PN108 PrepU Chapter 11
How should the nurse counsel a patient who has arrived for a scheduled repeat cesarean?
"An IV catheter will be placed, and we will do some preoperative blood work. Then we will give you some antibiotics."
A nursing student has learned that cervical readiness is generally a prerequisite for successful labor induction. The student correctly uses which of the following terms to describe a cervix favorable for induction?
"ripe" cervix
The nurse in the labor and delivery unit is caring for a pregnant female who has had no prenatal care. Tests are completed to determine fetal readiness for delivery. The lethicin/sphingomyelin (L/S) ratio results indicate fetal lung maturity. The nurse knows that the ratio results must have been greater than:
2
Mrs. Atkins is 40 weeks pregnant by ultrasound, and the induction of labor is being discussed by Mrs. Atkins and her birth attendant. The birth attendant tells Mrs. Atkins, "I am going to do a pelvic exam so that I can assess your readiness for labor. I will obtain what is known as a Bishop Score, and it will tell me how ready you are to go into labor." What Bishop Score would indicate a favorable response to oxytocin-induced labor?
8 or above
What is the most effective way to stimulate circulation after cesarean birth?
Ambulation within 4 hours of birth
What are the nursing responsibilities in the preoperative area for the woman about to undergo a scheduled cesarean? Choose the best answer.
Ask the woman when she last ate or drank, clip the hair from her abdomen and perineal area, and insert an 18-gauge IV catheter
A 35-year-old P1001 has been admitted for a scheduled repeat cesarean. As the nurse prepares the patient for surgery, what is the best way to begin preoperative teaching? Choose the best response.
Assess how much the woman already knows about cesarean.
A woman has just entered the recovery room after cesarean birth of a baby weighing 9 lb 14 oz. She asks the nurse for a drink of water. The nurse notices that her pulse is 120 bpm and her blood pressure is 80/40. What should the nurse do first?
Assess the firmness of the fundus and the perineum for bleeding
What are the benefits of a low segment transverse uterine incision?
It is least likely to rupture during subsequent labors.
A nurse is preparing a client for cesarean birth. Which of the following interventions is most critical, as it is associated with assessing for one of the gravest dangers of any surgical procedure?
Measuring the amount of postsurgical urinary output
A client who had a cesarean birth due to breech presentation asks why her incision goes horizontally instead of vertically. The nurse responds to the client based on the understanding that this type of incision:
Minimizes blood loss
Eight hours after a cesarean section, a postpartum woman is having heavy lochia. She informs the nurse, who suspects which of the following causes?
Postpartum hemorrhage
When counseling a patient about maternal risks and benefits of cesarean delivery, which of the following would NOT apply?
"A surgical incision may be made at the perineum to enlarge the vagina just before delivery of the baby."
A primigravida is admitted to the labor-and-delivery suite for an elective induction with oxytocin. As the nurse caring for this client you know that one of the risks with oxytocin inductions is what?
Uterine hyperstimulation
A student observing in labor and delivery watches a physician introduce a hard plastic instrument with a hook on the end into the vagina during a digital examination. The physician proceeds to guide the hook to snag a hole into the membranes. This process causes the
artificial rupture of membranes
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?
"Although there are some exceptions, surgical techniques allow for vaginal birth after cesarean birth."
While caring for a woman who underwent a primary cesarean section for a breech presentation, she states this baby seems to have so much more mucus than her first baby. Concerned, she asks why this has happened. How should the nurse respond?
"Babies born by cesarean section have more respiratory complications because they do not have the benefit of having the mucus in their lungs removed by the pressure experienced in the birth canal."
What is NOT part of the discharge planning for a woman who has had a cesarean birth?
"If you have any vaginal bleeding, you should contact your provider."
A woman with a history of a previous cesarean is in labor. She has signed the consent form for a VBAC. She is dilated 7 cm. and is making satisfactory progress in labor. She tells her nurse that she has changed her mind and she wants a cesarean. What is the best response by the nurse?
"Since you no longer consent to a VBAC, I will let the physician know, and we'll begin preparing you for a cesarean delivery."
