Chapter 11: Assisted Delivery and Cesarean Birth
According to the National Vital Statistics System (NVSS), what was the national cesarean rate in 2014? 10% 15% 25% 32% 35%
32%
The nurse is caring for a client who is insisting on a vaginal delivery. For which situation should the nurse explain a vaginal delivery is contraindicated? Select all that apply. Spina bifida Macrosomia Transverse lie Breech presentation Preterm delivery
Spina bifida Transverse lie
The type of skin incision done for a cesarean section will indicate the type of uterine incision. true false
false
While the nurse is assessing the prenatal client's understanding of the information provided at a recent appointment, the client states, "I want to avoid the pain and long hours of labor, so I'm electing to have a cesarean birth." How should the nurse respond? "A cesarean birth is a method to be used when vaginal birth is not possible—it is not a true option." "It is important to inform the health care provider of your decision so that we can plan appropriately for when the birth occurs." "Cesarean birth is a low-risk surgery that is the ideal option in many cases." "Many women elect to have a cesarean birth to avoid the risk of anoxia."
"A cesarean birth is a method to be used when vaginal birth is not possible—it is not a true option."
When counseling a client about maternal risks and benefits of cesarean birth, which of the following would not apply? "Complications that may occur include hemorrhage, infection, and damage to the bladder and bowel." "Although unlikely, if severe hemorrhage does occur, you may require a hysterectomy." "We will be giving you antibiotics preoperatively, but it is still possible to develop an infection at the incision site after the birth." "A surgical incision may be made at the perineum to enlarge the vagina just before the birth of the baby."
"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? "You will like cesarean birth so much that you will want repeat cesarean births in the future." "There is no way to predict that; it will depend on your individual uterine anatomy." "Yes. 'Once a cesarean always a cesarean' is a well-known rule." "Although there are some exceptions, surgical techniques allow for vaginal birth after cesarean birth."
"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? "You will undergo general anesthesia, so you will be asleep during the procedure." "A Foley catheter will be inserted before surgery and will be removed once you arrive to the postpartum unit." "After surgery, you will be immediately transferred to the postpartum unit." "An IV catheter will be placed, and we will do some preoperative blood work. Then we will give you some antibiotics."
"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." "There is no scientific reason for this occurrence." "All babies are different so it is unwise to make comparisons." "The pain medication given during the surgery may have contributed to the mucus build up."
"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."
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? "There's not an advantage; it's just more convenient." "Cesarean birth will reduce pressure on the immature head." "You will have reduced pain afterward." "Cesarean birth allows the placenta to deliver easier."
"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? "You will be able to have a vaginal birth with your next birthing experience." "The type of incision used on your uterus may hinder your ability to have a vaginal birth with your next birthing experience." "The reason for your cesarean birth may indicate an inability to have a vaginal birth in the future." "Having a cesarean birth does not mean you will have a cesarean birth with future births."
"Having a cesarean birth does not mean you will have a cesarean birth with future births."
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 is tiny like me and was unable to have the infant fit through the pelvis." "My sister's infant was breech and was unable to be turned." "My sister was in labor for 24 hours and the labor did not progress." "My sister had a cesarean birth with the first infant and now needs it for all subsequent pregnancies."
"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 delivery and is anxious to begin breast-feeding her baby. What is the best response from the nurse? "Sure, let me help you with that." "I need to monitor you closely for 30 minutes, first." "Just as soon as you get to the postpartum unit in an hour or 2." "You will not be able to breastfeed until you can get up and walk around."
"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? "I don't see why not. Let me ask the doctor." "The cervix must be completely dilated before forceps can be applied safely." "No. Once the water bag ruptures, the doctor cannot apply forceps." "Forceps are too dangerous. I'll get a vacuum extractor ready for your delivery."
