Success in CLS Ch. 13 General Laboratory Principles, Quality Assessment, and Safety (84 q.)

18. What does the preparation of a Levey- Jennings quality control chart for any single constituent of serum require? A. Analysis of control serum over a period of 20 consecutive days B. 20 to 30 analyses of the control serum, on 1 day, in one batch C. Analyses consistently performed byoneperson D. Weekly analyses of the control serum for 1month

A. Analysis of control serum over a period of 20 consecutive days

5. SI units are the designated units employed by the International System of Units. The unit class that encompasses the seven fundamental quantities of measurement is A. Base B. Primary C. Derived D. Elemental

A. Base

76. The phrase "Standard Precautions" refers to a concept of blood borne disease control that requires all human blood and other potentially infectious materials A. Be treated as if known to be infectious for bloodborne pathogens regardless of the perceived "low risk" of a patient population B. Be treated as if it is not infectious unless it is known to be infectious C. Must be handled using a respirator for aerosol exposure D. Need not be treated with caution unless there is a cut on your hand

A. Be treated as if known to be infectious for bloodborne pathogens regardless of the perceived "low risk" of a patient population

77. The biological safety cabinet is the single most useful safety device in the microbiology laboratory. How do Class 2A cabinets differ from Class 2B? A. Class 2A exhausts HEPA filtered air into the room. B. Class 2B exhausts HEPA filtered air into the room. C. Class 2B cabinets are larger. D. Class 2A cabinets contain gas jets for a Bunsen burner.

A. Class 2A exhausts HEP A filtered air into the room.

2. The National Institute of Standards and Technology (NIST) requires that volumetric pipettes and flasks be certified as A. Class A B. Class B C. Class C D. Class D

A. Class A

23. What is the purpose of a Youden plot? A. Compares results on two control specimens, low and high controls, for the same analyte analyzed by several laboratories B. Evaluates the validity of daily results on a single control specimen over a period of 30 days C. Compares results on a single control specimen by two different methods for the same analyte D. Evaluates the validity of daily results of two control specimens within a single laboratory

A. Compares results on two control specimens, low and high controls, for the same analyte analyzed by several laboratories

60. A corrosive material was spilled onto the hand of a laboratorian. After diluting the material under running cold water, what should be done next? A. Consult the material safety data sheet. B. Wipe up the spill with paper towels. C. Dilute the spill with water and remove it in a biohazard bag. D. Go to the nearest hospital emergency department.

A. Consult the material safety data sheet.

4. Lavender top blood collection tubes are used for complete blood counts. What is the anticoagulant in these tubes? A. EDTA B. Heparin C. Sodium citrate D. Sodium oxalate

A. EDTA

70. A stat procedure requiring a corrosive reagent (organic acid) is requested. To trans- port this reagent to the work area under the chemical fume hood a laboratorian should A. Employ a rubber carrier with handles B. Pour an amount near the storage site and transport it C. Pipette the required volume and carry the pipette to the work area D. Carry the brown bottle by the loop with one hand under the bottom of the container

A. Employ a rubber carrier with handles

64. The air-handling system for a microbiology laboratory should A. Maintain negative pressure with respect to the administrative areas B. Maintain positive pressure with respect to the administrative areas C. Have no particular requirement D. Have a HEPA filter

A. Maintain negative pressure with respect to the administrative areas

30. Which of the following terms refers to deviation from the true value caused by indeterminate errors inherent in every laboratory measurement? A. Random error B. Standard error of the mean C. Parametric analysis D. Nonparametric analysis

A. Random error

35. Which of the following describes the ability of an analytical method to maintain both accuracy and precision over an extended period of time? A. Reliability B. Validity C. Probability D. Sensitivity

A. Reliability

25. Which of the following monitoring factors would not be included in a laboratory's quality assessment program? A. Scheduling of staff B. Specimen collection and identification C. Accuracy and precision of analyses D. Preventive maintenance of instruments

A. Scheduling of staff

15. When performing a venipuncture,which of the following is the proper order of draw for evacuated blood collection tubes? A. Sterile specimen, light blue top, and plain red top B. Light blue top, plain red top, and sterile specimen C. Lavender top, light blue top, plain red top D. Green top, sterile specimen, and plain red top

A. Sterile specimen, light blue top, and plain red top

45. When comparing a potential new test with a comparative method in order to bring a new method into the laboratory, one observes error that is consistently affecting results in one direction. What is this type of error known as? A. Systematic error B. Random error C. Constant systematic error D. Proportional systematic error

A. Systematic error

12. The speed of a centrifuge should be checked at least once every 3 months with a(n) A. Tachometer B. Wiper C. Potentiometer D. Ergometer

A. Tachometer

6. Which of the following parameters does not have an effect on centrifugal force? A. Temperature of the centrifuge B. Mass of the material being centrifuged C. Speed of rotation D. Radius of the centrifuge

A. Temperature of the centrifuge

74. Based on the chemical properties of azides, which of the following factors has motivated laboratories to monitor their use? A. The buildup of salts can lead to explosions. B. They are corrosive to pipes even when diluted. C. They are extremely volatile. D. They are flammable and dangerous near an open flame.

