Intrapartum and Postpartum Care of Cesarean Birth Families

The nurse is preparing to transport a client accompanied by her partner to the operating room for a cesarean section. The client wears eyeglasses that must be removed. Where should the nurse place the glasses? 1. In the nightstand drawer 2. With the partner 3. In the safe in the room 4. With the client

2

The nurse is providing education to a client on when the Intravenous Catheter can be discontinued following a cesarean section. What information will the nurse include? 1. Client has adequate pain control with oral medication. 2. Client can maintain oral hydration without nausea. 3. Client has active bowel sounds in all four quadrants. 4. Client is breastfeeding infant well every couple of hours.

2

While assessing a post-operative cesarean section client, the nurse notes a temperature of 102.1?. Prior to calling the provider, what other assessment should the nurse complete to include when reporting the concern? 1. Identify the time of last pain medication 2. Assess the c-section incision 3. Assess lung sounds and incentive spirometry 4. Assess uterine fundus and lochia

2

Upon entering a client room to perform the initial assessment following a cesarean section, the nurse finds the client tearful and the client's partner mentions mutual disappointment with the unexpected c-section delivery, as they had desired a natural birth. How does the nurse respond to the couple? 1. "Since the baby is healthy, you should be happy." 2. "C-sections happen all the time, there is nothing to cry about." 3. "Tell me more about how you are feeling after the surgery." 4. "Maybe next time you can delivery vaginally."

3

When an emergency cesarean section is required a guideline is set for a time frame surrounding the decision time to the incision time. The nurse explains to the client the guidelines for time to optimize fetal outcomes. What timeframe does the nurse share with the client? 1. 60 minutes 2. 45 minutes 3. 30 minutes 4. 15 minutes

3

While preparing for a cesarean 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? 1. Three hours after the surgery 2. After partial return of sensation 3. After complete return of sensation 4. Twenty-four hours after the surgery

3

In addition to assessing bowel sounds, what other priority gastrointestinal assessment should be completed on a client following a cesarean section delivery? 1. Assessing for nausea 2. Last bowel movement before surgery 3. Assessing for flatulence 4. Tolerance of a full liquid diet

3

The nurse is preparing a client for a cesarean section who is scheduled for 0900. What time will the nurse administer cefazolin? 1. 07:30 2. 08:55 3. 08:00 4. 07:00

3

A client is pregnant with her second child following a cesarean section delivery with the first pregnancy for a breech fetal position. The couple plans to have three children total. What option does the nurse discuss as the best one for this couple? 1. Vaginal birth 2. Repeat c-section 3. External cephalic version 4. Only having two children

1

A client who had a cesarean section calls to the nurses' station and requests the nurse to come to the room two hours after the foley catheter was removed. The client asks the nurse to check for increased vaginal bleeding, due to a feeling of a gush of blood. The nurse notes a large amount of blood, and upon palpation notes that the uterus is displaced to the right and the fundus is boggy. What is the priority intervention the nurse will provide to the client? 1. Retrieve bedpan to allow for client to attempt to empty bladder 2. Administer oxytocin intramuscularly per order 3. Massage the uterus until a return to a midline position and firm 4. Administer a bolus of IV fluids due to the increased bleeding

1

A nurse is teaching a childbirth education class for expectant parents. One of the clients is concerned about cesarean sections and asks what the most common indication for needing a cesarean section would be. What is the appropriate nursing response? 1. Arrest of labor 2. Malpresentation 3. Multiple gestation 4. Preeclampsia

1

The nurse is assessing a client's incision following a cesarean section. The dressing has just been removed. What findings would require further intervention? Select all that apply. 1. Ecchymosis 2. Warmth 3. Edema 4. Approximation 5. Redness

1, 2, 3, 5

The nurse is performing preoperative care on a client scheduled for cesarean section. Which nursing actions should be performed? Select all that apply. 1. Insert an IV catheter 2. Administer sodium citrate 3. Trim pubic hair 4. Insert straight catheter 5. Apply sequential compression devices

1, 2, 3, 5

During assessment of a cesarean section incision, the nurse notes some concerns and decides to call the provider to report the findings. What findings would indicate a need for further nursing intervention? Select all that apply. 1. Ecchymosis 2. Edematous 3. Approximated 4. Redness 5. Drainage free

