20 Phlebotomy Practice Questions & Answers

Every Phlebotomy practice question from the CCMA Practice Test (NHA Clinical Medical Assistant), with the correct answer and a short explanation.

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1. A medical assistant has just completed a heel puncture on a 10-month-old infant, and the bleeding has stopped after pressure with gauze. What should the MA do about covering the site?
- A.Leave it uncovered once bleeding stops✓ Answer
- B.Apply a bandage for the parent to remove
- C.Wrap the heel with self-adhering wrap
- D.Apply a small adhesive bandage to it
Bandages are not used on children younger than 2 years because a bandage can come loose and become a choking hazard, and adhesive can irritate or tear fragile skin. The MA holds pressure until bleeding stops and then leaves the site uncovered while observing it.
Ref QB-8NFKTDSource: NHA CCMA Test Plan — Domain 3E Phlebotomy: postprocedural care and bandaging (CLSI GP42)Report a problem with this question
2. An adult outpatient in a hurry asks to stand at the counter for a quick blood draw instead of sitting down. What should the medical assistant do?
- A.Let her lean against the wall for it
- B.Let her stand but hold her arm firmly
- C.Allow standing if she has never fainted
- D.Seat her in a draw chair with armrests✓ Answer
Venipuncture is never performed on a standing patient because anyone can faint without warning, even with no history of syncope. A draw chair with an armrest supports the arm and keeps the patient from falling if syncope occurs; a bed or recliner is the alternative.
Ref QB-S5Z3KFSource: NHA CCMA Test Plan — Domain 3E Phlebotomy: patient preparation and positioning (CLSI GP41)Report a problem with this question
3. A patient scheduled for a fasting glucose and lipid panel tomorrow morning asks what she may have after dinner tonight. Which instruction is correct?
- A.Clear juice but no food for 8 hours
- B.No water or food at all for 12 hours
- C.Only plain water for the 8 to 12 hours✓ Answer
- D.Black coffee but no food for 8 hours
Fasting for glucose and lipid testing means no food or drink other than plain water for 8 to 12 hours. Water keeps the patient hydrated and makes the draw easier, while coffee and juice can alter glucose and lipid results; withholding water is unnecessary and can cause dehydration.
Ref QB-9NTWYESource: NHA CCMA Test Plan — Domain 3E Phlebotomy: patient preparation (fasting)Report a problem with this question
4. An adult patient needs a fingerstick hemoglobin. Which site and lancet orientation should the medical assistant use?
- A.Middle finger pad, off-center, across the print lines✓ Answer
- B.Index finger tip, centered, along the print lines
- C.Pinky finger side, centered, across the print lines
- D.Thumb pad, off-center, parallel to the print lines
The palmar surface of the middle or ring finger, slightly off-center, is used because these fingers have enough tissue and fewer nerve endings; the thumb has a pulse, the index finger is calloused and sensitive, and the pinky has too little tissue over the bone. Puncturing across the fingerprint whorls lets the blood form a round drop instead of running down the grooves.
Ref QB-T5CERGSource: NHA CCMA Test Plan — Domain 3E Phlebotomy: capillary puncture site selection (CLSI GP42)Report a problem with this question
5. A medical assistant selects a heel lancet for a newborn and confirms that its puncture depth is no more than 2.0 mm. What is the main reason for this depth limit?
- A.To keep tissue fluid out of the sample
- B.To keep arterial blood out of the sample
- C.To keep the infant from feeling pain
- D.To keep the lancet from reaching the bone✓ Answer
In an infant the heel bone (calcaneus) can lie only about 2 mm below the skin of the plantar surface, so a deeper puncture risks osteomyelitis and bone injury. Tissue-fluid contamination is controlled by wiping the first drop and not squeezing, not by lancet depth.
Ref QB-AN696GSource: NHA CCMA Test Plan — Domain 3E Phlebotomy: infant heel puncture depth (CLSI GP42)Report a problem with this question
6. A provider asks whether several tests for an adult with very difficult veins could be collected by fingerstick instead of venipuncture. Which test still requires a venipuncture?
- A.Set of blood cultures✓ Answer
- B.Blood glucose level
- C.Complete blood count
- D.Blood hemoglobin level
Blood cultures need a large volume of blood collected aseptically into culture bottles, which a dermal puncture cannot supply without skin contamination. Hemoglobin, glucose and a CBC can all be performed on properly collected capillary blood.
Ref QB-U5QRWHSource: NHA CCMA Test Plan — Domain 3E Phlebotomy: capillary puncture indications and limitations (CLSI GP42)Report a problem with this question
7. Using an evacuated tube system with a straight needle, a medical assistant must collect a CBC (lavender EDTA), a basic metabolic panel (gold SST) and STAT electrolytes (green lithium heparin). In which order should the tubes be filled?
- A.Green, gold, lavender
- B.Gold, green, lavender✓ Answer
- C.Lavender, gold, green
- D.Gold, lavender, green
