26 Patient Preparation Practice Questions & Answers

1. 1. A patient who has been lying down for two hours stands up, and blood is collected fifteen minutes later. Compared with the supine sample, how do the albumin and calcium results change?

   • A.Both rise, because standing shifts water out of the vessels and concentrates bound analytes✓ Answer
   • B.Neither changes, because posture affects cell counts alone and leaves plasma chemistry alike
   • C.Both fall, because standing pulls water into the vessels and dilutes the larger plasma proteins
   • D.Albumin rises but calcium falls, because only unbound analytes follow the shift in plasma water

   Standing moves plasma water out of the vessels into the tissues, and large protein-bound molecules cannot follow it, so albumin, calcium, cholesterol, and enzymes concentrate and can rise by roughly ten percent. Posture is a physiologic pre-analytical variable, not an analyzer error.

   Source: NHA CPT Test Plan, Core Knowledge, pre-analytical error: postureReport a problem with this question

2. 2. While palpating the medial aspect of the antecubital fossa, the phlebotomist feels a firm structure that pulses against the fingertip. What does this finding indicate and what should be done?

   • A.It is a well-filled median cubital vein, so it may be entered at a shallower angle than usual
   • B.It is the brachial artery, so another site should be selected instead of that structure✓ Answer
   • C.It is a sclerosed vein, so firm massage should be applied to restore flow before the puncture
   • D.It is a tendon, so the needle should be redirected slightly medial to it before the puncture

   A structure that pulses and feels firm is an artery, and the brachial artery runs through the medial antecubital area beneath the basilic vein. Nothing that pulsates is ever punctured for a routine venous specimen, so the phlebotomist moves to a different vein.

   Source: CLSI GP41 site selection; NHA CPT Test Plan, Core KnowledgeReport a problem with this question

3. 3. The median cubital vein cannot be palpated in either arm. Following CLSI vein-selection priority, which vein is chosen next and which is held back as a last resort?

   • A.The basilic is next; the cephalic is last because it rolls and lies over the median nerve
   • B.The cephalic is next; the basilic is last because the brachial artery and nerves lie beside it✓ Answer
   • C.The cephalic is next; the basilic is last because it is too deep to enter without a syringe
   • D.The basilic is next; the cephalic is last because it carries a higher risk of hematoma there

   CLSI GP41 ranks the veins by the risk of what lies beneath them: median or central veins first, then the lateral cephalic, and the medial basilic last because the brachial artery and the median and medial antebrachial cutaneous nerves run immediately alongside it. The cephalic rolls more but sits away from those structures.

   Source: CLSI GP41, vein selection priority (median, then lateral, then medial)Report a problem with this question

4. 4. A patient arrives visibly dehydrated after several days of vomiting. Which direction of change should be expected in the hematocrit and the total protein on that specimen?

   • A.Hematocrit is decreased and total protein is unchanged, because only cells react to fluid loss
   • B.Both are falsely decreased, because water from the tissues moves into the bloodstream
   • C.Both are falsely increased, because plasma water is lost and the remaining blood concentrates✓ Answer
   • D.Both are unchanged, because the body defends blood volume and keeps analyte levels constant

   Dehydration removes plasma water while cells and large proteins stay behind, so the blood is concentrated and hematocrit, total protein, and other large analytes read falsely high. This is hemoconcentration from a physiologic state rather than from the draw itself, and the direction of change is the tested point.

   Source: NHA CPT Test Plan, Core Knowledge, pre-analytical error: hemoconcentrationReport a problem with this question

5. 5. The structure the phlebotomist palpates in the antecubital area is hard and cord-like, does not roll or rebound, and stands out more when the patient clenches the hand. What is it most likely to be?

   • A.A vein in spasm, which will refill and become soft again if the tourniquet is retied
   • B.The brachial artery, which becomes firmer whenever the surrounding muscle contracts
   • C.A thrombosed vein, which will feel softer once the arm is warmed for several minutes
   • D.A tendon, which must be avoided because puncturing it is painful and yields no blood✓ Answer

   A tendon is hard and cord-like, does not have the soft bounce of a patent vein, and tightens with hand movement because it anchors muscle to bone. A healthy vein palpates soft and spongy and rebounds under the finger, and an artery pulses, so those two feel entirely different.

