Free ASCP PBT Practice Test: 80 Questions with Explained Answers
80 original practice questions for the U.S. ASCP Phlebotomy Technician exam, PBT(ASCP) — the same length as the real test, spread across the six content areas in ASCP BOC's current content guideline (revised October 2023).[1] Pick an answer, then open Show answer under each question for the explanation and source. Free, no signup; unofficial practice, not ASCP questions.
Practice questions
Question 1 · Specimen Collection
An outpatient hands you a requisition for a CBC and a basic metabolic panel. Which is the best way to identify her before you collect?
Show answer
Answer: B. Ask her to state her full name and date of birth, then compare both to the requisition
Positive identification means the patient supplies at least two identifiers (such as full name and date of birth) and you compare them to the requisition. A patient who is nervous or hard of hearing may say yes to the wrong name.
Why not the others
- A: A yes/no question invites a wrong yes; the patient has to state the information.
- C: A sign-in sheet is not the patient; it can be wrong or belong to someone else.
- D: Another staff member's recollection is not a substitute for the patient's own identifiers.
Source: The Joint Commission, NPSG.01.01.01 (2015 Ambulatory NPSG, EP 1) — p. 1 · WHO Guidelines on Drawing Blood (2010), Ch. 2 Best practices in phlebotomy — Section 2.2.3, Steps 2–9 · Item PBT-01
Question 2 · Specimen Collection
Which needle has the smallest inside diameter (lumen)?
Show answer
Answer: D. 23 gauge
The higher the gauge number, the smaller the needle's diameter. BD lists its 21-gauge blood collection needle for general use; smaller needles such as 23 gauge are chosen for small veins, and WHO advises matching the gauge to the vein.
Why not the others
- A: 18 gauge is a large needle (used for donations).
- B: 20 gauge is larger than 23.
- C: 21 gauge is larger than 23.
Source: Hamilton Company, What is needle gauge? — Gauge vs outer diameter · BD Vacutainer Eclipse 21G product page; WHO Ch. 3 — Typical application; WHO §3.1.1 at https://www.ncbi.nlm.nih.gov/books/NBK138666/ · Item PBT-18
Question 3 · Circulatory System
In which vessels does the exchange of oxygen, nutrients and wastes between blood and tissue cells take place?
Show answer
Answer: A. Capillaries
Capillaries are the smallest and most numerous vessels, and their main job is exchange between the blood and tissue cells. They connect the arterial side to the venous side.
Why not the others
- B: Veins return blood to the heart.
- C: Arteries carry blood away from the heart; their walls are too thick for exchange.
- D: The aorta is the largest artery.
Source: NCI SEER Training: Classification & Structure of Blood Vessels — Arteries; Veins; Capillaries · Item PBT-63
Question 4 · Specimen Collection
During a syringe draw you need to fill evacuated tubes. Which practice is most likely to hemolyze the specimen?
Show answer
Answer: A. Pushing hard on the plunger to force blood through the needle into the tube
Forcing blood through a needle with plunger pressure damages red cells and releases potassium and other cell contents. Let the tube's vacuum draw the blood in.
Why not the others
- B: That is the recommended way to fill from a syringe.
- C: Order of draw prevents carryover; it doesn't cause hemolysis.
- D: Gentle inversion is correct mixing.
Source: WHO Guidelines on Drawing Blood (2010), Ch. 2 Best practices in phlebotomy — Section 2.2.3, Steps 2–9 · Lippi et al., Clin Chem Lab Med 2006;44:311–6 — pp. 311, 313 (causes and effects of hemolysis) · Item PBT-19
Question 5 · Specimen Collection
A patient is asked to pump his fist repeatedly while the tourniquet is on. Which result is most likely to be falsely increased?
Show answer
Answer: B. Potassium
Fist pumping causes pseudohyperkalemia — muscle releases potassium, and hemoconcentration and pH shifts add to it — so the result can be falsely high. CLSI guidance recommends avoiding fist pumping.
Why not the others
- A: Glucose isn't meaningfully raised by fist clenching.
- C: PT is a coagulation time, not affected this way.
- D: A1c reflects months of glucose exposure.
Source: Mayo Clinic Laboratories, Top Gun Phlebotomy: Pseudohyperkalemia (Sept 10, 2018) — Fist pumping and tourniquet time; CLSI GP41 recommendation · Item PBT-32
Question 6 · Non-Blood Specimens
When collecting a throat swab for a strep test, where should the swab make contact?
Show answer
Answer: D. The back of the throat near the tonsils
The swab is rubbed along the back of the throat near the tonsils, where streptococcal pharyngitis is sampled.
Why not the others
- A: The tongue and cheeks are not the infection site; they add saliva and mouth flora instead.
- B: Nasal sampling is used for other tests.
- C: Not the infection site.
Source: MedlinePlus: Throat swab culture — How the test is performed · Item PBT-52
Question 7 · Specimen Handling, Transport & Processing
Which specimen must be kept at about 37 °C (body temperature) until the serum is separated?
Show answer
Answer: D. Cold agglutinins
Cold agglutinins are antibodies that bind red cells at cool temperatures. If the specimen cools, the antibodies attach to the cells and are lost from the serum, giving a falsely low result.
Why not the others
- A: Bilirubin needs light protection, not warming.
- B: Ammonia is chilled, not warmed.
- C: Lactic acid isn't a specimen that must be kept at body temperature.
Source: Mayo Clinic Laboratories test catalog: Cold agglutinin (test 614034) — Specimen collection · Item PBT-39
Question 8 · Specimen Collection
Before you start, a patient mentions she has fainted during blood draws before. What is the best response?
Show answer
Answer: B. Have her lie down or recline before the draw
Asking about prior fainting is part of patient assessment. A patient with a history of syncope should be lying down or reclined so a faint doesn't become a fall.
Why not the others
- A: Standing is the riskiest position.
- C: Skipping the tourniquet doesn't prevent fainting.
- D: Breath-holding can actually contribute to lightheadedness.
Source: WHO Guidelines on Drawing Blood (2010), Ch. 2 Best practices in phlebotomy — Section 2.2.3, Steps 2–9 · Item PBT-30
Question 9 · Specimen Collection
How should the vein be anchored for venipuncture?
Show answer
Answer: B. Place your thumb below the puncture site and pull the skin taut
Holding the patient's arm with a thumb below the site keeps the vein from rolling without putting a finger in the needle's path. WHO describes anchoring with the thumb below the venipuncture site.
Why not the others
- A: A finger over the vein near the needle path risks a needlestick and touches the cleaned site.
- C: The patient's hand is not a controlled anchor and may enter the field.
- D: A tourniquet doesn't stop a vein from rolling.
Source: WHO Guidelines on Drawing Blood (2010), Ch. 2 Best practices in phlebotomy — Section 2.2.3, Steps 2–9 · Item PBT-69
Question 10 · Specimen Collection
A CBC is ordered. Which tube is the standard choice?
Show answer
Answer: B. Lavender K2EDTA
EDTA preserves blood cells and is the routine anticoagulant for hematology tests such as the CBC.
Why not the others
- A: Citrate is for coagulation tests.
- C: Serum tubes clot, so there are no intact cells to count in a usable form.
- D: Fluoride tubes are for glucose.
Source: BD, Order of Draw for Multiple Tube Collections (VS5729-6, reflects CLSI order) — Order-of-draw sequence and tube uses · Item PBT-65
Question 11 · Specimen Collection
Midway through the draw, a seated patient says he feels lightheaded and becomes pale and sweaty. What is your first priority?
Show answer
Answer: C. Release the tourniquet, remove the needle, apply pressure, and protect him from falling while calling for help
These are signs of syncope (fainting). Stop the procedure safely, keep him from falling (lower the head or recline him), and get help per facility protocol.
Why not the others
- A: The patient's safety comes before the specimen.
- B: Drinking while nearly unconscious risks choking.
- D: Stopping the draw and protecting the patient come first; follow facility policy before using any inhalant.
Source: Hamad Medical Corporation Lab Guide, Venous collection complications — Hematoma, syncope, nerve injury · Item PBT-21
Question 12 · Specimen Collection
Which item belongs in a standard venipuncture setup?
Show answer
Answer: C. A single-use needle attached to a single-use holder, discarded together into a sharps container
The needle and holder are discarded as one unit into a sharps container, which avoids handling the used needle. Single-use items are never reused.
Why not the others
- A: Removing a needle from a holder to reuse the holder is an exposure risk.
- B: Reusable syringes are not used for routine phlebotomy.
