NHA CPT Exam Questions

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61.

Mario, a certified phlebotomy technician, is about to perform a venipuncture on Mrs. Thompson. He examines the elderly patient's arm and notices that, fortunately, she has several prominent veins.

Which vein should Mario select first for venipuncture?

  • Median cubital vein

  • Basilic vein

  • Cephalic vein

  • Median basilic vein

Correct answer: Median cubital vein

The median cubital vein is typically closer to the surface, more stationary, and located in an area where nerve injury is least likely, making it the preferred choice for venipuncture. 

The basilic and median basilic veins are the last-choice veins because they are near the median nerve and brachial artery. As a result, the risk of injury increases when these veins are attempted.

62.

How does posture affect blood pressure and blood volume?

  • As the patient stands from sitting or lying, blood pressure goes down, and blood volume goes up

  • As the patient sits from standing, blood pressure goes down, and blood volume goes down

  • As the patient stands from lying, blood pressure and blood volume remain the same

  • As the patient stands from sitting, blood pressure and blood volume go up

Correct answer: As the patient stands from sitting or lying, blood pressure goes down, and blood volume goes up

As blood volume goes up and blood pressure drops, the permeability of the cell walls changes, which can alter the blood products in a blood sample. Normally, patients are sitting or lying down when blood is being drawn. However, it is important to remember that posture can affect test results.

63.

What is the purpose of centrifuging samples?

  • To accelerate sedimentation

  • To prevent hemolysis

  • To prevent contamination

  • To accelerate enzymatic breakdown

Correct answer: To accelerate sedimentation

A centrifuge is used to accelerate the rate of sedimentation. During operation, the spinning rotor of a centrifuge creates a force many times that of gravity. This results in the separation of particulate matter (e.g., blood cells, clotted blood) from the liquid in which it's suspended within minutes. 

64.

The Bloodborne Pathogens (BPP) Standard is mandated by federal law and enforced by OSHA to reduce occupational exposure. The standard requires healthcare employers to:

  • Implement medical surveillance for all at-risk employees

  • Offer the Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV) vaccines

  • Limit Personal Protective Equipment (PPE) use among employees

  • Provide optional reporting tools for exposure incidents

Correct answer: Implement medical surveillance for all at-risk employees

The Bloodborne Pathogens (BPP) standard requires the following for all at-risk employees:

  • Medical surveillance
  • Availability of the Hepatitis B Virus (HBV) vaccine
  • Availability and use of Personal Protective Equipment (PPE)
  • Mandatory reporting for exposure incidents

65.

A patient with a severe injury is lying on the ground. You suspect that he is in shock.

How should you position the patient?

  • Lying on his back, legs elevated

  • Lying on his stomach

  • Standing

  • Sitting upright

Correct answer: Lying on his back, legs elevated

The primary objective of first aid for shock is to improve blood circulation so that an adequate supply of oxygen is delivered to all parts of the body. When providing first aid to a victim of shock, keep the victim lying down and elevate their legs approximately 12 inches so that the head is lower than the rest of the body. If you suspect a broken back, hip, or leg and this position is extremely painful, they can lay down without raising their legs. 

66.

Continuing to draw blood while a hematoma is forming can lead to which of the following? 

  • Nerve injury

  • Infection

  • Iatrogenic anemia

  • Arterial puncture

Correct answer: Nerve injury

Hematomas are caused by blood leaking into the tissues during or after venipuncture. By continuing to draw blood, instead of removing the needle and applying direct forceful pressure to stop the leak, large pools of blood can swell and cause nerve compression. 

Nerve injury is a rare but serious phlebotomy complication that can result in permanent damage to the motor or sensory nerve function of the arm or hand. This permanent injury can also result in a lawsuit. 

Arterial puncture and infection are also phlebotomy complications, but they are caused by incorrect phlebotomy technique, not by continuing to draw blood while a hematoma is forming. Iatrogenic anemia is blood loss anemia caused by removing too much blood and is unrelated to hematoma formation.

67.

