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Urinalysis Final Exam

STUDY
PLAY
What types of things listed can be considered pathological when found in urine?
a. WBCs, RBCs,
b. Bacteria
c. epithelial cells
d. Both A and B
d. Both A and B
What condition is associated with blue and purple color of urine?

a. Bacterial infection treatment
b. melanoma
c. Bleeding
d. Bilirubin- liver diseases
a. Bacterial infection treatment

Purple discoloration can occur in alkaline urine as a result of the degradation of indoxyl sulfate (indican), a metabolite of dietary tryptophan, into indigo (which is blue) and indirubin (which is red) by bacteria such as Providencia stuartii, Klebsiella pneumoniae, P. aeruginosa, Escherichia coli, and enterococcus species.
Which of the following items are not considered pathogenic when found in a urine specimen?
a. hair, pollen, powder
b. semen, sperm, vaginal creams
c. Yeast
d. Both A and B
d. Both A and B
What color of urine might indicate the patient was taking medication for a urinary tract infection?
orange color associated with medication
What is the base line setting for QC of the refractometer, and what substance is used to check?
1.000 using distilled water
What would cause a urine to turn dark when left standing for a while?
Homogentistic acid found in alkaptonuria

Urine that turns dark upon standing could be from melanin, or homogentistic acid formed in the disease alkaptonuria.
possible cause of postrenal proteinuria is:

A. multiple myeloma
B. prostatitis
C. posture
D. glomerulonephritis
B. prostatitis
A urine specimen with a pH of 9.0 indicates that the patient should be:
A. asked to collect a new specimen
B. placed on medication to lower the pH
C. tested further for metabolic or respiratory alkalosis
D. changed to a high meat diet to lower the pH
A. asked to collect a new specimen
All of the following descriptions apply to orthostatic proteinuria except:

A. urinary proteins are excreted only when the patient is lying down
B. usually occurs without apparent disease
C. is considered to be a functional, transitory proteinuria
D. most commonly appears in young adults
A. urinary proteins are excreted only when the patient is lying down
Failure to blot the edge of the reagent strip may result in errors in color interpretation caused by:
A. runover
B. reagent leaching
C. excess dilution
D. chemical concentration
A. runover
Following a prehospital rotation physical, a medical technology student is requested to collect a first morning urine specimen. The physician is checking for:

