Answer: B
Rationale:
Drawing from the opposite arm prevents contamination, dilution, or hematoma. Below IV or
same hand draws are not recommended; stopping IV requires nurse protocol.
Question 4
A patient’s sample appears lipemic. What should the phlebotomist do?
A. Repeat the draw immediately
B. Centrifuge and use it for testing
C. Notify the lab to determine acceptability
D. Discard without documentation
Correct Answer: C
Rationale:
Lipemia can interfere with results. Lab must decide if the sample is acceptable. Repeating
immediately or discarding violates safety and protocol. Centrifugation alone does not correct
interference.
Question 5
A tube is underfilled, resulting in clotted blood in an EDTA tube. Likely cause:
A. Tube underfilled
B. Tourniquet left too long
C. Tube inverted too gently
D. Patient dehydration
Correct Answer: A
Rationale:
EDTA tubes require proper additive-to-blood ratio. Underfilling alters the anticoagulant ratio,
causing clotting. Other factors may contribute but are less likely primary causes.
Question 6
