A 62-year-old man was admitted 2 days ago with community-acquired pneumonia and shares a ward room under standard precautions only. At 21:30, his first sputum auramine-rhodamine smear is read as 3+ acid-fast bacilli, confirmed by Kinyoun stain, and the M. tuberculosis complex NAAT on the same sample is positive. The laboratory's policy lists a patient's first positive AFB smear and a positive M. tuberculosis NAAT as critical results, and tuberculosis is reportable in the state. What should the technologist do first?

Phone the care team and infection prevention now

Report to the health department, then release

Hold the report until the culture is identified

Release the report and phone the team in the morning

Before a new autoverification rule set goes live for microbiology results, the laboratory must:

Test the rules and have the director approve them

Report every result manually for one year first

Send the rules to the state health department

Notify each clinician who orders the tests

Autoverification of laboratory results means that results are:

Released by validated rules without manual review

Reviewed by a pathologist before release

Released only after a phone call to the ward

Repeated automatically before every release

In the US, a laboratory result for a nationally notifiable condition is reported by the laboratory to:

The state or local health department

The laboratory's accrediting agency

The CDC directly, bypassing the state

A wound culture was finalized on Monday as Staphylococcus aureus, oxacillin susceptible. On Wednesday, a review shows the cefoxitin disk was misread and the isolate is MRSA. The correct action is to:

Issue a marked corrected report and call the provider

Record the error only in the lab's QA log

Overwrite the result in the LIS, as the report is final

Wait for the provider to ask before changing it

Documentation, critical values, autoverification, corrected reports and public health reporting

