The nurse continues to care for the client.

Exhibits

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

A. Urine culture: The client has fever (38.4°C), dysuria, leukocyte esterase, and WBC casts in the urine, suggesting a urinary tract infection (UTI) or pyelonephritis. A urine culture is necessary to identify the causative organism and guide antibiotic therapy.
B. Vaginal culture: The client has preterm contractions and a history of preterm birth. Infections (e.g., bacterial vaginosis, Group B Streptococcus, sexually transmitted infections) can trigger preterm labor. A vaginal culture can help determine if an infection is contributing to labor symptoms.
C. Ibuprofen 600 mg every 6 hr for mild to moderate pain: NSAIDs (e.g., ibuprofen) are contraindicated in pregnancy after 30 weeks gestation because they can cause premature closure of the ductus arteriosus, leading to fetal circulation issues and increase the risk of oligohydramnios (low amniotic fluid levels) by reducing fetal kidney function. Instead, acetaminophen (Tylenol) is preferred for pain relief in pregnant clients.
D. Obtain provider prescription for phenazopyridine: Phenazopyridine is a urinary analgesic used to relieve dysuria and bladder discomfort. This medication does not treat the infection but provides symptomatic relief while waiting for antibiotics to take effect.
E. Obtain provider prescription for antibiotics: The presence of WBC casts, fever, and positive leukocyte esterase suggests a UTI, possibly progressing to pyelonephritis. Prompt antibiotic therapy is critical to prevent complications such as preterm labor, maternal sepsis, or fetal distress.