FUNDAMENTALS OF URINE AND
BODY FLUID ANALYSIS
5TH EDITION
AUTHOR(S)NANCY A. BRUNZEL
TEST BANK
1
Reference
Ch. 1 — Quality Assessment and Safety
Stem
A urinalysis technologist notes that internal QC material for
reagent strip protein has trended upward over three days but
remains within control limits on a Levey-Jennings plot. The run
contains a single patient result with 3+ protein but no
,hematuria on microscopy. Which next-step laboratory action
most appropriately addresses analytical vs. pre-analytical
causes?
A. Release the patient result as reported; trending QC within
limits indicates acceptable performance.
B. Repeat the patient specimen and run QC again; obtain a fresh
specimen if the repeat differs.
C. Immediately reject all results from the day and contact the
manufacturer for a reagent recall.
D. Report the result but add a comment that QC trended
upward and recommend confirmatory albumin testing.
Correct Answer
B
Rationale — Correct (B)
Repeat of the patient specimen and re-running QC distinguishes
an analytical shift from sample-specific or pre-analytical causes;
a discrepant repeat suggests specimen or procedural error and
warrants collection of a fresh sample. This approach follows QA
practice: verify analytical integrity before clinical reporting. It
preserves patient safety by preventing false positives from
single, unverified runs.
Rationale — Incorrect
A. Trending toward a limit still requires verification when a
clinically significant abnormal result appears; releasing without
verification risks reporting an artifact.
C. Immediate day-wide rejection and contacting the
,manufacturer is disproportionate without reproducible QC
failure or evidence of reagent lot problem.
D. Adding a caveat without verification leaves the analytical
question unresolved and may mislead clinicians.
Teaching Point
Always verify unexpected abnormal results by repeating
specimen and QC before clinical reporting.
Citation
Brunzel, N. A. (2023). Fundamentals of Urine and Body Fluid
Analysis (5th ed.). Ch. 1.
2
Reference
Ch. 1 — Quality Assessment and Safety
Stem
During a proficiency testing (PT) event, your lab’s reported
microscopic RBC count is significantly lower than peer group
consensus. Internal QC and instrument verification data are
within limits. What is the most appropriate interpretation and
immediate action?
A. Accept the PT result; inter-laboratory variability is common
for microscopy.
B. Initiate a root-cause investigation focused on pre-analytic
specimen processing and staff technique; document corrective
actions.
, C. Ignore the PT failure because PT is not binding for urinalysis
microscopy.
D. Change the microscope objective to a higher magnification
and re-submit PT results.
Correct Answer
B
Rationale — Correct (B)
A PT discordance with acceptable internal QC indicates a
potential systematic issue in pre-analytical handling or operator
technique; regulatory and accreditation requirements mandate
investigation, documentation of root causes (training, SOPs,
specimen prep), and implementation of corrective actions. This
safeguards test reliability and compliance.
Rationale — Incorrect
A. While microscopy has inter-lab variability, a significant
deviation triggers mandatory investigation, not passive
acceptance.
C. PT outcomes are used for external quality assessment and
often required by accrediting bodies; ignoring failure risks
noncompliance.
D. Arbitrary equipment changes without investigation may not
address the true cause and could introduce new errors.
Teaching Point
Proficiency testing failures require documented root-cause
analysis and corrective actions.
BODY FLUID ANALYSIS
5TH EDITION
AUTHOR(S)NANCY A. BRUNZEL
TEST BANK
1
Reference
Ch. 1 — Quality Assessment and Safety
Stem
A urinalysis technologist notes that internal QC material for
reagent strip protein has trended upward over three days but
remains within control limits on a Levey-Jennings plot. The run
contains a single patient result with 3+ protein but no
,hematuria on microscopy. Which next-step laboratory action
most appropriately addresses analytical vs. pre-analytical
causes?
A. Release the patient result as reported; trending QC within
limits indicates acceptable performance.
B. Repeat the patient specimen and run QC again; obtain a fresh
specimen if the repeat differs.
C. Immediately reject all results from the day and contact the
manufacturer for a reagent recall.
D. Report the result but add a comment that QC trended
upward and recommend confirmatory albumin testing.
Correct Answer
B
Rationale — Correct (B)
Repeat of the patient specimen and re-running QC distinguishes
an analytical shift from sample-specific or pre-analytical causes;
a discrepant repeat suggests specimen or procedural error and
warrants collection of a fresh sample. This approach follows QA
practice: verify analytical integrity before clinical reporting. It
preserves patient safety by preventing false positives from
single, unverified runs.
Rationale — Incorrect
A. Trending toward a limit still requires verification when a
clinically significant abnormal result appears; releasing without
verification risks reporting an artifact.
C. Immediate day-wide rejection and contacting the
,manufacturer is disproportionate without reproducible QC
failure or evidence of reagent lot problem.
D. Adding a caveat without verification leaves the analytical
question unresolved and may mislead clinicians.
Teaching Point
Always verify unexpected abnormal results by repeating
specimen and QC before clinical reporting.
Citation
Brunzel, N. A. (2023). Fundamentals of Urine and Body Fluid
Analysis (5th ed.). Ch. 1.
2
Reference
Ch. 1 — Quality Assessment and Safety
Stem
During a proficiency testing (PT) event, your lab’s reported
microscopic RBC count is significantly lower than peer group
consensus. Internal QC and instrument verification data are
within limits. What is the most appropriate interpretation and
immediate action?
A. Accept the PT result; inter-laboratory variability is common
for microscopy.
B. Initiate a root-cause investigation focused on pre-analytic
specimen processing and staff technique; document corrective
actions.
, C. Ignore the PT failure because PT is not binding for urinalysis
microscopy.
D. Change the microscope objective to a higher magnification
and re-submit PT results.
Correct Answer
B
Rationale — Correct (B)
A PT discordance with acceptable internal QC indicates a
potential systematic issue in pre-analytical handling or operator
technique; regulatory and accreditation requirements mandate
investigation, documentation of root causes (training, SOPs,
specimen prep), and implementation of corrective actions. This
safeguards test reliability and compliance.
Rationale — Incorrect
A. While microscopy has inter-lab variability, a significant
deviation triggers mandatory investigation, not passive
acceptance.
C. PT outcomes are used for external quality assessment and
often required by accrediting bodies; ignoring failure risks
noncompliance.
D. Arbitrary equipment changes without investigation may not
address the true cause and could introduce new errors.
Teaching Point
Proficiency testing failures require documented root-cause
analysis and corrective actions.