   Source: CLSI GP41, palpation and site assessment; Core KnowledgeReport a problem with this question

6. 6. In a patient with many previous draws, one vein feels hard and cord-like along its whole length with no springiness when pressed. What does this indicate and what should follow?

   • A.It is sclerosed and scarred, so flow through it is poor and another site should be chosen✓ Answer
   • B.It is simply a deep vein, so a longer needle will reach it and the draw can proceed there
   • C.It is a collapsed vein, so releasing the tourniquet briefly will let it refill and be used
   • D.It is a valve-rich segment, so entering just above a valve will still give an adequate flow

   Repeated punctures scar a vein: the wall becomes fibrotic and the lumen narrows, so the vessel palpates hard and cord-like and loses its normal spongy rebound. Blood flow through a sclerosed vein is inadequate and the specimen is likely to be compromised, so a different site is selected.

   Source: CLSI GP41, veins to be avoided (sclerosed or thrombosed); Core KnowledgeReport a problem with this question

7. 7. Why are the dorsal metacarpal veins of the hand considered a second-choice site rather than a first-choice site for venipuncture?

   • A.They carry partly arterial blood, so results from them cannot be compared with venous ones
   • B.They pass directly over the radial artery, so the risk of arterial entry there is too high
   • C.They are smaller and less anchored than antecubital veins, so they roll more and hurt more✓ Answer
   • D.They have no valves at all, so blood pools backward in them and hemolysis follows easily

   Hand veins are narrower and are supported by far less surrounding tissue than the antecubital veins, so they roll away from the needle and the puncture is more painful, and a winged set with smaller tubes is used when they must be entered. Anatomy, not oxygen content, is what makes them a second choice.

   Source: CLSI GP41, alternate venipuncture sites; Core KnowledgeReport a problem with this question

8. 8. The tourniquet stays in place for more than a minute while a difficult vein is located. In which direction should the potassium and total protein results move, and why?

   • A.Both are unaffected, because tourniquet time changes cell counts without altering chemistry
   • B.Both rise, because stasis drives plasma water into the tissue and concentrates all that remains✓ Answer
   • C.Both fall, because blood stagnating in the vein loses its solutes to the surrounding tissue
   • D.Potassium rises but protein falls, because only the smaller ions are trapped by stalled flow

   Venous stasis raises the pressure inside the vein and forces plasma water out into the tissue, leaving potassium, total protein, calcium, and other large or cell-associated analytes concentrated in the sample. This is why CLSI limits tourniquet application to no more than one minute.

   Source: CLSI GP41 (tourniquet no more than 1 minute); Core Knowledge, hemoconcentrationReport a problem with this question

9. 9. An inpatient's wristband shows a date of birth that does not match the date of birth on the requisition, although the name matches in both places. What should the phlebotomist do first?

   • A.Draw the tubes now and let the processing staff correct the record after the specimens arrive
   • B.Hold the draw and ask the patient's nurse to resolve the mismatch and re-band the patient✓ Answer
   • C.Ask the patient to confirm the requisition date of birth with a simple yes-or-no question
   • D.Draw the tubes now and write the wristband date of birth on every label at the bedside

   Two independent identifiers must agree on both the requisition and the armband before any collection, so a date-of-birth mismatch means the identity is unverified and the draw stops until the nurse corrects the band. A yes-or-no confirmation is a leading question and is never an acceptable substitute for active identification.

   Source: NHA CPT Test Plan, Patient Preparation; CLSI GP41 patient identificationReport a problem with this question

10. 10. A competent adult patient says he does not want this blood test and pulls his sleeve back down. What is the appropriate response?

    • A.Record the tests as collected and leave the empty tubes for the nurse to handle
    • B.Explain that the provider ordered it and proceed once the patient stops objecting
    • C.Ask a family member at the bedside to consent to the venipuncture on his behalf
    • D.Stop, document the refusal in the record, and notify the patient's nurse or provider✓ Answer

    Consent may be withdrawn at any moment, and a competent adult who refuses cannot be drawn; proceeding anyway would be an unconsented procedure. The phlebotomist documents the refusal and passes it to the nurse or ordering provider, who decides what happens next, and a relative cannot consent for a competent adult.