A woman has just arrived to the recovery room after an emergency cesarean delivery. She asks to breastfeed. What is the best response from the nurse?
"Sure, let me help you with that."
A woman is dilated 9 centimeters, and the fetus is in an anterior position at a +1 station. The bag of water is ruptured. She has been in labor for several hours and is exhausted, so she asks the nurse, "My friend was tired at the end of her labor, and the doctor used forceps to help deliver the baby. Could the doctor pull the baby out with forceps so I can get this over with?" What is the nurse's best response?
"The cervix must be completely dilated before forceps can be applied safely."
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 to determine a favorable induction?
27 mm or less
A nurse is providing a client with preoperative teaching regarding cesarean birth. Which of the following interventions should she recommend as the most effective means of preventing lower-extremity circulatory stasis?
Ambulation
On exam the birth attendant finds that Mrs. Atkins's Bishop Score is a 9. The birth attendant tells Mrs. Atkins to come to the hospital at 7 a.m. tomorrow for induction of labor by oxytocin. What is the most common protocol for the induction of labor by oxytocin?
Baseline data collected from an EFM, then a mainline IV is started and oxytocin is connected as a secondary IV line. The oxytocin in started at 1 milliunit/minute and titrated upwards.
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.
A multigravid woman has been in labor for several hours and has dilated to 8 cm. Her fetal membranes have not yet ruptured and her contractions are not as strong as the birth attendant would like them to be. The decision is made to artificially rupture the woman's membranes. You are a new LPN/LVN on the unit. What is your role in this procedure?
Document fetal heart rate before and after the procedure
To prevent thrombophlebitis following a cesarean birth, which of the following would be most important to implement?
Encourage the woman to ambulate.
The nurse is monitoring the labor of a woman attempting a vaginal birth after cesarean (VBAC) delivery. The nurse correctly suspects a uterine rupture when which of the following occur? (Select all that apply.)
Excessive maternal pain Increased vaginal bleeding Unrelenting uterine contraction Signs of maternal shock
For which of the following fetal conditions is vaginal delivery contraindicated? Select all that apply
Hydrocephalus Transverse lie
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: (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. Increased incidence of maternal obesity.
It was once thought that an episiotomy made the birth less painful and healed faster than a spontaneous laceration of the perineum. Research has not shown these assumptions to be true. What is another finding in the research on episiotomies?
Increases risk of blood loss immediately after delivery
An elective induction is when the birth attendant and the pregnant woman agree to the induction of labor without medical indications. What should the birth attendant explain to the woman before she can give informed consent to induce her labor?
Induced labor can result in higher costs for the delivery
A woman is about to go for her first cesarean delivery and asks the nurse what complications can come from this type of delivery. The nurse correctly identifies which of the following as the number one complication of cesarean delivery?
Infection
What postoperative complication is most commonly associated with cesarean delivery?
Infection
To prevent tearing of the perineum of a client during birth, a physician performs a mediolateral episiotomy. The nurse recognizes that an advantage of a mediolateral episiotomy over a midline episiotomy is which of the following?
Lower risk for rectal mucosal tear
A 24-year-old primigravida has been laboring longer than 24 hours. She has entered the second stage of labor, and the baby is at +2 station. The fetal heart rate has been 90 bpm for the last 2 minutes. The physician applies a Kiwi vacuum; after 3 attempts (pop-offs), the baby is not delivered, and the fetal heart rate is still 90 bpm. What should the nurse do next? Choose the best answer.
Prepare for an emergency cesarean delivery
A primigravida whose baby is presenting breech is scheduled to have a cesarean birth. Which of the following would you prepare her for postoperatively?
Presence of an indwelling catheter
What are the four most common reasons for cesarean delivery?
Previous cesarean, labor dystocia, nonreassuring fetal status, and fetal malpresentation
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:
Reduces the risk of uterine rupture
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
A nurse assisting in a cesarean birth should essentially demonstrate which of the following understanding of which of the following?
Skill in either a scrubbing or circulating role
The Bishop score is calculated using which factors?
Station, effacement, cervical consistency, dilatation, and cervical position
A woman having a cesarean birth will have a low cervical incision. Which of the following would you cite as an advantage?
