Urinalysis and Body Fluids Problem Solving

Question 1

1. Given the following dry reagent strip urinalysis
   results, select the most appropriate course of
   action:
   pH = 8.0
   Protein = 1+
   Glucose = Neg Blood = Neg
   Ketone = Neg
   Nitrite = Neg Bilirubin = Neg

A. Report the results, assuming acceptable quality
control
B. Check pH with a pH meter before reporting
C. Perform a turbidimetric protein test and report
instead of the dipstick protein
D. Request a new specimen

Answer 1

C. Perform a turbidimetric protein test and report
instead of the dipstick protein

Question 2

2. Given the following urinalysis results, select the
   most appropriate course of action:
   pH = 8.0
   Protein = Trace
   Glucose = Neg
   Ketone = Small
   Blood = Neg
   Nitrite = Neg

Microscopic findings:
RBCs = 0–2/HPF
WBCs = 20–50/HPF
Bacteria = Large
Crystals = Small, CaCO3

A. Call for a new specimen because urine was
contaminated in vitro
B. Recheck pH because calcium carbonate (CaCO3)
does not occur at alkaline pH
C. No indication of error is present; results indicate
a UTI
D. Report all results except bacteria because the
nitrite test was negative

Answer 2

C. No indication of error is present; results indicate

Question 3

3.. SITUATION: A 6-mL pediatric urine sample is
processed for routine urinalysis in the usual
manner. The sediment is prepared by centrifuging
all of the urine remaining after performing the
biochemical tests. The following results are
obtained:

SG = 1.015
Protein = 2+
Blood = Large
RBCs: 5–10/HPF
WBCs: 5–10/HPF

Select the most appropriate course of action.
A. Report these results; blood and protein correlate
with microscopic results
B. Report biochemical results only; request a new
sample for the microscopic examination
C. Request a new sample and report as quantity
not sufficient (QNS)
D. Recentrifuge the supernatant and repeat the
microscopic examination

Answer 3

B. Report biochemical results only; request a new
sample for the microscopic examination

Question 4

4. Given the following urinalysis results, select the
   most appropriate course of action:
   pH = 6.5
   Protein = Neg
   Glucose = Neg
   Ketone = Trace
   Blood = Neg
   Bilirubin = Neg

Microscopic findings:
Mucus = Small Ammonium urate = Large

A. Recheck urine pH
B. Report these results, assuming acceptable quality
control
C. Repeat the dry reagent strip tests to confirm the
ketone result
D. Request a new sample and repeat the urinalysis

Answer 4

A. Recheck urine pH

Question 5

5. Given the following urinalysis results, select the
   most appropriate course of action:
   pH = 6.0
   Protein = Neg
   Glucose = Neg
   Ketone = Neg
   Blood = Neg
   Bilirubin = Neg

Other findings:
Color: Amber
Transparency: Microscopic: Crystals

Clear Bilirubin granules
= Small

A. Perform a tablet test for bilirubin before
reporting
B. Request a new sample
C. Recheck the pH
D. Perform a test for urinary urobilinogen

Answer 5

A. Perform a tablet test for bilirubin before
reporting

Question 6

6. A biochemical profile gives the following results:

Creatinine = 1.4 mg/dL
BUN = 35 mg/dL
K = 5.5 mmol/L

All other results are normal and all tests are in
control. Urine from the patient has an osmolality
of 975 mOsm/kg.

Select the most appropriate
course of action.

A. Check for hemolysis
B. Repeat the BUN and report only if normal
C. Repeat the serum creatinine and report only if
elevated
D. Report these results

Answer 6

D. Report these results

Question 7

7. A 2 p.m. urinalysis has a trace glucose by the dry
   reagent strip test. A fasting blood glucose drawn
   8 hours earlier is 100 mg/dL.

No other results
are abnormal. Select the most appropriate course
of action.

A. Repeat the urine glucose and report if positive
B. Perform a test for reducing sugars and report the
result
C. Perform a quantitative urine glucose; report as
trace if greater than 100 mg/dL
D. Request a new urine specimen

Answer 7

A. Repeat the urine glucose and report if positive

Question 8

8. Following a transfusion reaction, urine from a
   patient gives positive tests for blood and protein.
   The SG is 1.015. No RBCs or WBCs are seen in
   the microscopic examination.
   These results:

A. Indicate renal injury induced by transfusion
reaction
B. Support the finding of an extravascular
transfusion reaction
C. Support the finding of an intravascular
transfusion reaction
D. Rule out a transfusion reaction caused by
RBC incompatibility