What can be used for site cleansing instead of iodine when collecting blood cultures?

  • Chlorhexidine swabs

  • Hot water

  • Alcohol swab only

  • Antibiotic ointment

Correct answer: Chlorhexidine swabs

The single most important step following properly identifying the patient when drawing blood cultures is the proper cleansing of the venipuncture site. This can be done with an iodine tincture and 70% isopropyl alcohol, or chlorhexidine. If the patient's skin is visibly soiled, use soap and water.

Alcohol prep pads are not sufficient to clean the skin for blood cultures but are appropriate for cleaning the bottle tops.

68.

Rapid breathing, pale skin, dizziness, and perspiring are all symptoms of which venipuncture complication a phlebotomist could encounter?

  • Syncope

  • Heart problems

  • Head injury

  • Allergic reaction

Correct answer: Syncope

The medical term for fainting is syncope. It is preceded by any combination of the following symptoms:

  • Turning pale
  • Perspiration
  • Shallow breathing
  • Rapid pulse
  • Dizziness
  • Nausea
  • Tunnel vision
  • Sensation of spinning

Fainting is not entirely uncommon during the venipuncture procedure. The phlebotomist can ensure patient safety by making sure the patient is sitting in a chair when performing the procedure.

69.

In the event that a small electrical fire occurs in the lab, which of the following is not an appropriate response?

  • Run to call for help

  • Pull the nearest fire alarm

  • Evacuate patients using the elevator

  • Attempt to extinguish the small fire

Correct answer: Run to call for help

Fire Safety "Do's and Don'ts" include:

  • Do pull the nearest fire alarm
  • Do call the fire department
  • Do attempt to extinguish a small fire
  • Do close all doors and windows if leaving the area
  • Do smother a clothing fire with a fire blanket or have the person roll on the floor to smother the fire
  • Do crawl to the nearest exit if heavy smoke is present
  • Don't panic
  • Don't run
  • Don't use elevators

70.

If the average blood volume for a geriatric client is 70 milliliters (mL) per kilogram (kg) of body weight, what is 2.5% of the total blood volume in a patient that weighs 212 pounds?

  • 168.28 mL

  • 6731.2 mL

  • 673.12 mL

  • 16.82 mL

Correct answer: 168.28 mL 

212 pounds (lbs) = 96.16 kg (1 lb = 0.454 kg)

96.16 kg x 70 mL = 6,731.2 mL of total blood volume

2.5% of 6,731.2 = 168.28 mL (6,731.2 mL x 0.025)

71.

Why should phlebotomists never attempt to collect a blood specimen from a sleeping patient?

  • It could cause injury to the patient or the phlebotomist.

  • Veins are narrowed when patients are asleep.

  • It could cause nightmares if the patient is in a state of deep sleep.

  • Veins are more fragile when patients are asleep.

Correct answer: It could cause injury to the patient or the phlebotomist.

Phlebotomists should never attempt to collect a blood specimen from a sleeping patient for several important reasons. 

  • When patients sleep, they cannot verbally identify themselves according to CLSI standards. 
  •  Sticking a patient with a needle while they're sleeping will startle them, which changes the blood composition.
  •  A patient who wakes up to a needle poke is likely to be aggressive and combative, which could cause injury to the phlebotomist. 

When patients sleep, they are relaxed, and veins are more open (dilated) instead of narrow (constricted).

72.

A blood smear should be labeled:

  • With a pencil on the end of the slide near the thick part of the smear

  • With a pencil on the end of the slide near the thin part of the smear

  • With a pen on the end of the slide near the thin part of the smear

  • With a pen on the end of the slide near the thick part of the smear

Correct answer: With a pencil on the end of the slide near the thick part of the smear

Patient information should be written using a pencil on the slide at the thick end of the smear. If a frosted-end slide is used, the information should be written on the frosted area.

The ink from ballpoint pens will wash off or dissolve when the slide is processed.

73.

Which of the following blood products does not increase after a patient has been exercising?

