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The nurse continues to care for the client.

Nurses' Notes Day 1, 0900:

Client reports lower back pain and pinkish vaginal discharge. Uterine contractions every 8 minutes, palpate strong, duration 30 seconds.
FHR baseline 145, minimal variability.

Cervical exam indicates 2 cm, 50% effaced, 0 station. Membranes intact.
CBC and urinalysis collected and sent to lab. Day 1,0930:
Peripheral IV initiated. Provider prescriptions received and implemented. Day 1, 1000:
Client voided and reports pain and dicomfort upon urination. Client states, "I've noticed burning wife I urinate for the past 2 days."


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

A.

Urine culture

B.

Ibuprofen 600 mg every 6 hr for mild to moderate pain

C.

Obtain provider prescription for phenazopyridine

D.

Vaginal culture

E.

Obtain provider prescription for antibiotics

Answer and Explanation

Correct Answer : A,C,E

A.    Urine culture: This will help identify the presence of any urinary tract infection (UTI) causing discomfort and burning during urination.
B.    Ibuprofen 600 mg every 6 hr for mild to moderate pain: While ibuprofen can help with pain relief, it does not address the potential underlying urinary tract infection, so it's important to address the infection first.
C.    Obtain provider prescription for phenazopyridine: Phenazopyridine is a urinary analgesic that can provide relief from the pain and discomfort associated with UTIs.
D.    Vaginal culture: The client's symptoms are related to discomfort and burning upon urination, suggesting a urinary tract issue rather than a vaginal issue. Therefore, a vaginal culture may not be relevant in this context.
E.    Obtain provider prescription for antibiotics: If a urinary tract infection is suspected based on the client's symptoms and urine culture results, antibiotics may be needed to treat the infection.


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Related Questions

Correct Answer is D

Explanation

A. Incorrect. Documentation of sensitive material might have designated personnel, but this information does not need to be limited to the charge nurse.

B. Incorrect. Access to medical records should be limited to those with a need for that information, not every nurse in the facility.

C. Incorrect. Most facilities require more frequent password changes (e.g., every 90 days) to enhance security. Therefore, this statement may be inaccurate depending on the facility's policy.

D. Correct. Firewalls are security systems that are used to protect computer networks from unauthorized access. They are an important component of any computerized documentation system.

Correct Answer is B

Explanation

Choice A rationale:

Varicella vaccine is typically administered to children at the age of 1 year, not at 2 months. The first dose of varicella vaccine is usually given at 12-15 months of age, with a second dose recommended at 4-6 years of age.

Choice B rationale:

Rotavirus vaccine is recommended to be administered to infants at the age of 2 months. It is an oral vaccine that protects against rotavirus infections, a common cause of severe diarrhea and dehydration in infants and young children.

Choice C rationale:

Influenza vaccine is not typically administered to infants at 2 months of age. Influenza vaccination is recommended annually for children older than 6 months.

Choice D rationale:

Hepatitis A vaccine is not routinely given at 2 months of age. Hepatitis A vaccination is typically recommended starting at 1 year of age, with a second dose administered 6-18 months later.

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