NHA CPT NHA Certified Phlebotomy Technician - Set 2 - Part 3

Correct Answer: Lateral or medial plantar surface

the safe heel-stick site is the lateral or medial plantar surface, the curved outer or inner edge. The center risks calcaneus bone injury, and the arch risks nerve injury, so neither is acceptable in newborns. Option a is incorrect because the center of the heel overlies the calcaneus bone, where deep puncture can cause osteomyelitis or bone injury. The plantar edges are far safer, since they avoid the bony prominence underneath the central heel pad. Option b is incorrect because the arch of the foot lies near nerves and tendons that should never be punctured during capillary collection. Nerve injury would produce lasting harm, so the standard site is the lateral or medial plantar heel surface. Option c is incorrect because the big toe pad is not used for routine newborn capillary collection and lacks the vascular bed of the heel. The toe site does not yield reliable specimens and has no role in standard CLSI capillary guidance.

Correct Answer: Defer to trained nurse for port

implanted ports require a non-coring Huber needle and trained personnel, typically the nurse or IV team. The routine phlebotomist defers port access and either performs a peripheral draw or coordinates with the trained team for line draw. Option b is incorrect because accessing the port with a regular needle damages the port septum and breaks sterile technique. Coring the septum reduces device life and creates infection risk, so trained personnel must use the dedicated non-coring Huber needle for access. Option c is incorrect because canceling the labs without contacting anyone abandons clinical care for the patient. The correct path is escalation to the trained team, which can either access the port or coordinate a peripheral draw without losing the order entirely. Option d is incorrect because drawing from the foot in adults requires a physician order because of thrombosis risk, especially in oncology patients on chemotherapy. The proper approach starts with peripheral upper-extremit

Correct Answer: Twenty-three gauge butterfly, low vacuum

geriatric draws use smaller gauges like twenty-three with a butterfly to reduce vein collapse, and lower vacuum tubes prevent collapse during aspiration. The combination respects fragile vessels without compromising specimen quality during routine collection. Option a is incorrect because a sixteen-gauge straight needle is large enough for trauma resuscitation but excessive for geriatric venipuncture. The high-flow needle tears fragile veins and causes large hematomas, with no clinical benefit for routine specimen collection. Option c is incorrect because an eighteen-gauge straight needle is still on the larger end and would risk collapsing fragile geriatric veins. Smaller gauge butterfly devices with lower vacuum produce better outcomes in this population, which is why the standard recommends them. Option d is incorrect because skipping the tourniquet entirely undermines vein distention needed for successful access. The tourniquet remains useful, although the phlebotomist applies it b

Correct Answer: Use wider blood pressure cuff

a wider blood pressure cuff substitutes effectively for a tourniquet in bariatric patients, providing better venous distention without pinching the skin. Many facilities keep this option available specifically for patients with elevated body mass index during routine encounters. Option a is incorrect because a longer tourniquet on the wrist does not address limited venous distention in the antecubital area. The blood pressure cuff alternative produces better distention and accommodates larger arms more comfortably than tourniquets in this population during the draw. Option b is incorrect because stopping tourniquet use entirely undermines venous distention needed for successful access. Some form of venous occlusion is essential, even if the device must be a wider blood pressure cuff to fit and function properly on a larger arm. Option d is incorrect because stacking two tourniquets pinches the skin and creates additional risk without delivering the wider compression of a blood pressure

Correct Answer: EDTA first, additives, then serum

the capillary fill order places the EDTA tube first to preserve cell counts before platelet clumping begins. Other additive tubes follow, and serum or clot tubes come last, which inverts the venous order because of rapid clotting tendency. Option a is incorrect because placing bilirubin first and EDTA last reverses the capillary fill order. Platelet clumping in capillary blood begins quickly, so the EDTA tube must be filled first to preserve accurate counts in the newborn specimen reliably. Option b is incorrect because starting with whole blood gas tubes is not the standard capillary fill order for routine collections. Capillary blood gas is a separate workflow, and the standard fill order centers on EDTA first followed by other additive tubes. Option c is incorrect because serum tubes first allow clotting to complete before the EDTA tube fills, which leaves the complete blood count specimen unreliable. The capillary fill order specifically prioritizes EDTA to capture platelet counts

