Intrapartum and postpartum care of cesarean birth

A nurse has recently transferred to a labor and delivery unit. During a scheduled cesarean, the nurse notices a prescription for the administration of 1,000 mL of prewarmed IV fluid. For which reason does the health care provider prescribe the fluid in this manner? Select all that apply. 1. Results in an increased maternal core temperature 2. Results in improved neonatal umbilical arterial pH 3. Results in improved Apgar scores 4. Results in decreased risk for maternal shock 5. Results in lower incidence of post-partum hypothermia

ANS 1,2,3

The nurse is providing care for a patient who delivered via cesarean 24 hours ago. Which teaching does the nurse provide for the patient and family? Select all that apply. 1. Signs and symptoms to report to health care provider 2. Comfortable positions for feeding the newborn 3. Encouragement for early dietary intake of solid foods 4. Encourage family to help with infant care and housework 5. Provide information on nutrition to promote tissue healing

ANS 1,2,3,4,5

Following a cesarean birth, intrathecal morphine is administered to the patient for postoperative pain management. Of which fact about intrathecal morphine therapy is the nurse aware? Select all that apply. 1. An anesthesiologist or CRNA administers it intrathecally. 2. The nurse needs to closely monitor for common side effects. 3. The drug produces generalized CNS depression. 4. The recommended dose is 10 to 15 mg. 5. The drug alters perception of and response to painful stimuli

ANS 1,2,3,5

The nurse is making a plan of care for a patient who is in the first 24-hour period past a cesarean delivery. Which interventions will the nurse include in regards to medications? Select all that apply. 1. Continue a daily stool softener. 2. Manage pain with morphine. 3. Ensure the availability of naloxone. 4. Provide prophylaxis antibiotics. 5. Administer Rhogam if needed.

ANS 1,2,3,5

In preparation for a cesarean birth, the nurse expects which medical-based preoperative interventions? Select all that apply. 1. Administration of narrow-spectrum prophylactic antibiotics 2. Verification that the woman has been NPO for 6 to 8 hours before surgery 3. Assessment of the woman's knowledge and educational needs 4. Assessment for risk of venous thromboembolism (VTE) 5. Prescription for sequential compression devices prior to surgery

ANS 1.4.5

The nurse in the post-delivery unit is encouraging skin-to-skin contact for a mother and neonate after cesarean delivery. Which action, if noticed by the nurse, requires immediate intervention by the nurse? 1. Mother is sitting up with the neonate prone on her chest. 2. Mother is supine with the neonate prone on her chest. 3. The neonate is prone on mother's chest and facing to the side. 4. Neonate is prone with mother resting in semi-Fowler's position

ANS 2 Neonates are susceptible to sudden respiratory and cardiac arrest during the first few hours of life. Newborns in prone position on the mother's chest, especially if the mother is on her back, are especially susceptible to sudden unexpected newborn collapse (SUNC). The nurse will intervene immediately

The nurses in a labor and delivery unit are concerned about the high incidence of cesarean deliveries at their facility and initiate an internal study. Which is the most likely condition the nurses will recognize as a contributor to the rate of cesarean births? 1. The facility has a high rating for managing high-risk pregnancies. 2. Policies and parameters for cesarean need to be reviewed and refined. 3. Community education about the advantages of vaginal birth is deficient. 4. The incidence of maternal requests for cesarean delivery is increasing

ANS 2 Review of the current literature demonstrates the importance of adhering to appropriate definitions for failed induction and arrest of labor progress as a means to reduce the numbers of cesarean births. Clinical improvement strategies with careful examination of labor management practices is important.

An emergency cesarean is being implemented. The patient describes tingling in her ears and a metallic taste with the administration of regional anesthesia. The nurse is aware that which incidence has occurred? 1. Manifestation of maternal respiratory depression related to anesthesia 2. Inadvertent injection of the anesthetic agent into the maternal bloodstream 3. Maternal hypotension is occurring related to administration of anesthesia 4. Expected manifestations related to anesthetic medications are present

ANS 2 The patient is exhibiting cardinal signs related to inadvertent injection of the anesthetic agent into the maternal bloodstream. The patient may also exhibit hypotension that can lead to loss of consciousness and cardiac arrest.

The nurse is providing care for a prenatal patient who is told she will require a cesarean delivery because of cephalopelvic disproportion. Which explanation of the condition will the nurse provide to the patient? 1. The patient has a preexisting medical condition that supports cesarean birth. 2. The size and/or shape of either the fetal head or patient pelvis is an issue. 3.. The placenta is implanted in an unfavorable position in the uterus. 4. The patient had a surgery with an incision through the myometrium of the uterus.

ANS 2 The patient requires a definition of cephalopelvic disproportion, which prior to labor includes the determination that the size and/or shape of either the fetal head or patient pelvis is an issue.

