NHA CPT Exam Flashcards

Q: How many questions are on the NHA CPT exam?

The NHA Certified Phlebotomy Technician exam has 120 questions: 100 scored and 20 unscored pretest items, with a 2-hour time limit. Items are distributed across five domains—Safety and Compliance (26%), Patient Preparation (20%), Routine Blood Collections (28%), Special Collections (12%), and Processing (14%).

Q: What is the passing score for the NHA CPT exam?

You must score at least 390 on the NHA scaled 200-500 score range. Because scoring is scaled rather than a fixed percentage, the exact number of correct answers needed varies slightly with item difficulty; most candidates need roughly 70-75% correct.

Q: Which domains are most heavily weighted on the NHA CPT exam?

Routine Blood Collections (28%) and Safety and Compliance (26%) together make up more than half the scored exam. Mastering the order of draw, tube additives, OSHA bloodborne pathogen rules, and venipuncture complications has the highest payoff.

Q: Who is eligible to sit for the NHA CPT exam?

You generally need a high school diploma or GED plus completion of an NHA-approved phlebotomy program within the past 5 years, OR at least one year of supervised phlebotomy experience within the past 3 years. Documentation of 30 successful venipunctures and 10 capillary sticks is also required.

Q: How long does NHA CPT certification last?

The CPT credential is valid for 2 years and is renewed by completing 10 continuing education hours and paying the renewal fee. Keeping the certification active maintains national recognition of phlebotomy competency.

Question 1

Standard Precautions

Accepted Answer

Treat all blood and body fluids as potentially infectious regardless of the patient's diagnosis. This includes hand hygiene, gloves for every draw, and safe sharps handling for all patients without exception.

Question 2

OSHA Bloodborne Pathogens Standard

Accepted Answer

Requires employers to provide an exposure control plan, hepatitis B vaccination at no cost, PPE, engineering controls (safety-engineered needles), and post-exposure follow-up to protect workers from bloodborne pathogens.

Question 3

Donning and Doffing Order

Accepted Answer

Don PPE: gown, then mask, then goggles, then gloves. Doff in the order that removes the most contaminated items first: gloves, then goggles, then gown, then mask, performing hand hygiene after removal.

Question 4

Sharps Disposal Rule

Accepted Answer

Activate the safety device and discard the needle immediately at the point of use into a puncture-resistant, leakproof, labeled sharps container. Never recap, bend, or break a contaminated needle.

Question 5

Needlestick Exposure Response

Accepted Answer

Immediately wash the site with soap and water, report the incident to a supervisor, and begin the post-exposure protocol with prompt medical evaluation. Speed matters because some post-exposure prophylaxis is time-sensitive.

Question 6

Hand Hygiene Timing

Accepted Answer

Perform hand hygiene before patient contact, before gloving, after glove removal, and between patients. Gloves are not a substitute for hand hygiene because they can have unseen defects or contaminate hands on removal.

Question 7

Chain of Infection

Accepted Answer

Infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host. Breaking any link prevents infection; hand hygiene and PPE primarily interrupt transmission.

Question 8

HIPAA in Phlebotomy

Accepted Answer

Protected health information must be kept confidential and shared only on a need-to-know basis. Discussing results, leaving labeled specimens visible, or talking about patients in public areas can be a violation.

Question 9

Biohazard Waste Segregation

Accepted Answer

Contaminated, blood-soaked, or regulated medical waste goes into labeled biohazard containers, not regular trash. Sharps go in sharps containers. Correct segregation is required for compliant disposal.

Question 10

Quality Assurance vs. Quality Control

Accepted Answer

Quality assurance is the overall system of policies ensuring reliable results; quality control is the routine checks (such as monitoring reagents and equipment) within that system. Both protect specimen and result integrity.

Question 11

Hepatitis B Vaccination

Accepted Answer

Employers must offer the hepatitis B vaccine series free to at-risk workers. An employee who declines must sign a declination form but may receive the vaccine later at no cost.

Question 12

Two-Identifier Patient Verification

Accepted Answer

Confirm identity using two patient-specific identifiers (such as full name and date of birth) by having the patient state them and matching to the requisition and wristband. Room or bed number is not an acceptable identifier.

Question 13

Active vs. Passive Identification

Accepted Answer

Active identification means the patient states their own name and date of birth. Passive identification (you state it and the patient nods) is less reliable and not the preferred method for an alert patient.

