Urinalysis for the NCLEX

Urinalysis (UA) is a super common diagnostic test that you should absolutely know for the NCLEX!

A urinalysis can tell you basic information such as if you patient has an infection, renal disease, liver disease, diabetes or kidney stones. That’s kinda important for taking care of patients and the NCLEX, wouldn’t you agree? You can get lost in the details of all these tests, so here are the basics to make looking at the results of a urinalysis for the NCLEX a snap!

How to get a clean catch, mid stream sample

First of all, you need a sample of the patient’s urine. The client usually gets their own sample, but may need some help. Here are the steps:

1. clean the perineal area
   • female: 1 stroke over one side of labia, 1 stroke down the other side of the labia, 1 stroke down the middle (front to back)
   • male: 3 strokes: 1 on each side, 1 on the top
2. have the client pee just a bit first in the toilet/commode
3. have them pee 10-15 mL into the sterile cup (called a midstream or clean catch sample); pee the rest in the toilet
4. cap it, date it, time it, put client’s name and DOB (date of birth) on it
5. send it to the lab ASAP (if the urine sits around for too long stuff starts to grow in it and the cells start to break down making the results inaccurate)

How to get a urine sample from a foley

Getting a sample from a foley catheter is very common also.

1. clamp the tubing above the injection port
2. clean the port with an antiseptic
3. draw out the urine with a syringe

How long does it take?

It doesn’t take long to get the results back from the urinalysis because it only takes a couple minutes to process the test. So go see if the results are back within an hour or two of sending the sample.

The Urinalysis!

Exciting! So you got the results, let’s go see what’s wrong with the patient!

• cloudy and smelly: infection (you didn’t need to send it to the lab to figure this one out: common sense tells you this)
• + for WBCs: UTI or kidney inflammation
• + for leukocyte esterase: infection/UTI
• + for nitrates: UTI
• + for bactera (>1000 colonies/mL): UTI
• + for parasites: STI (trichomonas)
• + for RBCs: renal disease, tumors, trauma, bleeding disorders
• + for proteins: renal disease, infection, pre-eclampsia (if pregnant)
• + for glucose: hyperglyemia/diabetes
• + for ketones: hyperglycemia/DKA, anorexia
• + for bilirubin: liver disease
• + for crystals: kidney stones (or sample sat for too long)
• pH 4 – 6.8: too low or too high indicates all kinds of things!– diet, drugs, acid-base imbalance, kidney disease
• specific gravity < 1.005: urine is diluted caused by the patient peeing a lot such as too much diuretics or diabetes “inPISSidus”.
  • Their urine is PALE YELLOW
• specific gravity >1.030: urine is concentrated caused the by the patient not peeing very much such as dehydration, SIADH.
  • Their urine is DARK AMBER

Obviously the UA test isn’t the end-all, be-all. More testing that’s more specific would have to be done to see what is going on. However, the UA is a quick and easy way to see if your patient does indeed have a problem. And you definitely want to know if your patient has a problem, especially if you are taking the NCLEX!