- D: Pressure is applied with gauze first; tape alone doesn't stop bleeding.
Source: OSHA 29 CFR 1910.1030 Bloodborne Pathogens — (d)(2)(vii) · WHO Guidelines on Drawing Blood (2010), Ch. 2 Best practices in phlebotomy — Section 2.2.3, Steps 2–9 · Item PBT-33
Question 13 · Waived & Point-of-Care Testing
A staff member wants to read a waived test at 3 minutes instead of the 5 minutes the package insert specifies, to save time. What is correct?
Show answer
Answer: C. Not allowed — waived tests must be performed exactly as the manufacturer instructs
A test keeps its waived status only when performed according to the manufacturer's instructions. Changing timing changes the test and can give wrong results.
Why not the others
- A: A result read early can be falsely negative.
- B: Negatives read early are exactly the ones most likely to be wrong.
- D: A supervisor can't waive the manufacturer's procedure.
Source: CDC, Ready? Set? Test! (2024) and 42 CFR 493.15 — "Ready?" p. 7 (when to run QC); 42 CFR 493.15(e)(1) via https://www.law.cornell.edu/cfr/text/42/493.15 · Item PBT-46
Question 14 · Waived & Point-of-Care Testing
A point-of-care PT/INR test is most commonly used to:
Show answer
Answer: C. Monitor warfarin therapy
The PT and its standardized INR are the routine monitoring tests for warfarin.
Why not the others
- A: Strep uses a rapid antigen test or culture.
- B: Diabetes screening uses glucose or A1c.
- D: Hematocrit is a separate hematology measurement.
Source: MedlinePlus: Prothrombin time (PT) test — Why the test is performed · Item PBT-48
Question 15 · Specimen Handling, Transport & Processing
A neonatal bilirubin specimen has been collected. Which handling step is most important?
Show answer
Answer: C. Protect it from light
Bilirubin breaks down in light, which would falsely lower the result. Use an amber tube or wrap it in foil and transport promptly.
Why not the others
- A: Warming isn't required for bilirubin.
- B: Freezing whole blood hemolyzes it.
- D: Shaking damages cells.
Source: Mayo Clinic Laboratories test catalog: Bilirubin (test 81785) — Cautions; Specimen stability · Item PBT-37
Question 16 · Circulatory System
Which formed element is the most numerous in blood and is chiefly responsible for transporting oxygen?
Show answer
Answer: D. Erythrocytes (red blood cells)
Red blood cells are the most numerous formed elements, and their main job is carrying oxygen (and some carbon dioxide).
Why not the others
- A: Platelets help form clots.
- B: Lymphocytes are white cells involved in immunity.
- C: Neutrophils are white cells that fight bacteria.
Source: NCI SEER Training: Composition of the Blood — Erythrocytes · Item PBT-04
Question 17 · Specimen Collection
You are using a winged (butterfly) collection set, and the only tube ordered is a light-blue sodium citrate tube for a PT. What should you do first?
Show answer
Answer: D. Draw a discard tube first to fill the tubing's air space, then draw the light-blue tube
The tubing holds air. If the citrate tube is first, that air takes up space and the tube underfills, upsetting the 9:1 blood-to-citrate ratio. A discard tube (a plain tube or another citrate tube) primes the line first.
Why not the others
- A: The tubing air space would underfill the citrate tube.
- B: Underfilling is exactly the problem to avoid.
- C: An EDTA tube before citrate risks additive carryover.
Source: BD, Order of Draw for Multiple Tube Collections (VS5729-6) — Citrate footnote (winged set discard tube) · CAP TODAY Q&A, August 2016 (citrate tube fill) — 9:1 ratio; underfilled tubes · Item PBT-15
Question 18 · Specimen Handling, Transport & Processing
Which item is NOT typically required on a blood specimen tube label?
Show answer
Answer: C. The patient's diagnosis
Labels link the tube to the patient and the collection event: name, an identification number or date of birth, and the date and time of collection are typical requirements. A diagnosis isn't a label element.
Why not the others
- A: Name is a standard label element.
- B: An identifier such as date of birth or file number is standard.
- D: Collection date and time are needed, for example for timed tests and stability.
Source: WHO Guidelines on Drawing Blood (2010), Ch. 2 Best practices in phlebotomy — Section 2.2.3, Steps 2–9 · Item PBT-73
Question 19 · Specimen Collection
A provider orders a PT/INR (light blue), a comprehensive metabolic panel (gold SST), a CBC (lavender), a glucose (gray) and a STAT potassium (green lithium heparin). In what order should the tubes be drawn?
Show answer
Answer: D. Light blue → gold → green → lavender → gray
The CLSI order is sterile/blood cultures, citrate, serum (with or without clot activator or gel), heparin, EDTA, then glycolytic inhibitor. Drawing in that sequence keeps additives from being carried into the next tube.
Why not the others
- A: EDTA first would carry EDTA into every following tube.
- B: Clot activator can carry into the citrate tube and affect coagulation results.
- C: EDTA before serum and heparin tubes risks false potassium and calcium results.
Source: BD, Order of Draw for Multiple Tube Collections (VS5729-6, reflects CLSI order) — Order-of-draw sequence and tube uses · Item PBT-13
Question 20 · Specimen Collection
After a fingerstick, why is the first drop of blood wiped away?
Show answer
Answer: C. It may be contaminated with tissue fluid or debris
WHO advises wiping away the first drop because it may be contaminated with tissue fluid or debris (sloughing skin), which can dilute or alter results.
Why not the others
- A: There's no white-cell excess in the first drop.
- B: It isn't necessarily clotted.
- D: Capillary blood is mixed, not purely arterial.
Source: WHO Guidelines on Drawing Blood, Ch. 7 Capillary sampling — §7.2.2 (wipe away first drop) · Item PBT-28
Question 21 · Specimen Collection
A patient had a right mastectomy with axillary lymph node removal. Her left arm has good veins. Where should you draw?
Show answer
Answer: A. The left arm
After axillary lymph node removal, the arm on that side is at risk of lymphedema, so patients are advised to have blood drawn from the unaffected arm. With a usable vein on the left, draw there.
Why not the others
- B: Healing time doesn't remove lymphedema risk.
- C: Tourniquet time doesn't make the affected side acceptable.
- D: The hand is still on the affected side.
Source: Memorial Sloan Kettering, Common Questions About Breast-Related Lymphedema — After axillary lymph node dissection · Item PBT-23
Question 22 · Non-Blood Specimens
Which instruction is correct for a clean-catch midstream urine collection?
Show answer
Answer: C. Clean the area, start voiding into the toilet, then collect the middle portion in the sterile cup
Cleaning and letting the first part of the stream flush the urethra reduces contamination with skin and urethral bacteria; the midstream portion goes into the sterile container.
Why not the others
- A: The first stream carries the most contamination.
- B: Toilet water contaminates the sample.
- D: Touching the inside of the sterile cup contaminates it.
Source: MedlinePlus: Clean catch urine sample — How the test is performed · Item PBT-49
Question 23 · Waived & Point-of-Care Testing
Which practice with a fingerstick lancing device is correct?
Show answer
Answer: A. Never use a fingerstick device for more than one person
CDC states that fingerstick devices should never be used for more than one person. Shared devices have been linked to hepatitis B transmission.
Why not the others
- B: Changing the lancet doesn't make a shared device safe.
- C: There's no exception for family members in healthcare settings.
- D: A dry wipe doesn't disinfect, and sharing is still not allowed.
Source: CDC, Injection Safety: blood glucose monitoring — Blood glucose monitoring section · Item PBT-76
Question 24 · Laboratory Operations
You need to know the hazards and first-aid steps for a bleach-based disinfectant used in your drawing station. Where should you look first?
Show answer
Answer: A. The product's Safety Data Sheet (SDS)
OSHA's Hazard Communication Standard requires an SDS for each hazardous chemical, readily accessible to employees, covering hazards, handling and first aid.
Why not the others
- B: Charts don't hold chemical safety data.
- C: Equipment manuals cover the equipment.
- D: Requisitions list tests.
Source: OSHA 29 CFR 1910.1200 Hazard Communication — (g)(2), (g)(8) · Item PBT-59
Question 25 · Specimen Collection
Blood is flowing into the last tube. What should you do before withdrawing the needle?
Show answer
Answer: D. Release the tourniquet
Releasing the tourniquet before withdrawal lowers the pressure in the vein so it doesn't bleed into the tissue when the needle comes out.
Why not the others
- A: Bending the arm after a draw encourages a hematoma.
