Assisted Delivery and Cesarean Birth
A woman who has had a cesarean birth asks you if she will always need to have cesarean births in the future. Which of the following would be your best response? - -"You will like cesarean birth so much that you will want repeat cesarean births in the future." -"There is no way to predict that; it will depend on your individual uterine anatomy." -"Yes. 'Once a cesarean always a cesarean' is a well-known rule." -"Although there are some exceptions, surgical techniques allow for vaginal birth after cesarean birth."
"Although there are some exceptions, surgical techniques allow for vaginal birth after cesarean birth." Explanation: Low cervical incisions allow for vaginal birth following cesarean birth because they do not involve the fundal portion of the uterus.
A nurse has learned about methods newer than the Bishop score to determine if a cervix is favorable for induction. The method that measures cervical length uses which of the following measurements to determine a favorable induction? -27 mm or less -30 mm or less -35 mm or less -37 mm or less
27 mm or less Explanation: A new method for predicting labor readiness is determination of cervical length by endovaginal ultrasound. A cervix that measures 27 mm or less is associated with a favorable induction rate.
A 21-year-old has been in labor for 4 hours; her examination 2 hours ago revealed 6 cm/100%/-3. During a contraction, she spontaneously ruptures her membranes. The doctor checks the patient, finds her to be 9 cm/100%/-3, and states that the cord is palpable. What should the nurse do? -Call for help and prepare the patient for an emergency cesarean delivery. -Set up for imminent vacuum delivery. -Call the pediatricians into the room for imminent vaginal delivery. -Set up for imminent forceps delivery.
Call for help and prepare the patient for an emergency cesarean delivery. Explanation: When the cord is palpable on examination, this indicates that the cord has prolapsed and emergency cesarean delivery is needed. This patient is not a candidate for vacuum or forceps delivery because she is not 10 cm dilated.
A woman is being seen in the clinic for care during her first pregnancy and birth. The nurse will educate this woman and her significant other about their planned cesarean delivery and what can be expected. When should the nurse provide this family education? -At a preset time one month prior to the scheduled delivery - Only when she and her significant other can come to the clinic together -When the client presents for admission for the procedure -Each time the nurse sees the woman before surgery
Each time the nurse sees the woman before surgery Explanation: The focus of nursing intervention for a planned cesarean is family education. Each time you encounter the woman before surgery is an opportunity to explore with the woman and her partner what they know about cesarean delivery. Part of the education will include the circulatory and musculoskeletal activities which the woman can practice before the surgery to help prevent potential complications after the surgery. The nurse should also assess how much the family know and ensure they have the correct information.
A young woman comes into the clinic in the eighth month of her pregnancy. She is requesting information regarding cesarean delivery and wants to discuss this method of delivery. The nurse knows that the rate of cesarean deliveries has increased because of which reasons? Select all that apply. -Increased use of induction for nonmedical reasons -Rise in the number of older pregnant women -Change in perception of risk by patients and physicians -An increase in vaginal birth after cesarean (VBAC) attempts. -Increased incidence of maternal obesity
Increased use of induction for nonmedical reasons Rise in the number of older pregnant women Change in perception of risk by patients and physicians Increased incidence of maternal obesity Explanation: The decrease in VBAC attempts have lead to an increase in cesarean deliveries. All other answers are correct.
The nurse is concerned that a pregnant patient will have a complication from a medication after a cesarean birth. For which prescribed medications are complications most likely to occur? Select all that apply. -Insulin -Anticoagulant -Antihypertensive -Antianxiety agent -Beta2-adrenergic blocker
Insulin Anticoagulant Antihypertensive Antianxiety agent Explanation: Some medications can cause complications with cesarean births. Insulin may lead to hypoglycemia during labor or hyperglycemia if a dextrose solution is provided. Anticoagulants may cause hemorrhage due to lack of hemostasis during surgery. Antihypertensives may result in hypotension after anesthesia. Antianxiety agents may cause hypotension after anesthesia. There is no evidence to suggest that beta2-adrenergic blockers will cause a complication after a cesarean birth.
The nurse has received the beginning-of-shift report for five clients. With which conditions will the nurse anticipate a cesarean delivery? Select all that apply. -Placenta previa -A previous cesarean section -Active vaginal or cervical herpes lesions -Active breast cancer -A classical uterine scar
Placenta previa Active vaginal or cervical herpes lesions A classical uterine scar Explanation: Active herpetic lesions on the perineum, invasive cervical cancer, a previous classical incision on the uterus, and complete placenta previa are all contraindications to a vaginal delivery. A woman who has had a previous cesarean section or a low-lying placenta may be counseled about the risks and benefits of a trial of labor after cesarean and subsequent vaginal delivery. Breast cancer would not be an indication of needing a cesarean delivery.
A woman has just been informed that she needs to have a cesarean delivery due to cephalopelvic disproportion. The patient asks the nurse if there is any danger for the baby if delivered by cesarean. The nurse correctly identifies which of the following as potential fetal complications of cesarean delivery? Select all that apply. -Respiratory distress -Delivery of an immature fetus -Laceration of the fetus -Bruising -Increased respiratory drive due to anesthesia
Respiratory distress Delivery of an immature fetus Laceration of the fetus Bruising Explanation: All of the above are potential fetal complications of cesarean deliveries excepting increased respiratory drive due to anesthesia. Respiration is decreased.
