Which of the following are common errors associated with timed urine collections quizlet?

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§ In a timed collection urine is collected over a set period of time, 12 or 24 hours.

§ Urine concentration of an analyte may vary due to circadian or diurnal variation, state of hydration, effect of exercise, body metabolism, or excretion rates.

§ This sample is used to quantitatively measure an analyte (such as creatinine or protein).

§ Collection of a 24-hour urine typically begins in the morning. The patient is instructed to void and discard the first morning sample on Day 1 of collection, then collect all urine voided for the next 24 hours including Day 2 first morning sample. When the sample is received in the lab, it should be mixed thoroughly, the total volume recorded, and then aliquoted (divided) if more than one test is required. (see Box 2-1, page 20 in Brunzel)

Pathologic: Red blood cells, white blood cells, microbes, renal epithelial cells, fats and lipids, abnormal crystals , seamen or prostatic fluid, feces, cuts

non pathologic normal solute crystals like urate, phosphate, calcium oxalate. Squamous epithelial cells, mucus, semen and prostatic fluid, contaminants

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Terms in this set (224)

Normal functions of the kidney include all of the following except:

Elimination of serum proteins

The approximate number of nephrons contained in each kidney is:

1,000,000

The glomerular filtrate is described as a:

Protein-free ultrafiltrate of plasma

The specific gravity of the glomerular ultrafiltrate is:

1.010

All of the following substances are reabsorbed from the glomerular filtrate by active transport except:

Water

For active transport to occur, a substance:

Must combine with a carrier protein to create electrochemical energy

Clearance tests used to determine the glomerular filtration rate must measure substances that are:

Neither reabsorbed or secreted by the tubules

All of the following are endogenous clearance test substances except:

Inulin

The normal serum osmolality is:

275 to 300 mOsm

Following fluid deprivation, a patient has a serum osmolality of 276 mOsm and a urine osmolality of 1000 mOsm. This patient:

Has normal concentration ability

Which of the following tests provides information similar to specific gravity?

Osmolality

Following injection of ADH, a patient has a serum osmolality of 290 mOsm and a urine osmolality of 450 mOsm. The patient:

Lacks tubular response to ADH

The PAH test is used to measure:

Renal blood flow

A substance that is not filtered by the glomerulus will not be found in the urine.

False

Can a patient with the following results be given a nephrotoxic medication: urine volume—720 mL/24 h, urine creatinine—100 mg/dL, and serum creatinine—2.5 mg/dL?

No, clearance is 20 mL/min

Using the following values, calculate the creatinine clearance: urine volume—1200 mL/12h, urine creatinine—60 mg/dL, and serum creatinine—0.8 mg/dL.

125 mL/min

The extent to which the kidney concentrates the glomerular filtrate can be determined by measuring:

Urine and serum osmolality

In the measurement of osmolality, a solute that is dissolved in solvent will:

Decrease the freezing point

Decreased production of aldosterone:

Produces a high urine volume

For active transport to occur, a chemical:

must combine with a carrier protein to create electrochemical energy

Test to measure the tubular secretion of hydrogen ions include all of the following except:

urinary bicarbonate

The renal function that is most frequently the first affected by early renal disease is:

Tubular reabsorption

Water is passively reabsorbed in all parts of the nephron except the:

Ascending loop of Henle

A patient with polyuria shows a high specific gravity in the urine. The patient should be evaluated for:

Diabetes mellitus

All of the following are components of normal urine except:

Amino acids

Increased turbidity in urine stored at room temperature is usually caused by:

Bacterial growth

An unpreserved urine specimen left at room temperature overnight will have decreased:

Glucose and ketones

A person exhibiting oliguria would have a urine volume of:

200 to 500 mL

Which of the following will be least affected in an unpreserved specimen left at room temperature overnight?

Protein

Red blood cells will disintegrate more rapidly in urine that is:

Dilute and alkaline

The primary cause of the changes that take place in unpreserved urine is:

Bacterial growth

Which of the following urine chemicals will deteriorate when exposed to light?

