A client at 39-weeks gestation presents to labor and delivery with contractions occurring at regular intervals. Her obstetrical history includes a miscarriage at 16-weeks gestation and fetal demise at 31-weeks gestation.
How should the practical nurse (PN) record the client's gravida?

Choice A rationale

Proper disposal of personal tissues in a no-touch receptacle is a general infection control measure, but it is not specific to the pathophysiology or transmission of Lyme disease, which is caused by the bacterium *Borrelia burgdorferi* and transmitted by ticks. This action does not directly address the primary disease process.

Choice B rationale

Maintaining bedrest during the prodromal phase is not a specific or primary intervention for Lyme disease. While rest can be beneficial for any illness, Lyme disease treatment focuses on antibiotic therapy to eradicate the spirochete and prevent disease progression.

Choice C rationale

The prompt administration of antiinfectives, typically antibiotics like doxycycline or amoxicillin, is crucial in treating Lyme disease. Early and consistent antibiotic therapy prevents dissemination of the spirochetes, reduces the severity of symptoms, and minimizes the risk of developing chronic complications such as Lyme arthritis or neurological Lyme disease.

Choice D rationale

Lyme disease is transmitted through the bite of infected ticks, primarily the blacklegged tick (*Ixodes scapularis*). It is not transmitted from person to person or from family pets, making avoidance of pets irrelevant to disease transmission or management.

Choice A rationale

Obtaining blood gas samples from an umbilical artery catheter (UAC) is a procedure performed by advanced practitioners, such as physicians or specialized critical care nurses, due to the inherent risks of arterial sampling, including vasospasm, thrombosis, and infection. This is beyond the scope of practice for a practical nurse.

Choice B rationale

Administering nebulized inhalation therapy requires a specific prescription and careful assessment of the infant's respiratory status. While PN scope varies, initiating such a therapy without explicit instruction and comprehensive assessment is typically outside a PN's independent practice, especially in a neonate with evolving respiratory needs.

Choice C rationale

Initiating 50% oxygen supplementation is a significant intervention that requires a physician's order and continuous monitoring of the infant's oxygen saturation to prevent hyperoxia, which can lead to complications such as retinopathy of prematurity or pulmonary damage. A PN would not independently initiate this.

Choice D rationale

Assessing and recording oxygen saturation levels using pulse oximetry is a fundamental nursing responsibility and falls well within the scope of practice for a practical nurse. This non-invasive assessment provides crucial data regarding the infant's oxygenation status, guiding further interventions and monitoring the effectiveness of oxygen therapy. Normal range for neonates is typically 90-95% or higher.