FUNDAMENTALS OF URINE AND
BODY FLUID ANALYSIS
5TH EDITION
AUTHOR(S)NANCY A. BRUNZEL
TEST BANK
1 — Quality assessment overview — QA program failure
detection
Reference: Ch. 1 — Quality Assessment and Safety — Quality
Assessment
Stem: A urinalysis lab noticed an increase in reporting delays
and an uptick in post-analytic amendments over the past two
months. Root-cause review shows no change in staffing but
frequent instrument maintenance calls and variable control
recovery. Which QA action most appropriately addresses the
,root causes while aligning with continuous quality improvement
principles?
A. Halt testing until a full instrument replacement is approved.
B. Implement a process-mapping session followed by a Pareto
analysis and targeted corrective actions.
C. Increase staffing by hiring temporary technologists
immediately.
D. Report the issue to regulatory agencies before local
corrective steps.
Correct answer: B
Rationale — Correct (B): Process mapping with Pareto analysis
targets the most frequent causes of delays/amendments, aligns
with continuous quality improvement (CQI), and informs
focused corrective actions such as workflow changes or
preventive maintenance. It is pragmatic and evidence-based for
QA program improvement.
Rationale — Incorrect:
A. Full instrument replacement is costly and premature without
root-cause analysis.
C. Hiring addresses capacity but not instrument or process
failures identified by maintenance calls.
D. Regulatory reporting may be required for serious patient
harm but is not the first QA step for internal process issues.
Teaching point: Use process mapping + Pareto to prioritize
corrective actions in QA.
,Citation: Brunzel, N. A. (2023). Fundamentals of Urine and Body
Fluid Analysis (5th ed.). Ch. 1.
2 — Internal quality control — Levey-Jennings trends
Reference: Ch. 1 — Quality Assessment and Safety — Quality
Assessment / Internal QC
Stem: Daily chemical strip control results for glucose show a
slow upward drift across 10 days within ±2 SD but trending near
the upper control limit. Patient glucose positives have also
increased slightly. Which interpretation and next step reflect
best QC practice?
A. Accept results — within ±2 SD is acceptable; no action
needed.
B. Investigate potential analytic drift: review recent calibrations,
reagent lots, instrument maintenance, and perform repeat
controls.
C. Immediately report all affected patient results as unreliable
and recollect specimens.
D. Change to a different brand of reagent strips without further
investigation.
Correct answer: B
Rationale — Correct (B): A gradual trend toward control limits
suggests analytic drift. Best practice is to investigate calibration,
reagent lots, instrument performance, and repeat controls to
, determine cause before declaring patient results invalid.
Proactive investigation prevents harm.
Rationale — Incorrect:
A. Being within ±2 SD does not eliminate concern when a trend
toward a limit exists — trends need evaluation.
C. Reporting all results unreliable is excessive before confirming
failure source.
D. Switching reagents without investigation risks introducing
new variables and obscuring root cause.
Teaching point: Investigate drifting QC trends before discarding
patient data.
Citation: Brunzel, N. A. (2023). Fundamentals of Urine and Body
Fluid Analysis (5th ed.). Ch. 1.
3 — Westgard rules application
Reference: Ch. 1 — Quality Assessment and Safety — Quality
Assessment / QC Rules
Stem: A quantitative urine chemistry analyzer uses daily
controls. Today the control plot shows a 1:2s rule violation
(control exceeds ±2 SD but within ±3 SD). No other rules
triggered. What is the most appropriate immediate action?
A. Accept patient results because only 1:2s was violated.
B. Run duplicate controls and inspect for random error; if
duplicates are within limits, proceed with patient testing.
BODY FLUID ANALYSIS
5TH EDITION
AUTHOR(S)NANCY A. BRUNZEL
TEST BANK
1 — Quality assessment overview — QA program failure
detection
Reference: Ch. 1 — Quality Assessment and Safety — Quality
Assessment
Stem: A urinalysis lab noticed an increase in reporting delays
and an uptick in post-analytic amendments over the past two
months. Root-cause review shows no change in staffing but
frequent instrument maintenance calls and variable control
recovery. Which QA action most appropriately addresses the
,root causes while aligning with continuous quality improvement
principles?
A. Halt testing until a full instrument replacement is approved.
B. Implement a process-mapping session followed by a Pareto
analysis and targeted corrective actions.
C. Increase staffing by hiring temporary technologists
immediately.
D. Report the issue to regulatory agencies before local
corrective steps.
Correct answer: B
Rationale — Correct (B): Process mapping with Pareto analysis
targets the most frequent causes of delays/amendments, aligns
with continuous quality improvement (CQI), and informs
focused corrective actions such as workflow changes or
preventive maintenance. It is pragmatic and evidence-based for
QA program improvement.
Rationale — Incorrect:
A. Full instrument replacement is costly and premature without
root-cause analysis.
C. Hiring addresses capacity but not instrument or process
failures identified by maintenance calls.
D. Regulatory reporting may be required for serious patient
harm but is not the first QA step for internal process issues.
Teaching point: Use process mapping + Pareto to prioritize
corrective actions in QA.
,Citation: Brunzel, N. A. (2023). Fundamentals of Urine and Body
Fluid Analysis (5th ed.). Ch. 1.
2 — Internal quality control — Levey-Jennings trends
Reference: Ch. 1 — Quality Assessment and Safety — Quality
Assessment / Internal QC
Stem: Daily chemical strip control results for glucose show a
slow upward drift across 10 days within ±2 SD but trending near
the upper control limit. Patient glucose positives have also
increased slightly. Which interpretation and next step reflect
best QC practice?
A. Accept results — within ±2 SD is acceptable; no action
needed.
B. Investigate potential analytic drift: review recent calibrations,
reagent lots, instrument maintenance, and perform repeat
controls.
C. Immediately report all affected patient results as unreliable
and recollect specimens.
D. Change to a different brand of reagent strips without further
investigation.
Correct answer: B
Rationale — Correct (B): A gradual trend toward control limits
suggests analytic drift. Best practice is to investigate calibration,
reagent lots, instrument performance, and repeat controls to
, determine cause before declaring patient results invalid.
Proactive investigation prevents harm.
Rationale — Incorrect:
A. Being within ±2 SD does not eliminate concern when a trend
toward a limit exists — trends need evaluation.
C. Reporting all results unreliable is excessive before confirming
failure source.
D. Switching reagents without investigation risks introducing
new variables and obscuring root cause.
Teaching point: Investigate drifting QC trends before discarding
patient data.
Citation: Brunzel, N. A. (2023). Fundamentals of Urine and Body
Fluid Analysis (5th ed.). Ch. 1.
3 — Westgard rules application
Reference: Ch. 1 — Quality Assessment and Safety — Quality
Assessment / QC Rules
Stem: A quantitative urine chemistry analyzer uses daily
controls. Today the control plot shows a 1:2s rule violation
(control exceeds ±2 SD but within ±3 SD). No other rules
triggered. What is the most appropriate immediate action?
A. Accept patient results because only 1:2s was violated.
B. Run duplicate controls and inspect for random error; if
duplicates are within limits, proceed with patient testing.
