College of Nursing

Urine Testing - Protein

Instruction: Check on the column of your choice as to what level is the performance of the student in the following
procedure. Be guided in the scoring with the legend below.
4 Very satisfactory (Performed all the procedures correctly)
3 Satisfactory (Needs minimal assistance in performing the procedure)
2 Good (Needs more practice in performing the procedure)
1 Fair (inappropriate in the performance of the procedure)

STEP PROCEDURE 4 3 2 1
1 Prepares and assembles equipment.
2 Briefly and correctly states the name and purpose of the procedure.
3 Fills the test tube with 5cc urine.
4 Heats the test tube until the urine boils.
5 Adds 5 drops of Acetic Solution (drop by drop).
6 Provides a correct interpretation of results:
(+) Indicative of the presence of protein in the urine.
+ Faint turbidity
++ Moderate turbidity
+++ Heavy turbidity
++++ Opaque
(-) Indicative of the absence of protein in the urine
7 Performs complete aftercare.
Subtotal:
Total Score:
Perfect Score: 28
Remarks:

Name / Signature of Student Name / Signature of RD Instructor

UC-VPAA-CON-FORM- 74 Page 1 of 1
JUNE 2012 REV. 00