The skin incision will be just above her pubic hair.
Place the following events in order of occurrence for administration of spinal anesthesia before an elective primary cesarean delivery in a woman who is not in labor.
The woman enters the OR. The nurse instructs the patient to sit and make a C-curve with her back. The anesthesiologist cleanses the back. Spinal anesthesia is administered. The patient lies down on the delivery table, and a wedge is placed.
On the second day postpartum following a cesarean birth, at which of the following locations would you expect to palpate the woman's fundus?
Two fingers below the umbilicus
A cesarean delivery is a major surgery and carries with it many risks for complications. The most common complication is infection. At what site is the infection likely to occur?
Uterus
There is much discussion in the medical community about vaginal birth after a cesarean delivery (VBAC). When a woman has had a previous emergency cesarean delivery, she is at high risk for a ruptured uterus. When is VBAC contraindicated?
When a classical uterine incision has been made previously
A woman asks you if she will have any difficulty breastfeeding following a cesarean birth. Which of the following would be your best response?
You will help her find a comfortable position for breastfeeding her infant.
A student observing in labor and delivery watches a physician introduce a hard plastic instrument with a hook on the end into the vagina during a digital examination. The physician proceeds to guide the hook to snag a hole into the membranes. This process causes the body to release prostaglandins, which induces labor and is known as which of the following?
artificial rupture of membranes
A patient is admitted with a post-delivery date pregnancy. Her cervix is not ready so the nurse anticipates the cervix will have to be "ripened." Which methods are commonly used to do this? (Select all that apply.)
membrane stripping mechanical dilation locally applied prostaglandins artificial rupture of membranes oxytocin induction
A nursing student correctly identifies that an episiotomy that extends straight down into the true perineum is which of the following?
midline episiotomy
A nursing student asks the instructor if there are any reasons not to do an elective induction. The instructor correctly identifies which of the following as reasons? (Select all that apply.)
need for more interventions longer labor higher costs possible cesarean section
T/F: A woman who has a low segment or low transverse incision cesarean birth will not be able to have a vaginal birth with future pregnancies.
False
T/F: The type of skin incision done for a cesarean section will indicate the type of uterine incision.
False
A nursing student correctly identifies which of the following as the most important predictor of fetal maturity:
Fetal lung maturity
When an infant is born by cesarean delivery there is always a risk of complications. What is one of the most common complications to the fetus because of a cesarean delivery?
Respiratory distress
What are the two most common fetal complications of cesarean delivery?
Unintended delivery of a premature infant and respiratory distress
A primigravida is tired of being pregnant. She asks the nurse, "Why can't my doctor just schedule a cesarean delivery? My friend had a cesarean and everything went very well." What is the nurse's best reply?
"A cesarean birth involves major surgery, which puts you and your baby at higher risk for complications. Your physician will discuss the options with you."
Which of the following women most likely will not be a candidate to attempt a vaginal birth after having had a previous cesarean section?
A woman who had a cesarean section because of cephalopelvic disproportion
The nurse is preparing a pregnant female for an unexpected emergency Cesarean delivery. The patient expresses concern and fear for the procedure. Which nursing intervention is best for this patient?
Acknowledge the patient's feelings and be empathetic.
When is vaginal delivery contraindicated? Select all that apply.
Active vaginal or cervical herpes lesions Invasive cervical cancer Classical scar on the uterus
A nursing student is asking the instructor how to assess whether a cervix is ready and favorable for labor induction. The nurse informs the student that a score is used known as which of the following?
Bishop score
A nurse correctly recognizes which of the following as a current trend within the population of birthing women?
Increased rates of cesarean sections.
The nurse is helping a client prepare for cesarean birth. Which of the following are common reasons cesarean birth is performed? (Select all that apply.)
Cephalopelvic disproportion Breech presentation Failure to progress in labor Prevention of urinary or anal incontinence later in life
The national rise in cesarean birth can be attributed to what? Select all that apply.
Concerns about malpractice litigation Increased incidence of multiple gestations Increase in labor inductions Increase in consumer demand for primary cesarean Trend toward delivering breech presentations by cesarean