- B: Recapping a used needle is prohibited; activate the safety device instead.
- C: Pressing on the needle while it's in the vein hurts and can injure the vessel; apply pressure after withdrawal.
Source: WHO Guidelines on Drawing Blood (2010), Ch. 2 Best practices in phlebotomy — Section 2.2.3, Steps 2–9 · Item PBT-12
Question 26 · Laboratory Operations
Which feature is NOT one of OSHA's requirements for sharps containers?
Show answer
Answer: B. Transparent, so the contents can be seen
OSHA's bloodborne pathogens standard requires sharps containers to be closable, puncture resistant, leakproof on the sides and bottom, and labeled or color-coded. Transparency isn't a requirement.
Why not the others
- A: Required.
- C: Required.
- D: Required.
Source: OSHA 29 CFR 1910.1030 Bloodborne Pathogens — (d)(4)(iii)(A)(1); (f)(1)(ii)(A); (f)(2)(i) · Item PBT-79
Question 27 · Specimen Collection
For a routine chemistry draw, why is 70% alcohol generally preferred to povidone-iodine for cleaning the site?
Show answer
Answer: A. Povidone-iodine contamination can falsely raise results such as potassium, phosphorus or uric acid
WHO notes that blood contaminated with povidone-iodine may falsely increase potassium, phosphorus or uric acid, so alcohol is preferred for routine venipuncture.
Why not the others
- B: Povidone-iodine is an effective antiseptic; the issue is specimen contamination.
- C: Neither antiseptic is an anticoagulant.
- D: The antiseptic choice doesn't collapse veins.
Source: WHO Guidelines on Drawing Blood (2010), Ch. 2 Best practices in phlebotomy — Section 2.2.3, Steps 2–9 · Item PBT-71
Question 28 · Laboratory Operations
A patient's door shows a contact-precautions sign. What PPE do you put on before entering for a draw?
Show answer
Answer: C. Gown and gloves
Contact precautions call for a gown and gloves on room entry because the patient and environment may carry organisms spread by touch.
Why not the others
- A: Masks are for droplet precautions.
- B: Respirators are for airborne precautions.
- D: Contact precautions require PPE.
Source: CDC 2007 Isolation Precautions guideline — Contact Precautions — III.B.1 Contact Precautions · Item PBT-57
Question 29 · Specimen Collection
After withdrawing the needle, what should you tell the patient to do with the arm?
Show answer
Answer: D. Keep the arm extended, press on the gauze and don't bend the arm
Holding pressure with the arm extended helps the puncture seal. WHO advises asking the patient not to bend the arm, because bending causes a hematoma.
Why not the others
- A: Bending the arm is linked to hematoma formation.
- B: Pressure should be applied right away.
- C: Shaking the arm can restart bleeding.
Source: WHO Guidelines on Drawing Blood (2010), Ch. 2 Best practices in phlebotomy — Section 2.2.3, Steps 2–9 · Item PBT-70
Question 30 · Waived & Point-of-Care Testing
A blood glucose meter is used on several patients on a unit. What must happen between patients?
Show answer
Answer: B. Clean and disinfect the meter according to the manufacturer's instructions
Shared glucose meters contaminated with blood have been linked to hepatitis B transmission. Meters should ideally be dedicated to one patient; if shared, they must be cleaned and disinfected per the manufacturer after every use.
Why not the others
- A: The lancet isn't the only contamination risk; the meter itself carries blood.
- C: A dry wipe doesn't disinfect.
- D: Batteries have nothing to do with infection control.
Source: CDC, Injection Safety: blood glucose monitoring — Blood glucose monitoring section · Item PBT-47
Question 31 · Non-Blood Specimens
A patient is scheduled for a urea breath test for Helicobacter pylori. Which preparation question matters most?
Show answer
Answer: A. Whether the patient has been taking antibiotics, bismuth (such as Pepto-Bismol) or proton pump inhibitors
Antibiotics, bismuth and proton pump inhibitors can interfere with the test, so patients are typically told to stop them for a period before testing (up to two weeks) as their provider instructs.
Why not the others
- B: Tooth brushing isn't the key preparation issue.
- C: Handedness is irrelevant.
- D: A 24-hour fast isn't the standard preparation.
Source: MedlinePlus: Helicobacter pylori tests — Urea breath test; How to prepare · Item PBT-77
Question 32 · Specimen Collection
At what angle should the needle enter the vein for a routine venipuncture?
Show answer
Answer: A. 30 degrees or less
A shallow angle (30 degrees or less) lets the needle enter the vein without going through the back wall. Steeper angles raise the risk of a through-and-through puncture and a hematoma.
Why not the others
- B: Too steep for a superficial vein.
- C: Likely to pass through the vein.
- D: That is an intradermal-to-deep path, not venipuncture technique.
Source: WHO Guidelines on Drawing Blood (2010), Ch. 2 Best practices in phlebotomy — Section 2.2.3, Steps 2–9 · Item PBT-11
Question 33 · Specimen Handling, Transport & Processing
A potassium specimen arrives visibly hemolyzed (pink-red serum). What should happen?
Show answer
Answer: A. Request a recollection because hemolysis falsely raises potassium
Red cells contain far more potassium than plasma, so in vitro hemolysis releases it and falsely raises the result. The lab follows its policy, usually rejecting and recollecting.
Why not the others
- B: An unflagged hemolyzed potassium could lead to a treatment error.
- C: There's no valid correction factor to apply.
- D: Re-spinning doesn't remove released hemoglobin or potassium.
Source: Lippi et al., Clin Chem Lab Med 2006;44:311–6 — pp. 311, 313 (causes and effects of hemolysis) · Item PBT-41
Question 34 · Waived & Point-of-Care Testing
A newly hired medical assistant is about to start performing a waived test in your clinic. According to CDC's guidance for waived testing sites, when is a common time to run quality control materials?
Show answer
Answer: D. When each new testing person begins performing the test, as well as with new shipments and lots
CDC's Ready? Set? Test! lists new testing personnel, new shipments of test kits and new lot numbers among the occasions to run controls, in addition to whatever the manufacturer requires.
Why not the others
- A: Annual QC wouldn't catch problems with new staff, shipments or lots.
- B: Waived tests still follow the manufacturer's QC instructions.
- C: QC is preventive, not complaint-driven.
Source: CDC, Ready? Set? Test! (2024) and 42 CFR 493.15 — "Ready?" p. 7 (when to run QC); 42 CFR 493.15(e)(1) via https://www.law.cornell.edu/cfr/text/42/493.15 · Item PBT-75
Question 35 · Circulatory System
A tube of anticoagulated whole blood is centrifuged. The straw-colored fluid on top, which makes up roughly 55% of blood volume, is called:
Show answer
Answer: D. Plasma
Plasma is the fluid portion of blood — about 90% water — that carries proteins, nutrients and electrolytes. Because the tube contained an anticoagulant, the fluid is plasma, not serum.
Why not the others
- A: Serum comes from clotted blood, not anticoagulated blood.
- B: Lymph is tissue fluid in the lymphatic system, not a blood fraction.
- C: The buffy coat is the thin layer of white cells and platelets between plasma and red cells.
Source: NCI SEER Training: Composition of the Blood — Erythrocytes · Labcorp, Blood Specimens: Chemistry and Hematology — Serum vs plasma; clotting time; hemolysis · Item PBT-64
Question 36 · Specimen Collection
A swelling starts to rise under the skin around the needle as you draw. What should you do?
Show answer
Answer: D. Release the tourniquet, withdraw the needle and apply pressure
A growing swelling is a hematoma — blood leaking into tissue. Stop the draw: release the tourniquet, remove the needle and hold pressure, then choose another site if needed.
Why not the others
- A: Probing can damage the vein and nerve.
- B: Keeping the tourniquet on increases pressure and bleeding into tissue.
- C: Continuing enlarges the hematoma and the specimen may be compromised.
Source: Hamad Medical Corporation Lab Guide, Venous collection complications — Hematoma, syncope, nerve injury · Item PBT-20
Question 37 · Laboratory Operations
After a routine venipuncture, you remove your gloves. Your hands are not visibly soiled. What is CDC’s preferred hand-hygiene method in most clinical situations?
Show answer
Answer: A. Use an alcohol-based hand sanitizer
CDC prefers alcohol-based hand sanitizer in most clinical situations when hands are not visibly soiled. Soap and water is required or preferred in specific situations, including visibly soiled hands, before eating, after using the restroom, and during care of patients with suspected or confirmed C. difficile or norovirus during outbreaks.