A. The buildup of salts can lead to explosions.

83. When working with chemicals, the selection of your gloves depends on A. The chemical hazard and the tasks involved B. How far you must transport the chemical C. Whether or not you use a chemical fume hood D. Whatever is available in the laboratory

A. The chemical hazard and the tasks involved

20. In addition to utilizing Levey-Jennings charts, what other criteria should be applied to interpret internal quality control data? A. Westgard multirule B. Cusum C. Linear regression D. Youden

A. Westgard multirule

80. What written plan of specific measures must laboratories have in place to minimize the risk of exposure to bloodborne pathogens? A. Chemical hygiene plan B. Exposure control plan C. Material safety data sheets D. Infection control plan

B. Exposure control plan

56. Xylene, ethanol, methanol, and acetone would be in which hazard class? A. Corrosive B. Flammable C. Oxidizer D. Carcinogen

B. Flammable

51. Which of the following must be known in order to determine the predictive value of a negative test; that is, the percentage of individuals who test negative and are not diseased? A. True negatives and false negatives B. True positives and false positives C. True positives and false negatives D. True negatives and falsepositives

A. True negatives and false negatives

49. Which of the following must be known in order to determine the sensitivity of a test? A. True positives and false negatives B. True negatives and false positives C. True positives and false positives D. True negatives and false negatives

A. True positives and false negatives

8. "To deliver" (TD) pipettes are identified by A. Two etched bands near the top B. Self-drainingcapacity gel? C. Dual purpose pipette labels D. Blue graduation levels

A. Two etched bands near the top

16. What term applies to the sum of all the values in a set of numbers divided by the number of values in that set? A. Median B. Mode C. Arithmetic mean D. Geometric mean

C. Arithmetic mean

19. A batch of test results is out of control. What should you do first? A. Report the results to the physician first, and then look for the trouble. B. Follow the "out-of-control" procedure specified for the test method. C. Repeat the tests with a new lot of standards (calibrators). D. Repeat the tests with a new lot of reagents.

B. Follow the "out-of-control" procedure specified for the test method.

52. Which of the following statements is false about proficiency-testing programs? A. Participation is mandated by the Centers for Medicare and Medicaid Services under CLIA '88. B. College of American Pathologists and the American Association of Bioanalysts are two major providers of these programs. C. Samples of unknown concentrations are periodically sent to labs participating in the program. D. Acceptable ranges are provided with the samples so labs can determine if it is necessary to repeat the assay.

D. Acceptable ranges are provided with the samples so labs can determine if it is necessary to repeat the assay.

10. Which of the following is an advantage of the angle-head centrifuge over the horizontal-head centrifuge? A. Less air friction B. Smaller increase in sample tempera- ture during centrifugation C. Can be operated at a higher speed D. All the above

D. All the above

58. A Biosafety Level 2 (BSL-2) laboratory is designed to work with microorganisms that are A. Not associated with disease in healthy adult humans B. Associated with serious or lethal human disease for which preventative or therapeutic interventions may be available C. Likely to cause serious or lethal human disease for which preventative or therapeutic interventions are not usually available D. Associated with human disease that is rarely serious and for which preventative or therapeutic interventions are often available

D. Associated with human disease that is rarely serious and for which preventative or therapeutic interventions are often available

39. To provide independent validation of internal quality control programs, external surveys have been developed. Which of the following is a representative survey program? A. CLSI (Clinical and Laboratory Standards Institute) B. ASCLS (American Society for Clinical Laboratory Science) C. ASCP (American Society for Clinical Pathology) D. CAP (College of American Pathologists)

D. CAP (College of American Pathologists)

1. Which of the following is an aluminasilicate glass that is at least six times stronger than borosilicate and is resistant to alkaline etching and scratching? A. Kimax B. Pyrex C. Corning boron free D. Corex

D. Corex

81. Which of the following information is not found on a material safety data sheet? A. Health hazard data B. Fire and explosion hazard data C. Firstaidmeasures D. Cost of chemical

