Phlebotomy Special Collections Practice Test

25 practice questions

Choose an answer, then check it under Show answer.

1. Question 1 of 25Medium

   A 79-year-old patient in a long-term care facility needs a nasopharyngeal swab for a respiratory virus test. Which insertion technique is correct?

   1. AA. Upward toward the forehead until resistance is felt
   2. BB. Straight back along the nasal floor until resistance is felt
   3. CC. Straight back along the nasal floor, just until the tip is hidden
   4. DD. Upward toward the eye, just until the tip is hidden
   Show answer to question 1

   Answer: B. Straight back along the nasal floor until resistance is felt

   The nasopharynx lies straight back from the nostril, so the swab follows the floor of the nasal passage, parallel to the palate, until resistance is felt (about the distance from the nostril to the ear opening). It is then gently rotated, held briefly and slowly withdrawn.

   Why the other options are wrong

   • AAiming upward strikes the turbinates and upper nasal cavity, causing pain without reaching the nasopharynx.
   • CStopping when the tip is just hidden samples only the front of the nose, not the nasopharynx.
   • DThis path points the wrong way and stops far too short, so the specimen would be inadequate.

2. Question 2 of 25Hard

   During a urine drug collection under U.S. Department of Transportation (DOT) rules, the temperature strip reads 87°F (about 31°C) two minutes after the specimen is handed over. The acceptable range is 90 to 100°F (32 to 38°C). What should the collector do?

   1. AA. Have the donor drink water and then recollect in 3 hours
   2. BB. Warm the container in hand and read the strip again
   3. CC. Discard it and collect a second specimen without observation
   4. DD. Start a new collection at once under direct observation
   Show answer to question 2

   Answer: D. Start a new collection at once under direct observation

   Under DOT rules, an out-of-range temperature is recorded on the custody and control form, and a new collection is started immediately under direct observation, because the first specimen may have been substituted or altered.

   Why the other options are wrong

   • AWaiting hours gives the donor time to prepare another substitution and is not the required response.
   • BWarming the container would alter the evidence and make the reading meaningless.
   • CUnder DOT rules the first specimen is not discarded, and the second collection must be directly observed.

3. Question 3 of 25Hard

   Fifteen minutes after finishing the glucose drink for a 2-hour oral glucose tolerance test, a 47-year-old man vomits in the outpatient waiting area. What should the phlebotomist do?

   1. AA. Give a second glucose drink and restart the timing
   2. BB. Continue the draws and note it on the final label
   3. CC. Offer crackers to settle his stomach, then continue
   4. DD. Record the time and notify the provider or the lab
   Show answer to question 3

   Answer: D. Record the time and notify the provider or the lab

   Vomiting means the glucose load may not have been fully absorbed, which can invalidate the test. The phlebotomist records the time and notifies the provider or laboratory as facility policy directs, and the provider decides whether to stop and reschedule.

   Why the other options are wrong

   • AGiving another glucose load is not part of the protocol and is not the phlebotomist's decision.
   • BWaiting until the end to report the event misleads the provider about whether the results are valid.
   • CEating during the test adds carbohydrate and invalidates the results.

4. Question 4 of 25Medium

   After a donor hands over a urine specimen, the phlebotomist acting as collector is called to the front desk before the bottles are sealed. What should she do?

   1. AA. Seal the bottles and have the donor label them while she is away
   2. BB. Ask the donor to seal the bottles while she goes to the front desk
   3. CC. Seal and label the bottles first, with the donor watching
   4. DD. Carry the cup to the front desk and seal the bottles there
   Show answer to question 4

   Answer: C. Seal and label the bottles first, with the donor watching

   Until the bottles are sealed and labeled, the specimen must stay in view of both the donor and the collector, and the collector does the sealing and labeling. She completes these steps with the donor watching before she leaves.

   Why the other options are wrong

   • AThe collector, not the donor, completes the labeling, and leaving the donor alone with the bottles allows tampering.
   • BLeaving the donor alone with the unsealed specimen gives a chance to tamper with it, and sealing is the collector's task.
   • DCarrying the cup away takes the unsealed specimen out of the donor's view.