Correct Answer: Median cubital

the median cubital vein is the first choice because it sits centrally, anchors well, and tends to be the largest. Its location away from the brachial artery and median nerve makes it the safest selection in routine practice. Option b is incorrect because the cephalic vein is the second choice on the lateral side. It is acceptable when the median cubital is not viable, but its tendency to roll makes it less ideal as the routine first-line selection. Option c is incorrect because the basilic vein is the third and last choice because it lies adjacent to the brachial artery and median nerve. Its anatomic position makes accidental arterial puncture or nerve injury more likely, which is why it ranks last. Option d is incorrect because the brachial artery is not a venous draw target at all and would be punctured intentionally only for arterial blood gas. Targeting the artery during venipuncture would cause arterial bleeding and a hematoma, with possible aneurysm formation later.

Correct Answer: Withdraw, firm pressure, notify clinician

the bright red pulsatile flow signals arterial puncture, which requires immediate withdrawal, firm pressure for five to ten minutes, and clinical notification. The patient must be observed for hematoma and any neurovascular changes after the event. Option a is incorrect because continuing because flow is rapid ignores the arterial signal and risks a large hematoma or aneurysm formation. The phlebotomist must recognize the difference between fast venous flow and pulsatile arterial flow and stop the draw promptly. Option b is incorrect because switching to a smaller tube and finishing the draw still uses an arterial site, which is unsafe. Arterial puncture requires withdrawal and pressure rather than continued specimen collection from the wrong vessel under any circumstances during the event. Option d is incorrect because applying a tourniquet above the puncture site does not address arterial bleeding directly and may worsen distal flow. Direct firm pressure at the puncture site is the s

Correct Answer: Four milliliters

total blood volume in an infant is roughly eighty milliliters per kilogram, so the five-kilogram infant has about four hundred milliliters total. One percent equals four milliliters, the safe twenty-four-hour draw limit. Option a is incorrect because half a milliliter falls far below the actual one percent calculation for a five-kilogram infant. Setting the limit that low would prevent collection of even routine panels and does not match the standard neonatal calculation method. Option c is incorrect because one milliliter understates the safe limit and does not match the standard calculation. The one percent rule produces four milliliters in this case, since total blood volume in a five-kilogram infant is approximately four hundred milliliters. Option d is incorrect because forty milliliters represents ten percent of the infant's total blood volume rather than one percent. Drawing that volume in a single day would cause iatrogenic anemia, far exceeding the safe limit for routine

Correct Answer: Discard first void, collect through next morning

the patient discards the start-time void and collects every subsequent void into the container with appropriate preservative, including the next morning's first void at the same clock time. This captures exactly twenty-four hours of urine output. Option a is incorrect because collecting everything starting at the seven a.m. Monday void includes a void with urine produced before the start time. The collection would overestimate output for that day, since some of the urine accumulated before the official start. Option b is incorrect because collecting random samples four times daily does not match the twenty-four-hour technique and would not capture the full output. Random sampling answers a different clinical question and does not support analyte excretion calculations like creatinine clearance. Option c is incorrect because collecting for twenty-four hours but refrigerating only the last container ignores stability requirements for the rest of the specimen. Most collections need r

Correct Answer: Liquid or unformed stool

the assay requires liquid or unformed stool, since formed stool is associated with carriage rather than active infection. Laboratories reject formed specimens to avoid false-positive results from asymptomatic colonization, which can occur in many hospitalized patients. Option a is incorrect because formed stool only is explicitly the rejected sample type for this test. The clinical question is active infection, and formed stool typically reflects colonization rather than disease, so the assay is invalid on that consistency. Option b is incorrect because solid stool refrigerated overnight remains formed stool and is still rejected. Refrigeration affects organism viability for some tests but does not change the consistency requirement for this assay, which centers on the active diarrheal state. Option d is incorrect because a rectal swab is not the standard sample for routine toxin or PCR testing. Stool in a sealed cup is the accepted specimen, with liquid or unformed consistency, since