1.1 Urine Specimen Collection Flashcards
1
Q
It is one of the most important components in laboratory analysis
A
Specimen collection
2
Q
What is the most frequent specimen analyzed in clinical microscopy?
A
Urine
3
Q
Any matter or substance that would be coming out of the human body
A
Specimen
4
Q
T or F
Urine is considered to be a biohazardous substance
A
Trye
5
Q
It is the precaution that treat all specimen coming from the body as potentially infectious
A
Universal precaution
6
Q
What are the characteristics of a proper urine container?
A
- disposable
- wide-mouthed
- flat bottom
- with screw caps
7
Q
Most common types of sample are random urine samples placed in a clear container, at least _______ container
A
50 mL
8
Q
The clear container is recommended as the urine is to be checked physically by:
A
Color & clarity
9
Q
The actual requirement for a urine specimen is ___ to ____ or _____ which is enough for microscopic analysis, however at let 50 mL is required for the patient (to serve as a security specimen)
A
10-15 mL or 12mL
10
Q
What collection containers are used for pediatric specimens?
A
Adhesive bags / pediatric bags
11
Q
What collection containers are used for 24-hr urine specimens?
A
Large plastic container
12
Q
What are additional tests that require additional specimen for routine analysis or even repeat analysis?
A
- urine culture (gram stain)
- cell count
- microscopy division
- cell block (last priority)
13
Q
What are some exception in rejecting a specimen lesser than the minimum capacity of 50 mL?
A
- newborn (note the age and use adhesive bags)
- px is oliguric or a anuric
14
Q
Individually packaged sterile containers with secure closures should be used for ____________ studies of urine
A
microbiological syudies
15
Q
Sterile containers are also suggested if more than ___________ elapse between specimen collection and analysis
A
2 hours
16
Q
What must accompany a specimen?
A
Request form
17
Q
It is non-sterile, plastic holder device with a straw attachment that can be used with the collection container to fill:
- Evacuation tubes containing preservatives for microbiology testing
- Tubes with conical bottoms for sediment analysis
- Tubes with round bottoms for automated reagent strip testing
A
BD Vacutainer Urine Transfer Straw
18
Q
Specimen viability starts with __________
A
Time of collection
19
Q
Urine must be analyzed within ___________ of collection
A
2 hours
20
Q
T or F
Labels should be attached on the lid and not the body of the container
A
False (should be on the body of the container)
21
Q
It is the time the specimen was received in the laboratory which should be recorded on the form
A
Time of receipt
22
Q
Enumerate some situation that may lead to rejection of specimens
A
- unlabeled / improperly labeled
- labels and request form do not match
- spx contaminated with feces or paper
- contaminated exteriors
- insufficient quantity (<50mL)
- delayed or transported improperly
- not preserved
- spx collected in non sterile container
- inappropriate collection
23
Q
What are the 3 distinct phases of examination for urinalysis?
A
- physical examination
- chemical examination
- microscopic examination (uses most of the volume of urine)
24
Q
After collection, specimens should be delivered to the laboratory promptly and tested within ______
A
2 hours
25
A specimen that cannot be delivered and tested within 2 hours should be:
- refrigerated
- with preservative
26
What is a common problem that occurs when refrigerating urine?