A. orthostatic proteinuria
B. nocturnal proteinuria
C. glomerulonephritis
D. Bence Jones proteinuria
A. orthostatic proteinuria
Proper care of reagent strips includes all of the following except:
A. storing in a clear container
B. storing with a desiccant
C. checking the expiration date
D. preventing exposure to toxic fumes
A. storing in a clear container
Quality control on reagent strips must be performed whenever a/an:
A. abnormal result is obtained
B. new bottle of strips is opened
C. student is training in the laboratory
D. different person performs the test
B. new bottle of strips is opened
Reagent strip chemical tests may be inaccurate if the specimen is:
A. tested immediately after it is voided
B. mixed before delivery
C. collected by catheter
D. tested immediately after refrigeration
D. tested immediately after refrigeration
The normal range of urine pH is:
4.5-8.0
The principle of the reagent strip test for pH is:
A. the protein error of indicators
B. a double indicator reaction
C. a Greiss reaction
D. the diazo reaction
B. a double indicator reaction
The principle of the reagent strip test for protein is the:
A. salting out of proteins
B. protein error of indicators
C. pH affect on bromthymol blue
D. acid precipitation of protein
B. protein error of indicators
The protein section of the reagent strip is most sensitive to:
A. globulin
B. albumin
C. mucoprotein
D. Bence Jones protein
B. albumin
The reagent strip reaction that should be read last is the:
A. bilirubin
B. nitrite
C. protein
D. leukocyte esterase
D. leukocyte esterase
The SSA test should be performed on:
A. specimens with Bence Jones protein
B. urine that has been centrifuged
C. all negative reagent strip proteins
D. urine that has not been refrigerated
B. urine that has been centrifuged
The type of proteinuria least likely to be detected by reagent strip is:
A. postrenal
B. orthostatic
C. prerenal
D. renal
C. prerenal
To detect the presence of early renal disease, diabetic patients are tested for:
A. Bence Jones protein
B. microalbuminuria
C. glucose and ketones
D. orthostatic protein
b. microalbuminuria
When performing an SSA test, false-positive results may be obtained in the presence of:
A. ketones
B. radiographic contrast media
C. glucose
D. alkali
B. radiographic contrast media
When performing reagent strip quality control, the:
A. negative readings should match within one color block of the reference value
B. negative values except glucose and nitrite should be negative
C. positive readings except protein and bilirubin should match the reference value
D. positive readings should match the reference value by plus or minus one color block
D. positive readings should match the reference value by plus or minus one color block
When using the reagent strip protein method, false-positive results may occur in the presence of:
A. Bence Jones protein
B. radiographic contrast media
C. highly alkaline urine
D. large amounts of glucose
C. highly alkaline urine
Which of the following best describes the chemical principle of the protein reagent strip?
A. Protein reacts with an immune complex on the pad, which results in a color change.
B. Protein accepts hydrogen ions from an indicator dye, which results in a color change.
C. Protein causes protons to be released from a polyelectrolyte, resulting in a color change.
D. Protein causes a pH change on the reagent strip pad that results in a color change.
B. Protein accepts hydrogen ions from an indicator dye, which results in a color change.
Which of the following is a cause of prerenal proteinuria?
A. Diabetes mellitus
B. Prostatitis
C. Multiple myeloma
D. Pre-eclampsia
C. Multiple myeloma
When bilirubin is found in the urine, it can be assumed that:
a. it is attached to protein
b. it has passed through the small intestine
c. the patient is diabetic
d. it has been conjugated in the liver
d. it has been conjugated in the liver
The primary purpose of the Acetest tablets is to:
a. detect beta-hydroxybutyric acid
b. confirm positive reagent strip ketones
c. test serum for increased ketones
d. confirm a positive Clinitest result
c. test serum for increased ketones
The principle of the reagent strip test for bilirubin is that bilirubin:
a. causes a color change when it binds to a buffered pH indicator
b. binds to a diazonium salt to form a colored complex
c. is oxidized to biliverdin
d. causes a pH change detected by the reagent pad indicator
b. binds to a diazonium salt to form a colored complex
When performing an SSA test, false-positive results may be obtained in the presence of:
A. ketones
B. alkali
C. glucose
D. radiographic contrast media
D. radiographic contrast media
T/F Glucosuria is the same as glycosuria.
True
The protein section of the reagent strip is most sensitive to:
A. albumin
B. mucoprotein
C. Bence Jones protein
D. globulin
A. albumin
The principle of the reagent strip test for protein is the:
a. acid precipitation of protein
b. salting out of proteins
c. pH affect on bromthymol blue
d. protein error of indicators
d. protein error of indicators
The normal range of urine pH is:
4.5-8.0
Reagents must be labeled with all of the following except:
a. preparation or opening date
b. expiration date
c. instructions for use
d. safety information
c. instructions for use
T/F Bilirubin is a product formed in the liver from the breakdown of hemoglobin
True
Reagent strip chemical tests may be inaccurate if the specimen is:
A. mixed before delivery
B. tested immediately after refrigeration
C. tested immediately after it is voided
D. collected by catheter
B. tested immediately after refrigeration
The principle of the reagent strip test for pH is:
a. a double indicator reaction
b. the protein error of indicators
c. the diazo reaction
d. a Greiss reaction
a. a double indicator reaction
Reagent strip chemical tests may be inaccurate if the specimen is:
a. mixed before delivery
b. tested immediately after refrigeration
c. tested immediately after it is voided
d. collected by catheter
b. tested immediately after refrigeration
Reagent strip reactions for ketones react primarily with:
a. acetone
b. acetoacetic acid
c. beta-hydroxybutyric acid
d. all of the above
b. acetoacetic acid
Dipstick reactions for blood are based on the:
a. peroxidase activity of hemoglobin
b. oxidation of hemoglobin peroxidase
c. reaction of hemoglobin with bromthymol blue
a. peroxidase activity of hemoglobin
T/F Microalbumin is a smaller molecule of albumin.
False
What action would you take with the following results:
Color: YellowProtein: TraceBlood: Moderate
Clarity: HazyGlucose: NegativeUrobilinogen: 1.0 EU
Specific Gravity: 1.013Ketones: NegativeNitrite: Negative
pH: 8.0Bilirubin: NegativeLeukocyte esterase: Negative
Microscopic
4-8 WBC/hpf 20-25 RBC/hpf

