# A 32-year-old multiparous woman delivered vaginally 36 hours ago. She reports burning sensation during urination, urinary frequency, and urgency. Her vital signs are: temperature 100.2°F (37.9°C), pulse 88 bpm, respirations 18/min, and blood pressure 118/76 mmHg. What is the most appropriate initial nursing intervention? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=543127 > language: ko > subject: Maternal Newborn Health ## 문제 A 32-year-old multiparous woman delivered vaginally 36 hours ago. She reports burning sensation during urination, urinary frequency, and urgency. Her vital signs are: temperature 100.2°F (37.9°C), pulse 88 bpm, respirations 18/min, and blood pressure 118/76 mmHg. What is the most appropriate initial nursing intervention? The nurse is caring for a 28-year-old woman who delivered vaginally 48 hours ago. She reports experiencing a burning sensation when urinating, needing to urinate frequently, and feeling an urgent need to void even when her bladder is not full. ## 보기 1. Encourage increased oral fluid intake to 3000-4000 mL per day 2. Administer prescribed analgesics for pain relief 3. Apply ice packs to the perineal area for comfort 4. Obtain a clean-catch midstream urine specimen for culture and sensitivity **✔ 정답** **정답: 4** ## 해설 Obtaining a urine specimen for culture and sensitivity is the most appropriate initial intervention to confirm diagnosis and guide antibiotic therapy. Other options (fluid intake, analgesics, ice packs) do not address the need for diagnostic confirmation. ## 심화 해설 Understanding the Clinical Presentation The patient is a postpartum woman, 36 hours post-vaginal delivery, presenting with classic lower urinary tract symptoms: dysuria (burning sensation), urinary frequency, and urgency. She also has a low-grade fever (100.2°F / 37.9°C). This cluster of symptoms in a recently postpartum patient is highly suggestive of a urinary tract infection (UTI). The postpartum period creates a physiologically vulnerable state; as noted in the literature, the hypoestrogenic environment of lactation can contribute to a spectrum of genitourinary symptoms, including an increased risk for urinary tract infection (UTI) [1]. While perineal trauma from delivery can cause local discomfort, the specific combination of internal symptoms (urgency, frequency) with a systemic sign (fever) points away from simple wound pain and toward an infectious process. Prioritizing the Nursing Intervention The most appropriate initial nursing intervention is to obtain a clean-catch midstream urine specimen for culture and sensitivity. This is the essential first step in the diagnostic process. Before any treatment can be initiated, the causative organism must be identified to ensure appropriate therapy. Administering analgesics or applying ice packs addresses comfort but does not diagnose or treat the underlying cause of the symptoms. While encouraging increased oral fluid intake is a helpful supportive measure for UTI management, it is not the priority action before a proper diagnosis is established. The nurse must first collect a proper specimen to confirm the infection and guide antibiotic selection, a critical step in preventing progression to more severe conditions like pyelonephritis or, in rare cases, postpartum endometritis, which can be caused by atypical organisms and requires targeted treatment . Rationale for Diagnostic Priority over Symptom Management The clinical reasoning follows the nursing process: assessment and diagnosis must precede implementation of treatments. The patient's report of a burning sensation during urination, combined with frequency and urgency, provides subjective data that requires objective validation. A clean-catch urine specimen is a non-invasive, high-priority assessment that will yield a definitive diagnosis. The presence of a low-grade fever is an additional objective sign that an infectious process is likely systemic or ascending. In the postpartum context, where the vaginal and gut microbiota are in flux and can influence recovery and pain perception, distinguishing infectious pain from other sources of postpartum discomfort is vital for safe, effective care . Initiating pain relief without a specimen could mask symptoms and delay necessary antibiotic therapy, potentially leading to worsening infection.References (research sources) - [1]Postpartum health-seeking behaviours, awareness and experiences of Genitourinary Syndrome of Lactation.Research articleSantos E, Bradfield Strydom M, Perelmuter S, Schloss J. (2026) · DOI: 10.1016/j.midw.2026.104911 ## 임상 시나리오 Clinical Scenario A 32-year-old multipara, 36 hours post-vaginal delivery, reports dysuria, urinary frequency, and urgency. Vital signs show a low-grade fever (100.2°F / 37.9°C), pulse 88, respirations 18, and BP 118/76. The presentation is highly suggestive of a postpartum urinary tract infection (UTI). Nursing Prioritization The most appropriate **initial** nursing intervention is to obtain a clean-catch midstream urine specimen for culture and sensitivity. This aligns with the nursing process: assessment and diagnosis must precede implementation of treatments. A proper specimen ensures targeted antibiotic therapy and prevents antibiotic resistance or treatment delay. Clinical Practice Guide - **Specimen Collection:** Instruct the patient to clean the perineum front-to-back, begin voiding, pause, and then collect the midstream portion in a sterile container. Label and transport the specimen to the lab promptly or refrigerate it. - **Supportive Measures:** After the specimen is collected, encourage increased oral fluid intake (3000-4000 mL/day unless contraindicated) to promote urinary dilution and bladder flushing. Administer prescribed analgesics as needed for comfort. - **Ongoing Assessment:** Monitor for signs of ascending infection (pyelonephritis), such as costovertebral angle tenderness, high fever, chills, or nausea. Assess lochia, fundal height, and perineal healing to rule out endometritis or infected lacerations. - **Patient Education:** Teach proper perineal hygiene, complete prescribed antibiotic courses even if symptoms improve, and report worsening symptoms immediately. Emphasize the importance of emptying the bladder completely and frequently. Rationale for Avoiding Other Interventions Administering analgesics or applying ice packs (options 2 and 3) treats symptoms without addressing the underlying infection. Encouraging fluids (option 1) is a supportive, not diagnostic, measure and could dilute the urine specimen, potentially affecting culture results if collected afterward. ## 핵심 개념 - **Dysuria** — Painful or difficult urination, commonly described as a burning sensation, which is a classic symptom of a urinary tract infection. - **Clean-catch midstream urine specimen** — A collection method to minimize contamination from the perineum, requiring the patient to begin voiding, pause, and then collect urine midstream into a sterile container. - **Culture and sensitivity** — A laboratory test that identifies the specific bacteria causing an infection (culture) and determines which antibiotics are most effective against it (sensitivity). - **Postpartum physiologic vulnerability** — The period after childbirth when physiological changes, such as a hypoestrogenic state from lactation and urinary stasis, increase the risk of complications like UTIs. ## 같은 주제 문제 - [A postpartum client on her second day after vaginal delivery reports burning sensation dur…](https://mymerci.kr/pages/nclex_q.php?qn_id=543125) - [A postpartum client on her second day after vaginal delivery reports burning sensation dur…](https://mymerci.kr/pages/nclex_q.php?qn_id=543126) - [A postpartum client on her second day after vaginal delivery reports burning sensation dur…](https://mymerci.kr/pages/nclex_q.php?qn_id=543128) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._