"the cervix must be completely dilated before forceps can be applied safely"
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 41-year-old with two previous cesarean births 32-year-old with gestational diabetes 22-year-old with Rh-negative blood
28-year-old with a placenta previa
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? 5 or below 6 or above 3 or below 8 or above
8 or above
Which woman is most likely to have a successful VBAC (vaginal birth after cesarean)? A 41-year-old who has had 1 previous cesarean delivery and has gone into labor spontaneously A 20-year-old who has had 2 previous cesarean deliveries A 35-year-old who has had 1 previous cesarean delivery and has been induced with Pitocin A 32-year-old who has had 1 previous cesarean delivery, has gone into labor spontaneously, and then has been augmented with AROM
A 32-year-old who has had 1 previous cesarean delivery, has gone into labor spontaneously, and then has been augmented with AROM
The nurse is caring for a patient recovering from a cesarean birth. Which assessment should the nurse make a priority for this patient? Breast filling Plan to breastfeed Abdominal texture Perineum for edema
Abdominal texture
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? Ask her husband, who is fearful and anxious, to wait outside. Assess how much the woman already knows about cesarean. Start by going over the risks of cesarean so she has enough time to go over each one. Wait until the physician and the anesthesiologist have completed their history and assessment, so the teaching can be more focused and directed.
Assess how much the woman already knows about cesarean.
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 Increase the rate of oxytocin Assess the mother for bleeding Apply supplemental oxygen to the mother
Assess the infant for trauma
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. Set up for imminent vacuum delivery. Call the pediatricians into the room for imminent vaginal delivery. Set up for imminent forceps delivery.
Call for help and prepare the client for an emergency cesarean birth.
The nurse is caring for a group of clients on the birthing unit. For which client(s) should the nurse anticipate an emergency cesarean birth? Select all that apply. Client with bright red, painless vaginal bleeding Client with a fetus exhibiting variable decelerations Client with abnormal amniotic fluid volume Client with three contractions in 20 minutes, lasting 35 seconds each, in active phase of labor Client whose labor pain is not adequately controlled by epidural analgesia
Client with bright red, painless vaginal bleeding Client with a fetus exhibiting variable decelerations Client with abnormal amniotic fluid volume Client with three contractions in 20 minutes, lasting 35 seconds each, in active phase of labor
A client presents at 41 weeks gestation for induction of labor and an attempt at VBAC. The nurse is aware that which method would be contraindicated for this client? Oxytocin Artificial rupture of membranes Balloon catheter insertion Dinoprostone vaginal insert
Dinoprostone vaginal insert
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. The LPN/LVN is new on the unit. What is the LPN/LVN's role in this procedure? Obtain the amniohook and prepare the woman for delivery. Document fetal heart rate before and after the procedure. Get the delivery room ready. Document the woman's vital signs before and after the procedure.
Document fetal heart rate before and after the procedure.
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 delivery and what can be expected. When should the nurse provide this family education? At a preset time one month prior to the scheduled delivery Only when she and her significant other can come to the clinic together When the client presents for admission for the procedure Each time the nurse sees the woman before surgery
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? trauma from a Foley catheter trauma from a cesarean birth episiotomy infection
Episiotomy
The nurse is caring for a client who is Jehovah's Witness and was expecting a vaginal birth. The client needs a cesarean birth during labor and is at high risk for hemorrhage. Which action should the nurse prioritize at this time? Evaluate whether the client should be cared for in another setting Provide the client and family with a private time to pray before surgery Inform the client that certain life-saving interventions may be required if complications arise Determine if chaplain services that align with the client's beliefs are available
Evaluate whether the client should be cared for in another setting
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. Onset of fetal tachycardia Excessive maternal pain Increased vaginal bleeding Unrelenting uterine contraction Signs of maternal shock
Excessive maternal pain Increased vaginal bleeding Unrelenting uterine contraction Signs of maternal shock
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 Decreased blood pressure
Increased heart rate Bronchodilation Elevated blood glucose level Peripheral vasoconstriction
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? Causes loss of bowel control after the birth Increases risk of blood loss immediately after delivery Suturing of episiotomy increases sexual pleasure following delivery. Decreases risk of infection after delivery
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. Induced labor decreases the need for interventions during labor and delivery. Induced labors are less painful and progress faster. Induced labor decreases the possibility of cesarean birth.