- precipitation of amorphous urates
- crystal formation
27
If temperature of urine is _______, some enzymatic reactions in the reagent strip may be hindered
low
28
What is the most common method used in urine preservation
Refrigeration
29
What is the standard temperature for a refrigerator in preserving a urine spx
2-8 C or 4 C
30
T or F
Before analysizng a refrigerated spx, it should be returned in room temperature before analysis
True
31
Most problems of unpreserved urine spx are caused by :
Bacterial multiplication
32
Changes in unpreserved urine
Color
Changed/darkened - due to oxidation or reduction of metabolites
33
Changes in unpreserved urine
Turbidity
Increased - increased bacterial growth
34
Changes in unpreserved urine
Odor
Increase **ammonia** smell - bacterial multiplication causing breakdown of **urea back to ammonia**
35
Changes in unpreserved urine
pH
Increased - breakdown of **urea to ammonia** by **urease-producing** bacteria/loss of CO2
36
Changes in unpreserved urine
Nitrite
Increased - multiplication of **nitrate-reducing** bacteria
37
Changes in unpreserved urine
Bacteria
Increased
38
Changes in unpreserved urine
Trichimonas
Decreased - loss of motility / death
39
Changes in unpreserved urine
Clarity
Decreased - amorphous urates and bacteria
40
Changes in unpreserved urine
Glucose
Decreased - glycolysis & bacterial use
41
Changes in unpreserved urine
Ketones
Decreased - volatilization & bacterial metabolism
42
Changes in unpreserved urine
Bilirubin
Decreased - exposure to light / photooxidation to biliverdin
43
Changes in unpreserved urine
Urobilinogen
Decreased - oxidation to urobilin
44
Changes in unpreserved urine
RBC, WBC, & casts
Decreased - disintegration/lysed in dilute alkaline urine (more stable at acidic pH)
45
T or F
**Do not** use preservative/fixative (formalin) in analysis of urine and body fluids in Clinical Microscopy.
True
46
If there is a need for chemical preservation in AUBF, we can use __________
Sodium azide
47
The method of preservation used most refrigeration at ________
2°C to 8°C
48
If the urine is to be cultured, it should be **refrigerated during transit** and **kept refrigerated** until cultured, up to _________
24 hours
49
Afterr refrigeration, the specimen must return to **room temperature** before chemical testing by ________
reagent strips
50
Refrigeration of urine spx can cause precipitation of _________ and ________
- amorphous urate
- phosphate crystals
51
In using chemical preservative, commercially prepared transport tubes with a ________ preservative are available
lyophilized
52
The ideal preservative should be
- Bacetricidal
- inhibit urease
- preserve formed elements
53
Identify what urine preservative is being described:
- it or events bacterial growth for **24 hrs**
Adv:
- **doesn’t interfere** with chemical tests
Dis:
- ppts amorphous urates and phosphate crystals
Refrigeration
54
Identify what urine preservative is being described:
Adv:
- preserves **glucose** and sediments well
Dis:
- interfere with **acid ppt tests** for protein
Thymol
55
Identify what urine preservative is being described:
- keeps pH at **6.0**
- **bacteriostatic** (not bactericidal) at 18 g/L ; can use for culture transport
- interferes w **drug** and **hormone analyses**
Adv:
- preserves **protein** and formed elements well
- doesn’t interfere w routine analysis other than **pH**
Dis:
- may **ppt crystals** when used in large amounts
Boric acid
56
Identify what urine preservative is being described:
Adv:
- didn’t Interfere w routine tests
Dis:
- **floats on surface** of spx & **clings** to pipettes & testing materials
Toluene
57
Identify what urine preservative is being described:
- rinse spx container w this preservative to **preserve casts and cells**
Adv:
- excellent sediment preservative
Dis:
- acts as a **reducing agent**, interfering w chemical tests for **glucose, blood, leukocyte esterase, & copper reduction**
Formalin (formaldehyde)
58
Identify what urine preservative is being described:
Adv:
- prevents **glycolysis**
- good preservative for **drug analysis**
Dis:
- **inhibits reagent strips** for glucose, blood, leukocytes
Sodium flouride
59
What is an alternative for sodium fluoride for reagent strips testing ?