5. Question 5 of 25Medium

   A phlebotomy student asks why 70% isopropyl alcohol cannot be used to prepare the skin for an ethanol determination test. Which explanation is correct?

   1. AA. Isopropyl alcohol alters red blood cell antigens needed for typing procedures
   2. BB. Isopropyl alcohol neutralizes the sodium fluoride additive in the collection tube
   3. CC. Isopropyl alcohol causes rapid hemolysis that invalidates serum testing
   4. DD. Isopropyl alcohol can enter the tube and produce falsely elevated results
   Show answer to question 5

   Answer: D. Isopropyl alcohol can enter the tube and produce falsely elevated results

   Cleansing with an alcohol pad can introduce volatile alcohol vapors or liquid droplets into the puncture site and specimen tube, producing a falsely elevated blood ethanol reading. While hemolysis is an analytical concern in many laboratory tests, the specific danger with ethanol testing is chemical cross-contamination.

6. Question 6 of 25Medium

   An older adult patient in an intensive care unit requires multiple blood draws each day. Which collection strategy best helps prevent excessive blood volume loss?

   1. AA. Using pediatric or small-volume collection tubes
   2. BB. Performing all tests via capillary heel sticks
   3. CC. Using larger-gauge needles to speed up fill rates
   4. DD. Drawing an extra discard tube with each collection
   Show answer to question 6

   Answer: A. Using pediatric or small-volume collection tubes

   Using pediatric or small-volume collection tubes significantly reduces the total milliliters of blood removed during frequent testing, which protects older adults from hospital-acquired anemia. Drawing an extra discard tube before each collection is incorrect because it unnecessarily removes additional blood volume. Capillary heel sticks are inappropriate for adult patients and do not solve the issue of excessive diagnostic volume depletion.

7. Question 7 of 25Medium

   A police officer brings a 26-year-old woman to the emergency department for a legal blood alcohol draw. The tubes have just been filled and labeled at the bedside. What is the next step?

   1. AA. Give the unsealed tubes to the officer to seal later
   2. BB. Send the tubes to the lab along with the routine specimens
   3. CC. Apply tamper-evident seals and complete the custody form
   4. DD. Store the tubes in the unit refrigerator for pickup
   Show answer to question 7

   Answer: C. Apply tamper-evident seals and complete the custody form

   A legal specimen is sealed right away, in the officer's presence, with tamper-evident seals initialed and dated as the kit directs, and the chain-of-custody form is completed so every later transfer can be documented.

   Why the other options are wrong

   • AUnsealed tubes leave the collection open to challenge, because tampering could not be ruled out.
   • BRoutine handling has no documented chain of custody, so the result may not hold up legally.
   • DAn unsealed, unattended specimen in a shared refrigerator breaks the chain of custody.

8. Question 8 of 25Easy

   What is the main purpose of the transport medium in a culture swab tube?

   1. AA. To kill normal flora so only pathogens remain
   2. BB. To begin growing the organism before it reaches the lab
   3. CC. To keep organisms alive without letting them multiply
   4. DD. To preserve the specimen for chemistry testing
   Show answer to question 8

   Answer: C. To keep organisms alive without letting them multiply

   Transport media such as Amies or Stuart medium keep organisms moist and viable during transport but do not supply nutrients for growth, so the culture reflects what was present when the specimen was collected.

   Why the other options are wrong

   • ATransport media do not kill normal flora; selective culture media in the lab help sort organisms.
   • BGrowth starts only when the lab plates the specimen on culture media.
   • DCulture swabs go to microbiology, and the medium preserves organisms, not chemical analytes.

9. Question 9 of 25Hard

   On a medical unit, a phlebotomist applies a tourniquet to choose a vein for blood cultures on a 45-year-old woman. Facility protocol calls for a 30-second chlorhexidine scrub followed by complete air drying. Which approach is best?

