FUNDAMENTALS OF URINE AND
BODY FLUID ANALYSIS
5TH EDITION
AUTHOR(S)NANCY A. BRUNZEL
TEST BANK
1
Reference
Ch. 1 — Preanalytical Components — Specimen Integrity and
Transport
Stem
A busy ED sends a urine specimen collected in a nonsterile cup
labeled only with the patient’s name and “ED” (no time or
collector). The urine is cloudy and shows a urine dipstick with
,positive nitrite and leukocyte esterase but culture returns no
growth after 48 hours. As the MLS on shift, what is the most
appropriate immediate laboratory action?
A. Report the chemical and microscopic findings and note
“culture negative” — proceed with routine documentation.
B. Reject the specimen for culture due to incomplete labeling
and request a repeat, but report dipstick results with a
cautionary note.
C. Accept the specimen for reporting; annotate possible
contaminated specimen and advise clinician to interpret with
caution.
D. Hold results and perform Gram stain of the original urine
sediment before reporting.
Correct answer: D
Rationale — Correct (D)
Performing a Gram stain on the original sediment is the best
immediate action: it helps reconcile discordant dipstick
(nitrite/leukocyte esterase) with a negative culture by detecting
fastidious organisms, prior antibiotic effect, or contaminant
organisms. This provides additional data before reporting and
before requesting a repeat specimen. It preserves patient safety
while following QA principles for pre- and analytical
troubleshooting.
Rationale — Incorrect
A. Reporting without further investigation ignores the
discordance and undermines diagnostic accuracy.
,B. Rejecting for culture is premature if the specimen may still
yield diagnostic information (Gram stain can help).
C. Annotating without attempted resolution misses an
opportunity to provide useful analytic evidence and may
mislead clinicians.
Teaching point
Use Gram stain to resolve discordant dipstick–culture results
before rejecting or routine reporting.
Citation
Brunzel, N. A. (2023). Fundamentals of Urine and Body Fluid
Analysis (5th ed.). Ch. 1.
2
Reference
Ch. 1 — Analytical Components — Quality Control Materials &
Trending
Stem
Your urinalysis instrument’s daily internal QC shows low-level
protein control trending upward across five days but remains
within manufacturer limits. Patient results over the same period
show a small but consistent increase in low-range protein.
Which QA interpretation/action is most appropriate?
A. Continue routine testing—QC is within limits; analytical shift
is unlikely.
B. Run an independent third-party QC and perform instrument
, preventative maintenance (PM) if drift confirmed.
C. Immediately stop testing and decommission the analyzer
until recalibration.
D. Report patient results but add a note that repeat testing may
be necessary because QC is trending.
Correct answer: B
Rationale — Correct (B)
A trending but in-range QC warrants verification using an
independent third-party QC to detect bias not flagged by
manufacturer controls. Confirmed drift should trigger
preventive maintenance and possibly recalibration. This
approach follows QA monitoring and prevents systematic bias
affecting patient results.
Rationale — Incorrect
A. Ignoring a trend risks gradual bias; trends must be
investigated even if within limits.
C. Stopping testing immediately is disproportionate without
confirming bias.
D. Reporting with a note delays corrective action; investigation
should precede routine reporting if bias is suspected.
Teaching point
Investigate QC trends with independent controls and PM before
patient-result bias becomes clinically significant.
BODY FLUID ANALYSIS
5TH EDITION
AUTHOR(S)NANCY A. BRUNZEL
TEST BANK
1
Reference
Ch. 1 — Preanalytical Components — Specimen Integrity and
Transport
Stem
A busy ED sends a urine specimen collected in a nonsterile cup
labeled only with the patient’s name and “ED” (no time or
collector). The urine is cloudy and shows a urine dipstick with
,positive nitrite and leukocyte esterase but culture returns no
growth after 48 hours. As the MLS on shift, what is the most
appropriate immediate laboratory action?
A. Report the chemical and microscopic findings and note
“culture negative” — proceed with routine documentation.
B. Reject the specimen for culture due to incomplete labeling
and request a repeat, but report dipstick results with a
cautionary note.
C. Accept the specimen for reporting; annotate possible
contaminated specimen and advise clinician to interpret with
caution.
D. Hold results and perform Gram stain of the original urine
sediment before reporting.
Correct answer: D
Rationale — Correct (D)
Performing a Gram stain on the original sediment is the best
immediate action: it helps reconcile discordant dipstick
(nitrite/leukocyte esterase) with a negative culture by detecting
fastidious organisms, prior antibiotic effect, or contaminant
organisms. This provides additional data before reporting and
before requesting a repeat specimen. It preserves patient safety
while following QA principles for pre- and analytical
troubleshooting.
Rationale — Incorrect
A. Reporting without further investigation ignores the
discordance and undermines diagnostic accuracy.
,B. Rejecting for culture is premature if the specimen may still
yield diagnostic information (Gram stain can help).
C. Annotating without attempted resolution misses an
opportunity to provide useful analytic evidence and may
mislead clinicians.
Teaching point
Use Gram stain to resolve discordant dipstick–culture results
before rejecting or routine reporting.
Citation
Brunzel, N. A. (2023). Fundamentals of Urine and Body Fluid
Analysis (5th ed.). Ch. 1.
2
Reference
Ch. 1 — Analytical Components — Quality Control Materials &
Trending
Stem
Your urinalysis instrument’s daily internal QC shows low-level
protein control trending upward across five days but remains
within manufacturer limits. Patient results over the same period
show a small but consistent increase in low-range protein.
Which QA interpretation/action is most appropriate?
A. Continue routine testing—QC is within limits; analytical shift
is unlikely.
B. Run an independent third-party QC and perform instrument
, preventative maintenance (PM) if drift confirmed.
C. Immediately stop testing and decommission the analyzer
until recalibration.
D. Report patient results but add a note that repeat testing may
be necessary because QC is trending.
Correct answer: B
Rationale — Correct (B)
A trending but in-range QC warrants verification using an
independent third-party QC to detect bias not flagged by
manufacturer controls. Confirmed drift should trigger
preventive maintenance and possibly recalibration. This
approach follows QA monitoring and prevents systematic bias
affecting patient results.
Rationale — Incorrect
A. Ignoring a trend risks gradual bias; trends must be
investigated even if within limits.
C. Stopping testing immediately is disproportionate without
confirming bias.
D. Reporting with a note delays corrective action; investigation
should precede routine reporting if bias is suspected.
Teaching point
Investigate QC trends with independent controls and PM before
patient-result bias becomes clinically significant.
