Phlebotomy Routine Blood Collections Practice Test

25 practice questions

Choose an answer, then check it under Show answer.

1. Question 1 of 25Easy

   Which agent is routinely used to clean the skin before a venipuncture for a basic metabolic panel?

   1. AA. A diluted household bleach solution
   2. BB. Sterile normal saline solution
   3. CC. 70% isopropyl alcohol
   4. DD. A quaternary ammonium surface wipe
   Show answer to question 1

   Answer: C. 70% isopropyl alcohol

   Routine venipuncture sites are cleaned with 70% isopropyl alcohol, a skin antiseptic that reduces surface microorganisms before the needle enters.

   Why the other options are wrong

   • ABleach is a disinfectant for surfaces and spills and is not applied to skin.
   • BSaline has no antimicrobial action, so it does not prepare the site.
   • DA quaternary ammonium surface wipe is made for equipment and hard surfaces; routine venipuncture sites are cleaned with 70% isopropyl alcohol.

2. Question 2 of 25Hard

   After a difficult draw on a 58-year-old man, a phlebotomist's gold-top tube yields only 0.3 mL of serum. The specimen guide lists 0.5 mL as the minimum for the ordered test, although the analyzer uses only about 10 microliters per run. What best explains why the specimen is likely to be rejected?

   1. AA. The analyzer gives falsely high results on small serum volumes
   2. BB. The analyzer needs dead volume its probe cannot draw up
   3. CC. Small serum volumes break down before the analyzer tests them
   4. DD. The minimum is set so that tubes balance in the centrifuge
   Show answer to question 2

   Answer: B. The analyzer needs dead volume its probe cannot draw up

   Analyzers need a dead volume: specimen left in the tube or sample cup that the probe cannot draw up. The listed minimum covers this extra volume as well as the amount tested, and often enough for a repeat, so 0.3 mL is likely to be rejected as quantity not sufficient.

   Why the other options are wrong

   • ASerum concentration does not depend on volume, so a small amount gives the same result when enough of it can be sampled.
   • CSpecimen stability depends on time, temperature and handling, not on how much serum is in the tube.
   • DCentrifuges are balanced with a tube of equal weight; the minimum volume reflects what the analyzer needs.

3. Question 3 of 25Medium

   After cleaning the antecubital site of a 61-year-old woman on a hospital unit, a phlebotomist is unsure of the vein's exact location and needs to feel it again. What should be done?

   1. AA. Feel the vein again, then insert the needle right away
   2. BB. Feel the vein again, then reclean the site and let it dry
   3. CC. Mark the vein with a pen on the cleaned skin and proceed
   4. DD. Feel the vein again, then fan the site so it dries quickly
   Show answer to question 3

   Answer: B. Feel the vein again, then reclean the site and let it dry

   Touching the site after cleaning recontaminates it. If the vein must be palpated again, the site is recleaned and allowed to air dry before the needle is inserted.

   Why the other options are wrong

   • AInserting right after touching the cleaned skin carries contaminants into the puncture.
   • CA pen mark on cleaned skin recontaminates the site and is not an accepted way to locate a vein.
   • DFanning does not remove the contamination from palpating, and it can add more.

4. Question 4 of 25Medium

   Bleeding has stopped after a venipuncture on an 18-month-old boy at a pediatric clinic. How should the site be handled?

   1. AA. Apply an adhesive bandage and ask the parent to watch it
   2. BB. Wrap the arm tightly with tape so he cannot reach the site
   3. CC. Apply a cold pack to the site for the rest of the visit
   4. DD. Skip the adhesive bandage and recheck the site once more
   Show answer to question 4

   Answer: D. Skip the adhesive bandage and recheck the site once more

   Adhesive bandages are not used on children younger than 2 years because the child can pull one off and choke on it. The site is checked again to confirm bleeding has stopped.

   Why the other options are wrong

   • AA child this age may pull off the bandage and put it in the mouth, creating a choking hazard.
   • BTight taping can restrict circulation and irritate a young child's skin, and it is not needed once bleeding stops.
   • CA cold pack is not part of routine care after an uncomplicated draw.

