CC2 Lab Midterms (ARITA)

College of Nursing and Allied Medical Sciences
Medical Technology Department
CLINICAL CHEMISTRY 2 (LABORATORY)
Midterm Examination
MULTIPLE CHOICE. WRITE YOUR ANSWERS IN THE GIVEN ANSWER SHEET. STRICTLY NO ERASURES. MULTIPLE ANSWERS WILL ALSO BE CONSIDERED INCORRECT.
ANYONE CAUGHT IN ANY FORM OF CHEATING WILL BE CONSIDERED ZERO.
Analyte Specimen Methods Reference Range
(ADULT)
Interference/
Considerations/ Others
Clinical Sig.
High level
Clinical Sig.
Low level
Sodium 1.
2.
3.
4. Which may not affect 5.
6.
a. Serum
a. Severinghaus a. 136 – 145 mmol/L the results?
a. Decreased water a.Diuretic use
b. Lithium heparin
plasma
electrode
b. Fiske Subarrow
b. 3.5 – 5.1 mmol/L
c. 98-107 mmol/L a. Fasting
intake by elderly
b. Congestive heart
b. SIADH
c. Prolonged vomiting
c. Urine
method
d. 0.63-1.0 mmol/L b. Slight hemolysis failure
or diarrhea
d. Lithium oxalate
plasma
c. Glass ion
exchange
e. 0.78-1.42 mmol/L c. Pseudohyponatremia
d. All of the above
c. Diuretic use
d. All of the above
d. All of the above
e. None of the above
e. All of the above
membrane
d. CPC
e. None of the above e. None of the
above
e. None of the
above
Potassium 7.
Chloride 13.
a. Serum
b. Lithium heparin
plasma
c. Urine
d. None of the above
e. All of the above
a. Serum
b. Sweat
c. Plasma
d. None of the above
e. All of the above
8.
14.
a. Clarke electrode
b. Valinomycin
membrane
c. Glass ion
exchange
membrane
d. PEP
e. None of the
above
a. Cotlove
b. Electrophoresis
c. Glass ion
exchange
membrane
d. A & B
e. B & C
9.
a. 136 – 145 mmol/L
b. 3.5 – 5.1 mmol/L
c. 98-107 mmol/L
d. 0.63-1.0 mmol/L
e. 0.78-1.42 mmol/L
15.
a. 98 - 107 mmol/L
b. 110 - 250 mmol/d
c. 80 - 110 mmol/L
d. A & B
e. B & C
10. Which may affect the
results?
a. Exercise
b. Hemolysis
c. Hyperosmolality
d. All of the above
e. None of the above
16. To maintain electric
neutrality, what buffers
the dissociated H + ?
a. Bicarbonate
b. Deoxyhemoglobin
c. CO2
d. Sodium
e. Plasma protein
11.
a. Alkalosis
b. Thrombocytosis
c. Renal tubular
nephritis
d. All of the above
e. None of the
above
17.
a. Excess loss of
HCO3 -
b. RTA
c. Metabolic
acidosis
d. All of the above
e. None of the
above
12.
a. Intestinal tumor
b. Alkalosis
c. Decreased intake
d. All of the above
e. None of the above
18.
a. Prolonged
vomiting
b. DKA
c. Aldosterone
deficiency
d. Pyelonephritis
e. All of the above

Analyte Specimen Methods Reference Range
(ADULT)
Bicarbonate 19.
20.
21.
a. Serum
a. Severinghaus a. 23 - 29 mmol/L
b. Lithium heparin
electrode b. 35 - 45 mmol/L
plasma
b. PEP
c. 22 - 27 mmol/L
c. Arterial blood
c. Glass ion d. A & B
d. A & B
exchange e. B & C
e. All of the above
membrane
d. A & B
e. None of the
above
Interference/
Considerations/ Others
22. In alkalosis, with the
relative increase in
HCO3 - compared with
CO2, the kidneys will:
a. increase excretion of
HCO3 - into urine
b. increase excretion of
CO2
c. decrease excretion of
HCO3 - into urine
d. increase excretion of
Clinical Sig.
High level
23.
a. Metabolic alkalosis
b. Metabolic acidosis
c. Severe vomiting
d. A & B
e. A & C
Clinical Sig.
Low level
24.
a. Metabolic alkalosis
b. Metabolic acidosis
c. Severe vomiting
d. A & B
e. A & C
Magnesium 25.
a. Serum
b. Lithium heparin
plasma
c. Arterial blood
d. A & B
e. All of the above
Phosphate 31.
a. EDTA
b. Oxalate
c. Citrate
d. None of the above
e. All of the above
Calcium 37.
a. Serum
b. Lithium heparin
plasma
c. Whole blood
d. A & B
e. All of the above
26.
a. Calmagite
b. Formazan
c. AAS
d. A & B
e. All of the above
32.
a. Orthocresolphthalein
complexone
b. AAS
c. CPC
d. None of the
above
e. All of the above
38.
a. Orthocresolphthalein
complexone
b. AAS
c. CPC
d. A & B
e. All of the above
27.
a. 0.63-1.0 mmol/L
b. 1.26-2.10 mmol/L
c. A & B
d. None of the above
e. All of the above
33.
a. 98 - 107 mmol/L
b. 110 - 250 mmol/d
c. 80 - 110 mmol/L
d. None of the above
e. All of the above
39.
a. 2.15-2.50
mmol/L
b. 1.16-1.32
mmol/L
c. 1.03-1.23
mmol/L
d. None of the
above
e. All of the
above
CO2
e. None of the above
28. What anticoagulants
are unacceptable?
a. EDTA
b. Oxalate
c. Citrate
d. None of the above
e. All of the above
34. Regulating hormones
a. Calcitonin
b. 1,25-dihydroxy
cholecalciferol
c. Growth hormone
d. None of the above
e. All of the above
40. Regulating hormones
a. ACTH
b. 1,25-dihydroxy
cholecalciferol
c. Growth hormone
d. None of the above
e. All of the above
29.
a. Decreased platelet
adhesion
b. Depression
c. Arrythmia
d. Hypokalemia
e. None of the above
35.
a. Acute/Chronic renal
failure
b. Neoplastic
disorders
c. Hemolysis
d. A & B only
e. All of the above
41.
a. Primary
hyperparathyroidism
b. Hypomagnesemia
c. Vitamin D deficiency
d. None of the above
e. All of the above
30.
a. Hypocalcemia
b. Hypokalemia
c. Hypernatremia
d. A & B
e. B & C
36.
a. ICU patients
b. Diabetic ketoacidosis
c. Intensive exercise
d. A & B
e. All of the above
42.
a. Primary
hyperparathyroidism
b. Hypoalbuminemia
c. Multiple myeloma
d. Increased Vitamin D
e. All of the above

