Chapter 47
Collecting, Processing, and Testing Urine and Stool Specimens
Multiple Choice Questions
1. | Which of the following is a general urine collection guideline?
A. | Label the lid of a urine specimen container with the patient's name |
B. | If the collection container contains liquid or powdered preservative, pour it out before obtaining the specimen |
C. | Explain the procedure to the patient using technical terminology |
D. | Tell patients to refrigerate the labeled collection container or keep it in a cooler or pail filled with ice |
E. | Instruct patients to add alcohol to a sample collected at home to preserve the sample |
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2. | Which of the following is the most common type of urine sample?
C. | First morning urine specimen |
D. | Clean-catch midstream urine specimen |
E. | 24-hour urine specimen |
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3. | Which urine specimen contains the greatest concentration of substances?
A. | First morning urine specimen |
D. | Clean-catch midstream urine specimen |
E. | 24-hour urine specimen |
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4. | Which method of collecting a urine specimen is required when performing a urine culture to identify the number and the types of pathogens present?
B. | 24-hour urine specimen |
C. | Clean-catch midstream urine specimen |
D. | First morning urine specimen |
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5. | Which type of urine specimen can be used to measure a patient's urinary output or analyze substances collected over a specified period of time?
B. | Clean-catch midstream urine specimen |
D. | First morning urine specimen |
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6. | Which urine specimen is used to complete a quantitative and qualitative analysis of one or more substances such as sodium, chloride, or calcium?
C. | Clean-catch midstream urine specimen |
D. | First morning urine specimen |
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7. | A urine specimen collected for a culture and sensitivity test can be obtained either through catheterization or by obtaining a ____.
B. | clean-catch midstream urine specimen |
C. | first morning urine specimen |
D. | 24-hour urine specimen |
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8. | Which of the following would you include in teaching a female patient how to collect a clean-catch midstream urine specimen?
A. | Remove the lid of the specimen container and place the lid facing down a flat surface |
B. | Wipe down one side of the perineal area with the first towelette, down the other side with the second towelette, and down the middle with the third towelette |
C. | Void directly into the specimen container without discarding any urine |
D. | Keep the urine specimen warm while bringing it to the physician's office |
E. | Wipe around the inside edge of the collection container to clean it after collecting the specimen. |
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9. | Which of the following would you include in patient instruction about collecting a 24-hour urine specimen?
A. | Tell the patient to collect all urine starting with the first voided specimen |
B. | Encourage the patient to use a bedpan |
C. | Explain to the patient that the small collection container must not be washed between uses |
D. | Instruct the patient to keep the specimen covered and in the refrigerator throughout the test |
E. | Return the sample to the office or deliver it to the laboratory within 1 week of collection |
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10. | The procedure of a inserting a sterile plastic tube in order to drain urine is ____.
A. | the urine specific gravity |
B. | the urinometer measurement |
D. | a random urine specimen |
E. | a 24-hour urine specimen |
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11. | Catheterization is performed for which of the following reasons?
A. | Obtain a specific gravity |
B. | Relieve urinary retention |
C. | Obtain a random urine specimen |
D. | Prevent urinary infection |
E. | Prevent kidney disease |
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12. | Residual urine is ____.
A. | the leakage of urine despite voluntary control of urination |
B. | urine that is collected over a 24-hour period |
C. | urine remaining in the bladder after voiding |
D. | urine that is normally voided |
E. | urine collected by an indwelling urethral catheter |
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13. | What amount of residual urine is considered abnormal?
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14. | Which type of catheter is used to collect specimens or to instill medications?
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15. | Which type of catheter is used for drainage through a wound that leads to the bladder?
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16. | Which type of catheter is inserted after plastic repair of the ureter and must remain in place for at least a week after surgery?
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17. | When instructing a patient about how to collect a 24-hour urine specimen, which patient should be asked about possible urine leakage when laughing or coughing?
A. | 5-year-old female patient |
B. | 30-year-old male patient |
C. | 60-year-old female patient |
D. | 18-year-old male patient |
E. | 12-year-old female patient |
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18. | A pregnant patient's urine is checked for abnormal levels of protein during a prenatal visit to detect ____.
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19. | A pregnant patient who is having pain during urination or pain in the kidney area may be experiencing ____.
A. | a urinary infection or kidney stones |
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20. | Which of the following may indicate polycystic kidney disease?
