Free Phlebotomy Practice Test: 40 NHA-Style Questions With Answers

The four best-known national phlebotomy exams come from NHA, ASCP, AMT and NCCT. Each has its own exam, its own eligibility rules and its own letters after your name. Job postings often say which ones they accept, so look at postings near you before you pick.

A few states, including California and Louisiana, set their own phlebotomy rules. If you live in one of them, check the state requirements first.

NHA lets you take the CPT at your school, at a PSI testing center, or online with a live remote proctor. The free practice test below follows the NHA CPT outline. The same core skills, like order of draw and patient ID, show up on all four exams.

NHA builds the CPT from a job study of working phlebotomists, last done in 2024. The 100 scored questions fall into five areas.

• Safety and compliance: OSHA rules, sharps disposal, needlestick steps, isolation precautions, HIPAA, quality control and first aid.
• Patient preparation: checking the order, identifying the patient, consent, fasting and timing rules, picking the site, and positioning.
• Routine blood collections: equipment, tourniquet use, antiseptic, needle angle, order of draw, tube additives, mixing and labeling.
• Special collections: blood cultures, tolerance tests, point-of-care tests, blood alcohol and drug screen collections, and non-blood specimens like throat swabs.
• Processing: centrifuging, splitting samples, keeping specimens at the right temperature and out of light, chain of custody, and sending results.

Order of draw shows up across several areas. Our order of draw guide has the full CLSI sequence with tube colors and what each tube is for.

1. Take all 40 questions in one sitting, without notes. Give yourself about 40 minutes, close to the pace of the real NHA exam.
2. Read the reason under every answer, including the ones you got right. A lucky guess will not help you on test day.
3. Write down the topic of every question you missed. Each question shows its topic.
4. Study those topics, then take the test again a few days later.

Aim for 36 out of 40 or better before you book your exam. NHA scores on a scale, so there is no fixed number of questions you must get right. A strong score here gives you room to spare.

We wrote every question on this page ourselves, in the style of the NHA CPT. NHA keeps its real questions private.

• Days 1 and 2: Take the practice test. List the topics you missed.
• Days 3 and 4: Order of draw and tube additives. Learn the CLSI order (blood cultures, light blue, serum, green, lavender, gray), what each additive does, and how many times to invert each tube.
• Days 5 and 6: Safety and compliance. Sharps, needlestick steps, PPE for each type of isolation, and HIPAA.
• Days 7 and 8: Patient ID and site selection. Two identifiers, the vein order in the inner elbow, and when not to use an arm.
• Days 9 and 10: Special collections and processing. Blood cultures, timed draws, capillary order of draw, and which specimens need ice, warmth or protection from light.
• Days 11 and 12: Complications. Hematoma, fainting, nerve pain, and what causes hemolysis.
• Day 13: Retake the practice test and review anything you still miss.
• Day 14: Rest, check your ID, and confirm your test time and place.

Not in a program yet? WIOA, the federal job training law, can pay for approved phlebotomy training. See how WIOA pays for phlebotomy training. Capstone Careers also has license exam practice and interview practice for the jobs you apply to: $10 a month added to the Apply plan, or included in the Full plan.

Bring the ID your testing site asks for, and arrive early. If you test online with a live proctor, set up your room and computer ahead of time so you do not lose minutes at the start.

You have about one minute per question on the NHA CPT, since there are 120 questions in two hours. Do not spend too long on any one. Mark it, move on, and come back if your test lets you.

Read every choice before you answer. Many questions ask what you should do first. When two choices both look right, pick the one that keeps the patient safe and the specimen good, in that order.

NHA shows your score in your online account. A scaled score of 390 or higher, out of 500, is a pass.

Keep your certification current. NHA certifications renew every two years, and you need 10 continuing education credits each cycle. If yours expires, NHA gives you one year to reinstate it.

Next, get ready for the job interview. See common phlebotomy interview questions and how to answer them.