Answer 8

C. Support the finding of an intravascular
transfusion reaction

Question 9

9. A urine sample taken after a suspected transfusion
   reaction has a positive test for blood, but intact
   RBCs are not seen on microscopic examination.
   Which one test result would rule out an
   intravascular hemolytic transfusion reaction?
   A. Negative urine urobilinogen
   B. Serum unconjugated bilirubin below 1.0 mg/dL
   C. Serum potassium below 6.0 mmol/L
   D. Normal plasma haptoglobin

Answer 9

D. Normal plasma haptoglobin

Question 10

10. Given the following urinalysis results, select the
    most appropriate course of action:
    pH = 5.0 Protein = Neg Glucose = 1,000 mg/dL
    Blood = Neg
    Bilirubin = Neg
    Ketone = Moderate
    SSA protein = 1+

A. Report the SSA protein result instead of the dry
reagent strip result
B. Call for a list of medications administered to the
patient
C. Perform a quantitative urinary albumin
D. Perform a test for microalbuminuria

Answer 10

B. Call for a list of medications administered to the patient

Question 11

11. Urinalysis results from a 35-year-old woman are:

SG = 1.015
pH = 7.5
Protein = Trace
Glucose = Small
Ketone = Neg
Blood = Neg
Leukocytes = Moderate
Microscopic findings:

RBCs: 5–10/HPF
WBCs: 25–50/HPF

Select the most appropriate course of action.

A. Recheck the blood reaction; if negative, look for
budding yeast
B. Repeat the WBC count
C. Report all results except blood
D. Request a list of medications

Answer 11

A. Recheck the blood reaction; if negative, look for
budding yeast

Question 12

12. A routine urinalysis gives the following results:
    pH =6.5
    Protein = Neg
    Blood = Neg
    Glucose= Trace
    Ketone = Neg
    Microscopic findings:

Blood casts: Mucus: Crystals:
5–10/LFP Small Large, Amorphous

These results are most likely explained by:
A. False-negative blood reaction
B. False-negative protein reaction
C. Pseudocasts of urate mistaken for true casts
D. Mucus mistaken for casts

Answer 12

C. Pseudocasts of urate mistaken for true casts

Question 13

13. SITUATION: When examining a urinary sediment
    under 400× magnification, the technologist noted
    many red blood cells to have cytoplasmic blebs and
    an irregular distribution of the hemoglobin. This
    phenomenon is most often caused by:

A. Intravascular hemolytic anemia
B. Glomerular disease
C. Hypotonic or alkaline urine
D. Severe dehydration

Answer 13

B. Glomerular disease

Question 14

14. SITUATION: A urine specimen is dark orange
    and turns brown after storage in the refrigerator
    overnight. The technologist requests a new
    specimen. The second specimen is bright orange
    and is tested immediately. Which test result would
    differ between the two specimens?
    A. Ketone
    B. Leukocyte esterase
    C. Urobilinogen
    D. Nitrite

Answer 14

C. Urobilinogen

Question 15

15. A patient’s random urine consistently contains
    a trace of protein but no casts, cells, or other
    biochemical abnormality. The first voided morning
    sample is consistently negative for protein. These
    findings can be explained by:
    A. Normal diurnal variation in protein loss
    B. Early glomerulonephritis
    C. Orthostatic or postural albuminuria
    D. Microalbuminuria

Answer 15

C. Orthostatic or postural albuminuria

Question 16

16. A urine sample with a pH of 8.0 and a specific
    gravity of 1.005 had a small positive blood
    reaction, but is negative for protein and no RBCs
    are present in the microscopic examination of
    urinary sediment. What best explains these
    findings?
    A. High pH and low SG caused a false-positive
    blood reaction
    B. The blood reaction and protein reaction are
    discrepant
    C. Hemoglobin is present without intact RBCs
    due to hemolysis
    D. An error was made in the microscopic
    examination

Answer 16

C. Hemoglobin is present without intact RBCs
due to hemolysis

Question 17

17. A urine sample has a negative blood reaction and
    5–10 cells per high-power field that resemble red
    blood cells. What is the best course of action?
    A. Mix a drop of sediment with 1 drop of WBC
    counting fluid and reexamine
    B. Report the results without further testing
    C. Repeat the blood test and if negative report the
    results
    D. If the leukocyte esterase test is positive, report
    the cells as WBCs

Answer 17

A. Mix a drop of sediment with 1 drop of WBC
counting fluid and reexamine

Question 18

18. A toluidine blue chamber count on CSF gives the following values:

After correcting the WBC count in CSF, the
technologist should next:
A. Report the WBC count as 9 × 106/L without
additional testing
B. Report the WBC count and number of PMNs
identified by the chamber count
C. Perform a differential on a direct smear of
the CSF
D. Concentrate CSF using a cytocentrifuge and
perform a differential

Answer 18

D. Concentrate CSF using a cytocentrifuge and
perform a differential

Question 19

9. A blood-tainted pleural fluid is submitted for
   culture. Which test result would be most
   conclusive in classifying the fluid as an exudate?

