Complete Phlebotomy Exam Review - E-Book


461 Pages
Read an excerpt
Gain access to the library to view online
Learn more


Prepare for phlebotomy certification and licensure exam success with Complete Phlebotomy Exam Review, 2nd Edition. This comprehensive review book has 1,500 questions. A new pretest provides an assessment of strengths and weaknesses, and a mock certification exam at the end of the book tests your knowledge of necessary information. Organized into chapters that correlate with the trusted textbook by Warekois and Robinson, each chapter includes a content review followed by multiple-choice questions, each with an answer, a rationale, and a page-number reference to information in the companion textbook. An Evolve website offers even more opportunity to practice ,with all the questions in the book plus 500 extra and the ability to sort by category or test in study or exam modes.

  • 100-question mock certification exam at the end of the book allows you to test your comprehension of the material and identify areas of strength and weakness to target study.
  • Answers, rationales, and page-number references to the trusted companion test by Warekois and Robinson help you understand why your selected answer was right or wrong and strengthen your knowledge of key exam content areas.
  • The Evolve site provides you with myriad opportunities for practice. With all the text questions plus an additional 500, you can take tests in exam or study mode and sort questions by category or chapter to tailor practice to your individual needs.
  • Organized by chapters, each begins with a content review to break the subject of phlebotomy into manageable areas.
  • Multiple-choice questions with answers and rationales in each chapter test your comprehension of the material.
  • NEW! 1,500 questions provide you with even more opportunities for testing yourself and reinforcing the content.
  • NEW! 100-question pretest at the beginning of the book lets you assess where you stand from the start so you can target your study accordingly.
  • NEW! Photos and line drawings throughout the book illustrate what is being discussed and help you learn more about the equipment you will encounter on the job.



Published by
Published 25 February 2015
Reads 0
EAN13 9780323239134
Language English
Document size 8 MB

Legal information: rental price per page 0.0200€. This information is given for information only in accordance with current legislation.

Report a problem

Complete Phlebotomy
Exam Review
Pamela B. Primrose, PhD, MLS(ASCP)
Program Chair of Medical Laboratory Technology, Professor of Medical Laboratory
Technology/Life Sciences, Ivy Tech Community College, South Bend, IndianaTable of Contents
Cover image
Title page
Navigating the Certification/Licensure Process
Chapter 1. Introduction to Phlebotomy
Content Overview
Professional Organizations and Standards
Legal Issues in Phlebotomy
Certification Preparation Questions
Answers and Rationales
Chapter 2. Health Care Structure
Content Overview
Introduction to the Clinical Laboratory
Departments and Functions of the Clinical Pathology Laboratory
Standards and Accreditation for the Clinical Laboratory
Other Health Care SettingsCertification Preparation Questions
Answers and Rationales
Chapter 3. Safety
Content Overview
Types of Safety Hazards
Emergency First Aid
Certification Preparation Questions
Answers and Rationales
Chapter 4. Infection Control
Contact Overview
Bloodborne Pathogens
Chain of Infection
Means of Transmission
Breaking the Chain of Infection
Occupational Safety and Health Administration (OSHA)
OSHA Bloodborne Pathogens Standard
Isolation Control Measures
Certification Preparation Questions
Answers and Rationales
Chapter 5. Medical Terminology
Content Overview
Certification Preparation Questions
Answers and Rationales
Chapter 6. Human Anatomy and Physiology
IntroductionContent Overview
Anatomic Terminology
Skeletal System
Muscular System
Integumentary System
Nervous System
Digestive System
Urinary System
Respiratory System
Endocrine System
Reproductive Systems
Certification Preparation Questions
Answers and Rationales
Chapter 7. Circulatory, Lymphatic, and Immune Systems
Content Overview
Veins for Phlebotomy Procedures
Blood Facts
Lymphatic System Facts
Immune System Facts
Certification Preparation Questions
Answers and Rationales
Chapter 8. Venipuncture Equipment
Content Overview
Organizing and Transporting Equipment
Locating Veins
Cleaning the Puncture Site
Protecting the Puncture Site
NeedlesNeedle Safety
Needle Adapters
Evacuated Collection Tubes
Types of Blood Specimens
Tube Additives
Order of Draw Standards: CLSI
Needle Disposal and Containers
Certification Preparation Questions
Answers and Rationales
Chapter 9. Routine Venipuncture
Content Overview
Routine Venipuncture Procedure
Routine Venipuncture with a Syringe
Certification Preparation Questions
Answers and Rationales
Chapter 10. Capillary Collection
Content Overview
Reasons for Performing Dermal Puncture
Procedure of Choice for Some Situations and Patients
Tests Exempt from Dermal Puncture
Differences between Venous and Capillary Blood
Equipment for Dermal Puncture
Site Selection
Dermal Puncture Procedure
Other Dermal Puncture Procedures
Bleeding Time Procedure
Ancillary Blood Glucose TestCertification Preparation Questions
Answers and Rationales
Chapter 11. Venipuncture Complications
Content Overview
Barriers to Communicating with Patients
Problems in Site Selection—Avoid the Following Sites
Problems Associated with Cleaning the Site
Problems with Tourniquet Application
Complications during Collection
Problems in Completing the Procedure
Factors Affecting Sample Integrity
Long-Term Complications Associated with Venipuncture
Specimen Rejection
Specimen Recollection
Certification Preparation Questions
Answers and Rationales
Chapter 12. Blood Collection in Special Populations
Content Overview
Geriatric Patients
Patients Requiring Blood Draws for Extended Periods of Time
Special Equipment Used in the Intensive Care Unit and Emergency Room
Certification Preparation Questions
Answers and Rationales
Chapter 13. Arterial Blood Collection
Content Overview
Purpose of ABG TestingArterial Blood Gas Testing
Arterial Puncture Complications
Capillary Blood Gas Testing
Certification Preparation Questions
Answers and Rationales
Chapter 14. Special Collections and Procedures
Content Overview
Fasting Specimens and the Basal State
Blood Cultures
Blood Donor Collection
Special Specimen Handling
Blood Smears
Certification Preparation Questions
Answers and Rationales
Chapter 15. Special Nonblood Collection Procedures
Content Overview
Fecal Specimens
Semen Specimens
Throat Specimens
Nasopharyngeal Specimens
Nasal Washing
Culture and Sensitivity Testing
Sweat Electrolyte Specimens—Sweat Chloride Test
Cerebrospinal Fluid Specimens—STAT Collection
Body Fluid Specimens
Amniotic Fluid Specimens
Certification Preparation Questions
Answers and RationalesChapter 16. Specimen Handling, Transport, and Processing
Content Overview
Transporting Samples to the Lab
Certification Preparation Questions
Answers and Rationales
Chapter 17. Point-of-Care Testing
Content Overview
Important Points to Remember
Common Tests Performed at the Point-of-Care
Other CLIA-Waived Tests
Certification Preparation Questions
Answers and Rationales
Chapter 18. Quality Phlebotomy
Content Overview
Preanalytical Variables
Analytical Variables
Postanalytical Variables
Certification Preparation Questions
Answers and Rationales
Chapter 19. Legal Issues in Phlebotomy
Content Overview
The Legal System
Professional LiabilityConfidentiality
Certification Preparation Questions
Answers and Rationales
Appendix A. Mock Exam
Appendix B. Mock Exam Answers
3251 Riverport Lane
St. Louis, Missouri 63043
Copyright © 2016 by Elsevier, Inc.
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in
any form or by any means, electronic or mechanical, including photocopying,
recording, or any information storage and retrieval system, without permission in
writing from the publisher. Details on how to seek permission, further information
about the Publisher’s permissions policies and our arrangements with organizations
such as the Copyright Clearance Center and the Copyright Licensing Agency, can be
found at our website:
This book and the individual contributions contained in it are protected under
copyright by the Publisher (other than as may be noted herein).
Knowledge and best practice in this field are constantly changing. As new research
and experience broaden our understanding, changes in research methods,
professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and
knowledge in evaluating and using any information, methods, compounds, or
experiments described herein. In using such information or methods they should
be mindful of their own safety and the safety of others, including parties for whom
they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised
to check the most current information provided (i) on procedures featured or (ii) by
the manufacturer of each product to be administered, to verify the recommended
dose or formula, the method and duration of administration, and contraindications.
It is the responsibility of practitioners, relying on their own experience and
knowledge of their patients, to make diagnoses, to determine dosages and the best
treatment for each individual patient, and to take all appropriate safety
precautions.To the fullest extent of the law, neither the Publisher nor the authors, contributors,
or editors, assume any liability for any injury and/or damage to persons or property
as a matter of products liability, negligence or otherwise, or from any use or
operation of any methods, products, instructions, or ideas contained in the material
Library of Congress Cataloging-in-Publication Data
Primrose, Pamela B., author.