Bilirubin

Before analysis, a refrigerated urine specimen must be:

Returned to room temperature

The recommended specimen for routine urinalysis testing is the:

First morning specimen

The specimen of choice for routine urinalysis is the first morning urine because it:

Is more concentrated to better detect abnormalities

All of the following specimens are acceptable for a urine culture except:

Timed specimen

Quantitation of a substance that varies with daily activities should be performed on a:

24-hour specimen

Failure to empty the bladder before beginning the collection of a timed urine specimen will:

Cause falsely increased results

The least contaminated specimen for bacterial culture is the:

Suprapubic aspiration

Documentation of appropriate handling of specimens for drug analysis is provided by the:

Chain of custody form

The liver breaks down protein to form what waste product?

Urea

An increase in urine production during the night is described as:

Nocturia

What is the maximum length of time a urine specimen can remain unpreserved at room temperature before testing?

2 hours

All of the following statements are true except.

The concentrations of nitrite, glucose and white blood cells are increased in urine that remains unpreserved at room temperature.

For quantitative analysis of urinary constituents the required specimen is the:

timed specimen

Urine from a patient with diabetes insipidus has:

increased volume and decreased specific gravity

Bacterial decomposition of urea produces urine that has an odor resembling:

Ammonia

Results of a specific gravity reading obtained by refractometer in the urology clinic do not agree with the readings obtained by the laboratory's automated reagent strip reader. The laboratory should:

Report the results from the reagent strip reader

Urine specific gravity can be measured by both physical and chemical methods.

True

An antidiuretic hormone deficiency is associated with a:

Low specific gravity

Slightly warming a turbid urine specimen may dissolve:

Amorphous urates

The addition of dilute acetic acid to a cloudy urine specimen will dissolve:

Amorphous phosphate

The presence of a white precipitate in freshly voided urine can be caused by:

Amorphous phosphates in alkaline urine

Which of the following specific gravity readings correlates with a pale yellow urine?

1.005

Which of the following urine colors and causes match?

Black—melanin

The primary pigment responsible for normal urine color is:

Urochrome

A clear yellow urine will not contain any pathologically significant constituents.

False

A dark yellow urine producing yellow foam may contain:

bilirubin

A pale yellow urine is a primary indication of impaired renal function.

False

A refractometer reads 1.003 with distilled water. The technologist should:

adjust the set screw

A specific gravity of 1.040 in a specimen with a 1+ glucose and a negative reagent strip protein is most likely caused by:

radiographic contrast media

A urine specimen that remains at room temperature for several hours may develop a darker yellow color.

True

Bacterial decomposition of urea produces urine that has an odor resembling:

Ammonia

A urine specimen that turns black after standing may contain:

Homogentisic acid

Specimens that contain intact red blood cells can be visually distinguished from specimens that contain hemoglobin because:

Intact red blood cells produce a cloudy specimen

The protein section of the reagent strip is most sensitive to:

Albumin

The principle of the reagent strip test for protein is the:

Protein "error of indicators"

The type of proteinuria least likely to be detected by reagent strip is:

Prerenal

The type of protein that precipitates at 60°F and dissolves at 100°F is a/an:

Abnormal globulin associated with multiple myeloma

The pseudoperoxidase reaction is the principle for the reagent strip test(s) for:

Blood

Microalbumin tests are frequently used to screen patients with:

Diabetes mellitus

All of the following may interfere with glucose detection in a urine specimen except:

Galactose

A negative reagent strip test for glucose with a positive Clinitest indicates the possibility of:

Galactosuria

Which of the following will not cause ketonuria?

Increased metabolism of carbohydrates

A urine sample that tests positive for ketones and negative for glucose is most likely from a patient suffering from:

Starvation

Myoglobinuria may be caused by:

A "crushing" injury

A reagent strip test for blood is reported positive. No red blood cells are seen on the microscopic examination. The patient's condition is called:

Hemoglobinuria

When bilirubin is detected in the urine, it can be assumed that:

It has been conjugated in the liver

Reagent strip results associated with hemolytic disease would correspond with which of the following?

Bilirubin = 0 Urobilinogen = 8 EU

Which of the following can produce a negative nitrite test in the presence of significant bacteriuria?

The presence of many non-nitrate reducing bacteria

Which of the following will be detected by the reagent strip nitrite reaction?

