A 42-year-old woman is admitted with complaints of dysuria, frequency, and lower back pain. The urinalysis report is positive for red blood cells and the blood work shows an elevated white blood cell count. Which medication will the nurse anticipate that the healthcare provider will order.

Choice A rationale Bethanechol chloride is a cholinergic agonist primarily used to treat non-obstructive urinary retention by stimulating the detrusor muscle. In this clinical scenario, the patient is presenting with symptoms of a urinary tract infection, including dysuria and frequency. Stimulating bladder contraction without addressing the underlying infectious process is inappropriate and does not target the pathogen responsible for the elevated white blood cell count or the hematuria observed in the urinalysis report. Choice B rationale Meperidine is a potent opioid analgesic used for the management of severe pain, but it is not a primary treatment for urinary tract infections. While the patient has lower back pain, opioids do not address the systemic infection indicated by the elevated white blood cell count. Furthermore, meperidine is often avoided in patients with potential renal impairment due to the accumulation of its metabolite, normeperidine, which can cause significant neurotoxicity or seizures. Choice C rationale Metronidazole is an antimicrobial medication effective against anaerobic bacteria and certain protozoa, such as Trichomonas vaginalis. While it may be used for specific vaginal infections that cause urinary symptoms, it is not the standard first-line treatment for common bacterial cystitis or pyelonephritis. The symptoms of dysuria, frequency, and back pain with systemic leukocytosis typically suggest a Gram-negative bacterial infection, which falls outside the primary antimicrobial spectrum of metronidazole therapy. Choice D rationale Ciprofloxacin is a fluoroquinolone antibiotic that provides broad-spectrum coverage against many Gram-negative and Gram-positive organisms commonly causing urinary tract infections, such as Escherichia coli. Given the patient's symptoms of dysuria and flank pain combined with leukocytosis, an infection like pyelonephritis is suspected. Ciprofloxacin is highly effective because it reaches high concentrations in the urine and kidney tissue, directly treating the cause of the infection and preventing further systemic complications or renal damage.