FUNDAMENTALS OF URINE AND
BODY FLUID ANALYSIS
5TH EDITION
AUTHOR(S)NANCY A. BRUNZEL
TEST BANK
1
Reference
Ch. 1 — Quality Assessment — Quality control interpretation
(Levey-Jennings / Westgard)
Stem
A clinical chemist running reagent strip QC on a urine analyzer
obtains a 2SD shift above the mean for the control material on
,two consecutive days (same control lot). Patient protein strip
results that day are also higher than prior baseline. Which is the
most appropriate immediate laboratory action?
A. Release patient results and order duplicate patient testing.
B. Hold patient results, investigate the QC trend, and re-run
controls after instrument troubleshooting.
C. Replace the control lot and continue releasing patient results
pending further monitoring.
D. Ignore the shift because two consecutive days within 2SD is
acceptable.
Correct Answer
B
Rationale — Correct (B)
A persistent 2SD shift over consecutive days suggests a
systematic bias or drift; patient result elevation may be clinically
false. Holding results while investigating instrument function,
reagents, and environmental conditions and re-running controls
after corrective action follows QA principles to prevent
reporting erroneous patient data. Repeating controls after
troubleshooting confirms whether bias persists.
Rationale — Incorrect
A: Releasing results risks patient harm; duplicate patient testing
alone doesn't address QC drift.
C: Replacing control lot without investigating
instrument/reagent/environment could mask root cause.
,D: Two consecutive 2SD shifts indicate an actionable trend —
dismissing it violates Westgard/QA rules.
Teaching Point
Consecutive QC shifts indicate bias — investigate and correct
before releasing patient results.
Citation
Brunzel, N. A. (2023). Fundamentals of Urine and Body Fluid
Analysis (5th ed.). Ch. 1.
2
Reference
Ch. 1 — Quality Assessment — Proficiency testing and external
QA
Stem
Your lab receives a proficiency testing (PT) panel with urines
containing occult blood. Your technologist reports markedly
lower occult blood values than peer median. Prior internal QC
was acceptable. What is the best analytic interpretation and
next step?
A. Assume patient testing is accurate because internal QC was
acceptable; no action needed.
B. Investigate analytical method bias, compare reagent lot and
calibration to peers, and document corrective action.
C. Declare PT invalid and request a new panel without further
investigation.
, D. Retrain the technologist immediately for specimen handling
errors.
Correct Answer
B
Rationale — Correct (B)
A PT discrepancy despite acceptable internal QC suggests
method bias, calibration error, or reagent lot issues relative to
peer labs. Investigating method performance (reagents,
calibration, instrument settings) and documenting corrective
actions is required under external QA programs to maintain
accreditation and identify systemic errors.
Rationale — Incorrect
A: Internal QC passing doesn't exclude systematic bias relative
to other labs or PT target.
C: Declaring PT invalid without investigating contravenes PT
program rules and QA responsibility.
D: Immediate retraining may miss systemic causes — first
evaluate method/reagent/instrument factors.
Teaching Point
PT discordance with acceptable internal QC suggests method
bias — investigate calibration and reagent issues.
Citation
Brunzel, N. A. (2023). Fundamentals of Urine and Body Fluid
Analysis (5th ed.). Ch. 1.
BODY FLUID ANALYSIS
5TH EDITION
AUTHOR(S)NANCY A. BRUNZEL
TEST BANK
1
Reference
Ch. 1 — Quality Assessment — Quality control interpretation
(Levey-Jennings / Westgard)
Stem
A clinical chemist running reagent strip QC on a urine analyzer
obtains a 2SD shift above the mean for the control material on
,two consecutive days (same control lot). Patient protein strip
results that day are also higher than prior baseline. Which is the
most appropriate immediate laboratory action?
A. Release patient results and order duplicate patient testing.
B. Hold patient results, investigate the QC trend, and re-run
controls after instrument troubleshooting.
C. Replace the control lot and continue releasing patient results
pending further monitoring.
D. Ignore the shift because two consecutive days within 2SD is
acceptable.
Correct Answer
B
Rationale — Correct (B)
A persistent 2SD shift over consecutive days suggests a
systematic bias or drift; patient result elevation may be clinically
false. Holding results while investigating instrument function,
reagents, and environmental conditions and re-running controls
after corrective action follows QA principles to prevent
reporting erroneous patient data. Repeating controls after
troubleshooting confirms whether bias persists.
Rationale — Incorrect
A: Releasing results risks patient harm; duplicate patient testing
alone doesn't address QC drift.
C: Replacing control lot without investigating
instrument/reagent/environment could mask root cause.
,D: Two consecutive 2SD shifts indicate an actionable trend —
dismissing it violates Westgard/QA rules.
Teaching Point
Consecutive QC shifts indicate bias — investigate and correct
before releasing patient results.
Citation
Brunzel, N. A. (2023). Fundamentals of Urine and Body Fluid
Analysis (5th ed.). Ch. 1.
2
Reference
Ch. 1 — Quality Assessment — Proficiency testing and external
QA
Stem
Your lab receives a proficiency testing (PT) panel with urines
containing occult blood. Your technologist reports markedly
lower occult blood values than peer median. Prior internal QC
was acceptable. What is the best analytic interpretation and
next step?
A. Assume patient testing is accurate because internal QC was
acceptable; no action needed.
B. Investigate analytical method bias, compare reagent lot and
calibration to peers, and document corrective action.
C. Declare PT invalid and request a new panel without further
investigation.
, D. Retrain the technologist immediately for specimen handling
errors.
Correct Answer
B
Rationale — Correct (B)
A PT discrepancy despite acceptable internal QC suggests
method bias, calibration error, or reagent lot issues relative to
peer labs. Investigating method performance (reagents,
calibration, instrument settings) and documenting corrective
actions is required under external QA programs to maintain
accreditation and identify systemic errors.
Rationale — Incorrect
A: Internal QC passing doesn't exclude systematic bias relative
to other labs or PT target.
C: Declaring PT invalid without investigating contravenes PT
program rules and QA responsibility.
D: Immediate retraining may miss systemic causes — first
evaluate method/reagent/instrument factors.
Teaching Point
PT discordance with acceptable internal QC suggests method
bias — investigate calibration and reagent issues.
Citation
Brunzel, N. A. (2023). Fundamentals of Urine and Body Fluid
Analysis (5th ed.). Ch. 1.