Answer 19

A.

Question 20

20. A pleural fluid submitted to the laboratory is
    milky in appearance. Which test would be most
    useful in differentiating between a chylous and
    pseudochylous effusion?
    A. Fluid to serum triglyceride ratio
    B. Fluid WBC count
    C. Fluid total protein
    D. Fluid to serum LD ratio

Answer 20

A. Fluid to serum triglyceride ratio

Question 21

21. A cerebrospinal fluid sample from an 8-year-old
    child with a fever of unknown origin was tested
    for glucose, total protein, lactate, and IgG
    index. The glucose was 180 mg/dL but all other
    results were within the reference range. The
    CSF WBC count was 9 × 106/L and the RBC
    count was 10 × 106/L. The differential
    showed 50% lymphocytes, 35% monocytes,
    10% macrophages, 3% neutrophils, and
    2% neuroectodermal cells. What is the most
    likely cause of these results?
    A. Aseptic meningitis
    B. Traumatic tap
    C. Subarachnoid hemorrhage
    D. Hyperglycemia

Answer 21

D. Hyperglycemia

Question 22

22. A WBC count and differential performed on
    ascites fluid gave a WBC count of 20,000μL with
    90% macrophages. The gross appearance of the
    fluid was described by the technologist as “thick
    and bloody.” It was noted on the report that
    several clusters of these cells were observed and
    that the majority of the cells contained many
    vacuoles resembling paper-punch holes. What
    do the observations above suggest?
    A. Malignant mesothelial cells were counted as
    macrophages
    B. Adenocarcinoma from a metastatic site
    C. Lymphoma infiltrating the peritoneal cavity
    D. Nodular sclerosing type Hodgkin’s disease

Answer 22

A. Malignant mesothelial cells were counted as
macrophages

Question 23

23. Given the following data for creatinine clearance,
    select the most appropriate course of action.

Volume = 2.8 L/day;
surface area = 1.73 m2; urine creatinine = 100 mg/dL;
serum creatinine = 1.2 mg/dL

A. Report a creatinine clearance of 162 mL/min
B. Repeat the urine creatinine; results point to a
dilution error
C. Request a new 24-hour urine sample
D. Request the patient’s age and sex

Answer 23

C. Request a new 24-hour urine sample

Question 24

24. An elevated amylase is obtained on a stat serum
    collected at 8 p.m. An amylase performed at
    8 a.m. that morning was within normal limits.
    The technologist also noted that a urine amylase
    was measured at 6 p.m. Select the most
    appropriate course of action.
    A. Repeat the stat amylase; report only if within
    normal limits
    B. Repeat both the a.m. and p.m. serum amylase
    and report only if they agree
    C. Request a new specimen; do not report results
    of the stat sample
    D. Review the amylase result on the 6 p.m. urine
    sample; if elevated, report the stat amylase

Answer 24

D. Review the amylase result on the 6 p.m. urine
sample; if elevated, report the stat amylase

Question 25

25. Results of a fetal lung maturity (FLM) study from
    a patient with diabetes mellitus are as follows:
    L/S ratio = 2.0; Phosphatidyl glycerol = Pos;
    Creatinine = 2.5 mg/dL
    Given these results, the technologist should:
    A. Report the result and recommend repeating the
    L/S ratio in 24 hours
    B. Perform scanning spectrophotometry on the
    fluid to determine if blood is present
    C. Repeat the L/S ratio after 4 hours and report
    those results
    D. Report results as invalid

Answer 25

A. Report the result and recommend repeating the
L/S ratio in 24 hours

Question 26

26. A 24-hour urine sample from an adult submitted
    for catecholamines gives a result of 140 μg/day
    (upper reference limit 150 μg/day). The 24-hour
    urine creatinine level is 0.6 g/day. Select the best
    course of action.
    A. Check the urine pH to verify that it is less
    than 2.0
    B. Report the result in μg catecholamines per mg
    creatinine
    C. Request a new 24-hour urine sample
    D. Measure the VMA and report the catecholamine
    result only if elevated