15 ASCP MLS practice questions on Documentation, critical values, autoverification, corrected reports and public health reporting, part of Microbiology. The first 15 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Hard
A 62-year-old man was admitted 2 days ago with community-acquired pneumonia and shares a ward room under standard precautions only. At 21:30, his first sputum auramine-rhodamine smear is read as 3+ acid-fast bacilli, confirmed by Kinyoun stain, and the M. tuberculosis complex NAAT on the same sample is positive. The laboratory's policy lists a patient's first positive AFB smear and a positive M. tuberculosis NAAT as critical results, and tuberculosis is reportable in the state. What should the technologist do first?
1. AReport to the health department, then release
2. BHold the report until the culture is identified
3. CPhone the care team and infection prevention now
4. DRelease the report and phone the team in the morning
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Answer: C · Phone the care team and infection prevention now
A first positive AFB smear with a positive M. tuberculosis NAAT means probable infectious pulmonary tuberculosis, and this patient is in a shared room without airborne precautions. Critical results must be phoned at once, whatever the hour, to a responsible caregiver, with a read-back and a record of who was called and when. Infection prevention must also be told promptly, so the patient is moved to an airborne infection isolation room and exposed roommates and staff can be traced. Public health reporting follows the state's rules and time limits, but it does not replace the call to the care team. Waiting weeks for the culture would leave others exposed.
- A: Public health reporting does not replace the immediate call to the care team.
- B: The smear and NAAT are reported now; culture results follow later.
- D: A critical result cannot wait until the morning.
Question 2 · Medium
Before a new autoverification rule set goes live for microbiology results, the laboratory must:
1. AReport every result manually for one year first
2. BTest the rules and have the director approve them
3. CSend the rules to the state health department
4. DNotify each clinician who orders the tests
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Answer: B · Test the rules and have the director approve them
Autoverification rules are validated before use by running results that should pass and fail through the system and checking that each is handled correctly. The laboratory director or a designee approves the rules in writing, and they are re-checked whenever the LIS, middleware or instrument software changes. The lab must also be able to suspend autoverification quickly if a problem appears. CLSI guidance and accreditation checklists describe these requirements.
- A: A long period of manual reporting is not required; the rules must be validated.
- C: Health departments do not approve autoverification rules.
- D: Clinicians do not approve the lab's internal release rules.
Question 3 · Easy
Autoverification of laboratory results means that results are:
1. AReleased by validated rules without manual review
2. BReviewed by a pathologist before release
3. CReleased only after a phone call to the ward
4. DRepeated automatically before every release
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Answer: A · Released by validated rules without manual review
In autoverification, the laboratory information system or middleware checks each result against rules the laboratory has set, such as instrument flags, limits and delta checks. Results that pass every rule are released without a technologist reviewing them, and those that fail are held for manual review. In microbiology it is used, for example, for negative molecular results or for 'no growth' urine cultures read by imaging software. The rules must be validated and approved by the laboratory director.
- B: Pathologist review is manual review, the opposite of autoverification.
- C: Phone calls are for critical values, not routine release.
- D: Automatic repeat testing is a different process from autoverification.
Question 4 · Easy
In the US, a laboratory result for a nationally notifiable condition is reported by the laboratory to:
1. AThe laboratory's accrediting agency
2. BThe CDC directly, bypassing the state
3. CThe state or local health department
4. DThe FDA MedWatch program
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Answer: C · The state or local health department
Disease reporting in the US is set by state law, and laboratories report notifiable results to their state or local health department, often by electronic laboratory reporting. The state then sends case notifications to the CDC, which keeps the list of nationally notifiable conditions. Each state sets its own list and time frames, and some conditions, such as measles, must be reported immediately by phone. This report is in addition to, not instead of, telling the ordering clinician.
- A: Accrediting agencies inspect labs; they do not receive disease reports.
- B: The CDC receives case data from the states, not usually from labs directly.
- D: MedWatch is for adverse events with drugs and devices.
Question 5 · Hard
A wound culture was finalized on Monday as Staphylococcus aureus, oxacillin susceptible. On Wednesday, a review shows the cefoxitin disk was misread and the isolate is MRSA. The correct action is to:
1. ARecord the error only in the lab's QA log
2. BOverwrite the result in the LIS, as the report is final
3. CWait for the provider to ask before changing it
4. DIssue a marked corrected report and call the provider
Show answerHide answer
Answer: D · Issue a marked corrected report and call the provider
A change from MSSA to MRSA can change therapy, so the lab notifies the provider promptly and issues a corrected report that is labelled as corrected and keeps the original result traceable. Infection prevention is also told, because MRSA patients may need contact precautions. The error is documented and investigated, for example by reviewing how the cefoxitin disk was read, and other results from the same run are checked. Retraining or a process change follows if needed.
- A: An internal log alone leaves the wrong result in the patient's record.
- B: Final reports can be corrected, but never by silently overwriting them.
- C: The lab must act without waiting to be asked, because treatment may be wrong.
Question 6 · Medium
Four cultures are finalized in one shift. Which result must be reported to the public health department?
1. AMSSA from a wound swab
2. BNeisseria meningitidis from CSF
3. CEscherichia coli from urine
4. DEnterococcus faecalis from urine
Answer and explanation in LearnFree account
Question 7 · Medium
A lab refers a mold isolate to a reference laboratory for sequencing. Under CLIA, what must the ordering clinician be told?
1. AThe lot numbers of the reagents that were used
2. BThe name of the technologist at the reference lab
3. CThe reference lab's charge for performing the test
4. DWhich laboratory did the test, and its address
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Question 8 · Easy
When an error is found in a microbiology report that has already been released, the corrected report should:
1. ABe marked corrected and keep the original visible
2. BBe issued only if the clinician asks for it
3. CGo in the lab's QC log, not the patient record
4. DReplace the original result without any comment
Answer and explanation in LearnFree account
Question 9 · Medium
For 15 minutes, a technologist has tried and failed to reach the ordering physician about a CSF Gram stain showing neutrophils and gram-positive diplococci. The next step is to:
1. APost the result to the chart and stop calling
2. BFollow the escalation policy to another caregiver
3. CKeep paging the ordering physician until morning
4. DLeave a voicemail message for the physician
Answer and explanation in LearnFree account
Question 10 · Medium
A yeast from the urine culture of a ventilated patient is confirmed as Candida auris. Besides the ordering provider, the laboratory should promptly notify:
1. AThe instrument manufacturer and the FDA
2. BThe hospital pharmacy and the patient's insurer
3. CInfection prevention and the public health department
4. DOnly the microbiology section supervisor
Answer and explanation in LearnFree account
Question 11 · Easy
Under CLIA, how long at minimum must a laboratory keep, or be able to retrieve, copies of its patient test reports?
1. A6 months
2. B2 years
3. C5 years
4. D10 years
Answer and explanation in LearnFree account
Question 12 · Hard
An automated system reports Staphylococcus aureus with a vancomycin MIC of 16 µg/mL (16 mg/L), and the autoverification rules hold the result. What should be done next?
1. ADelete the vancomycin result and report the other drugs only
2. BConfirm by a reference method, then report and notify public health
3. CRelease the result as is, since the instrument shows no error flags
4. DReport vancomycin as susceptible, since resistance is so rare
Answer and explanation in LearnFree account
Question 13 · Medium
At 2 a.m., an inpatient's blood culture flags positive, and the Gram stain shows gram-negative rods. What should the technologist do?
1. APhone the patient's nurse or doctor at once
2. BHold the result for the routine morning report
3. CWait until the organism has been identified
4. DNotify only the infection prevention team
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Question 14 · Easy
A technologist phones a critical microbiology result to a nurse. What should the nurse do while taking the call?
1. AAsk the technologist to fax the result instead
2. BWait for the printed report before acting
3. CWrite the result down without repeating it
4. DRead back the result and patient identifiers
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Question 15 · Hard
A laboratory autoverifies 'no growth' urine cultures read by plate-imaging software. A weekly audit finds three plates released as 'no growth' that grew ≥ 10^5 CFU/mL of Escherichia coli. The first action is to:
1. ACorrect the three reports and keep the rule running
2. BSuspend the rule and review recent auto-released reports
3. CAsk the vendor for an update and continue meanwhile
4. DExtend incubation of all urine cultures to 72 hours
Answer and explanation in LearnFree account

