FUNDAMENTALS OF URINE AND
BODY FLUID ANALYSIS
5TH EDITION
AUTHOR(S)NANCY A. BRUNZEL
TEST BANK
Ch. 1 — Quality Assessment and Safety — Quality Indicators
and Turnaround Time (TAT)
Stem: A busy urinalysis lab tracks TAT for routine urinalysis from
specimen receipt to result verification. Over a month, the lab’s
median TAT has increased from 45 to 85 minutes while analyzer
uptime, staffing, and reagent availability remained stable.
Which QA action best addresses this trend?
A. Implement a policy to reject older specimens on arrival to
,reduce workload.
B. Perform a process-mapping (workflow) analysis and time–
motion study to identify bottlenecks.
C. Replace the analyzer with a faster model to improve
throughput.
D. Increase specimen re-collection requests to ensure sample
quality and decrease repeats.
Correct answer: B
Rationale — Correct Option: Performing a process-
mapping/time–motion analysis identifies non-analytical
bottlenecks (e.g., accessioning, transport, verification delays)
causing increased TAT. This QA approach targets systemic
process defects rather than blaming specimens or equipment
and yields actionable corrective steps. It aligns with continuous
quality improvement principles to reduce TAT.
Incorrect Options:
A. Rejection of older specimens without diagnosis of root cause
is punitive and may not reduce TAT; it risks clinical delays.
C. Replacing equipment is costly and unnecessary when
analyzer performance is reported stable; it bypasses analysis of
process causes.
D. Increasing recollection increases workload and TAT and is
inappropriate if specimen quality hasn’t been demonstrated to
be the issue.
Teaching point: Map processes to find non-analytical
bottlenecks before changing equipment or policies.
,Citation: Brunzel, N. A. (2023). Fundamentals of Urine and Body
Fluid Analysis (5th ed.). Ch. 1.
Ch. 1 — Quality Assessment and Safety — Internal QC vs
Proficiency Testing
Stem: A lab observes systematic low specific gravity readings
across two weeks. Internal QC materials are within ±2 SD, but
results from an external proficiency test returned as
“unsatisfactory” for specific gravity. Which interpretation and
next step is most appropriate?
A. Trust internal QC; contact the proficiency testing provider to
dispute the result.
B. Ignore proficiency testing; continue current procedures since
internal QC passes.
C. Investigate calibration, reagent lot differences, and perform
method comparison using patient samples.
D. Immediately report a critical analyzer failure and send all
specimens to a reference lab.
Correct answer: C
Rationale — Correct Option: Discrepancy between internal QC
and external proficiency suggests potential method bias,
calibration drift, or reagent/lot issue. A targeted investigation
comparing patient samples, checking calibration traceability,
and verifying reagent lot is the analytical troubleshooting path.
, This integrates internal and external QA data for root-cause
analysis.
Incorrect Options:
A. Contesting the proficiency result before investigation
disregards possible valid external findings and delays corrective
action.
B. Ignoring external PT undermines accreditation requirements
and fails to address possible method bias.
D. Immediate shutdown/sending out specimens is premature
unless evidence shows analyzer failure that risks patient safety.
Teaching point: Use both internal QC and external PT results to
detect bias; investigate method/calibration.
Citation: Brunzel, N. A. (2023). Fundamentals of Urine and Body
Fluid Analysis (5th ed.). Ch. 1.
Ch. 1 — Quality Assessment and Safety — Westgard Rule
Violation Interpretation
Stem: A urinalysis chemistry analyzer’s daily Levey–Jennings
chart for reagent lot A shows a single control point exceeding
the 3 SD limit on the positive control, with all other points
within limits. Which action best reflects appropriate QA
practice?
A. Apply corrective actions for a 2–2s rule violation and
continue testing.
B. Report results, as a single 3 SD exceedance is acceptable and
BODY FLUID ANALYSIS
5TH EDITION
AUTHOR(S)NANCY A. BRUNZEL
TEST BANK
Ch. 1 — Quality Assessment and Safety — Quality Indicators
and Turnaround Time (TAT)
Stem: A busy urinalysis lab tracks TAT for routine urinalysis from
specimen receipt to result verification. Over a month, the lab’s
median TAT has increased from 45 to 85 minutes while analyzer
uptime, staffing, and reagent availability remained stable.
Which QA action best addresses this trend?
A. Implement a policy to reject older specimens on arrival to
,reduce workload.
B. Perform a process-mapping (workflow) analysis and time–
motion study to identify bottlenecks.
C. Replace the analyzer with a faster model to improve
throughput.
D. Increase specimen re-collection requests to ensure sample
quality and decrease repeats.
Correct answer: B
Rationale — Correct Option: Performing a process-
mapping/time–motion analysis identifies non-analytical
bottlenecks (e.g., accessioning, transport, verification delays)
causing increased TAT. This QA approach targets systemic
process defects rather than blaming specimens or equipment
and yields actionable corrective steps. It aligns with continuous
quality improvement principles to reduce TAT.
Incorrect Options:
A. Rejection of older specimens without diagnosis of root cause
is punitive and may not reduce TAT; it risks clinical delays.
C. Replacing equipment is costly and unnecessary when
analyzer performance is reported stable; it bypasses analysis of
process causes.
D. Increasing recollection increases workload and TAT and is
inappropriate if specimen quality hasn’t been demonstrated to
be the issue.
Teaching point: Map processes to find non-analytical
bottlenecks before changing equipment or policies.
,Citation: Brunzel, N. A. (2023). Fundamentals of Urine and Body
Fluid Analysis (5th ed.). Ch. 1.
Ch. 1 — Quality Assessment and Safety — Internal QC vs
Proficiency Testing
Stem: A lab observes systematic low specific gravity readings
across two weeks. Internal QC materials are within ±2 SD, but
results from an external proficiency test returned as
“unsatisfactory” for specific gravity. Which interpretation and
next step is most appropriate?
A. Trust internal QC; contact the proficiency testing provider to
dispute the result.
B. Ignore proficiency testing; continue current procedures since
internal QC passes.
C. Investigate calibration, reagent lot differences, and perform
method comparison using patient samples.
D. Immediately report a critical analyzer failure and send all
specimens to a reference lab.
Correct answer: C
Rationale — Correct Option: Discrepancy between internal QC
and external proficiency suggests potential method bias,
calibration drift, or reagent/lot issue. A targeted investigation
comparing patient samples, checking calibration traceability,
and verifying reagent lot is the analytical troubleshooting path.
, This integrates internal and external QA data for root-cause
analysis.
Incorrect Options:
A. Contesting the proficiency result before investigation
disregards possible valid external findings and delays corrective
action.
B. Ignoring external PT undermines accreditation requirements
and fails to address possible method bias.
D. Immediate shutdown/sending out specimens is premature
unless evidence shows analyzer failure that risks patient safety.
Teaching point: Use both internal QC and external PT results to
detect bias; investigate method/calibration.
Citation: Brunzel, N. A. (2023). Fundamentals of Urine and Body
Fluid Analysis (5th ed.). Ch. 1.
Ch. 1 — Quality Assessment and Safety — Westgard Rule
Violation Interpretation
Stem: A urinalysis chemistry analyzer’s daily Levey–Jennings
chart for reagent lot A shows a single control point exceeding
the 3 SD limit on the positive control, with all other points
within limits. Which action best reflects appropriate QA
practice?
A. Apply corrective actions for a 2–2s rule violation and
continue testing.
B. Report results, as a single 3 SD exceedance is acceptable and