Complete phlebotomy exam review / Pamela B. Primrose. -- Second edition.
p. ; cm.
Includes index.
ISBN 978-0-323-23911-0 (alk. paper)
I. Title.
[DNLM: 1. Phlebotomy--Examination Questions. 2. Phlebotomy--Outlines. QY 18.2]
Content Strategist: Kristin Wilhelm
Content Development Manager: Ellen Wurm-Cutter
Publishing Services Manager: Hemamalini Rajendrababu
Project Manager: Umarani Natarajan
Design Direction: Margaret Reid
Printed in the United States
Last digit is the print number: 9 8 7 6 5 4 3 2 1D e d i c a t i o n
This book is dedicated to all the students I have had the privilege of advising and
teaching over the past 26 years. It has been my pleasure and joy to see you begin your
journey into health care with a career in phlebotomy and/or as an MLT. Whether you
choose to stay there, serving the community, or to carry your phlebotomy or MLT
skills forward into other health care careers, I wish you all the best that life has to
I give my heartfelt thanks to my husband Robert for his patience, sense of humor,
support, and love during the many hours I was sequestered at the computer each day.
A huge thank you to all!
Pamela PrimroseReviewers
Belinda Beeman, MEd, CMA(AAMA), PBT(ASCP), Medical Assisting and
Phlebotomy Instructor, Eastern New Mexico University, Roswell, New Mexico
Pamela Christianson, CMA(AAMA), CPhT(PTCB), BS, Medical Assistant and
Pharmacy Technician, Program Director, Great Falls College, Montana State
University, Great Falls, Montana
CMMary L. Doshi, MA, MLS(ASCP) , Medical Technical Program Director,
Associate Professor, San Juan College, Farmington, New Mexico(
P r e f a c e
The health care industry is growing, government oversight and regulatory policies are
becoming more common, and accreditation agencies are requiring hospitals and
laboratories to provide patient care that focuses on a higher level of quality and safety
—making qualified, competent health care workers more important than ever before.
Many hospitals and laboratories require formal training or certification, registration,
or licensure as minimum qualifications for entry-level phlebotomist positions.
Certification or licensure indicates to employers that a phlebotomist has met the
educational or experiential requirements as set forth by accreditation agencies in the
Complete Phlebotomy Exam Review was conceived and developed to go beyond
traditional examination review books by offering more than just a series of review
questions. This book provides a concise yet detailed review outline for each
phlebotomy content area, in addition to 1,300 review questions, answers, and
referenced rationales to aid students in their study, allowing them to assess their
knowledge level and application and evaluation skills.
Who Will Benefit from this Book?
Whether students are just beginning the study of phlebotomy through a formal
program or self-directed study, preparing to take a certification or licensure exam, or
refreshing their knowledge, Complete Phlebotomy Exam Review addresses each stage of
student learning. The outline at the beginning of each chapter is perfect for use in a
formal program se ing. I t allows students to follow along during lectures without
having to take copious notes, instead making small notations as necessary. Use of the
Certification Preparation Questions and A nswers and Rationales sections after each
outline allows students to test their understanding, reinforce the correctness of each
answer, and learn why other choices are incorrect. For those seeking self-directed
study or preparing for certification or licensure exams, Complete Phlebotomy Exam
Review can be used as a companion to a phlebotomy textbook, or it can be used as a
single resource that provides a quick, concise review of the content before testing
students’ knowledge in the Certification Preparation Questions section.
I n essence, Complete Phlebotomy Exam Review is an easy-to-use tool that will enable
students to put knowledge and practice together in a way that supersedes all other
review books by providing understanding and reinforcement of phlebotomy concepts
immediately followed by the opportunity for practical application of those concepts in
the assessment section of each chapter.
Organization of the Book
Complete Phlebotomy Exam Review provides a thorough review of each phlebotomy
content area in the same progression as most phlebotomy textbooks, beginning with(
an introduction to phlebotomy, the health care se ing, safety, and infection control;
phlebotomy basics that include medical terminology and anatomy and physiology;
routine, special, and nonblood specimen collection; special populations; specimen
handling, transport, and processing; and professional issues, such as quality
assurance/control, legal issues, and point-of-care testing. I t addresses each of the
content areas delineated in the various certification and licensure content outlines.
Each chapter begins with a detailed outline for review of the content area followed by
questions, answers, and rationales. A lthough rationales are referenced by page
number to Phlebotomy: Worktext and Procedures Manua,l fourth edition, by Warekois
and Robinson, they can also be easily matched to any textbook by referring to the
chapters covering similar content.
Distinctive Features and Learning Aids
The distinctive features of Complete Phlebotomy Exam Review differentiate it from
other phlebotomy review books:
• Progression of study from basic to more complex topics
• Companion book for phlebotomy textbooks
• Suitable for all levels of student: beginning students in formal programs,
selfstudy students, and those preparing for certification or licensure
• Detailed content outlines for each chapter precede assessment questions, answers,
and rationales
• Pretest of 100 questions to help students evaluate their current knowledge and
application phlebotomy principles and practice.
• Review questions offering a variety of styles ranging from simple knowledge to
more complex comprehension, application, analysis, synthesis, and evaluation
• Scenario questions that cover important situations that phlebotomists may
encounter in practice, allowing students to integrate and apply all the knowledge
they have acquired
• 1,300 different questions—no repeat questions as in other review books
• Two mock certification exams and an additional 200+ practice questions
• Online repository of questions on Evolve that can be used to create practice exams
based on content areas in which students need more practice
• Up-to-date information on phlebotomy certification and licensure requirements
and contact information for eight agencies
• Chart for anticoagulants and mode of action
• Chart for tube top color, additive, test, department
• Chart for clot activators and other additives
• Chart for CLSI order of draw standards
• Photos to enhance review
• Strategies for developing a plan of study, progression of study, retention of
information, and having efficient and effective study sessions
• Test-taking strategies for multiple-choice question exams.
• Tips on overcoming test anxiety
• Tips for certification day!
For additional practice, visit the Evolve website at to create practice exams based on(
areas of weakness and take mock exams using all the questions in the book, as well as
more than 200 additional questions.
Many people were involved in the conceptualization of this book and determining
what would make it stand above all the other review books in the marketplace. The
converging of all of these ideas has culminated in the production of Complete
Phlebotomy Exam Review . Many thanks to my editor, Ellen Wurm-Cu er, for all her
direction and support as we continue to update and enhance this book so that
students and phlebotomists who are seeking certification have a complete resource to
help them achieve success on any national certification exam that they choose. My
deepest gratitude and thanks to all. Please note that using this book does not
guarantee success on any national certification exam; rather, it is a tool that can aid
students who have prior successful learning and training, dedicated study,
commitment to preparing for a certification exam, and so forth in their preparation
for the exam of their choice.
I would also like to acknowledge Robin Warekois and Richard Robinson for the use
of the introductory paragraphs of their text, Phlebotomy: Worktext and Procedures
Manual, fourth edition.
Pamela PrimroseNavigating the
Certification/Licensure Process
Certification of a phlebotomist is evidence to health care employers that a person has
met the educational and training requirements set forth by the certifying agency.
Furthermore, successfully passing a certification exam is testament that a person has
demonstrated competency of the established standards for knowledge and skills in
S ome confusion exists regarding the completion of an accredited, approved, or
structured phlebotomy program that culminates in a certificate. This certificate
documents completion of a training program by the institution that provided the
education or training. I t does not confer certification to the individual. Certification is
a credential that is awarded by certifying agencies through successful completion of a
certification exam that demonstrates proficiency in a particular area of practice—in
this case, phlebotomy.
Phlebotomists who have successfully completed an accredited or approved training
program or who have documented work experience as a phlebotomist are eligible to
take a certification exam. S pecific requirements for eligibility are set forth by each
4,7,9,25,29certifying agency and are delineated on each agency’s website. Required
standards in skills and knowledge may include knowledge of the following: health
care providers in the medical field, interaction as a team, and the role of the
phlebotomist; organizational structure of the hospital and laboratory; anatomy and
physiology, medical terminology, and pathology as related to phlebotomy;
phlebotomy equipment and techniques for blood and nonblood collections; specimen
processing and handling; point-of-care testing; quality assurance, quality control, and
quality improvement; regulatory agencies; safety and infection control; interpersonal
3,7relations; and legal and ethical issues pertaining to phlebotomy.