   1. AA. Leave the tourniquet on through the scrub and drying to keep the vein full
   2. BB. Release the tourniquet for the scrub and drying, then reapply it to draw
   3. CC. Blot the antiseptic with sterile gauze so the puncture can be done sooner
   4. DD. Fan the site with a gloved hand so that the antiseptic dries more quickly
   Show answer to question 9

   Answer: B. Release the tourniquet for the scrub and drying, then reapply it to draw

   Scrubbing and drying can push tourniquet time past the 1-minute limit. Releasing the tourniquet once the vein is chosen, letting the antiseptic dry completely, and then reapplying it without touching the prepared site keeps both the specimen and the skin prep acceptable.

   Why the other options are wrong

   • ALeaving the tourniquet on through the scrub and drying would likely exceed 1 minute, causing hemoconcentration and discomfort.
   • CBlotting removes the antiseptic before it has finished working, which raises the risk of a contaminated culture.
   • DFanning can carry airborne particles onto the prepared skin; the antiseptic should be left to dry on its own.

10. Question 10 of 25Hard

    On an inpatient unit, a surgeon aspirates fluid from a deep abscess in a 50-year-old woman and asks the phlebotomist to prepare it for an anaerobic culture. Which handling is best?

    1. AA. Put it in an anaerobic transport container and send it promptly
    2. BB. Pour it into a sterile open cup so the fluid can be seen easily
    3. CC. Dip a cotton swab in it and place the swab in a dry sterile tube
    4. DD. Put it in an anaerobic transport container and refrigerate it overnight
    Show answer to question 10

    Answer: A. Put it in an anaerobic transport container and send it promptly

    Anaerobic bacteria are killed by oxygen, so the fluid goes into an oxygen-free anaerobic transport system, is kept at room temperature, and is delivered to the laboratory promptly, following the lab's instructions.

    Why the other options are wrong

    • BAn open cup exposes the fluid to air, which kills anaerobes before they reach the lab.
    • CA swab in a dry tube holds little material and exposes it to air and drying.
    • DEven in an anaerobic container, an overnight delay reduces anaerobe survival, and these specimens are generally not refrigerated.

11. Question 11 of 25Easy

    Which vascular access device is inserted into a vein of the upper arm and advanced until its tip lies in a large vein near the heart?

    1. AA. A peripherally inserted central catheter
    2. BB. An arteriovenous fistula used for dialysis
    3. CC. An arterial line placed in the radial artery
    4. DD. A peripheral IV catheter placed in the hand
    Show answer to question 11

    Answer: A. A peripherally inserted central catheter

    A peripherally inserted central catheter (PICC) enters a peripheral vein, usually in the upper arm, and is threaded until its tip rests in a large central vein near the heart. It is a central line, so only staff trained and authorized by facility policy access it.

    Why the other options are wrong

    • BAn arteriovenous fistula is a surgically created connection between an artery and a vein for dialysis, not an inserted catheter.
    • CAn arterial line sits in an artery and is used for pressure monitoring and arterial samples.
    • DA peripheral IV stays in a small vein of the hand or arm and does not reach the central circulation.

12. Question 12 of 25Easy

    About how much blood is collected in a standard unit of whole blood from an adult donor?

    1. AA. About 50 mL, roughly 3 tablespoons
    2. BB. About 150 mL, roughly two-thirds of a cup
    3. CC. About 1,000 mL, roughly 1 quart
    4. DD. About 450 to 500 mL, roughly 1 pint
    Show answer to question 12

    Answer: D. About 450 to 500 mL, roughly 1 pint

    A standard whole blood unit is about 450 to 500 mL, roughly 1 pint, collected into a bag that contains an anticoagulant-preservative. The blood center's procedure sets the exact target, and a collection scale shows when it is reached.

    Why the other options are wrong

    • AAbout 50 mL is only a small fraction of a standard unit of whole blood.
    • BAbout 150 mL is well below a standard unit and would leave too much anticoagulant for the amount of blood.
    • CAbout 1,000 mL is roughly twice a standard unit and would be unsafe to take from one donor at one time.

13. Question 13 of 25Hard

    A provider orders two sets of blood cultures for a 39-year-old man. A nursing student asks why the phlebotomist will perform two separate venipunctures at different sites instead of filling all four bottles from one puncture. Which explanation is best?