a. Call the floor because the urobilinogen is over the panic value
b. Notify the floor that the specimen is too old
c. Recheck the sediment
d. Report the result
d. Report the result
The reagent strip test for nitrite is based on the:
a. use of nitrite by bacteria present in the urine
b. reaction of nitrite with the cell wall of gram-negative bacteria
c. reduction of nitrate in urine to nitrite by bacteria
d. reaction of bacterial nitrite with an aromatic amine to produce a pH change
c. reduction of nitrate in urine to nitrite by bacteria
Failure to blot the edge of the reagent strip may result in errors in color interpretation caused by:
A. excess dilution
B. runover
C. reagent leaching
D. chemical concentration
B. runover
Reagent strip reactions for WBCs are based on the detection of:
a. bacterial peroxidase activity
b. esterase activity
c. reduction of indoxyl blue
d. binding of a diazonium salt
b. esterase activity
Phenylketonuria) is caused by:
a. excessive ingestion of milk products containing phenylalanine
b. inability to metabolize tyrosine
c. lack of the enzyme phenylalanine hydroxylase
d. a mousy odor in the urine
c. lack of the enzyme phenylalanine hydroxylase
Lesch-Nyhan disease is an inherited disorder which
a. is a disorder of purine metabolism
b. results in the massive excretion or uric acid crystals
c. patients suffer from mental retardation, severe motor defects, and gout
d. all of the above
c. patients suffer from mental retardation, severe motor defects, and gout
Confirmation of maple syrup urine disease is made on the basis of:
a. urine color
b. a positive 2,4-dinitrophenylhydrazine test
c. a positive ferric chloride test
d. amino acid chromatography
d. amino acid chromatography
The finding of a "blue diaper" is indicative of a defect in the metabolism of:
a. phenylalanine
b. tyrosine
c. tryptophan
d. cystine
c. tryptophan
The presence of maple syrup urine disease is first suspected by the presence of abnormal urine:
a. color
b. protein
c. odor
d. amino acids
c. odor
The presence of tyrosine and leucine crystals in the urine is associated with:
a. alkaptonuria
b. mental retardation
c. PKU
d. severe liver disease
d. severe liver disease
Urine with an odor of "sweaty feet" and a positive ketone test is indicates:
a. cystinuria
b. alkaptonuria
c. organic acidemia
d. tyrosyluria
c. organic acidemia
The Guthrie test is a:
a. fluorometric procedure
b. bacterial agglutination test
c. bacterial inhibition test
d. chemical procedure measured by spectrophotometer
c. bacterial inhibition test
Which of the following disorders results in the accumulation of large amounts of homogentisic acid in the urine?
a. Homocystinuria
b. Tyrosyluria
c. Alkaptonuria
d. PKU
c. Alkaptonuria
All of the following disorders are caused by defects in the phenylalanine-tyrosine pathway except:
a. alkaptonuria
b. PKU
c. Hartnup's disease
d. tyrosyluria
c. Hartnup's disease
Initial screening for PKU performed on newborns before their discharge from the hospital uses a blood sample rather than a urine sample because:
a. increased serum phenylalanine can be detected earlier
b. serum bilirubin levels are routinely measured on all newborns
c. it is easier to measure phenylalanine than phenylpyruvic acid
d. urine samples are more difficult to collect
a. increased serum phenylalanine can be detected earlier
A routine urinalysis is performed on a specimen that has turned dark after standing in the laboratory. The urine is acidic and has negative chemical tests except for the appearance of a red color on the ketone area of the reagent strip. One should suspect:
a. melanuria
b. alkaptonuria
c. diabetic ketosis
d. PKU
a. melanuria
In a positive Guthrie test:
a. bacterial growth occurs around the positive control disc but not around the patient disc
b. no bacterial growth occurs around either disc
c. bacterial growth occurs around the positive control disc and the patient disc
d. bacterial growth occurs only around the negative control disc
c. bacterial growth occurs around the positive control disc and the patient disc
A positive Clinitest reaction is seen in patients with:
a. cystinuria
b. melanuria
c. alkaptonuria
d. tyrosyluria
c. alkaptonuria
Urine with an odor of "sweaty feet" and a positive ketone test indicates:
a. organic acidemia
b. cystinuria
c. tyrosyluria
d. alkaptonuria
a. organic acidemia
The presence of maple syrup urine disease is first suspected by the presence of abnormal urine:
a. color
b. protein
c. amino acids
d. odor
d. odor
The presence of argentaffin cell tumors can be detected by the presence in the urine of:
a. melanin
b. homogentisic acid
c. 5-HIAA
d. serotonin
c. 5-HIAA
Porphyrins are intermediary compounds in the formation of:
a. bilirubin
b. heme
c. amino acids
d. serotonin
b. heme
The concept of vampires is associated with:
a. cystinosis
b. Sanfilippo syndrome
c. porphyrias
d. Hunter syndrome
c. porphyrias
The presence of "orange sand" in an infant's diaper is indicative of:
a. maple syrup urine disease
b. bilirubinuria
c. cystinuria
d. Lesch-Nyhan disease
d. Lesch-Nyhan disease
State what action the urinalysis supervisor could take in the following situations:

