FUNDAMENTALS OF URINE AND
BODY FLUID ANALYSIS
5TH EDITION
AUTHOR(S)NANCY A. BRUNZEL
TEST BANK
1️⃣ Question 1️
Reference: Ch. 1 — Quality Assessment and Safety — Quality
Indicators and Turnaround Time
Stem: A hospital urinalysis lab has an initiative to reduce
specimen-to-report turnaround time (TAT) for routine urinalysis.
Current median TAT is 75 minutes; target is 45 minutes. During
a 2-week audit, specimens with missing clinical history had TAT
,of 110 minutes and specimens from the ED had 40 minutes.
Which QA action best addresses reducing overall median TAT
while preserving result quality?
A. Implement a hard 45-minute clock; reject any specimen not
processed within target.
B. Prioritize ED specimens and route non-urgent outpatient
specimens to off-peak processing hours.
C. Eliminate microscopic testing on all specimens to speed TAT.
D. Require clinicians to complete clinical history fields before
specimen acceptance.
Correct answer: B
Rationale — Correct (B): Prioritizing emergent ED specimens
while scheduling non-urgent outpatient specimens during off-
peak times balances workload and reduces median TAT without
compromising testing quality. This is a systems-level QA
intervention addressing process flow rather than punitive
measures.
Rationale — Incorrect:
A: A rigid rejection policy risks patient harm and lost data; TAT
goals should be met by process changes, not by discarding
samples.
C: Removing microscopy sacrifices diagnostic information and
violates quality and clinical standards.
D: While complete histories are valuable, enforcing acceptance
delays could worsen TAT; better to allow processing while
working with clinicians to improve documentation.
,Teaching Point: Match staffing and workflow to specimen
sources to meet TAT targets.
Citation: Brunzel, N. A. (2023). Fundamentals of Urine and Body
Fluid Analysis (5th ed.). Ch. 1.
2️⃣ Question 2️
Reference: Ch. 1 — Quality Assessment and Safety — Internal
Quality Control (IQC) Frequency
Stem: A lab uses chemical reagent strips read by an automated
analyzer. Internal QC (two levels) is run once daily. Over three
weeks, low-level protein control drifts slowly toward out-of-
range before the daily QC detects it. Which QA modification
most effectively reduces risk from this drift?
A. Continue daily QC but expand acceptable limits.
B. Run low-level QC at the start of each shift and after reagent
lot changes.
C. Replace automated analyzer with manual reading to detect
drift.
D. Rely on external proficiency testing results to detect drift.
Correct answer: B
Rationale — Correct (B): Increasing QC frequency, especially at
the start of each shift and after reagent lot changes, enables
earlier detection of gradual drift. This aligns with IQC principles:
frequency must reflect test stability and clinical risk.
, Rationale — Incorrect:
A: Widening limits masks error and reduces patient safety.
C: Manual reading increases variability and workload; not a
sound QA correction for drift.
D: Proficiency testing is infrequent and retrospective —
unsuitable for timely drift detection.
Teaching Point: Adjust QC frequency based on analyte stability
and clinical risk.
Citation: Brunzel, N. A. (2023). Fundamentals of Urine and Body
Fluid Analysis (5th ed.). Ch. 1.
3️⃣ Question 3️
Reference: Ch. 1 — Quality Assessment and Safety —
Proficiency Testing (PT) and Corrective Action
Stem: Your lab receives a PT sample that was reported as
negative for nitrite, but the consensus and your prior internal
results indicate positive. PT coordinator flags an unacceptable
result. Which step is the most appropriate immediate corrective
action?
A. Disregard PT result—PT materials differ from patient
specimens.
B. Initiate an investigation: review instrument maintenance,
reagent lot, analyst competency, and repeat internal controls.
C. Blame the PT provider and request a re-score.
BODY FLUID ANALYSIS
5TH EDITION
AUTHOR(S)NANCY A. BRUNZEL
TEST BANK
1️⃣ Question 1️
Reference: Ch. 1 — Quality Assessment and Safety — Quality
Indicators and Turnaround Time
Stem: A hospital urinalysis lab has an initiative to reduce
specimen-to-report turnaround time (TAT) for routine urinalysis.
Current median TAT is 75 minutes; target is 45 minutes. During
a 2-week audit, specimens with missing clinical history had TAT
,of 110 minutes and specimens from the ED had 40 minutes.
Which QA action best addresses reducing overall median TAT
while preserving result quality?
A. Implement a hard 45-minute clock; reject any specimen not
processed within target.
B. Prioritize ED specimens and route non-urgent outpatient
specimens to off-peak processing hours.
C. Eliminate microscopic testing on all specimens to speed TAT.
D. Require clinicians to complete clinical history fields before
specimen acceptance.
Correct answer: B
Rationale — Correct (B): Prioritizing emergent ED specimens
while scheduling non-urgent outpatient specimens during off-
peak times balances workload and reduces median TAT without
compromising testing quality. This is a systems-level QA
intervention addressing process flow rather than punitive
measures.
Rationale — Incorrect:
A: A rigid rejection policy risks patient harm and lost data; TAT
goals should be met by process changes, not by discarding
samples.
C: Removing microscopy sacrifices diagnostic information and
violates quality and clinical standards.
D: While complete histories are valuable, enforcing acceptance
delays could worsen TAT; better to allow processing while
working with clinicians to improve documentation.
,Teaching Point: Match staffing and workflow to specimen
sources to meet TAT targets.
Citation: Brunzel, N. A. (2023). Fundamentals of Urine and Body
Fluid Analysis (5th ed.). Ch. 1.
2️⃣ Question 2️
Reference: Ch. 1 — Quality Assessment and Safety — Internal
Quality Control (IQC) Frequency
Stem: A lab uses chemical reagent strips read by an automated
analyzer. Internal QC (two levels) is run once daily. Over three
weeks, low-level protein control drifts slowly toward out-of-
range before the daily QC detects it. Which QA modification
most effectively reduces risk from this drift?
A. Continue daily QC but expand acceptable limits.
B. Run low-level QC at the start of each shift and after reagent
lot changes.
C. Replace automated analyzer with manual reading to detect
drift.
D. Rely on external proficiency testing results to detect drift.
Correct answer: B
Rationale — Correct (B): Increasing QC frequency, especially at
the start of each shift and after reagent lot changes, enables
earlier detection of gradual drift. This aligns with IQC principles:
frequency must reflect test stability and clinical risk.
, Rationale — Incorrect:
A: Widening limits masks error and reduces patient safety.
C: Manual reading increases variability and workload; not a
sound QA correction for drift.
D: Proficiency testing is infrequent and retrospective —
unsuitable for timely drift detection.
Teaching Point: Adjust QC frequency based on analyte stability
and clinical risk.
Citation: Brunzel, N. A. (2023). Fundamentals of Urine and Body
Fluid Analysis (5th ed.). Ch. 1.
3️⃣ Question 3️
Reference: Ch. 1 — Quality Assessment and Safety —
Proficiency Testing (PT) and Corrective Action
Stem: Your lab receives a PT sample that was reported as
negative for nitrite, but the consensus and your prior internal
results indicate positive. PT coordinator flags an unacceptable
result. Which step is the most appropriate immediate corrective
action?
A. Disregard PT result—PT materials differ from patient
specimens.
B. Initiate an investigation: review instrument maintenance,
reagent lot, analyst competency, and repeat internal controls.
C. Blame the PT provider and request a re-score.