The CLSI order of draw places serum tubes before heparin tubes and heparin before EDTA. Drawing lavender before green would carry EDTA into the chemistry tube, falsely raising potassium and lowering calcium, and drawing green before gold could carry heparin into the serum tube.
Ref QB-BNHKBHSource: NHA CCMA Test Plan — Domain 3E Phlebotomy: order of draw for venipuncture (CLSI GP41)Report a problem with this question
8. Only a PT/INR (light blue) and a comprehensive metabolic panel (gold SST) are ordered. The medical assistant is using a straight needle and tube holder, not a winged set. Which collection sequence is correct?
- A.Gold SST first, then the light blue
- B.Light blue first, with no discard tube✓ Answer
- C.A discard tube first, then light blue
- D.Separate venipunctures for each tube
With a straight needle there is no tubing dead space, so the light blue tube can be drawn first without a discard tube for routine PT/aPTT testing; the discard tube is required only when a winged set's tubing air would underfill the citrate tube. Light blue precedes the SST so clot activator is not carried into the coagulation tube.
Ref QB-V5344KSource: NHA CCMA Test Plan — Domain 3E Phlebotomy: order of draw and discard tube (CLSI GP41)Report a problem with this question
9. A provider orders a hemoglobin A1c on a patient with diabetes, to be collected by venipuncture and sent to the lab. Which tube should the medical assistant select?
- A.Gold-top SST gel tube
- B.Lavender-top EDTA tube✓ Answer
- C.Gray-top fluoride tube
- D.Light blue citrate tube
HbA1c is measured inside red blood cells, so it requires anticoagulated whole blood, and EDTA preserves cell morphology for hematology-type testing. The gray fluoride tube preserves plasma glucose, not hemoglobin A1c, and a serum tube contains no intact whole blood.
Ref QB-CNVWGJSource: NHA CCMA Test Plan — Domain 3E Phlebotomy: tube types and additives (EDTA, hematology)Report a problem with this question
10. Before an outpatient surgery, a type and crossmatch is ordered. Which tube and labeling should the medical assistant use?
- A.Green heparin with blood bank ID labels
- B.Gray fluoride with blood bank ID labels
- C.Light blue citrate with routine labels
- D.Pink EDTA with blood bank ID labels✓ Answer
The pink-top tube contains EDTA and is designated for blood bank testing such as type and crossmatch, and these specimens carry the blood bank's special identification band and labels so the patient can be matched to the transfused unit. Heparin, citrate and fluoride tubes are not used for compatibility testing.
Ref QB-88C2NFSource: NHA CCMA Test Plan — Domain 3E Phlebotomy: tube types and departments (blood bank, pink EDTA)Report a problem with this question
11. A fasting glucose specimen will be picked up by a courier and will not be processed for several hours. Which tube best preserves the glucose level?
- A.Lavender-top EDTA tube
- B.Green-top heparin tube
- C.Gray-top fluoride tube✓ Answer
- D.Light blue citrate tube
Blood cells keep consuming glucose after collection (glycolysis), which falsely lowers the result in a tube that sits unprocessed. Sodium fluoride in the gray tube inhibits glycolysis, while potassium oxalate serves as the anticoagulant, so the glucose stays stable longer.
Ref QB-RQH78GSource: NHA CCMA Test Plan — Domain 3E Phlebotomy: additives and preservatives (sodium fluoride)Report a problem with this question
12. A light blue sodium citrate tube has just filled to its line and been removed from the holder. How should the medical assistant mix it?
- A.Invert it gently 3 to 4 times✓ Answer
- B.Shake it briskly for a few seconds
- C.Leave it upright without mixing
- D.Roll it hard between both palms
The citrate must be mixed with the blood right away to prevent microclots, but gently, using 3 to 4 complete inversions. Shaking or rough rolling causes hemolysis and can activate platelets, and leaving the tube unmixed allows clots that make the coagulation specimen unacceptable.
Ref QB-98QCTGSource: NHA CCMA Test Plan — Domain 3E Phlebotomy: tube inversions (CLSI GP41)Report a problem with this question
13. A gold serum separator tube for a lipid panel has just been drawn. When may the medical assistant centrifuge it?
- A.Right away, before any clot can form
- B.After 5 minutes lying flat on the tray
- C.After clotting upright for 30 to 60 minutes✓ Answer
- D.After refrigerating it overnight first
Serum is the fluid left after blood clots, so a serum tube must clot completely, standing upright, for about 30 to 60 minutes before centrifugation. Spinning too early leaves fibrin strands that interfere with testing, and delaying processing for hours lets cells alter analytes such as glucose and potassium.
Ref QB-SQVHDHSource: NHA CCMA Test Plan — Domain 3E Phlebotomy: specimen processing (clotting time before centrifugation)Report a problem with this question
14. After centrifugation, the serum from a morning lipid panel is cloudy and milky white. What most likely caused this appearance?
- A.The tourniquet stayed on too long
- B.The patient has a high bilirubin
- C.The patient did not fast beforehand✓ Answer
- D.The tube was shaken after the draw
