Written to NHA's CPT test plan
- Safety and Compliance 26%
- Patient Preparation 20%
- Routine Blood Collections 28%
- Special Collections 12%
- Processing 14%
Free · 2026 · 12% of the NHA CPT Phlebotomy Special Collections practice questions
Special Collections is 12% of the NHA CPT. Answer 10 questions (6 on Special Collections) and see your score by domain, with every answer explained. Free, no sign-up.
A pregnant patient is having a 3-hour oral glucose tolerance test with a 100 g glucose drink. Right after the 1-hour draw, she asks whether she may chew a piece of sugar-free gum and step outside for a cigarette before the next draw. How should the phlebotomist respond?
Tap an answer, or press A to D
Blood cultures, newborn screening, blood donation, glucose tolerance and drug levels, point-of-care tests, blood alcohol and drug screens.
What the NHA CPT exam tests in Special Collections
- Blood cultures: skin preparation, bottle preparation, aerobic and anaerobic bottles and their order, volume requirements, number and timing of sets, place in the order of draw, preventing contamination
- Assisting other health care professionals: pediatric and geriatric collections, specimens from tunneled and non-tunneled central lines, ports and PICCs, transfer devices and specimen handoff
- Newborn screening for metabolic disorders (PKU, galactosemia): heel puncture and filter-paper blood spot technique, timing, drying and rejection reasons; calculating or looking up pediatric blood volume limits
- Blood donation: donor screening (hemoglobin or hematocrit, temperature, pulse, blood pressure, weight), donation needles and bags, unit volume, donor reactions; autologous donation and therapeutic phlebotomy
- Point-of-care testing (blood glucose, hemoglobin and hematocrit, urine pregnancy test, urinalysis dipstick) and non-blood collections (throat swab, nasal and nasopharyngeal swab, wound culture)
- Tolerance and timed tests: glucose tolerance tests including gestational testing, 2-hour postprandial glucose, lactose tolerance, therapeutic drug monitoring (peak and trough levels)
- Forensic and legal specimens: skin preparation for blood alcohol, specimen collection for drug screening (identity checks, temperature, volume, tampering), chain of custody
High-yield special collections facts
- Blood cultures: ordered for suspected bacteremia or septicemia (fever of unknown origin). Collect BEFORE antibiotics start when possible. The number, sites and timing of sets follow the order (often 2 sets from 2 separate venipuncture sites). 1 set = 1 aerobic + 1 anaerobic bottle.
- Culture skin prep is stricter than routine: chlorhexidine (often in alcohol) or iodine-based antiseptic, scrubbed with friction for the product's required time and allowed to DRY completely (iodine takes longer). Re-prep if you touch the site.
- Bottle prep: remove the caps, wipe each septum with 70% isopropyl alcohol and let it dry, mark the fill line.
- Fill volume is the biggest factor in detecting infection: underfilling misses organisms; follow the bottle maker's volume.
- Winged set: fill the AEROBIC bottle first (the tubing air goes into it). Keep bottles upright and below the site (no backflow of broth into the vein). Cultures are FIRST in the order of draw.
- After a culture draw: label each bottle with site, time and set number; don't refrigerate; send promptly.
| Test | Dose | Fasting? |
|---|---|---|
| Standard 2-h OGTT, nonpregnant adult | 75 g | Yes |
| Gestational one-step | 75 g | Yes |
| Gestational 1-h screen | 50 g | No |
| Gestational 3-h diagnostic | 100 g | Yes |
The full Phlebotomy High-Yield Cram Sheet comes with full prep.
Common special collections traps
- Blood cultures come FIRST in the order of draw; the prep must dry completely.
- Winged set: aerobic bottle before anaerobic.
- Never clean with alcohol for blood alcohol; fill the gray top and keep it stoppered.
- Newborn card: one drop per circle, one side only, dry flat away from heat and sun, never stacked.
- Newborn screen drawn before 24 h may miss PKU.
- Trough = just before the next dose; peak timing is drug-specific.
- GTT: fasting draw first, ordered dose, exact intervals, only water, label each tube with its time.
- Donor Hgb: 12.5 g/dL female, 13.0 g/dL male; earlobe blood not allowed; whole blood every 8 weeks at most.
Free Phlebotomy special collections practice questions
Question 1
A phlebotomist collects an adult set of blood cultures with a winged collection set. The bottle manufacturer recommends 8-10 mL per bottle. The vein collapses after only about 3 mL has entered the aerobic bottle. Which statement about this bottle is correct?
- AVolume doesn't matter, because even a single organism will multiply in the broth
- BThe low volume reduces the chance of detecting organisms and can cause a false-negative result
- CThe low volume raises the risk of a false-positive result from skin contaminants
- DThe bottle should be refrigerated to preserve the sample until more blood is obtained
Show answer and explanation
Answer: B. Underfilled bottles may miss bacteremia, so collectors aim for the manufacturer's recommended volume and mark the fill level on the bottle.