Sodium benzoate
60
Identify what urine preservative is being described:
- use 1 drop/oz of spx
Adv:
- doesn’t interfere with routine tests
Dis:
- causes an **odor change**
Phenol
61
Identify what urine preservative is being described:
Adv:
- convenient when refrigeration isn’t possible
- have **controlled concentration** to minimize interference
Dis:
- may contain **one or more of the preservative** including **sodium fluoride**
Commercial preservative tablet
62
Identify what urine preservative is being described:
Adv:
- contains **collection cup**, C&S preservative tube or UA tube
Urine collection kits (Benton Dickinson, Rutherford, NJ)
63
Identify what urine preservative is being described:
- preservative is **boric acid** and not be used for UA
Adv:
- sample stable at **room temp** for **48 hrs**
- preserves bacteria
Dis:
- decreases pH
- do not use if urine is below minimum full line
Gray C&S tube
64
Identify what urine preservative is being described:
- round or conical bottom
Adv:
- used on **automated instruments**
Dis:
- must **refrigerate** within **2 hrs**
Yellow plain UA tube
65
Identify what urine preservative is being described:
- preservative is **sodium propionate** ; conical bottom
Adv:
- stab,e for **72 hrs** at **room temp**
- instrument-compatible
Dis:
- **bilirubin & urobilinogen** may be **decreased** if spx is **exposed to light** & and left at **room temp**
Cherry red / yellow top tube
66
Identify what urine preservative is being described:
- used for cytology studies
Adv:
- preserves cellular elements
Saccomanno fixative
67
The composition of urine depends on the patient’s ___________ (Healthy or Pathogenic) and the ________ (Diurnal/Nocturnal variation) and procedure used for collection
metabolic state & timing
68
Enumerate the purpose of the type of spx
Random spx
Routine screening
69
Enumerate the purpose of the type of spx
First morning
- routine screening
- pregnancy test
- orthostatic protein
70
Enumerate the purpose of the type of spx
24 hr (or timed)
Quantitative chemical test
71
Enumerate the purpose of the type of spx
Catheterized
Bacterial culture
72
Enumerate the purpose of the type of spx
Midstream clean-catch
- to urine screening
- bacterial culture
73
Enumerate the purpose of the type of spx
Suprapubic aspiration
- bladder urine for bacterial culture
- Cytology
74
Enumerate the purpose of the type of spx
Three-glass collection
Prostatic infrcion
75
Enumerate the purpose of the type of spx
Four-glass collection
Prostatic infection
76
This type of spx is received **most commonly** because of its ease of collection and convenience for the px (however, not the most preferred)
Random spx
77
This type of spx may be collected at any time
Random sox
78
Type of spx useful for routine screening tests to detect **obvious abnormalities**
Random spx
79
This type of spx may show **erroneous results** resulting from **dietary intake** or **physical activity** just before collection
Random spx
80
This is the **first “batch” of urine** that the patient excreted from his/her body for the day
First morning spx
81
It is the ideal screening specimen
First morning spx
82
It is essential for preventing **false-negative** results for:
- pregnancy tests
- evaluating orthostatic proteinuria
First morning sox
83
A **more concentrated** specimen than a random specimen (single urine)
First morning spx
84
In a first morning spx, the px is in a ______ state
Basal state
85
This type of spx is used for **orthostatic protein confirmation** and urine **pregnancy tests**
First morning sox
86
In Orthostatic proteinuria, the patient’s protein in the urine is affected by ________
Long standing
87
T or F
The first morning spx is highly concentrated that is why it is preferred for pregnancy tests
True
88
What is the hormone responsible for a positive pregnancy test
Human chorionic gonadotropin (HCG)
89
It is the spx that is actually *second specimen voided** and collected after the first morning spx
Fasting spx
90
This spx doesn’t contain metabolites from evening meal
Fasting sox
91
This spx is recommended for **glucose testing**
Fasting sox
92
This spx requires the px to void before eating routine meal
2-hr Postprandial spx
93
Posprandial means
After eating
94
In a 2-hrs postprandial sox, the
voided urine would be the _____
Baseline (normal)
95
After 2 hrs after finishing a meal, a next collection is done
2-hr postprandial spx
96
This spx is used for **insulin monitoring**
2-hr postprandial sox
97
How many spx are to be submitted for a 2-hr postprandial spx?