1, 2, 4

During a childbirth education class focused on labor and delivery, the nurse is discussing Cesarean Delivery on Maternal Request. What neonatal complications does the nurse include when addressing deliveries earlier then 39 weeks' gestation? Select all that apply. 1. Respiratory distress 2. Hypothermia 3. Hysterectomy 4. Feeding intolerance 5. Hypoglycemia

1, 2, 5

The operating room nurse is ready to conduct the "time out" process before the start of the cesarean section on a client. What will the operating room staff confirm during this process? Select all that apply. 1. Right patient 2. Right procedure 3. Right time 4. Right gestation 5. Right site

1, 2, 5

While presenting an educational session on childbirth the nurse was asked to discuss risk factors requiring a cesarean section. What should the nurse include in her response? Select all that apply. 1. Advanced maternal age 2. Spontaneous labor onset 3. Breech position 4. Maternal request 5. Multiparity

1, 3

The nurse is providing discharge instructions to a client and family following a cesarean section delivery three days ago. The family is unsure how to help the client at home. What does the nurse include in the education? Select all that apply. 1. Bring meals to the family. 2. Do not visit for three weeks. 3. Take infant for a walk each day. 4. Offer to do housework. 5. Feed the infant for the mother.

1, 4

A nurse is preparing to assist a new mother with breastfeeding following a cesarean section delivery. Which positions will the nurse recommend to maximize patient comfort while breastfeeding? Select all that apply. 1. Side-lying position 2. Cradle hold 3. C-cup positioning 4. Using a breast pump 5. Football hold

1, 5

A mother-baby nurse just received report on four mother baby couplets and is preparing to start the first assessments of the shift. All are recovering from cesarean section deliveries. Which couplet will need to be seen first? 1. Couplet #1: the infant and mother have been doing well since delivery 3 days ago and would like to be discharged in the next couple hours. 2. Couplet #2: the infant has been breastfeeding successfully and the mother has required the uterine fundus to be massaged to firm. 3. Couplet #3: the mother has chosen to bottle feed the infant, and the infant has lost 89 grams of the 3200-gram birth weight at 2 days of age 4. Couplet #4: the infant has been experiencing difficulties latching on to breastfeed and last nursed successfully an hour and a half ago.

2

A new labor and delivery nurse is working with a preceptor to prepare a client for a cesarean section delivery. There is a fetal scalp electrode in place to monitor the fetal heart rate. When does the preceptor advise the new nurse to remove the scalp electrode? 1. Right after the infant is delivered during the surgery 2. After the abdominal prep for surgery 3. Prior to placement of the epidural anesthesia 4. Prior to transfer to the operating room

2

A nurse is caring for a client following a cesarean section four hours ago that occurred due to arrest of labor. Initially, the client was admitted to the hospital two days ago after experiencing spontaneous rupture of membranes. Which medication order does the nurse anticipate for this client? 1. Bisacodyl 2. Ampicillin 3. Methergine

2

The anesthesiologist reviews the blood work for a client scheduled for a cesarean section and determines that an epidural or spinal anesthesia are not possible. The nurse explains which lab result to the client as the reason for this determination? 1. White blood cell 9.8 th/mm3 2. Platelet 99 th/mm3 3. Hemoglobin 12.7 g/dL 4. Red blood cell 5.1 mil/mm3

2

The nurse is scheduling a client for pre-operative blood work prior to a scheduled repeat cesarean section next week. The client is very concerned about needing more bloodwork. How does the nurse respond to the client's concern? 1. "The provider would order bloodwork even if you were having a vaginal delivery." 2. "You need to get this done or anesthesia will not allow for the surgery to occur." 3. "The bloodwork helps the provider to identify potential risk factors that could complicate the surgery." 4. "Just take your husband with you to help you stay calm while getting the blood drawn."

3

The obstetric nurse is preparing a client for an epidural. What is the priority nursing intervention prior to this procedure? 1. Monitor fetal heart tones 2. Obtain maternal blood pressure 3. Administer IV fluid bolus 4. Assess for prior epidural anesthesia

3

Following a cesarean section, a client with asthma is concerned with developing post-operative pneumonia. What will the nurse include in the education on preventative measures during the first 12 hours after surgery? Select all that apply. 1. Assessing lungs every four hours 2. Utilizing the incentive spirometer regularly. 3. Encourage cough and deep breathing regularly. 4. Ambulate within 24 hours of surgery. 5. Use oxygen when lying in bed.

