Davis Edge Chapter 11: Intrapartum Care Cesarean Birth

Following completion of four deliveries via C-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 6 APGAR 8, APGAR 8 APGAR 9, APGAR 10 APGAR 7, APGAR 9

1 APGAR 5, APGAR 6 Rationale: APGAR scores are expected to be 7 or above at 1 and in 5 minutes following the delivery, unless there is fetal intolerance to labor before delivery. APGAR 8, APGAR 8 APGAR 9, APGAR 10 APGAR 7, APGAR 9

A nurse is teaching a childbirth education class for expectant parents. One of the clients is concerned about C-sections and asks what the most common indication for needing a C-section would be. What is the appropriate nursing response? Arrest of labor Malpresentation Multiple gestation Preeclampsia

1 Arrest of labor. Rationale: Accounts for 34% of C-sections Malpresentation. Rationale: Accounts for 17%of C-sections Multiple gestation. Rationale: Accounts for 7% of C-sections Preeclampsia. Rationale: Accounts for 3% of C-sections

A term, multiparous, laboring client has just had a SROM, and the nurse has performed an SVE. Based on the assessment findings, what does the nurse anticipate the provider's next course of action to be? Perform an emergent C-section Perform a nonurgent C-section Perform an urgent C-section

1 Perform an emergent C-section. Rationale: A loop of pulsating cord in the vagina indicates a prolapsed cord, a medical emergency that places the fetus at significant risk of injury or death. The nurse should anticipate the provider performing an emergent C-section. An emergent C-section indicates an immediate need to deliver the fetus. Perform a nonurgent C-section. Rationale: A nonurgent C-section is performed when there is minimal threat to the infant or mother, such as a failure to progress or descend. Perform an urgent C-section. Rationale: An urgent C-section is performed when a rapid delivery is indicated, such as a malpresentation diagnosed after onset of labor.

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

1, 2, and 5 Insert an IV catheter. Rationale: IV fluids are given during surgery, so starting the IV before is required. Administer sodium citrate. Rationale: Sodium citrate is administered before the surgery to neutralize stomach acids. Trim pubic hair. Rationale: This is an outdated practice that is no longer performed. Insert straight catheter. Rationale: A Foley catheter is utilized for surgery, as opposed to a straight catheter, to allow for continual draining of the bladder. This allows for the bladder to not obscure the surgery field. Apply sequential compression devices. Rationale: SCDs are used as prophylaxis for thrombosis and are applied before surgery.

The nurse is preparing a client in the operating room for a C-section. The client asks the nurse why a roll is being placed under the hip. How should the nurse respond? "The hip tilt position allows the provider easier access to the uterus for delivery." "The hip tilt position ensures your blood flow to your lower body and placenta aren't interrupted by the weight of your baby on the large blood vessels in your back, which can cause your blood pressure to drop." "The hip tilt position decreases bladder distention and reduces the risk of bladder injury during surgery." "The hip tilt position allows for a quicker delivery of the infant during the C-section."

2 "The hip tilt position allows the provider easier access to the uterus for delivery." "The hip tilt position ensures your blood flow to your lower body and placenta aren't interrupted by the weight of your baby on the large blood vessels in your back, which can cause your blood pressure to drop." Rationale: The hip tilt position is utilized to decrease the pressure on the inferior vena cava, reducing maternal hypotension and subsequent fetal intolerance. Although other benefits may result from this position, they are not the reasoning for such. "The hip tilt position decreases bladder distention and reduces the risk of bladder injury during surgery." "The hip tilt position allows for a quicker delivery of the infant during the C-section."

To decrease the risk of bleeding following a C-section, the nurse administers which medication to the client following delivery of the placenta? Cefazolin Oxytocin Famotidine Magnesium sulfate

2 Cefazolin Rationale: This is an antibiotic Oxytocin Rationale: Oxytocin assists the uterus to contract and decreases the risk of excessive bleeding. Famotidine Rationale: This is an antacid med used to decrease gastric acid. Magnesium sulfate Rationale: This is given to prevent seizures in preeclamptic women.

A new labor and delivery nurse is working with a preceptor to prepare a client for a C-section delivery. There is a fetal scalp electrode in place to monitor the FHR. When does the preceptor advise the new nurse to remove the scalp electrode? Right after the infant is delivered during the surgery After the abdominal prep for surgery Before placement of the epidural anesthesia Before transfer to the operating room

2 Right after the infant is delivered during the surgery. Rationale: The scalp electrode must be removed before delivery of the infant. After the abdominal prep for surgery. Rationale: The scalp electrode will be removed after anesthesia is done and the abdomen is prepped, but before the incision is made. Before placement of the epidural anesthesia. Rationale: The scalp electrode should be in place throughout anesthesia placement and long enough for fetal assessment following anesthesia placement. Before transfer to the operating room. Rationale: The scalp electrode will need to remain in place for fetal monitoring in the operating room before the start of surgery.

