, Score: 0%, must retake test. Scroll down for missed test question numbers

POCT Competency Assessment

Name:  

Date:

Emp ID:

Clinic / Unit
TSM Name:

Preceptor(s):

CERT EXPIRES: 

UA DIP (Chemstrip)

Competency Assessment:
      1.  Read entire Policy/Procedure
     2.  Complete and pass written test (Passing criteria is 100%)
     3.  Direct observation by preceptor (return demonstration complete)

TEST SCORE 0

Test taken on: 5/19/2013

 CRITICAL POINTS FROM POLICY AND PROCEDURE

 OPERATOR INITIALS BELOW

a. Sample Application:  Mix specimen 10 times by inversion if allowed to settle; dip and remove immediately from container; blot excess urine.

 

b. Interpretation of Results:  Match reagent pads to appropriate areas on key - not exceeding the time limits as indicated on bottle.

 

c. Quality Control: Two levels of quality control are performed and documented weekly.

 

d. Storage Requirements: UA strip vials must remain closed until ready to use; urine must be examined within 1 hour of collection.

 
e. Interfering substances: Glucose- High oncentrations of Vitamin C (ascorbic acid) and moderately high amounts of ketones (40 mg/dl) may cause false negatives for specimens containing small a mounts of glucose  

SAMPLE # _______           RESULTS: (check appropriate boxes)

Specific Gravity

   □         □       □           □        □         □          □
1.000        1.005        1.010        1.015        1.020        1.025        1.030

pH

   □           □             □             □             □  
   5            6              7              8              9

Leukocytes

   □             □             □             □     
   Neg             Trace             +             ++

Nitrite

   □             □      
   Neg               Pos

Protein

   □        □             □            □            □  
   Neg         Trace         +             ++          +++

Glucose

   □         □         □          □         □         □         
  Norm         50            100           250           500         1000 mg/dL

Ketones

   □             □             □             □        
  Neg                   +                 ++                +++

Urobininogen

   □         □             □             □             □          
 Norm            1                 4                    8                  12 mg/dL

Bilirubin

   □             □             □             □   
  Neg                  +                  ++                 +++ 

Blood

   □             □             □             □          
  Neg               trace                about 50           about 250 Ery/uL

 

o Pass o Fail 

Validator:_____________
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