Escherichia coli

All of the following will produce a positive leukocyte esterase (LE) reaction except:

Bands

A false-negative LE reaction may be caused by:

Failure to wait 2 minutes to read the reaction

A burn injury may occur if incorrect technique is used when performing the:

Clinitest

The urinalysis result most closely associated with renal disease is a positive:

Protein

A laboratory error that can result in an infant developing severe mental retardation could be attributed to failure to perform a/an:

Clinitest

The number of fields that should be examined when quantitating urinary sediment constituents is:

10

A urine specimen is referred for cytodiagnostic urine testing to detect the presence of:

Malignant cells

The purpose of scanning the perimeter of urine sediment placed under a conventional glass slide is to:

Detect the presence of casts

Substances found in the urinary sediment that can be confirmed using polarized light are:

Lipids

Using a bright-field microscope, the final magnification of a high-power field is:

400X

To detect the presence of casts, the sediment is examined using:

Reduced light under low power

An increase in urinary WBCs is called:

Pyuria

Urine sediments containing increased WBCs should be observed closely for the presence of:

Bacteria

Oval fat bodies are:

Renal tubular epithelial cells that contain lipids

Collection of a midstream clean-catch specimen will alleviate contamination by:

Squamous epithelial cells

Which of the following cells found in increased numbers in the urine sediment is only indicative of nephron damage?

Renal tubular cells

The primary factor that favors the formation of urinary casts is:

Urinary stasis

The major constituent of urinary casts is:

Uromodulin protein

Broad casts may form as a result of:

Extreme urinary stasis

The urinary sediment constituent most closely associated with bleeding within the nephron is the:

RBC cast

Waxy casts can be found in the urine sediment:

In patients with renal failure

All of the following may be detected in the urine following strenuous exercise except:

Glucose

To distinguish a cellular cast from a clump of cells, the clinical laboratory scientist should:

Look carefully for a cast matrix

Urinary crystals that appear yellow to reddish-brown are:

Uric acid

All of the following crystals can be found in acid urine except:

Ammonium biurate

Abnormal crystals are most frequently seen in a urine that is:

Acid

Which of the following crystals occurs in two very distinct forms?

Calcium oxalate

Nonpathogenic or "normal" crystals found in alkaline urine include:

Triple phosphate, calcium carbonate, ammonium biurate

All of the following affect the formation of crystals except:

Urinary casts

The significance of seeing bacteria in the urine sediment is increased when:

WBCs are present

Blood tests can be used to confirm the diagnosis of acute glomerulonephritis because of the detection of:

Antistreptococcal antibodies

Goodpasture syndrome and Wegener's granulomatosis are associated with the presence of which of the following in the urine sediment?

Red blood cell casts

The presence of which of the following crystals can be associated with nephrotic syndrome?

Cholesterol

The presence of heavy proteinuria is most characteristic of:

Nephrotic syndrome

The pronounced edema associated with nephrotic syndrome is related to the:

Hypoalbuminemia

Oval fat bodies and fatty casts are characteristic urine sediment constituents in patients with:

Nephrotic syndrome

A decrease in systemic blood flow affects the renal tubules by producing:

Ischemia (hypoxia)

Glucosuria and generalized aminoaciduria are characteristics of:

Fanconi syndrome

In which part of the kidney is uromodulin produced?

Proximal and distal tubules

Which of the following renal disorders is most likely to be inherited?

Fanconi syndrome

Infection of the bladder is termed:

Cystitis

Cystitis can be differentiated from pyelonephritis by:

The presence of white blood cell casts

The finding of bacterial casts can be associated with:

Acute pyelonephritis

Patients with glomerular disorders usually have reduced creatinine clearance tests.

True

Antigen antibody complexes deposited in the glomerulus recruit complement and other immunological "weapons" that inadvertently damage healthy renal tissue.

True

Acute streptococcal glomerulonephritis has a poor prognosis.

False

Wegener's Granulomatosis affects mainly children; raised red patches on the skin are typical.

False

In nephrotic syndrome, increased permeability of the glomerular membrane is caused by damage to the shield of negativity.

True

The presence of amino acids is of particular concern in which population?

Newborns

The concept of vampires is associated with:

Porphyrias

All of the following porphyrin compounds can be found in urine except:

Protoporphyrin

Which of the following compounds does not react directly with either Ehrlich reagent or fluorescence?

