The nurse is teaching a pregnant client about fetal kick counts.
Which statement made by the client indicates a need for further instruction?

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:

Trisomy 21, also known as Down syndrome, is a genetic condition caused by the presence of an extra copy of chromosome 21.

The nuchal translucency test (NT) is a non-invasive ultrasound screening test that measures the thickness of the fluid-filled space at the back of a developing baby's neck.

Evidence suggests that fetuses with Down syndrome tend to have increased fluid accumulation in this area, resulting in a larger-than-average nuchal translucency measurement.

Therefore, an increased NT measurement can be a marker for an increased risk of Down syndrome.

It's important to emphasize that the NT test is a screening tool, not a diagnostic test.

This means it can only indicate an increased risk of Down syndrome; it cannot definitively diagnose the condition.

To confirm a diagnosis, further testing, such as chorionic villus sampling (CVS) or amniocentesis, is required.

Choice B rationale:

Neural tube defects (NTDs) are birth defects that affect the brain, spine, or spinal cord.

The most common NTDs are spina bifida and anencephaly.

The NT test is not a diagnostic test for NTDs, although it might detect some cases of open spina bifida.

However, it's not specifically designed for this purpose, and other tests, such as alpha-fetoprotein (AFP) screening or detailed ultrasound, are more reliable for diagnosing NTDs.

Choice C rationale:

The NT test is typically performed in the first trimester of pregnancy, between 11 and 14 weeks gestation.

It's not available in the second trimester because the nuchal translucency measurement becomes less reliable after this point in pregnancy.

Choice D rationale:

A nuchal translucency measurement of 3mm or less is generally considered normal.

Measurements greater than 3mm are associated with an increased risk of Down syndrome and other chromosomal abnormalities.

The higher the measurement, the greater the risk.