5. Question 5 of 25Medium

   An 84-year-old resident with dementia in a long-term care facility seems confused when the phlebotomist arrives for an ordered draw. Which approach best supports a safe venipuncture?

   1. AA. Explain every step using detailed medical terms first
   2. BB. Speak calmly in short sentences and get help steadying her arm
   3. CC. Insert the needle quickly before she notices what is happening
   4. DD. Tape her arm to the bed rail so she cannot pull it away
   Show answer to question 5

   Answer: B. Speak calmly in short sentences and get help steadying her arm

   Patients with dementia may be confused or move suddenly. Calm, simple explanations and a staff member or caregiver gently supporting the arm reduce the risk of injury, with consent handled per facility policy.

   Why the other options are wrong

   • ADetailed medical terms are hard for a confused patient to follow and can raise anxiety.
   • CSurprising the patient can trigger sudden movement and injury, and she should be told what is happening.
   • DTaping an arm to a bed rail is a restraint and is not used without an order and facility policy.

6. Question 6 of 25Medium

   On a surgical unit, a phlebotomist has drawn and labeled the tubes for a 45-year-old woman. What check should be made before leaving her bedside?

   1. AA. Compare the tube labels with the number on her room door
   2. BB. Ask her nurse to relabel the tubes with a second set
   3. CC. Check the labels against the unit's hallway census board
   4. DD. Match the tube labels against the details on her ID band
   Show answer to question 6

   Answer: D. Match the tube labels against the details on her ID band

   Before leaving, the phlebotomist compares each tube label with the patient's ID band (and the requisition) to confirm that the name and identification number match.

   Why the other options are wrong

   • AA room number is never an identifier because patients change rooms and beds.
   • BRelabeling by someone who did not collect the specimen adds error risk and is not standard practice.
   • CA census board is not a patient identifier and may be out of date.

7. Question 7 of 25Easy

   While the first tube fills from a 70-year-old woman's antecubital vein in her hospital room, a raised swelling quickly forms around the needle. What should the phlebotomist do?

   1. AA. Release the tourniquet, remove the needle, apply pressure
   2. BB. Tighten the tourniquet to slow the blood leaking into tissue
   3. CC. Massage the swelling while the remaining tubes are filled
   4. DD. Finish the draw, then apply a cold pack to the swelling
   Show answer to question 7

   Answer: A. Release the tourniquet, remove the needle, apply pressure

   Rapid swelling means blood is leaking into the tissue and a hematoma is forming. The draw is stopped: release the tourniquet, remove the needle and apply direct pressure to limit bleeding and bruising.

   Why the other options are wrong

   • BA tighter tourniquet raises pressure in the vein and pushes more blood into the tissue.
   • CMassaging spreads the bleeding, and continuing the draw lets the hematoma grow.
   • DContinuing the draw keeps blood leaking into the tissue; a cold pack, if used, comes after the needle is out.

8. Question 8 of 25Medium

   In the emergency department, a phlebotomist uses a syringe for a 33-year-old woman with difficult veins. A light blue, a gold, and a lavender tube are needed. In what order should the tubes be filled from the syringe?

   1. AA. Lavender, light blue, gold
   2. BB. Gold, lavender, light blue
   3. CC. Light blue, gold, lavender
   4. DD. Gold, light blue, lavender
   Show answer to question 8

   Answer: C. Light blue, gold, lavender

   Tubes filled from a syringe follow the same CLSI order of draw as tubes filled directly: sodium citrate, then serum tubes, then EDTA. This prevents additive carryover between tubes.

   Why the other options are wrong

   • AFilling lavender first could carry EDTA into the citrate and serum tubes and alter coagulation and chemistry results.
   • BPlacing the citrate tube last exposes the coagulation specimen to carryover of clot activator and EDTA.
   • DClot activator from the gold tube could be carried into the citrate tube and alter coagulation results.