Aminolevulinic acid

The presence of porphobilinogen in the urine can be suspected when:

Urine turns a port wine color after standing

Symptoms of inherited porphyrias include all of the following except:

Fanconi syndrome

The most common cause of acquired porphyria is:

Lead poisoning

All of the following porphyrin compounds will exhibit fluorescence under ultraviolet light except:

Porphobilinogen

Phenylketonuria is caused by:

Lack of the enzyme phenylalanine hydroxylase

Accumulation of large amounts of homogentisic acid in the urine is the result of which of the following disorders?

Alkaptonuria

Initial screening for PKU performed on newborns before their discharge from the hospital uses a blood sample rather than a urine sample because:

Increased serum phenylalanine can be detected earlier

Patients who have unusually fair complexions can be indicative for phenylketonuria because:

Tyrosine is not available for conversion to melanin

A positive urine Clinitest reaction can be seen in patients with:

Alkaptonuria

A disease that causes large amounts of branched-chain amino acids to be excreted in the urine is:

Maple syrup urine disease

A urinalysis and a dinitrophenylhydrazine (DNPH) test are performed on an infant who is failing to thrive. If the DNPH test is positive, what result in the urinalysis will also be positive?

Ketones

The presence of maple syrup urine disease is first suspected by the presence of abnormal urine:

Odor

Porphyrins are intermediary compounds in the formation of:

Heme

The specimen of choice when testing for protoporphyrin is:

Blood

Chemical analysis of CSF shows that the fluid contains:

Plasma chemicals in concentrations different from those in the plasma

CSF is produced primarily by:

Selective filtration of plasma in the choroid plexus

Cell counts on CSF are performed on:

Cells as they are counted in the hemocytometer

The third tube of CSF collected from a lumbar puncture should be used for:

Hematology tests

Nucleated red blood cells (RBCs) seen in the CSF indicate:

Bone marrow contamination from the puncture

White blood cell (WBC) counts on clear CSF specimens are performed:

On undiluted specimens if there is no cell overlapping

To determine the WBC count on a cloudy CSF specimen that contains both RBCs and WBCs, it is necessary to:

Dilute the specimen using glacial acetic acid

A CSF specimen, in which there is uneven distribution of blood among the three tubes and clots are detected, is an indication of:

Traumatic tap

Examination of a CSF shows 1000 WBCs, of which 75% are lymphocytes and 25% are monocytes. This finding is consistent with:

Viral meningitis

The normal CSF protein is:

15 to 45 mg/dL

Conditions that produce elevated CSF protein include all of the following except:

Fluid leakage

When performing protein electrophoresis on CSF, why is it important to also perform a serum protein electrophoresis?

To determine if oligoclonal banding in the CSF is due to a neurologic inflammation

The normal CSF glucose is:

60% to 70% of the blood glucose

Myelin basic protein is measured in the CSF to assess the condition of patients with:

Multiple sclerosis

The CSF/serum albumin index is performed to determine:

The integrity of the blood-brain barrier

To determine if IgG is being produced within the central nervous system, the laboratory must calculate the:

IgG index

The primary cause of a decreased CSF glucose in bacterial meningitis is:

Alteration of blood-brain glucose transport

A CSF protein report of 32 g/dL:

Is an erroneous report

A positive fluorescent treponemal antibody absorption test (FTA-ABS) and a positive CSF venereal disease research laboratory test (VDRL) indicate:

Neurosyphilis

Using a 1:10 dilution, 120 cells are counted in the four large corner squares on one side of the hemocytometer.

3000 cells/µL

Normal semen should liquefy:

Within 1 hour

If the first portion of the ejaculation is not collected, which parameter of the semen analysis is most critically affected?

Sperm concentration

Semen viscosity is most closely related to:

Specimen liquefaction

Proper collection of a semen specimen should include all of the following except:

At the laboratory followed by 1 hour of refrigeration

Abnormal sperm morphology is determined by:

Head and tail morphology and size

Before analysis, semen specimens should be:

Allowed to completely liquefy

Sperm motility after 1 hour should be at least:

50%

Prior to reporting a postvasectomy specimen as negative for the presence of sperm, the specimen must be:

Centrifuged

Evaluation of sperm motility includes:

Differentiation between forward and lateral movement

When performing sperm morphology analysis, the minimum number of sperm that should be evaluated is:

200

Semen specimens should be processed for analysis:

After complete liquefaction

The normal sperm concentration is:

20 to 160 million/mL

A yellow semen specimen with a normal sperm concentration and decreased motility may contain:

Urine

Using a 1:20 dilution and the 5 RBC counting squares of the Neubauer counting chamber, an average of 54 sperm is counted. The sperm concentration is:

54,000,000/mL

The sugar of interest in most cases of infertility is:

Fructose

Using a 1:10 dilution of a specimen with a volume of 2 mL, 400 sperm are counted in four large squares (WBC) of the Neubauer hemocytometer.

