Week 5 Davis

The nurse is preparing a client for a cesarean section who is scheduled for 0900. What time will the nurse administer cefazolin?

8:00

Following completion of four deliveries via cesarean section, the nurse states in shift report the APGAR scores for the four newborns. Which infant does the oncoming nurse see first?

APGAR 5, APGAR 7

The obstetric nurse is preparing a client for an epidural. What is the priority nursing intervention prior to this procedure?

Administer IV fluid bolus

While presenting an educational session on childbirth the nurse was asked to discuss risk factors requiring a cesarean section. What should the nurse include in her response? Select all that apply.

Advanced maternal age, breech position

The nurse is preparing a client for a cesarean section. Following the epidural anesthesia, the nurse is ready to show the partner where to stay during the surgery. Where does the nurse show the partner to go?

On a stool next to the clients head

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?

Client #3

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?

Client can maintain oral hydration without nausea

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?

"Itchiness, also known as pruritis, is a common reaction to morphine and is not considered an allergy."

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?

"The hip tilt position eases pressure on the inferior vena cava and decreases the risk of hypotension."

The nurse is providing discharge instructions to a client and family following a cesarean section delivery three days ago. The family is unsure how to help the client at home. What does the nurse include in the education? Select all that apply.

1. bring meals to the family 4. Offer to do housework

Following the occurrence of several cesarean sections, the charge nurse is reviewing the blood loss on four clients. What is the expected maximum value of blood loss for a client who underwent a cesarean section?

1000ml

The nurse in the Post Anesthesia Care Unit is weighing pads to calculate blood loss following a cesarean section delivery. The nurse converts the grams of weight to milliliters of blood loss. What is the conversion formula that is used in this calculation?

1ml = 1g

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?

30 minutes

The nurse is calculating total estimated blood loss for an eight-hour shift on a client. The client is recovering from a c-section on the previous day. The nurse has documented the following weights for four pads during the shift: 153 g, 208 g, 92 g, and 346 g. What is the total estimated blood loss in mL for the client during the shift? Enter numerical value only.

799

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?

After the abdominal prep for surgery

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?

Ampicillin

A nurse is teaching a childbirth education class for expectant parents. One of the clients is concerned about cesarean sections and asks what the most common indication for needing a cesarean section would be. What is the appropriate nursing response?

Arrest of Labor

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?

Assess the c-section incision

In addition to assessing bowel sounds, what other priority gastrointestinal assessment should be completed on a client following a cesarean section delivery?

Assessing for flatulence

The provider is providing an emergency cesarean section and uses the following skin incision. How will the nurse document this type of incision?

Classical

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?

Couplet #2: the infant has been breastfeeding successfully and the mother has required the uterine fundus to be massaged to firm.

The nurse is assessing a client's incision following a cesarean section. The dressing has just been removed. What findings would require further intervention? Select all that apply.

Ecchymosis, warmth, edema, redness

While preparing a client for an emergency cesarean section, the nurse places an oxygen mask on the client. What is the rationale for this nursing intervention?

Fetal intolerance to labor

The nurse is preparing a client for a scheduled cesarean section for a breech presentation and a failed external cephalic version. The couple has two other children at home. What statement made by the client during the admission would require intervention by the nurse?

I will miss being able to breastfeed. I breastfed my other children for one year each.

Following cesarean delivery, a stable female infant weighing 3,126 grams is placed skin-to-skin with the mother. The client's partner asks why the infant is placed with the mother during the remainder of the surgery. What is the best response from the nurse?

Infants are less likely to need NICU care when placed skin-to-skin with the mother

The anesthesiologist reviews the blood work for a client scheduled for a cesarean section and determines that an epidural or spinal anesthesia are not possible. The nurse explains which lab result to the client as the reason for this determination?

Platelet 99th/mm3

A nurse is completing an assessment on a client following a cesarean section delivery the day before. The client appears to be short of breath. Vital signs are as follows: Temperature 98.5?, Pulse 62, Respirations 42, Blood pressure 102/74, and Pulse oximetry 88%. Based on these assessment findings, what concern does the nurse relay to the provider?

Pulmonary embolism

During a childbirth education class focused on labor and delivery, the nurse is discussing Cesarean Delivery on Maternal Request. What neonatal complications does the nurse include when addressing deliveries earlier then 39 weeks' gestation? Select all that apply.

Respiratory distress, hypothermia, hypoglycemia

A client reports a headache and dizziness following a scheduled cesarean section yesterday with spinal anesthesia. What does the nurse report to the provider as a concern for this client?

Spinal headache

Upon entering a client room to perform the initial assessment following a cesarean section, the nurse finds the client tearful and the client's partner mentions mutual disappointment with the unexpected c-section delivery, as they had desired a natural birth. How does the nurse respond to the couple?

Tell me more about how you are feeling after the surgery

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. How does the nurse respond to the client's concern?

The bloodwork helps the provider to identify potential risk factors that could complicate the surgery.

A nurse on the postpartum care unit is anticipating admission of a client immediately after an emergency cesarean section. The surgery was due to a Category III fetal monitor tracing and was performed under general anesthesia. What client concerns does the nurse anticipate as addressing with this client?

The need for C-section delivery

A nurse is caring for a client following a cesarean section delivery the day before. During the assessment, the nurse checks for Homan's sign. Why is the nurse conducting this assessment?

There is an increased risk for thromboembolism after surgery.

A nurse is caring for a client following a cesarean section delivery the day before. During the assessment, the nurse checks for Homan's sign. Why is the nurse conducting this assessment?

There is an increased risk of thromboembolism after surgery

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?

Vaginal birth

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?

You can remove the staples at home tomorrow utilizing this staple remover.