9. Question 9 of 25Medium

   Which practice is safest when engaging the safety feature of a used venipuncture needle?

   1. AA. Use a one-handed technique and check that the tip is covered
   2. BB. Slide the shield over the needle with the fingers of the free hand
   3. CC. Replace the original needle cap before discarding the device
   4. DD. Set the device on the tray and engage the feature after bandaging
   Show answer to question 9

   Answer: A. Use a one-handed technique and check that the tip is covered

   Safety features are designed for one-handed activation so the free hand stays away from the needle. The phlebotomist then confirms the tip is fully covered or retracted, per manufacturer instructions, before discarding the device.

   Why the other options are wrong

   • BMoving the free hand toward the needle tip creates the needlestick risk that one-handed designs avoid.
   • CRecapping a used venipuncture needle is not permitted and is a common cause of needlestick injuries.
   • DA used needle left uncovered on a tray is a hazard; the feature is engaged at once.

10. Question 10 of 25Hard

    While searching for a vein on a 48-year-old man at a sports medicine clinic, a phlebotomist leaves the tourniquet on for about 3 minutes before completing the draw. Which result is most likely to be falsely increased?

    1. AA. Albumin
    2. BB. Sodium
    3. CC. Chloride
    4. DD. Glucose
    Show answer to question 10

    Answer: A. Albumin

    A tourniquet left on longer than 1 minute lets plasma water and small molecules move into the tissue while cells and large molecules stay behind. This hemoconcentration falsely raises proteins such as albumin, protein-bound substances and cell counts.

    Why the other options are wrong

    • BSodium is a small ion that moves with plasma water, so it changes little with hemoconcentration.
    • CChloride also moves freely with plasma water and is not significantly concentrated.
    • DGlucose is a small molecule that passes freely through capillary walls and is little affected.

11. Question 11 of 25Hard

    Using a winged set on a 44-year-old man at an endocrinology office, the phlebotomist sees a flash of blood in the tubing, but the first evacuated tube does not fill. That tube had been pushed onto the holder needle before the venipuncture. What should the phlebotomist do?

    1. AA. Withdraw and reinsert the needle at another site
    2. BB. Advance the needle deeper into the vein
    3. CC. Ask the patient to clench and release his fist
    4. DD. Replace it with a new tube of the same type
    Show answer to question 11

    Answer: D. Replace it with a new tube of the same type

    The blood flash shows the needle is in the vein. Pushing the tube onto the needle before the venipuncture let air in and released its vacuum, so a new tube is needed to start the flow.

    Why the other options are wrong

    • AA new puncture is unnecessary because the needle is already in the vein.
    • BAdvancing a needle that is already in the vein can push it through the back wall.
    • CClenching the fist cannot restore a tube's lost vacuum.

12. Question 12 of 25Easy

    How should a 70% isopropyl alcohol pad be used on a routine venipuncture site?

    1. AA. Rub the site with friction, then let it air dry
    2. BB. Leave the pad resting on the site during the draw
    3. CC. Dab the site lightly, then blot it dry with gauze
    4. DD. Wipe once across the site, then blow it dry
    Show answer to question 12

    Answer: A. Rub the site with friction, then let it air dry

    The site is cleaned with friction to loosen and remove microorganisms, then left to air dry so the alcohol can finish its work.

    Why the other options are wrong

    • BA pad left on the site blocks the needle and keeps the skin wet.
    • CLight dabbing removes fewer microbes, and blotting removes the alcohol before it can work.
    • DA single wipe is not enough cleaning, and blowing on the site recontaminates it.

13. Question 13 of 25Medium

    At the bedside of a 59-year-old man, a phlebotomist is applying a printed barcode label to a filled lavender tube. How should the label be placed?

    1. AA. Flat and straight on the tube, leaving the blood visible
    2. BB. Folded over the top of the tube so it covers the stopper
    3. CC. Around the whole tube so that none of the blood shows
    4. DD. On the specimen bag, with the tube placed inside it
    Show answer to question 13

    Answer: A. Flat and straight on the tube, leaving the blood visible

    The label goes on the tube itself, applied flat and straight so the barcode scans, with a window left so laboratory staff can see the specimen and check its fill level. Facility policy may add details, such as placing it over the manufacturer's label.

