The nurse is reviewing the urinalysis results of an older adult patient admitted with elevated temperature and incontinence. Which urinalysis properties are indicative of an infection? (Select all that apply.)

Choice A rationale Specific gravity measures the concentration of solutes in the urine, providing information about the kidney's ability to concentrate urine. A value of 1.014 falls within the normal range of 1.005 to 1.030. While a very high or very low specific gravity can indicate dehydration or fluid overload, a value of 1.014 is not a primary indicator of infection. Therefore, this result does not support a diagnosis of a urinary tract infection in this older adult patient without other findings. Choice B rationale Straw color or light yellow is considered a normal color for urine, indicating a proper balance between waste products and water. Changes in color, such as dark amber or cloudy urine, are more indicative of concentrated urine or the presence of pus and bacteria. Because straw color represents a healthy, well hydrated state, it is not a property associated with an active infection. The nurse would look for cloudiness or turbidity as a more relevant sign of bacteriuria. Choice C rationale Trace glucose in the urine, or glucosuria, occurs when the blood glucose level exceeds the renal threshold, which is typically around 180 milligrams per deciliter. While it can be seen in patients with diabetes, glucose in the urine can provide a growth medium for bacteria, but its presence alone is not a diagnostic marker for infection. It is a metabolic finding rather than an inflammatory one. Normal urine should generally be negative for glucose upon standard dipstick testing. Choice D rationale A foul odor in urine is often caused by the presence of bacteria or the breakdown of urea into ammonia by specific organisms like Proteus. While some foods or medications can change urine odor, a strong, unpleasant smell in a patient with a fever and incontinence is a classic clinical indicator of a urinary tract infection. In the elderly, this change in odor can be one of the few objective signs of infection when typical symptoms like dysuria are absent. Choice E rationale The normal pH of urine typically ranges from 4.6 to 8.0, with an average around 6.0. A pH of 8.2 is alkaline. Certain urea splitting bacteria, such as Proteus mirabilis, produce urease which converts urea into ammonia, significantly raising the pH of the urine. An alkaline urine pH can also predispose a patient to the formation of certain types of kidney stones. In the context of suspected infection, an elevated pH is a significant finding that suggests the presence of uropathogens.