Why not the others
- B: Soap and water is appropriate in specific situations, but CDC does not require it after every routine glove removal when hands are not visibly soiled.
- C: Hand hygiene is still required after removing gloves.
- D: A dry towel does not provide hand hygiene.
Source: CDC, Clinical Safety: Hand Hygiene for Healthcare Workers — Recommendations; When to wash with soap and water · Item PBT-56
Question 38 · Laboratory Operations
Routine patient specimens are being shipped by courier to a reference laboratory as "Biological Substance, Category B" (UN3373). What packaging is required?
Show answer
Answer: D. Triple packaging: a leakproof primary receptacle, leakproof secondary packaging with absorbent, and a rigid outer package
Under 49 CFR 173.199, Category B specimens must be triple-packaged — primary receptacle, secondary packaging and a rigid outer packaging — with absorbent material for liquids, so a leak or break in transit is contained.
Why not the others
- A: One bag doesn't meet the packaging standard.
- B: An envelope isn't rigid outer packaging.
- C: Unlabeled packaging fails marking requirements.
Source: 49 CFR 173.199 Category B infectious substances — (a)(1), (b)(2)–(3) · Item PBT-60
Question 39 · Specimen Collection
How should a lavender-top K2EDTA tube be mixed immediately after it fills?
Show answer
Answer: C. Gently invert it about 8–10 times
Gentle, complete inversions mix the EDTA with blood to prevent microclots; BD recommends 8–10 inversions for EDTA tubes. Shaking damages cells.
Why not the others
- A: Vigorous shaking can hemolyze the specimen.
- B: One inversion is not enough to prevent clotting.
- D: Unmixed EDTA tubes form microclots that ruin a CBC.
Source: BD, Order of Draw for Multiple Tube Collections (VS5729-6) — Inversions column · Item PBT-16
Question 40 · Specimen Collection
You have had the tourniquet on for about three minutes while searching for a vein. What should you do?
Show answer
Answer: B. Release the tourniquet and let the arm rest before you reapply it
Prolonged tourniquet time causes hemoconcentration — fluid shifts out of the vessel and analytes such as proteins and cell counts rise falsely. Release it and let circulation return before trying again; standard practice keeps tourniquet time to about one minute.
Why not the others
- A: Drawing now would give a hemoconcentrated specimen.
- C: Vigorous fist pumping adds its own error (for example, raising potassium).
- D: Tighter and longer makes the problem worse.
Source: Center for Phlebotomy Education, Tourniquet Time (cites CLSI); WHO Ch. 2 — One-minute limit; hemoconcentration. WHO §2.2.3 Step 6 · Mayo Clinic Laboratories, Top Gun Phlebotomy: Pseudohyperkalemia (Sept 10, 2018) — Fist pumping and tourniquet time; CLSI GP41 recommendation · Item PBT-09
Question 41 · Specimen Handling, Transport & Processing
When should tubes be labeled?
Show answer
Answer: D. Immediately after collection, in the patient's presence
Labeling at the bedside, in the patient's presence, links each tube to the identified patient. Pre-labeling or batch labeling invites mix-ups.
Why not the others
- A: Pre-labeled tubes can end up with the wrong patient's blood.
- B: Unlabeled tubes leaving the patient's side can't be traced.
- C: Batch labeling away from the patient causes mislabels.
Source: The Joint Commission, NPSG.01.01.01 (2015 Ambulatory NPSG, EP 1) — p. 1 · Item PBT-40
Question 42 · Specimen Collection
An emergency department asks for a blood alcohol (ethanol) level. How should the site be cleaned?
Show answer
Answer: B. With a non-alcohol antiseptic
Alcohol-based antiseptics could contaminate the specimen and falsely raise the result. Use a non-alcohol antiseptic per the test's collection instructions.
Why not the others
- A: Isopropyl alcohol is the problem for this test.
- C: The site still needs antisepsis.
- D: Hand sanitizer is alcohol-based.
Source: Sky Lakes Laboratory test catalog, Blood Alcohol — Collection instructions · Item PBT-29
Question 43 · Specimen Collection
Before inoculating blood culture bottles, what should you do to each bottle's rubber septum?
Show answer
Answer: A. Disinfect it with 70% isopropyl alcohol
The septum under the cap is not guaranteed sterile. CDC's contamination-prevention tool calls for disinfecting it with 70% isopropyl alcohol before inoculation.
Why not the others
- B: Assuming sterility is a contamination risk.
- C: CDC's tool specifies 70% isopropyl alcohol for the septum.
- D: Opening the bottle breaks the closed system and the vacuum.
Source: CDC, Preventing Adult Blood Culture Contamination: A Quality Tool — SOP best practices, Steps 2–3 · Item PBT-67
Question 44 · Non-Blood Specimens
During a 24-hour urine collection at home, how should the container be stored?
Show answer
Answer: C. In the refrigerator or another cool place
MedlinePlus instructs patients to keep the container in the refrigerator or a cool place during the collection, which slows changes in the specimen. Some collections also use a preservative supplied by the lab.
Why not the others
- A: Warmth and light speed up changes in the specimen.
- B: Freezing isn't the standard home instruction.
- D: Storage affects specimen quality.
Source: MedlinePlus: 24-hour urine collection — How the test is performed · Item PBT-78
Question 45 · Specimen Handling, Transport & Processing
Which specimen should be placed on ice (a slurry of ice and water) and delivered to the lab immediately?
Show answer
Answer: B. Ammonia
Ammonia rises in a specimen at room temperature because of ongoing cell metabolism. Chilling and fast delivery slow that change.
Why not the others
- A: Cold agglutinin specimens must be kept warm.
- C: Blood culture bottles aren't placed on ice.
- D: Routine CBCs don't need ice.
Source: Mayo Clinic Laboratories test catalog: Ammonia (test 35130) — Specimen required · Item PBT-38
Question 46 · Specimen Collection
An IV is infusing in a hospitalized patient's left forearm. The right antecubital area has a suitable vein. Which site is best?
Show answer
Answer: B. The right antecubital vein
Draw from the arm without the IV. Blood near an infusion can be diluted or contaminated with IV fluid or medication, giving false results.
Why not the others
- A: Above an IV is the most likely place to collect diluted, contaminated blood.
- C: WHO advises against drawing from an existing peripheral venous access site because it can give false results.
- D: Any draw from the arm with an infusion risks dilution; use the other arm when it's available.
Source: WHO Guidelines on Drawing Blood (2010), Ch. 2 Best practices in phlebotomy — Section 2.2.3, Steps 2–9 · Item PBT-24
Question 47 · Specimen Collection
A competent adult outpatient changes her mind and says she doesn't want her blood drawn. What should you do?
Show answer
Answer: B. Respect the refusal, don't collect, and notify the ordering provider or supervisor per policy
A patient has the right to refuse a test at any time before the blood is drawn. Respect it, don't collect, and document and notify per policy.
Why not the others
- A: Proceeding over a refusal violates consent.
- C: Restraining a competent adult is not acceptable.
- D: Volume doesn't change consent.
Source: WHO Guidelines on Drawing Blood (2010), Ch. 2 Best practices in phlebotomy — Section 2.2.3, Steps 2–9 · Item PBT-31
Question 48 · Circulatory System
Which statement about arteries is correct?
Show answer
Answer: B. They carry blood away from the heart and have thicker, more muscular walls than veins
Arteries carry blood away from the heart under higher pressure, so their walls carry more muscle and connective tissue than veins. That is one reason routine venipuncture targets veins, not arteries.
Why not the others
- A: That describes veins.
- C: Exchange with tissues happens in capillaries.
- D: Valves are a feature of veins, especially in the limbs.
Source: NCI SEER Training: Classification & Structure of Blood Vessels — Arteries; Veins; Capillaries · Item PBT-03
Question 49 · Specimen Collection
Under The Joint Commission's patient-identification goal, which of these does NOT count as a patient identifier?
Show answer
Answer: C. The patient's room number
Identifiers must be specific to the person. A room number belongs to a location, and patients move — The Joint Commission states that a room number is not a unique patient identifier.
Why not the others
- A: Name is an accepted person-specific identifier.
- B: Date of birth is an accepted identifier.
- D: An assigned identification number such as an MRN is accepted.
Source: The Joint Commission, Standards FAQ: Two patient identifiers (NPSG) — FAQ answer; Home Care manual, updated Aug 29, 2022 · Item PBT-02
Question 50 · Laboratory Operations
Several times a year the lab receives samples from an HHS-approved outside program, tests them the same way as patient specimens, and reports the results for grading. This is:
Show answer
Answer: A. Proficiency testing
Proficiency testing (PT) is how an approved outside program evaluates a laboratory's performance; PT samples must be tested the same way as patient specimens and never sent to another lab. QC uses control materials with known expected ranges, run routinely.
