Chapter 11 Intrapartum And Postpartum Care of Cesarean Birth Families

You are caring for a woman having a surgical birth who is low risk for developing a postpartum venous thromboembolism. The recommended treatment would include: A. Bilateral sequential compression devices and early ambulation B. Low molecular weight heparin 12-24 hours after birth C. Warfarin 24 hours after birth D. Daily, low dose of aspirin

A. Bilateral sequential compression devices and early ambulation

The experiences of cesarean birth parents differ from vaginal birth parents in which of the following A. Emotional responses to the childbirth experience B. Ability to breastfeed C. Nutritional needs D. Maternal hormonal changes

A. Emotional responses to the childbirth experience

A common indication for an urgent surgical birth includes A. Fetal intolerance of labor B. Posterior vertex position C. Failed assisted vaginal birth without fetal stress D. Maternal request for the procedure

A. Fetal intolerance of labor

When assessing a woman's pain after a surgical birth, the nurse should A. Recognize pain management is the responsibility of the nurse, anesthesia provider, and the primary physician B. Ensure that the prescribed pain medications are effective C. Implement non-pharmacologic interventions for promoting maternal comfort before administering D. Determine whether the pain is visceral or somatic

A. Recognize pain management is the responsibility of the nurse, anesthesia provider, and the primary physician

The best time to give prophylactic antibiotics to the women undergoing cesarean section is: A. One hour before the surgery B. Two hours before the surgery C. Not indicated unless she has an active infection D. At the time the cord is clamped

ANS: A Administration of narrow-spectrum prophylactic antibiotics should occur within 60 minutes prior to the skin incision.

A post-cesarean section client has been ordered to receive 500 mL of 5% dextrose in water every 4 hours. The drop factor of the macrodrip tubing is 10 gtt/mL. To what drip rate should the nurse regulate the IV? __________ gtt/min

ANS: 21

Tanya, a 30-year-old woman, is being prepared for an elective cesarean birth. The perinatal nurse assists the anesthesiologist with the spinal block and then positions Tanya in a supine position. Tanya's blood pressure drops to 90/52, and there is a decrease in the fetal heart rate to 110 bpm. The perinatal nurse's best response is to: A. Place a wedge under Tanya's left hip. B. Discontinue Tanya's intravenous administration. C. Have naloxone (Narcan) ready for administration. D. Have epinephrine ready for administration

ANS: A In the event of severe maternal hypotension, the nurse should place the patient in a lateral position or use a wedge under the hip to displace the uterus, elevate the legs, maintain or increase the IV infusion rate, and administer oxygen by face mask at 10 to 12 L/min, or according to institution protocol.

A post-cesarean birth woman has been diagnosed with paralytic ileus. Which of the following symptoms would the nurse expect to see? A. Abdominal distension B. Polyuria C. Diastasis recti D. Dependent edema

ANS: A The nurse would expect to see a distended abdomen in a client with a paralytic ileus.

The perinatal nurse teaches the student nurse that deep breathing exercises following a cesarean birth are critical to the prevention of (Select all that apply): A. Pneumonia B. Atelectasis C. Abdominal distension D. Increased tidal volume

ANS: A, B Incisional pain and abdominal distention often cause patients to adopt shallow breathing patterns that can lead to decreased gas exchange and a reduced tidal volume. To facilitate adequate lung functions, patients should be taught how to perform pulmonary exercises. Expectoration of secretions and deep breathing help prevent common complications including atelectasis and pneumonia. Abdominal distention and gas pains are common after abdominal surgery and result from delayed peristalsis.

A nurse is caring for a woman who is 4 hours post-cesarean birth for arrest of labor. The labor and operative records indicate that she had premature rupture of membranes followed by 36 hours of labor. Her IV fluid intake for the past 24 hours is 2500 mL. The estimated blood loss is 1500 mL. Based on this data, the woman is at risk for which of the following? (Select all that apply.) A. Fluid volume deficit B. Infection C. Impaired mother-infant attachment D. Falls

ANS: A, B, C, D The woman is at risk for fluid volume deficit related to blood loss and risk for postpartum hemorrhage due to risk of uterine atony. She is at risk for infection related to premature and prolonged rupture of membranes. The woman is at risk for impaired mother-infant attachment related to maternal pain and exhaustion. She is at risk for falls related to anesthesia and orthostatic hypotension.

The perinatal nurse understands that the purpose of combining an opioid with a local anesthetic agent in an epidural is primarily to: A. Increase the total anesthetic volume B. Preserve a greater amount of maternal motor function C. Increase the intensity of the motor and sensory block D. Decrease the number of side effects

ANS: B Combining an opioid with a local anesthetic agent reduces the total amount of anesthetic required and helps to preserve a greater amount of maternal motor function.

The perinatal nurse is preparing a woman for a scheduled cesarean birth. The woman will be receiving spinal anesthesia for the birth. In order to prevent maternal hypotension, the nurse: A. Assists the woman to lie down in a supine position. B. Administers a rapid intravenous infusion of 500 mL of normal saline. C. Assesses blood pressure and pulse every 5 minutes, three times, before the spinal insertion. D. Encourages frequent cleansing breaths after the patient has been placed in the correct position for the anesthesia administration.

ANS: B Complications that may occur with spinal anesthesia block include maternal hypotension, decreased placental perfusion, and an ineffective breathing pattern. Prior to administration, the patient's fluid balance is assessed, and IV fluids are administered to reduce the potential for sympathetic blockade (decreased cardiac output that results from vasodilation with pooling of blood in the lower extremities). Following administration of the anesthetic, the patient's blood pressure, pulse, and respirations and fetal heart rate must be taken and documented every 5 to 10 minutes.