Regulations governing health care workers within each state change over time,
making it important to know the laws that govern phlebotomists in the state where
you are seeking employment. I n N evada, for example, phlebotomists are classified as
laboratory assistants (employed in a licensed clinical lab) or office assistants
(employed in a physician’s office). Both are required to be licensed by the state of
Nevada. Licensure for laboratory assistants requires a high school diploma or GED, as
well as 6 months of training in a licensed clinical laboratory OR successful completion
of a certification exam. Licensure of office assistants simply requires the signature of
the office physician in addition to a high school diploma or GED . This process differsfrom licensure requirements of phlebotomists in other states: For example, California
and Louisiana are currently the only states that require licensure of phlebotomists
who are working in health care facilities. Each of these states has specific
requirements and regulations governing the education, training, and certification of
phlebotomists. Certification for licensure approval also requires successful
completion of either a state examination or an approved certifying agency exam. I f
you are planning on working as a phlebotomist in either of these states, you will need
6,11,22to meet eligibility requirements for licensure.
• California licensure information:
Contact Laboratory Field S ervices for eligibility or board approval questions:
Online application questions: email CPS at
• Louisiana State Board of Medical Examiners
Physical Address: 630 Camp Street, New Orleans LA 70130
Mailing Address: PO Box 54383, New Orleans LA 70154-4383
504-568-6823 (fax)
Clinical Laboratory Personnel:
• Nevada Department of Health and Human Services
Health Care Quality and Compliance
Bureau of Licensure and Certification Medical Laboratories
Certification Agencies
Many organizations offer examinations for phlebotomy certification. Reputability and
national recognition levels vary among agencies. When choosing a certifying agency,
research which agencies are recognized by the health care institutions with which you
are seeking employment in your particular geographical region. A lso compare the
13requirements and benefits of each agency to select the one that best fits your needs.
The Center for Phlebotomy Education w( identifies several
12key factors you should keep in mind when choosing a certifying agency. D oes the
• Have national recognition?
• Have good standing with the Better Business Bureau?
• Engage in ethical business practices?
• Base its instruction materials and examinations on current CLSI practices?
• Require examination of all applicants certified?
• Require continuing education to maintain certification status?
S everal certifying agencies (in alphabetical order) meet these criteria and also meet11,22state approval for California and Louisiana licensure:
American Certification Agency
PO Box 58
Osceola IN 46561
American Medical Technologist
710 Higgins Road
Park Ridge IL 60068
American Society for Clinical Pathology
33 W Monroe, #1600
Chicago IL 60603
312-541-4999 or 800-267-2727
National Center for Competency Testing
7007 College Boulevard, Suite 705
Overland Park KS 66211
National Healthcareer Association
11161 Overbrook Road
Leawood KS 66211
913-661-5592 or 800-499-9092
I n addition to the aforementioned certifying agencies, Louisiana has also approved
22the following certifying agencies for Louisiana licensure:
American Society of Phlebotomy Technicians
PO Box 1831
Hickory NC 28603
International Academy of Phlebotomy Sciences
629 D’Lyn Street
Columbus, OH 43228614-878-7751
National Phlebotomy Association
1901 Brightseat Rd.
Landover, MD 20785
The following certifying agencies (in alphabetical order) meet the state approval
criteria for Nevada:
American Medical Technologist
710 Higgins Road
Park Ridge IL 60068
American Society for Clinical Pathology
33 W Monroe, #1600
Chicago IL 60603
312-541-4999 or 800-267-2727
On successful completion of a certification or licensure examination, you will be
awarded a certificate that documents your achievement as proof to employers that
you have met the requirements set forth by the certifying agency or licensing agency.
Most certifying and licensing agencies require completion of a specified number of
continuing education credits or units per year, or within a specified time period, to
maintain certification or licensure. S ome certifying agencies also offer continuing
education programs and award CEUs upon completion of each competency activity or
unit of study. These requirements are explained on each agency’s website, and
information for CEUs is usually disseminated along with the credentialing
I f you have been out of the field for some time and are contemplating reentry, it is
always wise to update your skills by retaking a phlebotomy course or geKing
recertified if your certification credentials have lapsed. This documents your currency
in the field and makes you more marketable to employers, whose applicant pool will
also include recent completers of phlebotomy programs.
Getting Certification or Recertification
Recertification requires you to research the certifying agencies to see what each
agency’s specific requirements are for eligibility and to find one that matches your
training program or work experience and your needs. You should be aware of
certifying agency deadlines for application. A fter you have selected your certifying
1,4,7,9,26,27agency, complete the application process by doing the following:• Verify your academic education: high school graduation diploma; official college
• Verify your work experience, if required.
• Verify the training program completed.
• Get required signatures and/or other required documentation.
• Complete the online application or mail in a downloaded application.
• Pay the assessment fee.
• Schedule the examination date and select the examination site.
The Exam
J ust as there are a number of certifying agencies, so there are also a number of
different types of exam offered. The traditional paper-and-pencil exam is still
available as an examination option at several certifying agencies. A few agencies also
require a practical component as a part of their certification process, as part of which
the individual must physically demonstrate venipuncture procedures. Many certifying
agencies offer computer-based knowledge examinations that offer the convenience of
multiple examination sites, faster exam scoring, and immediate pass/fail notification
1,4,7,9,25,27,29at the conclusion of the exam or within a few days; time.
Most certifying agencies have exam content outlines posted on their websites or
available for purchase. These outlines reflect various phlebotomy categories,
including routine venipuncture, dermal punctures, special procedures, equipment,
nonblood specimens, complications, safety, and legal issues. Procedures are based on
the Clinical and Laboratory S tandards I nstitute (CLS I ) standard procedures and
Exam questions are based on levels of difficulty and taxonomy categories of
knowledge, comprehension, application, analysis, synthesis, and evaluation of
required standards in skill and knowledge of phlebotomy, as previously discussed.
Being able to answer questions at a higher taxonomy level allows for recognition of
those who have grasped the depth of knowledge to ensure competency and safety in
the practice of phlebotomy.
• Knowledge (recall) questions assess the ability to recall or remember facts.
• Comprehension questions assess the ability not only to recall facts, but also to
explain, classify, or identify facts, ideas, or concepts.
• Application questions determine the ability to use information. Facts are recalled
and understood but now must also be applied to a real situation to interpret,
solve, or identify the effects of those facts on a situation.
• Analysis questions require the ability to interpret, compare, and contrast the
information presented to determine the correct answer.
• Evaluation requires the ability to appraise, judge, evaluate, and support the
information as it relates to a situation.
I s it important for you to know which questions fall into these taxonomy levels? N o,
but what is important is that you be prepared beyond the basic recall or knowledge
level so that you can correctly answer questions that require higher levels of thought
processes. You can achieve higher levels of critical thinking by practicing the review
15questions as presented in this book.
Computer adaptive testing (CAT) is the format of computer-based knowledge
testing offered by the A S CP. A ll questions are criterion-referenced to the contentoutline for the phlebotomy exam. This type of testing format is driven by the ability
level of the student answering the questions. When the question is answered
correctly, the next question presented has a slightly higher degree of difficulty. The
degree of difficulty increases as each question is answered correctly and then drops to
an easier level when a question is incorrectly answered. Questions in the test bank are
calibrated or given a weighted value based on the level of difficulty. The resulting
score is calculated according to the number of questions answered correctly and their
weighted values. The more difficult the questions answered correctly, the higher the
score. Passing the exam requires that a person demonstrate competency at higher
cognitive levels than merely straight recall, thereby ensuring an appropriate level of
8knowledge in the examinee for competent and safe practice.
Strategies for Developing A Plan of Study
Determine Your Style of Study
Engaging in productive study for your selected certification exam requires that you
determine what works best for you in terms of when, where, and how to study. N o
two people are the same when it comes to studying, and what works for one person
16may not work for you. S ome people, being auditory learners, learn much faster by
hearing the information. Others are visual learners, who need to see information in
wriKen or illustrated format. S ome are kinesthetic learners, who like to perform a
physical activity such as tapping fingers or a foot, writing things out, or moving
around as they learn. A nd other people prefer study groups and learn much more
quickly through discussion. A fter you identify which method is most effective for
your own learning and retention of information, focus on that particular preference
24and complement it with other techniques.
Positive Attitude
I t is said that the biggest difference between people is their aKitudes. S ome people
love to learn, and for others learning is complete drudgery. Those in between the two
extremes view learning as a requirement for success. Keeping a positive mindset
requires a mental aKitude that expects success. D o not let negative thoughts and
actions dissuade you from your goal of certification. A positive aKitude toward your
review session changes the chemistry of your brain by producing more dopamine, the
neurotransmiKer that makes you feel good. A positive mindset will keep you
motivated in your study and will improve your performance on your certification
exam. Expect success in your study and preparation for the exam. Expect success
24,31when you take the exam. Visualize success. Success is within your reach!
Three Cs
Martin’s study skills booklet presents numerous tips on being a successful student
that have stood the test of time. He states that proactiveness in your study
preparation not only requires knowing your style of study and having a positive
mindset, but also requires three Cs—the commitment, control, and challenge to put
24your style of study into action and to promote positive thinking.
Make a positive commitment to yourself to prepare for the exam, to be enthusiastic inyour study, to praise yourself for your successes along the way, and to dream of
24success on your certification exam.
