The nurse is examining a female patient in an OB clinic who complains of severe pain during menstruation and intercourse.

The nurse suspects endometriosis.

Which of the following is true?

Rationale for Choice A:

Encouraging the woman to rest between contractions can promote relaxation and help conserve energy, but it does not directly address the mechanisms of pain transmission as explained by the gate-control theory. Rest can have indirect benefits for pain management, but it does not directly interfere with pain signals in the same way that massage does.

Rationale for Choice B:

Administering prescribed medication can effectively block pain signals, but it does not rely on the principles of the gatecontrol theory. Medications typically work through pharmacological mechanisms that target pain receptors or neurotransmitters, rather than by competing with pain signals at the spinal cord level.

Rationale for Choice D:

Changing the woman's position can sometimes alleviate discomfort by shifting pressure or encouraging fetal movement, but it does not directly apply the gate-control theory either. Position changes can offer some physical relief, but they do not directly modulate the transmission of pain signals.

Rationale for Choice C:

Massaging the woman's back directly aligns with the gate-control theory of pain management. This theory proposes that nonpainful sensory input can effectively compete with pain signals, preventing them from reaching the brain. The following mechanisms explain how massage applies this theory:

Stimulation of non-painful nerve fibers: Massage activates large-diameter nerve fibers that transmit touch, pressure, and vibration sensations. These signals travel faster than pain signals and can effectively "close the gate" at the spinal cord, preventing pain signals from ascending to the brain.

Release of endorphins: Massage can stimulate the release of endorphins, the body's natural pain relievers. Endorphins bind to opioid receptors in the brain and spinal cord, reducing the perception of pain.

Reduction of muscle tension: Labor pain often involves muscle tension and spasms. Massage can help relax tense muscles, which can indirectly reduce pain by decreasing muscle ischemia and the release of pain-provoking substances.

Promotion of relaxation and distraction: Massage can induce a state of relaxation and provide a distraction from pain. This psychological effect can further contribute to pain relief by reducing anxiety and focusing attention on pleasant sensations.

Conclusion:

Massage offers a non-pharmacological, evidence-based approach to pain management that directly aligns with the gate-control theory. By stimulating non-painful sensory input, promoting relaxation, and releasing endorphins, massage effectively interrupts pain signals and provides significant relief for women in labor.

Choice A rationale:

Electrolytes do not consistently improve during the diuretic phase of renal failure. While urine output increases, the kidneys' ability to regulate electrolytes may still be impaired. Electrolyte imbalances, such as hyperkalemia, hyponatremia, and hyperphosphatemia, can persist or even worsen during this phase.

Close monitoring of electrolytes is crucial to guide appropriate interventions, such as electrolyte replacement or restriction.

Choice B rationale:

Urine output (UO) does not remain unchanged during the diuretic phase. It is a defining characteristic of this phase that urine output increases, often significantly. This increase in urine output is a result of the recovering kidney tubules' ability to excrete fluid and waste products.

Choice C rationale:

Urine output (UO) increases in the diuretic phase of renal failure. This is a key feature that distinguishes this phase from the oliguric phase, which is characterized by decreased urine output. The increase in urine output is typically a sign of kidney function recovery. However, it is important to note that the increase in urine output does not necessarily mean that kidney function has fully recovered.

Choice D rationale:

Oxygenation does not typically worsen during the diuretic phase of renal failure. In fact, oxygenation may improve as fluid overload is resolved and pulmonary edema decreases. However, patients with underlying respiratory conditions or those who experience rapid fluid shifts may still require respiratory support.