1. Right after you pull the needle out of the patient's arm, what should you do with it?
   Answer: Activate the safety feature right away and drop the whole unit in the sharps container. Activating the safety device at once and using the sharps container prevents needlesticks. Never recap, bend or break a used needle.
2. You stick yourself with a used needle. What should you do?
   Answer: Wash the area with soap and water and report it right away. Wash the site with soap and water, then report the exposure right away. Quick reporting means quick testing and treatment if needed.
3. Which federal law requires employers to provide safer needle devices and keep a log of sharps injuries?
   Answer: The Needlestick Safety and Prevention Act. The Needlestick Safety and Prevention Act of 2000 updated OSHA's Bloodborne Pathogens Standard to require safer devices and a sharps injury log.
4. A friend asks what tests her neighbor had drawn at your lab today. Which law keeps you from telling her?
   Answer: HIPAA. HIPAA protects a patient's health information, including which tests were ordered. Share it only with people who need it for care.
5. A patient is on airborne precautions for tuberculosis. What must you wear to go into the room?
   Answer: A fit-tested N95 respirator, plus gloves for the draw. TB spreads through tiny particles in the air. A surgical mask does not filter them well enough; a fit-tested N95 respirator does.
6. When should you clean your hands during a routine blood draw?
   Answer: Before you put gloves on and again after you take them off. Gloves can have tiny holes and hands get dirty when you remove gloves. Clean your hands before gloving and after removing gloves, for every patient.
7. What is the right way to identify an outpatient before a draw?
   Answer: Ask the patient to state her full name and date of birth, then match them to the requisition. Use at least two identifiers, and have the patient say them. A yes-or-no question can get a yes from a patient who misheard.
8. An inpatient you are about to draw has no ID band on his wrist. What do you do?
   Answer: Wait to draw until nursing puts an ID band on him. An inpatient must be identified by an attached ID band before a draw. The nurse is responsible for putting one on.
9. A patient is here for a fasting glucose test. He tells you he ate a donut an hour ago. What should you do?
   Answer: Follow facility policy: tell the ordering provider or note that he was not fasting before you draw. A fasting test drawn after eating gives a false result. The provider decides whether to draw now or reschedule, and the lab must know he was not fasting.
10. You explain the draw, and the patient rolls up her sleeve and holds out her arm. What kind of consent is this?
    Answer: Implied consent. Implied consent is shown by actions, like holding out an arm. Expressed consent is given in words or writing.
11. A patient had her left breast and lymph nodes removed. Where should you draw her blood?
    Answer: The right arm. After lymph node removal, a draw on that side can cause swelling and infection. Use the other arm unless a provider gives permission.
12. Which vein is the first choice for most routine venipunctures?
    Answer: Median cubital vein. The median cubital vein is usually large, well anchored and away from major nerves and arteries. It is also the least painful.
13. Why is the basilic vein the last choice in the inner elbow?
    Answer: It lies close to the brachial artery and a major nerve. The basilic vein sits near the brachial artery and the median nerve. A draw there has a higher risk of hitting one of them.
14. How long can a tourniquet stay on the arm before it should be released?
    Answer: No more than 1 minute. Leaving a tourniquet on longer than a minute concentrates the blood and can change test results.
15. Where should you place the tourniquet for a draw in the inner elbow?
    Answer: About 3 to 4 inches above the puncture site. Three to four inches above the site makes the vein fill without getting in the way of the needle.
16. At what angle should the needle go into the vein?
    Answer: 15 to 30 degrees, bevel up. A shallow angle of 30 degrees or less, with the bevel up, enters the vein without going through it.
17. You clean the site with 70 percent isopropyl alcohol. What should you do next?
    Answer: Let it air dry before you insert the needle. Wet alcohol stings and can damage red cells in the sample. Air drying also gives the alcohol time to kill germs, and fanning or wiping can bring germs back.
18. In the CLSI order of draw, which is collected first?
    Answer: Blood culture bottles. Blood cultures come first so the sample stays sterile and no additive from another tube gets in.
19. Which tube is drawn right after the light blue sodium citrate tube?
    Answer: Serum tube (red or gold). The CLSI order is blood cultures, light blue citrate, serum, heparin, EDTA, then gray. Serum tubes follow citrate.
20. Which tube is drawn last in the CLSI order of draw?
    Answer: Gray (sodium fluoride and potassium oxalate). The gray tube is last. Its additives could change results in any tube drawn after it.
21. EDTA from a lavender tube carries over into a chemistry tube. Which result is most likely to come out falsely high?
