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 trending
Stem
A urinalysis lab notices that the frequency of specimen
rejections due to mislabeled containers rose from 0.4% to 1.8%
over the past quarter. The lab director reviews accessioning logs
and finds most errors occur during high-volume morning shifts.
,Which is the best first action to reduce this quality indicator and
why?
A. Immediately hire additional accessioning staff to reduce
workload.
B. Implement a mandatory two-person label verification at
accessioning for morning shifts.
C. Retrain all accessioning staff on labeling policy in a single 30-
minute session.
D. Switch to preprinted barcoded labels for all specimens
without changing procedures.
Correct answer
B
Rationale — Correct
A targeted two-person verification directly addresses human
error at the point where mislabeling occurs, creating a
redundant check during the high-risk period. This is a low-cost,
rapid intervention likely to reduce mislabeled specimens while
the lab evaluates longer-term system changes.
Rationale — Incorrect
A. Hiring may reduce workload but is slow, costly, and may not
target the specific process failure.
C. A single brief retraining is unlikely to change behavior or
sustain improvements without ongoing reinforcement and
process change.
D. Barcoded labels can be highly effective but require
procurement, validation, and procedure changes; implementing
,them immediately without interim controls risks continued
errors.
Teaching point
Address process failures with targeted, redundancy-based
controls at the point of error.
Citation
Brunzel, N. A. (5th ed.). Ch. 1.
2)
Reference
Ch. 1 — Quality Assessment and Safety — Preanalytical errors
and specimen integrity
Stem
You receive a refrigerated urine culture specimen with a request
for urinalysis; the specimen shows cloudy turbidity and a pH of
9.0 on dipstick. Patient notes indicate collection at home 36
hours earlier and transit at ambient temperature. What is the
most likely cause of the abnormal pH and turbidity, and what
should the lab report recommend?
A. Contaminant bacteria growth; recommend recollection with
prompt transport.
B. Renal tubular acidosis; report results as is and recommend
metabolic workup.
C. Preservation with boric acid causing alkalinization; accept
and report results.
, D. True alkaline urinary infection with urea-splitting organism;
request antibiotic history.
Correct answer
A
Rationale — Correct
Specimen held long at ambient temperature allows bacterial
overgrowth and urea-splitting organisms to raise pH and cause
turbidity; preanalytical delay is the likely cause. The correct
action is to recommend recollection with instructions for proper
collection and prompt transport or refrigeration.
Rationale — Incorrect
B. Renal tubular acidosis typically causes acidic urine, not high
pH; clinical correlation would still not explain turbidity from
time delay.
C. Boric acid is a preservative that inhibits bacterial growth but
does not raise pH to 9.0; acceptance without comment risks
reporting misleading results.
D. While urea-splitting organisms can raise pH, given the long
delay and lack of preservation, contamination/overgrowth is
more likely than true infection; recollection is indicated.
Teaching point
Preanalytical delays cause bacterial overgrowth and pH shifts;
recollect when collection/transport were improper.
Citation
Brunzel, N. A. (5th ed.). Ch. 1.
BODY FLUID ANALYSIS
5TH EDITION
AUTHOR(S)NANCY A. BRUNZEL
TEST BANK
1)
Reference
Ch. 1 — Quality Assessment and Safety — Quality indicators
and trending
Stem
A urinalysis lab notices that the frequency of specimen
rejections due to mislabeled containers rose from 0.4% to 1.8%
over the past quarter. The lab director reviews accessioning logs
and finds most errors occur during high-volume morning shifts.
,Which is the best first action to reduce this quality indicator and
why?
A. Immediately hire additional accessioning staff to reduce
workload.
B. Implement a mandatory two-person label verification at
accessioning for morning shifts.
C. Retrain all accessioning staff on labeling policy in a single 30-
minute session.
D. Switch to preprinted barcoded labels for all specimens
without changing procedures.
Correct answer
B
Rationale — Correct
A targeted two-person verification directly addresses human
error at the point where mislabeling occurs, creating a
redundant check during the high-risk period. This is a low-cost,
rapid intervention likely to reduce mislabeled specimens while
the lab evaluates longer-term system changes.
Rationale — Incorrect
A. Hiring may reduce workload but is slow, costly, and may not
target the specific process failure.
C. A single brief retraining is unlikely to change behavior or
sustain improvements without ongoing reinforcement and
process change.
D. Barcoded labels can be highly effective but require
procurement, validation, and procedure changes; implementing
,them immediately without interim controls risks continued
errors.
Teaching point
Address process failures with targeted, redundancy-based
controls at the point of error.
Citation
Brunzel, N. A. (5th ed.). Ch. 1.
2)
Reference
Ch. 1 — Quality Assessment and Safety — Preanalytical errors
and specimen integrity
Stem
You receive a refrigerated urine culture specimen with a request
for urinalysis; the specimen shows cloudy turbidity and a pH of
9.0 on dipstick. Patient notes indicate collection at home 36
hours earlier and transit at ambient temperature. What is the
most likely cause of the abnormal pH and turbidity, and what
should the lab report recommend?
A. Contaminant bacteria growth; recommend recollection with
prompt transport.
B. Renal tubular acidosis; report results as is and recommend
metabolic workup.
C. Preservation with boric acid causing alkalinization; accept
and report results.
, D. True alkaline urinary infection with urea-splitting organism;
request antibiotic history.
Correct answer
A
Rationale — Correct
Specimen held long at ambient temperature allows bacterial
overgrowth and urea-splitting organisms to raise pH and cause
turbidity; preanalytical delay is the likely cause. The correct
action is to recommend recollection with instructions for proper
collection and prompt transport or refrigeration.
Rationale — Incorrect
B. Renal tubular acidosis typically causes acidic urine, not high
pH; clinical correlation would still not explain turbidity from
time delay.
C. Boric acid is a preservative that inhibits bacterial growth but
does not raise pH to 9.0; acceptance without comment risks
reporting misleading results.
D. While urea-splitting organisms can raise pH, given the long
delay and lack of preservation, contamination/overgrowth is
more likely than true infection; recollection is indicated.
Teaching point
Preanalytical delays cause bacterial overgrowth and pH shifts;
recollect when collection/transport were improper.
Citation
Brunzel, N. A. (5th ed.). Ch. 1.