Why not the others
- B: QC uses controls with known expected ranges.
- C: Calibration sets an instrument's measuring scale.
- D: Competency assessment evaluates an individual's performance.
Source: CMS CLIA brochure: Proficiency Testing — p. 1, PT definition · Item PBT-62
Question 51 · Waived & Point-of-Care Testing
A clinic opens a new shipment and lot of rapid strep test kits. Before testing patients, what should staff do?
Show answer
Answer: C. Run the external quality control materials as directed by the manufacturer and the site's policy
Waived testing still requires following the manufacturer's instructions, including quality control. New lots and shipments are a common point to run external controls.
Why not the others
- A: Waived status doesn't exempt a site from the manufacturer's QC instructions.
- B: Duplicate patient testing isn't quality control.
- D: Routine QC is a site task, not a health department report.
Source: CDC, Ready? Set? Test! (2024) and 42 CFR 493.15 — "Ready?" p. 7 (when to run QC); 42 CFR 493.15(e)(1) via https://www.law.cornell.edu/cfr/text/42/493.15 · Item PBT-45
Question 52 · Non-Blood Specimens
A sweat chloride test using pilocarpine iontophoresis is most commonly ordered to help diagnose:
Show answer
Answer: B. Cystic fibrosis
Pilocarpine iontophoresis stimulates sweating, and the chloride level in the collected sweat is the standard test for cystic fibrosis.
Why not the others
- A: Diabetes insipidus uses urine and blood osmolality studies.
- C: Stone workups use urine and stone analysis.
- D: Thyroid disease uses blood tests.
Source: Cystic Fibrosis Foundation: Sweat Test — How the test works · Item PBT-51
Question 53 · Specimen Handling, Transport & Processing
A light-blue sodium citrate tube for a PT/INR arrives in the lab filled to about half its intended volume. What is the appropriate action?
Show answer
Answer: D. Reject it and request a recollection
Citrate tubes rely on a 9:1 blood-to-anticoagulant ratio. Too little blood means too much citrate, which falsely prolongs clotting times.
Why not the others
- A: Coagulation testing is highly sensitive to fill volume.
- B: Combining tubes is never acceptable.
- C: Diluting the specimen makes it worse.
Source: CAP TODAY Q&A, August 2016 (citrate tube fill) — 9:1 ratio; underfilled tubes · Item PBT-35
Question 54 · Circulatory System
Blood obtained by a fingerstick or heel stick is best described as:
Show answer
Answer: B. A mixture of arterial, venous and capillary blood plus interstitial and intracellular fluid
A skin puncture opens tiny arterioles, venules and capillaries at once, and tissue fluid mixes in. That is why some results differ between capillary and venous specimens and why the first drop is wiped away.
Why not the others
- A: Arterial blood requires an arterial puncture.
- C: Venous blood requires venipuncture.
- D: Skin puncture collects whole blood, cells included.
Source: UnityPoint St. Luke's lab procedure CC102, Capillary collection (cites CLSI) — Principle (capillary blood composition) · Item PBT-06
Question 55 · Specimen Collection
Blood cultures, a PT/INR and a CBC are ordered for the same draw. Which should be collected first?
Show answer
Answer: D. The blood culture bottles
Blood cultures (sterile collections) come first in the order of draw, so the bottles are inoculated before any tube stopper or additive can contaminate the needle.
Why not the others
- A: Citrate follows blood cultures.
- B: EDTA comes near the end of the order.
- C: Order matters for both sterility and additive carryover.
Source: BD, Order of Draw for Multiple Tube Collections (VS5729-6, reflects CLSI order) — Order-of-draw sequence and tube uses · Item PBT-66
Question 56 · Specimen Collection
About how far above the intended puncture site should the tourniquet be placed for a routine antecubital draw?
Show answer
Answer: A. About 3–4 inches above it — roughly four to five finger widths
A tourniquet a few inches above the site slows venous return so the vein fills, without getting in the way of the needle. WHO describes the position as four to five finger widths above the site.
Why not the others
- B: It would be in the way and could contaminate the cleaned site.
- C: Too far away to distend the antecubital veins reliably.
- D: Below the site does not trap blood in the target vein.
Source: WHO Guidelines on Drawing Blood (2010), Ch. 2 Best practices in phlebotomy — Section 2.2.3, Steps 2–9 · Item PBT-08
Question 57 · Laboratory Operations
Your lab struggles with one proficiency testing (PT) sample. A coworker suggests sending it to the reference laboratory and reporting their result. What is correct?
Show answer
Answer: C. PT samples must be tested in your own lab, the same way as patient specimens, and not sent to another lab
Under CLIA, PT samples are tested like patient specimens in the laboratory being evaluated; referring them to another laboratory is prohibited.
Why not the others
- A: Referral is prohibited regardless of the other lab's accreditation.
- B: Reporting an expected value isn't testing.
- D: Skipping a sample isn't how PT is handled; follow the program's instructions.
Source: CMS CLIA brochure: Proficiency Testing — p. 1, PT definition · Item PBT-80
Question 58 · Specimen Handling, Transport & Processing
A collection for workplace drug testing requires a chain-of-custody form. What is its purpose?
Show answer
Answer: A. To document every person who handles the specimen from collection to testing
Chain of custody makes the specimen legally defensible by recording each transfer, with signatures, dates and times.
Why not the others
- B: Billing is separate from custody.
- C: It is not a medication history.
- D: The specimen is still labeled and sealed.
Source: 49 CFR 40.3 Definitions — Chain of custody — "Chain of custody" · Item PBT-42
Question 59 · Circulatory System
Blood collected in a plain red-top tube with no anticoagulant is allowed to clot and is then centrifuged. Compared with plasma, the liquid you separate lacks:
Show answer
Answer: C. Fibrinogen
When blood clots, fibrinogen is converted to fibrin and trapped in the clot. The remaining fluid is serum. Plasma comes from anticoagulated blood and still contains fibrinogen.
Why not the others
- A: Glucose remains in serum (it falls over time only if cells keep using it).
- B: Serum is still mostly water.
- D: Albumin remains in serum.
Source: Labcorp, Blood Specimens: Chemistry and Hematology — Serum vs plasma; clotting time; hemolysis · Item PBT-05
Question 60 · Specimen Collection
A hospitalized patient is not wearing an ID band and is too confused to state her name. The nurse says, "That's Mrs. Kim, go ahead." What should you do?
Show answer
Answer: D. Don't collect until the patient is identified according to facility policy (for example, an ID band is placed)
Blood collection requires at least two person-specific identifiers, confirmed through the facility's identification procedure. A room or door sign isn't an identifier, and drawing first and identifying later is how wrong-blood-in-tube errors happen.
Why not the others
- A: A coworker's verbal statement doesn't replace the facility's identification procedure.
- B: Collecting first and identifying later is how wrong-blood-in-tube errors happen.
- C: Room and door signs are locations, not identifiers.
Source: The Joint Commission, NPSG.01.01.01 (2015 Ambulatory NPSG, EP 1) — p. 1 · The Joint Commission, Standards FAQ: Two patient identifiers (NPSG) — FAQ answer; Home Care manual, updated Aug 29, 2022 · Item PBT-34
Question 61 · Specimen Handling, Transport & Processing
A provider calls asking to add a PT/INR to a lavender EDTA tube collected an hour ago. What is the correct response?
Show answer
Answer: A. Explain that a PT requires a light-blue sodium citrate tube, so a new specimen is needed
Add-on testing is acceptable only when the existing specimen is the right type and still within stability. Coagulation testing requires citrated plasma.
Why not the others
- B: EDTA is the wrong anticoagulant for coagulation testing.
- C: Transferring between additive tubes is never acceptable.
- D: Adding citrate doesn't create a valid specimen.
Source: BD, Order of Draw for Multiple Tube Collections (VS5729-6, reflects CLSI order) — Order-of-draw sequence and tube uses · Item PBT-44
Question 62 · Specimen Handling, Transport & Processing
About how long should a gold-top serum separator tube stand before it is centrifuged?
Show answer
Answer: D. About 30 minutes, to allow complete clotting
Serum tubes need time to clot completely; spinning too early leaves fibrin strands and a gel barrier that doesn't form well. BD's instructions call for about 30 minutes.
