1. Why is the first-voided morning urine specimen the most desirable specimen for routine urinalysis?

A. Most dilute specimen of the day and therefore any chemical compounds
present will not exceed the detectability limits of the reagent strips
B. Least likely to be contaminated with microorganisms because the bladder is a sterile environment
C. Most likely to contain protein because the patient has been in the orthostatic position during the night
*D. Most concentrated specimen of the day and therefore it is more likely that abnormalities will be detected

2. The physical characteristic of color is assessed when a routine urinalysis is performed. What substance is normally
found in urine that is principally responsible for its yellow coloration?
A. Bilirubin
B. Melanin
C. Carotene
*D. Urochrome

3. In certain malignant disorders, what substance is found in the urine that turns the urine dark brown or black on
exposure of the urine to air?
A. Urobilinogen
B. Indican
*C. Melanin
D. Porphyrin

4. What is the expected pH range of a freshly voided urine specimen?

A. 3.5-8.0
B. 3.5-9.0
C. 4.0-8.5
*D. 4.5-8.0

5. Urine specimens should be analyzed as soon as possible after collection. If urine specimens are allowed to stand at
room temperature for an excessive amount of time, the urine pH will become alkaline because of bacterial
decomposition of
A. Protein
*B. Urea
C. Creatinine
D. Ketones

6. Which term is defined as a urine volume in excess of 2000 mL excreted over a

24-hour period?
A. Anuria
B. Oliguria
*C. Polyuria
D. Hypersthenuria

7. The reagent test strips used for the detection of protein in urine are most reactive to
*A. Albumin
B. Hemoglobin
C. Alpha-globulins
D. Beta-globulins

8. A urine specimen that exhibits yellow foam on being shaken should be suspected of having an increased
concentration of
A. Protein
B. Hemoglobin
*C. Bilirubin
D. Nitrite

9. How should controls be run to ensure the precision and accuracy of the reagent test strips used for the chemical
analysis of urine?
A. Positive controls should be run on a daily basis and negative controls when opening a new bottle of test strips.
B. Positive and negative controls should be run when the test strips' expiration date is passed.
*C. Positive and negative controls should be run on a daily basis.
D. Positive controls should be run on a daily basis and negative controls on a weekly basis.

10. The colorimetric reagent strip test for protein is able to detect as little as 5-20 nig of protein per deciliter. What may
cause a false-positive urine protein reading?
A. Uric acid concentration is greater than 0.5 g/day.
B. Vitamin C concentration is greater than 0.5 g/day.
C. Glucose concentration is greater than 130mg/day.
*D. pH is greater than 8.0.
11. "Isosthenuria" is a term applied to a series of urine specimens from the same patient
that exhibit a
A. Specific gravity of exactly 1.000
B. Specific gravity less than 1.007
C. Specific gravity greater than 1.020
*D. Fixed specific gravity of approximately 1.010

12. A urine specimen is tested by a reagent strip test and the sulfosalicylic acid test to
determine whether protein is present. The former yields a negative protein, whereas the latter results in a reading of 2+
protein. Which of the following statements best explains this difference?
A. The urine contained an excessive amount of amorphous urates or phosphates that caused the turbidity seen
with the sulfosalicylic acid test.
B. The urine pH was greater than 8, exceeding the buffering capacity of the reagent strip, thus causing a false-
negative reaction.
*C. A protein other than albumin must be present in the urine.
D. The reading time of the reagent strip test was exceeded (the reading being taken at 2 minutes), causing a false-
negative reaction to be detected.

13. Which of the following is the major organic substance found in urine?
A. Sodium
B. Potassium
C. Glucose
*D. Urea

14. Each of the following is included in the quality assurance program for a urinalysis laboratory. Which one represents a
preanalytical component of testing?
*A. Setting collection guidelines for 24-hour urines
B. Setting a maintenance schedule for microscopes
C. Reporting units to be used for crystals
D. Requiring acceptable results for control specimens before any patient results are reported out

15. The presence of ketone bodies in urine specimens may be detected by use of a reagent strip impregnated with
sodium nitroprusside. This strip test is sensitive to the presence of
A. Acetoacetic acid and betahydroxybutyric acid
*B. Acetoacetic acid and acetone
C. Diacetic acid and beta-hydroxybutyric acid
D. Beta-hydroxybutyric acid and acetone

16. A routine urinalysis is performed on a young child suffering from diarrhea. The reagent test strip is negative for
glucose but positive for ketones. These results may be explained by which of the following statements?
A. The child has Type 1 diabetes mellitus.
B. The child is suffering from lactic acidosis, and the lactic acid has falsely
reacted with the impregnated reagent area for ketones.
*C. The child is suffering from increased catabolism of fat because of decreased intestinal absorption.
D. The reagent area for ketones was read after the maximum reading time allowed.