Why not A: Organisms are often present in very low numbers, so a small sample may contain none. Blood volume is the biggest factor in detecting infection.
Why not C: Contamination comes from poor skin or bottle preparation, not from low volume. Overfilling, not underfilling, is linked to false positives in some systems.
Why not D: Blood culture bottles must never be refrigerated; cold can harm organisms. Bottles are sent to the lab promptly at room temperature.
Remember: Blood volume is the biggest factor in blood culture detection: underfilled bottles risk false negatives, and bottles are never refrigerated.
Question 2
A nurse draws blood from a PICC line into a syringe and hands it to the phlebotomist to fill a light blue (sodium citrate), a gold SST and a lavender (EDTA) tube. How should the tubes be filled?
- ARemove each stopper and gently push the blood into the open tube
- BPush the syringe needle through each stopper and depress the plunger
- CUse a safety transfer device and fill the lavender tube first
- DUse a safety transfer device and let each tube's vacuum fill it in order of draw
Show answer and explanation
Answer: D. A transfer device prevents needlesticks. Letting the vacuum draw the blood avoids hemolysis, and the venous order prevents additive carryover.
Why not A: Opening tubes risks spills and aerosols, and pouring or pushing blood in disturbs the blood-to-additive ratio.
Why not B: This risks needlesticks, and forcing blood through a needle hemolyzes it and can pop the stopper.
Why not C: EDTA first applies only to capillary collection. Syringe transfers follow the venous order, so lavender comes after citrate and serum tubes.
Remember: Transfer syringe blood with a safety transfer device, let the vacuum fill each tube, and follow the venous order of draw.
Question 3
A phlebotomist is collecting one set of blood cultures with a winged collection set directly into the bottles. Which bottle should be filled first, and why?
- AAerobic first, so the air in the tubing goes into the aerobic bottle
- BAnaerobic first, because that bottle needs the larger blood volume
- CAnaerobic first, because the first blood is the least contaminated
- DEither bottle first, because tubing air does not affect the culture
Show answer and explanation
Answer: A. The winged tubing holds air. Sending that air into the aerobic bottle keeps oxygen out of the anaerobic bottle.
Why not B: Fill volumes are set by the bottle maker for each bottle and do not decide the order. Tubing air is the deciding factor.
Why not C: Contamination is prevented by skin and septum prep, not bottle sequence. With a winged set, the aerobic bottle goes first.
Why not D: Air in the tubing would introduce oxygen into the anaerobic bottle if that bottle were filled first.
Remember: With a winged set, fill the aerobic bottle first so tubing air doesn't enter the anaerobic bottle.
Question 4
A provider orders an aerobic wound culture from a leg ulcer. The wound surface is covered with pus and loose debris. Which collection approach is best?
- ASwab the intact skin at the edge of the wound, avoiding the open area
- BGently clean away surface debris with sterile saline, then swab viable tissue at the wound base
- CClean the wound with 70% isopropyl alcohol, let it dry, then swab the wound base
- DSwab the surface pus before any cleaning, because it holds the most organisms
Show answer and explanation
Answer: B. saline removes contaminating surface material without killing pathogens. Sampling the wound base targets the organisms causing the infection.
Why not A: Intact skin grows normal skin flora rather than the wound pathogen, so the culture would not reflect the infection.
Why not C: An antiseptic in the wound kills the organisms being cultured and can cause a false-negative result.
Why not D: Surface pus and debris contain colonizing bacteria that may not cause the infection. Swabbing it can give misleading results.
Remember: For a wound culture, rinse off surface debris with sterile saline and swab viable tissue in the wound base, not surface pus.
Question 5
Which finding on a dried newborn screening card would most likely cause the state laboratory to reject the specimen?
- AA card that was air-dried flat before it was placed in its mailing envelope
- BBlood spots that are uniform in color and soaked evenly through to the back
- CBlood applied to one side of the filter paper only, with a single application per circle
- DCircles showing overlapping drops with darker rings where blood was layered
Show answer and explanation
Answer: D. Layering or applying blood to a circle more than once gives uneven, layered spots that cannot be measured accurately, so the specimen is unsatisfactory and must be recollected.
Why not A: Drying flat before packaging is the correct procedure and is not a reason for rejection.
Why not B: Even color and complete saturation from front to back is what an acceptable specimen looks like.
Why not C: A single application to one side of the paper is the correct technique and produces an acceptable spot.
Remember: Layered, incompletely filled, oversaturated, clotted or contaminated spots are common reasons newborn screening cards are rejected.
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