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
indicators and corrective action
Stem: A mid-size hospital urinalysis lab notes a rising rate of
centrifuge tube breakage during transport (from 0.2% to 2%
over two months). Failure mode effects analysis (FMEA) shows
no change in centrifuge settings. Which QA action is the most
appropriate immediate step?
,A. Replace all specimen tubes with a different manufacturer’s
tube.
B. Implement targeted staff competency retraining on specimen
transport and handling.
C. Increase centrifuge speed to shorten spin time and reduce
handling.
D. Report the increase as acceptable variation and continue
monitoring.
Correct answer: B
Rationale — Correct (B): The sudden increase in breakage with
unchanged equipment suggests a pre-analytical handling issue.
Competency retraining targets transport/handling practices,
which FMEA flagged. This corrective action is immediate,
minimally disruptive, and testable by subsequent monitoring.
Rationale — Incorrect:
A. Changing tube manufacturer is premature without evidence
the tubes themselves are faulty.
C. Increasing centrifuge speed risks sample integrity and does
not address transport breakage.
D. Accepting the rise ignores a likely preventable quality
problem and fails QA improvement.
Teaching point: Start with human-factor corrective actions
(training) before equipment replacement.
Citation: Brunzel, N. A. (2023). Fundamentals of Urine and Body
Fluid Analysis (5th ed.). Ch. 1.
,2)
Reference: Ch. 1 — Quality Assessment and Safety — Quality
control materials and Westgard rules
Stem: An automated chemistry analyzer used for urine
creatinine shows a single control point exceeding the 2σ
warning but within 3σ. The technologist debates whether to
release patient results. What is the best QA decision?
A. Release results; a single 2σ event is a warning not a rejection.
B. Hold patient results and run duplicate controls and a new
calibrator check.
C. Release results and add a comment indicating increased
control variability.
D. Discard the control run and rerun patient samples
immediately without investigation.
Correct answer: B
Rationale — Correct (B): A 2σ exceedance is a warning that
warrants investigation; best practice is to rerun controls and
verify calibration before releasing patient data to prevent
reporting erroneous values. Duplicate controls and calibrator
checks follow quality-control protocols.
Rationale — Incorrect:
A. Releasing without investigation risks reporting inaccurate
patient results.
C. Adding a comment does not correct potential analytic drift or
bias.
D. Rerunning patients without first confirming control/calibrator
status bypasses proper QC troubleshooting.
, Teaching point: Investigate 2σ warnings with repeat controls
and calibration checks before releasing results.
Citation: Brunzel, N. A. (2023). Fundamentals of Urine and Body
Fluid Analysis (5th ed.). Ch. 1.
3)
Reference: Ch. 1 — Quality Assessment and Safety — Pre-
analytical variables: specimen labelling and identification
Stem: A stat urine specimen arrives with two patient identifiers
but the accession label lacks the collection time. The clinician
requests immediate urinalysis for suspected acute hematuria.
What should the laboratorian do?
A. Proceed with testing and document the missing time on the
report.
B. Refuse testing until the collector adds the collection time to
the label.
C. Accept the specimen, perform testing, and note “collection
time not provided” on the report.
D. Assign the current time as collection time and proceed.
Correct answer: C
Rationale — Correct (C): Critical patient identifiers must be
present, and two identifiers are acceptable; collection time,
while important for interpretation, is not always an absolute
exclusion. Testing with documentation of the missing collection
time preserves patient care while informing clinical
interpretation.
BODY FLUID ANALYSIS
5TH EDITION
AUTHOR(S)NANCY A. BRUNZEL
TEST BANK
1)
Reference: Ch. 1 — Quality Assessment and Safety — Quality
indicators and corrective action
Stem: A mid-size hospital urinalysis lab notes a rising rate of
centrifuge tube breakage during transport (from 0.2% to 2%
over two months). Failure mode effects analysis (FMEA) shows
no change in centrifuge settings. Which QA action is the most
appropriate immediate step?
,A. Replace all specimen tubes with a different manufacturer’s
tube.
B. Implement targeted staff competency retraining on specimen
transport and handling.
C. Increase centrifuge speed to shorten spin time and reduce
handling.
D. Report the increase as acceptable variation and continue
monitoring.
Correct answer: B
Rationale — Correct (B): The sudden increase in breakage with
unchanged equipment suggests a pre-analytical handling issue.
Competency retraining targets transport/handling practices,
which FMEA flagged. This corrective action is immediate,
minimally disruptive, and testable by subsequent monitoring.
Rationale — Incorrect:
A. Changing tube manufacturer is premature without evidence
the tubes themselves are faulty.
C. Increasing centrifuge speed risks sample integrity and does
not address transport breakage.
D. Accepting the rise ignores a likely preventable quality
problem and fails QA improvement.
Teaching point: Start with human-factor corrective actions
(training) before equipment replacement.
Citation: Brunzel, N. A. (2023). Fundamentals of Urine and Body
Fluid Analysis (5th ed.). Ch. 1.
,2)
Reference: Ch. 1 — Quality Assessment and Safety — Quality
control materials and Westgard rules
Stem: An automated chemistry analyzer used for urine
creatinine shows a single control point exceeding the 2σ
warning but within 3σ. The technologist debates whether to
release patient results. What is the best QA decision?
A. Release results; a single 2σ event is a warning not a rejection.
B. Hold patient results and run duplicate controls and a new
calibrator check.
C. Release results and add a comment indicating increased
control variability.
D. Discard the control run and rerun patient samples
immediately without investigation.
Correct answer: B
Rationale — Correct (B): A 2σ exceedance is a warning that
warrants investigation; best practice is to rerun controls and
verify calibration before releasing patient data to prevent
reporting erroneous values. Duplicate controls and calibrator
checks follow quality-control protocols.
Rationale — Incorrect:
A. Releasing without investigation risks reporting inaccurate
patient results.
C. Adding a comment does not correct potential analytic drift or
bias.
D. Rerunning patients without first confirming control/calibrator
status bypasses proper QC troubleshooting.
, Teaching point: Investigate 2σ warnings with repeat controls
and calibration checks before releasing results.
Citation: Brunzel, N. A. (2023). Fundamentals of Urine and Body
Fluid Analysis (5th ed.). Ch. 1.
3)
Reference: Ch. 1 — Quality Assessment and Safety — Pre-
analytical variables: specimen labelling and identification
Stem: A stat urine specimen arrives with two patient identifiers
but the accession label lacks the collection time. The clinician
requests immediate urinalysis for suspected acute hematuria.
What should the laboratorian do?
A. Proceed with testing and document the missing time on the
report.
B. Refuse testing until the collector adds the collection time to
the label.
C. Accept the specimen, perform testing, and note “collection
time not provided” on the report.
D. Assign the current time as collection time and proceed.
Correct answer: C
Rationale — Correct (C): Critical patient identifiers must be
present, and two identifiers are acceptable; collection time,
while important for interpretation, is not always an absolute
exclusion. Testing with documentation of the missing collection
time preserves patient care while informing clinical
interpretation.
