FUNDAMENTALS OF URINE AND
BODY FLUID ANALYSIS
5TH EDITION
AUTHOR(S)NANCY A. BRUNZEL
TEST BANK
1.
Reference: Ch. (Quality Assessment and Safety) — Quality
Indicators & Turnaround Time
Stem: The urinalysis lab’s monthly dashboard shows median
turnaround time (TAT) for routine urines rose from 45 to 78
minutes and mislabeled specimens increased from 0.4% to 2.9%
this month. A recent instrument firmware update coincided
with the changes. Which action most appropriately addresses
,these findings?
A. Immediately revert to the previous firmware and stop data
collection until stability returns.
B. Perform a root-cause analysis focusing on workflow, firmware
effects, and specimen-handling steps. (Correct)
C. Increase staffing for peak hours to reduce TAT without
investigating other causes.
D. Report the week’s elevated TAT to clinicians and recommend
delays in ordering.
Correct Answer: B
Rationale — Correct (B): A root-cause analysis systematically
examines all possible contributors (firmware, instrument
behavior, workflow, labeling practices) and is required to
identify corrective actions. It integrates QA principles and
prevents knee-jerk fixes that may not address the true cause.
Rationale — Incorrect:
A. Reverting firmware without analysis risks repeating the
problem and forfeits traceable corrective action.
C. Staffing might reduce TAT but ignores the linked increase in
labeling errors and the firmware timing.
D. Informing clinicians before root-cause analysis creates
unnecessary alarm and avoids corrective action.
Teaching Point: Use root-cause analysis to link process changes
with quality indicator shifts.
Citation: Brunzel, N. A. (2023). Fundamentals of Urine and Body
Fluid Analysis (5th ed.). Ch. (Quality Assessment and Safety).
,2.
Reference: Ch. (Quality Assessment and Safety) — Internal
Quality Control & Control Materials
Stem: Daily positive and negative dipstick control results on a
new lot of reagent strips show a small but consistent decrease
in reagent color intensity compared with prior lot controls.
Patient dipstick albumin categories are shifting downward.
What is the best laboratory action?
A. Continue testing; document the change and notify users only
if patient harm occurs.
B. Stop using the new lot, perform lot-to-lot verification with
control materials, and investigate reagent storage/transport.
(Correct)
C. Adjust interpretive categories (cutoffs) in the LIS to match the
new lot’s performance.
D. Run patient samples in duplicate and average results to
compensate for the shift.
Correct Answer: B
Rationale — Correct (B): Lot-to-lot verification and checking
storage/transport identify whether the reagent lot or handling
caused the shift; stopping use prevents reporting biased results
until verification. This is consistent with QC and QA procedures.
Rationale — Incorrect:
A. Passive documentation without verification risks systematic
patient harm.
, C. Changing LIS cutoffs without verification is unsafe and
noncompliant.
D. Averaging duplicates masks systematic bias and wastes
resources.
Teaching Point: Always perform lot-to-lot verification and
investigate reagent handling when controls shift.
Citation: Brunzel, N. A. (2023). Fundamentals of Urine and Body
Fluid Analysis (5th ed.). Ch. (Quality Assessment and Safety).
3.
Reference: Ch. (Quality Assessment and Safety) — Proficiency
Testing & External Assessment
Stem: A lab receives PT (proficiency testing) results showing a
marginally unacceptable microscopic RBC count compared with
peer group. The instrument QC and internal controls are within
limits. Which step best meets QA expectations?
A. Describe the PT failure as random variation and file with no
further action.
B. Initiate an investigation documenting personnel competency,
method performance, and sample handling, then implement
corrective action. (Correct)
C. Request to be removed from the peer group to improve score
comparisons.
D. Re-run the PT specimen until an acceptable result is
achieved.
Correct Answer: B
BODY FLUID ANALYSIS
5TH EDITION
AUTHOR(S)NANCY A. BRUNZEL
TEST BANK
1.
Reference: Ch. (Quality Assessment and Safety) — Quality
Indicators & Turnaround Time
Stem: The urinalysis lab’s monthly dashboard shows median
turnaround time (TAT) for routine urines rose from 45 to 78
minutes and mislabeled specimens increased from 0.4% to 2.9%
this month. A recent instrument firmware update coincided
with the changes. Which action most appropriately addresses
,these findings?
A. Immediately revert to the previous firmware and stop data
collection until stability returns.
B. Perform a root-cause analysis focusing on workflow, firmware
effects, and specimen-handling steps. (Correct)
C. Increase staffing for peak hours to reduce TAT without
investigating other causes.
D. Report the week’s elevated TAT to clinicians and recommend
delays in ordering.
Correct Answer: B
Rationale — Correct (B): A root-cause analysis systematically
examines all possible contributors (firmware, instrument
behavior, workflow, labeling practices) and is required to
identify corrective actions. It integrates QA principles and
prevents knee-jerk fixes that may not address the true cause.
Rationale — Incorrect:
A. Reverting firmware without analysis risks repeating the
problem and forfeits traceable corrective action.
C. Staffing might reduce TAT but ignores the linked increase in
labeling errors and the firmware timing.
D. Informing clinicians before root-cause analysis creates
unnecessary alarm and avoids corrective action.
Teaching Point: Use root-cause analysis to link process changes
with quality indicator shifts.
Citation: Brunzel, N. A. (2023). Fundamentals of Urine and Body
Fluid Analysis (5th ed.). Ch. (Quality Assessment and Safety).
,2.
Reference: Ch. (Quality Assessment and Safety) — Internal
Quality Control & Control Materials
Stem: Daily positive and negative dipstick control results on a
new lot of reagent strips show a small but consistent decrease
in reagent color intensity compared with prior lot controls.
Patient dipstick albumin categories are shifting downward.
What is the best laboratory action?
A. Continue testing; document the change and notify users only
if patient harm occurs.
B. Stop using the new lot, perform lot-to-lot verification with
control materials, and investigate reagent storage/transport.
(Correct)
C. Adjust interpretive categories (cutoffs) in the LIS to match the
new lot’s performance.
D. Run patient samples in duplicate and average results to
compensate for the shift.
Correct Answer: B
Rationale — Correct (B): Lot-to-lot verification and checking
storage/transport identify whether the reagent lot or handling
caused the shift; stopping use prevents reporting biased results
until verification. This is consistent with QC and QA procedures.
Rationale — Incorrect:
A. Passive documentation without verification risks systematic
patient harm.
, C. Changing LIS cutoffs without verification is unsafe and
noncompliant.
D. Averaging duplicates masks systematic bias and wastes
resources.
Teaching Point: Always perform lot-to-lot verification and
investigate reagent handling when controls shift.
Citation: Brunzel, N. A. (2023). Fundamentals of Urine and Body
Fluid Analysis (5th ed.). Ch. (Quality Assessment and Safety).
3.
Reference: Ch. (Quality Assessment and Safety) — Proficiency
Testing & External Assessment
Stem: A lab receives PT (proficiency testing) results showing a
marginally unacceptable microscopic RBC count compared with
peer group. The instrument QC and internal controls are within
limits. Which step best meets QA expectations?
A. Describe the PT failure as random variation and file with no
further action.
B. Initiate an investigation documenting personnel competency,
method performance, and sample handling, then implement
corrective action. (Correct)
C. Request to be removed from the peer group to improve score
comparisons.
D. Re-run the PT specimen until an acceptable result is
achieved.
Correct Answer: B