Why not the others
- A: An unclotted SST forms fibrin in the serum after spinning.
- B: Prolonged storage before separation isn't the standard.
- C: Waiting hours lets cells alter analytes such as glucose and potassium.
Source: BD Tech Talk Vol. 4 No. 2 (Nov 2005), SST processing — 30-minute minimum clotting time · Labcorp, Blood Specimens: Chemistry and Hematology — Serum vs plasma; clotting time; hemolysis · Item PBT-36
Question 63 · Specimen Collection
A green-top plasma result shows a potassium of 9.8 mmol/L and a calcium of 3.1 mg/dL (0.77 mmol/L) in a patient who is talking normally and has no symptoms. The lavender tube was drawn before the green tube. What is the most likely explanation?
Show answer
Answer: C. EDTA carryover from the lavender tube
Potassium EDTA contamination raises potassium and binds calcium, so the pattern is a falsely high potassium with a falsely low calcium. Hemolysis also raises potassium but does not drop calcium like this. Drawing EDTA after heparin prevents it.
Why not the others
- A: Hemolysis explains high potassium, not the very low calcium.
- B: Tourniquet time causes hemoconcentration, which would not drop calcium this way.
- D: Fasting status doesn't produce this potassium–calcium pattern.
Source: Bazzano et al., Int J Environ Res Public Health 2021;18:1568 (systematic review) — EDTA contamination: hyperkalaemia, hypocalcaemia · BD, Order of Draw for Multiple Tube Collections (VS5729-6, reflects CLSI order) — Order-of-draw sequence and tube uses · Item PBT-14
Question 64 · Specimen Collection
How many gentle inversions does BD recommend for a light-blue sodium citrate tube right after collection?
Show answer
Answer: B. 3 to 4
BD's order-of-draw guide lists 3 to 4 gentle inversions for citrate tubes. Enough to mix the citrate, not so much that the specimen is damaged.
Why not the others
- A: Unmixed citrate tubes can clot.
- C: 8 to 10 inversions is the recommendation for EDTA, heparin and fluoride tubes.
- D: Excessive mixing isn't recommended and can damage the specimen.
Source: BD, Order of Draw for Multiple Tube Collections (VS5729-6) — Inversions column · Item PBT-72
Question 65 · Specimen Handling, Transport & Processing
The lab needs a STAT plasma chemistry result and can't wait for a tube to clot. Which tube is the usual choice?
Show answer
Answer: D. Green-top lithium heparin tube
Heparin prevents clotting, so lithium heparin plasma can be centrifuged right away for many chemistry tests.
Why not the others
- A: Serum tubes must clot first.
- B: Citrate tubes are for coagulation testing.
- C: SSTs must clot first, too.
Source: BD, Order of Draw for Multiple Tube Collections (VS5729-6, reflects CLSI order) — Order-of-draw sequence and tube uses · Labcorp, Blood Specimens: Chemistry and Hematology — Serum vs plasma; clotting time; hemolysis · Item PBT-43
Question 66 · Laboratory Operations
A centrifuge's power cord starts smoking and catches fire. Which class of fire extinguisher is designed for energized electrical equipment?
Show answer
Answer: C. Class C
Class C covers energized electrical equipment. Class A is ordinary combustibles, B is flammable liquids such as gasoline, oils and solvents, and D is combustible metals. Many facilities teach PASS (Pull, Aim, Squeeze, Sweep) for using an extinguisher.
Why not the others
- A: Ordinary combustibles like paper and wood.
- B: Flammable liquids such as gasoline and solvents.
- D: Combustible metals.
Source: OSHA eTool: Portable Fire Extinguishers — About / Use — Extinguisher basics (classes); PASS on the 'use' page · Item PBT-58
Question 67 · Laboratory Operations
Under OSHA's bloodborne pathogens standard, how must hepatitis B vaccination be offered to a newly hired phlebotomist?
Show answer
Answer: A. At no cost to the employee
OSHA requires employers to make the hepatitis B vaccine series available at no cost to employees with occupational exposure, within 10 working days of initial assignment and after training.
Why not the others
- B: Cost can't be passed to the employee.
- C: It must be offered before exposure, not only after.
- D: Age is not a criterion.
Source: OSHA 29 CFR 1910.1030 Bloodborne Pathogens — (d)(4)(iii)(A)(1); (f)(1)(ii)(A); (f)(2)(i) · Item PBT-54
Question 68 · Specimen Collection
A CBC, a basic metabolic panel and a blood culture set are ordered at the same time. What is the most important step to reduce blood culture contamination?
Show answer
Answer: D. Apply the skin antiseptic and let it dry completely, and don't re-touch the site
Contamination comes mostly from skin flora. Proper antisepsis with full drying time and not re-palpating the site are core contamination-prevention steps; cultures are drawn first in the order of draw.
Why not the others
- A: Blood cultures go first in the order of draw.
- B: Overfilling bottles is not recommended and can raise false positives.
- C: Needle size isn't the contamination control.
Source: CDC, Preventing Adult Blood Culture Contamination: A Quality Tool — SOP best practices, Steps 2–3 · WHO Guidelines on Drawing Blood (2010), Ch. 2 Best practices in phlebotomy — Section 2.2.3, Steps 2–9 · BD, Order of Draw for Multiple Tube Collections (VS5729-6, reflects CLSI order) — Order-of-draw sequence and tube uses · Item PBT-25
Question 69 · Specimen Collection
Which order correctly describes collection of microcollection tubes from a fingerstick?
Show answer
Answer: B. EDTA tube first, then other additive tubes, then serum tubes
Capillary order differs from venous order: EDTA (hematology) is collected first because platelets begin clumping as the puncture starts to clot. Other additive tubes follow, then serum.
Why not the others
- A: Serum tubes come last in capillary collection.
- C: Fluoride isn't first.
- D: Order matters because of clotting at the puncture site.
Source: UnityPoint St. Luke's lab procedure CC102, Capillary collection (cites CLSI); WHO Ch. 7 — Order of collection; WHO §7.1.3 at https://www.ncbi.nlm.nih.gov/books/NBK138654/ · Item PBT-26
Question 70 · Laboratory Operations
In the cafeteria, a coworker asks you about a celebrity patient's lab results that you saw at work. What should you do?
Show answer
Answer: B. Decline; you may only use or disclose protected health information as needed for your job
The HIPAA Privacy Rule protects individually identifiable health information. Employees access and share it only as their role requires — the minimum necessary.
Why not the others
- A: Working at the same hospital doesn't create a need to know.
- C: Any result is protected.
- D: A promise of secrecy doesn't make the disclosure permitted.
Source: HHS, Summary of the HIPAA Privacy Rule — Protected Health Information; Minimum Necessary · Item PBT-61
Question 71 · Specimen Collection
After cleaning the site, you lose track of the vein and touch the site again with your gloved finger to find it. What should you do before inserting the needle?
Show answer
Answer: A. Clean the site again and let it dry
Touching the cleaned site recontaminates it. WHO's guidance is to repeat the disinfection if the site is touched — and not to place a finger over the vein to guide the needle.
Why not the others
- B: The site is no longer clean.
- C: Cleaning your glove doesn't re-clean the skin you touched.
- D: Blowing on the site adds contamination; let it air-dry.
Source: WHO Guidelines on Drawing Blood (2010), Ch. 2 Best practices in phlebotomy — Section 2.2.3, Steps 2–9 · Item PBT-68
Question 72 · Laboratory Operations
After a venipuncture with a needle-and-holder system, what is the correct disposal?
Show answer
Answer: C. Activate the safety feature and discard the needle and holder together into a sharps container
OSHA's bloodborne pathogens standard prohibits bending, recapping or removing contaminated needles except in narrow circumstances using a mechanical device or one-handed technique. Activate the safety device and discard the unit.
Why not the others
- A: Two-handed recapping is a classic needlestick cause.
- B: Hand removal of a contaminated needle is prohibited.
- D: Bending contaminated needles is prohibited.
Source: OSHA 29 CFR 1910.1030 Bloodborne Pathogens — (d)(2)(vii) · Item PBT-53
Question 73 · Specimen Collection
Where should a heel puncture be performed on an infant?
Show answer
Answer: A. The medial or lateral side of the plantar (bottom) surface of the heel
The medial and lateral plantar surfaces keep the lancet away from the calcaneus (heel bone). Puncturing the posterior curvature or the center risks bone injury and infection.
Why not the others
- B: The posterior curvature is too close to bone.
- C: The central area overlies the heel bone.
- D: Toes are not an acceptable infant heel-stick site.
