A woman is in the 36th week of pregnancy. The nurse practitioner (NP) providing prenatal care learns that the woman has a history of two previous urinary tract infections during this pregnancy
A dipstick urinalysis in the office today is negative for leukocyte esterase and nitrites. The NP should: a. prescribe a low-dose sulfonamide antibiotic for urinary tract infection prophylaxis.
b. order nitrofurantoin daily to minimize the patient's risk of urinary tract infection late in her pregnancy.
c. encourage the patient to increase daily water intake and to wear only cotton underwear.
d. order a voiding cystourethrogram to rule out structural anomalies that may cause urinary tract infection.
C
For women at risk for recurrent urinary tract infection while pregnant, prevention and treatment begin with nonpharmacologic therapy: forcing fluids and wearing cotton underpants. Sulfonamide antibiotics and nitrofurantoin are used for documented urinary tract infection during pregnancy, but not after the 36th week of gestation. A voiding cystourethrogram is not indicated and would expose the fetus to radiation.
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