2, 3

A client calls for the nurse to come to the room the day after a cesarean section delivery. Upon arrival to the client's room, the nurse notes that the client is dyspneic and appears short of breath. The client reports that her chest feels tight. Based on these assessment findings, what does the nurse report to the provider? 1. Postpartum hemorrhage 2. Wound infection 3. Pulmonary embolism 4. Wound dehiscence

3

A client is requiring a rubella vaccination before discharge following cesarean section delivery of a 34-week gestation female infant. The infant is in the Neonatal Intensive Care Unit. The nurse is explaining why the immunization is required. What should be included in the explanation? 1. Rubella vaccine is given to parents of premature infants. 2. The mother must not have been vaccinated as a child. 3. The mother's blood work demonstrated a non-immune status. 4. This is a normal booster vaccine given to all adults.

3

A nurse is completing an assessment on a client following a cesarean section the day before. The client appears short of breath and vital signs are as follows: Temperature 98.5?, Pulse 62, Respirations 42, Blood pressure 102/74, and Pulse oximetry 88%. What concern does the nurse relay to the provider? 1. Uterine infection 2. Postpartum hemorrhage 3. Pulmonary embolism 4. Disseminated intravascular coagulation

3

A provider has determined a client needs a cesarean section for cephalopelvic disproportion. The client asks the nurse to explain what cephalopelvic disproportion means. What is the best response by the nurse? 1. "You are needing a c-section due to the baby experiencing stress from labor." 2. "Let's focus on preparing for the surgery." 3. "The baby is too large for your pelvis." 4. "Have you had a recent ultrasound to estimate the baby's weight?"

3

A client reports a headache and dizziness following a scheduled cesarean section yesterday with spinal anesthesia. What does the nurse report to the provider as a concern for this client? 1. Migraine headache 2. Sinus infection 3. Vertigo 4. Spinal headache

4

A new nurse is providing discharge instructions to a client who is going home three days after a cesarean section delivery. The charge nurse walks by the room and overhears the nurse giving the instructions. Which information would require intervention by the charge nurse? 1. "You will want to continue pain medication as needed to manage the pain." 2. "The baby will need to follow up with the pediatrician in a couple days." 3. "You should try to rest when the baby is resting to help with recovery." 4. "You can remove the staples at home tomorrow utilizing this staple remover."

4

Following a cesarean section, the nurse caring for the client notes the following assessment data: Temperature 99.1?, Heart rate 136, Respirations 20, Blood pressure 82/48, and skin pale and clammy to the touch. The nurse reports concern of what postpartum complication to the provider? 1. Respiratory depression 2. Renal failure 3. Wound infection 4. Postpartum hemorrhage

4

Following the occurrence of several cesarean sections, the charge nurse is reviewing the blood loss on four clients. What is the expected maximum value of blood loss for a client who underwent a cesarean section? 1. 750 mL 2. 825 mL 3. 950 mL 4. 1000 mL

4

The nurse in the Post Anesthesia Care Unit is weighing pads to calculate blood loss following a cesarean section delivery. The nurse converts the grams of weight to milliliters of blood loss. What is the conversion formula that is used in this calculation? 1. 1 mL = 2 g 2. 2 mL = 1 g 3. 0.5 mL = 2 g 4. 1 mL = 1 g

4

The nurse is assessing client 12 hours post cesarean section delivery, of a healthy male infant weighing 9 pounds 3 ounces. The client's Foley catheter was removed three hours ago. Which subjective assessment data requires immediate intervention? 1. The client reports pain at a level of four and can tolerate a five. 2. The client reports the infant nursed for about 20 minutes one and a half hours ago. 3. The client has a blood pressure of 92/48. 4. The client reports no voiding since the catheter was removed.

4

The nurse is preparing a client for a scheduled cesarean 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? 1. "My mother is coming to stay with us for a couple weeks. She will be helping with housework." 2. "I am disappointed with having to have a c-section, but am glad to finally meet my new son today." 3. "It is a relief to know my partner can stay in the room with me during the surgery." 4. "I will miss being able to breastfeed. I breastfed my other children for one year each."