    1. AA. Different veins can carry different bacteria, so each arm must be sampled
    2. BB. Two punctures allow each bottle to be filled with less blood than usual
    3. CC. Comparing growth in the two sets helps tell infection from contamination
    4. DD. Two punctures allow the second set to be drawn after antibiotics begin
    Show answer to question 13

    Answer: C. Comparing growth in the two sets helps tell infection from contamination

    When the same organism grows in sets drawn from separate venipunctures, a true bloodstream infection is likely, while a skin organism growing in only one set suggests contamination during collection. Filling every bottle from one puncture removes this comparison.

    Why the other options are wrong

    • AOrganisms in the bloodstream circulate throughout the body; the purpose is comparison, not sampling each arm.
    • BEach bottle still needs the volume the manufacturer specifies; separate punctures do not lower it.
    • DBoth sets should be collected before antibiotics, because antibiotics in the specimen can keep organisms from growing.

14. Question 14 of 25Easy

    Which blood alcohol request requires chain-of-custody documentation?

    1. AA. An ethanol level the ED provider orders after a car crash
    2. BB. A level ordered while a patient is treated for withdrawal
    3. CC. A specimen drawn at a police officer's request in a traffic case
    4. DD. A level added on to a patient's routine morning labs
    Show answer to question 14

    Answer: C. A specimen drawn at a police officer's request in a traffic case

    Chain of custody is required when a specimen may be used as legal evidence, such as a blood alcohol requested by law enforcement in a traffic case. It documents everyone who handles the specimen from collection to testing.

    Why the other options are wrong

    • AA level the provider orders for the patient's care is a medical specimen, even when a crash was involved.
    • BMonitoring a patient during withdrawal treatment is patient care, not legal evidence.
    • DAn add-on test for clinical care does not need chain-of-custody documentation.

15. Question 15 of 25Easy

    In a urine drug screen collection, why is the temperature of the specimen read within a few minutes after the donor hands it to the collector?

    1. AA. To help detect a specimen that was substituted or altered
    2. BB. To decide whether the specimen needs refrigeration
    3. CC. To confirm that the donor does not have a fever
    4. DD. To estimate how much fluid the donor drank beforehand
    Show answer to question 15

    Answer: A. To help detect a specimen that was substituted or altered

    Freshly voided urine is close to body temperature. Reading the container's temperature strip within the required time (4 minutes under federal workplace rules) helps detect a specimen that was substituted or altered, for example with added water.

    Why the other options are wrong

    • BThe temperature check is a tampering check, not a storage decision.
    • CThe reading checks the specimen's integrity, not whether the donor has a fever.
    • DTemperature does not measure fluid intake; the laboratory evaluates dilute specimens.

16. Question 16 of 25Medium

    On a medical unit, a phlebotomist collects two sets of blood cultures from a 29-year-old woman, using a separate venipuncture for each set. Besides her identifiers and the date and time of collection, which detail is most important to record on each bottle?

    1. AA. The body site from which that set was drawn
    2. BB. Her room and bed number, as a second identifier
    3. CC. The lot number of the antiseptic used for that set
    4. DD. The time the tourniquet was applied for that set
    Show answer to question 16

    Answer: A. The body site from which that set was drawn

    Blood culture bottles are labeled at the bedside with the patient's identifiers, the collection date and time and the collector's initials or ID, plus the site of each draw, such as left antecubital or right hand. Knowing which set came from which site helps the provider interpret growth, especially when only one set is positive. Labels should not cover the bottle's barcode.

    Why the other options are wrong

    • BRoom and bed numbers are never used as patient identifiers on specimen labels.
    • CThe antiseptic lot number is not a required label element for blood culture bottles.
    • DTourniquet application time is not recorded on specimen labels; the collection time is.

17. Question 17 of 25Medium

    A 58-year-old man on a surgical unit needs blood cultures, a coagulation panel in a light blue tube and a CBC in a lavender tube, all from one venipuncture. In which order should they be collected?

