FUNDAMENTALS OF URINE AND
BODY FLUID ANALYSIS
5TH EDITION
AUTHOR(S)NANCY A. BRUNZEL
TEST BANK
1
Reference
Ch. 1 — Quality Assessment and Safety — Quality assessment
program design
Stem
A 3-person urinalysis bench routinely reports an increased
frequency of microscopic epithelial cells and occasional false-
positive nitrite on dipsticks. Review of the quality log shows no
,changes to reagents or equipment. As the lab’s MLS educator,
which first step best addresses whether this reflects pre-
analytical, analytical, or post-analytical problems?
A. Immediately change the dipstick lot and re-run patient
samples.
B. Perform an audit of specimen collection and transport
procedures and review recent training records.
C. Retrain staff on microscopic identification of epithelial cells
and document competency.
D. Report an out-of-control condition to laboratory
management and halt testing until vendor responds.
Correct answer: B
Rationale — Correct (B)
Auditing specimen collection/transport and training records
targets pre-analytical causes (contamination, improper
midstream collection) that explain epithelial cells and
intermittent nitrite changes. This step evaluates human/process
factors before assuming reagent or instrument failure.
Rationale — Incorrect
A. Changing dipstick lot assumes analytical reagent failure
without evidence; unnecessary and wastes resources.
C. Retraining on microscopy addresses analytical skill but
doesn’t evaluate whether specimen contamination occurred.
D. Halting testing and escalating to vendor prematurely treats
the issue as an equipment/reagent failure rather than a process
problem.
,Teaching point
Start with pre-analytical process audit before assuming
analytical or reagent failure.
Citation
Brunzel, N. A. (2023). Fundamentals of Urine and Body Fluid
Analysis (5th ed.). Ch. 1.
2
Reference
Ch. 1 — Quality Assessment and Safety — Internal quality
control (IQC) interpretation
Stem
A urinalysis dipstick analyzer’s daily QC (low and high) run for
two weeks shows most points within the expected range but
the high control exceeded ±2 SD on two nonconsecutive days
and then returned within range. What interpretation and action
best reflect sound QA practice?
A. Ignore the excursions because results returned to range;
continue routine monitoring.
B. Investigate on the days of excursion, document possible
causes, and consider trending for a pattern.
C. Replace the analyzer because repeated ±2 SD excursions
indicate imminent failure.
D. Change the QC acceptance limits to ±3 SD to avoid false
alarms.
, Correct answer: B
Rationale — Correct (B)
Nonconsecutive ±2 SD excursions warrant investigation
(operator error, reagent temp variations, lot changes),
documentation, and trend analysis to detect systematic bias.
This balances sensitivity to problems with avoidance of
overreaction.
Rationale — Incorrect
A. Ignoring excursions risks missing intermittent bias.
C. Replacing equipment is premature without root-cause
evidence.
D. Broadening QC limits undermines QC sensitivity and
regulatory compliance.
Teaching point
Investigate and document QC excursions; trend data before
major corrective actions.
Citation
Brunzel, N. A. (2023). Fundamentals of Urine and Body Fluid
Analysis (5th ed.). Ch. 1.
3
Reference
Ch. 1 — Quality Assessment and Safety — Proficiency testing
(external QA)
BODY FLUID ANALYSIS
5TH EDITION
AUTHOR(S)NANCY A. BRUNZEL
TEST BANK
1
Reference
Ch. 1 — Quality Assessment and Safety — Quality assessment
program design
Stem
A 3-person urinalysis bench routinely reports an increased
frequency of microscopic epithelial cells and occasional false-
positive nitrite on dipsticks. Review of the quality log shows no
,changes to reagents or equipment. As the lab’s MLS educator,
which first step best addresses whether this reflects pre-
analytical, analytical, or post-analytical problems?
A. Immediately change the dipstick lot and re-run patient
samples.
B. Perform an audit of specimen collection and transport
procedures and review recent training records.
C. Retrain staff on microscopic identification of epithelial cells
and document competency.
D. Report an out-of-control condition to laboratory
management and halt testing until vendor responds.
Correct answer: B
Rationale — Correct (B)
Auditing specimen collection/transport and training records
targets pre-analytical causes (contamination, improper
midstream collection) that explain epithelial cells and
intermittent nitrite changes. This step evaluates human/process
factors before assuming reagent or instrument failure.
Rationale — Incorrect
A. Changing dipstick lot assumes analytical reagent failure
without evidence; unnecessary and wastes resources.
C. Retraining on microscopy addresses analytical skill but
doesn’t evaluate whether specimen contamination occurred.
D. Halting testing and escalating to vendor prematurely treats
the issue as an equipment/reagent failure rather than a process
problem.
,Teaching point
Start with pre-analytical process audit before assuming
analytical or reagent failure.
Citation
Brunzel, N. A. (2023). Fundamentals of Urine and Body Fluid
Analysis (5th ed.). Ch. 1.
2
Reference
Ch. 1 — Quality Assessment and Safety — Internal quality
control (IQC) interpretation
Stem
A urinalysis dipstick analyzer’s daily QC (low and high) run for
two weeks shows most points within the expected range but
the high control exceeded ±2 SD on two nonconsecutive days
and then returned within range. What interpretation and action
best reflect sound QA practice?
A. Ignore the excursions because results returned to range;
continue routine monitoring.
B. Investigate on the days of excursion, document possible
causes, and consider trending for a pattern.
C. Replace the analyzer because repeated ±2 SD excursions
indicate imminent failure.
D. Change the QC acceptance limits to ±3 SD to avoid false
alarms.
, Correct answer: B
Rationale — Correct (B)
Nonconsecutive ±2 SD excursions warrant investigation
(operator error, reagent temp variations, lot changes),
documentation, and trend analysis to detect systematic bias.
This balances sensitivity to problems with avoidance of
overreaction.
Rationale — Incorrect
A. Ignoring excursions risks missing intermittent bias.
C. Replacing equipment is premature without root-cause
evidence.
D. Broadening QC limits undermines QC sensitivity and
regulatory compliance.
Teaching point
Investigate and document QC excursions; trend data before
major corrective actions.
Citation
Brunzel, N. A. (2023). Fundamentals of Urine and Body Fluid
Analysis (5th ed.). Ch. 1.
3
Reference
Ch. 1 — Quality Assessment and Safety — Proficiency testing
(external QA)
