Chapter 11: Assisted Delivery and Cesarean Birth Maternal Prep-U
Following a cesarean birth, a woman has 3000 ml of intravenous fluid ordered. The nurse anticipates in the plan of care that she will be kept NPO except for minimal ice chips until which time?
until bowel sounds have returned
A client is being prepared for a scheduled cesarean birth by the medical team. Which intervention will be most critical for the team to monitor in the first 24 hours post-cesarean birth?
urinary output
A primigravida is admitted to the labor-and-delivery suite for an elective induction with oxytocin. The nurse caring for this client knows that one of the risks with oxytocin inductions is:
uterine hyperstimulation.
A cesarean birth is 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
The nurse is caring for a woman who has had a baby by cesarean birth. Which of the following would be the most important assessment to make?
whether her abdomen is soft or not
When counseling a client about maternal risks and benefits of cesarean birth, which of the following would not apply?
"A surgical incision may be made at the perineum to enlarge the vagina just before the birth of the baby."
A woman who has had a cesarean birth asks you if she will always need to have cesarean births in the future. What would be the nurse's best response?
"Although there are some exceptions, surgical techniques allow for vaginal birth after cesarean birth."
How should the nurse counsel a client who has arrived for a scheduled repeat cesarean birth?
"An IV catheter will be placed, and we will do some preoperative blood work. Then we will give you some antibiotics."
A woman who underwent a primary cesarean birth for a breech presentation states that her neonate 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."
The nurse cares for a client scheduled for a cesarean birth for a breech presentation. The client requests general anesthesia instead of regional anesthesia for the procedure because of increased anxiety about being awake during the surgery. How does the nurse respond?
"Can you tell me more about what you are concerned about during the surgery?"
A pregnant client tells the nurse, "Labor and birth sounds so awful. Can't I just schedule a cesarean birth instead?" How will the nurse reply?
"Can you tell me more about your concerns regarding the labor and birth processes?"
A woman whose fetus at 30 weeks' gestation is failing to thrive in utero is told her physician wants to deliver the baby by cesarean birth today. She asks the nurse why this would be preferred to a vaginal birth. Which of the following would be your best response?
"Cesarean birth will reduce pressure on the immature head."
The fetus of a client who is 30 weeks' pregnant is failing to thrive in utero. The health care provider wants to deliver the fetus through cesarean birth today. The client asks why this approach is preferred over a vaginal delivery. What should the nurse respond to the client?
"Cesarean birth will reduce pressure on the immature head."
A client underwent a cesarean birth due to fetal distress. The medical records reflect a low transverse uterine incision was used. When speaking with the nurse, the client questions her ability to give birth vaginally with her next pregnancy. What response by the nurse is most appropriate?
"Having a cesarean birth does not mean you will have a cesarean birth with future births."
The nurse is caring for a client who underwent a cesarean birth 2 days ago. Which statement by the client demonstrates the need for further education about postoperative recovery and care?
"I will carry the baby in the car seat between the car and the house."
The nurse is preparing a pregnant client for a scheduled cesarean birth. The health care provider has spoken to the client about the procedure and the informed consent has been signed. Right before going to the operating room, the client tells the nurse, "I am not sure I want to go through with this." What is the nurse's best response?
"I will get the health care provider to come back and talk with you."
A client underwent a cesarean birth due to fetal distress. The medical records reflect a low transverse uterine incision was used. When speaking with the nurse, the client questions her ability to give birth vaginally with her next pregnancy. What response by the nurse is most appropriate?
"It sounds like you are disappointed by the outcome of the birth. Would you like to talk more about this?"
A client who planned an unmedicated vaginal birth at a freestanding birth center is transferred to the hospital for a cesarean birth due to cephalopelvic disproportion. The client says to the nurse, "I feel like such a failure. I could not even give my baby the gentle start that I wanted!" How does the nurse respond?
"It sounds like you are disappointed by the outcome of the birth. Would you like to talk more about this?"