  • Oxygen (O2)

  • Lactate

  • Bilirubin

  • Creatine kinase

Correct answer: Oxygen (O2)

As exercise increases, oxygen supply to the muscles decreases, forcing the muscles to use anaerobic metabolism. Creatine kinase and bilirubin increase due to exercise and stress. A major product of anaerobic metabolism is lactate. The other products that decrease as a result of exercise are glucose and hemoglobin.

74.

According to current Clinical & Laboratory Standards Institute (CLSI) guidance, serum and plasma that have been separated must be refrigerated if not used within what timeframe?

  • 8 hours

  • 2 hours

  • 48 hours

  • 16 hours

Correct answer: 8 hours

According to CLSI, serum and plasma that have been separated from the cells should not remain at room temperature for longer than 8 hours. If not tested within 8 hours, then the sample should be refrigerated at a temperature between 2° and 8° Celsius.

75.

Blood volume for adults is generally reported in:

  • Liters

  • Milliliters

  • Deciliters

  • Nanometers

Correct answer: Liters

Blood volume is reported in liters rather than milliliters for adults. One thousand milliliters equals one liter of volume.

76.

How can a phlebotomist prevent patient injury before performing venipuncture?

  • By ensuring the patient is sitting in a chair

  • By asking the patient about their family medical history

  • By asking the patient to stand during venipuncture

  • By ensuring a nurse is present at all times

Correct answer: By ensuring the patient is sitting in a chair

A phlebotomist can greatly minimize the risk of injury to patients by ensuring they are sitting in a chair with a back and armrests. Patients should never be standing during venipuncture due to the risk of syncope.

77.

Phlebotomist Melanie feels sexually harassed by her boss. Recently, he made a joke about her taking off her lab coat, which made her uncomfortable. 

How should an employee who experiences or witnesses harassment handle the situation?

  • Write an email to the boss clearly stating that the comment was unwelcome

  • Resign and find a new job

  • Tell co-workers so that they can act as witnesses

  • Avoid future contact with the boss and politely refuse to speak to him

Correct answer: Write an email to the boss clearly stating that the comment was unwelcome

An employee who experiences or witnesses harassment is responsible for reporting the occurrence. It must be made clear to the other personnel involved that the action was unwelcome. Documentation of the interaction or copies of the correspondence should be kept. If the issue is not resolved, a meeting with the supervisor to file a complaint should be scheduled. 

If a situation is uncomfortable to report to a supervisor, human resources should be contacted.

78.

Why is it important to keep a victim warm when they are experiencing shock?

  • To support blood flow

  • To prevent infection

  • To induce hypothermia 

  • To provide comfort

Correct answer: To support blood flow

Keeping the victim warm helps support blood flow. It also helps prevent hypothermia, which can worsen the condition of a person in shock by reducing blood flow to vital organs, such as the brain, heart, and lungs. 

Though it may provide comfort, that is not the primary reason to keep the victim warm.

79.

For a sweat chloride test, what is the preferred site for electrode placement?

  • Forearm

  • Thigh

  • Stomach

  • Back

Correct answer: Forearm

Sweat analysis can aid in the diagnosis of cystic fibrosis (CF), a disorder of the exocrine glands. The test involves transporting a sweat-stimulating drug called pilocarpine into the skin through electrical stimulation from electrodes placed on the arm. This process is called iontophoresis. Sweat is collected, weighed for volume, and analyzed for chloride content. The forearm is the preferred site for this test. However, in infants and toddlers, the leg or thigh may be used. 

80.

When a woman has had a bilateral mastectomy, what must the phlebotomist do before performing venipuncture?

  • Get written permission from the doctor.

  • Check her pulses.

  • Notify the surgeon.

  • Order a lymphedema needle.

Correct answer: Get written permission from the doctor.

The phlebotomist must never draw blood from an arm on the same side as a mastectomy due to the risk of lymphostasis and lymphedema. When a mastectomy has been performed on both sides or there is no suitable site for blood collection, you must obtain written permission from the patient's physician for a blood draw on that arm.