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AUBF > Introduction to Urinalysis > Flashcards

Introduction to Urinalysis Flashcards

1
Q

“The testing of urine with procedures commonly
performed in an expeditious, reliable, accurate, safe,
and cost-effective manner.” (CLSI)

A

URINALYSIS

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2
Q

they continuously form urine as an ultrafiltrate
of plasma.

A

KIDNEYS

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3
Q

Ultrafiltration of plasma takes place in the?

A

glomerular capillaries

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4
Q

Reabsorption of water and filtered substances
essential to body function converts approximately
150,000 mL of filtered plasma

TRUE OR FALSE

A

FALSE

It reabsorbs 170,000mL not 150,000mL

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5
Q

the average daily urine output is?

A

1,200 mL

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6
Q

consists of urea and other organic and inorganic
chemicals dissolved in water.

A

Urine

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7
Q

Urine is normally 95% water and 5% solutes.

TRUE OR FALSE

A

TRUE

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8
Q

Urine is normally 95% water and 5% solutes.

These 5% solutes include:

A

Organic components;
Inorganic components.

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9
Q

(most abundant organic component), a metabolic
waste product produced in the liver from the
breakdown of protein and amino acids, accounts for
nearly half of the total dissolved solids in urine.

A

Urea

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10
Q

Aside from Urea other organic substances include primarily creatinine and uric acid, and other nitrogen-containing
compounds.

TRUE OR FALSE

A

TRUE

These are your main organic substances:
Urea
Creatinine
Uric Acid
Nitrogen-containing compounds

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11
Q

The major inorganic solid dissolved in urine is?

A

Chloride

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12
Q

principal salt in urine

A

sodium chloride salt

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13
Q

The major inorganic solid dissolved in urine is chloride followed by?

A

sodium and potassium

usually in the form of sodium chloride salt

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14
Q

excreted in the form of di-hydrogen phosphate

A

Calcium, phosphate

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15
Q

Small or trace amounts of many additional inorganic
chemicals are also present in the urine

TRUE OR FALSE

A

TRUE

Because other substances found in urine include
hormones, vitamins, and medications; may also contain formed elements such as cells, casts, crystals, mucus, and bacteria.

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16
Q

Primary organic component; product
of metabolism of protein and amino
acids

A

UREA

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17
Q

Product of metabolism of creatine by
muscles.

A

CREATININE

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18
Q

Product of breakdown of nucleic acid
in food and cells

A

URIC ACID

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19
Q

Primary inorganic component; found
in combination with sodium and many
other inorganic substances.

A

CHLORIDE

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20
Q

Primarily from salt, varies by intake.

A

SODIUM

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21
Q

Combined with chloride and other
salts.

A

POTASSIUM

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22
Q

Combines with sodium to buffer the
blood.

A

PHOSPHATE

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23
Q

Regulates blood and tissue fluid
acidity.

A

AMMONIUM

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24
Q

Combines with chloride, sulfate, and
phosphate.

A

CALCIUM

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25
Q

Refers to the 24-hr or Daily Output; the amount of urine
voided or excreted over a period of 24 hours

A

URINE VOLUME

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26
Q

Urine volume depends on the amount of _____ that the
kidneys excrete.

A

Water

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27
Q

is a major body constituent; therefore,
the amount excreted is usually determined by
the body’s state of hydration

A

Water

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28
Q

D/N (Day-to-Night) Ratio

A

2:3:1

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29
Q

Night output is 2 – 3x larger than the
Day output.

TRUE OR FALSE

A

FALSE

Day output is 2 – 3x larger than the
night output.

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30
Q

NORMAL DAILY URINE OUTPUT

RANDOM

A

600 – 2000 mL/day

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31
Q

NORMAL DAILY URINE OUTPUT

AVERAGE

A

1200 – 1500 mL/day (1.2 – 1.5 L/day)

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32
Q

Persistent production of large volumes of urine; an
abnormal increase in daily urine volume

A

Polyuria

2.5 L/day in adults;
2.5 – 3 mL/kg/day in children

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33
Q

Seen in cases of diabetes mellitus and diabetes
insipidus; differ in terms of specific gravity.

A

Polyuria

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34
Q

↑SG (hypersthenuria; due to
osmotic diuresis).