D. Cost of chemical

78. Chlorine is most often used in the form of sodium hypochlorite (NaOCl), found in household bleach, for a disinfectant. What dilution of household bleach is recommended by the Centers for Disease Control and Prevention to clean up blood spills? A. 1:1 B. 1:10 C. 1:20 D. 1:100

B. 1:10

84. What is the maximum capacity of a chemical storage safety can used in the laboratory? A. 1 gallon B. 5 gallons C. 20 gallons D. 55 gallons

B. 5 gallons

17. Calculate the coefficient of variation (percent) for a set of data where the mean (x) = 89 mg/dL and 2 standard deviations 0) = 14 mg/dL. A. 7.8 B. 7.9 C. 15.7 D. 15.8

B. 7.9

65. Precautions such as using a chemical fume hood, wearing rubber gloves, donning a respirator, and cleaning glassware with a strong acid or organic solvent are consistent with working with A. Corrosives B. Carcinogens C. Azides D. Acids

B. Carcinogens

75. A biological safety cabinet that forces HEPA filtered air downward at the front of the cabinet where the laboratorian is working describes a A. Class 1 cabinet B. Class 2 cabinet C. Class 3 cabinet D. Class 4 cabinet

B. Class 2 cabinet

40. A tech is scheduled to perform a specialized test that she/he is familiar with, but is not exactly certain of the steps required. What is the best course of action to take? A. Ask another tech to perform the test. B. Consult the procedure manual and notify the supervisor. C. Run the test as best as possible, being careful to note control values. D. Reject the specimen.

B. Consult the procedure manual and notify the supervisor.

71. Which of the following statements pertains to the safe handling of compressed gases? A. Large cylinders should be loosely placed on a hand cart when being transported. B. Cylinders must be secured to a wall or bench when in use. C. Cylinders should be stored along with flammable liquids because both are combustible. D. Large cylinders should be ordered to avoid frequent movement in and out of stock.

B. Cylinders must be secured to a wall or bench when in use.

9. If a laboratory needs to keep certain chemical materials dry, the apparatus used will be a A. Buret B. Desiccator C. Separatory funnel D. Vacuum

B. Desiccator

55. In the National Fire Protection Association identification system, four color-coded, diamond-shaped symbols are arranged to form a larger diamond shape. What type of hazard does the blue diamond identify? A. Flammable B. Health C. Reactivity D. Contact

B. Health

47. A small laboratory has collected blood samples from 20 individuals as part of a reference interval study for a new test being introduced into the laboratory. Of the test results, four are outside the reference interval published by the manufacturer. How should you proceed? A. Delete the four results and only use the 16 within the range to establish the lab's reference interval. B. Use all 20 results when calculating the ± 2 s range because outliers are to be expected. C. Run four additional samples and if within the manufacturer's range, add them to the original 16 for statistical analysis. D. Obtain an additional 20 samples for testing, and if two or less are outside the suggested range, then the manufacturer's reference interval can be accepted.

D. Obtain an additional 20 samples for testing, and if two or less are outside the suggested range, then the manufacturer's reference interval can be accepted.

53. Which of the following is a reactive chemical that has the potential to become shock sensitive if stored for a prolonged period of time? A. Xylene B. Picric Acid C. Chloroform D. Phenol

B. Picric Acid

69. A laboratorian spills a bottle of concentrated sulfuric acid and slips in the fluid, exposing the lower length of her body to the burning fluid. What would be the most advisable action for a coworker to take? A. Call security. B. Put the person under the safety shower. C. Take the injured person to the nearest hospital emergency department. D. Pour concentrated base on the person to neutralize the acid.

B. Put the person under the safety shower.

79. The clinical hematology laboratory just received a new disinfectant to use in place of the one normally used. Never having used this particular disinfectant before, how should the lab professional proceed? A. Use it full strength; you can always be sure if you do this. B. Read the manufacturer's package insert and prepare the product according to directions. C. Make the concentration 10% higher than the manufacturer's recommendations. D. Put the new disinfectant under the sink for storage.

