A nurse is assisting a pregnant patient in labor who is experiencing discomfort. The nurse decides to use effleurage as a comfort measure. Which of the following best describes the technique of effleurage?
Choices:
Counterpressure of the lower back.
Gentle, rhythmic tapping on the patient’s abdomen.
Rapid, firm kneading of the patient’s arms and legs.
Light, circular stroking movements on the patient’s abdomen.
The Correct Answer is D
Choice A rationale
Counterpressure of the lower back involves applying firm pressure to alleviate back pain, but it is not effleurage. Effleurage is focused on light, circular strokes.
Choice B rationale
Gentle, rhythmic tapping on the patient’s abdomen is not part of effleurage. Effleurage consists of smooth, circular movements rather than tapping motions.
Choice C rationale
Rapid, firm kneading of the patient’s arms and legs describes petrissage, a different massage technique. Effleurage is characterized by light, circular stroking movements on the abdomen.
Choice D rationale
Light, circular stroking movements on the patient’s abdomen describe effleurage. This technique is used to provide comfort and relaxation during labor by stimulating skin receptors.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D"]
Explanation
Choice A rationale: Performing a sterile vaginal examination (SVE) is important for assessing cervical dilation and effacement, but it does not address the immediate concern of a Category 3 fetal heart rate tracing, which indicates fetal distress and requires prompt intervention.
Choice B rationale: Placing the client in a side-lying position can improve uteroplacental blood flow and oxygenation to the fetus by relieving compression on the inferior vena cava and enhancing venous return, thereby reducing fetal distress observed in Category 3 tracings.
Choice C rationale: Applying oxygen at 10 L/min via a venturi mask increases maternal oxygenation, which can enhance oxygen delivery to the fetus. This intervention is crucial in addressing fetal distress and improving fetal oxygenation, as observed in Category 3 fetal heart rate tracings.
Choice D rationale: Initiating a bolus of primary IV fluids can improve maternal blood volume and circulation, thereby enhancing uteroplacental perfusion and fetal oxygenation. This intervention is important in managing Category 3 fetal heart rate tracings and reducing fetal distress.
Choice E rationale: Increasing the oxytocin infusion to 13 mu/min is not appropriate as it can lead to hyperstimulation of the uterus, reducing uteroplacental blood flow and exacerbating fetal distress. In Category 3 tracings, the oxytocin infusion should be discontinued to reduce contractions.
Correct Answer is ["A","C","E","F"]
Explanation
Choice A rationale
Cervical dilation and effacement indicate the body is preparing for labor by allowing the cervix to open and thin out for childbirth.
Choice B rationale
Swelling of the feet and ankles is common in pregnancy due to increased fluid retention but is not a specific sign of imminent labor.
Choice C rationale
The nesting instinct, a burst of energy and urge to prepare the home, often occurs as labor approaches, driven by hormonal changes.
Choice D rationale
Increase in maternal blood pressure may indicate preeclampsia, a pregnancy complication, but not a premonitory sign of labor.
Choice E rationale
Bloody show involves the discharge of mucus with blood from the cervix, signaling that labor is likely to begin soon.
Choice F rationale
Increase in Braxton Hicks contractions, or practice contractions, helps the uterus prepare for true labor by strengthening muscles.
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