NHA CPT Exam Questions

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101.

At least how full must all light-blue (sodium citrate) blood tubes be filled?

  • 90%

  • 50%

  • 75%

  • 25%

Correct answer: 90%

Light blue-top tubes contain a 9:1 ratio of blood to anticoagulant when filled to the stated volume and must be filled to within 90% of that volume for accurate coagulation results. Exact fill volume is hard to tell on most tubes; however Vacuette sodium citrate tubes have arrows that can be used to identify correct fill volume.

102.

What does the "statute of limitations" mean?

  • The time after an alleged injury in which a victim may file a lawsuit

  • The law that says a person injured as a result of negligence may sue a healthcare worker

  • The regulation stating that a hospital can be held liable for an employee's actions

  • The person who is charged with malpractice

Correct answer: The time after an alleged injury in which a victim may file a lawsuit

The statute of limitations refers to the time after an alleged injury in which an injured person is permitted to file a lawsuit. This period usually begins at one of the following points:

  • The day the alleged act was committed
  • When the injury is discovered
  • The day the physician-patient relationship ended
  • The day of the last medical treatment in a series
  • In the case of minors, when the minor reaches the age of majority

A term that means the employer can be held legally responsible for an employee's actions is respondeat superior.

A person charged with a crime is called a defendant.

103.

What is the function of the gray-top urine collection tube?

  • Urine cultures

  • Pregnancy test

  • Diabetes test

  • Drug screen

Correct answer: Urine cultures

Urine collection tubes look much like blood tubes; however, they are only to be used for urine. Although they are somewhat uncommon in the inpatient setting, a phlebotomist may need to use one of these tubes in the event the urine needs to be stored for a period of time without degrading.

104.

What is the relationship between oral medications, intramuscular (IM), and intravenous (IV) medications?

  • Oral medications take longer to reach peak levels than IV medications.

  • IV medications take longer to reach peak levels than oral medications.

  • Oral medications reach peak levels faster than IM or IV medications.

  • IV medications reach peak levels slower than IM but faster than oral medications.

Correct answer: Oral medications take longer to reach peak levels than IV medications.

The phlebotomist should be aware of this fact when assisting in therapeutic drug monitoring. Peak levels screen for drug toxicity, and specimens are collected when the highest serum concentration of the drug is anticipated. Peak times are influenced by many factors but typically occur at the following intervals:

  • 30 minutes after IV administration
  • 60 minutes after IM administration
  • 1–2 hours after oral intake

Careful coordination of sample collection with dosing times is essential for accurate results. 

105.

When drawing blood from the antecubital area, what is the ideal position for the arm?

  • Extending downward in a straight line, with no bend

  • Extended forward in front of the patient, in a straight line

  • Bent at a 120-degree angle, with the hand below elbow level

  • Bent at a 90-degree angle, with the forearm propped 

Correct answer: Extending downward in a straight line, with no bend

For venipuncture in the antecubital (AC) area, the patient's arm should extend downward in a straight line from shoulder to wrist and not be bent at the elbow. This position helps fix the veins, so they are less apt to roll. Gravity also causes them to enlarge, making them easier to locate. In addition, the downward position is necessary to ensure that the tubes fill from the bottom up. This prevents reflux, or backflow of the tube contents into the patient's vein. 

Sometimes a slight bend may be necessary to avoid hyperextension of the elbow. Other times, depending on the setting, it may be hard to achieve a straight downward line (e.g., during a home draw in which the patient is lying in a bed that is not adjustable).

106.

At least how full must all coagulated blood tubes be filled?

  • 90%

  • 75%

  • 50%

  • 100%

Correct answer: 90%

The additives in coagulated blood tubes are measured very carefully and require a specific amount of blood to provide accurate results. The only tube that requires 100% is the light-blue top blood collection tube; the other coagulant tubes require at least 90%.

107.

According to the FDA guidelines, what does not meet the requirements of a venipuncture "safety device"?