    Why the other options are wrong

    • BA label folded over the stopper can tear or come away when the tube is opened, separating the identifiers from the specimen.
    • CCovering all of the blood keeps staff from checking the fill level and the condition of the specimen.
    • DBags are opened and discarded in the laboratory, so each tube must carry its own label.

14. Question 14 of 25Medium

    After drawing blood with a syringe, a phlebotomist uses a transfer device to fill the evacuated tubes. Which practice helps prevent hemolysis during the transfer?

    1. AA. Push the plunger firmly so each tube fills quickly
    2. BB. Remove each stopper and squirt the blood in
    3. CC. Let each tube's vacuum pull the blood in
    4. DD. Shake each tube hard right after it is filled
    Show answer to question 14

    Answer: C. Let each tube's vacuum pull the blood in

    With a transfer device, each tube's own vacuum should draw blood from the syringe. Forcing the plunger pushes cells through a narrow opening under pressure and ruptures them.

    Why the other options are wrong

    • AForcing blood through the transfer device damages red cells and can cause hemolysis.
    • BRemoving stoppers to squirt in blood creates splatter and exposure risk and is not an approved transfer method.
    • DShaking tubes hard damages red cells; additive tubes are mixed by gentle inversion.

15. Question 15 of 25Easy

    A provider orders a zinc level. Which stopper color identifies a tube made with certified low levels of trace metals for this kind of testing?

    1. AA. Lavender
    2. BB. Royal blue
    3. CC. Gold
    4. DD. Gray
    Show answer to question 15

    Answer: B. Royal blue

    Royal blue tubes are made with stoppers and tube materials certified to contain very low levels of trace metals, so the tube itself does not contaminate tests such as zinc.

    Why the other options are wrong

    • AStandard lavender EDTA tubes are made for hematology and are not certified for trace metal testing.
    • CGold serum tubes are used for general chemistry, and their stoppers are not certified for trace metals.
    • DGray tubes are used to preserve glucose and are not designed for trace element testing.

16. Question 16 of 25Easy

    Before using a syringe for venipuncture, what should the phlebotomist do with the plunger?

    1. AA. Pull it halfway back so suction is already set before entry
    2. BB. Slide it back and forth, then push it fully in to expel air
    3. CC. Draw up a small amount of sterile saline to lubricate the barrel
    4. DD. Take it out of the barrel to inspect the inside for defects
    Show answer to question 16

    Answer: B. Slide it back and forth, then push it fully in to expel air

    Moving the plunger briefly confirms that it slides smoothly, and pushing it fully forward expels air so the whole barrel is available for blood. The plunger never leaves the barrel, so the syringe stays sterile.

    Why the other options are wrong

    • APulling the plunger back before entry only fills the barrel with air and leaves less room for blood.
    • CSaline would dilute the specimen and change test results.
    • DRemoving the plunger contaminates the inside of the barrel, so the syringe is no longer sterile.

17. Question 17 of 25Medium

    At an outpatient clinic, a phlebotomist will use a winged set on a 52-year-old man, and the first tube needed is a light blue citrate tube. Which discard tube choice is appropriate?

    1. AA. A lavender EDTA tube, filled to the fill line
    2. BB. A gold tube with clot activator and gel, filled completely
    3. CC. A green heparin tube, filled about halfway
    4. DD. A non-additive tube, filled only to prime the tubing
    Show answer to question 17

    Answer: D. A non-additive tube, filled only to prime the tubing

    The discard tube only removes air from the tubing so the citrate tube fills correctly. It should be a non-additive tube (or another citrate tube), it does not need to be filled completely, and it is then thrown away.