The nurse is aware that there are multiple classifications for cesarean deliveries. Which situations does the nurse classify as an unscheduled cesarean birth? Select all that apply. 1. Patient had a previous cesarean delivery. 2. There is evidence of a prolapsed cord with membrane rupture. 3. The cervix fails to fully dilate after prolonged labor. 4. Patient has a preexisting cardiac health condition. 5. There is recognition of placenta previa with mild bleeding.

ANS 2,3,4,5

A patient is being prepared for an unplanned cesarean section. Which pre-procedure information is most important for the nurse to report before the administration of regional anesthesia? 1. Hypovolemia corrected with IV fluid administration 2. Inability of the patient to sit on the bedside and flex forward 3. Laboratory value indicating a low platelet count 4. History of patient experiencing headaches after a spinal

ANS 3 The most important information to be reported by the nurse is the laboratory value that indicates a low platelet count. It is the most common contraindication, especially with women who have preeclampsia and/or HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome

The nurse is monitoring a patient who has been in prolonged labor. Which assessment finding will result in the nurse notifying the health care provider about the development of an emergent situation requiring a cesarean delivery? 1. Maternal blood pressure indicative of hypotension 2. Maternal exhaustion from prolonged uterine activity 3. Recognition of a Category II fetal heart rate pattern 4. Increased maternal temperature related to infection

ANS 3 The nurse will notify the health care provider about recognition of a Category II fetal heart rate pattern, which is an indication of fetal intolerance of labor

In a research study performed by Schneuder, L., Crenshaw, J., and Gilder, R. (2017), which action by the nurse will be implemented following a cesarean delivery? 1. Allow the birth partner to hand the neonate to the mother. 2. Assist the mother and partner to cut the umbilical cord. 3. Move the neonate into the visual field of the mother. 4. Encourage skin-to-skin contact between the mother and neonate.

ANS 4 Evidence-based practice from a research study performed by Schneuder, L., Crenshaw, J., and Gilder, R. (2017) strongly supports skin-to-skin contact between the mother and neonate in the operating room. The action significantly decreases the percentage of newborns who are separated from their parents due to transfers to the NICU for observation.

The nurse in labor and delivery notices an increase in the number of women requesting cesarean births. Which are the parameters and criteria used when making the decision to perform a cesarean delivery on maternal request (CDMR)? Select all that apply. 1. Patient is able to self-pay for the procedure. 2. Patient is willing to defer from legal litigation. 3. Mother is planning to only have one child. 4. Patient is aware of possible neonatal complications. 5. Procedure is performed after 39 weeks gestation

ANS 4,5

The nurse understands that logically ____________________ cesarean births are an influential factor related to the overall incidence of cesarean births.

Previous

The nurse is assisting with the preparation of a patient admitted for a planned cesarean birth. The patient has signed the consent form and discussed the elected regional anesthesia with the nurse anesthetist. Which is the most important action for the nurse related to anesthesia? 1. Verify the patient has been NPO for 6 to 8 hours. 2. Start an IV line and administer an IV fluid as ordered. 3. Administer preoperative medications per orders. 4. Obtain a baseline fetal heart rate monitor strip

ANS 4 Obtaining a baseline fetal heart rate monitor strip for at least 20 minutes before the administration of anesthesia is the most important nursing action. Another 20-minute strip will be obtained after the administration of the anesthesia. This comparison makes fetal monitoring more effective.

A patient who is expecting her first baby tells the nurse, "I am afraid of the whole birth experience and plan to ask the doctor for a cesarean delivery." Which response by the nurse is most appropriate? 1. "I will get you some material about how labor pain is managed." 2. "Most women avoid cesarean births unless it is an emergency." 3. "I suggest you talk with the physician and get another opinion." 4. "Cesarean will cause you issues with additional pregnancies."

ANS 4 The nurse needs to inform the patient that if additional pregnancies are desired, cesarean delivery risks increase with each additional pregnancy. Risk for placenta previa, placenta accreta, and gravid hysterectomy rises with each cesarean delivery

The nurse-manager on a labor and delivery unit is monitoring the reasons for cesarean births at the facility. Which reasons contribute to the high rates of cesarean births? Select all that apply. 1. Fetuses in breech position unable to deliver vaginally 2.. Increased number of elective or maternal request cesareans 3. Incidences of women of older maternal age getting pregnant 4. Decreasing rate of malpractice litigation with cesarean birth 5. Presence of nonreassuring fetal tracings during labor

ANS: 1, 2, 3, 5

The nurse is providing care in PACU for a patient who just delivered a neonate via cesarean section. The patient reports tightness in her chest. Assessment findings include tachypnea, hypotension, and decreasing oxygen saturation levels. Which complication does the nurse report to the health care provider? 1. Pulmonary embolism 2. Postpartum hemorrhage 3. Surgical-site infection 4. Developing endometritis

ANS 1 The patient's manifestations are classic for pulmonary embolus. Other assessment findings will include dyspnea, shortness of breath, and hypotension