2 spx
98
This spx were sometimes collected to correspond with the blood specimens drawn during an **oral glucose tolerance test (OGTT)**
Glucose tolerance spx
99
These are usually done in pregnant patients in intervals
Glucose tolerance spx
100
T or F
The number of specimens varied with the length of the test
GTTs included:
- fasting
- half-hour
- 1-hour
- 2-hour
- 3-hour
- 4-hour
- 5 hour
- 6-hour
True
101
Specimens are collected at the same intervals as the blood
samples
Glucose tolerance spx
102
Used to **correlate renal threshold** with patient’s ability to **metabolize glucose**
Glucose tolerance test
103
What is the most common timed spx
24 hr spx
104
In this spx, measuring the exact amount of a urine chemical is often necessary instead of just reporting its presence or absence
24-hr spx
105
Many solutes exhibit diurnal variations such as
- catecholamines
- 17-hydroxysteroids
- electrolytes
lowest concentration is in the __________ and the highest concentration occurs in the _______
low - morning
high - afternoon
106
This spx is required when the concentration of the substance to be measured changes with **diurnal variations** and with daily activities, such as exercise, meals, and body metabolism
24 hr spx
107
T or F
In a 24 hr collection, if the concentration of a particular substance remains **constant**, the specimen may be collected over a **shorter period**
True
108
In this spx, accurate timing is critical for accurate results
24 hr spx
109
The principle of this spx is:
To obtain an accurate timed specimen, the patient must **begin and end** the collection period with an **empty bladder**
24 hr spx
110
In 24 hr urine collection, calculation for units per 24 hours includes the volume in _____ of urine collected
Milliliters
111
T or F
For a 24 hr spx, all specimens should be **refrigerated or kept on ice during the collection period (entire 24-hour period)** and may require addition of a **chemical preservative**
True
112
What are some common errors associated with timed urine collections
- loss of urine spx
- inclusion of two first morning spx ( 1 only from 2nd day)
- inaccurate measurement of total urine volume
- Inadequate urine preservation
- transcription error
113
In a timed collection, **adding urine formed before** the start of the collection period will ___________ the results
falsely elevate
114
In a timed collection, **failure** to include the urine produced at the end of the collection period will _________ the results
falsely decrease
115
This specimen is collected under **sterile conditions** by **passing a hollow tube (catheter) through the urethra into the bladder**
Catheterized sox
116
The test requested most commonly on a catheterized specimen is a _________
bacterial culture and sensitivity
117
In a Catheterized spx, what test should be performed first?
Culture before routine analysis
118
In a catheterized spx, the catheter will mostly be inserted into the external genitalia until the __________
urinary bladder
119
What are the anesthesias used during Catheterized spx collection?
- lubricant
- lubricant w/ lidocaine
- topical anesthesia (no injection)
120
If the catheter will then be removed, the fluid in the balloon (saline or water) will be aspirated back, this is called
Indwelling catheter
121
As an alternative to Catheterized spx, this method provides a safer, less traumatic method for obtaining urine for bacterial culture and routine urinalysis
Midstream clean-catch
122
It provides a specimen that is less contaminated by the epithelial cells and bacteria therefore is more representative of the actual urine than the routinely voided specimen
Midstream clean-catch
123
T or F
In midstream clean-catch, px can use strong bacterial agents, such as **hexachlorophene** or **povidone-iodine** as cleansing agents
False (mild antiseptic towelettes are preferred)
124
Occasionally urine may be collected by **external introduction** of a needle (syringe) through the abdomen into the bladder
Suprapubic aspiration
125
Because the bladder is sterile under normal conditions, suprapubic aspiration provides a specimen for bacterial culture that is **completely free of extraneous contamination** particularly in _________
pediatric
126
Suprapubic aspirate collects what type of urine
Bladder urine
127
T or F
if the patient’s suprapubic aspirate undergoes bacterial culture, there should be no growth of bacteria.