    Why the other options are wrong

    • AEDTA could be carried into the citrate tube and interfere with coagulation testing.
    • BClot activator carried into the citrate tube can activate clotting and alter coagulation results.
    • CHeparin carried into the citrate tube would falsely prolong clotting times.

18. Question 18 of 25Easy

    What is the purpose of the rubber sleeve that covers the tube end of a multisample needle?

    1. AA. It keeps the vein from collapsing as each tube is pushed on
    2. BB. It filters small clots out of the blood before it enters the tube
    3. CC. It mixes the tube additive with the blood as the tube fills
    4. DD. It stops blood from leaking into the holder during tube changes
    Show answer to question 18

    Answer: D. It stops blood from leaking into the holder during tube changes

    The sleeve is pushed back when a tube stopper is engaged and slides back over the needle when the tube is removed. This lets several tubes be filled without blood leaking into the holder.

    Why the other options are wrong

    • AThe sleeve does not control vacuum; vein collapse is managed by choosing smaller tubes or a syringe.
    • BThe sleeve has no filtering role, and a specimen with clots is unacceptable for many tests.
    • CAdditives are mixed by gentle inversion of the tube after it is removed from the holder.

19. Question 19 of 25Medium

    During a heel puncture on a 4-month-old at a family practice office, blood flow slows after a few drops. Which action is appropriate?

    1. AA. Squeeze the heel firmly and steadily near the puncture
    2. BB. Apply gentle, intermittent pressure around the site
    3. CC. Make a second puncture through the same wound
    4. DD. Wipe each drop and wait for a larger one to form
    Show answer to question 19

    Answer: B. Apply gentle, intermittent pressure around the site

    Gentle, intermittent pressure on the surrounding tissue, with the foot held lower than the heart, helps blood flow. Strong squeezing, called milking, must be avoided.

    Why the other options are wrong

    • AMilking forces tissue fluid into the specimen and can hemolyze it, causing errors such as a falsely high potassium.
    • CRepuncturing the same wound is not acceptable; a new site is used if another puncture is needed.
    • DOnly the first drop is wiped away; wiping later drops wastes blood and slows the collection.

20. Question 20 of 25Hard

    A lavender EDTA tube receives far less blood than its stated draw volume. If it is tested, which CBC error is most likely?

    1. AA. Falsely low hematocrit from red cell shrinkage
    2. BB. Falsely high platelet count from platelet clumping
    3. CC. Falsely high hematocrit from hemoconcentration
    4. DD. Falsely high white count from fibrin strands
    Show answer to question 20

    Answer: A. Falsely low hematocrit from red cell shrinkage

    An underfilled EDTA tube has too much anticoagulant for the blood volume. The excess EDTA draws water out of red cells so they shrink, which can falsely lower the hematocrit and alter red cell indices and morphology.

    Why the other options are wrong

    • BPlatelet clumping makes the platelet count falsely low, and it is not the expected effect of excess EDTA.
    • CHemoconcentration comes from prolonged tourniquet time, not from the fill level of the tube.
    • DExcess EDTA prevents clotting, so fibrin strands are not the expected problem.

21. Question 21 of 25Medium

    In capillary collection, why are serum microcollection containers filled last?

    1. AA. Serum needs the blood that has been warmed the longest
    2. BB. Serum containers hold the largest volume of blood
    3. CC. Serum additives would contaminate the EDTA container
    4. DD. Serum is meant to clot, so the delay does no harm
    Show answer to question 21

    Answer: D. Serum is meant to clot, so the delay does no harm

    Clotting starts at the puncture site as soon as blood begins to flow. Anticoagulated containers are filled first, and serum containers come last because a specimen that is supposed to clot is not harmed by the delay.

    Why the other options are wrong

    • AWarming is done before the puncture and does not decide the order of containers.
    • BContainer volume does not set the capillary order of draw.
    • CDrops flow straight from the skin into each container, so additive carryover is not the reason for this order.

22. Question 22 of 25Hard

    At an outpatient oncology clinic, a 61-year-old man's vein collapses each time the phlebotomist pushes a 6 mL tube onto the needle, although blood flashes briefly at first. What is the best adjustment?