17. The principle of the colorimetric reagent strip test for hemoglobin is based on the peroxidase activity of hemoglobin
in catalyzing the oxidation of a dye with peroxide to form a colored compound. This method may yield false-positive
results for the presence of hemoglobin when the urine specimen contains
A. Ascorbic acid
B. Tetracycline
*C. Myoglobin
D. Nitrite

18. A reagent test strip impregnated with a diazonium salt such as diazotized 2,4-dichloroaniline may be used to
determine which analyte?
A. Glucose
B. Ketone
C. Hemoglobin
*D. Bilirubin

19. Which of the following will contribute to a specimen's specific gravity if it is present in a person's urine?
A. 50-100 RBC/hpf
*B. 85 mg/dL glucose
C. 3+ amorphous phosphates
D. Moderate bacteria
MICROSCOPIC
20. With infections of the urinary system, white blood cells are frequently seen in the urine sediment. What type of
white blood cell is seen the most frequently in urine sediment?
A. Eosinophil
B. Lymphocyte
C. Monocyte
*D. Neutrophil

21. A random urine is collected from a patient and the results obtained are as follows: urine albumin =16 mg/dL and
urine creatinine = 140 mg/dL. These findings are consistent with
*A. Microalbuminuria
B. Macroalbuminuria
C. Nephrotic syndrome
D. Obstructive jaundice

22. To detect more easily the presence of casts in urine sediments, which microscopic method can be used?
A. Fluorescent microscopy
*B. Phase-contrast microscopy
C. Polarized microscopy
D. Brightfield microscopy

23. Which substance found in urinary sediment is more easily distinguished by use of polarized microscopy?
*A. Lipids
B. Casts
C. Red blood cells
D. Ketone bodies

24. "Glitter cell" is a term used to describe a specific type of

A. Ketone body
B. Oval fat body
C. Fatty droplet
*D. Neutrophil

25. The final phase of degeneration that granular casts undergo is represented by which of the following casts?
A. Fine
B. Coarse
C. Cellular
*D. Waxy

26. A 40-year-old female patient with a history of kidney infection is seen by her physician because she has felt lethargic
for a few weeks. She has decreased frequency of urination and a bloated feeling. Physical examination shows periorbital
swelling and general edema, including a swollen abdomen. Significant urinalysis results show the following:
color = yellow;
appearance = cloudy/frothy;
specific gravity = 1.022;
pH = 7.0;
protein = 4+;
0-3 WBC/hpf; 0-1 RBC/hpf;
0-2 renal epithelial cells/hpf;
10-20 hyaline casts/lpf;
0-1 granular casts/lpf;
0-1 fatty casts/lpf;
occasional oval fat bodies.
Her serum chemistries show significantly decreased albumin, increased urea nitrogen, and increased creatinine. These
findings suggest which condition?
A. Multiple myeloma
B. Glomerulonephritis
*C. Nephrotic syndrome
D. Chronic renal failure

27. A 47-year-old female patient with controlled type 2 diabetes mellitus complains of urinary frequency and burning.
She provides a first-morning, clean-catch specimen. Results show color = yellow; appearance = cloudy; pH = 6.5. Which
of the following is true for this patient?
A. The number of bacteria seen would result in a positive nitrite.
*B. The major formed elements are white blood cells and yeast.
C. The type and number of epithelial cells suggest incorrect sample collection.
D. The red blood cells would be sufficient to give a positive blood result on the reagent strip.
28. Alkaptonuria, a rare hereditary disease, is characterized by the urinary excretion of
A. Alkaptone
B. Phenylalanine
C. 5-Hydroxyindole acetic acid
*D. Homogentisic acid

29. A 22-year-old female clinical laboratory student performs a urinalysis on her own
urine as part of a lab class. Significant results include:
color = yellow;
appearance = cloudy;
pH = 7.5;
nitrite = positive;
leukocyte esterase - 2+;
25^0 WBC/hpf; 0-3 RBC/hpf;
2-5 squamous epithelial cells/hpf;
moderate bacteria.
All other chemistries and microscopic results were normal. These findings suggest
A. Glomerulonephritis
B. Upper urinary tract infection
*C. Lower urinary tract infection
D. Nephrolithiasis