    1. AA. Light blue tube, blood culture bottles, lavender tube
    2. BB. Lavender tube, light blue tube, blood culture bottles
    3. CC. Blood culture bottles, light blue tube, lavender tube
    4. DD. Light blue tube, lavender tube, blood culture bottles
    Show answer to question 17

    Answer: C. Blood culture bottles, light blue tube, lavender tube

    Sterile specimens such as blood culture bottles are collected first so the culture media are not contaminated from nonsterile tube stoppers. In the CLSI order of draw, the light blue sodium citrate tube then comes before the lavender EDTA tube.

    Why the other options are wrong

    • ADrawing the citrate tube first means the needle pierces a nonsterile stopper before the sterile bottles are filled.
    • BDrawing EDTA first risks additive carryover into the citrate tube, and blood culture bottles should never come last.
    • DFilling the culture bottles last raises the risk of contaminating them after nonsterile stoppers have been pierced.

18. Question 18 of 25Medium

    When blood cultures are collected with a winged collection set and a culture bottle adapter, how should each bottle be held while it fills?

    1. AA. Upright and below the puncture site, watching the fill marks
    2. BB. Upside down and above the site, so the blood drops into it
    3. CC. On its side at the level of the site, so the blood flows evenly
    4. DD. Upright and above the site, so air rises out of the tubing
    Show answer to question 18

    Answer: A. Upright and below the puncture site, watching the fill marks

    Holding the bottle upright and below the level of the puncture site keeps the culture broth from flowing back into the patient's vein. It also lets the phlebotomist watch the fill marks to reach the volume the manufacturer specifies.

    Why the other options are wrong

    • BAn inverted bottle above the site puts broth against the stopper and allows backflow into the vein.
    • CA bottle on its side lets broth reach the stopper, which allows backflow, and makes the fill marks hard to read.
    • DA bottle held above the puncture site lets broth reflux through the tubing into the patient's vein.

19. Question 19 of 25Hard

    A patient brings a urine specimen to a physician office for a dipstick test. It was collected at home and kept at room temperature for about 3 hours. Which change is most likely?

    1. AA. Glucose rises as cells release stored sugar
    2. BB. pH rises as bacteria convert urea to ammonia
    3. CC. Bacteria decrease as they settle to the bottom
    4. DD. Nitrite disappears as bacteria die off
    Show answer to question 19

    Answer: B. pH rises as bacteria convert urea to ammonia

    In urine left unrefrigerated, bacteria multiply and convert urea to ammonia, making the urine more alkaline. Dipstick testing should be done on fresh urine, or on urine refrigerated and brought back to room temperature, per laboratory policy.

    Why the other options are wrong

    • AGlucose falls, not rises, because multiplying bacteria use it.
    • CBacteria multiply in unrefrigerated urine; settling does not lower their number.
    • DNitrite tends to increase as nitrate-reducing bacteria multiply.

20. Question 20 of 25Medium

    Which of the following actions properly maintains specimen integrity when completing a split-specimen urine drug collection?

    1. AA. Allowing the donor to carry the sealed specimens to the shipping room
    2. BB. Applying tamper-evident seals across the bottle caps in view of the donor
    3. CC. Refrigerating the urine specimen before reading the temperature indicator
    4. DD. Combining two separate voids to meet the minimum required volume
    Show answer to question 20

    Answer: B. Applying tamper-evident seals across the bottle caps in view of the donor

    Tamper-evident seals must be applied to the primary and split specimen bottles in the direct presence of the donor, followed by the donor initialing the seals. The donor is never permitted to handle sealed specimens or deliver them to shipping, and combining separate voids or refrigerating specimens prior to checking temperature violates chain of custody rules.

21. Question 21 of 25Easy

    Which red blood cell type is called the universal donor type because it can be given in an emergency to a patient of any ABO and Rh type?

    1. AA. AB positive
    2. BB. O positive
    3. CC. AB negative
    4. DD. O negative
    Show answer to question 21

    Answer: D. O negative

    Type O negative red cells lack the A, B and D (Rh) antigens, so the patient's anti-A or anti-B antibodies will not attack them. They are used when there is no time to type and crossmatch, which makes O negative donors especially valuable.

    Why the other options are wrong

    • AAB positive is the universal recipient type for red cells, because these patients have no anti-A or anti-B antibodies.
    • BO positive cells carry the D (Rh) antigen, so they can sensitize a patient who is Rh negative.
    • CAB negative cells carry A and B antigens, so they react with anti-A or anti-B antibodies in many patients.