    Answer: Potassium. Lavender tubes usually hold potassium EDTA, which raises the potassium result. EDTA also binds calcium, so calcium reads falsely low.
22. A light blue sodium citrate tube is used most often for which test?
    Answer: PT/INR. Light blue tubes are for clotting tests like PT/INR and PTT. The citrate stops clotting in a way the lab can reverse during the test.
23. Why does a gray top tube contain sodium fluoride?
    Answer: It stops blood cells from using up the glucose in the sample. Blood cells keep burning glucose after the draw. Sodium fluoride slows that down so the glucose result stays accurate.
24. Why must a light blue sodium citrate tube be filled all the way to its fill line?
    Answer: Clotting tests need an exact 9-to-1 ratio of blood to anticoagulant. Too little blood leaves too much citrate in the tube, which throws off clotting test results.
25. How should you mix a lavender EDTA tube right after it fills?
    Answer: Gently invert it 8 to 10 times. Gentle full inversions mix the EDTA with blood so it does not clot. Shaking can break red cells.
26. You are using a winged (butterfly) set, and a light blue tube is the first tube. What should you do first?
    Answer: Draw a discard tube first to fill the air space in the tubing. The tubing holds air. Without a discard tube, that air takes up space and the light blue tube will be underfilled.
27. When should you label the tubes?
    Answer: At the patient's side right after the draw, before you leave. Labeling in front of the patient right after the draw prevents mix-ups. Labeling tubes ahead of time can put the wrong name on blood.
28. How do you prepare the site before drawing blood cultures?
    Answer: Scrub with an approved antiseptic such as chlorhexidine and let it dry fully. Blood cultures look for germs in the blood, so germs from the skin must not get in. A careful antiseptic scrub that dries fully prevents false positive results.
29. You are collecting blood cultures with a winged set. Which bottle do you fill first?
    Answer: The aerobic bottle. Air in the tubing goes into the first bottle. The aerobic bottle can take that air; the anaerobic bottle needs to stay oxygen free.
30. When is a trough drug level drawn?
    Answer: Just before the next dose is due. A trough is the lowest level of the drug in the blood, which comes right before the next dose.
31. You are doing a skin puncture and need several tubes. Which of these do you collect first?
    Answer: An EDTA (lavender) microtube. Capillary order is different from venous order. After any blood gas sample, EDTA comes first so platelets do not clump before the tube fills.
32. Where should you puncture an infant's heel?
    Answer: The inner or outer edge of the bottom of the heel. The inner and outer edges of the bottom of the heel avoid the heel bone. A puncture in the back or center can injure the bone.
33. During a finger stick, what do you do with the first drop of blood?
    Answer: Wipe it away with clean gauze. The first drop can hold tissue fluid and leftover antiseptic. Wiping it away gives a cleaner sample.
34. Which specimen should go into an ice slurry right after it is collected?
    Answer: Ammonia. Ammonia keeps rising in the tube at room temperature. Chilling it right away keeps the result accurate.
35. Which test needs the tube protected from light?
    Answer: Bilirubin. Light breaks down bilirubin and lowers the result. Use an amber tube or wrap the tube in foil.
36. For most tests, how soon should serum or plasma be separated from the cells?
    Answer: Within 2 hours of collection. Cells left sitting in serum or plasma keep changing it. CLSI guidance sets 2 hours from collection as the usual limit.
37. What must happen before you spin serum tubes in the centrifuge?
    Answer: Let them clot fully, usually 30 to 60 minutes, and balance the centrifuge. Serum only forms after the blood clots. A balanced load with stoppers on keeps the centrifuge safe and prevents aerosols.
38. During the draw, the patient feels a sharp, electric pain shooting down her arm. What should you do?
    Answer: Stop and remove the needle right away. Shooting or electric pain means the needle may be touching a nerve. Remove it at once to prevent lasting nerve damage.
39. A swelling starts to form under the skin around the needle during the draw. What should you do?
    Answer: Release the tourniquet, remove the needle, and apply pressure. Swelling means blood is leaking into the tissue, which forms a hematoma. Stop the draw and hold pressure to limit it.
40. Which of these can cause hemolysis in a blood sample?
    Answer: Shaking the tube hard. Shaking breaks red cells open and spills their contents into the sample. Hemolysis can change results such as potassium.

• NHA, CPT test plan (2024 job analysis)
• NHA, Certified Phlebotomy Technician (CPT)
• NHA, eligibility requirements
• NHA, how to view exam results
• ASCP BOC, Phlebotomy Technician (PBT)
• ASCP BOC, about the examination
• AMT, Phlebotomy Technician (RPT)
• AMT, RPT exam content outline
• AMT, applying and testing FAQ
• NCCT, candidate handbook
• CLSI, order of blood draw tubes and additives