30. Metastatic carcinoid tumors arising from the enterochromaffin cells of the gastrointestinal tract are characterized by
increased excretion of urinary
A. Serotonin
B. 5-Hydroxytryptophan
C. Homogentisic acid
*D. 5-Hydroxyindole acetic acid

31. Some clinical conditions are characterized by unique urinalysis result patterns. Which of the following shows such a
relationship?
A. Nephrotic syndrome: positive protein on reagent strip, negative protein with sulfosalicylic acid
*B. Intensive dieting: increased ketones, negative glucose
C. Multiple myeloma: positive protein by both reagent strip and sulfosalicylic acid
D. Cystitis: positive nitrite and protein

32. Nitrite in a urine specimen suggests the presence of

A. White blood cells
B. Red blood cells
*C. Bacteria
D. Yeasts

34. A 35-year-old man has just experienced severe crush injuries sustained in a car accident. He has a broken pelvis and
right femur and has numerous abrasions and contusions. A random urinalysis specimen shows a brown color and clear
appearance. pH is 6.0, protein is 1 + , and blood is 3+. There is, however, only 0-1 RBC/hpf, along with 0-3 WBC/hpf.
Casts found include hyaline (0-2/lpf) and granular
(0-1/Ipf). Other urine results are normal. Which of the following is true about this patient?
A. The positive blood result is from a hemolytic anemia.
B. The bilirubin result should have also been positive for this patient.
*C. Rhabdomyolysis may be a cause for the discrepant chemical/microscopic blood findings.
D. The bone crushing led to the increased protein result.

35. A 67-year-old male has routine testing done and shows an estimated glomerular filtration rate (eGFR) of 42
mL/min/1.73 m2. Which of the following is true for this patient?
A. This test requires a 24-hour urine collection.
B. The patient does not have chronic kidney damage, based on these results.
C. Similar results would be obtained using the Cockgroft-Gault formula.
*D. The patient is in Stage 3 chronic kidney damage.

36. Which is true about triple phosphate crystals?

*A. May be found in normal alkaline urine
B. Associated with renal pathology
C. Characteristic of glomerulonephritis
D. Associated with lung pathology
37. A formed element was observed under high power and characterized by having fringed appearance at the one end.
A. Granular cast
B. Hyaline cast
C. Waxy cast
*D. Fiber artifact

38. Which of the following is true about the final concentrating of urine in the kidney?
A. The distal convoluted tubule, through active transport, reabsorbs water.
B. Water is reabsorbed under the direct influence of angiotensin II.
*C. Vasopressin controls the collecting duct reabsorption of water.
D. Water reabsorption is influenced by urine filtrate levels of potassium.

39. If a urine specimen is left standing at room temperature for several hours, which of the following changes may
occur?
*A. Multiplication of bacteria
B. An increase in the glucose concentration
C. Production of an acid urine
D. Deterioration of any albumin present

40. The formed element has e flat colorless plates and have a characteristic hexagonal shape with equal or unequal
sides, would usually be found in the patient's urine along with which soluble biochemicals?
A. Phenylalanine and tyrosine
*B. Ornithine and arginine
C. Isoleucine and leucine
D. Acetoacetic acid and B-hydroxybutyric acid

41. A 13-year-old ice skater is having her routine physical before the school year. Her first morning urinalysis results
include color = straw; appearance = hazy; pH = 6.0; protein = trace. All other chemical results were normal. The major
formed elements are and
suggest .
A. Hyaline casts and waxy casts; nephrotic syndrome
B. Mucus and fibers; no pathology
C. Granular casts and red blood cells; glomerulonephritis
*D. Hyaline casts and mucus; normal sediment

42. Phenylketonuria may be characterized by which of the following statements?

*A. It may cause brain damage if untreated.
B. It is caused by the absence of the enzyme, phenylalanine oxidase.
C. Phenylpyruvic acid excess appears in the blood.
D. Excess tyrosine accumulates in the blood.

43. What condition is suggested by the appearance of monohydrate form of calcium oxalate?
A. Glomerulonephritis
B. Improperly collected specimen
C. Pyelonephritis
*D. Normal sample