During a cesarean section, which action by the nurse is done to prevent compression of the descending aorta and vena cava? A. Right lateral tilt B. Left lateral tilt C. Elevate head of gurney at 30 degrees D. Administration of IV fluid preload of 500 to 1000 mL

ANS: B Positioning of the patient with a left tilt maintains a left uterine displacement to decrease the risk of aortocaval compression related to compression on the aorta and inferior vena cava due to weight of the gravid uterus.

A nurse is preparing a woman in early labor for an urgent cesarean birth related to breech presentation. Select the best nursing action for reducing the couple's anxiety levels. A. Explain the reason for the need for a cesarean section. B. Inform parents that their baby is in distress. C. Ask the couple to share their concerns. D. Reassure the couple that both the woman and baby are in no danger

ANS: C By asking the couple to share their concerns, the nurse can address these concerns.

Which of the following is a medical indication for a cesarean birth? (Select all that apply.) A. Maternal blood pressure of 130/90 B. Cervical dilation of 1.5 cm per hour during the active phase of labor C. Late deceleration of the fetal heart rate with minimal variability D. Complete placenta previa E. Arrest of fetal descent

ANS: C, D, E A maternal blood pressure of 130/90 may be an indication of mild PHI which is not a medical indication for cesarean birth. Cervical dilation of 1.5 cm/minutes is within normal limits for cervical changes during the active phase. Late decelerations combined with minimal variability in the fetal heart rate reflect fetal intolerance of labor and are an indication for cesarean birth. A complete placenta previa covers the internal os necessitating a cesarean birth. Arrest of fetal descent indicates cephalopelvic disproportion.

The perinatal nurse listens as Chantal describes her labor and emergency cesarean birth. Providing an opportunity to review this experience may assist Chantal in: A. Her role development in the "letting go" stage B. Decreasing her ambivalence about her labor and birth C. Understanding her guilt involved in her labor and birth D. Developing more positive feelings about her labor and birth

ANS: D After a cesarean birth, especially when unplanned, nurses must be aware of the myriad of potential psychological issues that may arise. Research suggests that women may perceive cesarean birth to be a less positive experience than a vaginal birth. Unplanned or emergent cesarean deliveries and the experience of cesarean birth may be associated with more negative perceptions of the birthing experience. Allowing Chantal to talk about the experience can help her develop a more positive attitude about her own experience.

A nurse is caring for a woman 10 hours post-cesarean birth. She received a dose of intrathecal morphine at the time of the birth. Which of the following assessment data would require immediate intervention? A. Itching of the palms and feet B. Nausea C. Urinary output of 300 mL in the past 4 hours D. Respiratory rate of 10 breaths/minute

ANS: D An adverse effect of intrathecal morphine that requires immediate intervention is respiratory distress.

A nurse is admitting a woman for a scheduled cesarean section. Which of the following assessment data should be immediately reported to the physician? A. White cell count of 11,000 B. Hemoglobin of 11 g/dL C. Hematocrit of 33% D. Platelet count of 97,000

ANS: D Normal range of platelets is 150,000 to 400,000. A low platelet count places the woman at risk for increased bleeding.

A client delivered a 2800-gram neonate 4 hours ago by cesarean section with epidural anesthesia. Which of the following interventions should the nurse perform on the mother at this time? A. Maintain the client flat in bed B. Assess the client's patellar reflexes C. Monitor hourly urinary outputs D. Assess the client's respiratory rate

ANS: D The client has undergone major abdominal surgery. Her respiratory function should be assessed regularly.

The perinatal nurse knows that the presence of abdominal distention and gas in the post-cesarean birth mother is due to __________. A. Uterine contractions B. Normal changes C. Fluid in the abdomen D. Delayed peristalsis

ANS: D. Delayed peristalsis Delayed peristalsis and constipation commonly occur because of slowed peristalsis associated with pregnancy hormones and childbirth anesthesia. In addition, incisional pain may contribute to a decrease in ambulation which contributes to delayed peristalsis.

The best intervention to help maintain maternal normothermia in the operating room is to A. Preheat the radiant warmer and have an insensible fluid loss barrier available B. Provide warm blankets, warmed IV fluids and maintain the temperature in the operating room C. Increase the operating room temperature D. Have the woman wear a heavy cloth gown and slippers to the operating room

B. Provide warm blankets, warmed IV fluids and maintain the temperature in the operating room

In the operating room, the circulating nurse calls a time out before the surgery begins. The purpose of the time out is to A. Confirm that the surgeon is ready B. Verify that it is the correct site, procedure, and patient C. Verify that the anesthesia is adequate D. Confirm that the neonatal team is in attendance

B. Verify that it is the correct site, procedure, and patient

You are assigned to take care of a woman, Lisa, who is 24 hours postoperative after an emergent cesarean birth related to fetal intolerance of labor. Lisa tells you that she is upset about having a cesarean birth. Your best initial action is to A. Inform her she has a healthy newborn B. Inform her that most women experience disappointment in having a C-section C. Ask her to tell you more about her feelings D. Explain why she had a C-section birth

C. Ask her to tell you more about her feelings

Indication for a cesarean delivery on maternal request is A. Nonreassuring fetal HR B. Placenta previa C. Woman's desire to have a C section birth vs vaginal birth D. Obstetrician preference for C section

C. Woman's desire to have a C section birth vs vaginal birth

The most serious complication of the use of intrathecal morphine in the first 24 hours postoperative is A. Urinary retention B. Nausea and vomiting C. Decreased sensation in legs D. Respiratory depression

D. Respiratory depression