A nurse assisting in a cesarean birth should essentially demonstrate understanding of which of the following? -Oxytoxin mechanism of action -Complications associated with uterine hyperstimulation -Skill in either a scrubbing or circulating role -Interpretation of non-reassuring FHR patterns
Skill in either a scrubbing or circulating role Explanation: The nurse would be required to demonstrate her skill in either a scrubbing or circulating role when assisting in a cesarean birth since caesarean births involve surgical procedures. Having an understanding of oxytoxin pharmacology, knowing the complications of uterine hyperstimulation, and an understanding of non-reassuring fetal heart rate tracings are associated with the procedure of induction for vaginal birth and not with the surgical procedures involved in cesarean births.
The nurse is caring for a client who is insisting on a vaginal delivery. For which situation should the nurse explain a vaginal delivery is contraindicated? Select all that apply. -Spina bifida -Macrosomia -Transverse lie -Breech presentation -Preterm delivery
Spina bifida Transverse lie Explanation: Suspected macrosomia, preterm delivery, and breech presentation as an isolated factor are not absolute contraindications for vaginal delivery, even though many healthcare providers prefer to perform a cesarean in these situations. Transverse lie and spina bifida are an absolute contraindication to a vaginal delivery.
The type of skin incision done for a cesarean section will indicate the type of uterine incision. true false
false Explanation: The type of skin incision does not indicate the type of uterine incision during a cesarean section. If the woman's obstetric history is unknown, the surgeon will ask to see the previous surgical record to determine the type of uterine incision.
A client is being admitted at 41-weeks gestation with a cervix which is not ready for labor and delivery. Which procedure might the nurse prepare the client for? (Select all that apply.) -membrane stripping -mechanical dilation -locally applied prostaglandins -artificial rupture of membranes -episiotomy
membrane stripping mechanical dilation locally applied prostaglandins artificial rupture of membranes Explanation: If the cervix is not ready and a medical reason exists for labor induction, the nurse can expect one of the following methods to be used: membrane stripping, mechanical dilation, locally applied prostaglandins, artificial rupture of membranes, or oxytocin induction. An episiotomy is a surgical incision made into the perineum to enlarge the vaginal opening just before the baby is born.
A nursing student asks the instructor if there are any reasons not to do an elective induction. The instructor correctly identifies which reasons? Select all that apply. -need for more interventions -longer labor -higher costs -possible cesarean section -shorter stay
need for more interventions longer labor higher costs possible cesarean section Explanation: An elective induction should never be done unless the woman understands that it often results in more interventions, longer labors, highers costs, and possible cesarean births. Shorter stays are not negative or a concern for elective inductions.
A nursing student correctly identifies which of the following as medical reasons to induce labor? Select all that apply. -postdate pregnancy -pregnancy that persists beyond the due date -gestational hypotension -premature rupture of membranes without spontaneous labor -preeclampsia
postdate pregnancy pregnancy that persists beyond the due date premature rupture of membranes without spontaneous labor preeclampsia Explanation: Some situations that warrant a medically induced induction are postdate pregnancy, pregnancy that persists beyond the due date, premature rupture of membranes without the onset of spontaneous labor, infection of fetal membranes, and preeclampsia. Gestational hypotension is not a reason.
The physician has just examined the patient and determined that she needs to have a cesarean section. He notifies the nurse that he will be doing a low cervical vertical incision into the uterus. The nurse knows that the physician has chosen this type of incision over the classical incision because the low cervical vertical incision: -is larger than a classical incision and will allow for easier delivery. -reduces the risk of uterine rupture. -is less complicated to perform. -has a lower risk of maternal injury.
reduces the risk of uterine rupture. Explanation: The incision in the low cervical vertical incision is smaller than a classical incision. The low cervical vertical incision is more complicated to perform and has a higher risk of maternal injury. The low cervical vertical incision reduces the risk of uterine rupture.
After learning about the need for a cesarean birth, the pregnant patient begins to cry and hyperventilate. Which nursing diagnosis should the nurse use to guide the care that the patient needs at this time? -Fear related to impending surgery -Risk for infection related to a surgical incision -Powerlessness related to medical need for cesarean birth -Risk for impaired parent/infant attachment related to unplanned method of birth
Fear related to impending surgery Explanation: The patient's emotional response after learning about a cesarean birth is most likely fear. The nurse should use the diagnosis of "fear related to impending surgery" to guide interventions at this time. The patient's emotional response is not likely because of a risk of infection, powerlessness, or a risk for impaired parent/infant attachment.
A woman has just entered the recovery room after cesarean birth of a baby weighing 9 lb 14 oz. After connecting the client to the blood pressure monitor, it is noted her HR is 120 and BP is 80/40. What nursing action should be a priority? -Assess for bleeding -Call the MD -Administer oxygen -Administer an IV bolus of fluids
Assess for bleeding Explanation: The elevated HR and BP could be an indication of hemorrhaging. The priority will be to assess for bleeding by assessing the uterine fundus and checking the perineum. Although this is a responsibility of the RN, the LPN should also be aware. The other choices may follow if deemed necessary, depending on the cause of the elevated HR and BP.
