chapters 1, 2 , and 3 urinalysis
Upon running QC, the technologist notes abnormal results on all QC levels. Which component(s) of QA will the technologist assess to determine the cause?1. Preanalytical2. Analytical3. Postanalytical Select one: a. 1 and 2 b. 1 and 3 c. 2 and 3 d. 1, 2, and 3
a. 1 and 2
Which of the following contribute(s) to the reabsorption of water by the renal tubules?1. Osmolality gradient2. High solute concentration3. Hypertonicity of the renal medulla Select one: a. 1 and 2 b. 2 and 3 c. 1 and 3 d. 1, 2, and 3
a. 1 and 2
Which of the following urine sample volumes and tests is correctly matched? Select one: a. 1 mL; quantitative hormone analysis b. 4 mL; routine urinalysis c. 10 to 15 mL; automated urinalysis system d. 25 mL aliquot from 24-hour urine; creatinine
a. 1 mL; quantitative hormone analysis
Hypertonicity or hypotonicity of urine is controlled by: Select one: a. ADH. b. renin. c. osmotic pressure. d. countercurrent multiplier mechanism.
a. ADH
The countercurrent multiplier mechanism multiplies the osmotic gradient as a result of which of the following? Select one: a. Active reabsorption of sodium and chloride and passive reabsorption of water b. Passive secretion of sodium and potassium and passive reabsorption of water c. Active secretion of sodium and water and passive reabsorption of chloride d. Passive reabsorption of potassium and chloride and active reabsorption of sodium
a. Active reabsorption of sodium and chloride and passive reabsorption of water
Acidic urine specimens provide a stable environment for which of the following urine constituents? Select one: a. Cellular elements b. Chemical substances c. Glucose d. Nitrites
a. Cellular elements
Urine formation occurs as the plasma ultrafiltrate passes through the renal structures in the following order: Select one: a. Nephron, calyces, renal pelvis, ureters, bladder b. Nephron, Bowman's capsule, renal pelvis, calyces, ureters, bladder c. Glomerulus, nephron, loop of Henle, renal pelvis, calyces, bladder d. Bowman's capsule, renal calyces, renal pelvis, ureters, bladder
a. Nephron, calyces, renal pelvis, ureters, bladder
The Occupational Health and Safety Act of 1970 established formal regulation of safety and health for all employees, regardless of employer; these regulations are administered by: Select one: a. OSHA. b. CLIA. c. NIDA. d. TJC.
a. OSHA.
The net filtration pressure of 10 mm Hg is the result of which three pressures working in concert for the formation of a plasma ultrafiltrate in Bowman's space? Select one: a. Oncotic, hydrostatic, afferent arteriole b. Renal artery, hydrostatic, osmotic c. Hyperosmotic, oncotic, hydrostatic d. Renal artery, afferent arteriole, glomerular
a. Oncotic, hydrostatic, afferent arteriole
In addition to a Chemical Hygiene Plan, the laboratory must provide employees access to _____ under the employee "right to know." Select one: a. SDSs b. NFPA c. OSHA d. BSI
a. SDSs
Plasma proteins (e.g., albumin) are not normally found in the urine filtrate because of which of the following? Select one: a. Shield of negativity b. Size c. Neutral charge d. Viscosity
a. Shield of negativity
Collection of urine for anaerobic culture requires which of the following urine collection methods? Select one: a. Suprapubic b. Catheterized urethra c. First morning urine d. Midstream clean catch
a. Suprapubic
A client comes to the outpatient department for a urine drug screen. You follow the protocol for collection but question whether the specimen is truly urine. You then follow the procedure for urine verification and obtain the following results. Which result causes you to reject the specimen? Select one: a. Temperature of 30 °C b. pH of 4.0 c. Specific gravity of 1.002 d. None of the above
a. Temperature of 30 °C
Cost-effective practices in the laboratory include which of the following? Select one: a. Test utilization b. Turnaround time c. Competency testing d. External QA
a. Test utilization
To achieve uniformity of technique by all those working in the urinalysis department, a laboratory requires all of the following except: Select one: a. adherence to procedure manual protocols. b. performance of quality control checks. c. proper training of new employees. d. comparison of results reported out each shift.
a. adherence to procedure manual protocols.