Control your mind, keeping it focused as you study. S et goals and priorities for your
study plan. D evelop a strategy for dealing with distractions and problems that might
impede your study time and progress. How will you handle interruptions by phone
calls, children, and non-essential demands on your time? Be honest with yourself
24about what plan is realistic for you, and don’t be afraid to tweak it as you go.
Be optimistic as you approach each study session. D o your very best, and you will see
improvement and success as you progress through your course of study. D on’t be
discouraged when it seems as if you are not progressing as well as you had
anticipated. View this as a challenge—an opportunity to learn and to add to your
knowledge base. Each review session will improve your ability to retain, comprehend,
24apply, and analyze your phlebotomy study materials.
Plan Your Study
Before you think about the process of studying for the certification exam, you must
develop a study schedule. A schedule allows you to manage your time effectively so
that you can meet the needs of your lifestyle and commitments. Your schedule should
include work hours, doctor’s appointments, grocery store and errand runs, children’s
schedules, and time for you so that you can see where you have time to incorporate
your study hours. Your study time should not be at the end of the day, when you are
exhausted and your mind is weary. S et times of 1–3 hours, at the most, when you are
most energetic and alert so that you can efficiently and effectively review the material.
I t may be necessary to temporarily delete some activities from your schedule and
delegate them to someone in your support system to make time for your own study.
A fter your schedule has been set, follow it. I f you find that it is not meeting your
needs, you can always revise it accordingly. But the important thing is to have
achievable blocks of time scheduled for uninterrupted study. Equally important is
that you plan and implement your study schedule well in advance of the date of your
certification exam so that you have plenty of time to cover all of the review material
16and practice exams.
The Process of Study
A n effective study process must include where to study, when to study, what to study,
16and how to study to have a productive study session.
Where to Study
You can study anywhere, but some places are more conducive to study than others.
The place you choose should be free of distractions, including those posed by
television, telephones, and children. It may be at home, in a secluded room away from
the family, or perhaps at the library or in some other seKing. Wherever you choose to
16study should be offer comfortable seating, lighting, temperature, and noise level.
When to StudyThe issue of when to study has been set by your study schedule. However, it is
important to keep in mind that you should schedule your study for times when you
are rested and alert. D o not wait until the day’s and night’s activities are over to begin
your study. S ome people are morning people, and some are night people. At what
time of the day do you feel your energy and performance are highest? D o not
schedule your study at times when you find yourself too tired to retain any
information; try to schedule them at your peak performance times. Physical and
emotional exhaustion will derail your study. D o not let unimportant things push your
16,20study time off schedule.
What to Study
This review book is an excellent means of reviewing all the content that is included in
the certifying agencies’ exam content outlines. The chapter outlines provide a quick
review of phlebotomy topics to assess your strengths and weaknesses. I f you need
further clarification or more in-depth review of particular topics, you can use your
textbook and notes to supplement your review as well. The review questions for each
chapter in this review book provide various taxonomic levels of questions to test your
level of retention of knowledge (recall), comprehension, application, analysis,
synthesis, and evaluation of phlebotomy practice. Each question has an explanation
for the correct answer, as well as insight into the other choices and why they are
incorrect. A s you go through the review questions, mark your selected answer and
check to see whether you were correct; you can then circle the incorrect questions and
go back to the outline to review the areas in which you had difficulty. The pretest,
mock exams, and the Evolve website provide further practice for various types of
questions that may be encountered on a certification exam.
I n addition to this review book, some of the certifying agencies offer practice exams
for purchase to provide further study, review, and practice.
Strategies for Retention of Information
Retaining information after you have studied it requires effort on your part. The
following brain-compatible learning principles will help to refine your study habits
and retention. Carolyn H. Hopper’sP ractice College Learning Strategies (2007) presents
the following tips for study.
Intent to Remember
A s you study and review you may find your mind wandering. Learning is different
from aKention. But if you do not pay aKention, you will not learn. Your intent to
remember requires using concentration techniques, such as a concentration
checksheet, to help you stay focused. When your mind starts to wander, simply put a
check mark on the sheet. By doing this each time you lose concentration, you will
program your mind to pay aKention to what you are studying. You can also put a
rubber band on your wrist, snapping it each time you lose focus. Another technique is
to talk out loud as you read and answer the questions or recite information from the
14outlines included in the review book.
Meaningful Organization
Remembering a large block of information is difficult, but if you break it down into
smaller, more manageable blocks the information is easier to remember. Use thesubheadings in the outlines or in your textbook to categorize information as you
review. S ome people alphabetize items and make up groupings of leKers to organize
and retain information. A nother method of organizing information for memory is the
use of first-leKer mnemonic devices whereby the first leKers of items to be
remembered correspond with a word, phrase, or sentence. Two types of mnemonics
that are typically used are acronyms and acrostics. S ome mnemonics are well-known,
but you can make up your own to help you remember as you study.
• Acronyms are formed from the first initials of words contained in a phrase to form
a pronounceable word. Examples include NICU for neonatal intensive care unit
and PASS for fire extinguisher use, where P = Pull, A = Aim, S = Squeeze, and S =
• Acrostics are usually in the form of a saying whose words begin with the first
letters of the item to be remembered. They can also be a phrase in which the first
letter of each word is a cue for remembering it. The most commonly remembered
acrostic is Roy G. Biv, used to remember the colors of the rainbow: R = red, O =
orange, Y = Yellow, G = Green, B = Blue, I = indigo, and V = violet.
There is no right or wrong way to use these memory techniques or mnemonics. Use
your creativity to come up with something that works for you. I f a device is not useful
to you, then do not use it as a study technique. Use only those memory devices that
will help you remember the information in a meaningful way. To form a sharp
memory, encode the information accurately into your memory however works for
your style of learning, strengthening and maintaining the information over time, then
14triggering it using an association or cue.
Strengthening Neural Connections
I f you read and then recite in your own words what you have learned when reviewing
the chapter outlines, you are using your intent to remember, you get immediate
feedback, you demonstrate understanding, and you are using a different part of your
brain in the process. The more senses you engage in the learning process, the
stronger your neural trace. S aying the information out loud and in your own words
strengthens the synaptic connections to the information in your brain. You may find
14flashcards or a study partner useful in this process.
Mental Visualization
A pproximately 90% of sensory input into the brain is visual, so it stands to reason
that the majority of people remember what they see much beKer than what they hear
or read. Visualizing mnemonics, writing what you recite and making charts,
14diagrams, or image associations as you study improves retention of material.
A ssociation is the process of encoding and retrieving information. N ew information
must be consciously encoded, because optimal learning occurs when the neural
networks of the brain work in synchrony. A ssociating your review of phlebotomy
content areas with information you already know about phlebotomy will help you
beKer comprehend, apply, synthesize, and evaluate the information. For example,
knowledge about the tourniquet can be associated with routine venipuncture, site
14selection, preanalytical sampling errors, complications, and so forth.Solidifying Neural Pathways
The brain requires time for new information to become solidified in memory.
Consolidation of information into long-term memory takes time to develop pathways
of connectivity and recall. Reinforce the acquisition of knowledge through your
preferred learning style (e.g., auditory, visual, kinesthetic). Reinforce learning as
many times as it takes for you to be able to recall it without fail. The number of times
to study a piece of material varies by individual. The length of study time for
reinforcing learning may take seconds to hours, depending on the individual and the
information. A s you study, you will find content that you know very well that has
already been solidified in your memory, but there will be other areas of content that
you cannot recall as quickly or as completely: Those are the areas that need further
14reinforcement and consolidation into your long-term memory.
Distributed Practice
Learning is optimized when distributed practice is put into play. Taking a 10-minute
break after each hour of study to go back and review what you have just learned
allows time for the brain to consolidate information. Hopper (2007) reports that short
sessions of review and study promote the growth of dendrites and neural connections
exponentially. That means when you divide the information into smaller sections and
take breaks from continuous learning by stopping every hour to review, you will
14dramatically improve your retention and recall.
Strategies for Efficient and Effective Study Sessions
There are several strategies that you can use to provide efficient and effective study.
Divide the Content
A ssess the amount of time (e.g., days, weeks, months) that you have between now
and your exam date. D ivide the chapters by days or weeks into manageable sections
of material to be covered for each study session, and indicate the topics or chapters
on each day of your schedule. This will serve as a guide and keep you focused during
your study sessions. Your goal is to complete the assigned content area by reviewing
the outline, notes, book, and review questions as necessary. You may know some
topics beKer than others, requiring less study time for these. A s you divide the
content, assign the easier topics to the shorter blocks of study time and those that
require more study to the longer blocks of time.
Practice Review Questions
Certifying agencies presume that you are already well versed in phlebotomy, because
you have completed a training program or have worked in the field as a phlebotomist.