10 million/mL and 20 million/specimen

Antisperm antibodies are produced by both males and females.

True

Development of male antisperm antibodies can be caused by all of the following except:

Prolonged abstinence

All of the following statements on synovial fluid are true except that it:

Is found only in the knee

The concentration of which of the following chemicals found in normal synovial fluid differs most noticeably from the plasma concentration?

Protein

A turbid synovial fluid with yellow-green color indicates:

Infection

A milky-appearing synovial fluid can be associated with the presence of:

Monosodium urate crystals

All of the following are tests frequently performed on synovial fluid except:

Uric acid

Before performing a cell count on highly viscous synovial fluid, it may be necessary to incubate the fluid with:

Hyaluronidase

In the Ropes' or mucin clot test, normal synovial fluid:

Forms a solid clot when added to glacial acetic acid

Synovial fluid for crystal examination should be:

Examined unstained under direct and red compensated polarized light

Delayed analysis of synovial fluid affects the results of all of the following tests except the:

Mucin clot test

Crystals frequently seen in patients' joints with chronic inflammation are:

Cholesterol

Synovial fluid viscosity is caused by the presence of filtered serum proteins.

False

The polymerization of hyaluronic acid is decreased when arthritis is present.

True

Monosodium urate crystals may be present in synovial fluid from patients receiving chemotherapy for leukemia.

True

Monosodium urate crystals are found both extracellularly and intracellularly.

True

Synovial fluid crystals that occur as a result of purine metabolism or chemotherapy for leukemia are...

Monosodium urates

Before testing very viscous synovial fluid should be treated with...

Hyaluronidase

Normal synovial fluid resembles...

Egg whites

The function of synovial fluid include all of the following except...

Removal of cartilage debris

Exudate fluids usually result from:

Inflammation of the serous membrane

The pathologic accumulation of fluid in a body cavity is termed a/an:

Effusion

The function of serous fluid is to:

Provide lubrication for the serous membranes

Production of serous fluid is controlled by all of the following except:

Lymphatic secretions

What is the significance of a pleural fluid with a hematocrit value of 30% (blood hematocrit: 34%)?

Hemothorax

Increased serous fluid can be caused by all of the following except:

Increased plasma sodium

Pericardial fluid from a patient with the nephrotic syndrome appears pale yellow. The fluid-to-protein ratio is 0.3, and the WBC count is 500/L.
Based on the information provided, is this fluid a transudate or an exudate?

Transudate

The term occult blood in fecal analysis can indicate which of the following?

Blood that is not visibly apparent in the stool specimen

To prevent false-positive fecal occult blood results, patients should be instructed to avoid eating all of the following for 3 days before testing except:

Chicken

Tests for the detection of occult blood rely on which chemical reaction?

Pseudoperoxidase activity of hemoglobin

The volume of amniotic fluid increases after the first trimester as a result of:

Production of fetal urine

Amniotic fluid for fetal lung maturity testing should be preserved:

In the refrigerator

A dark yellow amniotic fluid is caused by:

Bilirubin

The presence of a fetal neural tube disorder may be detected by:

Increased maternal serum alpha fetoprotein

Hemolytic disease of the newborn is caused by:

Maternal antibodies

Analysis of amniotic fluid bilirubin levels is performed using:

Spectrophotometry

The foam, or shake, test is a screening test for amniotic fluid:

Surfactants

Amniotic fluid tests for determining fetal lung maturity include:

L/S ratio and lamellar bodies

The test for amniotic fluid lamellar bodies uses which of following?

An automated cell counter

When an L/S ratio by thin-layer chromatography is performed, a mature fetal lung will show:

Lecithin twice as concentrated as sphingomyelin

Failure of the fetus to begin swallowing will result in:

Polyhydramnios

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