You arrive in the UA department at 7 AM and find five routine urine samples in the refrigerator awaiting analysis. You pull the specimens out, check the dates and times, and let them warm to room temperature before analysis. You groan because you know that if a microscopic is required, the view may be obscured by: Select one: a. amorphous crystals. b. bacteria. c. epithelial cells. d. degenerated cells.
a. amorphous crystals.
All of the following statements regarding ADH are correct except: Select one: a. as blood pressure increases, release of ADH increases. b. ADH increases as blood pressure decreases. c. hypertonic urine is produced with low levels of ADH. d. ADH secretion does not alter sodium or chloride reabsorption.
a. as blood pressure increases, release of ADH increases.
Aerosol risks in the laboratory setting include all of the following except: Select one: a. centrifuging capped tubes. b. pouring body fluid into a container. c. removing tight-fitting caps from a tube. d. spilling a specimen during testing.
a. centrifuging capped tubes.
After an extremely busy night collecting and performing STAT tests, you find a routine urine specimen in the drop basket. You check the collection time and note that the specimen is over 2 hours old. You call the floor and request a new specimen because: Select one: a. chemical constituents may be altered, producing invalid results. b. bacteria may have disintegrated because of an increased ammonia level. c. precipitation of crystals as the urine cooled may interfere with analysis. d. pH levels may be falsely lowered because of bacterial conversion of urea to ammonia.
a. chemical constituents may be altered, producing invalid results.
Intralaboratory assessment is useful in monitoring analytical components of QA by: Select one: a. determining the accuracy and precision of technologists' performance. b. verifying turnaround times for procedures. c. measuring the productivity of laboratory shifts. d. comparing the laboratory's performance with other laboratories.
a. determining the accuracy and precision of technologists' performance.
A random clean catch urine specimen for cytology studies requires: Select one: a. drinking 24 to 32 ounces of water each hour 2 hours before urine collection. b. fasting for 12 hours before urine collection. c. urine collection on 3 different days 1 week apart. d. refraining from any exercise activity 5 days before each collection.
a. drinking 24 to 32 ounces of water each hour 2 hours before urine collection.
Renin is released in response to all of the following except: Select one: a. increased sodium. b. increased potassium. c. vascular hemorrhage. d. decreased arterial pressure.
a. increased sodium
Which of the following does not result in changes in the physical examination of urine? Select one: a. Ketones b. Increased bacterial growth c. Solute precipitation d. Alteration of urine solutes
a. ketones
Preventive maintenance schedules on the centrifuge used to spin down urine samples is a _________ component of quality assessment. Select one: a. preanalytical b. analytical c. postanalytical d. test utilization
a. preanalytical
Glucose is actively transported back into the peritubular capillary blood in the: Select one: a. proximal tubule. b. loop of Henle. c. distal tubule. d. medullary collecting tubule.
a. proximal tubule.
Timed urine specimens are used for: Select one: a. quantitative chemical analysis. b. fluid depravation studies. c. routine screening. d. confirmation of orthostatic proteinuria.
a. quantitative chemical analysis.
All of the following are noted as the filtrate moves through the proximal tubule except: Select one: a. secretion of urea b. two-thirds of volume reduction c. reabsorption of salts, glucose, and proteins d. unchanged osmolality
a. secretion of urea
The means of preservation used to preserve urine sediment elements is: Select one: a. thymol. b. refrigeration. c. hydrochloric acid. d. formalin.
a. thymol
Principle solutes in the end product of the urine filtrate include all of the following except: Select one: a. water. b. sodium. c. chloride. d. urea.
a. water
Normal urine output averages how many milliliters per 24 hours? Select one: a. 500 b. 1200 c. 2500 d. 3000
b. 1200
Transmission-Based Precautions apply to:1. all patients admitted to the hospital.2. patients colonized with infectious agents.3. patients who are immunocompromised.4. patients with second- and third-degree burns.5. patients where use of Standard Precautions alone are insufficient. Select one: a. 1, 3, and 5 b. 2 and 5 c. 2, 3, and 4 d. 2, 3, 4, and 5
b. 2 and 5
The technologist transferred a stock chemical into a secondary container and labeled it with the required: Select one: a. NFPA hazard identification symbols. b. 2012 OSHA standard's 5 labeling elements. c. HCS hazard category number. d. chemical name, date opened, and expiration date.
b. 2012 OSHA standard's 5 labeling elements.