Answer 26

C. Request a new 24-hour urine sample

Question 27

27. A 5-hour urinary D-xylose test on a 7-year-old
    boy who was given 0.5 g of D-xylose per pound
    is 15%. The 2-hour timed blood D-xylose is
    15 mg/dL (lower reference limit 30 mg/dL). Select
    the most appropriate action.
    A. Request that a β carotene absorption test be
    performed
    B. Repeat the urinary result because it is borderline
    C. Request a retest using a 25-g dose of D-xylose
    D. Request a retest using only a 1-hour timed blood
    sample

Answer 27

D. Request a retest using only a 1-hour timed blood
sample

Question 28

28. A quantitative serum hCG is ordered on a male
    patient. The technologist should:
    A. Perform the test and report the result
    B. Request that the order be cancelled
    C. Perform the test and report the result if
    negative
    D. Perform the test and report the result only if
    greater than 25 IU/L

Answer 28

A. Perform the test and report the result

Question 29

29. SITUATION: A lamellar body count (LBC) was
    performed on an amniotic fluid sample that was
    slightly pink in color within 1 hour of specimen
    collection. The sample was stored at 4°C prior to
    analysis. The result was 25,000/μL, classified as
    intermediate risk of respiratory distress syndrome.
    The physician waited 24 hours and collected a
    new sample that was counted within 2 hours of
    collection on the same instrument. The LCB count
    of the new sample was 14,000/ μL and the patient
    was reclassified as high risk. Which statement best
    explains these results?
    A. Loss of lamellar bodies occurred in the second
    sample because of storage
    B. Blood caused a falsely elevated result for the first
    sample
    C. The fetal status changed in 24 hours owing to
    respiratory illness
    D. The difference in counts is the result of day-to-day
    physiological and instrument variance

Answer 29

B. Blood caused a falsely elevated result for the first
sample

Question 30

30. When testing for drugs of abuse in urine, which
    of the following test results indicate dilution and
    would be cause for rejecting the sample?
    A. Temperature upon sample submission 92°F
    B. Specific gravity 1.002; Creatinine 15 mg/dL,
    C. pH 5.8; temperature 94°C
    D. Specific gravity 1.012, creatinine 25 mg/dL

Answer 30

B. Specific gravity 1.002; Creatinine 15 mg/dL,

Question 31

31. SITUATION: A urine specimen has a specific
    gravity of 1.025 and is strongly positive for nitrite.
    All other dry reagent strip test results are normal,
    and the microscopic exam was unremarkable,
    showing no WBCs or bacteria. The urine sample
    was submitted as part of a preemployment
    physical exam that also includes drug testing.
    Which most likely caused these results?
    A. A viral infection of the kidney
    B. A urinary tract infection in an immunosuppressed
    person
    C. An adulterated urine specimen
    D. Error in reading the nitrite pad caused by poor
    reflectometer calibration

Answer 31

C. An adulterated urine specimen

Question 32

32. A CSF sample submitted for cell counts has a
    visible clot. What is the best course of action?
    A. Count RBCs and WBCs manually after diluting
    the fluid with normal saline
    B. Tease the cells out of the clot before counting,
    then dilute with WBC counting fluid
    C. Request a new sample
    D. Perform a WBC count without correction

Answer 32

C. Request a new sample

Question 33

33. Total hemolytic complement and glucose are
    ordered on a synovial fluid sample that is too
    viscous to pipet. What is the best course of action?
    A. Dilute the sample in saline
    B. Add 1 mg/mL hyaluronidase to the sample and
    incubate at room temperature for 30 minutes
    C. Warm the sample to 65°C for 10 minutes
    D. Request a new specimen

Answer 33

B. Add 1 mg/mL hyaluronidase to the sample and
incubate at room temperature for 30 minutes

Question 34

34. A CSF CytoPrep smear shows many smudge cells
    and macrophages with torn cell membranes. What
    most likely caused this problem?
    A. Failure to add albumin to the cytospin cup
    B. Failure to collect the CSF in EDTA
    C. Centrifuge speed too low
    D. Improper alignment

Answer 34

A. Failure to add albumin to the cytospin cup

Question 35

35. An automated electronic blood cell counter was
    used to count RBCs and WBCs in a turbid pleural
    fluid sample. The WBC count was 5 × 1010/L
    (50,000/μL) and the RBC count was 5.5 × 1010/L
    (55,000/ μL). What is the significance of the
    RBC count?
    A. The RBC count is not significant and should be
    reported as 5,000/μL
    B. The RBC count should be reported as
    determined by the analyzer
    C. A manual RBC count should be performed
    D. A manual RBC and WBC count should be
    performed and reported instead

Answer 35

A. The RBC count is not significant and should be
reported as 5,000/μL