Question 14

Fasting Specimen Requirements

Accepted Answer

True fasting usually means no food or drink except water for a specified period before the draw. Confirm and document fasting status; common fasting tests include glucose and lipid panels, where eating alters results.

Question 15

Antecubital Vein Selection Order

Accepted Answer

The median cubital vein is generally the first choice—well anchored and away from major nerves and the artery. The cephalic vein is a secondary choice; the basilic vein is used last due to proximity to the brachial artery and median nerve.

Question 16

Tourniquet Time Limit

Accepted Answer

Leave the tourniquet on no longer than one minute to avoid hemoconcentration, which falsely elevates certain analytes. Release it before it has been on too long and reapply if needed.

Question 17

Site Avoidance

Accepted Answer

Avoid drawing from an arm with a mastectomy on that side, an active IV line, edema, hematoma, scarring, or a fistula/graft. These sites risk inaccurate results or patient harm; choose an alternative site.

Question 18

Antiseptic for Routine Venipuncture

Accepted Answer

Cleanse the site with 70% isopropyl alcohol in a circular or back-and-forth motion and allow it to air dry. Drawing before it dries can cause stinging and may hemolyze the specimen.

Question 19

Patient Communication and Consent

Accepted Answer

Explain the procedure, confirm the patient consents, and address concerns before the draw. A competent patient may refuse; document the refusal and notify the appropriate provider rather than proceeding.

Question 20

Equipment Inspection

Accepted Answer

Before use, check that needles are sterile and unexpired with intact packaging and no defects, and that tubes are not expired. Expired tubes may have lost vacuum or additive effectiveness, compromising results.

Question 21

Order of Draw (CLSI)

Accepted Answer

Blood culture (yellow/SPS), then light blue (citrate), then serum/SST (red/gold), then green (heparin), then lavender (EDTA), then gray (fluoride/oxalate). The order minimizes additive carryover between tubes.

Question 22

Light Blue Tube (Sodium Citrate)

Accepted Answer

Used for coagulation studies (PT/INR, PTT). Requires a full-volume draw because the fixed citrate-to-blood ratio is critical—an underfilled tube dilutes the sample and produces inaccurate clotting results.

Question 23

Lavender Tube (EDTA)

Accepted Answer

Anticoagulant of choice for hematology (CBC) because EDTA preserves cell morphology by binding calcium. The tube must be gently inverted several times immediately to prevent clotting.

Question 24

Gray Tube (Sodium Fluoride / Potassium Oxalate)

Accepted Answer

Fluoride is a glycolytic inhibitor that preserves glucose by stopping cells from consuming it. Used for glucose and blood alcohol; oxalate is the anticoagulant.

Question 25

SST / Serum Separator Tube

Accepted Answer

Contains a clot activator and gel. The specimen must fully clot (typically about 30 minutes) before centrifugation; spinning too early can cause fibrin contamination and inaccurate results.

Question 26

Needle Gauge Relationship

Accepted Answer

The higher the gauge number, the smaller the needle bore. A large-bore needle (low gauge number) used with a small vein can cause vein collapse; too small a bore can hemolyze the sample.

Question 27

Needle Insertion Angle

Accepted Answer

Insert the needle bevel up at a shallow angle (generally 30 degrees or less) for venipuncture. Too steep an angle risks going through the vein; too shallow may not enter it.

Question 28

Hemolysis Causes

Accepted Answer

Rupture of red cells releasing intracellular contents. Common causes: vigorous mixing, drawing through a small needle, frothing, prolonged tourniquet time, or drawing before alcohol dries. It falsely elevates potassium and other analytes.

Question 29

Hematoma Formation

Accepted Answer

Blood leaking into tissue, causing swelling and bruising. Stop the draw immediately if it forms during venipuncture, remove the tourniquet and needle, and apply firm pressure.

Question 30

Probing Risk

Accepted Answer

Blind redirection of the needle (probing) can damage nerves and the artery and cause significant patient harm. If the vein is missed, withdraw slightly and redirect minimally, or stop and reattempt at another site.

Question 31

Arterial Puncture Recognition

Accepted Answer

Bright red, rapidly pulsing blood that fills the tube quickly suggests an inadvertent arterial puncture. Remove the needle and apply firm, prolonged pressure for at least several minutes and notify a supervisor.

