Urinalysis and Body Fluids Problem Solving Flashcards
- 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
C. Perform a turbidimetric protein test and report
instead of the dipstick protein
- 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
C. No indication of error is present; results indicate
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
B. Report biochemical results only; request a new
sample for the microscopic examination
- 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
A. Recheck urine pH
- 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
A. Perform a tablet test for bilirubin before
reporting
- 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
D. Report these results
- 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
A. Repeat the urine glucose and report if positive
- 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
C. Support the finding of an intravascular
transfusion reaction
- 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
D. Normal plasma haptoglobin
- 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
B. Call for a list of medications administered to the patient
- 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
A. Recheck the blood reaction; if negative, look for
budding yeast
- 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
C. Pseudocasts of urate mistaken for true casts
- 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
B. Glomerular disease
- 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
C. Urobilinogen
- 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
C. Orthostatic or postural albuminuria
- 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
C. Hemoglobin is present without intact RBCs
due to hemolysis
- 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
A. Mix a drop of sediment with 1 drop of WBC
counting fluid and reexamine
- 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
D. Concentrate CSF using a cytocentrifuge and
perform a differential
- A blood-tainted pleural fluid is submitted for
culture. Which test result would be most
conclusive in classifying the fluid as an exudate?
A.
- 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
A. Fluid to serum triglyceride ratio
- 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
D. Hyperglycemia
- 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
A. Malignant mesothelial cells were counted as
macrophages
- 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
C. Request a new 24-hour urine sample
- 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
D. Review the amylase result on the 6 p.m. urine
sample; if elevated, report the stat amylase
- 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
A. Report the result and recommend repeating the
L/S ratio in 24 hours
- 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
C. Request a new 24-hour urine sample
- 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
D. Request a retest using only a 1-hour timed blood
sample
- 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
A. Perform the test and report the result
- 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
B. Blood caused a falsely elevated result for the first
sample
- 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
B. Specific gravity 1.002; Creatinine 15 mg/dL,
- 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
C. An adulterated urine specimen
- 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
C. Request a new sample
- 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
B. Add 1 mg/mL hyaluronidase to the sample and
incubate at room temperature for 30 minutes
- 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
A. Failure to add albumin to the cytospin cup
- 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
A. The RBC count is not significant and should be
reported as 5,000/μL