A quick review of the outline at the beginning of each chapter in this review book
should suffice to refresh your memory on the content contained in each section. At
this point, it is important that you learn how to successfully answer various types of
multiple-choice questions that may be asked on the certification exam. S imply
memorizing factual knowledge and answering simple recall questions will most likely
not be enough to deliver a passing score. Certification exams are designed to probe
beyond the mastery level of simple recall. You must be able to actively apply, analyze,
synthesize, and evaluate the information in the questions in the exam. By practicingthe multiple-choice questions in the review book, you will get experience answering
these types of questions, so be sure to complete the review questions for the chapter
you are reviewing during each session. Go back and check your answers, reading the
rationales for each answer and marking the questions that you answered incorrectly.
Examine the questions and the correct answers, looking for the connections that make
them correct. Review the outline material pertaining to that question, or refer to your
textbook or class notes. A s you progress through the book, note which areas or topics
you are weak in, and then revisit those areas for further study and review.
Review, Re-Review, and Review Again
A s previously discussed in the distributed practice section, repetition embeds
information into long-term memory. A ccordingly, as you study each section and
progress, go back and review previously studied material. I f you have learned the
content well, the review will go much more quickly than the first time. To quote Vince
10Lombardi: “Practice doesn’t make perfect; perfect practice makes perfect.” Perfect
practice entails keeping to your schedule, reviewing the outlines, practicing review
questions, reviewing content areas in which you are weak, and practicing review
questions again. By practicing review questions, you will become more adept at
analyzing what a question is asking, which choice best answers the question, and why
the other choices are incorrect.
The Importance of Breaks
D uring longer periods of study, take breaks and get up and move around so that you
can refresh your mind and be more productive in your study. S hort breaks away from
your study room for refreshment or even just to stretch help you relieve the stress
and fatigue of study. But do not forget to go back to resume your study! I f you cannot
wander out of your study space to take a break for fear of becoming captive to family
or friends’ activities, then make sure ahead of time that you have refreshments
21,34available in your study area.
Ready for the Practice Exam and Evolve
A fter you have completed your review of the chapter outlines and review questions
and are confident in your grasp and understanding of the material, then take the
mock exam at the end of the book. Furthermore, an additional 150+ questions on the
Evolve website can will also further test your knowledge and understanding. A gain, it
is important to note the questions you answer incorrectly so that you can go back and
review specific areas of weakness.
Study on the Go
Carry your review book with you in the car wherever you go, including to your
appointments and your workplace. You never know when you might be able to
squeeze in some time for review.
Test-Taking Strategies
Knowing strategies for approaching a test and the questions contained therein will
help you remain relaxed and in control as you take your certification exam. The
following tips are worth learning and applying as you review for the exam and will be
second nature when you are ready to take the certification exam. A gain, perfectpractice builds confidence and aids in attaining a successful score on the exam.
• Read all instructions carefully. If you do not understand an instruction, ask the
proctor for clarification.
• Most exams are timed, so pace yourself so that you will have time at the end of the
exam to go back and review. Monitor the time periodically throughout the exam.
Do not panic as time ticks down: Remain in control. If you find you are moving too
slowly, make the necessary adjustments to increase your pace. The more questions
you answer, the better your score will be, and the better your odds of achieving a
passing score.
• Answer each question even if you are unsure. Guessing gives you a 20–25% chance
of getting the question correct versus a 0% chance if you do not answer it. You can
temporarily skip a question and come back to it later, but answer to the best of
your ability first. Do NOT, however, spend too much time on questions whose
answer you do not: That wastes precious time. As you progress through the rest of
exam questions, your memory may be triggered, allowing you to go back and
correctly answer questions you may have temporarily skipped.
Tips for Taking Multiple-Choice Exams
The best way to ensure that you select the correct answer in a multiple-choice exam is
t o know the right answer, so pre-exam preparation is your key to success. The
following tips will help you read, interpret, and answer the questions on your
certification exam, but nothing is beKer than knowing the information and being able
to comprehend, apply, synthesize, and analyze that information.
• Multiple-choice questions are made up of two parts: the stem and the
• Stem: statement or question
- Read the stem as if it were a standalone statement.
- Anticipate the word or phrase that would correctly complete the
statement, and compare the choices to the one you anticipated.
- Read EACH choice before selecting your answer, even if one matches
19,30,32your answer; there may be a choice that is better.
19,30,32• Choices: known as distracters or foils
- Four or five options are usually presented to complete the stem
statement or question.
- The correct choice will be the option that completely satisfies the
thought expressed in the statement or question.
- Choosing the correct option requires reasoning ability on the part of
the test taker. Relate each option to the statement or question to see
which one logically completes the expressed statement or question.
- Use information in previous questions to answer questions whose
19,30,32answer you do not know.
• Strategies for selecting the correct answer
- Choose the BEST answer available. There may not be a perfect answer,
but there will be one that satisfies the question more accurately than
the other choices.
- Eliminate answers that are obviously incorrect. You can then focus on
those answers that appear to be more reasonable before selecting the19,32,33one that is most correct.
- Mark key terms in the question either mentally or, if possible, on paper.
• Identify and focus on the important information in the question, discarding
the rest.
• Look for the terms not, except, and but: They change the meaning of the
statement or question.
• Examine options that appear similar, comparing them to each other and to
the question to see which one is more correct.
• Look for grammatical construction between the question and the answers. If
the statement ends in “an,” then the answer begins with a vowel—and not
every choice may not begin with a vowel. Also watch for agreement
19,32,33between the subject and the verb or predicate.
- Avoid choosing answers that contain words that are unfamiliar or that
seem odd to you. If you studied thoroughly, you should recognize the
terminology presented in the questions.
- Do not panic if you are presented with a question that you did not
expect to see. Use all your knowledge about phlebotomy and the
terminology to decide on a reasonable answer.
- If you draw a blank, you have options before moving on to the next
question. Try slowly rereading the question using each distracter, to
see which one fits best. If you are still unsure, then temporarily skip
the question and go back later. Succeeding questions may trigger your
- If more than ONE answer seems correct, some strategies can help you
19,32,33eliminate incorrect answers:
• Ask whether the answer completely addresses the question. If it is only
partially true or is only true under specific conditions, it is probably not the
correct answer.
• Do you have to make an assumption for the answer to be true? Is that
assumption obvious to everyone who would take the exam? If not, then the
answer is probably incorrect.
• Is it a trick question? No. Certification exams will not ask trick questions. Be
sure to read and interpret the question at face value. Do NOT read anything
into the question. Only your knowledge and the skills you have acquired are
needed to answer the questions. You may need to do an analysis or
synthesis of the scenario within the question to arrive with the correct
answer, but it will not be a trick.
• As a last resort, if you cannot choose between two plausible answers don’t
use the one that feels wrong to you. This tip is useful to some students, but
19,32,33remember it is NOT infallible.
- Do NOT be afraid to change your answer. The first answer selected is
often correct but IF it seems incorrect on reflection, change it. Studies
conducted over the past 70 years demonstrate that students who
change dubious answers usually end up with higher scores. A 2005
study reported in Journal of Personality and Social Psychology revealed
that students who changed their answers went from a wrong answer to
a right answer 51% of the time; went from a right answer to a wrong
answer 25% of the time, and went from a wrong answer to a different17,33wrong answer 23% of the time.
- Review the test after you have completely finished. Many times you will
catch some mistakes, or you may find better answers after you have
19,32,33gone through the entire test.
Test Anxiety
Most people experience some anxiety before or during an exam, but your the anxiety
level negatively affects your performance on the exam, it should be addressed. Text
anxiety is actually performance anxiety and can result in buKerflies in the stomach, a
stomachache, or a tension headache or may make you shaky, sweaty, or nauseated or
18even give you heart palpitations—and so on. Use several tips for minimizing,
alleviating, and learning to cope with anxiety:
• Be prepared for the exam. Begin your review well ahead of time so that you have
adequate time to cover all of the material and practice exam style questions.
Follow the suggestions for developing a plan of study, retention of information,
and developing efficient and effective study sessions. Nothing reduces anxiety
more than knowing that you are well prepared and having confidence in your
knowledge and skills.
• Approach the exam with confidence.
• Personalize your success on the exam:
• Visualize success as you answer each question.
• Logically assure yourself that you are well prepared.
18• Use positive self-talk before and during the exam.
• View the exam as an opportunity to demonstrate your skill and knowledge and
receive the reward of certification for all your hard work.
• Strive to achieve and maintain a relaxed state of concentration:
• Relax by taking slow, deep breaths: You are in control.
• Do not think about being afraid before or during the exam.
18• Stay focused on the questions, answering step by step.
• Use positive reinforcement by acknowledging that you are doing your very best.
• Expect to have some anxiety, remembering that it can be a good thing:
• Use it as a reminder that you want to perform to the best of your ability.
• Use it to provide positive energy—not stress.
