Intrapartum and Postpartum Care of Cesarean Birth Families

The charge nurse is reviewing documentation with a newly hired postpartum nurse. During review of the uterine fundus assessments, which client requires prompt intervention by the charge nurse? 1. Client #1 2. Client #2 3. Client #3 4. Client #4

3

A client is pregnant with her second child following a cesarean section delivery with the first pregnancy for a breech fetal position. The couple plans to have three children total. What option does the nurse discuss as the best one for this couple? 1. Vaginal birth 2. Repeat c-section 3. External cephalic version 4. Only having two children

1

A client who had a cesarean section calls to the nurses' station and requests the nurse to come to the room two hours after the foley catheter was removed. The client asks the nurse to check for increased vaginal bleeding, due to a feeling of a gush of blood. The nurse notes a large amount of blood, and upon palpation notes that the uterus is displaced to the right and the fundus is boggy. What is the priority intervention the nurse will provide to the client? 1. Retrieve bedpan to allow for client to attempt to empty bladder 2. Administer oxytocin intramuscularly per order 3. Massage the uterus until a return to a midline position and firm 4. Administer a bolus of IV fluids due to the increased bleeding

1

Following a cesarean section a few hours ago, the partner of a client comes out to the nurses' station to report severe itchiness the client is experiencing. The partner voices concern that the client is experiencing an allergic reaction to the morphine given during surgery. How does the nurse respond to the client when entering to the room to assess the itching? 1. "Itchiness, also known as pruritis, is a common reaction to morphine and is not considered an allergy." 2. "Here is some medication to stop the itching." 3. "I will note in your medical record that you have an allergy to morphine." 4. "Let me call the provider and report the itching."

1

While the nurse is preparing a client for an emergency cesarean section, the family voices concern that the client is extremely nervous about the procedure. How does the nurse respond to the client? 1. "Tell me about how you are feeling right now." 2. "We do many c-sections every day, you will be fine." 3. "I am going to insert the foley catheter now." 4. "It is important that you try to calm down for the baby."

1

The nurse is performing preoperative care on a client scheduled for cesarean section. Which nursing actions should be performed? Select all that apply. 1. Insert an IV catheter 2. Administer sodium citrate 3. Trim pubic hair 4. Insert straight catheter 5. Apply sequential compression devices

1, 2, 3, 5

The nurse is caring for a client who delivered a nulliparous pregnancy via cesarean section late the day before. The client is requesting eggs for breakfast. The grandmother is concerned with the client eating a regular diet so soon after surgery. How does the nurse respond to the concern? 1. "That is not how we do it anymore." 2. "Eating actually helps with return of bowel function." 3. "Research changes how things are done frequently." 4. "It is best to always give the client what they want."

2

The nurse is preparing a client in the operating room for a cesarean section. The client asks the nurse why a roll is being placed under the hip. How should the nurse respond? 1. "The hip tilt position allows the provider easier access to the uterus for delivery." 2. "The hip tilt position eases pressure on the inferior vena cava and decreases the risk of hypotension." 3. "The hip tilt position decreases bladder distention and reduces the risk of bladder injury during surgery." 4. "The hip tilt position allows for a quicker delivery of the infant during the c-section."

2

Following a cesarean section, a client with asthma is concerned with developing post-operative pneumonia. What will the nurse include in the education on preventative measures during the first 12 hours after surgery? Select all that apply. 1. Assessing lungs every four hours 2. Utilizing the incentive spirometer regularly. 3. Encourage cough and deep breathing regularly. 4. Ambulate within 24 hours of surgery. 5. Use oxygen when lying in bed.

2, 3,

A client calls for the nurse to come to the room the day after a cesarean section delivery. Upon arrival to the client's room, the nurse notes that the client is dyspneic and appears short of breath. The client reports that her chest feels tight. Based on these assessment findings, what does the nurse report to the provider? 1. Postpartum hemorrhage 2. Wound infection 3. Pulmonary embolism 4. Wound dehiscence

3

A client is requiring a rubella vaccination before discharge following cesarean section delivery of a 34-week gestation female infant. The infant is in the Neonatal Intensive Care Unit. The nurse is explaining why the immunization is required. What should be included in the explanation? 1. Rubella vaccine is given to parents of premature infants. 2. The mother must not have been vaccinated as a child. 3. The mother's blood work demonstrated a non-immune status. 4. This is a normal booster vaccine given to all adults.

