A nurse is assessing a newborn who is 48 hr old and has a maternal history of methadone use during pregnancy. Which of the following manifestations should the nurse identify as an indication of neonatal abstinence syndrome?

Choice D rationale:

During the transition phase of labor, the nurse should encourage the client to use a pant- blow breathing pattern. The transition phase is intense, and pant-blow breathing (a form of controlled breathing) can help the client manage the pain and reduce anxiety. Panting during contractions allows the client to focus on short, shallow breaths, which can be more effective than deep breathing during this stage.

Choice A rationale:

Assisting the client to void every 3 hours is important during labor, but it is not specific to the transition phase. The nurse should encourage the client to void regularly during the entire labor process to prevent bladder distension and facilitate the descent of the baby. However, during the transition phase, the client may be more focused on contractions and may not need reminders to void every 3 hours.

Choice B rationale:

Monitoring contractions every 30 minutes is not appropriate during the transition phase of labor. The transition phase is characterized by frequent and strong contractions, and continuous monitoring of contractions is usually required during this phase to ensure fetal well-being and progress in labor.

Choice C rationale:

Placing the client into a lithotomy position is not appropriate during the transition phase of labor. The lithotomy position, where the client lies on their back with legs raised and supported in stirrups, is often used during the pushing phase. During the transition phase, it is more common for the client to be in an upright or semi-reclining position to facilitate the descent of the baby through the birth canal.

Choice A rationale:

The client's statement about needing to have the IUD replaced each year is incorrect. The lifespan of most IUDs is longer than a year. Copper IUDs can last up to 10 years, and hormonal IUDs can last between 3 to 7 years, depending on the brand.

Choice B rationale:

The client's statement about needing to apply a spermicide prior to intercourse is unrelated to the correct use of an intrauterine device (IUD) for contraception. Spermicides are not required when using an IUD.

Choice C rationale:

The client's statement about expecting periods to stop while having the IUD is incorrect. Hormonal IUDs can often lead to lighter periods, and in some cases, periods may stop altogether. However, with a copper IUD, periods usually remain the same.

Choice D rationale:

This is the correct choice. The client's statement indicates an understanding of the teaching. Checking for the string each month after menstruation is crucial because it confirms that the IUD is still in place, reducing the risk of unintended pregnancy.