B. Read the manufacturer's package insert and prepare the product according to directions.

66. A laboratorian, properly dressed in white pants, laboratory coat, and shoes, prepares to leave the laboratory for lunch. In addition to washing his hands, he should A. Put on safety goggles B. Remove his laboratory coat C. Wipe the bench with water D. Remove polyvinyl gloves and place them into labcoat pocket for future use

B. Remove his laboratory coat

29. The percentage of individuals without a specific disease who are correctly identified or predicted by the test as not having the disease describes A. Sensitivity B. Specificity C. Positive predictive value D. Negative predictive value

B. Specificity

61. The federal agency charged with the enforcement of safety and health legislation is the A. College of American Pathologists B. International Air and Transportation Association C. Joint Commission D. Occupational Safety and Health Administration

D. Occupational Safety and Health Administration

63. The air from a chemical fume hood is A. Recirculated through a HEPA filter B. Totally exhausted from the building C. Totally exhausted from the building through a HEPA filter D. Recirculated through a HEPA filter (30%) and 70% is exhausted to the outside

B. Totally exhausted from the building

36. What is the following formula used to calculate? (see book for formula) A. Coefficient of variation B. Variance C. Confidence limits D. Standard deviation

B. Variance

24. If the therapeutic range for the gentamicin assay is a trough level of less than 2 ug/mL and a peak level of 5-8 ug/mL, what would be appropriate mean values for two control levels (in micrograms per milliliter) used to monitor the system? A. 1 and 2 B. 1 and 3 C. 1, 5, and 6 D. 5 and 6

C. 1, 5, and 6

22. The ±2 standard deviation (±2 s) range of acceptable values for a digoxin control is established as 2.0-2.6 ng/mL. On the average, the expectation that a value will be greater than 2.6 ng/mL is 1 in A. 10 B. 20 C. 40 D. 100

C. 40

50. A new test to assess for the presence of malignancy has been developed. By testing a group of benign individuals, it is determined that 45 of 50 subjects test negative for the new marker. What is the specificity of this new assay? A. 10% B. 11% C. 90% D. 100%

C. 90%

33. What percentage of values will fall between ±2 s in a Gaussian (normal) distribution? A. 34.13% B. 68.26% C. 95.45% D. 99.74%

C. 95.45%

32. Which of the following terms refers to the closeness with which the measured value agrees with the true value? A. Random error B. Precision C. Accuracy D. Variance

C. Accuracy

37. Which of the following does not pertain to the characteristics and use of assayed control material? A. Has physical and chemical properties resembling test specimen B. Contains preanalyzed concentrations of analytes being measured C. Can be interchanged in terms of use with primary standards or calibrators D. Concentrations of analytes should be in normal and abnormal ranges.

C. Can be interchanged in terms of use with primary standards or calibrators

57. Which of the following terms is used to identify a chemical that causes cancer? A. Mutagen B. Teratogen C. Carcinogen D. Reactive

C. Carcinogen

27. Which of the following would result in a sudden shift in daily values on a quality control chart? A. Recalibrating the instrument when changing reagent lot numbers during an analytical run B. Replacing the instrument's sample aspiration probe C. Changing the spectrophotometer lamp in the middle of a sample run D. Changing personnel operating the instrument

C. Changing the spectrophotometer lamp in the middle of a sample run

41. A tech has completed the first run of morning specimens. She/he notices that the one control being used is outside ±3 s. What course of action should be taken? A. Release the results. B. Repeat the control only, and if it comes in, release results. C. Check equipment and reagents to determine source of error; repeat the entire analysis, including the control and patients; if the control value is within ±2 s, release results. D. Repeat the control; if the same thing happens, attribute the cause to random error; release results.

C. Check equipment and reagents to determine source of error; repeat the entire analysis, including the control and patients; if the control value is within ±2 s, release results.

73. The responsibility to implement and maintain a safety program in a clinical laboratory belongs to the A. State public health laboratory B. Chemical hygiene officer C. Laboratory safety officer D. Chief pathologist

C. Laboratory safety officer

26. On a quality control chart, when would a statistical out-of-control situation requiring corrective action be suspected? A. Six successive plots fall above and below the mean within ± 1 s. B. Six successive plots fall above and below the mean within ± 2 s. C. One plot falls within the area of ±2 s to 3 s within a 20-consecutive- day span. D. One plot falls outside the area of ±3 s within a 20-consecutive-day span.

D. One plot falls outside the area of ±3 s within a 20-consecutive-day span.

11. The type of water desired for use in test methods requiring maximum accuracy is A. Distilled B. Pure Grade C. Reagent Grade D. Special reagent water

C. Reagent Grade

59. The flash point of a liquid may be defined as the A. Minimum temperature at which self- sustained ignition will occur B. Maximum vapor pressure at which spontaneous ignition will occur C. Temperature at which an adequate amount of vapor is produced, forming an ignitable mixture with air at the liquid's surface D. Temperature that is 10°C greater than the liquid's boiling point

C. Temperature at which an adequate amount of vapor is produced, forming an ignitable mixture with air at the liquid's surface

62. The maximum chemical exposure allowable for an employee during one 8-hour day is the A. Flashpoint B. HEPA standard C. Threshold limit value D. Limit established by the United Nations

C. Threshold limit value

42. Which of the following describes the Westgard multirule 2 2s? A. Two control data points are within ±2 s. B. One control data point falls outside + 2 s and a second point falls outside -2s. C. Two consecutive data points fall outside + 2 s or fall outside -2 s. D. Two consecutive data points fall outside +2s.