3

During a scheduled cesarean section for placenta accreta, the client required a hysterectomy due to failure of the placenta to separate. The gravida 1 para 1 client delivered a healthy baby boy. What concern does the nurse anticipate addressing with the client? 1. Family dysfunction 2. Postpartum psychosis 3. Postpartum depression 4. Ineffective bonding

3

The nurse is scheduling a client for pre-operative blood work prior to a scheduled repeat cesarean section next week. The client is very concerned about needing more bloodwork drawn. How should the nurse respond to the client's concern? 1. "The provider would order bloodwork even if you were having a vaginal delivery." 2. "You need to get this done, or anesthesia will not allow for the surgery to occur." 3. "The bloodwork helps the provider to identify potential risk factors that could complicate the surgery." 4. "Just take your husband with you to help you stay calm while getting the blood drawn."

3

While preparing for a cesarean section delivery, a client asks the nurse when she will be able to ambulate following the surgery. What information will the nurse share with the client? 1. Three hours after the surgery 2. After partial return of sensation 3. After complete return of sensation 4. Twenty-four hours after the surgery

3

A new nurse is providing discharge instructions to a client who is going home three days after a cesarean section delivery. The charge nurse walks by the room and overhears the nurse giving the instructions. Which information would require intervention by the charge nurse? 1. "You will want to continue pain medication as needed to manage the pain." 2. "The baby will need to follow up with the pediatrician in a couple days." 3. "You should try to rest when the baby is resting to help with recovery." 4. "You can remove the staples at home tomorrow utilizing this staple remover."

4

While assessing a post-operative cesarean section client, the nurse notes a temperature of 102.1?. Prior to calling the provider, what other assessment should the nurse complete to include when reporting the concern? 1. Identify the time of last pain medication 2. Assess the c-section incision 3. Assess lung sounds and incentive spirometry 4. Assess uterine fundus and lochia

Option 2: An infection in the incision could be a concern when the client presents with a fever, so the provider will need this information.

The nurse is providing education to a client on when the Intravenous Catheter can be discontinued following a cesarean section. What information will the nurse include? 1. Client has adequate pain control with oral medication. 2. Client can maintain oral hydration without nausea. 3. Client has active bowel sounds in all four quadrants. 4. Client is breastfeeding infant well every couple of hours.

Option 2: The client must be able to maintain hydration without the use of IV fluids.

A new labor and delivery nurse is working with a preceptor to prepare a client for a cesarean section delivery. There is a fetal scalp electrode in place to monitor the fetal heart rate. When does the preceptor advise the new nurse to remove the scalp electrode? 1. Right after the infant is delivered during the surgery 2. After the abdominal prep for surgery 3. Prior to placement of the epidural anesthesia 4. Prior to transfer to the operating room

Option 2: The scalp electrode will be removed after the anesthesia is done and the abdomen is prepped, but before the incision is made.

A mother-baby nurse just received report on four mother baby couplets and is preparing to start the first assessments of the shift. All are recovering from cesarean section deliveries. Which couplet will need to be seen first? 1. Couplet #1: the infant and mother have been doing well since delivery 3 days ago and would like to be discharged in the next couple hours. 2. Couplet #2: the infant has been breastfeeding successfully and the mother has required the uterine fundus to be massaged to firm. 3. Couplet #3: the mother has chosen to bottle feed the infant, and the infant has lost 89 grams of the 3200-gram birth weight at 2 days of age 4. Couplet #4: the infant has been experiencing difficulties latching on to breastfeed and last nursed successfully an hour and a half ago.

Option 2: When the fundus requires massage to firm up, there is a need for close follow up and monitoring of blood loss to assess for postpartum hemorrhage.

A nurse is caring for a client following a cesarean section four hours ago that occurred due to arrest of labor. Initially, the client was admitted to the hospital two days ago after experiencing spontaneous rupture of membranes. Which medication order does the nurse anticipate for this client? 1. Bisacodyl 2. Ampicillin 3. Methergine 4. Dexamethasone

Option 2: Women who experience prolonged rupture of membranes (>24 hours) will require antibiotic treatment

In addition to assessing bowel sounds, what other priority gastrointestinal assessment should be completed on a client following a cesarean section delivery? 1. Assessing for nausea 2. Last bowel movement before surgery 3. Assessing for flatulence 4. Tolerance of a full liquid diet

Option 3: Flatulence, or passing gas, along with active bowel sounds demonstrates peristalsis following abdominal surgery.

The nurse is preparing a client for a cesarean section who is scheduled for 0900. What time will the nurse administer cefazolin? 1. 07:30 2. 08:55 3. 08:00 4. 07:00

Option 3: Prophylactic antibiotics should be administered one hour before the time of the c-section.

When an emergency cesarean section is required a guideline is set for a time frame surrounding the decision time to the incision time. The nurse explains to the client the guidelines for time to optimize fetal outcomes. What timeframe does the nurse share with the client? 1. 60 minutes 2. 45 minutes 3. 30 minutes 4. 15 minutes

Option 3: The guidelines for decision to incision are 30 minutes.