AMCA PHLEBOTOMY EXAM QUESTIONS AND ANSWERS WITH
RATIONALES LATEST UPDATE GRADED A
1. While collecting a blood specimen for coagulation testing, the phlebotomist notes the tube
was underfilled. What is the most likely effect on test results?
A. Prolonged clotting time
B. Decreased platelet count
C. Hemolyzed plasma
D. Falsely increased hematocrit
Answer: A
Rationale: The sodium citrate additive requires a precise blood-to-additive ratio (9:1).
Underfilling alters the ratio, falsely prolonging clotting time.
2. A phlebotomist must collect blood cultures before antibiotic therapy. Which of the following
best ensures accurate detection of bacteremia?
A. Use of alcohol swab only for site prep
B. Collect both aerobic and anaerobic bottles
C. Drawing from IV line already in place
D. Filling tubes without cleansing bottle stoppers
Answer: B
Rationale: Both aerobic and anaerobic bottles are necessary to detect different organisms. Strict
aseptic technique is critical to avoid contamination.
3. A patient has a left mastectomy and right arm fistula. Where should the phlebotomist draw
blood?
A. Left antecubital vein
,B. Right wrist vein
C. Left hand vein
D. Dorsal foot vein (with permission)
Answer: D
Rationale: Neither arm is suitable due to lymphatic compromise and fistula. The foot may be
used only with physician approval.
4. Which complication occurs if tourniquet pressure is excessive or prolonged beyond
recommended time?
A. Polycythemia
B. Hemoconcentration
C. Leukocytosis
D. Hemodilution
Answer: B
Rationale: Prolonged tourniquet application causes fluid to leave veins, concentrating cells and
analytes, leading to false test results.
5. A phlebotomist collects a potassium level but shakes the tube vigorously. What erroneous
result is most expected?
A. Falsely elevated potassium
B. Falsely low calcium
C. Increased glucose level
D. Decreased cholesterol
Answer: A
Rationale: Vigorous shaking causes hemolysis, releasing intracellular potassium into plasma,
falsely elevating results.
,6. A patient refuses venipuncture. The nurse insists you proceed. What is the correct
phlebotomist action?
A. Proceed since nurse gave approval
B. Document and leave patient’s room
C. Draw from alternate site quietly
D. Restrain patient if necessary
Answer: B
Rationale: Patient consent is mandatory. Proceeding without consent violates ethics and law,
even if staff insist.
7. Which of the following specimens requires chilling immediately after collection?
A. Bilirubin
B. Ammonia
C. Blood culture
D. Serum iron
Answer: B
Rationale: Ammonia is unstable at room temperature and requires chilling on ice to prevent
decomposition before testing.
8. During venipuncture, the patient suddenly reports tingling and sharp pain radiating down the
arm. What should the phlebotomist do first?
A. Continue but switch needle angle
B. Withdraw needle immediately
C. Tighten tourniquet for stability
D. Re-anchor vein and proceed
Answer: B
Rationale: Tingling indicates possible nerve contact. Immediate withdrawal prevents permanent
nerve damage.
, 9. Which additive is found in the gray-top tube and why is it used?
A. Sodium citrate – prevents clotting
B. EDTA – preserves morphology
C. Sodium fluoride – inhibits glycolysis
D. Lithium heparin – accelerates clotting
Answer: C
Rationale: Gray-top tubes contain sodium fluoride and potassium oxalate, preventing glucose
breakdown for accurate testing.
10. A specimen for lactic acid is delayed in reaching the lab. Which effect will occur if not
handled correctly?
A. False increase due to glycolysis
B. False decrease due to glycolysis
C. Hemolysis interference
D. Serum contamination
Answer: B
Rationale: Cells continue to metabolize glucose and lactic acid if not chilled and processed
promptly, leading to falsely low results.
11. A phlebotomist draws from above an IV line. What is the likely impact on specimen
integrity?