True
128
A common reason for presence of bacteria in bladder urine for Suprapubic aspirate is secondary to _________
kidney stones
129
T or F
Suprapubic aspirate can also be used for culture and cytological examination
True
130
Who can only perform suprapubic aspiration?
Urologists
131
A specimen to check for prostate gland infection
Prostatitis spx
132
Type of spx done only for male patients
Prostatitis spx
133
A make can get screen for prostatitis as early as ____
45 y/o
134
Normally, a male would exhibit signs of prostatitis around the age of _____
60 y/o
135
What type of spx collection is this
- Before collection, the area is cleansed using the male midstream clean-catch collection
● For the first method, collection is similar to the midstream clean-catch urine sample
● All containers must be sterile prior to collection
● Only done for males
Three-glass collection
136
T or F
In a 3 glass collection, the first urine passed and the mid stream are both collected in separate containers
True
137
What is done to the prostate by a physician or nurse in order to stimulate the excretion/release of prostatic fluid
Massage the prostate
138
In a 3 glass collection, what are the contents of each container
1. First urine passed
2. Midstream portion
3. Remaining urine and fluid after the massage (EPS)
139
In a 3 glass collection, the ___ and ___ specimens are examined microscopically for **WBCs or bacteria**
1st and 3rd
140
In a prostatic infection, the____ spx will have **WBC/high-power field count and a bacterial count 10 times** that of the first specimen
3rd spx
141
In a 3 glass collection, the specimen is used as a **control** for bladder and kidney infection/UTI.
2nd spx
142
T or F
In a 3 glass collection, 3rd specimen cannot differentiate urinary tract infection from prostate infection
True
143
In the pre- and postmassage test (PPMT), a __________ urine specimen is collected
clean-catch midstream
144
A positive result is ___________ in the postmassage specimen of greater than 10 times the premassage coun
significant bacteriuria
145
What are the contents of the two spx in the pre-and posrmassage test
Spx 1 - midstream clean-catch
Spx 2 - post-massage spx
146
The traditional four-glass urine collection technique, as described by ___________ includes examination of four urine specimens as follows:
- Initial voided bladder (VB1)
- Voided bladder 2 (VB2)
- EPS
- Voided bladder 3 (VB3)
Meares and Stamey
147
What are the order for 4 glass collection / Stamey-Meares test?
1. VB1: urethral spx
2. VB2 : bladder spx
3. EPS : during prostatic massage
4. VB3: Voided bladder 3
148
**All 4** specimens of the Stamey-Meares are sent for ______
Culture
149
In Stamey-Meares test, VB1 is tested for ________ while VB2 is for _________
VB1: urethral infection of inflammation
VB2 : urinary bladder infection
150
In the stamey-meares test, the __________ are examined for WBC and having **>10-20 WBC** is considered **abnormal**
Prostatic secretions
151
What are the result of a px positive for **prostatitis** in a stamey-meares test
- negative culture on VB1 & VB2
- positive on EPS & VB3
152
What are the result of a px with UTI in a stamey-meares test
VB1 & VB2 Positive
153
What are the result of a px that is abnormal in a stamey-meares test
- EPS examined for WBCs >10-20/ hpf
- Higher WBC count
154
The bags used for this specimens are soft, clear plastic bags that have hypoallergenic skin adhesive attached to the cleaned genital area
Pediatric spx
155
Sterile spx from pediatric are obtained through
- catheterization
- Suprapubic aspiration
156
documentation from the time of specimen collection until the time of receipt of laboratory results; standardized form always accompanies specimen
Chain of custody
157
the most vulnerable part of a drug-testing program
Urine specimen collection
158
In an adulteration test, temperature taken within 4 minutes must be ________
32.5 - 37.7°C