Guidelines for developing written safety policies and procedures required by OSHA are available from: Select one: a. OSHA. b. CLSI. c. NIDA. d. TJC.
b. CLSI.
Which of the following provide(s) the proximal tubular cells with maximal surface area for reabsorption activities? Select one: a. Interdigitating cells b. Microvilli c. Macula densa d. Trilayer membrane
b. Microvilli
Upon opening a urine specimen container, you are almost knocked over by the smell of ammonia. You check the time of collection and note that it is not within the 2-hour time frame. You expect which of the following results? Select one: a. Decreased pH b. Positive nitrites c. Positive RBCs d. Positive glucose
b. Positive nitrites
The day shift medical laboratory scientist pulls the UA reagent box out of the drawer and begins performing QC using the following reagents from the box: dipsticks, Clinitest, phenylalanine, Ictotest, and water in the dropper bottle. The technologist is in violation of which QA component? Select one: a. Preanalytical b. Analytical c. Postanalytical d. Documentation
b. analytical
The renal artery branches off into the afferent arteriole, which: Select one: a. surrounds the proximal convoluted tubule. b. becomes the capillary tuft within the glomerulus. c. rejoins the anastomosing capillary network in the glomerulus. d. reabsorbs substances from the ultrafiltrate.
b. becomes the capillary tuft within the glomerulus.
The function of the basement membrane in the glomerulus is to: Select one: a. provide structural integrity to the glomerulus. b. limit passage of filtrate substances by size. c. anchor the glomerulus to Bowman's capsule. d. form a sheath around the glomerulus.
b. limit passage of filtrate substances by size.
The proximal and distal convoluted tubules are connected by the: Select one: a. lumen of the capillary tuft. b. loop of Henle. c. glomerulus. d. Bowman's space.
b. loop of Henle.
A positive glucose test result on a urinalysis indicates: Select one: a. tubular flow rate exceeded. b. maximal tubular reabsorptive capacity exceeded. c. tubular secretory capacity exceeded. d. reduced time solute in contact with renal epithelium.
b. maximal tubular reabsorptive capacity exceeded.
If used correctly, personal protective equipment (PPE) protects the health care worker from bloodborne pathogens from all of the following types of exposures except: Select one: a. aerosols. b. needle sticks. c. direct contact with a cut. d. ingestion.
b. needle sticks
While performing quality control (QC) checks on an open reagent bottle, the technologist notes that no open date/time is written on the bottle. The technologist should address this as a(n): Select one: a. analytical error; the technologist should continue with testing if the QC results are within range. b. preanalytical error; the technologist should discard the bottle, obtain a new one, and start over. c. postanalytical error; the QC and patient results are all within normal range, so the technologist should just make a notation in the log. d. procedural error; the technologist should check the time of the last run on the previous shift, mark the day/time on the bottle, and continue testing.
b. preanalytical error; the technologist should discard the bottle, obtain a new one, and start over.
As the only technologist on the third shift, you receive a routine urine specimen that was collected at 0300 hours. It is now 0400 hours. You have been called to the emergency department for STAT blood draws on two trauma patients. You decide to: Select one: a. call the floor and have the staff collect another specimen around 7 AM for the day shift. b. put the specimen in the refrigerator for later testing. c. leave the specimen in the drop basket so you do not forget to do it later. d. perform the UA before going to the ED, because the specimen's viability expires in 1 hour.
b. put the specimen in the refrigerator for later testing.
Peritubular capillaries function in the process of reabsorption and secretion of substances in conjunction with the: Select one: a. glomerulus. b. renal tubules. c. collecting duct. d. renal pyramids.
b. renal tubules.
The technologist receives an unlabeled urine specimen in the laboratory; the technologist should promptly: Select one: a. call the floor nurse and ask him or her to come label the specimen. b. request that the specimen be recollected. c. generate a label and apply it before testing. d. complete the required testing and wait for the nurse to call.
b. request that the specimen be recollected.