Source: WHO Guidelines on Drawing Blood, Ch. 7 Capillary sampling; UCHealth SC011.2 Infant heel puncture — §7.1.2 (avoid posterior heel — bone); UCHealth https://www.uchealth.com/wp-content/uploads/sites/5/2012/08/SC011.2-Infant-Heel-Puncture-website.pdf · Item PBT-27
Question 74 · Specimen Collection
Which antecubital vein is generally the first choice for routine venipuncture?
Show answer
Answer: A. Median cubital vein
The median cubital vein usually lies between muscles, is well anchored and is the easiest to puncture. The basilic vein runs near an artery and a nerve, so it is the last choice in the antecubital area.
Why not the others
- B: The basilic vein lies over the brachial artery and median nerve — higher risk.
- C: The cephalic vein can be used, but the median cubital is usually the easiest to puncture.
- D: A strong pulse signals an artery nearby, which you want to avoid.
Source: WHO Guidelines on Drawing Blood (2010), Ch. 2 Best practices in phlebotomy — Section 2.2.3, Steps 2–9 · Item PBT-07
Question 75 · Laboratory Operations
The core idea of Standard Precautions is to:
Show answer
Answer: D. Treat all blood and body fluids as potentially infectious for every patient
Standard Precautions apply to all patients, regardless of diagnosis, because infection status is often unknown.
Why not the others
- A: Many infections are unknown at the time of care.
- B: Respirators are for specific airborne precautions.
- C: Private-room isolation is transmission-based, not standard.
Source: CDC 2007 Isolation Precautions guideline — Standard Precautions — III.A Standard Precautions · Item PBT-55
Question 76 · Specimen Collection
Why is a gray-top sodium fluoride/potassium oxalate tube used for some glucose specimens?
Show answer
Answer: A. Fluoride inhibits glycolysis, helping preserve glucose after collection
Blood cells keep consuming glucose after collection. Sodium fluoride inhibits enolase in glycolysis, helping preserve glucose, while potassium oxalate acts as the anticoagulant. Fluoride does not stop glycolysis immediately, so prompt processing still matters.
Why not the others
- B: Oxalate is an anticoagulant — it prevents clotting.
- C: Smears use EDTA blood; fluoride is for glucose preservation.
- D: Point-of-care meters typically use fresh capillary blood, not gray-top tubes.
Source: CAP TODAY Q&A, July 2022 (fluoride and glycolysis) — Sodium fluoride inhibits enolase; delay of 2–4 h · Item PBT-17
Question 77 · Specimen Collection
As the needle enters, the patient reports a sharp, electric pain shooting down the forearm. What should you do?
Show answer
Answer: B. Remove the needle immediately and apply pressure
Shooting or electric pain suggests the needle has touched a nerve. Stop immediately to prevent nerve injury, then document and report per policy.
Why not the others
- A: Continuing risks permanent nerve damage.
- C: Lateral redirecting is how nerves get injured.
- D: Fist clenching won't help and delays stopping.
Source: Hamad Medical Corporation Lab Guide, Venous collection complications — Hematoma, syncope, nerve injury · Item PBT-22
Question 78 · Non-Blood Specimens
How should a patient start a 24-hour urine collection on the first morning?
Show answer
Answer: C. Urinate into the toilet and discard the first morning void, note the time, then collect all urine for the next 24 hours
The first void contains urine made before the timed period, so it is discarded and the clock starts. The collection ends with the first void the next morning at the same time.
Why not the others
- A: Including it adds urine from outside the 24-hour window.
- B: Night urine must be included.
- D: All urine is collected, not hourly samples.
Source: MedlinePlus: 24-hour urine collection — How the test is performed · Item PBT-50
Question 79 · Specimen Collection
Why should 70% isopropyl alcohol be allowed to air-dry completely before the venipuncture?
Show answer
Answer: C. Wet alcohol can interfere with the specimen and sting, and drying time is part of the antiseptic's contact time
WHO recommends cleaning for 30 seconds and letting the site dry completely; not allowing enough contact time increases contamination risk. Labcorp notes that alcohol that isn't allowed to dry can hemolyze the specimen, and wet alcohol stings.
Why not the others
- A: Drying has nothing to do with the tourniquet.
- B: Alcohol is an antiseptic, not an anticoagulant.
- D: Skipping the drying step defeats the antisepsis.
Source: WHO Guidelines on Drawing Blood (2010), Ch. 2 Best practices in phlebotomy — Section 2.2.3, Steps 2–9 · Labcorp, Blood Specimens: Chemistry and Hematology — Serum vs plasma; clotting time; hemolysis · Item PBT-10
Question 80 · Specimen Handling, Transport & Processing
How should specimens be packaged for transport from a clinic to the laboratory?
Show answer
Answer: A. In a leakproof plastic bag, with the requisition in the bag's separate outside pocket
WHO recommends a leakproof bag with an outside compartment for the requisition, so paperwork stays clean if a tube leaks. Racks or padded holders prevent breakage.
Why not the others
- B: Pockets offer no leak or breakage protection.
- C: Putting paperwork with the tubes lets a leak contaminate it.
- D: Open racks offer no containment if a tube breaks.
Source: WHO Guidelines on Drawing Blood (2010), Ch. 2 Best practices in phlebotomy — Section 2.2.3, Steps 2–9 · Item PBT-74
Score yourself by content area
Count your correct answers in each area. Because this set keeps each content area inside ASCP BOC’s published percentage range, the area where you missed the most questions is a practical place to start reviewing. On a tie, start with the area that carries more of the real exam. This is study triage, not ASCP scoring.
| Content area | Questions in this set | Question numbers | Real exam share | Your correct |
|---|---|---|---|---|
| Circulatory System | 6 | 3, 16, 35, 48, 54, 59 | 5–10% | ___ / 6 |
| Specimen Collection | 38 | 1, 2, 4, 5, 8, 9, 10, 11, 12, 17, 19, 20, 21, 25, 27, 29, 32, 36, 39, 40, 42, 43, 46, 47, 49, 55, 56, 60, 63, 64, 68, 69, 71, 73, 74, 76, 77, 79 | 45–50% | ___ / 38 |
| Specimen Handling, Transport & Processing | 12 | 7, 15, 18, 33, 41, 45, 53, 58, 61, 62, 65, 80 | 15–20% | ___ / 12 |
| Waived & Point-of-Care Testing | 6 | 13, 14, 23, 30, 34, 51 | 5–10% | ___ / 6 |
| Non-Blood Specimens | 6 | 6, 22, 31, 44, 52, 78 | 5–10% | ___ / 6 |
| Laboratory Operations | 12 | 24, 26, 28, 37, 38, 50, 57, 66, 67, 70, 72, 75 | 15–20% | ___ / 12 |
| Total | 80 | ___ / 80 |
What your score means. It's feedback on these 80 questions, not an ASCP score and not a prediction. The real exam is computer adaptive: it starts near the passing standard, gets harder when you answer correctly and easier when you miss, and scores the pattern of your answers on a 100–999 scale, where 400 passes. ASCP says there is no set number or percentage of correct answers needed to pass, so there's no way to convert a practice percentage into an ASCP score. Six questions in an area is also too few to measure that area precisely; use the tally to choose what to study, not to judge your odds.
If you already took the exam and didn't pass, your ASCP score report breaks the result down by subtest area. Line those areas up with the table above and start where the report and this set agree.
How to get the most from this test
- Take it under exam conditions once. Set a 2-hour timer, answer all 80 without notes, and don't open any answers until you finish. That's the real exam's pace: 90 seconds per question on average.
- Read every explanation, including the ones you got right. A lucky guess and a solid answer look the same on a score sheet.
- Review by area, then retest. Go back to the source behind each missed question, study that topic, and retake only that area's questions a few days later.
