The nurse continues to care for the client.

Exhibits

Which of the following actions should the nurse take? Select all that apply.

Vaginal culture

Obtain provider prescription for antibiotics

Ibuprofen 600 mg every 6 hr for mild to moderate pain

Obtain provider prescription for phenazopyridine

Urine culture

Answer and Explanation

Correct Answer : B,D,E

A.   The client’s symptoms (burning with urination, pain) and urinalysis findings are indicative of a urinary tract infection (UTI), which is typically caused by bacteria in the urinary tract. There are no clear indications of a vaginal infection (e.g., discharge, odor, or other symptoms specific to vaginal infections), so a vaginal culture is not needed for this clinical scenario.
B.   The client’s symptoms and laboratory results (positive leukocyte esterase, WBC casts, cloudy urine) strongly suggest a UTI, and the elevated WBC count further confirms infection. Antibiotics are the primary treatment for a urinary tract infection. For pregnant clients, it is crucial to select antibiotics that are safe in pregnancy, as untreated UTIs can lead to preterm labor, kidney infections (pyelonephritis), and fetal complications.
C.   Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is generally contraindicated during pregnancy, especially in the third trimester, due to its potential for causing premature closure of the ductus arteriosus, renal complications, and increased bleeding risk. Alternative pain management strategies should be used in pregnancy.
D.   Phenazopyridine is a urinary analgesic that can be used to relieve the pain, burning, and discomfort associated with UTIs. However, it is generally not recommended during pregnancy, especially in the first trimester, and should only be used in pregnancy if prescribed by a healthcare provider. There are potential concerns with the safety of phenazopyridine in pregnancy, and it should not be administered without a provider's approval.
E.   A urine culture is a diagnostic test that can confirm the presence of a urinary tract infection and
identify the specific bacteria responsible for the infection. Given the client’s symptoms and positive findings on urinalysis, a urine culture should be obtained to help guide the choice of appropriate antibiotics. This will help ensure the effective treatment of the infection and prevent complications.

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Correct Answer is D

Explanation

A. Crusting of exudate is typical during wound healing and does not require immediate reporting unless other complications arise.
B. Mild swelling is expected, but it should be monitored closely.
C. Pink-tinged coloration is a normal part of healing and does not require reporting unless the incision shows signs of infection or other complications.
D. Partial separation of the incision may indicate a risk for wound dehiscence, which requires immediate provider attention.

A. Client rates lower back pain a 0 on a scale from 0 to 10. No reports of vaginal discharge. B. No uterine contractions noted. C. No further reports of burning with urination. D. WBC 12,000/mm2 (5,000 to 10,000/mm3) E. Temperature 37.1° C (98.7° F) F. Membranes intact G. FHR baseline 138, minimal variability. H. Platelet count 188,000/mm3 (150,000 to 400,000/mm3) I. Blood pressure 120/78 mm Hg

Correct Answer is ["A","B","C","D","E"]

Explanation

Client rates lower back pain as 0 on a scale from 0 to 10:

On Day 1, the client reported lower back pain, which could be associated with uterine contractions or other complications. By Day 2, the pain has resolved completely, with the client reporting a pain level of 0/10. This is a clear sign of improvement in her condition, especially since pain is often a key indicator of progress in antepartum care.

No reports of vaginal discharge:

On Day 1, the client reported pinkish vaginal discharge, which can be indicative of preterm labor or other complications. By Day 2, the absence of vaginal discharge suggests that the situation has improved, and the risk of preterm labor may be decreasing.

No uterine contractions noted:

On Day 1, the client had uterine contractions occurring every 8 minutes, which could be indicative of early labor or preterm labor. By Day 2, the absence of uterine contractions is a positive sign that the client is no longer experiencing early labor signs. This indicates that the situation is improving.

No further reports of burning with urination:

On Day 1, the client reported burning with urination, which was indicative of a urinary tract infection (UTI). On Day 2, the client no longer reports this symptom, suggesting that the urinary symptoms have resolved, and the infection may be improving, especially in light of ongoing treatment (e.g., antibiotics).

Laboratory Results Indicating Improvement:

WBC count 12,000/mm³ (Day 2) vs. 16,000/mm³ (Day 1):

The WBC count has decreased from 16,000/mm³ on Day 1 (which indicated infection or inflammation) to 12,000/mm³ on Day 2. Although the WBC count is still slightly elevated above the normal range (5,000-10,000/mm³), the decrease in WBC count suggests that the client's body is responding to treatment, and the infection or inflammation may be resolving.

Vital Signs Indicating Improvement:

Temperature 37.1° C (98.7°F) (Day 2) vs. 38.4° C (101.1°F) (Day 1):

The client’s fever has resolved, with a temperature decrease from 38.4°C (101.1°F) on Day 1 to 37.1°C (98.7°F) on Day 2. Fever is a common sign of infection, and the reduction in temperature suggests that the infection (likely a urinary tract infection) is being controlled and is improving.

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The nurse continues to care for the client. Exhibits Which of the following actions should the nurse take? Select all that apply.

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Explanation

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Exhibits

Which of the following actions should the nurse take? Select all that apply.