  • Needle accessory device

  • Re-sheathing device

  • Blunting needle

  • Device with a retractable needle

Correct answer: Needle accessory device

The FDA is responsible for clearing medical devices for marketing. FDA safety features include:

  • Fixed/permanent safety features that create a barrier between the user's hands and the needle after use
  • Safety features that allow or require the workers' hands to stay behind the needle at all times
  • Safety features that are integral or connected to the device, not an accessory

Common safety features include re-sheathing devices such as shields that cover the needle after use, blunting devices, and devices that retract the needle after use.

108.

David, a new phlebotomist, is drawing blood from a patient. After filling the last tube, he removes the needle with the tube engaged in the holder. He activates the needle safety feature and applies pressure to the site. 

What should David have done instead?

  • Remove the tube first before removing the needle

  • Ask the patient to apply pressure to the site

  • Apply pressure before activating the safety feature

  • Release the tourniquet before activating the safety feature 

Correct answer: Remove the tube first before removing the needle

By not removing the tube first, David risks blood dripping from the needle, which can cause contamination. Removing the tube first and mixing it ensures the safety and proper handling of the blood specimen. 

The tourniquet should not be tied at this stage of the procedure. The phlebotomist should apply pressure rather than asking the patient to do it. 

109.

Which of the following tests requires warming after collection?

  • Cryoglobulins

  • Glucose

  • Blood lithium

  • pH/blood gases

Correct answer: Cryoglobulins

The normal body temperature is about 37 degrees Celsius, and that is the temperature that samples must be warmed to ensure correct test results. Correct methods for warming samples include using a heel warmer or holding the sample in hand. Warmed samples are very rare and will have instructions from the lab on how to handle them. Tests that must be warmed are:

  • Cold agglutinins
  • Cryoglobulin

110.

Which of the following tubes contains heparin?

  • Dark-green top

  • Yellow top

  • Orange top

  • Gold top

Correct answer: Dark-green top

The dark green-top blood collection tube inactivates thrombin and thromboplastin to prevent the blood from clotting in the tube. Its uses include ammonia, lactate, and HLA typing.

111.

Which agency is responsible for identifying workplace hazards and developing regulations to minimize hazard exposure?

  • The Occupational Safety and Health Administration (OSHA)

  • The Food and Drug Administration (FDA)

  • The Centers for Disease Control and Prevention (CDC)

  • The Environmental Protection Agency (EPA)

Correct answer: The Occupational Safety and Health Administration (OSHA)

OSHA is responsible for identifying workplace hazards and establishing rules and regulations to minimize exposure and ensure safe working conditions. 

The FDA regulates food, drugs, medical devices, and other products. 

The CDC promotes public health and safety by providing health information and partnering with state health departments. 

The EPA enforces regulations regarding pollution, waste, and the environment.

112.

When it comes to proper handling of blood specimen tubes, which of the following is an acceptable secondary container?

  • Self-sealing bag

  • Locked safe

  • Pants pocket

  • Pneumatic tube container

Correct answer: Self-sealing bag

The most basic form of a secondary container is a self-sealing (zip-loc) bag with a biohazard symbol on it.

Locked safes are not common as secondary containers. Patients may often put samples they collect at home in their pockets; however, phlebotomists should not. Pneumatic tubes are not forms of secondary containers.

113.

Phenylketonuria (PKU) is a genetic disorder characterized by deficiency of an enzyme that breaks down the amino acid phenylalanine. Treatment for PKU involves:

  • A diet low in phenylalanine

  • A diet high in phenylalanine

  • Medication

  • Enzyme supplements

Correct answer: A diet low in phenylalanine

Phenylketonuria (PKU) cannot be cured, but normally it can be treated with a diet low in phenylalanine. If not treated, PKU can lead to brain damage, seizures, and severe mental retardation.

114.

Christian has just finished a venipuncture procedure on an inpatient. After applying the bandage, he begins cleaning up the area. He notices some unused items left on the tray.

What should Christian do with the unused items? 