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21. | Abnormally high levels of glucose in the urine may indicate ____.
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22. | Which of the following is important when obtaining a urine specimen from a patient for drug and alcohol testing?
A. | Tell the patient that the results will be released only with his permission. |
B. | Inform the patient that any drugs consumed longer than 7 days before the test will not show up. |
C. | Explain to the patient that no water may be running in the bathroom while he is providing the sample. |
D. | Instruct the patient to take the specimen to the laboratory as soon as possible. |
E. | Measure and record the temperature within 30 minutes of collection. |
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23. | Which of the following statements about refrigerating urine specimens is true?
A. | It causes changes in the physical, chemical, and microscopic makeup of the urine, causing the test to be invalid. |
B. | It may affect the sediment and specific gravity. |
C. | It should never be used as a method of storing or preserving urine. |
D. | It is acceptable only if the urine must be kept for 2 or more days. |
E. | It causes bacterial growth to accelerate. |
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24. | Chemical and microscopic changes that invalidate a urine specimen occur if the urine is kept at room temperature for more than ____.
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25. | What is the normal lab value for protein in urine?
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26. | Which of the following is one of the first signs of liver disease?
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27. | On average a healthy adult’s daily urine output, with an adequate fluid intake, is ____ mL per 24 hours.
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28. | Which of the following are nonpathologic causes for colorless or pale urine?
A. | Low fluid intake and excessive sweating |
B. | Excessive intake of water, beer, and coffee |
D. | Strict vegetarian diet |
E. | Specimen collection first thing in the morning |
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29. | Normal urine color ranges from ____.
C. | salmon pink to light red |
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30. | Which of the following refers to an insufficient production of urine?
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31. | Renal or urethral obstruction and renal failure can cause ____.
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32. | Which of the following measures the concentration of substances dissolved in urine?
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33. | In which condition would the odor of urine be characterized as “fruity”?
C. | Urinary tract infection |
E. | Polycystic kidney disease |
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34. | Increased specific gravity occurs in ____.
B. | urinary tract infection |
D. | systemic lupus erythematosus |
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35. | When measuring specific gravity with a reagent strip, which of the following is required?
A. | Use a refrigerated urine specimen |
B. | Read the results 30 minutes after dipping |
C. | Check the expiration date on the reagent strip container |
D. | Blot the test pads of the reagent strip |
E. | Allow sediment to fall to the bottom before testing |
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36. | Which of the following would you include when measuring specific gravity with a refractometer?
A. | Use a specimen that was collected at least 2 hours ago |
B. | Calibrate the refractometer once a week |
C. | Place three drops of the specimen under the lid of the refractometer |
D. | Turn on the light and look into the eyepiece to measure refraction |
E. | Clean the refractometer and dropper every three days |
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37. | Intermediary products of fat and protein metabolism in the body are ____.
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38. | Which of the following is a measure of the degree of acidity or alkalinity of the urine?
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39. | Hematuria is ____. rev: 07_17_2014_QC_51309
B. | white blood cells in the urine |
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40. | The correct procedure for testing for ketones using a reagent strip includes ____.
A. | using a strip you found sitting out on the counter |
B. | using a strip from a bottle that was opened 7 months ago |
C. | testing urine immediately or covering and refrigerating it until you can test it |
D. | testing a urine sample immediately after removing it from the refrigerator |
E. | running a control sample once a year to check for proper operation |
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41. | A rare condition caused by transfusion reactions, malaria, drug reactions, snakebites, or severe burns is ____.
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42. | A genetically inherited disorder in which the body cannot properly metabolize the nutrient phenylalanine, resulting in mental retardation, is ____.
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43. | The presence of which of the following in the urine suggests a bacterial infection in the urinary tract?
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44. | The best urine specimen to test for nitrates is a ____.
B. | first morning specimen |
C. | 24-hour urine specimen |
E. | clean-catch midstream specimen |
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45. | Which of the following are present in large amounts in the urine if inflammation is present?
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46. | Which of the following is important in processing a urine specimen for microscopic examination of sediment?
A. | Fill one test tube with 2 mL of water and the other test tube with 2 mL of urine |
B. | Balance the centrifuge by placing the test tubes upside down |
C. | Set the centrifuge for 20 minutes |
D. | After the centrifuge stops, discard most of the supernatant from the tube |
E. | Avoid using a coverslip on the specimen slide |
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47. | The liquid portion from the tube of urine that is discarded down the drain after the centrifuge stops is called the ____.