Milky serum is lipemia, caused by fat particles in the blood, most often because the patient ate before the draw. Shaking causes hemolysis, which turns serum pink or red, and high bilirubin causes icterus, a dark yellow color; the MA documents the lipemia and confirms the fasting status with the provider.
Ref QB-A83QYHSource: NHA CCMA Test Plan — Domain 3E Phlebotomy: preanalytical specimen quality (lipemia)Report a problem with this question
15. Forty minutes after drinking the glucose solution during a glucose tolerance test, the patient vomits. What should the medical assistant do?
- A.Give another glucose drink and restart
- B.Keep drawing on the original schedule
- C.Stop the test and notify the provider✓ Answer
- D.Give crackers and continue the test
Once the patient vomits, the amount of glucose absorbed is unknown, so the timed results can no longer be interpreted. The MA stops the test, notifies the provider, who decides whether and when to reschedule, and documents the event; the MA does not re-dose the patient or allow food on their own judgment.
Ref QB-TQ8VJJSource: NHA CCMA Test Plan — Domain 3E Phlebotomy: special collections (glucose tolerance test)Report a problem with this question
16. A provider orders a peak gentamicin level after an intravenous dose. In addition to drawing at the time the lab specifies, what must the medical assistant record?
- A.Exact dose time and exact draw time✓ Answer
- B.The time of the patient's last meal
- C.Only the time the tube reached the lab
- D.Only the time the order was placed
A peak level reflects the highest drug concentration, which depends on how much time has passed since the dose, so the result can only be interpreted when both the exact dose time and the exact collection time are documented. The order time and arrival time do not show where the draw fell relative to the dose.
Ref QB-B8E26KSource: NHA CCMA Test Plan — Domain 3E Phlebotomy: special collections (therapeutic drug monitoring)Report a problem with this question
17. A provider ordered a cortisol level to be drawn at 8 a.m., but the patient arrives at 2 p.m. and asks to have it drawn now. What should the medical assistant do?
- A.Draw now; afternoon levels are the highest
- B.Ask the provider; levels vary by time of day✓ Answer
- C.Chill the tube and draw now with a note
- D.Draw now; levels stay the same all day long
Cortisol follows a diurnal rhythm, highest in the early morning and lower in the afternoon, so a sample drawn at the wrong time cannot be compared with the morning reference range. Because the timing is part of the order, the MA checks with the provider before collecting at a different time.
Ref QB-UQK7RKSource: NHA CCMA Test Plan — Domain 3E Phlebotomy: special collections (timed draws, diurnal variation)Report a problem with this question
18. A medical assistant must send a test she has never collected before to an outside reference laboratory. Where should she find the required tube type, volume and storage temperature?
- A.The patient's insurance coverage list
- B.The tube maker's package insert
- C.A coworker who sent a similar test
- D.The reference lab's specimen manual✓ Answer
Each reference laboratory publishes a specimen collection manual (test directory) that states the tube type, minimum volume, processing, temperature and stability it accepts for each test. Requirements differ between laboratories, so a coworker's memory or a tube insert can lead to a rejected specimen.
Ref QB-C8SCBMSource: NHA CCMA Test Plan — Domain 3E Phlebotomy: preparing samples for outside laboratoriesReport a problem with this question
19. Reference laboratory results with a value flagged high arrive in a patient's chart before the provider has reviewed them. The patient calls and asks the medical assistant what the high value means. What should the MA do?
- A.Advise her to change her diet until seen
- B.Route the question to the provider for a reply✓ Answer
- C.Say the value is only slightly high and fine
- D.Explain what the high value most likely means
Interpreting results and giving medical advice are outside the medical assistant's scope; results are routed to the ordering provider, who reviews them and decides what to tell the patient. Reassuring or advising the patient on the MA's own judgment could delay care or give wrong information.
Ref QB-VQXHWMSource: NHA CCMA Test Plan — Domain 3E Phlebotomy: distributing results to providersReport a problem with this question
20. After the needle is withdrawn from an antecubital vein, the patient starts to bend the elbow tightly to hold the gauze in place. What should the medical assistant do?
- A.Let the bent elbow hold the gauze in place
- B.Raise the arm overhead with elbow bent
- C.Rub the site with the gauze to stop it
- D.Have her keep the arm straight and press✓ Answer
Bending the elbow can reopen the puncture and squeeze blood into the tissue, causing a hematoma, so firm pressure is applied over the gauze with the arm kept straight until bleeding stops. Rubbing the site disturbs the forming platelet plug and also promotes bruising.
Ref QB-KG3W78Source: NHA CCMA Test Plan — Domain 3E Phlebotomy: postprocedural care (hematoma prevention, CLSI GP41)Report a problem with this question

