UA Problem Solving Questions

#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 results assuming acceptable QC 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

#2 Given the following urinalysis results, select the most appropriate course of action pH = 8.0, Protein =Trace, Ketone = Small, Blood = Neg, Glucose = Neg, Nitrite = Neg Microscopic findings: RBCs = 0-2/HPF WBCs = 20-50/HPF Bacteria= Large Crystals= Small,CaC0 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 WBCs: 5-10/HPF, RBCs: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 microscoic examination.

#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

#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: Clear Microscopic:CrystalsBilirubin 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

#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

#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

#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 D. Rule out a transfusion reaction caused by RBC incompatibility

#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

#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

#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

#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

#13 SITUATION: When examining a urinary sediment under 400x 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

#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

#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

#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

#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