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48. | Which of the following are frequently associated with vaginitis, urethritis, and prostatitis?
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49. | Which of the following is the most common urinary parasite?
B. | Beta-Hemolytic streptococci |
D. | Trichomoniasis vaginalis |
E. | Streptococcus pneumoniae |
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50. | Which of the following is commonly found in renal disease, in pregnant patients, or after heavy exercise?
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51. | Which of the following conditions is suspected when a reagent urine strip for human chorionic gonadotropin (HCG) shows positive?
C. | Polycystic kidney disease |
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52. | Which of the following is part of the medical assistant's responsibility in collecting and testing urine and stool samples?
A. | Work directly with bloodborne pathogens |
B. | Dispose of specimens in the trashcan after use |
C. | Wear adequate personal protective equipment |
D. | Diagnose urinary infections |
E. | Analyze patient health based on test results |
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53. | If the practitioner suspects that a patient has a protozoal or parasitic infection, what type of specimen may be ordered?
A. | First morning urine specimen |
B. | Clean-catch midstream urine specimen |
C. | 24-hour urine specimen |
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54. | When the practitioner suspects that a patient has a protozoal or parasitic infection, what is the minimum number of stool specimens that need to be examined?
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55. | Which of the following statements is true about patient collection of a stool sample?
A. | The sample can be collected in a clean waxed-paper carton. |
B. | The sample should be kept warm if transport to the lab is delayed. |
C. | A stool sample cannot be collected from a diaper. |
D. | Using a tongue depressor to transfer the specimen will contaminate it. |
E. | The sample must not be contaminated with urine. |
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56. | In your office, patients collect samples using the patient restroom and leave the samples on the back of the toilet. You send April into the restroom after giving her the collection kit, including three towelettes, and instructing her on how to perform a clean-catch midstream urine specimen. After she returns to the exam room and you go into the restroom to collect the specimen, you notice the three towelette packages, unopened, in the trashcan. What should you do?
A. | Process the urine sample as usual; the towelettes are not important. |
B. | Let April know that you know she did not follow instructions, but proceed to process the sample. |
C. | Process the urine sample as usual, but make a note in April's record that this is not a clean-catch sample. |
D. | Explain the instructions again and send April back to the restroom to produce another sample. |
E. | Inform the physician or your supervisor and ask whether you should process the sample. |
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57. | Wendy has provided a random urine sample and has returned to the examination room. You notice that the sample is a blue-green color. Which of the following questions would you ask Wendy to help rule out nonpathologic causes for the unusual color?
A. | "Are you a vegetarian?" |
B. | "How much coffee have you drunk in the last 2 hours?" |
C. | "Did you have asparagus for lunch?" |
D. | "Are you taking any prescription medications, such as Primaquine?" |
E. | "Are you taking an iron supplement?" |
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58. | Tyrone has provided a random urine sample, and you are performing a routine urinalysis. The specific gravity of the urine is 1.043. Which of the following conditions might the physician suspect based on this result?
E. | Systemic lupus erythematosus |
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59. | You are performing a microscopic examination of Mr. Henderson's urine sample. Under high-power magnification, you see the items shown in the picture. Which of the following is the most likely cause?
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Fill in the Blank Questions
60. | When you obtain a urine specimen for drug or alcohol analysis, you must establish a proper ________.
________________________________________ |
61. | For an O&P test to determine if the patient has a protozoal or parasitic infection, both a fresh and a(n) ________ stool specimen are collected for examination.
________________________________________ |
62. | A fecal occult blood test (FOBT) is a test for ________, or occult, blood in the stool.
________________________________________ |
63. | The type of cells pictured here are ________ cells.
________________________________________  |
64. | The microscopic cast found in urine and pictured here is a(n) ________ cast.
________________________________________  |
65. | The epithelial cells found in urine and pictured here are ________ cells.
________________________________________  |
66. | The crystals found in urine and pictured here are ________ crystals.
________________________________________  |
67. | Renal or urethral obstruction and renal failure can cause absence of urine production, known as ________.
________________________________________ |
68. | Presence of the bile pigment bilirubin in the urine, called ________, is one of the first signs of liver disease or conditions that involve the liver.
