FUNDAMENTALS OF URINE AND
BODY FLUID ANALYSIS
5TH EDITION
AUTHOR(S)NANCY A. BRUNZEL
TEST BANK
1)
Reference
Ch. 1 — Quality Assessment — Internal Quality Control (IQC)
Stem
A urine chemistry analyzer shows repeated low-specific-gravity
readings for the morning batch; the daily control material run 1
hour earlier was within acceptable limits. The technologist
notes that the reagent lot was recently changed and ambient
temperature in the instrument room has been 5°C lower than
,usual overnight. Which action best follows the IQC and quality-
assurance principles?
A. Report results and advise clinician about possible low SG due
to dehydration.
B. Re-run the control material and patient specimens after
warming reagents and instrument to recommended
temperature.
C. Replace the analyzer membrane and proceed without re-
running controls.
D. Apply a statistical correction factor to the patient SG results
based on previous month’s means.
Correct Answer
B
Rationale — Correct (3–4 sentences)
Re-running controls and patient specimens after ensuring
reagents and instrument are at validated operating temperature
addresses a likely pre-analytical/analytical cause. Quality-
assurance principles require confirmation that an
environmental change (temperature) affected results before
reporting. This step ensures that IQC remains valid for the
current run.
Rationale — Incorrect
A. (1–2 sentences) Reporting without verifying the analytical
integrity ignores possible instrument/reagent effects and
violates QA.
C. (1–2 sentences) Replacing hardware without confirming
,temperature effect is premature and wasteful; QC must be run
after maintenance.
D. (1–2 sentences) Applying ad hoc statistical corrections is
unacceptable; QC/verification procedures are required before
modifying results.
Teaching Point
Verify instrument/reagent conditions and re-run controls before
reporting questionable results.
Citation
Brunzel, N. A. (2023). Fundamentals of Urine and Body Fluid
Analysis (5th ed.). Ch. 1.
2)
Reference
Ch. 1 — Quality Assessment — Westgard Rules & Control
Interpretation
Stem
A laboratory uses two levels of urinalysis chemical QC. On
today’s Levey–Jennings chart, Level 1 control is at +3 SD and
Level 2 is at +1 SD. Which interpretation and action align with
established Westgard and QA protocols?
A. Accept the run since at least one control is within ±2 SD.
B. Reject the run and investigate for systematic error before
releasing patient results.
C. Release results with a comment noting increased variability.
, D. Dilute all patient specimens two-fold to bring analyte
concentrations into expected range.
Correct Answer
B
Rationale — Correct (3–4 sentences)
A control at +3 SD indicates a likely systematic error or shift; this
violates single-rule acceptability and requires run rejection.
Westgard rules dictate investigation (reagents, calibration,
instrument) and corrective action before patient reporting.
Rejecting the run preserves patient safety and QA integrity.
Rationale — Incorrect
A. (1–2 sentences) Single control within ±2 SD does not
compensate for another control at +3 SD; run should not be
accepted.
C. (1–2 sentences) Releasing with a comment bypasses
corrective action and may harm patients.
D. (1–2 sentences) Dilution of specimens without diagnosing
analytical failure is inappropriate and could introduce error.
Teaching Point
A ±3 SD control breach mandates run rejection and
investigation.
Citation
Brunzel, N. A. (2023). Fundamentals of Urine and Body Fluid
Analysis (5th ed.). Ch. 1.
BODY FLUID ANALYSIS
5TH EDITION
AUTHOR(S)NANCY A. BRUNZEL
TEST BANK
1)
Reference
Ch. 1 — Quality Assessment — Internal Quality Control (IQC)
Stem
A urine chemistry analyzer shows repeated low-specific-gravity
readings for the morning batch; the daily control material run 1
hour earlier was within acceptable limits. The technologist
notes that the reagent lot was recently changed and ambient
temperature in the instrument room has been 5°C lower than
,usual overnight. Which action best follows the IQC and quality-
assurance principles?
A. Report results and advise clinician about possible low SG due
to dehydration.
B. Re-run the control material and patient specimens after
warming reagents and instrument to recommended
temperature.
C. Replace the analyzer membrane and proceed without re-
running controls.
D. Apply a statistical correction factor to the patient SG results
based on previous month’s means.
Correct Answer
B
Rationale — Correct (3–4 sentences)
Re-running controls and patient specimens after ensuring
reagents and instrument are at validated operating temperature
addresses a likely pre-analytical/analytical cause. Quality-
assurance principles require confirmation that an
environmental change (temperature) affected results before
reporting. This step ensures that IQC remains valid for the
current run.
Rationale — Incorrect
A. (1–2 sentences) Reporting without verifying the analytical
integrity ignores possible instrument/reagent effects and
violates QA.
C. (1–2 sentences) Replacing hardware without confirming
,temperature effect is premature and wasteful; QC must be run
after maintenance.
D. (1–2 sentences) Applying ad hoc statistical corrections is
unacceptable; QC/verification procedures are required before
modifying results.
Teaching Point
Verify instrument/reagent conditions and re-run controls before
reporting questionable results.
Citation
Brunzel, N. A. (2023). Fundamentals of Urine and Body Fluid
Analysis (5th ed.). Ch. 1.
2)
Reference
Ch. 1 — Quality Assessment — Westgard Rules & Control
Interpretation
Stem
A laboratory uses two levels of urinalysis chemical QC. On
today’s Levey–Jennings chart, Level 1 control is at +3 SD and
Level 2 is at +1 SD. Which interpretation and action align with
established Westgard and QA protocols?
A. Accept the run since at least one control is within ±2 SD.
B. Reject the run and investigate for systematic error before
releasing patient results.
C. Release results with a comment noting increased variability.
, D. Dilute all patient specimens two-fold to bring analyte
concentrations into expected range.
Correct Answer
B
Rationale — Correct (3–4 sentences)
A control at +3 SD indicates a likely systematic error or shift; this
violates single-rule acceptability and requires run rejection.
Westgard rules dictate investigation (reagents, calibration,
instrument) and corrective action before patient reporting.
Rejecting the run preserves patient safety and QA integrity.
Rationale — Incorrect
A. (1–2 sentences) Single control within ±2 SD does not
compensate for another control at +3 SD; run should not be
accepted.
C. (1–2 sentences) Releasing with a comment bypasses
corrective action and may harm patients.
D. (1–2 sentences) Dilution of specimens without diagnosing
analytical failure is inappropriate and could introduce error.
Teaching Point
A ±3 SD control breach mandates run rejection and
investigation.
Citation
Brunzel, N. A. (2023). Fundamentals of Urine and Body Fluid
Analysis (5th ed.). Ch. 1.
