BLD 313 EXAM 2 Actual Exam Complete
Questions and Answers Detailed Rationales
Pass Guaranteed - A+ Graded
TABLE OF CONTENTS
Section 1 | Lab Regulations & Quality Assurance | Q1 – Q10
Section 2 | Hematology & Hemostasis | Q11 – Q20
Section 3 | Clinical Chemistry & Metabolism | Q21 – Q30
Section 4 | Immunohematology & Transfusion Medicine | Q31 – Q40
Section 5 | Urinalysis, Body Fluids & Microbiology | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
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SECTION 1: CLINICAL LABORATORY REGULATIONS & QUALITY ASSURANCE Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A medical technologist in a moderate complexity lab is asked by the emergency
physician to add a new rapid flu test that uses a lateral flow device not currently on the
lab's CLIA certificate. The lab director is on vacation for two weeks. What is the
appropriate regulatory action?
A. Perform the test since lateral flow devices are CLIA-waived by default
B. Wait for the lab director to return and update the certificate in 30 days
C. Refuse to perform the test until the lab amends its CLIA certificate ✓ CORRECT
D. Run the test as a laboratory-developed procedure without additional oversight
Correct Answer: C
Rationale: CLIA requires laboratories to possess the appropriate certificate category for
all testing performed, and adding a new test requires prior notification or amendment
depending on the complexity. Performing the test without proper certification places the
,laboratory in immediate violation and can result in sanctions. Waiting for the director's
return without stopping the testing is not acceptable because the violation begins the
moment the unapproved test is performed.
Question 2 of 50
During morning QC on an automated chemistry analyzer, the level 2 control for
potassium registers 6.8 mmol/L when the target is 4.0 mmol/L and the level 1 control is
within range. The previous run was acceptable and there were no maintenance activities
overnight. What is the most appropriate first step?
A. Report patient results since the level 1 control is acceptable
B. Repeat the level 2 control to determine if the result is a random error ✓ CORRECT
C. Recalibrate the potassium electrode and release all pending results
D. Switch to the backup analyzer and discard all specimens from this run
Correct Answer: B
Rationale: A single control out of range should prompt an immediate repeat to
distinguish between random error and a true system failure before taking corrective
action. Reporting results or recalibrating based on a single outlier can mask a simple
control issue or unnecessarily delay patient care. Switching analyzers is premature
without first confirming the error is reproducible.
Question 3 of 50
A 62-year-old male presents to the ER with chest pain. His initial troponin I drawn
yesterday was 0.02 ng/mL, and today's specimen shows 0.06 ng/mL with a different lot
number of reagent. The reference range is 0.00-0.04 ng/mL. The patient has no ECG
changes. What quality issue should the technologist investigate first?
A. The patient's evolving myocardial infarction requiring immediate notification
B. The delta check failure indicating pre-analytical specimen mix-up
C. The critical value requiring a phone call to the emergency physician
,D. The reagent lot change potentially affecting calibration bias ✓ CORRECT
Correct Answer: D
Rationale: A change in reagent lot number between two closely timed specimens is the
most probable cause of a minor shift near the reference limit, and the technologist
should verify that the new lot performed acceptably on QC and that results are
comparable to the previous lot. While delta checks and critical values matter, a lot-to-lot
shift is a common source of apparent patient change that can be mistaken for clinical
deterioration. Investigating the reagent change prevents unnecessary clinical
interventions.
Question 4 of 50
A phlebotomist brings a CBC specimen to the hematology bench that is clearly labeled
with the patient's name and date of birth but lacks the time of collection and the
phlebotomist's initials. The patient has an active order for a STAT hemoglobin. What is
the correct course of action?
A. Reject the specimen and request a properly labeled redraw per laboratory policy ✓
CORRECT
B. Accept the specimen and add the missing information to the label
C. Run the test STAT and ask the phlebotomist to complete the label later
D. Process the specimen but hold the result until the label is corrected
Correct Answer: A
Rationale: Laboratory accreditation standards require two patient identifiers plus the
collection date and time on the primary label, and missing information constitutes a
specimen rejection regardless of the STAT status. Adding information to a label after
collection or processing before proper identification violates patient safety protocols
and creates liability. Asking the phlebotomist to complete the label later does not verify
that the specimen was collected from the correct patient at the correct time.
, Question 5 of 50
A laboratory supervisor receives a proficiency testing sample for cholesterol analysis.
The technologist assigned to the test asks if she can run the sample in duplicate and
average the results before reporting to the PT provider. What should the supervisor
instruct?
A. Run the sample in duplicate to improve precision since PT samples are often
challenging
B. Average the duplicate results to reduce the impact of random analytical error
C. Analyze the sample exactly as patient specimens are tested without special handling
✓ CORRECT
D. Have the most experienced technologist perform the testing alone
Correct Answer: C
Rationale: Proficiency testing samples must be analyzed using the same routine
methods, number of replicates, and reporting procedures applied to patient specimens;
any special handling invalidates the PT assessment and is considered cheating under
CMS regulations. Duplicate analysis and selective technologist assignment artificially
inflate performance and hide systemic problems. PT is designed to mirror real-world
performance, not laboratory ideal conditions.
Question 6 of 50
A chemistry technologist notices that the calcium control has been trending upward
over the past five days, moving from the mean to 1.5 standard deviations above the
mean, while all other analytes remain stable. There have been no calibrations or reagent
changes during this period. What statistical quality control rule is most useful here?