The nurse is instructing a primipara who has concerns about the need for a cesarean birth due to her sister's obstetrical history. Which statement by the client needs further instruction?
"My sister had a cesarean birth with the first infant and now needs it for all subsequent pregnancies."
A woman has just arrived to the recovery room after an emergency cesarean birth and is anxious to begin breastfeeding her baby. What is the best response from the nurse?
"Sure, let me help you with that."
A woman is dilated 9 cm, and the fetus is in an anterior position at +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 client who has had a cesarean birth is receiving intravenous fluids. The client asks the nurse, "When will I be able to eat something?" Which response by the nurse is appropriate?
"When I hear noises in your abdomen, then it is safe to eat."
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 maternal health nurse is caring for multiple women who wish to attempt a vaginal birth after cesarean (VBAC). Which client will not be able to attempt a VBAC due to contraindications?
28-year-old with a placenta previa
The nurse is assessing a neonate after a cesarean birth. Which most common complication should the nurse be prepared for?
respiratory distress
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
A client in labor had no change in cervical dilation (dilatation) over the past 2 hours. The health care provider performs an amniotomy. Based on the chart above, what should the nurse do first after the amniotomy?
Assess fetal heart rate.
A 35-year-old P1001 has been admitted for a scheduled repeat cesarean. As the nurse prepares the client for surgery, what is the best way to begin preoperative teaching?
Assess how much the woman already knows about cesarean.
The nurse assists while a pregnant client has an amniotomy. Which action should the nurse take immediately at the conclusion of the procedure?
Assess the fetal heart rate
The maternal health nurse assists the birth attendant in a forceps-assisted birth. After the birth of the infant, what is the nurse's priority?
Assess the infant for trauma.
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 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 client for an emergency cesarean birth.
To prevent thrombophlebitis following a cesarean birth, which of the following would be most important to implement?
Encourage the woman to ambulate.
A husband asks if he can view his wife's cesarean birth. Which of the following reflects a modern policy on this subject?
He can view it if he chooses, especially because his wife will be awake.
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 client who has been in labor for 20 hours is being prepared for an emergent cesarean birth. Which action will help ensure the client's fluid status during the procedure?
Initiate intravenous fluid therapy.
A pregnant client is scheduled for induction of labor at 37 weeks' gestation. The nurse performs a Bishop test. The nurse obtains a score of 5. What action will the nurse take?
Notify the health care provider.
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 birth.
A client is having an induction of labor with oxytocin (above). The nurse is having difficulty monitoring the fetal heart rate and requests that the health care provider apply a fetal scalp electrode. What will be needed for this procedure for this client?
The client will need an amniotomy before a scalp electrode may be applied.
The nurse encourages a client recovering from a cesarean birth to begin early ambulation. For which outcome would this action be indicated?
The client will not develop manifestations of thrombophlebitis.
A woman having a cesarean birth will have a low transverse incision ("bikini cut"). Which of the following would the nurse 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 birth in a woman who is not in labor.
The woman enters the OR. The nurse instructs the client to sit and make a C-curve with her back. The anesthesiologist cleanses the back. Spinal anesthesia is administered. The client lies down on the delivery table, and a wedge is placed.
A client is scheduled for a cesarean birth. The nurse is discussing with the client the different types of incisions that may be used. Which statement would the nurse likely include in the teaching about a low-segment incision?
Vaginal births are possible with future pregnancies.
What is the most effective way to stimulate circulation after cesarean birth?
ambulation within 4 hours of birth
The nurse is caring for a client recovering from a cesarean birth. Which assessment should the nurse make a priority for this client?
abdominal texture
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 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 heart rate (HR) is 120 and blood pressure (BP) is 80/40. What nursing action should be a priority?
assess for bleeding
It was once thought that an episiotomy made the birth less painful and heal 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 the risk of blood loss immediately after delivery
Four women have come to the labor and delivery unit in labor. After obtaining the women's histories which client will the nurse assess first?
client with a previous classical uterine incision
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 birth and what can be expected. When should the nurse provide this family education?