A hospital courier picks up various laboratory specimens from local physicians' offices including urine specimens and transports them to the laboratory at the end of the day. Since urine specimens collected throughout the day for routine analysis will be delayed in testing, refrigeration of the specimen is required. The recommended collection container for patient urine is: Select one: a. disposable glass container with leakproof seal. b. sterile plastic container with screw-top lid. c. translucent plastic container with leakproof lid. d. 12 mL aliquot in plastic top with screw-top lid.
b. sterile plastic container with screw-top lid.
The patient comes in with an order for a creatinine clearance test. The technologist will instruct the patient to collect which specimen type? Select one: a. Random b. Timed c. First morning d. Clean catch midstream
b. timed
Hydrogen ions are secreted in which of the following locations?1. Proximal tubule2. Loop of Henle3. Distal tubule4. Collecting tubule Select one: a. 2 b. 1 and 3 c. 1, 3, and 4 d. 2, 3, and 4
c. 1, 3, and 4
While running a second load of urine samples on the automated urinalysis instrument, a seasoned technologist notes that all the patient samples are showing positive nitrates but no indication of bacteria upon microscopic examination. This is an example of which of the following?1. Postanalytical error; further examination of the urine sediments is required2. Analytical error; troubleshooting of the instrument is required3. Analytical error; a new bottle of dipsticks is required4. Competency error; the technologist must rerun the patient samples Select one: a. 1 b. 1 and 4 c. 2 and 3 d. 1, 2, and 3
c. 2 and 3
The percentage of cardiac output that flows through the kidneys per minute is: Select one: a. 5%. b. 15%. c. 25%. d. 30%.
c. 25%
The term critical value refers to a(n):1. abnormal quality control result.2. test result that indicates illness.3. life-threatening test result.4. incorrect competency test result.5. result exceeding lower or upper critical limit. Select one: a. 1 and 2 b. 1 and 4 c. 3 and 5 d. 1, 4, and 5
c. 3 and 5
Water reabsorption in the collecting tubules is controlled by: Select one: a. renin. b. aldosterone. c. ADH. d. angiotensin.
c. ADH
Which statement is not true about cellular morphology in urine specimens? Select one: a. It is enhanced by the high osmolality of the first morning specimen. b. It can be evaluated in a random urine collection. c. It degenerates as pH decreases. d. All of the above.
c. It degenerates as pH decreases.
Which of the following ultrafiltrate substances is passively reabsorbed into the peritubular capillary blood? Select one: a. Na+ b. Amino acids c. K+ d. Uric acid
c. K+
The presence of which of the following constituents in the urine filtrate is evidence of the loss of shield of negativity or alteration of the filtration barrier? Select one: a. Urea and creatinine b. Sodium and albumin c. Protein and RBCs d. Casts and WBCs
c. Protein and RBCs
Which of the following specimen types is not suitable for bacterial and fungal cultures? Select one: a. Midstream clean catch b. Catheterized, urethra c. Routine void d. Suprapubic aspiration
c. Routine void
Large numbers of mitochondria and enzymatic activity in the proximal convoluted tubule and the loop of Henle are necessary for: Select one: a. reabsorption. b. cellular integrity. c. active transport. d. filtrate flow.
c. active transport.
In the countercurrent multiplier mechanism, the flow of the ultrafiltrate is in opposite directions between the: Select one: a. peritubular capillaries and the proximal tubule. b. medullary interstitium and the papilla. c. ascending and descending loops of Henle. d. glomerulus and Bowman's capsule.
c. ascending and descending loops of Henle.
The patient is a 3-month-old infant with a possible bladder infection. The best method of urine collection for routine urinalysis testing and culture is: Select one: a. clean catch using a pediatric bag. b. sterile pediatric bag. c. catheterization, urethral. d. random.
c. catheterization, urethral.
Proper collection of a midstream clean catch urine specimen requires the patient to: Select one: a. cleanse the area, void the first portion into the toilet, and collect the remainder in a container. b. void the first portion into the toilet, cleanse the area, collect the middle portion in a container, and void the remainder into the toilet. c. cleanse the area, void into the toilet, stop, collect the middle portion into a container, and void the remainder into toilet. d. cleanse the area, void into the toilet, stop, and collect the remainder into a container.
c. cleanse the area, void into the toilet, stop, collect the middle portion into a container, and void the remainder into toilet.