A. The 1-3s rule because the control exceeds three standard deviations
B. The 4-1s or 10x rule because the trend indicates systematic drift ✓ CORRECT
C. The R-4s rule because the range between controls is widening
D. The 2-2s rule because two consecutive controls exceed two standard deviations
Questions and Answers Detailed Rationales
Pass Guaranteed - A+ Graded
TABLE OF CONTENTS
Section 1 | Lab Regulations & Quality Assurance | Q1 – Q10
Section 2 | Hematology & Hemostasis | Q11 – Q20
Section 3 | Clinical Chemistry & Metabolism | Q21 – Q30
Section 4 | Immunohematology & Transfusion Medicine | Q31 – Q40
Section 5 | Urinalysis, Body Fluids & Microbiology | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CLINICAL LABORATORY REGULATIONS & QUALITY ASSURANCE Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A medical technologist in a moderate complexity lab is asked by the emergency
physician to add a new rapid flu test that uses a lateral flow device not currently on the
lab's CLIA certificate. The lab director is on vacation for two weeks. What is the
appropriate regulatory action?
A. Perform the test since lateral flow devices are CLIA-waived by default
B. Wait for the lab director to return and update the certificate in 30 days
C. Refuse to perform the test until the lab amends its CLIA certificate ✓ CORRECT
D. Run the test as a laboratory-developed procedure without additional oversight
Correct Answer: C
Rationale: CLIA requires laboratories to possess the appropriate certificate category for
all testing performed, and adding a new test requires prior notification or amendment
depending on the complexity. Performing the test without proper certification places the
,laboratory in immediate violation and can result in sanctions. Waiting for the director's
return without stopping the testing is not acceptable because the violation begins the
moment the unapproved test is performed.
Question 2 of 50
During morning QC on an automated chemistry analyzer, the level 2 control for
potassium registers 6.8 mmol/L when the target is 4.0 mmol/L and the level 1 control is
within range. The previous run was acceptable and there were no maintenance activities
overnight. What is the most appropriate first step?
A. Report patient results since the level 1 control is acceptable
B. Repeat the level 2 control to determine if the result is a random error ✓ CORRECT
C. Recalibrate the potassium electrode and release all pending results
D. Switch to the backup analyzer and discard all specimens from this run
Correct Answer: B
Rationale: A single control out of range should prompt an immediate repeat to
distinguish between random error and a true system failure before taking corrective
action. Reporting results or recalibrating based on a single outlier can mask a simple
control issue or unnecessarily delay patient care. Switching analyzers is premature
without first confirming the error is reproducible.
Question 3 of 50
A 62-year-old male presents to the ER with chest pain. His initial troponin I drawn
yesterday was 0.02 ng/mL, and today's specimen shows 0.06 ng/mL with a different lot
number of reagent. The reference range is 0.00-0.04 ng/mL. The patient has no ECG
changes. What quality issue should the technologist investigate first?
A. The patient's evolving myocardial infarction requiring immediate notification
B. The delta check failure indicating pre-analytical specimen mix-up
C. The critical value requiring a phone call to the emergency physician
,D. The reagent lot change potentially affecting calibration bias ✓ CORRECT
Correct Answer: D
Rationale: A change in reagent lot number between two closely timed specimens is the
most probable cause of a minor shift near the reference limit, and the technologist
should verify that the new lot performed acceptably on QC and that results are
comparable to the previous lot. While delta checks and critical values matter, a lot-to-lot
shift is a common source of apparent patient change that can be mistaken for clinical
deterioration. Investigating the reagent change prevents unnecessary clinical
interventions.
Question 4 of 50
A phlebotomist brings a CBC specimen to the hematology bench that is clearly labeled
with the patient's name and date of birth but lacks the time of collection and the
phlebotomist's initials. The patient has an active order for a STAT hemoglobin. What is
the correct course of action?
A. Reject the specimen and request a properly labeled redraw per laboratory policy ✓
CORRECT
B. Accept the specimen and add the missing information to the label
C. Run the test STAT and ask the phlebotomist to complete the label later
D. Process the specimen but hold the result until the label is corrected
Correct Answer: A
Rationale: Laboratory accreditation standards require two patient identifiers plus the
collection date and time on the primary label, and missing information constitutes a
specimen rejection regardless of the STAT status. Adding information to a label after
collection or processing before proper identification violates patient safety protocols
and creates liability. Asking the phlebotomist to complete the label later does not verify
that the specimen was collected from the correct patient at the correct time.
, Question 5 of 50
A laboratory supervisor receives a proficiency testing sample for cholesterol analysis.
The technologist assigned to the test asks if she can run the sample in duplicate and
average the results before reporting to the PT provider. What should the supervisor
instruct?
A. Run the sample in duplicate to improve precision since PT samples are often
challenging
B. Average the duplicate results to reduce the impact of random analytical error
C. Analyze the sample exactly as patient specimens are tested without special handling
✓ CORRECT
D. Have the most experienced technologist perform the testing alone
Correct Answer: C
Rationale: Proficiency testing samples must be analyzed using the same routine
methods, number of replicates, and reporting procedures applied to patient specimens;
any special handling invalidates the PT assessment and is considered cheating under
CMS regulations. Duplicate analysis and selective technologist assignment artificially
inflate performance and hide systemic problems. PT is designed to mirror real-world
performance, not laboratory ideal conditions.
Question 6 of 50
A chemistry technologist notices that the calcium control has been trending upward
over the past five days, moving from the mean to 1.5 standard deviations above the
mean, while all other analytes remain stable. There have been no calibrations or reagent
changes during this period. What statistical quality control rule is most useful here?
A. The 1-3s rule because the control exceeds three standard deviations
B. The 4-1s or 10x rule because the trend indicates systematic drift ✓ CORRECT
C. The R-4s rule because the range between controls is widening
D. The 2-2s rule because two consecutive controls exceed two standard deviations