A

DIABETES MELLITUS

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35
Q

↓SG (hyposthenuria;
consistently within 1.002 –
1.003)

A

DIABETES INSIPIDUS

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36
Q

Failure in ADH secretion
(produces large amounts of
dilute urine).

A

DIABETES INSIPIDUS

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37
Q

Caused by a defect either in the pancreatic production of insulin or in the function of insulin, which results in an increased concentration of body glucose.

A

DIABETES MELLITUS

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38
Q

Results from a decrease in the production or function of ADH; thus, the water necessary for adequate body hydration is not reabsorbed from the plasma filtrate.

A

DIABETES INSIPIDUS

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39
Q

Fluid loss in both diabetes (Mellitus and Insipidus) diseases is compensated by increased ingestion of water (polydipsia), producing an even greater volume of urine. Polyuria is accompanied by increased fluid intake is often the first symptom of either disease.

TRUE OR FALSE

A

TRUE

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40
Q

increased ingestion of water

A

polydipsia

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41
Q

Persistent production of low volumes of urine; abnormal decrease in urine output

A

OLIGURIA

<400 mL/day in adults,
<1 mL/kg/hr in infants,
<0.5 mL/kg/hr in children

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42
Q

Identify this condition

Clinical Significance: Dehydration, renal insufficiency, poorly compensated heart disease, renal calculi (kidney stones), and kidney tumors

Characterized either by decreased renal blood flow or obstruction

A

OLIGURIA

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43
Q

Complete cessation of urine production; one of the main findings or manifestations of renal failure.

A

ANURIA

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44
Q

Almost all glomerular and tubulointerstitial disorders terminate in renal failure.

TRUE OR FALSE

A

TRUE

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45
Q

Identify this condition

Clinical Significance: Severe acute nephritis, tubular necrosis, Hg poisoning, obstructive uropathy, kidney failure.

May result from any serious damage to the kidneys or from a decrease in the flow of blood to the kidneys.

A

ANURIA

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46
Q

Increase in the nocturnal excretion of urine. Excretion of more than 500 mL urine at night with a specific gravity of less than 1.018.

If S.G. = 1.010, it is usually associated with impairment of tubular function or renal failure/necrosis.

A

NOCTURIA

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47
Q

“Transient polyuria;” may be due to the intake of substances with a diuretic effect, such as alcohol, coffee, or diuretic drugs

Transitory increase in urine volume

A

DIURESIS

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48
Q

A SMALL volume of urine is produced, as long as the diuretic substances are in one’s system.

TRUE OR FALSE

A

FALSE

A large volume of urine is produced by diuretic substances

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49
Q

PREFERRED SPECIMEN FOR URINE

A

First Morning

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50
Q

(most concentrated specimen of the day) collected using midstream clean-catch technique.

A

First Morning

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51
Q

The most common indication of routine urinalysis is?

A

the diagnosis of urinary tract infection (UTI).

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52
Q

One way to collect sterile urine suitable for bacterial culture, which will also be in conjunction with urinalysis

A

First Morning

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53
Q

Specimens must be collected in STERILE, dry, leakproof, and clear containers.

TRUE OR FALSE

A

FALSE

For first morning routine urinalysis CLEAN is enough

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54
Q

Disposable containers should be used because?

A

they eliminate the chance of contamination due to improper washing

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55
Q

Properly applied screw-top lids are less likely to leak than are snap-on lids.

TRUE OR FALSE

A

TRUE

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56
Q

Containers for routine urinalysis should have a NARROW mouth to facilitate collections from female patients and a wide, flat bottom to prevent overturning.

They should also be made of a IMPERMEABLE material to allow for determination of color and clarity.

TRUE OR FALSE

A

FALSE

Containers for routine urinalysis exhibit WIDE mouths and are made of CLEAR material

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57
Q

For routine urinalysis, we only need how much urine?

A

10 – 15 mL (avg. of 12 mL).

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58
Q

Containers must be large enough to allow room for mixing.

TRUE OR FALSE

A

TRUE

The recommended capacity of the container is 50 mL, which allows 12 mL of specimen needed for microscopic analysis, additional specimen for repeat analysis, and enough room for the specimen to be mixed by swirling the container.

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59
Q

used for microbiological studies of urine.

A

Individually packaged STERILE containers with secure closures

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60
Q

Labels must be attached to the LID of the container, not to the BODY, and should not become detached if the container is refrigerated or frozen.