Analyte Specimen Method Interference/
Considerations/ Others
Lactate 43.
44.
a. Serum
b. Heparinized plasma
c. Whole blood
d. a & b only
e. b & c only
a. ISE
b. Coupled
Enzymatic
c. AAS
d. All of the above
e. None of the
above
45.
a. Do not use tourniquet
(as much as possible)
b. Plasma separated
quickly
c. Delivered with ice
d. All of the above
e. None of the above
Clinical Significance
46.
a. severe CHF
b. hypoxia
c. myocardial infarction
d. All of the above
e. None of the above
Measured Electrode Principle Reference Range
pO 2 47.
a. Clarke electrode
b. Severinghaus electrode
c. Glass electrode
d. Valinomycin membrane
e. Iontophoresis
48.
a. Amperometric
b. Potentiometry
49.
a. 35-45mmHg
b. 22-26mmHg
c. 80-110mmHg
d. 23-27mmHg
e. None of the above
pCO 2 50.
pH 53.
a. Clarke electrode
b. Severinghaus electrode
c. Glass electrode
d. Valinomycin membrane
e. Iontophoresis
a. Clarke electrode
b. Severinghaus electrode
c. Glass electrode
d. Valinomycin membrane
e. Iontophoresis
51.
54.
a. Amperometric
b. Potentiometry
a. Amperometric
b. Potentiometry
52.
55.
a. 35-45mmHg
b. 22-26mmHg
c. 80-110mmHg
d. 23-27mmHg
e. None of the above
a. 35-45mmHg
b. 22-26mmHg
c. 80-110mmHg
d. 23-27mmHg
e. None of the above

Choose the letter that makes the equation incorrect.
Lactate oxidase
56. Lactate + O2 -----------------------> pyruvate + H2O2 (All are correct)
A B C D E
Peroxidase
57. H2O2 + H donor + chromogen --------------------> colored dye + 2 H2O2 (All are correct)
A B C D E
58. Ag 2+ + Cl - --------> AgCl2 (All are correct)
A B C D
CA
CA
59. CO2 + H2O ------------> H2CO3 -------------> H + + HCO3 - (All are correct)
A B C D E
PEF carboxylate
60. Phosphoenolpyruvate + HCO3 - -------------------------------------> Oxaloacetate + NAD + (All are correct)
A B C D E
CASE STUDY
The following are laboratory results of a 60 year old man. He entered the ER after 2
days of not feeling well. History revealed myocardial infarction 5 years ago and he
was prescribed digoxin. Two years ago, he was prescribed a diuretic after periodic
bouts of edema. An ECG at time of admission indicated a cardiac arrhythmia.
Admitting lab results are shown:
Digoxin: 1.4 ng/mL (therapeutic 0.5-2.2)
Sodium: 137 mmol/L Potassium: 2.5 mmol/L
Chloride: 100 mmol/L Bicarbonate: 25 mmol/L
Magnesium: 0.4 mmol/L Ionized Calcium: 1.0 mmol/L
61. Interpret Sodium level
a. Increased b. Normal c. Decreased
62. Interpret Potassium level
a. Increased b. Normal c. Decreased
63. Interpret Chloride
a. Increased b. Normal c. Decreased
64. Interpret Bicarbonate
a. Increased b. Normal c. Decreased
65. Interpret Magnesium
a. Increased b. Normal c. Decreased
66. Interpret Ionized Calcium
a. Increased b. Normal c. Decreased
67. Because the digoxin level is within therapeutic range, what may be the cause of
arrhythmia?
a. Sodium b. Potassium c. Chloride d. Ionized Calcium
68. What does the patient’s condition indicate?
a. Hypomagnesemia b. Hypocalcemia c.Decreased AG d. None of the above
69. What type of treatement would be helpful?
a. Oral intake of Mg b. IV fluid c. Diuretics d.Digoxin therapy
70. Which is not included in the symptoms of the patient’s condition?
a. Cardiovascular b. Psychiatric c. Neuromuscular d. None of the above
GOODLUCK!