1. A medical assistant has just completed a heel puncture on a 10-month-old infant, and the bleeding has stopped after pressure with gauze. What should the MA do about covering the site?

2. An adult outpatient in a hurry asks to stand at the counter for a quick blood draw instead of sitting down. What should the medical assistant do?

3. A patient scheduled for a fasting glucose and lipid panel tomorrow morning asks what she may have after dinner tonight. Which instruction is correct?

4. An adult patient needs a fingerstick hemoglobin. Which site and lancet orientation should the medical assistant use?

5. A medical assistant selects a heel lancet for a newborn and confirms that its puncture depth is no more than 2.0 mm. What is the main reason for this depth limit?

6. A provider asks whether several tests for an adult with very difficult veins could be collected by fingerstick instead of venipuncture. Which test still requires a venipuncture?

7. Using an evacuated tube system with a straight needle, a medical assistant must collect a CBC (lavender EDTA), a basic metabolic panel (gold SST) and STAT electrolytes (green lithium heparin). In which order should the tubes be filled?

8. Only a PT/INR (light blue) and a comprehensive metabolic panel (gold SST) are ordered. The medical assistant is using a straight needle and tube holder, not a winged set. Which collection sequence is correct?

9. A provider orders a hemoglobin A1c on a patient with diabetes, to be collected by venipuncture and sent to the lab. Which tube should the medical assistant select?

10. Before an outpatient surgery, a type and crossmatch is ordered. Which tube and labeling should the medical assistant use?

11. A fasting glucose specimen will be picked up by a courier and will not be processed for several hours. Which tube best preserves the glucose level?

12. A light blue sodium citrate tube has just filled to its line and been removed from the holder. How should the medical assistant mix it?

13. A gold serum separator tube for a lipid panel has just been drawn. When may the medical assistant centrifuge it?

14. After centrifugation, the serum from a morning lipid panel is cloudy and milky white. What most likely caused this appearance?

15. Forty minutes after drinking the glucose solution during a glucose tolerance test, the patient vomits. What should the medical assistant do?

16. A provider orders a peak gentamicin level after an intravenous dose. In addition to drawing at the time the lab specifies, what must the medical assistant record?

17. A provider ordered a cortisol level to be drawn at 8 a.m., but the patient arrives at 2 p.m. and asks to have it drawn now. What should the medical assistant do?

18. A medical assistant must send a test she has never collected before to an outside reference laboratory. Where should she find the required tube type, volume and storage temperature?

19. Reference laboratory results with a value flagged high arrive in a patient's chart before the provider has reviewed them. The patient calls and asks the medical assistant what the high value means. What should the MA do?

20. After the needle is withdrawn from an antecubital vein, the patient starts to bend the elbow tightly to hold the gauze in place. What should the medical assistant do?

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