    Source: NHA CPT Test Plan, consent and refusal; Patient Bill of RightsReport a problem with this question

11. 11. A patient has a functioning arteriovenous fistula in the right forearm and an intravenous infusion running in the left forearm. Where should the specimen be collected?

    • A.From the right hand on the fistula side, using a smaller gauge to reduce the pressure
    • B.From the left arm above the infusion, leaving the drip running throughout the collection
    • C.From a vein distal to the fistula in the right forearm, using a winged collection set
    • D.From the left arm below the infusion, after the nurse has stopped the drip for two minutes✓ Answer

    A limb carrying an arteriovenous fistula or graft is never punctured, because of the risk of infection and of clotting the access, and that exclusion covers the hand on that side as well. The infusion arm may be used only distal to the IV after the nurse turns the infusion off for about two minutes, and the specimen is documented as drawn below an IV; drawing above a running line dilutes it with fluid.

    Source: CLSI GP41 site selection; NHA CPT Test PlanReport a problem with this question

12. 12. While searching for a vein, a phlebotomist leaves the tourniquet in place far longer than a minute. Which effect on the results is most likely?

    • A.Hemodilution, which falsely lowers potassium, total protein and calcium results
    • B.Glycolysis, which falsely lowers the glucose but leaves the total protein unchanged
    • C.Hemoconcentration, which falsely raises potassium, total protein and calcium✓ Answer
    • D.Fibrin formation, which falsely lowers the platelet count in that same specimen

    Prolonged tourniquet pressure drives water out of the vessel at that site, concentrating cells and everything bound to protein, so potassium, calcium, total protein, cholesterol and packed cell volume all read falsely high. Stasis also promotes hemolysis, which pushes potassium higher still, which is why the tourniquet is released as soon as blood flow is established.

    Source: CLSI GP41 tourniquet application; NHA CPT Test PlanReport a problem with this question

13. 13. When confirming a patient's identity before a blood draw, which question or request is most appropriate?

    • A.Are you Mr. John Smith, and is your birthday May 3?
    • B.Please state your full name and date of birth for me.✓ Answer
    • C.Is the name printed on this requisition form yours?
    • D.Can you confirm the room number posted on your door?

    Identification must use open-ended questions so the patient actively states at least two identifiers (full name and date of birth); yes/no questions invite a confused or hard-of-hearing patient to agree to wrong information, and a room number is never a valid identifier.

    Source: NHA CPT Test Plan Task 2E / k41; CLSI GP41 — patient actively states two identifiers (full name + DOB); room number is not an identifierReport a problem with this question

14. 14. A hospitalized patient scheduled for a draw has no ID wristband on either wrist. What should the phlebotomist do?

    • A.Ask the patient to state their own name and proceed with the collection
    • B.Draw the specimen now and label it after the nurse confirms the identity
    • C.Ask the nurse to attach a new ID band and verify identity before drawing✓ Answer
    • D.Match the name on the bedside chart to the requisition and then proceed

    An inpatient must never be drawn without an attached ID wristband that matches the stated identifiers and the requisition; the phlebotomist stops and has the nurse apply and verify a new band first, because verbal statements or bedside charts alone cannot rule out a misidentification — the most serious pre-analytical error.

    Source: NHA CPT Test Plan Task 2E / k41; CLSI GP41 — missing/damaged wristband: do not collect until a band is attached and identity verifiedReport a problem with this question

15. 15. According to the NHA CPT test plan, the diagnosis code required on a laboratory requisition comes from which coding system?

    • A.Common Procedure Coding System for Healthcare (HCPCS)
    • B.International Classification of Diseases (ICD-10-CM)✓ Answer
    • C.Systematized Nomenclature of Medicine (SNOMED CT)
    • D.Current Procedural Terminology, 4th Edition (CPT-4)

    The NHA test plan (knowledge statement k44) explicitly names ICD-10-CM as the system that codes the patient's diagnosis on the requisition, which justifies medical necessity for billing; CPT and HCPCS code procedures and services, not diagnoses, and SNOMED CT is a clinical terminology, not the required billing diagnosis code set.