TRUE OR FALSE

A

FALSE

Labels must be attached to the BODY

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61
Q

All specimens must be labeled immediately after collection

What are the minimum requirements for urine specimens?

A

o (1) Patient’s full name;
o (2) Date and time of collection;
o (3) Identification number (if present);
o (4) Additional information such as the patient’s age and location, the health care provider’s name, and the preservative used.

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62
Q

the form that must accompany specimens delivered to the laboratory.

A

Requisition Form

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63
Q

This form may include additional information such as method of collection or type of specimen, possible interfering medications, and the patient’s clinical information

The time the specimen is received in the laboratory should be recorded on the form. So that the staff will have a basis for determining the acceptability of the specimen

A

Requisition form

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64
Q

THE CRITERIA FOR URINE SPECIMEN REJECTION

A
  • (1) Specimens in containers that are unlabeled or improperly labeled;
  • (2) Labels and requisition forms that do not match;
  • (3) Specimens contaminated with feces or toilet paper;
  • (4) Containers with contaminated exteriors;
  • (5) Specimens of insufficient quantity;
  • (6) Specimens that have been transported improperly;
  • (7) Specimens that have not been preserved correctly during a time delay
  • (8) Specimens for urine culture collected in a nonsterile container;
  • (9) Inappropriate collection for the type of testing needed (ex. midstream clean-catch specimen for bacterial culture).
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65
Q

After collection, specimens should be delivered to the laboratory promptly and tested within ___ hours

A

2hrs to preserve specimen integrity

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66
Q

A specimen that cannot be delivered and tested within 2 hours should be?

A

refrigerated or have an appropriate chemical preservative added.

67
Q

Identify the analyte of changes in unpreserved urine

Oxidation or reduction of metabolites

A

Color

Modified/Darkened

68
Q

Identify the analyte of changes in unpreserved urine

Bacterial growth and precipitation of amorphous material

A

Clarity

Decreased

69
Q

Identify the analyte of changes in unpreserved urine

Bacterial multiplication causing breakdown of urea to ammonia

A

Odor

Increased ammonia smell

70
Q

Identify the analyte of changes in unpreserved urine

Breakdown of urea to ammonia by urease-producing bacteria/loss of CO2.

A

pH

Increased

71
Q

Identify the analyte of changes in unpreserved urine

Glycolysis and bacterial use.

A

Glucose

Decreased

72
Q

Identify the analyte of changes in unpreserved urine

Volatilization and bacterial metabolism.

A

Ketones

Decreased

73
Q

Identify the analyte of changes in unpreserved urine

Exposure to light/photo oxidation to biliverdin.

A

Bilirubin

Decreased

74
Q

Identify the analyte of changes in unpreserved urine

Oxidation to urobilin.

A

Urobilinogen

Decreased

75
Q

Identify the analyte of changes in unpreserved urine

Multiplication of nitrate-reducing bacteria

A

Nitrite

Increased

76
Q

Identify the analyte of changes in unpreserved urine

Disintegration/lyse in dilute alkaline urine

A

Red and white blood cells and casts

Decreased

77
Q

Identify the analyte of changes in unpreserved urine

Multiplication

A

Bacteria

Increased

78
Q

Identify the analyte of changes in unpreserved urine

Loss of motility, death.

A

Trichomonas

Decreased

79
Q

Most commonly used method of preservation; does not interfere with routine tests. Done at 2°C – 8°C which decreases bacterial growth and metabolism.

A

Refrigeration

80
Q

If the urine is to be cultured, it should be refrigerated during transit and kept refrigerated until cultured, up to ___ hours

A

24hrs

81
Q

If a technique prevents bacterial growth, the term “________” is used

A

“bacteriostatic”

82
Q

Maintains an acid pH for up to 8 hours

A

REFRIGERATION

83
Q

This is the disadvantage of what specimen preservation

Disadvantage: Can cause precipitation of amorphous urate and phosphate crystals, which would make the specimen turbid and increase its’ specific gravity

A

REFRIGERATION

84
Q

When a specimen must be transported over a long distance and refrigeration is impossible, what is added as a substitute?

A

chemical preservatives may be added

85
Q

The ideal specimen should be BACTERICIDAL, inhibit urease, and preserve formed elements in the sediment. The preservative should not interfere with chemical tests.