The exclusive site of plasma filtration is the: Select one: a. medulla. b. major calyces. c. cortex. d. renal pelvis.
c. cortex
The single most useful means of identifying a fluid as urine is to test: Select one: a. pH. b. specific gravity. c. creatinine. d. sodium and chloride.
c. creatinine.
Standard Precautions are infection control practices designed to prevent all of the following except: Select one: a. patient-to-patient disease transmission. b. health care worker-to-patient disease transmission. c. disease transmission only for patients put in contact precautions. d. bloodborne pathogen disease transmission.
c. disease transmission only for patients put in contact precautions.
A decrease in the quality of laboratory testing can be pinpointed by: Select one: a. quality control. b. proficiency testing. c. documentation. d. technical competence.
c. documentation.
The patient brings in a 24-hour urine collection at 8 AM and states that upon collection of the first morning specimen today, he wasn't quite awake, forgot, and voided a small portion into the toilet but quickly stopped and then properly collected the remainder into the container. You should: Select one: a. ask the patient to estimate the amount voided into the toilet and note it on the container. b. process the specimen as usual, because the small amount lost will not significantly alter the test results. c. give the patient another container and instruct him to recollect a new 24-hour specimen. d. ask the patient to provide another specimen to be added to the container to make up for the lost volume
c. give the patient another container and instruct him to recollect a new 24-hour specimen.
False-negative or decreased chemical analysis test results due to changes in unpreserved urine include which of the following? Select one: a. RBCs b. Nitrites c. Glucose d. Casts
c. glucose
As blood flows through the glomerulus, the plasma ultrafiltrate collects in Bowman's space as a result of: Select one: a. osmotic pressure. b. hyperosmotic pressure. c. hydrostatic pressure. d. renal artery pressure.
c. hydrostatic pressure.
All of the following chemical changes may occur in unpreserved urine specimens except: Select one: a. color change. b. decreased glucose. c. increased urobilinogen. d. increased nitrites.
c. increased urobilinogen.
The primary producer of renin is a small endocrine organ located in the: Select one: a. podocytes. b. basement membrane. c. juxtaglomerular apparatus. d. juxtamedullary nephrons.
c. juxtaglomerular apparatus.
External quality assessment (QA) is a means to measure the: Select one: a. accuracy of a method. b. precision of a procedure. c. performance relative to other laboratories. d. analytical error during a procedure.
c. performance relative to other laboratories.
A urine specimen is received in the laboratory with the patient's name, the date, and the time of collection on the lid of the container. You should: Select one: a. mark the specimen as received in the computer system. b. make a label and attach it to the container. c. reject the specimen as unlabeled. d. call the nurse to come down and properly label the specimen.
c. reject the specimen as unlabeled.
Secretion of aldosterone stimulates the kidneys to retain: Select one: a. potassium and sodium. b. water and potassium. c. sodium and water. d. sodium, potassium, and water.
c. sodium and water.
The ability to resolve discrepant test results in the laboratory is an example of: Select one: a. in-house quality assessment. b. documentation of errors. c. technical competence. d. QA monitoring.
c. technical competence
Which of the following is exempt from decontamination by autoclaving or incineration before disposal? Select one: a. Needles b. Blood c. Urine d. Other body fluids
c. urine
Chemical labels must include which of the following elements?1. Product identifier (name)2. Signal word (danger/warning)3. Hazard statement4. Precautionary statements/pictograms5. Supplier identification6. Global harmonization system ID code Select one: a. 1, 2, and 4 b. 1, 3, 5, and 6 c. 1, 2, 3, 4, and 6 d. 1, 2, 3, 4, and 5
d. 1, 2, 3, 4, and 5
The purpose(s) of a quality assessment program in the laboratory is (are) to provide which of the following?1. Administrative structure to ensure laboratory practice standards are met2. Quality test results3. Mechanism for detection of problems4. Opportunity to improve services Select one: a. 1, 3, and 4 b. 3 and 4 c. 1 and 4 d. 1, 2, 3, and 4
d. 1, 2, 3, and 4
The kidneys play a role in which of the following processes: 1. acid-base equilibrium.2. blood pressure.3. metabolic waste removal.4. water and electrolyte regulation. Select one: a. 1 and 3 b. 1, 3, and 4 c. 3 and 4 d. 1, 2, 3, and 4.
d. 1, 2, 3, and 4.
