Deck 5: Performance Improvement in the Microbiology Laboratory

Question 1

The following are provisions of CLIA 88 EXCEPT:

A) Verify employee competency upon employment.
B) Determine an employee's competency.
C) Reverify the employee's competency monthly.
D) Reverify the employee's competency annually.

Answer 1

C
To maintain quality in the laboratory,CLIA 88 mandated that an employee's competency must be verified upon employment,an employer must determine an employee's competency,and the employee's competency must be reverified annually.It did not mandate reverifying an employee's competency monthly because this would be an impossible task-the time frame is too short.

Question 2

All of the following activities are included in a laboratory quality control program EXCEPT:

A) Air quality
B) Temperatures
C) Media
D) Antimicrobial susceptibility testing

Answer 2

A
The air quality in a laboratory is not routinely tested.A quality control program focuses on procedures,equipment,and policies that affect how well laboratory tests are performed,the quality of submitted specimens,and test results.

Question 3

Preventive maintenance on an instrument includes all the following EXCEPT:

A) Disinfecting the surface of the instrument
B) Oiling and cleaning the instrument
C) Replacing filters
D) Recalibrating instruments

Answer 3

A
Disinfecting the surface of an instrument is usually done as a daily activity and is generally not considered preventive maintenance.All the other choices are preventive maintenance activities that will keep an instrument in top shape and functioning at the proper level so as to increase its lifetime and keep it producing quality results.

Question 4

Popular media choices for maintaining stock cultures include:

A) TSA deeps
B) Cornmeal
C) Sabouraud dextrose
D) CTA with glucose

Question 5

Commercial media must have quality control testing performed by the manufacturer.Because of high failure rates,all of the following media must be retested by the hospital laboratory EXCEPT:

A) Campylobacter media
B) Selective media for pathogenic Neisseria
C) Trypticase soy agar with 5% sheep blood
D) Chocolate

Question 6

Susceptibility testing of control organisms is usually conducted daily until precision can be demonstrated with _____ or _____ _____ days of susceptibility testing using Clinical and Laboratory Standards Institute (CLSI)guidelines.

A) 20, 30, consecutive
B) 15, 20, consecutive
C) 30, 40, nonconsecutive
D) 5, 10, consistent

Question 7

In January 2004,The Joint Commission (TJC)implemented performance measurements for organizational systems that are critical to patient safety,quality of care,treatment,and services.This new initiative is called:

A) Performance improvement
B) Quality control
C) Quality assurance
D) Shared visions-new pathway

Question 8

The morning tech arrives at the microbiology laboratory and goes around checking daily temperatures.This person will check temperatures daily on all of the following temperature-dependent equipment EXCEPT:

A) Centrifuges
B) Incubators
C) Heating blocks
D) Refrigerators

Question 9

Quality control is designed to:

A) Ensure the medical reliability of lab data
B) Check media
C) Check reagents
D) Monitor incubator and refrigerator temperatures

Question 10

In any susceptibility system,variables that can affect the results include the following:1.Antibiotic potency2.Inoculum concentration3.Bactericidal level4.Ph5.Anion content

A) 1, 2, and 3 are correct
B) 1, 3, 4, and 5 are correct
C) 1, 2, 3, 4, and 5 are correct
D) 1, 2, and 4 are correct

Question 11

Reagents that should undergo quality control in the microbiology laboratory include all the following EXCEPT:

A) Optochin
B) Immersion Oil
C) b-Lactamase
D) Nitrate

Question 12

Thermometers used in the laboratory must be calibrated before they are put into use.This is accomplished by:

A) Sending to the National Institute of Standards and Technology (NIST) to determine its accuracy
B) Checking against an NIST thermometer
C) Measuring the grades to make sure they are the standard size and accuracy
D) Using a colored dye

Question 13

Actual laboratory testing is called a(n):

A) Preanalytic activity
B) Analytic activity
C) Postanalytic activity
D) Research activity

Question 14

Antimicrobial susceptibility is hard to control because many of the same species of organisms have a varied susceptibility to particular antibiotics.To reduce this variation,Clinical and Laboratory Standards Institute (CLSI)guidelines recommend the following:

A) Use in-house organisms isolated from past patients
B) Share strains between hospital laboratories
C) Use specific strains from American Type Culture Collection (ATCC)
D) Obtain test strains from Centers for Disease Control and Prevention (CDC)

Question 15

How can personnel competency be determined?

A) Asking an employee to explain how to do a test
B) Proficiency testing
C) Asking another employee to comment on someone's competency
D) Assuming competency from one's credentials

Question 16

All of the following activities will directly affect the quality of a laboratory test EXCEPT:

A) Preanalytic
B) Analytic
C) Accreditation
D) Postanalytic

Question 17

Media that do not need to be retested by the hospital laboratory must still undergo observation for all of the following EXCEPT:

A) Moisture
B) Sterility
C) Breakage
D) Organism colony characteristics

Question 18

When a medium needs to be quality controlled because it was prepared in-house or because it is complex,all the following rules must be followed EXCEPT:

A) Only media not specified in Clinical and Laboratory Standards Institute (CLSI) guidelines should be tested.
B) The medium should be tested for sterility and pH.
C) The organism selected for quality control testing should represent most fastidious organisms for which the medium is designed.
D) Testing techniques should be different for primary plating media than for biochemical or subculturing media.