• Keep it manageable by streaming it into positive action and thoughts during the
exam: Change positions; stretch; breathe.
18• Visualize your success!
Test-Taking Tips for Certification Day!
18A number of strategies will make your certification day much easier:
• Know where you are going. Do a practice run to the examination center you have
selected so that you know exactly where you are going and how long it will take
you to get there. Driving the route at the time of day that you will be going will
give a more accurate estimate of your travel time. Be sure to add some extra travel
time to leave time for unexpected delays such as an accident, inclement weather,
or car trouble.
• Get a good night’s sleep before the exam.• Set your alarm and a backup alarm so you that do not oversleep and then have to
rush to get to the testing center on time. This will reduce your stress and anxiety
• Eat a good breakfast or lunch before you go. Be sure to eat some protein, and do
not eat a lot of carbohydrates, which will make you sleepy.
• Check to make sure that you have the required and recommended items to take
the exam, such as a photo ID, pencils, calculator, cough drops, and tissues. Make
sure you organize these items the night before. If you do not have a photo ID, get
a state ID or other form of ID in advance of your test date.
• Bring earplugs if you are distracted by noises. There may be other testers in the
same room taking a different type of exam in which they are continuously typing.
The clicking of computer keys can be very distracting to some test takers.
• Wear layers of comfortable clothing so that you are prepared if the room is too
warm (in which case you can remove an outer layer) or too cool.
• Arrive early so that you can get acclimated to the environment of the testing
• Choose a computer or desk that is located in an area where you will feel the most
• Stay relaxed. Your nerves may start to kick in, but take a few deep, relaxing breaths
18before you begin. You have studied, you are prepared, and you can succeed!
Keep a POSITIVE attitude throughout the exam!
1. American Certification Agency. 2014. Recertification: Phlebotomy technician.
2. American Certification Agency. 2014. Examination requirements.
3. American Medical Technologists. 2014. AMT Registered Phlebotomy Technician (RPT)
certification examination construction parameters.
4. American Medical Technologists. 2014. Certification process.
5. American Medical Technologists. 2014. Continuing education.
6. American Society for Clinical Laboratory Scientists. 2009. Personnel licensure.
7. American Society for Clinical Pathology. 2009. Get certified: Certification by the ASCP
Board of Registry.
8. American Society for Clinical Pathology. 2014. Computer adaptive
9. American Society of Phlebotomy Technicians. 2009. Welcome to the American Society
of Phlebotomy Technicians.
10. Brainy Quote. 2014. Vince Lombardi quotes.
11. California Department of Public Health Department. 2014. Phlebotomy certification.
12. Center for Phlebotomy Education. 2014. Directory of phlebotomy certification
13. Dilulio R. 2006. “The science of credentialing scientists.” Clinical Lab Products.
14. Hopper C. 2007. “Memory principles.” In C Hopper, ed. Practicing college learning
strategies. Boston: Houghton Mifflin.
15. Huitt W. 2004. Bloom et al.’s taxonomy of the cognitive domain. Educational
Psychology Interactive. Valdosta, GA: Valdosta State University.
16. Kizlik R. 2009. Effective study skills: How to study and make the most of your time.
17. Kruger J, Wirtz D, Miller DT. 2005. “Counterfactual thinking and the first instinct
fallacy.” Journal of Personality and Social Psychology 88 725.
18. Landsberger J. n.d. Study guides and strategies: Overcoming test anxiety.
19. Landsberger J. n.d. Study guides and strategies: Multiple choice tests.
20. Landsberger J. n.d. Study guides and strategies: Organizing for test-taking.
21. Landsberger J. n.d. Study guides and strategies: Time management.
22. Louisiana State Board of Medical Examiners. 2009. Clinical laboratory personnel.
23. Madsen Myers, K. 2004. “Certification, professional competency, and licensure.”
NAACLS News 87 4–7.Chicago: NAACLS.
24. Martin D. 1991 How to be a successful student.
25. National Center for Competency Testing. 2014. Value of competency testing.
26. National Center for Competency Testing. 2014. Certification types.
27. National Healthcare Association. n.d. Certified phlebotomy technician.
28. National Credentialing Agency for Laboratory Personnel. 2009. Tips and guidance.
29. National Phlebotomy Association. 2014. A non-profit organization for education and
certification of phlebotomists.
30. Netwind Learning Center. 2014. A+ certification test-taking tips.
31. Peale N. 2011. The power of positive thinking. Simon and Schuster/Ishi Press: New
32. Shippensburg University. 2008. Study skills: Tips for taking multiple choice exams.
33. Social Psychology Network. 2014. Tips on taking multiple choice tests.
34. Webster University. n.d. How to study effectively.
1. All of the following are attributes a phlebotomist should have, except which?
a. Organization
b. Good interpersonal skills
c. Attention to detail
d. Aggression2. A phlebotomist who is sensitive to a patient’s concerns is exhibiting what?
a. Interpersonal skills
b. Empathy and compassion
c. Positive attitude
d. Honesty and integrity
3. Which of the following phlebotomy behaviors is unprofessional?
a. Smiling when greeting the patient
b. Making small talk with the patient
c. Sighing over the slowness with which a patient rolls up his or her sleeve
d. Laughing at the patient’s joke
4. The phlebotomist who was performing blood collections at the local nursing home
early in the morning knocked on the door of a room, entered, and grabbed the
patient’s shoulder to waken her. The patient started yelling for help. Why?
a. The patient was afraid to have her blood drawn.
b. The patient had dementia.
c. The patient was startled instead of being gently awakened.
d. The patient was known for being difficult.
5. When a phlebotomist performs a venipuncture on a patient using minimal
conversation and stiff body language and quickly dismisses the patient, how may
the phlebotomist be viewed?
a. Competent
b. Efficient
c. Rude
d. Courteous
6. The physician walks into the patient’s room and begins discussing a medical
condition the patient has but that is unrelated to the patient’s hospitalization and
blood test being drawn. It is a rare and interesting condition. The phlebotomist
knows what about this information?
a. It falls under HIPAA and can be shared with her colleagues.
b. It is privileged and can only be shared with those directly taking care of the
patient if pertinent.
c. It is not privileged and can be shared, because it is not the patient’s hospital
d. It is HIPAA-approved information, accessible by all health care providers at
the hospital.
7. With what does the oncology department deal?
a. Arthritis
b. Tumors
c. Pulmonary conditions
d. Elderly patients
8. A patient who receives treatments at a nephrology department has a
_______________ disorder.
a. Gastrointestinal
b. Vein
c. Heart
d. Kidney
9. Which of the following meets the educational and training requirements required
of the laboratory director?
a. MLSb. Pathologist
c. MLT
d. Supervisor
10. The world is a global society, and phlebotomists must be culturally sensitive to their
patients by understanding which of the following?
a. Beliefs
b. Values
c. Traditions
d. All of the above
11. Which standard requires chemical manufacturers to supply safety data sheets?
a. Hazcom
d. The Joint Commission
12. RACE is an acronym used in ___________safety.
a. Electrical
b. Bloodborne pathogen
c. Fire
d. Chemical
13. What does storage of flammable chemicals require?
a. Designated storage room
b. Leakproof cabinet
c. Temperature-regulated climate
d. Flammable storage cabinet
14. What do electrical safety guidelines include?
a. Use of extension cords
b. Reporting of frayed cords
c. Marking of equipment by electrical caution warning signs
d. Knowledge of the location of the circuit breaker
15. What is the most common hazard encountered by a phlebotomist?
a. Fire
b. Sharps
c. Chemicals
d. Electrical
16. Of what does the NFPA label warn firefighters?
a. Location of hazardous materials
b. Potential radiation exposure
c. Electrical hazards
d. Biohazardous rooms
17. The phlebotomist is taking a shortcut back to the lab and finds a hospital worker
collapsed in the stairwell; the worker appears cyanotic. What does the phlebotomist
immediately do?
a. Perform CPR.
b. Start DOT.
c. Check for pulse.
d. Elevate the worker’s legs.