TRUE OR FALSE

A

TRUE

86
Q

Urine preservative that does not interfere with chemical tests (Advantage)

A

Refrigeration

87
Q

Urine preservative that precipitates amorphous phosphates and urates (Disadvantage)

A

Refrigeration

88
Q

Urine preservative that prevents bacterial growth for 24 hours

A

Refrigeration

89
Q

Urine preservative that prevents bacterial growth and metabolism. (advantage)

A

Acids (boric acid*, HCL, acetic acid, tartaric acid)

90
Q

Urine preservative that Interferes with analysis of drugs and hormones (disadvantage)

A

Acids (boric acid*, HCL, acetic acid, tartaric acid)

91
Q

Urine preservative that Keeps pH at about 6.0 (may be considered as a disadvantage; may interfere with pH reading); can be used for transport of urine cultures.

A

Acids (boric acid*, HCL, acetic acid, tartaric acid)

92
Q

Urine preservative that is an Excellent sediment preservative (advantage)

A

Formalin (formaldehyde)

93
Q

Urine preservative that Acts as a reducing agent, interfering with chemical tests for glucose, blood, leukocyte esterase, and copper reduction. (disadvantage)

A

Formalin (formaldehyde)

94
Q

Urine preservative that is a Good preservative for drug analyses. (advantage)

A

Sodium fluoride

95
Q

Urine preservative that Inhibits reagent strip tests for glucose, blood, and leukocytes (disadvantage)

A

Sodium fluoride

96
Q

Urine preservative that is 50% alcohol and 2% carbowax 1540; prevents cell collapse.(advantage)

A

Saccomanno’s fixative (acellular/sediment preservative)

97
Q

Urine preservative that May contain dehydrating agents. (disadvantage)

A

Saccomanno’s fixative (acellular/sediment preservative)

98
Q

Urine preservative that is Commercially available preservative for cytology studies

A

Saccomanno’s fixative (acellular/sediment preservative)

99
Q

Urine preservative that is Convenient when refrigeration not possible. Have controlled concentration to minimize interference (advantage)

A

Commercial preservative tablets

100
Q

Urine preservative that Check tablet composition to determine possible effects on desired tests (disadvantage)

A

Commercial preservative tablets

101
Q

Urine preservatives that Does not interfere with routine tests. (advantage)

A

PHENOL AND TOLUENE

102
Q

Urine preservative that Causes odor change (disadvantage)

A

PHENOL

103
Q

Urine preservative that Floats and clings to pipettes and other instruments.(disadvantage)

A

TOLUENE

104
Q

Urine preservative that Acts as a physical barrier to air and bacteria.

A

TOLUENE

105
Q

Urine preservative that Preserves glucose and sediments.(advantage)

A

Thymol

106
Q

Urine preservative that Interferes with protein precipitation test (disadvantage)

A

Thymol

107
Q

Urine preservative that is Effective against bacteria and molds.

A

Thymol

108
Q

Contains collection cup, transfer straw, culture and sensitivity (C&S) preservative tube, or UA tube

A

URINE COLLECTION KITS (BECTON, DICKINSON, RUTHERFORD, NJ)

109
Q

URINE COLLECTION KITS (BECTON, DICKINSON, RUTHERFORD, NJ)

Needle that mimics the vacutainer system in blood collection.

A

Transfer Device

110
Q

Rinse specimen container with formalin to preserve cells and casts.

TRUE OR FALSE

A

TRUE

111
Q

Identify this tube

  • Culture and sensitivity.
  • Preservative is boric acid, sodium borate, and sodium formate.
  • Keeps pH at about 6.0.
A

Light Gray and Gray C&S Tube

112
Q

Identify this tube

Use on automated instruments.

A

Yellow UA Plus Tube (Plain)

113
Q

Identify this tube

  • Preservative is sodium proprionate, ethyl paraben, and chlorhexidine.
  • Round or conical bottoms.
A

Cherry Red/Yellow Preservatuve Plus Tube

114
Q

This is an advantage of what tube?

Specimen is stable at room temperature (RT) for 48 hours; prevents bacterial growth and metabolism

A

Light Gray and Gray C&S Tube

115
Q

This is an advantage of what tube?