________________________________________ |
69. | Cylinder-shaped elements with flat or rounded ends that are formed when protein from the breakdown of cells accumulates and precipitates in the kidney tubules and are washed into the urine are called ________.
________________________________________ |
70. | The procedure in which a sterile plastic tube is inserted into the kidney, ureter, or bladder to provide urinary drainage is called ________.
________________________________________ |
71. | The ________ midstream urine specimen may be collected and submitted for culturing to identify the number and the types of pathogens present and requires special cleansing of the external genitalia to avoid contamination.
________________________________________ |
72. | Naturally produced solids of definite form that are commonly seen in urine specimens and usually do not indicate a significant disorder are ________.
________________________________________ |
73. | Catheters used to withdraw fluids, including Foley, retention, ureteral, and straight versions, are collectively known as ________ catheters.
________________________________________ |
74. | A(n) ________ urine specimen contains greater concentrations of substances that collect overnight than do specimens taken during the day.
________________________________________ |
75. | Occurring in patients with diabetes, ________ is the presence of significant glucose in the urine.
________________________________________ |
76. | The presence of blood in the urine, or ________, can be caused by cystitis, kidney stones, menstruation, ureteral or bladder catheters, or urethral irritation.
________________________________________ |
77. | The presence of free hemoglobin in the urine is known as ________, a rare condition caused by transfusion reactions, malaria, drug reactions, snakebites, or severe burns.
________________________________________ |
78. | Injured or damaged muscle tissue can cause ________, which is the presence of myoglobin in the urine.
________________________________________ |
79. | Patients that are dehydrated, have a decreased fluid intake, are in shock, or have renal disease may have an insufficient production (or volume) of urine. This is called ________.
________________________________________ |
80. | A genetically inherited disorder in which the body cannot properly metabolize the nutrient phenylalanine is ________ (PKU).
________________________________________ |
81. | An excess of protein in the urine is called ________ and usually indicates renal disease. However, it may occur in pregnant patients or after heavy exercise.
________________________________________ |
82. | The ________ urine specimen is the most common type of sample and may be obtained at any time of the day.
________________________________________ |
83. | A(n) ________ is an optical instrument that measures the refraction, or bending, of light as it passes through a liquid and is used to measure specific gravity of the liquid.
________________________________________ |
84. | A(n) ________ catheter is inserted after plastic repair of the ureter and must remain in place for at least a week after surgery.
________________________________________ |
85. | The centrifuge is used to spin the urine to force the solids (cells, casts, and crystals) to the bottom of the tube. Most of the liquid portion, called the ________, is poured off, and the remaining sediment is examined by microscope.
________________________________________ |
86. | A(n) ________ urine specimen is used to complete a quantitative and qualitative analysis of one or more substances, such as sodium, chloride, and calcium, and is collected over a full day.
________________________________________ |
87. | The evaluation of urine to obtain information about body health and disease is called a(n) ________.
________________________________________ |
88. | A sterile plastic tube inserted to provide urinary drainage is called a urinary ________.
________________________________________ |
89. | Urinary ______ is a measure of the degree of acidity or alkalinity of the urine and can provide information about a patient's metabolic status, diet, and medications being taken.
________________________________________ |
90. | A measure of the concentration or amount of substances dissolved in urine is ________.
________________________________________ |
91. | When hemoglobin breaks down, it converts into conjugated bilirubin in the liver and then to ________ in the intestines. It is normally present in the urine in small amounts, but high levels may indicate increased red blood cell destruction or liver disease, and a lack of it in the urine may suggest total bile duct obstruction.
________________________________________ |
Multiple Choice Questions
92. | Which type of specimen is collected for a urine culture and sensitivity test?
A. | First morning urine specimen |
B. | Clean-catch midstream urine specimen |
C. | 24-hour urine specimen |
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93. | Bacterial infections caused by _______ species can cause loose, bloody, or mucus-tinged stools.
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Fill in the Blank Questions
94. | When collecting a urine specimen for drug and alcohol analysis for legal purposes, a transfer bag that is permanently sealed is used to ensure that there has been no tampering with the specimen. Then for legal purposes, a chain of ______ must be established to document the handling of this type of specimen.
________________________________________ |
95. | The type of test performed if a patient is suspected of having a complicated urinary tract infection or if there are bacteria in the patient’s urine is a urine ______.
________________________________________ |