A. Dilution with IV fluid
B. Increased red blood cells
C. Elevated potassium
D. Clotted specimen
Answer: A
RATIONALES LATEST UPDATE GRADED A
1. While collecting a blood specimen for coagulation testing, the phlebotomist notes the tube
was underfilled. What is the most likely effect on test results?
A. Prolonged clotting time
B. Decreased platelet count
C. Hemolyzed plasma
D. Falsely increased hematocrit
Answer: A
Rationale: The sodium citrate additive requires a precise blood-to-additive ratio (9:1).
Underfilling alters the ratio, falsely prolonging clotting time.
2. A phlebotomist must collect blood cultures before antibiotic therapy. Which of the following
best ensures accurate detection of bacteremia?
A. Use of alcohol swab only for site prep
B. Collect both aerobic and anaerobic bottles
C. Drawing from IV line already in place
D. Filling tubes without cleansing bottle stoppers
Answer: B
Rationale: Both aerobic and anaerobic bottles are necessary to detect different organisms. Strict
aseptic technique is critical to avoid contamination.
3. A patient has a left mastectomy and right arm fistula. Where should the phlebotomist draw
blood?
A. Left antecubital vein
,B. Right wrist vein
C. Left hand vein
D. Dorsal foot vein (with permission)
Answer: D
Rationale: Neither arm is suitable due to lymphatic compromise and fistula. The foot may be
used only with physician approval.
4. Which complication occurs if tourniquet pressure is excessive or prolonged beyond
recommended time?
A. Polycythemia
B. Hemoconcentration
C. Leukocytosis
D. Hemodilution
Answer: B
Rationale: Prolonged tourniquet application causes fluid to leave veins, concentrating cells and
analytes, leading to false test results.
5. A phlebotomist collects a potassium level but shakes the tube vigorously. What erroneous
result is most expected?
A. Falsely elevated potassium
B. Falsely low calcium
C. Increased glucose level
D. Decreased cholesterol
Answer: A
Rationale: Vigorous shaking causes hemolysis, releasing intracellular potassium into plasma,
falsely elevating results.
,6. A patient refuses venipuncture. The nurse insists you proceed. What is the correct
phlebotomist action?
A. Proceed since nurse gave approval
B. Document and leave patient’s room
C. Draw from alternate site quietly
D. Restrain patient if necessary
Answer: B
Rationale: Patient consent is mandatory. Proceeding without consent violates ethics and law,
even if staff insist.
7. Which of the following specimens requires chilling immediately after collection?
A. Bilirubin
B. Ammonia
C. Blood culture
D. Serum iron
Answer: B
Rationale: Ammonia is unstable at room temperature and requires chilling on ice to prevent
decomposition before testing.
8. During venipuncture, the patient suddenly reports tingling and sharp pain radiating down the
arm. What should the phlebotomist do first?
A. Continue but switch needle angle
B. Withdraw needle immediately
C. Tighten tourniquet for stability
D. Re-anchor vein and proceed
Answer: B
Rationale: Tingling indicates possible nerve contact. Immediate withdrawal prevents permanent
nerve damage.
, 9. Which additive is found in the gray-top tube and why is it used?
A. Sodium citrate – prevents clotting
B. EDTA – preserves morphology
C. Sodium fluoride – inhibits glycolysis
D. Lithium heparin – accelerates clotting
Answer: C
Rationale: Gray-top tubes contain sodium fluoride and potassium oxalate, preventing glucose
breakdown for accurate testing.
10. A specimen for lactic acid is delayed in reaching the lab. Which effect will occur if not
handled correctly?
A. False increase due to glycolysis
B. False decrease due to glycolysis
C. Hemolysis interference
D. Serum contamination
Answer: B
Rationale: Cells continue to metabolize glucose and lactic acid if not chilled and processed
promptly, leading to falsely low results.
11. A phlebotomist draws from above an IV line. What is the likely impact on specimen
integrity?
A. Dilution with IV fluid
B. Increased red blood cells
C. Elevated potassium
D. Clotted specimen
Answer: A