Must refrigerate within 2 hours

A

Yellow UA Plus Tube (Plain)

116
Q

This is an advantage of what tube?

Specimen stable at 72 hours at RT; instrument-compatible.

A

Cherry Red/Yellow Preservatuve Plus Tube

117
Q

This is an disadvantage of what tube?

Do not use if urine is below minimum fill line.

A

Light Gray and Gray C&S Tube

118
Q

This is an disadvantage of what tube?

Round or conical bottom; no preservative.

A

Yellow UA Plus Tube (Plain)

119
Q

This is an disadvantage of what tube?

Must be filled to minimum fill line. Bilirubin and urobilinogen may be decreased if specimen is exposed to light and left at RT.

A

Cherry Red/Yellow Preservatuve Plus Tube

120
Q

If the specimen stands for more than 2 hours and no preservative has been added, the color will change; usually LIGHTENS upon standing due to oxidation and reduction of metabolites.

TRUE OR FALSE

A

FALSE

The color DARKENS

121
Q

The goal of preservation is either to prevent bacterial growth (bacteriostatic) or kill bacteria (bactericidal).

TRUE OR FALSE

A

TRUE

122
Q

becomes alkaline; due to ammonia from the breakdown of urea by urease-producing bacteria

A

urine pH in unpreserved urine

123
Q

These all increase in urine

A

Odor
pH
Nitrite (NO2)
Bacteria Crystals

124
Q

These all decrease in urine

A

Clarity
Glucose
Ketones
Bilirubin
Urobilinogen
Cells and casts
T. Vaginalis

125
Q

reduction of nitrate is done by?

A

nitrate-reducing bacteria.

126
Q

decreased glucose is due to?

A

Glycolysis

127
Q

Decreased ketones are due to?

A

due to volatilization or bacterial metabolism

128
Q

Identify the type of specimen based on the given purpose

Routine screening

A

RANDOM

129
Q

Identify the type of specimen based on the given purpose

Routine screening
Pregnancy tests
Orthostatic protein

A

FIRST MORNING

130
Q

Identify the type of specimen based on the given purpose

Quantitative chemical tests

A

24-HOUR (OR TIMED)

131
Q

Identify the type of specimen based on the given purpose

Bacterial culture

A

CATHETERIZED (sterile)

132
Q

Identify the type of specimen based on the given purpose

Routine screening
Bacterial culture

A

MIDSTREAM CLEAN-CATCH

133
Q

Identify the type of specimen based on the given purpose

Bladder urine for bacterial culture
Cytology

A

SUPRAPUBIC ASPIRATION

134
Q

Identify the type of specimen based on the given purpose

Prostatic Infection

A

THREE-GLASS COLLECTION AND FOUR-GLASS COLLECTION

135
Q

A RANDOM specimen can be accepted for analysis if it is not to DILUTE.

TRUE OR FALSE

A

TRUE

It must not be DILUTE, otherwise, it can lead to falsely low counts and concentrations of chemical components. It also may show erroneous results resulting from dietary intake or physical activity just before collection.

136
Q

This is the specimen received most commonly because of its’ ease of collection and convenience for the patient. Can be collected at any time, but the actual time of voiding should be recorded on the container

A

Random Specimen

137
Q

Preferred specimen for routine urinalysis, pregnancy testing, and for evaluating (orthostatic proteinuria)

A

FIRST MORNING SPECIMEN

138
Q

a benign type of proteinuria, which is only due to the gravitational pull (that is, if you stand for 2 hours or so).

A

Orthostatic (Postural) Proteinuria

139
Q

▪ Common among young adults; there is a significant excretion of protein in urine.
▪ This disappears once the patient assumes a recumbent or lying position.
▪ Results should be negative; otherwise, it indicates true proteinuria

A

Orthostatic (Postural) Proteinuria

140
Q

The most concentrated specimen of the day; thereby, assuring detection of chemicals and formed elements that may not be present in a dilute random specimen.

A

FIRST MORNING SPECIMEN

141
Q

Successive voidings within a specific period are combined in a single container

Rule: Begin and end the collection with an empty bladder. Then void or discard the first urine (time zero); should not be collected at the container.

A

24-HOUR (OR TIMED) SPECIMEN

142
Q

When the concentration of the substance to be measured changes with DIURNAL VARIATIONS and with daily activities, such as exercise, meals, and body metabolism, 12-HOUR collection is required.