A routine urinalysis test can aid in the diagnosis of what type of disease process? Select one: a. Prerenal b. Renal c. Postrenal d. All of the above
d. All of the above
Which urine collection method can be used to determine whether kidney disease affects one or both kidneys? Select one: a. Suprapubic b. Midstream clean catch c. Timed, diurnal variation d. Catheterized ureters
d. Catheterized ureters
Which of the following exhibit tubular reabsorptive capacity? Select one: a. Proteins b. Uric acid c. Glucose d. Phosphates/sulfates
d. Phosphates/sulfates
Which of the following are metabolically active cells with phagocytic abilities that prevent occlusion of the filtration barrier by macromolecules? Select one: a. Mesangium cells b. Visceral epithelial cells c. Podocytes d. Podocytes and mesangium cells
d. Podocytes and mesangium cells
Which of the following is not considered potentially infectious and capable of disease transmission and is exempted from Universal Precautions protocols? Select one: a. Blood b. Body fluids c. Secretions d. Sweat
d. Sweat
Standard Precautions are a combination of major features of which two practice guidelines? Select one: a. BPS and UP b. UP and OSHA c. OSHA and BSP d. UP and BSI
d. UP and BSI
Timed urine collections can be categorized into all of the following types except: Select one: a. predetermined length of time. b. specific time of day. c. predetermined length plus specific time of day. d. All are correct.
d. all are correct
Water reabsorption occurs in all of the following areas of the nephron except: Select one: a. collecting duct. b. proximal tubule. c. distal tubule. d. ascending limbs of loops of Henle.
d. ascending limbs of loops of Henle.
It is important to keep the lids on urine specimens before testing so that volatilization does not occur for which urine constituent? Select one: a. Nitrate b. Urobilinogen c. Bilirubin d. Ketones
d. ketones
All of the following are principal roles of the secretory process except: Select one: a. removal of metabolic waste. b. elimination of substances bound to plasma proteins. c. adjustment of acid-base equilibrium. d. maintenance of fluid volume.
d. maintenance of fluid volume.
The functional unit of the kidney is the: Select one: a. renal calyces. b. Bowman's capsule. c. glomerulus. d. nephrons.
d. nephrons
Which factor will not affect urinalysis results? Select one: a. Time of collection b. Preservation method c. Collection method d. None of the above
d. none of the above
Which personnel are exempt from adherence to Standard Precautions?1. Health care volunteers2. Food service employees3. Health care staff4. Custodial staff Select one: a. 1 and 2 b. 2 and 4 c. 1, 2, and 4 d. None of the above
d. none of the above
The three secretory mechanisms that maintain blood pH and involve the secretion of H- include all of the following except: Select one: a. exchange of sodium and bicarbonate in acidic conditions. b. formation of titratable acids (i.e., monosodium phosphates). c. secretion of NH3- yielding ammonium salts. d. phosphate reabsorption.
d. phosphate reabsorption.
First morning specimens provide the ideal specimen for all of the following reasons except: Select one: a. concentrated specimen. b. incubated 8 hours. c. acidic. d. reduced number of epithelial cells.
d. reduced number of epithelial cells.
Timed urine collections are useful in measuring the excretion of urine substances affected by diurnal variation, which include all of the following except: Select one: a. albumin. b. hormones. c. glomerular filtration rate. d. renal cells.
d. renal cells
Disposal methods of chemicals and other organic solvents include all of the following except: Select one: a. dilution or neutralization prior to disposal in sewer system. b. flushing drain with copious amounts of water after pouring down drain. c. collecting each chemical in separate glass or other appropriate containers for disposal. d. single universal recovery container to collect all chemical waste each day for disposal.
d. single universal recovery container to collect all chemical waste each day for disposal.