    Source: NHA CPT Test Plan knowledge statement k44 — ICD-10-CM diagnosis coding on requisitionsReport a problem with this question

16. 16. A trough level of vancomycin is ordered. When should the phlebotomist collect the specimen?

    • A.At the halfway point between two scheduled doses
    • B.Immediately before the next scheduled dose is given✓ Answer
    • C.Thirty minutes after the dose has finished infusing
    • D.At the same time each day, regardless of the dosing

    A trough is the lowest drug concentration in the blood, which occurs just before the next dose is administered; drawing shortly after the infusion instead captures the peak, and drawing at an arbitrary or midpoint time makes the level uninterpretable for dosing decisions.

    Source: NHA CPT Test Plan k45 — timed collections: trough drawn immediately before next dose; peak after administrationReport a problem with this question

17. 17. After the phlebotomist explains the procedure, the patient silently rolls up a sleeve and extends the arm. Which type of consent does this represent?

    • A.Expressed consent
    • B.Implied consent✓ Answer
    • C.Informed consent
    • D.Written consent

    Consent given through the patient's actions rather than words — such as extending the arm for the draw — is implied consent; expressed consent requires a verbal or written agreement, and informed consent specifically requires that the procedure, its purpose, and its risks be explained and understood before agreeing.

    Source: NHA CPT Test Plan k43 — implied vs. expressed vs. informed consent definitionsReport a problem with this question

18. 18. A requisition orders a CBC for a 7-year-old child in the outpatient lab. Before collecting, whose permission must the phlebotomist obtain?

    • A.The consent of a parent or the legal guardian✓ Answer
    • B.The written approval of the laboratory supervisor
    • C.The ordering physician's signature on the chart
    • D.The child's own verbal agreement is sufficient

    Minors cannot legally consent to medical procedures, so a parent or legal guardian must give permission before the draw; a physician's order authorizes the test but does not substitute for consent, and a lab supervisor has no legal authority to consent for a patient.

    Source: NHA CPT Test Plan Tasks 2F/2G, k43 — legal-guardian permission required for minorsReport a problem with this question

19. 19. An outpatient's insurance plan requires a copayment for laboratory services. How should the phlebotomist handle it?

    • A.Tell the patient the lab will simply mail a bill afterward
    • B.Waive the charge whenever a patient says money is tight
    • C.Collect and record it according to the facility's protocol✓ Answer
    • D.Send the patient to the ordering physician's billing office

    The current NHA test plan makes collecting copayments and documenting or billing them per the facility's established protocol an explicit phlebotomist task (2I); waiving copays can violate the insurance contract and anti-kickback rules, and deferring or redirecting the payment ignores the facility's protocol.

    Source: NHA CPT Test Plan Task 2I — collect copayments and document/bill per established protocol (2024 job analysis)Report a problem with this question

20. 20. During the introduction, a patient states pronouns and a chosen name different from the legal name in the chart. What should the phlebotomist do?

    • A.Use only the legal name in the chart to prevent any identity errors
    • B.Ask an accompanying family member which name is really correct
    • C.Use the stated name and pronouns while verifying required identifiers✓ Answer
    • D.Note the discrepancy and postpone the draw until it is resolved

    The 2024 job analysis added gender identity, expression, and pronoun use to the required knowledge (k18): respectful care means addressing the patient by their stated name and pronouns, while identification still proceeds normally against the required identifiers on record — a chosen name is not an ID mismatch and is no reason to delay the draw.

    Source: NHA CPT Test Plan k18 — gender identity/expression and pronoun use (added in 2024 job analysis)Report a problem with this question

21. 21. A patient scheduled for a fasting lipid panel reports drinking coffee with cream an hour ago. What should the phlebotomist do?

    • A.Cancel the test and ask the physician to reorder it next week
    • B.Send the patient home to come back after fasting for 12 hours
    • C.Notify the ordering provider and follow the facility's protocol✓ Answer
    • D.Draw the specimen as ordered, since liquids do not break a fast

    Only water is permitted during a fast, so coffee with cream breaks it; the phlebotomist neither silently proceeds nor unilaterally reschedules or cancels — the correct action is to notify the ordering provider and follow facility protocol, which may allow drawing the specimen labeled as non-fasting.