    1. AA. Use larger tubes so the draw finishes before the vein collapses
    2. BB. Ask him to pump his fist to push more blood into the vein
    3. CC. Change to smaller-volume tubes, which apply less vacuum
    4. DD. Advance the needle deeper and probe for a larger vein
    Show answer to question 22

    Answer: C. Change to smaller-volume tubes, which apply less vacuum

    A vein that flattens each time a tube is engaged is being pulled on too strongly by the vacuum. Smaller-volume tubes, or a syringe with gentle pull, reduce the suction so blood can keep flowing.

    Why the other options are wrong

    • ALarger tubes have more vacuum and would collapse the vein even faster.
    • BFist pumping can falsely raise potassium and does nothing to reduce excess suction.
    • DProbing is painful, can injure nerves or arteries, and does not address the cause.

23. Question 23 of 25Easy

    Which description matches correct tying of a flat, single-use tourniquet for venipuncture?

    1. AA. Tied in a double knot so it stays secure for the entire draw
    2. BB. Tied so its free ends hang down across the puncture site
    3. CC. Looped to release with one pull, ends away from the site
    4. DD. Twisted into a narrow cord first so it applies more pressure
    Show answer to question 23

    Answer: C. Looped to release with one pull, ends away from the site

    The band is tied in a partial loop (half bow) that releases with a single pull of one hand, and its free ends point away from the site so they cannot touch the cleaned area or block the needle.

    Why the other options are wrong

    • AA double knot cannot be released quickly with one hand once blood flow is established or a problem arises.
    • BEnds hanging over the site can contaminate the cleaned skin and get in the way of the needle.
    • DA twisted cord pinches the skin and concentrates pressure; the band should lie flat and snug.

24. Question 24 of 25Hard

    On a medical unit, a phlebotomist must collect a STAT CBC in a lavender tube and a routine PT in a light blue tube from a 63-year-old woman with good veins, using one venipuncture with a multisample needle. In what order should the tubes be filled?

    1. AA. Lavender first, because STAT tubes are always filled first
    2. BB. Light blue first only if the PT is also marked STAT
    3. CC. Either order, since only two tubes are being filled
    4. DD. Light blue first, then lavender, regardless of priority
    Show answer to question 24

    Answer: D. Light blue first, then lavender, regardless of priority

    Test priority sets how quickly a specimen is collected, delivered and processed, not the sequence of tubes within one venipuncture. The light blue citrate tube is filled before the lavender EDTA tube so EDTA cannot be carried into the coagulation specimen, and the STAT CBC is then delivered at once.

    Why the other options are wrong

    • APriority does not change the order of draw, and filling lavender first could carry EDTA into the citrate tube and alter the PT.
    • BThe order of draw does not depend on priority; the light blue tube comes first whether the PT is STAT or routine.
    • CEven with only two tubes, EDTA carried into the citrate tube can alter coagulation results, so the order still matters.

25. Question 25 of 25Hard

    After tying the tourniquet on a 66-year-old woman at a family medicine office, the phlebotomist sees tiny, flat, red spots appear on the skin below it. The vein is easy to find. What should the phlebotomist be prepared for?

    1. AA. A latex allergy reaction spreading up the arm
    2. BB. A hemolyzed specimen that must be redrawn
    3. CC. Bleeding that takes longer than usual to stop
    4. DD. A vein that collapses as soon as a tube is engaged
    Show answer to question 25

    Answer: C. Bleeding that takes longer than usual to stop

    Tiny, flat, red spots are petechiae, a sign of fragile capillaries or a platelet or clotting problem. They warn that the site may bleed longer than usual, so pressure is held until bleeding has fully stopped.

    Why the other options are wrong

    • AAn allergic reaction usually causes itching, hives or a rash, not pinpoint flat spots below a tourniquet.
    • BPetechiae on the skin do not damage the red cells inside the tube.
    • DPetechiae reflect capillary or platelet problems and do not predict that the vein will collapse.

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