Answer key
Show the complete answer key
| # | Answer | Area | Separator | # | Answer | Area |
|---|---|---|---|---|---|---|
| 1 | B | Specimen Collection | 41 | D | Specimen Handling, Transport & Processing | |
| 2 | D | Specimen Collection | 42 | B | Specimen Collection | |
| 3 | A | Circulatory System | 43 | A | Specimen Collection | |
| 4 | A | Specimen Collection | 44 | C | Non-Blood Specimens | |
| 5 | B | Specimen Collection | 45 | B | Specimen Handling, Transport & Processing | |
| 6 | D | Non-Blood Specimens | 46 | B | Specimen Collection | |
| 7 | D | Specimen Handling, Transport & Processing | 47 | B | Specimen Collection | |
| 8 | B | Specimen Collection | 48 | B | Circulatory System | |
| 9 | B | Specimen Collection | 49 | C | Specimen Collection | |
| 10 | B | Specimen Collection | 50 | A | Laboratory Operations | |
| 11 | C | Specimen Collection | 51 | C | Waived & Point-of-Care Testing | |
| 12 | C | Specimen Collection | 52 | B | Non-Blood Specimens | |
| 13 | C | Waived & Point-of-Care Testing | 53 | D | Specimen Handling, Transport & Processing | |
| 14 | C | Waived & Point-of-Care Testing | 54 | B | Circulatory System | |
| 15 | C | Specimen Handling, Transport & Processing | 55 | D | Specimen Collection | |
| 16 | D | Circulatory System | 56 | A | Specimen Collection | |
| 17 | D | Specimen Collection | 57 | C | Laboratory Operations | |
| 18 | C | Specimen Handling, Transport & Processing | 58 | A | Specimen Handling, Transport & Processing | |
| 19 | D | Specimen Collection | 59 | C | Circulatory System | |
| 20 | C | Specimen Collection | 60 | D | Specimen Collection | |
| 21 | A | Specimen Collection | 61 | A | Specimen Handling, Transport & Processing | |
| 22 | C | Non-Blood Specimens | 62 | D | Specimen Handling, Transport & Processing | |
| 23 | A | Waived & Point-of-Care Testing | 63 | C | Specimen Collection | |
| 24 | A | Laboratory Operations | 64 | B | Specimen Collection | |
| 25 | D | Specimen Collection | 65 | D | Specimen Handling, Transport & Processing | |
| 26 | B | Laboratory Operations | 66 | C | Laboratory Operations | |
| 27 | A | Specimen Collection | 67 | A | Laboratory Operations | |
| 28 | C | Laboratory Operations | 68 | D | Specimen Collection | |
| 29 | D | Specimen Collection | 69 | B | Specimen Collection | |
| 30 | B | Waived & Point-of-Care Testing | 70 | B | Laboratory Operations | |
| 31 | A | Non-Blood Specimens | 71 | A | Specimen Collection | |
| 32 | A | Specimen Collection | 72 | C | Laboratory Operations | |
| 33 | A | Specimen Handling, Transport & Processing | 73 | A | Specimen Collection | |
| 34 | D | Waived & Point-of-Care Testing | 74 | A | Specimen Collection | |
| 35 | D | Circulatory System | 75 | D | Laboratory Operations | |
| 36 | D | Specimen Collection | 76 | A | Specimen Collection | |
| 37 | A | Laboratory Operations | 77 | B | Specimen Collection | |
| 38 | D | Laboratory Operations | 78 | C | Non-Blood Specimens | |
| 39 | C | Specimen Collection | 79 | C | Specimen Collection | |
| 40 | B | Specimen Collection | 80 | A | Specimen Handling, Transport & Processing |
About the real ASCP PBT exam
| Exam feature | Official fact |
|---|---|
| Questions and time | 80 questions in 2 hours |
| Format | Multiple choice, four options, one best answer; computer adaptive testing (CAT) |
| Skipping and review | You must answer each question before moving on and can't skip, but you can flag questions and review them if time remains after answering all of them |
| Unscored questions | Field-test questions are mixed in and look the same as scored ones |
| Calculator | An onscreen calculator is available |
| Scoring | Scaled score 100–999; minimum passing score 400; no set number or percentage correct |
| Results | Preliminary pass/fail on screen; email notice to view your official score report within four business days, once required transcripts are processed |
| Where | Pearson testing centers |
| Application fee | $155, non-refundable, for PBT(ASCP) |
| Content guideline | Revised October 2023 — six content areas (table below); ASCP BOC’s practice analysis identifies January 1, 2024 as the publication date for the corresponding PBT exam |
| Lab values on the exam | Shown in both conventional and SI units; regulatory questions are based on U.S. sources |
This practice test matches the real exam's length and pace, but it isn't adaptive: everyone sees the same 80 questions in the same order.
Sources: ASCP BOC About the Examination · PBT content guideline, revised October 2023 · PBT Practice Analysis Report · ASCP BOC PBT credential page · ASCP BOC Examination Results. Last verified November 2, 2026.
How this set matches the content guideline
ASCP publishes a percentage range for each of six content areas, not a fixed number of questions. We sized each area of this 80-question set to land inside its official range.
| Content area | What it covers (official description, shortened) | Official range | This set |
|---|---|---|---|
| Circulatory System | Heart, vessels, blood composition, terminology | 5–10% | 6 questions (7.5%) |
| Specimen Collection | Orders, patient communication and ID, site selection, technique, order of draw, complications, equipment | 45–50% | 38 questions (47.5%) |
| Specimen Handling, Transport & Processing | Specimen acceptability, labeling, centrifugation, transport and storage | 15–20% | 12 questions (15.0%) |
| Waived & Point-of-Care Testing | Waived and point-of-care tests, instrument operation, quality control | 5–10% | 6 questions (7.5%) |
| Non-Blood Specimens | Urine, stool, sputum, swabs, breath and sweat testing, chain of custody | 5–10% | 6 questions (7.5%) |
| Laboratory Operations | Quality, proficiency testing, ethics and HIPAA, regulations, safety and infection control | 15–20% | 12 questions (15.0%) |
Specimen Collection is roughly half the exam. It's where order of draw, patient identification, site selection and complications live, so if your time is short, spend most of it there and on the two 15–20% areas.
Every question is original, written by Castleport Test Prep to the guideline's topics. None are recalled, shared or official ASCP items. Each explanation links to the public guideline, regulation or reference behind the answer so you can check it.
Common questions
Is this the real ASCP exam or real ASCP questions? No. These are original questions written to the public content guideline. ASCP doesn't release its exam items.
How many questions are on the ASCP PBT exam, and how long is it? 80 questions in 2 hours, delivered as a computer adaptive test.
What score do I need to pass? A scaled score of 400 on ASCP's 100–999 scale. There's no fixed percentage, so no practice test — this one included — can tell you your ASCP score.
Can I go back and change answers on the real exam? You can't skip a question, but you can flag questions and return to them if you have time after answering everything.
Do I need to bring a calculator? No. ASCP provides an onscreen calculator.
What if I fail? ASCP lets you retest no earlier than 30 days after your previous exam, with a new application and fee, up to five attempts under one eligibility route. Details are on ASCP BOC's After the Examination page.
Am I eligible, and how do I apply? Eligibility depends on which current PBT(ASCP) route you meet. Check the official ASCP BOC PBT eligibility requirements, then use our ASCP exam registration guide for the application process. The current PBT(ASCP) application fee is $155 and is non-refundable.
Is this the same as the NHA CPT phlebotomy exam? No. NHA's CPT is a different exam with its own test plan, and many free phlebotomy questions online are written for it. If CPT is your exam, use our free NHA CPT practice test.
What should I study from? Start with ASCP BOC's PBT content guideline — it lists every topic the exam can cover — and its suggested reading list for PBT. ASCP notes the reading list is partial and that the exam isn't drawn solely from those publications.
Sources and verification
Exam facts on this page — question count, time, format, scoring, content areas, fee and retake rule — were checked against ASCP BOC's own pages, the October 2023 PBT content guideline, and the PBT practice-analysis report on November 2, 2026. Each answer explanation links to the public guideline, regulation or reference behind it; where a professional standard isn't publicly available, we cite a public manufacturer, laboratory or health-agency document that states the same practice. The questions were written and source-checked by the Castleport Test Prep Editorial Team. They have not been reviewed by a credentialed phlebotomist. Procedures can differ between facilities, so at work, follow your laboratory's policy.
Found an error? Report it and we'll correct it publicly.
Written by the Castleport Test Prep Editorial Team · Last verified: November 2, 2026
Castleport Test Prep is an independent exam prep publisher. It is not affiliated with, endorsed by, or approved by the American Society for Clinical Pathology (ASCP) or the ASCP Board of Certification. PBT(ASCP) and other exam and credential names are used only to identify the subjects discussed; trademarks belong to their respective owners. All questions on this page are original, unofficial practice items, and using them does not guarantee any score or certification outcome.
Researched and drafted with AI assistance against the sources listed above. See our methodology and editorial standards. Source checking is not professional review.
Source-link updates: Three obsolete reference links now open NCI’s current “Composition of Blood” section, CDC’s blood-culture quality tool at its current URL, and the Center for Phlebotomy Education’s May 2026 tourniquet guidance. Question, answer and citation wording is unchanged.