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

2 & 3 Assess the lungs every 4 hours. Rationale: Assessing the lungs is important; however, it does not prevent pneumonia. Utilizing the incentive spirometer regularly. Rationale: Incentive spirometry, along with cough and deep breathing, encourages the client to fully expand the lungs and helps to prevent pneumonia. Encourage cough and deep breathing regularly. Rationale: Incentive spirometry, along with cough and deep breathing, encourages the client to fully expand the lungs and helps to prevent pneumonia. Ambulate within 24 hours of surgery. Rationale: Ambulation after surgery is important, however, this is not a direct preventative measure for pneumonia. Use of oxygen when lying in bed. Rationale. The use of oxygen may be indicated for respiratory depression, but it is not a preventative measure for pneumonia.

The nurse is scheduling a client for preoperative blood work before a scheduled repeat C-section in 2 days. The client is very concerned about needing more blood work. How does the nurse respond to the client's concern? "The provider would order blood work even if you were having a vaginal delivery." "You need to get this done or anesthesia will not allow for surgery to occur." "The blood wok helps the provider to identify potential risk factors that could complicate the surgery." "Just take your husband with you to help you stay calm while getting the blood drawn."

3 "The provider would order blood work even if you were having a vaginal delivery." Rationale: Often blood work is done for vaginal delivery as well; however, this response does not address the concern. "You need to get this done or anesthesia will not allow for surgery to occur." Rationale: Although anesthesia will want the results, this response only offers a limited explanation and is not therapeutic. "The blood wok helps the provider to identify potential risk factors that could complicate the surgery." Rationale: This response addresses the client's concern and is therapeutic in nature. "Just take your husband with you to help you stay calm while getting the blood drawn." Rationale: This response may not be sensitive to the client's needs, as the nurse assumed the client was married - specifically married to a male.

While preparing for a C-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? At 3 hours after surgery After partial return of sensation After complete return of sensation 24 hours after the surgery

3 At 3 hours after surgery. After partial return of sensation. After complete return of sensation. Rationale: Following anesthesia, the client must wait until complete return of sensation occurs in the lower extremities before ambulating. This usually happens around 6 to 12 hours. 24 hours after the surgery.

The obstetric nurse is preparing a client for an epidural. What is the priority nursing intervention before this procedure? Monitor fetal heart tones. Obtain maternal blood pressure. Administer IV fluid bolus. Assess for prior epidural anesthesia.

3 Monitor fetal heart tones. Rationale: Although monitoring fetal heart tones is important, this intervention does not avoid adverse reactions. Obtain maternal blood pressure. Rationale: Obtaining the maternal blood pressure is important, but it does not prevent and adverse reaction. Administer IV fluid bolus. Rationale: The most common reaction to epidural anesthesia is hypotension, so a fluid bolus before is important to prevent this complication. Assess for prior epidural anesthesia. Rationale: There is no impact of prior anesthesia on prevention of hypotension.

The nurse is preparing a client for a scheduled C-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? "My mother is coming to stay with us for a couple weeks. She will be helping with housework." "I am disappointed with having to have a C-section but am glad to finally meet my new son today." "It is a relief to know my partner can stay in the room with me during the surgery." "I will miss being able to breastfeed. I breastfed my other children for 1 year each."

4 "My mother is coming to stay with us for a couple weeks. She will be helping with housework." Rationale: Having help during the recovery period following surgery is quite beneficial to a new mother. "I am disappointed with having to have a C-section but am glad to finally meet my new son today." Rationale: Disappointment is a normal feeling and is not concerning when partnered with happiness. "It is a relief to know my partner can stay in the room with me during the surgery." Rationale: Support from the partner can make a C-section process less scary for the client. "I will miss being able to breastfeed. I breastfed my other children for 1 year each." Rationale: Women can breastfeed following surgery. However, the nurse would want to discuss positions that would be more comfortable due to the incision.

While preparing a client for an emergency C-section, the nurse places an oxygen mask on the client. What is the rationale for this nursing intervention? Prevent hypertension Prevent tachypnea Decrease anxiety Fetal intolerance

4 Prevent hypertension Rationale: Although the client may have hypertension because of increased anxiety, the use of oxygen is not to prevent this possibility. Prevent tachypnea Rationale: Tachypnea may occur due to anxiety; however, the use of oxygen is not related to this possibility. Decrease anxiety Rationale: Anxiety would be anticipated due to the emergent nature of the surgery; however, oxygen is not used for that expected client response. Fetal intolerance to labor Rationale: A common indication for C-section is fetal intolerance to labor, and when that occurs, oxygen is utilized to assist the fetus.

A new labor and delivery nurse is working with a preceptor to prepare a client for a C-section delivery. The new nurse is asking about the timeline for placing the Foley catheter in the operating room. What does the preceptor advise? The patient should be straight catheterized after delivery of the infant in the OR. The patient should be straight catheterized after spinal or epidural placement but before the abdomen is prepped. The patient should be straight catheterized before placement of the epidural anesthesia The patient should be straight catheterized before transfer to the operating room.

The patient should be straight catheterized after delivery of the infant in the OR. Rationale: The client will be draped and the nurse will not be able to reach her urethra to straight catheterize her. The patient should be straight catheterized after spinal or epidural placement but before the abdomen is prepped. Rationale: The Foley should be placed in the OR after the spinal or epidural placement but before surgery prep is performed on the abdomen. The patient should be straight catheterized before placement of the epidural anesthesia. The patient should be straight catheterized before transfer to the operating room.