Routine Blood Collections is 28 of the 100 scored items on the NHA CPT exam. Answer 10 exam style questions on venipuncture complications and troubleshooting and see exactly which concepts would cost you points on test day.
Start the 10 questions →Bright red blood pulses rapidly into the tube. What is the most likely cause?
These questions cover troubleshooting, syringe draws, needle selection, complications and syncope. Each one shows the correct answer and why every other option is wrong, so a miss tells you exactly what to review before the NHA CPT.
Prefer to read first? Every question from the practice set above, with the correct answer and why each wrong option is wrong.
Answer: A. Pulsing, bright red blood indicates arterial puncture. The needle is removed, firm pressure is held for at least 5 minutes, and the event is reported and the specimen labeled per policy.
Why not B: Anemia does not cause pulsing flow.
Why not C: A loose tourniquet does not cause arterial flow.
Why not D: Expired tubes fill poorly, they do not pulse.
Exam tactic: Pulsing bright red: artery, pressure 5+ minutes.
Answer: A. A slow, steady pull prevents vein collapse and hemolysis. Pulling too hard collapses small veins and damages cells.
Why not B: Jerking damages cells and moves the needle.
Why not C: Syringes need gentle manual suction.
Why not D: Fast pulling collapses veins and hemolyzes cells.
Exam tactic: Syringe: slow and steady.
Answer: D. A 21 gauge needle is the standard for most adult venipunctures. 16 gauge is used for blood donation, and very fine gauges hemolyze samples.
Why not A: 30 gauge is for insulin injections.
Why not B: 27 gauge is too fine for tube collection.
Why not C: 16 gauge is for donor collection.
Exam tactic: Routine adult: 21 gauge.
Answer: C. Shooting or electric pain suggests nerve contact. The tourniquet is released and the needle removed at once, then pressure is applied and the event documented and reported.
Why not A: Continuing risks permanent nerve injury.
Why not B: Probing deeper increases the risk of nerve damage.
Why not D: The needle must come out first, the cold pack is not the response.
Exam tactic: Electric pain: needle out now.
Answer: B. Pallor, sweating, lightheadedness, nausea and a faint feeling are warning signs of vasovagal syncope.
Why not A: A strong grip is not a warning sign.
Why not C: Sneezing is unrelated.
Why not D: These do not signal fainting.
Exam tactic: Pale, sweaty, woozy: act now.
Answer: A. When both arms are restricted, the phlebotomist consults the nurse or provider for an approved site and follows facility policy.
Why not B: Drawing above an IV contaminates the specimen.
Why not C: The mastectomy side needs provider approval.
Why not D: Line draws are done by trained staff per protocol, not ad hoc.
Exam tactic: Both arms restricted: ask first.
Answer: B. Most facility policies allow two attempts by one phlebotomist. After that, another qualified person attempts or the provider or supervisor is notified.
Why not A: Repeated attempts by the same person go against common policy and stress the patient.
Why not C: Leg and foot sites usually require provider approval.
Why not D: The ordering provider or nurse must be informed when a specimen cannot be collected.
Exam tactic: Two strikes, hand it off.
Answer: A. Prolonged tourniquet time causes hemoconcentration. Plasma water shifts into the tissue, which falsely raises large molecules and cell-based values such as total protein.
Why not B: Ethanol is a small molecule spread through total body water, so a short shift of plasma water into tissue barely changes its concentration.
Why not C: Urine testing is not affected by a tourniquet.
Why not D: ABO and Rh typing are not changed by tourniquet time.
Exam tactic: Long tourniquet: proteins rise.
Answer: D. Underfilling gives too much EDTA for the blood volume. Excess EDTA shrinks red cells, which can falsely lower the hematocrit and affect other indices.
Why not A: Short draws are not a classic cause of falsely high platelets.
Why not B: Fill volume matters because the additive amount is fixed for a full draw.
Why not C: Excess anticoagulant does not cause clotting.
Exam tactic: Short lavender: too much EDTA, cells shrink.
Answer: B. A collapsed vein may refill if the tourniquet is loosened and reapplied briefly. If not, the needle is removed and another site is used, possibly with less vacuum.
Why not A: Pushing deeper risks passing through the vein.
Why not C: Breath holding or fist pumping does not reopen a collapsed vein, and pumping alters results.
Why not D: Pulling the tube does not reopen the vein.
Exam tactic: Collapsed vein: loosen, retighten, or move.
The free 20 question diagnostic covers all 5 areas of the NHA CPT outline and shows the 3 fixes worth the most points.
Take the free diagnosticSee all 22 Phlebotomy practice topics →