CCMA Practice Test

CCMA Phlebotomy Practice Questions

Phlebotomy makes up 4 of every 50 questions on a Tigertest CCMA practice test. Here are 10 of the 16 questions on it, each with the answer and the reason.

Updated 2026-11-10 by the Tigertest team. Weighted to the NHA CCMA test plan (3.0). Scope of practice varies by state.

1. 1. A provider orders a PT/INR in a light blue tube, a CMP in a gold SST, and a CBC. In what order are the tubes filled?

   • A.Gold, light blue, lavender
   • B.Light blue, gold, lavender
   • C.Gold, lavender, light blue
   • D.Lavender, gold, light blue

   Answer: B. The order of draw is blood cultures, light blue, red, gold SST, green, lavender, then gray. Drawing lavender before light blue can carry EDTA into the coagulation tube and falsely alter PT/INR.

2. 2. Which additive is in the lavender-top tube used to collect a complete blood count?

   • A.Sodium citrate
   • B.Lithium heparin
   • C.Sodium fluoride
   • D.EDTA

   Answer: D. Lavender tubes contain EDTA, which preserves cell shape for a CBC. Sodium citrate is the light blue coagulation additive and sodium fluoride is in the gray glucose tube.

3. 3. Which tube is drawn last in the standard venipuncture order of draw?

   • A.Gray top
   • B.Light blue top
   • C.Red top
   • D.Green top

   Answer: A. Gray tubes contain sodium fluoride and potassium oxalate, which could interfere with other tests, so they are filled last. Light blue is drawn early, right after blood cultures.

4. 4. A medical assistant has just filled a light blue sodium citrate tube for a coagulation study. The tube should be mixed by:

   • A.Rolling it hard between the palms
   • B.Shaking it vigorously for 10 seconds
   • C.Gently inverting it 3 to 4 times
   • D.Leaving it upright without mixing

   Answer: C. Gentle inversion mixes the anticoagulant with blood without damaging cells; light blue tubes need about 3 to 4 inversions. Shaking or rough handling causes hemolysis, and no mixing allows clotting.

5. 5. Which needle gauge is routinely used for adult venipuncture with an evacuated tube system?

   • A.26 gauge
   • B.30 gauge
   • C.21 gauge
   • D.16 gauge

   Answer: C. A 21-gauge needle is the standard for routine adult venipuncture, and higher numbers mean smaller needles. Very fine 26- to 30-gauge needles are for injections and would hemolyze the sample.

6. 6. An older patient has small, fragile veins on the back of the hand. Which equipment is the best choice for the draw?

   • A.23-gauge butterfly with small-volume tubes
   • B.Straight 21-gauge needle with a tight tourniquet
   • C.16-gauge needle with large tubes
   • D.Large syringe with strong suction

   Answer: A. A 23-gauge winged set with small tubes causes less vacuum pressure and trauma to fragile veins. Large needles or strong suction can collapse the vein and hemolyze the specimen.

7. 7. Before a routine venipuncture in the antecubital area, the medical assistant applies the tourniquet. Which placement is correct?

   • A.1 inch above the site, left in place for 5 minutes
   • B.Below the elbow for the entire draw
   • C.Directly over the planned puncture site
   • D.3 to 4 inches above the site, under 1 minute

   Answer: D. The tourniquet goes 3 to 4 inches above the site and stays on no longer than 1 minute. Longer use causes hemoconcentration and can falsely change test results.

8. 8. Which antecubital vein is the first choice for venipuncture?

   • A.Brachial artery
   • B.Median cubital vein
   • C.Basilic vein
   • D.Cephalic vein on the thumb side

   Answer: B. The median cubital vein is large, well anchored, and away from major nerves, so it is tried first, then the cephalic. The basilic is used last because it lies near the brachial artery and median nerve.

9. 9. After cleansing with 70% alcohol and letting it air-dry, the medical assistant anchors the vein. At what angle should the needle enter?

   • A.45 to 60 degrees, bevel down
   • B.15 to 30 degrees, bevel up
   • C.90 degrees, bevel up
   • D.Under 5 degrees, bevel down

   Answer: B. The needle enters bevel up at a 15 to 30 degree angle to enter the vein without passing through it. A 90-degree angle is used for intramuscular injections, not venipuncture.

10. 10. The last tube has filled during a routine venipuncture. Which sequence correctly completes the draw?

    • A.Remove needle, release tourniquet, apply pressure
    • B.Apply pressure, release tourniquet, remove needle
    • C.Remove needle, bend the arm, release tourniquet
    • D.Release tourniquet, remove needle, apply pressure

    Answer: D. Releasing the tourniquet first lowers venous pressure so blood does not leak into tissue when the needle comes out, then pressure is held 2 to 3 minutes, longer for patients on anticoagulants. Removing the needle with the tourniquet on promotes a hematoma.