each time the nurse sees the woman before surgery
A new mother calls the clinic on her fourth day after delivery and reports difficulty urinating and defecating because of the perineal pain. What does the nurse suspect is causing these problems?
episiotomy
The nurse is caring for a client who experienced an emergency cesarean birth. During the course of the client's care, the client exhibits impaired parent-infant attachment related to an unplanned method of birth, and anxiety related to unanticipated circumstances surrounding birth. Which interventional focus may have improved this client's outcomes?
establishing an early helping relationship
The nurse is caring for a client following a cesarean birth who received a low segment incision. Which outcome is possible for the client?
experiencing vaginal delivery during future births
After learning about the need for a cesarean birth, the pregnant client begins to cry and hyperventilate. Which nursing diagnosis should the nurse use to guide the care that the client needs at this time?
fear related to impending surgery
A nursing student correctly identifies which of the following as the most important predictor of fetal maturity?
fetal lung maturity
The nurse is caring for a postoperative client who has experienced a cesarean birth. Which physiologic response(s) should the nurse anticipate? Select all that apply.
increased heart rate bronchodilation elevated blood glucose level peripheral vasoconstriction
A nurse correctly recognizes which of the following as a current trend within the population of birthing women?
increased rates of cesarean sections
A woman is about to undergo her first cesarean birth and asks the nurse what complications can come from this type of birth. The nurse correctly identifies which of the following as the number one complication of cesarean birth?
infection
The nursing instructor is conducting a class presenting the various aspects of a cesarean birth. The instructor determines the class is successful after the students correctly choose which complication as the most common postoperative complication?
infection
A woman is scheduled to have epidural anesthesia for a cesarean birth. Which of the following would the nurse anticipate including in the preoperative plan of care while she waits for the anesthetic?
keeping her turned on her side
The nurse is teaching a prenatal class about a cesarean birth. What benefit of a low transverse uterine incision should the nurse point out in the teaching?
least likely to rupture during subsequent labors
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 nursing student correctly identifies that an episiotomy that extends straight down into the true perineum is which of the following?
midline episiotomy
The nurse is caring for a client who is postoperative after cesarean birth and receiving treatment with antibiotics. For which condition(s) should the nurse monitor? Select all that apply.
opportunistic infections renal insufficiency
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
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
The nurse is caring for a client who has developed a paralytic ileus following a cesarean birth. Which element of the procedure results in this condition?
pressure on the intestine
Which pregnant client(s) will the nurse identify as a suitable candidate for a vaginal birth after cesarean (VBAC)? Select all that apply.
previous cesarean for active vaginal herpes; no herpes lesions in current pregnancy previous cesarean for breech; current pregnancy with cephalic presentation
The nurse is caring for a woman who is 1 day postpartum following a cesarean birth. Why does the nurse encourage the woman to walk in the hallway? Select all that apply.
provides pain relief from intestinal gas decreases respiratory complications decreases the risk of a blood clot forming in the legs
The physician has just examined the patient and determined that she requires a cesarean birth. 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.
The maternal health nurse assists the health care provider during an artificial rupture of membranes procedure. Which direct outcome does the nurse expect?
release of prostaglandins
What will the nurse include in the care plan of a client who underwent cesarean birth to reduce the risk of postoperative urinary tract infection?
removal of indwelling catheter as soon as possible
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
A pregnant woman who required labor induction for a previous pregnancy says to the nurse, "The last time the practitioner used a score to see if I was ready for induction. But I've heard of other methods that have been developed since then." The nurse understands that the woman is referring to cervical length measurements and fetal fibronectin levels. When responding to the woman, which information would the nurse need to keep in mind when telling the woman about these methods?
shorter time needed for obtaining the Bishop score results
A pregnant client is to receive epidural anesthesia for a cesarean birth. When reviewing this procedure with the client, the nurse reinforced the need to remain in which position?
side-lying
The nurse is caring for a client who is insisting on a vaginal birth. For which situation should the nurse explain a vaginal birth is contraindicated? Select all that apply.
spina bifida transverse lie