18. Which of the following are disease-causing organisms called?
a. Infectious
b. Pathogensc. Fomites
d. Vectors
19. A hospitalized patient who has hepatitis A is placed in which type of isolation?
a. Airborne
b. Protective environment
c. Contact
d. Droplet
20. Why are gloves required when performing venipuncture?
a. To protect the patient from health care–associated illnesses
b. To prevent phlebotomist from exposure to patient’s blood
c. To reduce the risk of needlestick puncture
d. To reduce handwashing between patients
21. Standard precautions include all of the following except which?
a. Wearing scrubs when drawing blood
b. Disinfecting hands
c. Using gloves when collecting or handling blood
d. Disposing of needles in a puncture-proof sharps container
22. When performing a venipuncture on a patient who has been placed in droplet
precautions, what must the phlebotomist don?
a. Goggles
b. Mask
c. Shoe covers
d. None of the above
23. Which of the following parts of the word “nephropathy” means “kidney”?
a. Nephrop
b. Nephr
c. Neph
d. Nepho
24. Which of the follow prefixes means “black”?
a. Cyan
b. Melano
c. Lute
d. Albi
25. Which of the following prefixes means “the same”?
a. Gen
b. Osis
c. Iso
d. Neo
26. The MLS received a specimen that did not contain enough serum to perform the
required blood test. How did he report the specimen?
a. q
b. qs
c. qns
d. SOS
27. Which of the following cell types extrudes the nucleus at maturity?
a. Nerve
b. RBCs
c. Platelets
d. Mitochondria28. Which of the following is in the dorsal cavity?
a. Lungs
b. Uterus
c. Brain
d. Pancreas
29. What is the sectional plane dividing the body into top and bottom?
a. Midsagittal plane
b. Transverse plane
c. Lateral plane
d. Frontal
30. Which of the following test is a bone metabolism marker?
a. RA
b. ALP
c. Uric acid
d. Calcium
31. Sarcoma is a disease of what?
a. Muscle
b. Skin
c. Bone
d. Kidney
32. What is a function of smooth muscle?
a. Provide agonist–antagonist movement.
b. Anchor ligaments and tendons.
c. Cover internal organs.
d. Regulate passage of materials through vessels.
33. Which of the following tests is a marker for muscle disease?
a. CK-MB
b. AST
c. Myoglobin
d. Troponin
34. Which of the following tests is useful in diagnosing meningitis?
a. CSF analysis
b. CK-MB
c. CBC
d. Creatine
35. All of the following tests are useful in diagnosing respiratory system
diseases/illnesses, except which?
a. ABGs
b. PPD
c. Electrolytes
d. PTH
36. Which vessel contains the least amount of oxygen?
a. Capillary
b. Vena cava
c. Artery
d. Venule
37. Which of the following is not an acceptable site for venipuncture by a phlebotomist?
a. Basilic vein
b. Femoral arteryc. Dorsal hand vein
d. Cephalic vein
38. Components of peripheral blood include all of the following, except which?
a. Plasma
b. Proteins
c. Cells
d. Megakaryocytes
39. Bleeding at the venipuncture site begins to stop with the onset of what?
a. Fibrinolysis
b. Homeostasis
c. Platelet aggregation
d. t-PA
40. Tests ordered by the physician require the following tubes: SPS, Green, Red,
Lavender. Which one will be drawn last?
a. SPS
b. Green
c. Red
d. Lavender
41. Which is the correct order of tube draw?
a. SST, light blue, gray
b. Light blue, gray, SST
c. Gray, SST, light blue
d. Light blue, SST, gray
42. What tube contains sodium fluoride?
a. Green
b. Yellow
c. Gray
d. Pink
43. What tube contains ACD or acid citrate dextrose?
a. Lavender
b. Yellow (nonsterile)
c. Royal
d. Pearl
44. The phlebotomist had to gently redirect the needle several time before entering the
vein. This may cause erroneous results for which of the following tests?
a. Coagulation
b. RPR
c. Glucose
d. Blood culture
45. What does a royal blue–stoppered tube contain?
b. Heparin
c. Nothing
d. All are correct
46. All of the following additives prevent clotting by binding calcium, except which?
a. Heparin
c. SPS
d. Potassium oxalate47. In which of the following procedures is a tourniquet not used?
a. Evacuated tube with butterfly
b. ABG
c. Syringe draw
d. Blood culture
48. A patient who has an irrational fear about having his or her blood drawn may likely
experience any of the following, except which?
a. Syncope
b. Diaphoresis
c. Nausea
d. Sinus rhythm
49. All of the following ensure proper identification of a patient, except which?
a. Asking a patient to spell his or her last name
b. Checking computer-generated labels against the patient’s wrist band
c. Asking whether the patient is “Mary Smith”
d. Checking a photo ID against the requisition
50. Risk of accidental arterial puncture during a venipuncture is best avoided by
selecting which of the following sites?
a. Basilic vein
b. Ventral wrist vein
c. Cephalic vein
d. Superficial vein overlying an artery
51. Assessment of a vein requires palpation to determine all of the following
characteristics, except which?
a. Bouncy
b. Pulsating
c. Firm
d. Spongy
52. The MLS called the phlebotomy department to request a redraw on a specimen that
was hemolyzed. Which of the following did not contribute to hemolysis of the
a. Leaving tourniquet on too long
b. Using a needle gauge too small for the tube
c. Applying tourniquet too tightly
d. Inverting tube 8–10 times
53. Not allowing the site to dry 30–60 seconds after cleansing it with 70% alcohol may
result in all of the following, except which?
a. Specimen hemolysis
b. Adequate bacteriostatic action
c. Stinging at puncture site
d. All of the above
54. You attempted 2 venipunctures on a patient without success. The patient tells you
it’s okay to try again. What should you do?
a. Do as the patient requests.
b. Get permission to stick a third time.
c. Find another phlebotomist to collect the specimen.
d. Any of the above.
55. Capillary blood is a mixer of ___________.
a. Interstitial fluid and arteriole bloodb. Arteriole and venole blood
c. Venole and interstitial fluid
d. Arteriole, venole, and interstitial fluid
56. For which of the following conditions are dermal punctures not appropriate?
a. Dehydration
b. Obesity
c. Burns
d. Venous thrombosis
57. Which of the following dermal puncture devices provides high blood flow?
a. 21-gauge × 1.8 mm depth
b. 2.4 mm width × 1 mm depth
c. 1.75 mm width × 0.85 mm depth
d. 30-gauge × 1.5 mm depth
58. The phlebotomist drew ABGs, PT, ammonia and electrolytes and put all specimens
in the slurry of ice, in a hurry to get back to the lab because his shift was ending.
Which test did his actions compromise?
a. ABGs
b. PT
c. Ammonia
d. Electrolytes
59. When drawing blood from an unconscious patient, what should the phlebotomist
not do?
a. Introduce himself and describe the procedure.
b. Monitor patient reaction to the procedure.
c. Try to gently shake the patient back to awareness before starting the
d. Talk to the patient during the procedure.
60. Erroneous results may occur if blood is drawn from all of the following sites, except
a. Area exhibiting petechiae
b. Hematoma
c. Edematous tissue
d. Occluded vein
61. All of the following except ___________ may result in prolonged bleeding at the
puncture site.
a. Coumadin
b. Vitamin K
c. Aspirin
d. Petechiae
62. The development of a hematoma can result from all of the following, except which?
a. Removing the tourniquet before removing the needle from the vein
b. Bending the elbow as pressure is applied to puncture site
c. Excessive probing during venipuncture procedure
d. Not inserting the needle far enough into the vein
63. What does protocol for using a butterfly device to draw a PT require?
a. Drawing a discard tube before a blue-topped tube
b. Using a chilled citrate tube
c. Placing the specimen in a warming device after the tube is filled
d. No tourniquet application64. The protocol for hand hygiene when performing routine blood draws states that
hands must be washed when?
a. After gloves become soiled
b. After every other patient
c. After every patient
d. Before and after every patient
65. Why is verifying the fasting state of a patient important for lab tests that require a
12-hour fast?
a. Ingestion of food and/or drink will produce erroneous results.
b. Blood may be more diluted and yield false negative results.
c. Plasma will have less chylomicrons and give false readings.
d. To ensure that the patient is in a diurnal state.
66. When performing a dermal puncture on pediatric patients, the sites vary depending
upon the age of the patient. All of the following sites are acceptable, except which?
a. Ring finger
b. Heel
c. Middle finger
d. Pinky finger
67. When performing a dermal puncture, what is the fill order of microcollection tubes?
a. Blue, green, lavender
b. Lavender, green, gray
c. Green, lavender, gray
d. Gray, blue, lavender
68. What are PICC lines used for?
a. Withdrawing blood from patients who must have multiple blood draws
b. Administering medications
c. Measuring blood pressure in vena cava
d. Connecting an artery and a vein
69. The phlebotomist drew a PT tube, laid it down on the tabletop and inserted the tube
for a CBC. As she was removing the final tube, she noticed that the patient had
become very diaphoretic and was close to fainting. She immediately removed the
needle, engaged the safety device, and laid the tube down next to the PT tube. She
instructed the patient to put her head down, while she held the gauzed on the
puncture site until the patient was able to do so and then wet proceeded to get a
cool cloth for the patient. She then remembered that she needed to invert the tubes
and began to do so. Which of the following is true of the actions of the
a. They compromised patient safety.
b. They contributed to a preanalytic variable.
c. They protected both patient and sample integrity.
d. They exemplify good quality assurance.
70. Which of the following tests is included in a neonatal screen?
a. Hemoglobin
b. Bilirubin
c. Phenylalanine
d. Ammonia
71. What is the purpose of transporting some specimens in a slurry of ice?
a. Prevent bacterial growth.
b. Increase clotting time.c. Slow down metabolic processes.
d. Stop hemolysis.
