A nurse is reinforcing teaching with a client about the use of a transcutaneous electrical nerve stimulation (TENS) device for back pain during labor.
Which of the following information should the nurse include?
TENS intensity is manually increased during a contraction.
TENS is most useful during the third stage of labor.
TENS eliminates pain during a contraction.
TENS is contraindicated for clients who have gestational diabetes.
The Correct Answer is A
Choice A rationale
Transcutaneous electrical nerve stimulation (TENS) operates on the Gate Control Theory of Pain, where non-painful electrical stimuli are applied, attempting to block the transmission of pain signals. The intensity must be manually increased by the client during a contraction to override the escalating pain impulse and achieve maximum analgesic effect when the pain is most intense, providing the best pain modulation.
Choice B rationale
TENS is primarily used for the low back pain and abdominal pain experienced during the active phase of the first stage of labor (cervical dilation), providing a distraction and non-pharmacological pain relief option. It is less effective during the second stage (pushing) and is not typically indicated for the third stage of labor (placental expulsion), which has different pain mechanisms.
Choice C rationale
TENS works by stimulating large sensory nerve fibers to modulate or decrease the perception of pain (pain modulation), offering a sense of control and relief, but it does not eliminate the pain entirely, particularly the intense visceral pain of uterine contractions. It is a non-invasive pain coping mechanism, not an anesthetic agent that would abolish pain sensation.
Choice D rationale
Gestational diabetes mellitus (GDM) is a maternal metabolic condition and is not a contraindication for the use of TENS during labor. The primary contraindications for TENS include the use of a cardiac pacemaker, application over the heart or head, or in the presence of fetal electronic monitoring electrodes that could conduct the current, none of which are related to GDM.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Loosely wrapping the cord is an important secondary intervention for prolapsed umbilical cord but is not the immediate first action. The priority is to relieve pressure on the cord to maintain fetal oxygenation by reducing compression and sustaining blood flow until delivery can be safely achieved.
Choice B rationale
Assisting the client into a knee-chest position (or Trendelenburg) is the immediate priority action for an umbilical cord prolapse. This maternal position uses gravity to shift the presenting fetal part off the umbilical cord, immediately relieving compression and restoring blood flow to the fetus, preventing fetal hypoxia.
Choice C rationale
Applying an external fetal monitor is a vital step for continuous fetal assessment, but it is not the first action in this emergency. Relieving the cord compression and ensuring adequate oxygenation by changing the maternal position takes precedence over monitoring the fetal heart rate, which will likely be non-reassuring due to the cord compression.
Choice D rationale
Administering high-flow oxygen to the mother is an important intervention to maximize maternal-fetal oxygen transfer and improve fetal oxygenation. However, restoring placental blood flow by relieving the cord compression via proper maternal positioning is the physiologically immediate and most critical action to prevent fetal injury.
Correct Answer is A
Explanation
Choice A rationale
Elevated maternal serum alpha-fetoprotein (MSAFP) levels can suggest a neural tube defect (NTD), such as spina bifida or anencephaly. Alpha-fetoprotein is a glycoprotein produced by the fetal liver and yolk sac. With an open NTD, this protein leaks from the exposed fetal tissue into the amniotic fluid and subsequently crosses the placenta into the maternal bloodstream, causing the observed elevation.
Choice B rationale
Trisomy 21 (Down syndrome) is typically associated with lower than normal MSAFP levels. MSAFP is part of the quad screen (or triple screen) that screens for common chromosomal abnormalities. Low levels of MSAFP, often combined with abnormal levels of other markers like β-hCG, unconjugated estriol, and inhibin A, suggest an increased risk for this aneuploidy.
Choice C rationale
Phenylketonuria (PKU) is an inherited metabolic disorder where the body cannot properly metabolize the amino acid phenylalanine due to a deficiency of the enzyme phenylalanine hydroxylase. It is not directly associated with elevated MSAFP levels. PKU is screened for in newborns via a heel stick blood test, usually 24 to 48 hours after birth.
Choice D rationale
Hemophilia is an X-linked recessive bleeding disorder caused by a deficiency in specific clotting factors, typically factor VIII (Hemophilia A) or factor IX (Hemophilia B). This condition involves defective hemostasis and is not indicated by an elevated MSAFP. Hemophilia is often diagnosed through specific clotting factor assays.
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