Phlebotomy is 12 of the 150 scored items on the NHA CCMA. Answer 10 exam style questions on phlebotomy and see exactly which concepts would cost you points on test day.
Start the 10 questions →Before a venipuncture, which method correctly confirms the patient's identity?
These questions cover patient identification, site selection, tourniquet use, order of draw and tube additives. Each one shows the correct answer and why every other option is wrong, so a miss tells you exactly what to review before the CCMA.
Prefer to read first? Every question from the practice set above, with the correct answer and why each wrong option is wrong.
Answer: D. Two identifiers stated by the patient (name and date of birth) are compared with the order before any specimen is collected. Yes/no questions invite errors because anxious or hard-of-hearing patients agree without listening.
Why not A: A leading yes/no question is not verification; patients often say yes reflexively.
Why not B: Room assignments change and are not a patient identifier.
Why not C: Identity is confirmed before the needle goes in, never after.
Exam tactic: Open-ended, two identifiers, before the draw. Never lead the patient.
Answer: B. Blood drawn above or near a running IV is diluted or contaminated with the infused fluid. If the arm must be used, the draw is made below the IV after the infusion is paused for a short time according to facility protocol, and the site is documented so results can be interpreted.
Why not A: Drawing above the IV captures infused fluid flowing down the vein; results can be badly altered.
Why not C: Drawing from an IV catheter is outside the medical assistant's scope and yields contaminated samples.
Why not D: Drawing at the antecubital with fluid running into the forearm collects diluted blood.
Exam tactic: Below the IV, infusion paused, site documented. Never above, never from the line.
Answer: B. The tourniquet goes 3 to 4 inches above the site, snug enough to slow venous return but not stop arterial flow, and stays on no longer than about a minute. Longer application causes hemoconcentration and altered results such as falsely high potassium.
Why not A: A tourniquet over the site obscures the vein and interferes with the needle.
Why not C: Occluding the artery prevents blood from entering the arm and is painful and dangerous.
Why not D: Prolonged application beyond a minute changes the sample; release and reapply if needed.
Exam tactic: 3 to 4 inches above, 1 minute max, radial pulse still present.
Answer: D. The order of draw prevents additive carryover: sterile blood culture bottles first, then light blue (citrate), then serum tubes (red or gold SST), then green (heparin), then lavender (EDTA), then gray (fluoride/oxalate).
Why not A: Blood cultures must be first because they require the sterile draw before any tube tops are pierced.
Why not B: EDTA drawn before citrate contaminates the coagulation tube and can falsely prolong clotting times.
Why not C: Serum tube before the coagulation tube can carry clot activator into the citrate tube.
Exam tactic: Cultures → light blue → red/gold → green → lavender → gray. Sterile first, anticoagulant that matters most (citrate) second.
Answer: D. Coagulation tubes require a precise 9:1 blood-to-citrate ratio. Underfilling leaves excess anticoagulant, falsely prolonging PT and aPTT. Underfilled light blue tubes are rejected and must be redrawn.
Why not A: Centrifugation does not change the anticoagulant ratio.
Why not B: No calculation corrects the altered ratio; the sample is invalid.
Why not C: Adding blood from an EDTA tube contaminates the citrate tube with a different anticoagulant.
Exam tactic: Light blue must be full. Short draw = redraw.
Answer: B. The needle enters bevel up at a shallow 15 to 30 degree angle in the direction of venous flow. A steeper angle risks going through the vein into deeper structures; bevel down makes clean entry harder and can press the opening against the vein wall, blocking flow.
Why not A: Bevel down and 45 degrees increase the chance of passing through the vein.
Why not C: Parallel entry with the bevel down does not reliably enter the lumen.
Why not D: A 90 degree angle is for intramuscular injections, not venipuncture.
Exam tactic: Bevel up, 15 to 30 degrees, smooth single motion.
Answer: C. A 21-gauge needle balances flow and comfort for most adults. Smaller-lumen needles (higher gauge numbers, such as 23 on a butterfly) are used for small or fragile veins; very small gauges risk hemolysis. Large-bore needles like 16 are for donation or infusion, not routine draws.
Why not A: 16-gauge is far larger than needed and causes unnecessary trauma.
Why not B: 30-gauge is an injection needle size, unsuitable for drawing blood.
Why not D: 25-gauge is too narrow for tube draws and can hemolyze the sample.
Exam tactic: Higher gauge number = thinner needle. Routine adult = 21; butterfly = 23.
Answer: C. Signs of impending syncope require stopping the procedure immediately, securing the site, and positioning the patient to increase blood flow to the brain (head down or supine, legs elevated). The assistant stays with the patient and calls for help if needed.
Why not A: A fainting patient can fall with a needle in the arm; the draw is never finished first.
Why not B: An unstable patient is never left alone; call for help from the room.
Why not D: Standing a presyncopal patient risks a fall and injury.
Exam tactic: Presyncope: needle out, patient down, never alone. The tube can wait.
Answer: D. The lateral aspect of the fingertip pad of the third or fourth finger is used because it is less calloused, less sensitive, and away from the bone. The puncture is made perpendicular to the fingerprint lines so blood forms a drop instead of running along the ridges.
Why not A: Heel sticks are for infants under about 1 year; the adult heel is too thick.
Why not B: The thumb has a pulse and is calloused, making it a poor choice.
Why not C: The center of the tip is over bone and more painful, and the index finger is heavily used and more sensitive.
Exam tactic: Adults: side of the middle or ring finger. Infants: lateral heel.
Answer: D. Tubes are labeled right after the draw in the presence of the patient with at least two identifiers, the date and time, and the collector's initials. Pre-labeling risks using the wrong tube if the draw fails; delayed labeling risks mixing up patients.
Why not A: Labeling must occur at the point of collection, not at checkout.
Why not B: Pre-labeled tubes may end up used on another patient or discarded with a label attached.
Why not C: Labeling away from the patient is the classic cause of specimen mix-ups.
Exam tactic: Draw, then label, before the patient leaves your sight. Never pre-label.
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