72. Collection of ABGs requires all of the following, except which?
a. Heparin-coated syringe
b. Verification of collateral circulation
c. Thermometer
d. Blood transfer device
73. On collecting an ABG sample, what must the phlebotomist do?
a. Apply pressure to the puncture site for at least 5 minutes.
b. Protect the specimen from light.
c. Take the patient’s blood pressure.
d. Perform the modified Allen test.
74. When is the best time to collect a blood culture for optimal recovery of
a. When the physician orders them
b. Just before a spike in the patient’s temperature
c. With peak and trough collections
d. By collecting more than 1 set of vials from the same site
75. Which of the following specimen and transportation methods is paired correctly?
a. Cold agglutinin and ice slurry
b. Ammonia and warming device
c. Beta-carotene and amber biohazard bag
d. ALT and aluminum foil wrap
76. All of the following apply to legal blood alcohol collection, except which?
a. Cleanse site with nonalcohol antiseptic
b. Chain of custody protocol
c. Properly labeled sample aliquots for testing verification
d. Full tube draw
77. Which of the following tests uses iontophoresis?
a. Sweat chloride
b. RSV
c. Whooping cough
d. Strep test
78. The phlebotomist works in a satellite laboratory at a multi-physician practice
collecting blood specimens, throat cultures, and assisting with collection of other
body fluids. Specimens must be processed for transportation via courier from the
main lab. After a CSF specimen is collected, the phlebotomist prepares the
specimen for the courier, who will arrive in 30 minutes, by doing which of the
a. Storing all tubes at room temperature
b. Placing all tubes in the refrigerator
c. Placing the tube for hematology in the refrigerator and storing all other
tubes at room temperature
d. Placing the microbiology tube in the refrigerator and storing all other tubes
at room temperature
79. The phlebotomist drew an SST tube without incident at 0900 and centrifuged the
tube at 0920. Upon removal of the tube from the centrifuge, what did the
phlebotomist observe?
a. Clean separation of the serum and clotb. Hemolysis of the specimen
c. Gelatinous and fibrinous serum
d. Gel separation of plasma and clot
80. All of the following are preanalytic variables, except which?
a. Verifying information on requisition
b. Checking phlebotomy equipment
c. Asking patient if they are fasting
d. Following test procedure
81. The phlebotomist was performing early morning routine draws on 18 patients.
Checking her watch, she noted that she had been collecting specimens for 1 hour
and 50 minutes and still had 6 more patients to draw. What should she do?
a. Finish up the other 6 patients before heading back to the lab.
b. Return to the lab to drop off the first 12 patient’s specimens for processing.
c. Put all the specimens in a slurry of ice before finishing up the remaining
blood draws.
d. Put the chemistry tests on ice, leaving all others at room temperature.
82. The phlebotomist had a hard time collecting a CBC, PT, and BUN; creatinine; and
electrolytes on a patient. Upon centrifugation of the PT and chemistry tests, the
phlebotomist realized that the sample was just barely hemolyzed and that there
was not enough sample for the chemistry analysis. What did she do?
a. Transferred an aliquot of plasma from the PT sample into the light green PST
b. Respun the specimen three times to get the cells packed down
c. Made aliquots from the PT plasma for both the PT and chemistry tests
d. Logged QNS and called the patient back for a redraw
83. Which of the following represents a quality assurance indicator?
a. Turnaround times for a STAT CBC 30 minutes or less
b. Phlebotomists’ using PPE when performing venipuncture procedures
c. Not storing food in the microbiology media refrigerator
d. No use of coffee mugs at workstations
84. All of the following may compromise sample integrity, except which?
a. Use of outdated evacuated tubes
b. Mixing a lavender tube 3 times by gentle inversion
c. Allowing an SST tube to clot for 60 minutes
d. Collecting a lavender tube after a green-topped tube
85. It is important not to use expired evacuated tubes for all of the following reasons,
except which?
a. Vacuum loss
b. Degradation of additives
c. Risk of erroneous test results
d. Risk of fragile glass tubes’ breaking
86. All of the following are also considered to be point-of-care tests, except which?
a. Cholesterol
b. PT
c. ABGs
d. Ammonia
87. Which of the following point-of-care tests requires a blood sample?
a. Group A strep
b. Cardiac troponin Tc. RSV
d. Occult blood
88. Which of the following tests detects a UTI?
a. Throat swab
b. C & S
c. Blood test
d. Nasal washing
89. Which of the following specimens is both temperature- and time-sensitive?
a. Vitamin B6
b. Ammonia
c. Platelet aggregation
d. Pyruvate
90. HIPAA is a federal law that sets standards for what?
a. Reimbursement of laboratory tests
b. Laboratory practices
c. Protection of PHI
d. Laboratory safety
91. The CLIA Act of 1988 mandated the regulation of what?
a. Reimbursement practices of laboratory tests done in doctor’s offices
b. All laboratories that perform patient testing
c. The exchange of PHI between health care facilities
d. Laboratory safety for bloodborne pathogens
92. A specimen was received into central processing from a physician office and was
missing the date and time of collection. What did the processor do?
a. Add current date and estimate the time based on the test ordered.
b. Put the current date on the tube, with no time specified.
c. Check the requisition for date and time, verifying with the office.
d. Call the patient to verify date and time.
93. The phlebotomist drew a green-topped tube for electrolyes and a red-topped tube
for digitoxin testing on an outpatient but did not see the request for a differential
until after the patient had departed. Which of the following will the phlebotomist
a. Make 2 slides before centrifuging the green top tube.
b. Hurry and make 2 slides from the red top tube before it clots.
c. Cancel the differential test in the computer.
d. Give the lab assistant a request to call and let the patient know that he needs
to return.
94. The patient was instructed to collect a semen sample and deliver it to the laboratory
within 30 minutes of collection, keeping it at body temperature, which is what?
a. 25° C
b. 30° C
c. 37° C
d. 43° C
95. The phlebotomist was attempting to draw blood on a child when the child leaned in
and bit the phlebotomist on the arm, refusing to let go. The phlebotomist
immediately reacted and flicked the child’s face several time with his thumb and
forefinger until the child released. The child’s face reddened and bruised slightly.
The parents sued on what basis?
a. Malpracticeb. Assault and battery
c. Breach of contract
d. Negligence
96. A phlebotomist forgot to remove the tourniquet from an unconscious patient’s arm
after performing a venipuncture. In a hurry, the phlebotomist applied a pressure
bandage and moved on to the next patient. About 30 minutes later, the family
returned from lunch and found the patient’s arm blue, cold, and swollen because
blood had leaked into the tissues. For what was the phlebotomist sued?
a. Malpractice
b. Egregious conduct
c. Negligence
d. Both A and C
97. All of the following are examples of standard of care, except which?
a. Putting the bed rail up if you lowered it
b. Waiting 30–60 seconds for alcohol to try after cleansing the arm
c. Making small talk with the patient to distract him or her
d. Only attempting 1 more venipuncture if you missed the first
98. The phlebotomist just completed a heel stick on a baby, and the mother was very
upset and angry with the phlebotomist because the baby was inconsolable. The
mother left, saying she was taking the baby to her physician right away to make
sure the baby was okay. What should the phlebotomist do?
a. Continue to try to get the mother to understand that babies cry when they
get a heelstick.
b. Call the physician to warn him or her that the mother is on her way with the
c. Shrug it off and finish processing the specimen.
d. Fill out an incident report and give it to his or her supervisor.
99. The phlebotomist, reviewing the patient’s requisition form, notes several tests of
which he or she has never heard before. What does the phlebotomist do?
a. Draw one of each tube color so that at least one of the tubes will be correct.
b. Know that the tests are not a hematology or coagulation test, making an SST
tube correct.
c. Use the specimen collection manual to verify tube type and any special
handling requirements.
d. Tell the patient to go to the central lab, because these are special tests.
100. A phlebotomist who has been trained to perform the urine dipstick test goes to help
out a tech who is busy with STAT CBCs. The phlebotomist does all of the following
before testing, except which?
a. Check label for proper ID.
b. Make sure the specimen is at room temperature.
c. Check the time of collection.
d. Verify that the specimen has been maintained at body temperature.
Pre-Test Answers
1. D
2. B
3. C
4. C
5. C6. B
7. B
8. D
9. B
10. D
11. A
12. C
13. D
14. A
15. B
16. A
17. C
18. B
19. C
20. B
21. A
22. B
23. B
24. B
25. C
26. C
27. B
28. C
29. B
30. B
31. C
32. D
33. B
34. A
35. D
36. B
37. B
38. D
39. C
40. D
41. D
42. C
43. B
44. A
45. D
46. A
47. B
48. D
49. C
50. C
51. B
52. D
53. C
54. D