    Source: NHA CPT Test Plan Task 2K / k46 — verify fasting compliance; non-compliance is escalated to the ordering provider per protocolReport a problem with this question

22. 22. Which patient is closest to a basal state at the time of collection?

    • A.One who fasted since noon and is drawn at 8 in the evening
    • B.One who fasted overnight but just climbed four flights of stairs
    • C.One drawn early in the morning after a light protein breakfast
    • D.One drawn at 7 a.m. at rest, about 12 hours after last eating✓ Answer

    Basal state requires all three conditions at once: early morning, roughly 12 hours after the last food intake, and before any activity; recent stair-climbing, an evening draw, or any breakfast each violates one of those conditions and alters analytes such as glucose, lipids, and cortisol.

    Source: NHA CPT Test Plan k46 — basal state: early morning, ~12 h after last intake, prior to activityReport a problem with this question

23. 23. A patient had a left mastectomy with lymph node removal two years ago. Where should the phlebotomist perform the venipuncture?

    • A.The left hand, because it lies far enough below the surgical site
    • B.A suitable vein in the right arm, away from the affected side✓ Answer
    • C.The left antecubital fossa, since the surgery has fully healed
    • D.A vein in the foot, so that neither of the arms must be used

    Lymph node removal impairs drainage on the entire operated side indefinitely, so any draw from that arm — including the hand — risks lymphedema and infection; the unaffected right arm is used, and foot veins are a last resort requiring physician permission, not the routine alternative.

    Source: NHA CPT Test Plan k48/k49; CLSI GP41 — avoid the arm on the side of a mastectomy (lymphedema/infection risk)Report a problem with this question

24. 24. During the interview, a patient mentions having fainted during previous blood draws. What should the phlebotomist do?

    • A.Seat the patient on a high stool so help can reach them quickly
    • B.Place the patient supine (lying down) before beginning the draw✓ Answer
    • C.Draw in the standard chair but complete the stick very quickly
    • D.Have the patient lie down only if dizziness actually develops

    A history of syncope is acted on preventively: positioning the patient supine before the needle goes in eliminates the fall risk if fainting recurs; a high stool is never acceptable for any draw, speed does not prevent a vasovagal reaction, and waiting for dizziness means the patient may already be falling.

    Source: NHA CPT Test Plan Task 2N / k52; CLSI GP41 — patients with fainting history are drawn recumbent; never on stools or standingReport a problem with this question

25. 25. A provider orders PT and aPTT coagulation tests. Which collection tube should the phlebotomist select?

    • A.A lavender-top tube containing EDTA
    • B.A gray-top tube with sodium fluoride
    • C.A light blue-top tube with citrate✓ Answer
    • D.A green-top tube containing heparin

    Coagulation tests (PT/aPTT) require sodium citrate in the light blue-top tube, which preserves clotting factors and must be filled to maintain the exact 9:1 blood-to-additive ratio; EDTA is for hematology (CBC), sodium fluoride for glucose/alcohol, and heparin for stat chemistry — all would invalidate coagulation results.

    Source: NHA CPT Test Plan k47/k51 — tube-test matching: sodium citrate (light blue) for coagulation, 9:1 ratio requiredReport a problem with this question

26. 26. Under what circumstance may a phlebotomist collect blood from a patient's foot or ankle veins?

    • A.Whenever hand veins are too small for a butterfly set
    • B.Only when the patient specifically requests that site
    • C.Only after the treating physician has given permission✓ Answer
    • D.Whenever both antecubital areas are bruised or scarred

    Lower-extremity veins carry a higher risk of thrombosis, phlebitis, and serious complications in diabetic patients and those with poor circulation, so CLSI-based practice allows foot or ankle draws only with the physician's explicit permission; neither unusable arm sites nor patient preference authorizes that site on its own.

    Source: NHA CPT Test Plan Task 2O / k53; CLSI GP41 — foot/ankle venipuncture only with physician permissionReport a problem with this question

Concept-focused practice questions based on CLSI GP41 (venous blood collection), the CLSI order of draw, and the OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030). Not affiliated with the NHA, ASCP, or CLSI, and not medical advice. Facility protocols and current CLSI standards take precedence — always follow your employer's procedures. About the CPT exam →