  • Return them to their proper storage place

  • Give them to the patient as a keepsake

  • Discard them in the biohazard container

  • Leave them on the tray for the next use

Correct answer: Return them to their proper storage place

After performing venipuncture, labeling the specimens, and bandaging the site, the phlebotomist should clean up their area and return any unused items to their proper storage place. This maintains order and ensures that supplies are readily available for future use. 

115.

What additive(s) does the tan-top blood collection tube contain?

  • Dipotassium EDTA

  • Separating gel

  • Sodium fluoride

  • ACD or SPS

Correct answer: Dipotassium EDTA

The tan-top blood collection tube uses another form of EDTA to inactivate thrombin and thromboplastin. This is an uncommon tube and is used primarily for serum lead determination.

116.

Maren, a phlebotomist who specializes in geriatrics, is preparing to draw blood from Mr. Chadwick. Maren wants to choose the best vein with the lowest risk of complications.

Which vein is in a preferable location, over the bicipital aponeurosis?

  • Median cubital vein

  • Cephalic vein

  • Basilic vein

  • Median basilic vein

Correct answer: Median cubital vein

Typically, the most prominent AC veins are:

  • The median cubital, cephalic, and basilic veins in the "H" pattern
  • The median, median cephalic, and median basilic veins in the "M" pattern

The medial cubital and median veins are normally closer to the surface, more stationary, and in an area where nerve injury is least likely because they overlie the bicipital aponeurosis, a fibrous membrane that offers some protection to the nerves and arteries beneath it. Consequently, they are the first choices for venipuncture, followed by the cephalic and median cephalic veins.

117.

When working with infants and children, how can a phlebotomist greatly reduce the risk of damaging bones, arteries, and nerves when collecting specimens via capillary puncture?

  • Use a spring-loaded puncture device set for a specific depth

  • Use a manual lancet

  • Use a non-retractable blade lancet

  • Perform venipuncture

Correct answer: Use a spring-loaded puncture device set for a specific depth

Spring-loaded puncture devices contain needles or blades that puncture the skin to a preset depth. Using this type of device provides protection for underlying structures when working with the anatomy of pediatric patients. In addition, present spring-loaded devices improve phlebotomist safety and patient satisfaction. 

Manual lancets should not be used on youngsters or babies due to the difficulty in controlling puncture depth. As a result, there is a greater risk of harm from deep punctures.

Non-retractable blade lancets should not be used due to the risk of accidental injury to the healthcare worker and patient.

Venipuncture is acceptable, but not preferred for obtaining blood from infants and very young children, since infants have a small blood volume, and removing too much blood could lead to anemia.

118.

Which substance in blood is likely to be at its lowest level before 12:00 p.m.?

  • Phosphate

  • Iron

  • Potassium

  • Testosterone

Correct answer: Phosphate

In general, blood levels of eosinophils, creatinine, glucose, triglycerides, and phosphate are lowest in the morning. This is an example of diurnal variation. Diurnal (daily) variation means that the levels of many blood components exhibit daily cycles or fluctuations. 

Factors such as eating, sleeping, and physical activity can affect the diurnal variations. For example, someone who sleeps during the day and works all night may show different results. 

119.

The Joint Commission (TJC) National Patient Safety Goals (NPSG) Goal #1 says that specimens must be labeled in what manner?

  • In the patient's presence 

  • Before the specimen is collected

  • In the presence of a witness

  • Within 2 hours of specimen collection

Correct answer: In the patient's presence 

Labeling must be exact, and labeling requirements should be strictly followed. Inaccuracies can result in specimen rejection. The national standard says that specimens must be labeled in the patient's presence. 

Tubes should be labeled in the presence of the patient immediately after blood collection to avoid labeling errors. 

120.

Blood in the urine may indicate what condition?

  • Damage to renal organs

  • Liver disease

  • Infection of the stomach

  • Heart disease

Correct answer: Damage to renal organs

Blood in the urine is usually easily detected. The phlebotomist will see orange or red urine in the sample cup. If this is the case, notify the nurse and physician immediately. Without other symptoms, this may not be an emergency, or the condition may be known.