Many uric acid crystals are reported in the urine of a 15-year-old boy with an unremarkable medical history, except for previous episodes of renal calculi.
a. notify the health-care provider
b. report possible Lesch-Nyhan disease
c. check for specimen mix-up
d. check for possible cystine crystals
d. check for possible cystine crystals
Choose the characteristic odor for the following disorders:
Phenylketonuria
a. sweet
b. mousy
c. sweaty feet
d. sulfur
b. mousy
Choose the characteristic odor for the following disorders:

Isovaleric academia
a. sweaty feet
b. sulfur
c. aromatic
d. mousy
a. sweaty feet
A 13 year-old boy is awakened with severe back and abdominal pain and is taken to the emergency room by his parents. A complete blood count is normal. Family history shows that both his father and uncle are chronic kidney stone formers. Results of the urinalysis are as follows:
COLOR-Yellow APPEARANCE: hazy
KETONES: negative BLOOD: moderate
Sp Gravity: 1.025 BILIRUBIN: negative
pH: 6.0 UROBILINOGEN: Normal
PROTEIN: negative NITRITE: negative
GLUCOSE: negative LEUKOCYTE: negative
MICROSCOPIC:
>15-20 rbc/hpf 0-3 WBCs/hpf Few squamous epithelial cells
Many cystine crystals.