C. Two consecutive data points fall outside + 2 s or fall outside -2 s.

54. A fire extinguisher used in the event of an electrical fire should include which of the following classifications? A. Type A B. Type B C. Type C D. Type D

C. Type C

21. A new standard (calibrator) has been prepared in error at a lower concentration than that required for the test. How would such an error appear on a quality control chart? A. Upward trend B. Downward trend C. Upward shift D. Downward shift

C. Upward shift

34. Which of the following terms refers to a measure of dispersion or spread of values around a central value? A. Range B. Validity C. Variance D. Coefficient of variation

C. Variance

46. When establishing a reference interval for a new test being introduced into the laboratory, what is the preferred number of subjects that should participate? A. 30 B. 50 C. 75 D. 120

D. 120

67. Which of the following may be a potentially hazardous biological situation? A. Handling specimens collected from patients in isolation according to standard precautions B. Keeping the centrifuge lid closed until the system has stopped completely C. Discarding sharp objects, including broken glass, in a puncture-proof container D. Discarding disposable blood collection needles in the patient's wastebasket

D. Discarding disposable blood collection needles in the patient's wastebasket

13. The type of balance that uses an electromagnetic force to counterbalance the load placed on the pan is a(n) A. Trip balance B. Class A balance C. Class S balance D. Electronic balance

D. Electronic balance

72. The major job related disease hazard in clinical laboratories is A. Tularemia B. Salmonella C. Tuberculosis D. Hepatitis

D. Hepatitis

3. Which of the following desiccants is the most hygroscopic? A. Silica gel B. Alumina C. Barium oxide D. Magnesium perchlorate

D. Magnesium perchlorate

82. Work is being done with Mycobacterium tuberculosis in the microbiology laboratory. It is important that you enter this laboratory while work is being done with positive samples. What is the most important personal protective equipment you should don before entering this laboratory? A. Carbon cartridge respirator B. Mask C. Gloves D. N95 HEPA filter respirator

D. N95 HEPA filter respirator

44. Upon admission to the hospital ,a chemistry profile is performed on a patient. The patient has a total bilirubin of 2.0 mg/dL. The next day a second chemistry profile is done, and the patient's total bilirubin is 6.2 mg/dL. What should be done in regard to these results because the normal and abnormal controls are within acceptable limits? A. Immediately call the physician to alert him/her to the second abnormal result. B. Immediately send the second result to the patient's floor for charting. C. Repeat the entire second run of patient specimens because there must be an error. D. Perform a delta check and, if warranted, look for possible sources of error.

D. Perform a delta check and, if warranted, look for possible sources of error.

48. Which of the following parameters is not needed to determine the predictive value of a positive test? A. Sensitivity B. Specificity C. Disease prevalence D. Precision

D. Precision

43. Which Westgard multi rule applies to a situation where one control point exceeds the mean by + 2 s and a second control point exceeds the mean by -2 s? A. 1 2s B. 2 2s C 4 1s D. R 4s

D. R 4s

7. What class of weights should be used to check the calibration of analytical balances? A. J B. M C. P D. S

D. S

14. Which of the following blood collection tube tops would contain a serum separator gel? A. Blue B. Grey C. Lavender D. Speckled

D. Speckled

28. Which of the following terms refers to the measure of scatter of experimental data around the mean of a Gaussian (normal) distribution curve? A. Median B. Mode C. Coefficient of variation D. Standard deviation

D. Standard deviation

31. What is the following formula used to calculate? (see book for formula) A. Coefficient of variation B. Variance C. Confidence limits D. Standard deviation

D. Standard deviation

38. A group of physicians consistently complains that they are not receiving stat patient results quickly enough. The supervisor is likely to refer to which quality assessment variable? A. Specimen separation and aliquoting B. Test utilization C. Analytical methodology D. Turnaround time

D. Turnaround time

68. Which of the following is associated with proper storage of chemicals? A. All chemicals should be stored in alphabetical order for ease of handling. B. Flammable chemicals should be stored in a chemical fume hood. C. Large containers of liquid chemicals should be stored on a top shelf to allow easy visibility from below. D. Volatile solvents should be stored in small amounts in an explosion-proof refrigerator.

D. Volatile solvents should be stored in small amounts in an explosion-proof refrigerator.