Documentation, critical values, autoverification, corrected reports and public health reporting

Before a new autoverification rule set goes live for microbiology results, the laboratory must:

Autoverification of laboratory results means that results are:

In the US, a laboratory result for a nationally notifiable condition is reported by the laboratory to:

A wound culture was finalized on Monday as Staphylococcus aureus, oxacillin susceptible. On Wednesday, a review shows the cefoxitin disk was misread and the isolate is MRSA. The correct action is to:

Four cultures are finalized in one shift. Which result must be reported to the public health department?

A lab refers a mold isolate to a reference laboratory for sequencing. Under CLIA, what must the ordering clinician be told?

When an error is found in a microbiology report that has already been released, the corrected report should:

For 15 minutes, a technologist has tried and failed to reach the ordering physician about a CSF Gram stain showing neutrophils and gram-positive diplococci. The next step is to:

A yeast from the urine culture of a ventilated patient is confirmed as Candida auris. Besides the ordering provider, the laboratory should promptly notify:

Under CLIA, how long at minimum must a laboratory keep, or be able to retrieve, copies of its patient test reports?

An automated system reports Staphylococcus aureus with a vancomycin MIC of 16 µg/mL (16 mg/L), and the autoverification rules hold the result. What should be done next?

At 2 a.m., an inpatient's blood culture flags positive, and the Gram stain shows gram-negative rods. What should the technologist do?

A technologist phones a critical microbiology result to a nurse. What should the nurse do while taking the call?

A laboratory autoverifies 'no growth' urine cultures read by plate-imaging software. A weekly audit finds three plates released as 'no growth' that grew ≥ 10^5 CFU/mL of Escherichia coli. The first action is to: