Phlebotomy is 12 of the 150 scored items on the NHA CCMA. Answer 10 exam style questions on special blood collection procedures and see exactly which concepts would cost you points on test day.
Start the 10 questions →When collecting blood cultures, which step is MOST important for preventing a false-positive result?
These questions cover blood cultures, timed specimens, temperature and light, specimen processing and specimen rejection. 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. Skin bacteria introduced during collection are the main cause of contaminated (false-positive) blood cultures. Careful skin antisepsis with the recommended agent and full drying time, plus disinfecting the bottle septa, are the key steps. Volume guidance comes from the bottle manufacturer.
Why not A: Blood cultures come first in the order of draw so the sterile collection happens before any tube is pierced.
Why not B: Bottles are gently inverted to mix; vigorous shaking is unnecessary.
Why not C: Bottles are filled to the manufacturer's marked volume, not to the brim; overfilling can also give false positives.
Exam tactic: Blood culture questions almost always come down to one thing: keep skin flora out of the bottle.
Answer: C. If the glucose load is not retained, the test cannot be interpreted. The standard action is to stop, inform the provider, and document; the provider decides whether to reschedule.
Why not A: Eating during a glucose tolerance test invalidates the results.
Why not B: Repeating the glucose load is a provider decision and would not produce a valid standard test.
Why not D: Results after vomiting are invalid regardless of how they are labeled.
Exam tactic: Anything that breaks the protocol of a timed test = stop, notify, document.
Answer: D. Bilirubin breaks down when exposed to light, which falsely lowers the result. Light-sensitive specimens are collected in amber tubes or wrapped in foil. Other light-sensitive analytes include some vitamins such as B12 and folate.
Why not A: Body temperature transport is used for cold agglutinins and cryoglobulins.
Why not B: Chilling is used for analytes such as ammonia or lactate, not bilirubin.
Why not C: Tubes are always capped to prevent contamination and evaporation.
Exam tactic: Three handling families: chill it (ammonia, lactate), keep it warm (cold agglutinins), keep it dark (bilirubin).
Answer: B. An unbalanced centrifuge vibrates, can break tubes, and can damage the machine. Tubes are balanced with an opposite tube of equal volume (using a water-filled balance tube if needed), caps stay on, and the lid is closed and latched before starting.
Why not A: Refrigeration is not a general prerequisite for centrifuging.
Why not C: A single tube on one side is exactly what causes an unbalanced load; use a balance tube.
Why not D: Uncapped tubes release aerosols and can spill; caps stay on.
Exam tactic: Balance, capped, lid closed. Never open until the rotor has fully stopped.
Answer: C. Specimens without at least two patient identifiers are rejected because identity cannot be confirmed. Other common rejection reasons are hemolysis, clotted anticoagulated tubes, wrong tube type, underfilled citrate tubes, and missed timing or temperature requirements.
Why not A: A properly filled citrate tube is acceptable.
Why not B: Allowing a serum tube to clot fully is correct processing.
Why not D: Gentle inversion of an EDTA tube is correct technique.
Exam tactic: Unlabeled or mislabeled = rejected, every time. Labs do not guess.
Answer: D. Shooting or electric pain, numbness, or tingling indicates the needle may be touching a nerve. The draw is stopped immediately to prevent permanent injury, the event is documented, and the draw is attempted at another site if appropriate. Excessive probing and deep basilic-side draws raise nerve injury risk.
Why not A: Fist clenching does not relieve nerve contact and is not part of the response.
Why not B: Probing is the most common cause of nerve injury; it makes it worse.
Why not C: Continuing while a nerve is irritated risks lasting damage.
Exam tactic: Electric pain = needle out now. Never probe.
Answer: C. A widely followed standard is no more than two attempts per collector. After that, another trained collector tries, or the provider is informed. Repeated attempts by the same person increase pain, hematoma, and nerve-injury risk.
Why not A: Switching sites with unsuitable equipment is not a solution for repeated failure.
Why not B: Repeated attempts beyond two cause harm and erode the patient's trust.
Why not D: Rescheduling without involving the provider may delay needed testing.
Exam tactic: Two strikes, then hand it off.
Answer: B. Chain of custody is documentation that accounts for the specimen at every moment: who collected it, sealed it, handled it, and received it, with tamper-evident seals and signatures. Any gap can make the result legally unusable.
Why not A: Identification requirements are stricter for forensic specimens, not looser.
Why not C: The collector labels and seals the container in the donor's presence; the donor typically initials the seal.
Why not D: An unattended specimen breaks the chain of custody.
Exam tactic: Chain of custody = no gaps, no unattended moments, signatures at every handoff.
Answer: C. Excess tissue fluid can mix with the sample and alter results, and swelling hides veins and makes accurate needle placement difficult. The area also heals poorly and is prone to infection.
Why not A: There is no specific rise in glucose from edema; the concern is dilution and contamination.
Why not B: Edema does not accelerate clotting in the tube.
Why not D: Edema involves fluid in tissues, not arterial blood.
Exam tactic: Swollen, scarred, burned, bruised, IV side, mastectomy side: all on the avoid list.
Answer: A. A transfer device lets the tube's vacuum pull blood in without a needle and without forcing the plunger. This prevents needlesticks, avoids hemolysis from pressure, and keeps the correct additive ratio. Tubes are filled in the order of draw.
Why not B: Removing stoppers breaks the closed system and forcing blood causes hemolysis.
Why not C: Pouring is unsafe and risks spills, contamination, and incorrect volumes.
Why not D: Holding the tube while pushing a needle through it is a classic needlestick injury.
Exam tactic: Syringe to tube = transfer device, no hands near needles, no pushing the plunger.
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