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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Vesicles on the skin, lips, and around the eyes are characteristic findings for a herpes simplex virus (HSV) infection, which is a significant and potentially life-threatening viral infection in a newborn. Candida albicans, a fungus, typically causes superficial mucocutaneous infections and is not associated with vesicular skin lesions unless disseminated, which is rare.
Choice B rationale
A temperature of 37.5°C (99.5°F) is within the normal thermal range for a newborn; normal rectal temperature is 36.5°C to 37.5°C (97.7°F to 99.5°F). While an infection could cause fever, this specific temperature is not necessarily indicative of a Candida infection and is an expected normal finding.
Choice C rationale
Edematous red conjunctivae are classic signs of conjunctivitis (ophthalmia neonatorum), often caused by bacterial pathogens like Chlamydia trachomatis or Neisseria gonorrhoeae, acquired during passage through the birth canal. Candida albicans rarely causes ocular infection unless in immunocompromised infants.
Choice D rationale
White patches on the tongue that cannot be removed with gentle scraping are the pathognomonic sign of oral candidiasis (thrush). This is caused by an overgrowth of the yeast Candida albicans, forming a superficial pseudomembrane composed of yeast, debris, and inflammatory cells on the buccal mucosa and tongue.
Correct Answer is C
Explanation
Choice A rationale
While bonding time is crucial for establishing parent-newborn attachment, it is not the immediate priority during the third stage of labor. The third stage is the period from the baby's birth until the placenta is delivered. The newborn's physiological stability, particularly temperature regulation and respiratory transition, takes precedence over private bonding immediately after birth.
Choice B rationale
Applying identification bands is a critical safety measure to prevent infant abduction or mix-up. However, it is not the absolute first action the nurse should take. Thermoregulation and initial stabilization, such as drying, are the immediate priorities to prevent cold stress and ensure the newborn's physiological adaptation before applying bands or allowing prolonged bonding.
Choice C rationale
Drying the newborn with clean towels is the first and most critical action to prevent heat loss through evaporation. Immediate drying and removing the wet linens are essential for thermoregulation and preventing cold stress, which can lead to increased oxygen consumption and metabolic acidosis. This action also provides tactile stimulation, which can help initiate or sustain respirations.
Choice D rationale
Checking the newborn's axillary temperature is an essential step for monitoring thermoregulation. However, it is an assessment action that follows the intervention of drying the baby. Immediate drying is the priority to prevent heat loss and stabilize the baby's temperature; the temperature check is then used to evaluate the effectiveness of the warming measures.
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