Exam 1 - (CH 5) Performance Improvement in the Microbiology Laboratory Textbook Review Questions

Question 1

Which of the following require(s) daily temperature checks?
A. Water baths
B. Freezers
C. Incubators
D. All of the above

Answer 1

D. All of the above

Question 2

Which of the following media must be retested for quality control of sterility and performance by the user?
A. Chocolate agar
B. Campylobacter agar
C. Neisseria selective media
D. All of the above

Answer 2

D. All of the above

Question 3

The Clinical Laboratory Standards Institute (CLSI) recommended control organisms are specific strains from
A. American Type Culture Collection (ATCC).
B. Inoculation Swab Quality Control (ISQC).
C. Proficiency Testing.
D. College of American Pathologists (CAP).

Answer 3

A. American Type Culture Collection (ATCC).

Question 4

A Quality Control Manual must be reviewed and signed
A. monthly.
B. biannually.
C. annually.
D. every 3 years.

Answer 4

C. annually.

Question 5

Which of the follow are the three required parts of an individualized quality control plan (IQCP)?
A. Preanalytical analysis, analytical oversight, and postanalytical evaluation
B. Proficiency testing, competency assessment, and continuing education
C. Risk assessment, quality control plan, and quality assessment
D. Protocol assessment, protocol improvement, outcome analysis

Answer 5

C. Risk assessment, quality control plan, and quality assessment

Question 6

Productivity and cost-effectiveness are two large categories commonly used in
A. benchmarking comparisons.
B. Q-probes.
C. proficiency testing.
D. cross-functional teams.

Answer 6

A. benchmarking comparisons.

Question 7

A test’s ability not to react with substances other than the analyte of interest is
A. accuracy.
B. precision.
C. analytic sensitivity.
D. analytic specificity.

Answer 7

D. analytic specificity.

Question 8

Bias is the mean difference of test results from an accepted reference method caused by this type of error.
A. Random
B. Systematic
C. Precision
D. Preanalytical

Answer 8

B. Systematic

Question 9

Which of the following best describes the most important considerations for a confirmatory test?
A. High analytic sensitivity and negative predictive value
B. High analytic sensitivity and positive predictive value
C. High analytic specificity and negative predictive value
D. High analytic specificity and positive predictive value

Answer 9

D. High analytic specificity and positive predictive value

Question 10

Which of the following terms refers to checking media and reagents with specific organisms to determine whether expected results are obtained?

a. Preventive maintenance
b. Quality control (QC)
c. Performance improvement (PI)
d. Total quality management (TQM)

Answer 10

b. Quality control (QC)

Question 11

Which of the following describes the process of PI?

a. It involves only preanalytic activities.
b. It is measured by patient outcome.
c. It singles out individuals with poor performance.
d. It is enhanced by understanding customer perception.

Answer 11

b. It is measured by patient outcome.

Question 12

The laboratory must perform QC on all of the following media except which one?

a. Complex media
b. Media made by the laboratory
c. Media with a history of failure
d. All media obtained from a commercial source

Answer 12

d. All media obtained from a commercial source

Question 13

Which of the following describes the correct way to select organisms for QC?

a. They should represent the most fastidious organisms for which the medium was designed.
b. They should be organisms that will grow most easily.
c. They should be immediately removed from the freezer.
d. Streaking should be done only once after their removal from the freezer.

Answer 13

a. They should represent the most fastidious organisms for which the medium was designed.

Question 14

Susceptibility tests must be quality controlled daily except when which of the following is the case?

a. An automated system is in use.
b. Controls have been in an acceptable range for 6 months.
c. Precision is demonstrated for 20 or 30 consecutive days.
d. A new antimicrobial agent is added.

Answer 14

c. Precision is demonstrated for 20 or 30 consecutive days.

Question 15

Which of the following mandates annual employee competency testing?

a. Clinical and Laboratory Standards Institute (CLSI)
b. Clinical Laboratory Improvement Act of 1988 (CLIA ‘88)
c. National Institute of Standards and Technology (NIST)
d. American Type Culture Collection (ATCC)

Answer 15

b. Clinical Laboratory Improvement Act of 1988 (CLIA ‘88)

Question 16

A problem-action form should contain which of the following information?

a. Date and problem
b. Evaluation and corrective action
c. Outcome
d. All of the above

Answer 16

d. All of the above

Question 17

What is the term for PI monitors created in response to a specific issue? \

a. Focused monitors
b. Process monitors
c. Outcome monitors
d. Multitask monitors

Answer 17

a. Focused monitors

Question 18

Who is defined as a customer in the laboratory?

a. The patient
b. The physician and nurse
c. The insurance company
d. All of the above

Answer 18

d. All of the above

Question 19

What is a The Joint Commission (TJC) initiative to monitor performance measurement?

a. PI
b. TQM
c. ORYX
d. Continuous quality improvement (CQI)

Answer 19

a. PI

Question 20

Which of the following refers to the ability of a test to detect a particular analyte?

a. Analytic specificity
b. Analytic sensitivity
c. Efficiency of tests
d. Test validation

Answer 20

b. Analytic sensitivity

Question 21

Using the formula provided in the chapter, determine the positive predictive value (PPV) for the Chlamydia test in a population in which the prevalence of the disease is 15%. The sensitivity and specificity of the test are 95% and 98%, respectively.

Answer 21

89.3%

Question 22

If 100 individuals without syphilis were tested for the disease and 95 tested negative, what is the diagnostic specificity of the test?

Answer 22

95%

Question 23

What parameter would be used to determine the percentage of patients who are appropriately classified as having a disease or not having a disease?

Answer 23

Efficiency of tests

Question 24

Points to Remember

Answer 24

■ Quality patient care is directly attributed to the quality of all the processes involved in that care.
■ The laboratory can ensure reliability of laboratory data through the implementation of an active quality control program.
■ Performance improvements and performance measurement allow organizations to monitor their performance continually and provide opportunities to improve.
■ Customers must be taken into account in quality assurance because all customers will have their own perception of what quality means.
■ When outcomes are less than desirable, the entire process must be reviewed and may require cross-functional teams and a trained facilitator to achieve the desired outcome.
■ Analytic specificity of a test is its ability to not react with substances other than the analyte of interest. ■ Clinical or diagnostic sensitivity is the proportion of positive test results in patients with disease (true-positive results).
■ Clinical or diagnostic specificity is the proportion of negative test results in patients without the disease (true-negative results).
■ Incidence is the number of new cases of a disease over a period of time; prevalence is the frequency of a disease at a designated single point in time.
■ Predictive values are influenced by the prevalence of the disease or analyte unless the test is 100% sensitive (for negative predictive value) or specific (for positive predictive value).