TRUE OR FALSE

A

FALSE

24-HOUR

143
Q

Preferred specimen for clearance tests (tests used to estimate the glomerular filtration rate).

A

24-HOUR (OR TIMED) SPECIMEN

144
Q

Addis count

  • Sediments constituents are enumerated using a hemocytometer.
  • Preservative: Formalin (excellent sediment preservative).
A

12-HOUR SPECIMEN

145
Q

Urobilinogen is subjected to photooxidation; container must be protected from light (wrapped in aluminum foil or an amber container is used).

o Period of the day where urobilinogen concentration is at
its’ peak. (2:00 – 4:00).

A

2-HOUR SPECIMEN

146
Q

SPECIMENS FOR DIABETIC SCREENING/MONITORING

  • Second morning specimen (as to not get false positive results for glucose and ketones).
  • The first morning specimen, after a period of fasting, must be discarded
    o It is expected to contain food metabolites prior to the
    beginning of period
A

FASTING SPECIMEN

147
Q

SPECIMENS FOR DIABETIC SCREENING/MONITORING

  • Best for detecting glucosuria (Renal threshold for glucose is exceeded or met)
A

2-H POST-PRANDIAL

148
Q

SPECIMENS FOR DIABETIC SCREENING/MONITORING

Used to accompany blood specimen in a routine oral GTT (Glucose Tolerance Test).

A

GTT URINE

149
Q

Renal threshold for glucose is exceeded or met.

A

glucosuria

150
Q

is the most vulnerable part of a drug-testing program; requires the most stringent protocol due to the possibility of legal implications

A

Urine specimen collection

151
Q

the process that provides this documentation of proper specimen identification from the time of collection to the receipt of laboratory results.

A

Chain of Custody (COC)

152
Q

Urine specimen collections may be “witnessed” or “unwitnessed.”

TRUE OR FALSE

A

TRUE

153
Q

Volume of urine observed by a same-gender collector under witnessed collection for a drug testing specimen

A

30 – 45 mL of urine;

154
Q

Temperature range for urine drug testing specimen

A

32.5°C to 37.7°C.

The urine temperature must be taken within 4 minutes from the time of collection to confirm the specimen has not been adulterated.

155
Q

A specific gravity of less than 1.005 could indicate dilution of the urine specimen and requires re-collection for drug testing specimens.

TRUE OR FALSE

A

TRUE

156
Q

This technique provides a safer, less traumatic method for obtaining urine for bacterial culture and routine analysis.

A

MIDSTREAM CLEAN-CATCH TECHNIQUE

157
Q

Patients must be provided with appropriate cleansing materials, a sterile container, and instructions for cleansing and voiding in what collection technique

A

MIDSTREAM CLEAN-CATCH TECHNIQUE

158
Q

Strong bacterial agents, such as hexachlorophene or povidone-iodine, should NOT be used as cleansing agents in performing MIDSTREAM CLEAN-CATCH TECHNIQUE

TRUE OR FALSE

A

TRUE

Mild antiseptic towelettes are recommended.

159
Q

Collected under STERILE conditions by passing a hollow tube (catheter) through the urethra into the bladder

A

CATHETERIZATION

160
Q

Occasionally, urine may be collected by external introduction of a needle through the abdomen into the bladder; traumatic procedure

A

SUPRAPUBIC ASPIRATION

161
Q

the bladder is STERILE under normal conditions, this provides a specimen for bacterial culture that is completely free of extraneous contamination, particularly in infants or children. The specimen also can be used for cytology studies.

TRUE OR FALSE

A

TRUE

162
Q

In 3 glass collection WBC and bacterial counts in tube 3 is 10x of those of tube 1.

TRUE OR FALSE

A

TRUE

163
Q

Also known as the (FOUR-GLASS TECHNIQUE)

A

STAMEY-MEARES TEST

164
Q

These are observed in what specimen collection?

  • Soft, clear plastic bags are available for collecting routine specimens.
    o These bags have hypoallergenic skin adhesive to attach to the cleaned genital area of both boys and girls.
    o Sterile specimens may be obtained by catheterization or by suprapubic aspiratio
A

PEDIATRIC SPECIMEN COLLECTION

AUBF (3 decks)

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