22. Question 22 of 25Hard

    In the neonatal intensive care unit, a 36-hour-old infant is scheduled for a red blood cell transfusion this afternoon, and the newborn screening specimen has not been collected yet. Which plan is best?

    1. AA. Wait until after the transfusion so the infant's blood volume is restored
    2. BB. Collect it before the transfusion if possible, and record the timing
    3. CC. Collect it from the transfusion line while the blood is being given
    4. DD. Skip it for now, since infants in the NICU are screened at discharge
    Show answer to question 22

    Answer: B. Collect it before the transfusion if possible, and record the timing

    Transfused donor red cells can mask some disorders, such as galactosemia and hemoglobin disorders, because they carry normal enzymes and hemoglobin. Newborn screening specimens are collected before a transfusion whenever possible, and transfusion status is recorded on the card.

    Why the other options are wrong

    • AA specimen collected after the transfusion reflects donor red cells and may miss galactosemia or hemoglobin disorders.
    • CDrawing from a line during a transfusion would sample donor blood and contaminate the specimen.
    • DInfants in the NICU are screened too; collection is timed around transfusions and other care per protocol.

23. Question 23 of 25Easy

    Newborn screening for PKU looks for an inherited inability to break down which substance?

    1. AA. Galactose, a sugar found in milk
    2. BB. Phenylalanine, an amino acid
    3. CC. Bilirubin, from red cell breakdown
    4. DD. Thyroxine, a thyroid hormone
    Show answer to question 23

    Answer: B. Phenylalanine, an amino acid

    PKU (phenylketonuria) is an inherited disorder in which the body cannot properly break down the amino acid phenylalanine, which builds up and can damage the developing brain if untreated. Newborn screening allows a special diet to begin early.

    Why the other options are wrong

    • ATrouble breaking down galactose is galactosemia, a separate disorder on the newborn screening panel.
    • CBilirubin from red cell breakdown is measured for newborn jaundice, not for PKU.
    • DThyroxine relates to congenital hypothyroidism, a different condition included in newborn screening.

24. Question 24 of 25Medium

    After collecting a newborn screening specimen from a 2-day-old girl in the nursery, how should the phlebotomist dry the card?

    1. AA. Hang it upright so that extra blood can drain from the circles
    2. BB. Seal it in a plastic bag right away to prevent contamination
    3. CC. Place it under a warming light so that it dries more quickly
    4. DD. Lay it flat to air dry, away from heat and direct sunlight
    Show answer to question 24

    Answer: D. Lay it flat to air dry, away from heat and direct sunlight

    Blood spot cards are dried flat at room temperature on a clean, dry, nonabsorbent surface, away from direct heat and sunlight, for the time the state program requires. Cards must be completely dry before they are packaged for the laboratory.

    Why the other options are wrong

    • ADrying the card upright lets blood move within the paper and produces uneven spots.
    • BSealing a wet card in plastic traps moisture, which can damage the specimen.
    • CHeat from a warming light can damage the substances being tested and lead to rejection.

25. Question 25 of 25Medium

    In a wound care clinic, a provider asks the phlebotomist to collect a swab culture from a 58-year-old man's open leg ulcer. What should be done to the wound just before swabbing?

    1. AA. Scrub it with povidone-iodine and let it dry
    2. BB. Leave the surface drainage in place so the swab can absorb it
    3. CC. Rinse it with sterile saline to remove loose debris
    4. DD. Apply antibiotic ointment and let it soak in first
    Show answer to question 25

    Answer: C. Rinse it with sterile saline to remove loose debris

    Rinsing with sterile saline removes surface drainage and debris that carry colonizing bacteria. The swab then samples clean, viable tissue in the wound bed, which better reflects the organism causing the infection.

    Why the other options are wrong

    • AAn antiseptic scrub leaves a residue that kills organisms in the wound and can cause a falsely negative culture.
    • BOld surface drainage holds colonizing bacteria that do not reflect the true infection.
    • DAntibiotic ointment can suppress bacterial growth and cause a falsely negative culture.

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