Question 32

Syncope During a Draw

Accepted Answer

If a patient feels faint or loses consciousness, immediately stop the draw, remove the needle, lower the head, and protect the patient from injury. Stay with the patient and call for help as needed.

Question 33

Capillary Order of Draw

Accepted Answer

Capillary collection order differs from venous: EDTA (lavender) first, then other additive tubes, then serum last. EDTA is collected first to ensure an adequate hematology sample before the blood begins to clot.

Question 34

Capillary Puncture Depth

Accepted Answer

Use a lancet with a depth appropriate to the site and patient (shallower for infants) to avoid striking bone, which can cause osteomyelitis in neonates. Wipe away the first drop, which is contaminated with tissue fluid.

Question 35

Blood Culture Skin Antisepsis

Accepted Answer

Requires more rigorous antisepsis than routine draws (e.g., chlorhexidine or iodine with full contact and dry time) to prevent skin-flora contamination, which causes false-positive cultures and unnecessary treatment.

Question 36

Blood Culture Set Sequence

Accepted Answer

Inoculate or fill blood culture bottles first in the order of draw to minimize contamination. Adequate volume and aseptic technique are critical for accurate organism detection.

Question 37

Glucose Tolerance Test (GTT)

Accepted Answer

A timed series of draws after a glucose load to assess glucose metabolism. Strict adherence to the timing schedule from the baseline draw is essential—mistimed samples invalidate the test.

Question 38

Blood Alcohol Concentration (BAC) Draw

Accepted Answer

Use a non-alcohol antiseptic to clean the site so the prep does not contaminate the result, fill the gray tube appropriately, and follow chain-of-custody procedures for legal specimens.

Question 39

Therapeutic Drug Monitoring Timing

Accepted Answer

Peak and trough levels must be drawn at precise times relative to the dose (trough just before the next dose; peak after administration). Documenting the exact collection time is essential for interpretation.

Question 40

Neonatal Heelstick Site

Accepted Answer

Puncture the medial or lateral plantar surface of the heel, avoiding the central arch and posterior curvature, to prevent bone injury. Warming the site increases blood flow for collection.

Question 41

Newborn Screening Card

Accepted Answer

Apply free-flowing blood drops to fill each circle completely from one side only, do not layer or smear, and let it air dry. Improperly collected cards are rejected and require recollection.

Question 42

Chain of Custody

Accepted Answer

A documented, unbroken record of specimen handling for legal/forensic samples (such as drug screens), tracking every person who possessed the specimen. A break can render the result legally inadmissible.

Question 43

Specimen Labeling Timing

Accepted Answer

Label tubes at the patient's side immediately after collection, never before drawing or away from the patient, to prevent misidentification—a leading cause of serious transfusion and treatment errors.

Question 44

Required Label Information

Accepted Answer

Minimum label data includes patient full name, a unique identifier (such as date of birth or medical record number), date and time of collection, and the collector's initials. Missing data is grounds for rejection.

Question 45

Centrifugation Rule

Accepted Answer

Centrifuge balanced tubes only after a serum specimen has fully clotted, at the specified speed and time. Never re-spin a gel tube or open the lid while it is spinning; improper handling causes inaccurate results.

Question 46

Specimen Rejection Criteria

Accepted Answer

Reject hemolyzed, clotted (in anticoagulant tubes), underfilled coagulation tubes, mislabeled or unlabeled, or improperly transported specimens. Recollection is safer than reporting an inaccurate result.

Question 47

Light-Sensitive Specimens

Accepted Answer

Analytes such as bilirubin degrade with light exposure and must be protected (e.g., amber tube or foil) during transport. Failure to protect them produces falsely low results.

Question 48

Chilled Specimen Requirements

Accepted Answer

Certain tests (such as ammonia or lactic acid) require transport on ice or in a slurry to slow metabolism. Using ice when not required, or omitting it when required, can compromise the result.

Question 49

Specimen Stability and Turnaround

Accepted Answer

Many analytes are time-sensitive; delays in transport, centrifugation, or testing can degrade the specimen. Prompt processing within the lab's stated time limits preserves accuracy.

Question 50

Aliquot Preparation

Accepted Answer

An aliquot is a portion of a specimen transferred to a labeled secondary tube for separate testing. The aliquot must carry the same identifiers as the primary tube to prevent mismatched results.

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