What is the significance of the family history

a. The family members could have been exposed to the same substances
b. The family has the same diet
c. Formation of kidney stones is the family could indicate an inherited condition
c. Formation of kidney stones in the family could indicate an inherited condition
T/F Persons diagnosed with PKU should avoid foods containing aspartame.
True
The most common cause of end-stage renal disease is:
a. acute glomerulonephritis
b. diabetic nephropathy
c. minimal change disease
d. Alport syndrome
b. diabetic nephropathy
Which of the following renal disorders may be inherited?
a. Nephrotic syndrome
b. Acute interstitial nephritis
c. Acute tubular necrosis
d. Fanconi's syndrome
d. Fanconi's syndrome
The finding of bacterial casts is associated with:
a. acute pyelonephritis
b. acute interstitial nephritis
c. chronic pyelonephritis
d. both A and C
d. both A and C
Which of the following disorders results in the accumulation of large amounts of homogentisic acid in the urine?
a. Alkaptonuria
b. Tyrosyluria
c. PKU
d. Homocystinuria
a. Alkaptonuria
Damage to the glomerulus can occur as a result of all of the following except:
a. increased filtration of electrolytes
b. deposition of immune complexes
c. deposition of amyloid materials
d. cellular infiltration
a. increased filtration of electrolytes
Cystitis can be differentiated from pyelonephritis by:
a. performing a cystoscopy
b. the presence of white blood cell casts
c. performing blood cultures
d. the presence of bacteriuria
b. the presence of WBC casts
Urine with an odor of "sweaty feet" and a positive ketone test is indicates:
a. cystinuria
b. alkaptonuria
c. organic acidemia
d. tyrosyluria
c. organic acidemia
The presence of tyrosine and leucine crystals in the urine is associated with:
a. alkaptonuria
b. mental retardation
c. PKU
d. severe liver disease
d. severe liver disease
Glucosuria and generalized amino aciduria are characteristics of:
a. Fanconi's syndrome
b. nephrotic syndrome
c. focal segmental glomerulosclerosis
d. diabetes mellitus
a. Fanconi's syndrome
Lesch-Nyhan disease is an inherited disorder which
a. is a disorder of purine metabolism
b. results in the massive excretion or uric acid crystals
c. patients suffer from mental retardation, severe motor defects, and gout
d. all of the above
c. patients suffer from mental retardation, severe motor defects, and gout
Phenylketonuria) is caused by:
a. excessive ingestion of milk products containing phenylalanine
b. inability to metabolize tyrosine
c. lack of the enzyme phenylalanine hydroxylase
d. a mousy odor in the urine
c. lack of the enzyme phenylalanine hydroxylase
Damage to the glomerulus can occur as a result of all of the following except:
a. increased filtration of electrolytes
b. deposition of immune complexes
c. deposition of amyloid materials
d. cellular infiltration
a. increased filtration of eletrolytes
In which of the following disorders would waxy and broad casts be most likely to be seen?`
a. Chronic pyelonephritis
b. Acute renal failure
c. Chronic renal failure
d. Acute interstitial nephritis
b. Chronic renal failure
Confirmation of maple syrup urine disease is made on the basis of:
a. urine color
b. a positive 2,4-dinitrophenylhydrazine test
c. a positive ferric chloride test
d. amino acid chromatography
d. amino acid chromatography
A routine urinalysis is performed on a specimen that has turned dark after standing in the laboratory. The urine is acidic and has negative chemical tests except for the appearance of a red color on the ketone area of the reagent strip. One should suspect:
a. PKU
b. diabetic ketosis
c. alkaptonuria
d. melanuria
d. melanuria
A 13 year-old boy is awakened with severe back and abdominal pain and is taken to the emergency room by his parents. A complete blood count is normal. Family history shows that both his father and uncle are chronic kidney stone formers. Results of the urinalysis are as follows:
COLOR-Yellow APPEARANCE: hazy
KETONES: negative BLOOD: moderate
Sp Gravity: 1.025 BILIRUBIN: negative
pH: 6.0 UROBILINOGEN: Normal
PROTEIN: negative NITRITE: negative
GLUCOSE: negative LEUKOCYTE: negative
MICROSCOPIC:
>15-20 rbc/hpf 0-3 WBCs/hpf Few squamous epithelial cells
Many cystine crystals.
What is the significance of the family history
What conditions does the patient's symptoms represent.
c. Formation of kidney stones is the family could indicate an inherited condition

c. Cystinuria