Question 19

Quality control stock cultures are available from all of the following EXCEPT:

A) American Type Culture Collection (ATCC)
B) Commercial sources
C) Proficiency testing isolates
D) Centers for Disease Control and Prevention (CDC)

Question 20

Which of the following is an example of a mission statement for an institution?

A) "The AFMS Flagship-Comprehensive Healthcare…On Time…On Target"
B) "Working Together for a Healthy America"
C) "Your Total eLearning Solution"
D) "Will Answer Questions Correctly 95% of the Time"

Question 21

All of the following provide guidelines to ensure the continual correct performance of tests EXCEPT:

A) Accrediting agencies
B) Regulatory agencies
C) Centers for Disease Control and Prevention (CDC)
D) Manufacturers

Question 22

The efficiency of a test indicates:

A) The percentage of patients who test positive for the disease
B) The percentage of patients who are correctly identified as having or not having the disease
C) The percentage of patients who test negative for the disease
D) The number of patients tested for a disease

Question 23

A technician is performing a chemistry test on a control sample.The technician gets the following values for the control: 4.3,4.3,4.3,4.2,4.4,4.3,4.2,and 4.4.The actual value is 4.3.These results are said to be:

A) Systematically inaccurate
B) Sensitive
C) Accurate
D) Bias

Question 24

Assume that a certain test for group A Streptococcus has reported sensitivity and specificity of 90% and 98%,respectively,and the estimated prevalence for group A Streptococcus infection in acute pharyngitis is 5%.What is the positive predictive value of this test?

A) 99.5%
B) 30%
C) 90%
D) 70.3%

Question 25

A group of 10 patients are to be tested: six are known to have a disease and four are disease free.If the four disease-free patients tested negative for this disease,what would the clinical specificity of this test be?

A) 100%
B) 60%
C) 40%
D) 50%

Question 26

Test validation is the ongoing process providing information that a test is performing correctly.The components of validation include all the following EXCEPT:

A) Quality control
B) Specimen requirements
C) Proficiency testing
D) Instrument calibration

Question 27

A test can have both a positive and negative predictive value.All the following elements are needed to compute the positive and negative predictive value of a test EXCEPT:

A) Sensitivity of a test
B) Specificity of a test
C) Incidence of the disease being tested
D) Prevalence of the disease being tested

Question 28

When choosing a test to perform in your laboratory,an in-house verification is always performed.Verification of a test:

A) Serves to establish that the performance parameters of the test are satisfactory
B) Lets techs actually perform the test
C) Lets physicians perform the test
D) Allows laboratory management to view positive results

Question 29

All the following are components of JCAHO recommendations for establishing performance monitors EXCEPT:

A) Plan
B) Design
C) Do
D) Assess

Question 30

Confirmation is used after:

A) Careful consideration by the doctor to do the test
B) A test that has a low predictive value
C) A test that has a low specificity
D) Obtaining a positive screening result

Question 31

Incidence is:

A) The frequency of a disease at a designated single point in time in the population being tested
B) The number of new cases of disease over a period of time
C) Proportion of negative test results in a population known to be free of disease
D) Positive results in patients with the disease

Question 32

An unlabeled specimen is sent from the intensive care unit to the laboratory.When the specimen arrives in the laboratory,the laboratory manager decides that correct action needs to occur.What can be constructed to evaluate and correct the problem?

A) Find fault with the nurse causing the problem.
B) Provide training for the nurse responsible for the problem.
C) Empower a facilitator.
D) Make a cross-functional team.

Question 33

When is a broken process fixed?

A) When the problem is prevented from happening again.
B) When everyone is happy with the process.
C) When the process becomes seamless.
D) When the hospital administrator determines that the cross-functional team is no longer needed.

Question 34

What is benchmarking?

A) Identifying a problem to be fixed
B) Seeking an industry's or profession's best practices to imitate and improve
C) Explaining why a problem occurred
D) Asking the CEO's opinion and going with his or her idea

Question 35

A test is performed on a group of 10 patients.Six patients have a disease,and four are free of the disease.If six patients (all known to have the disease)of this group test positive for the disease,we say that the clinical sensitivity of this test is:

A) 60%
B) 40%
C) 50%
D) 100%

Question 36

Customers of a laboratory include all the following EXCEPT:

A) Patients
B) Insurers
C) Doctors
D) Accrediting organizations

Question 37

Screening is:

A) Used for only particular test analytes
B) Not practical in a hospital laboratory
C) Used for testing large populations of patients
D) When a high incidence of a disease is found in a population

Question 38

Usually,negative test results are more reliable in predicting:

A) The absence of disease
B) The presence of disease
C) The sensitivity of a test
D) The specificity of a test

Question 39

When performing tests in the microbiology laboratory,the detection limit of a test refers to the _____ of that test.

A) Analytic specificity
B) Analytic sensitivity
C) Clinical sensitivity
D) Clinical specificity