4

While preparing a client for an emergency cesarean section, the nurse places an oxygen mask on the client. What is the rationale for this nursing intervention? 1. Prevent hypertension 2. Prevent tachypnea 3. Decrease anxiety 4. Fetal intolerance to labor

4

The nurse is preparing a client in the operating room for a cesarean section. The client asks the nurse why a roll is being placed under the hip. How should the nurse respond? 1. "The hip tilt position allows the provider easier access to the uterus for delivery." 2. "The hip tilt position eases pressure on the inferior vena cava and decreases the risk of hypotension." 3. "The hip tilt position decreases bladder distention and reduces the risk of bladder injury during surgery." 4. "The hip tilt position allows for a quicker delivery of the infant during the c-section."

2

A nurse is caring for a client following a cesarean section delivery the day before. During the assessment, the nurse checks for Homan's sign. Why is the nurse conducting this assessment? 1. There is an increased risk of thromboembolism after surgery. 2. This assessment checks for wound healing on the surgery site. 3. It is important to check for peripheral circulation following surgery. 4. Constipation is a risk after a cesarean delivery.

1

A nurse on the postpartum care unit is anticipating admission of a client immediately after an emergency cesarean section. The surgery was due to a Category III fetal monitor tracing and was performed under general anesthesia. What client concerns does the nurse anticipate as addressing with this client? 1. The need for the C-section delivery 2. The frequency of vital signs 3. The need to bottle feed the infant 4. The type of delivery for future pregnancies

1

Following a cesarean section a few hours ago, the partner of a client comes out to the nurses' station to report severe itchiness the client is experiencing. The partner voices concern that the client is experiencing an allergic reaction to the morphine given during surgery. How does the nurse respond to the client when entering to the room to assess the itching? 1. "Itchiness, also known as pruritis, is a common reaction to morphine and is not considered an allergy." 2. "Here is some medication to stop the itching." 3. "I will note in your medical record that you have an allergy to morphine." 4. "Let me call the provider and report the itching."

1

Following completion of four deliveries via cesarean section, the nurse states in shift report the APGAR scores for the four newborns. Which infant does the oncoming nurse see first? 1. APGAR 5, APGAR 7 2. APGAR 8, APGAR 8 3. APGAR 9, APGAR 10 4. APGAR 7, APGAR 9

1

The nurse is preparing a client for a cesarean section. Following the epidural anesthesia, the nurse is ready to show the partner where to stay during the surgery. Where does the nurse show the partner to go? 1. On a stool next to the client's head. 2. On a stool next to the infant warmer. 3. In a waiting room next to the operating room. 4. In the recovery room, to await completion of the surgery.

1

While the nurse is preparing a client for an emergency cesarean section, the family voices concern that the client is extremely nervous about the procedure. How does the nurse respond to the client? 1. "Tell me about how you are feeling right now." 2. "We do many c-sections every day, you will be fine." 3. "I am going to insert the foley catheter now." 4. "It is important that you try to calm down for the baby."

1

The nurse calls the provider on a cesarean section client the day after surgery to report concerns about peristaltic ileus. What assessment data does the nurse include in the report to the provider to support this concern? 1. Foul smelling discharge from the incision 2. Absent bowel sounds in the lower right quadrant 3. Temperature of 101.3℉ and 102.1℉ and hour later 4. Redness, pain, and swelling in the left calf

2

The nurse is caring for a client who delivered a nulliparous pregnancy via cesarean section late the day before. The client is requesting eggs for breakfast. The grandmother is concerned with the client eating a regular diet so soon after surgery. How does the nurse respond to the concern? 1. "That is not how we do it anymore." 2. "Eating actually helps with return of bowel function." 3. "Research changes how things are done frequently." 4. "It is best to always give the client what they want."

2

During a scheduled cesarean section for placenta accreta, the client required a hysterectomy due to failure of the placenta to separate. The gravida 1 para 1 client delivered a healthy baby boy. What concern does the nurse anticipate addressing with the client? 1. Family dysfunction 2. Postpartum psychosis 3. Postpartum depression 4. Ineffective bonding

3

Following cesarean delivery, a stable female infant weighing 3,126 grams is placed skin-to-skin with the mother. The client's partner asks why the infant is placed with the mother during the remainder of the surgery. What is the best response from the nurse? 1. "Placing the infant with the mother reduces the need to have another nurse in the crowded operating room." 2. "We can discuss this later, I need to help the surgeon right now." 3. "Infants are less likely to need NICU care when placed skin-to-skin with the mother." 4. "It is important to get a picture immediately after delivery of the infant."

3