Induced labor can result in higher costs for the delivery.
The nursing instructor is conducting a class presenting the various aspects of a cesarean delivery. The instructor determines the class is successful after the students correctly choose which complication as the most common postoperative complication? Thrombosis Infection Laceration of the uterine artery Pneumonia
Infection
A patient who has been in labor for 20 hours is being prepared for an emergent cesarean birth. Which action will help ensure the patient's fluid status during the procedure? Provide with a clear liquid tray. Encourage intake with ice chips. Initial intravenous fluid therapy. Administer an antiemetic as prescribed.
Initial intravenous fluid therapy.
A woman is scheduled to have epidural anesthesia for a cesarean birth. What should the nurse anticipate to include in the preoperative plan of care while the patient waits for the anesthetic? Encouraging her to ambulate Administering an oral antacid Administering morphine sulfate Keeping in a side-lying position
Keeping in a side-lying position
The nurse is teaching a prenatal class about a cesarean delivery. What benefit of a low transverse uterine incision should the nurse point out in the teaching? Least likely to rupture during subsequent labors. Easier to extend the incision in the uterus is needed. Quickest way to delivery a baby. Best way to deliver a premature breech baby.
Least likely to rupture during subsequent labors.
A nursing student correctly identifies that an episiotomy that extends straight down into the true perineum is which of the following? mediolateral episiotomy midline episiotomy lateral episiotomy unilateral episiotomy
Midline episiotomy
The nurse is caring for a client who is postoperative after a cesarean birth and receiving treatment with antibiotics. For which condition(s) should the nurse monitor? Select all that apply. Opportunistic infections Renal insufficiency Elevated liver enzymes Hypokalemia Tachycardia
Opportunistic infections Renal insufficiency
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 bed rest for the first 4 days insertion of a nasogastric tube separation from her infant for 72 hours
Presence of an indwelling catheter
The nurse is assessing a neonate after a cesarean delivery. Which most common complication should the nurse be prepared for? Respiratory distress Shoulder dystocia A facial nerve injury Hemorrhage
Respiratory distress
A pregnant woman who required labor induction for a previous pregnancy says the to 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? The need for an amniocentesis to do cervical length measurements. Increased costs associated with both of these 2 newer methods. Shorter time need for obtaining the Bishop score results Increased level of predictabiity with fetal fibronectin levels.
Shorter time need for obtaining the Bishop score results
The nursing instructor is conducting a session exploring the various factors related to induction of labor. The instructor determines the session is successful after the students correctly choose which factors are used to determine if the cervix is ripe enough for induction? Station, effacement, cervical consistency, dilatation, and cervical position Dilatation, cervical consistency, presentation, station, and effacement Dilatation, cervical position, presentation, station, and effacement Effacement, dilatation, presentation, attitude, and cervical position
Station, effacement, cervical consistency, dilatation, and cervical position
The maternal health nurse is caring for a group of pregnant clients. Which client will the nurse determine is most ready for labor? The client whose Bishop score is 9 today. The client whose cervical length via endovaginal ultrasound has increased. The client who is 41 weeks gestation today. The client whose cervical secretions are negative for fetal fibronectin.
The client whose Bishop score is 9 today.
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 uterine incision will be vertical. The skin incision will be just above her pubic hair. Because the cervix is cut, the operation proceeds rapidly. Because the fundus of the uterus is cut, the infant can be resuscitated rapidly.
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 client lies down on the delivery table, and a wedge is placed. 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 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 being prepared for a scheduled cesarean delivery by the medical team. Which intervention will be most critical for the team to monitor in the first 24 hours post cesarean delivery? Urinary output Administration of sodium citrate Preparing for blood transfusion Maintaining IV access
Urinary output
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? Vagina Urinary tract Uterus Rectus muscle wall
Uterus
A patient having a cesarean birth will have a low segment incision. What should the nurse explain to the patient as an advantage for this type of incision? The uterine incision will be vertical. Vaginal deliveries can occur with future births. Because the cervix is cut, the operation proceeds rapidly. Because the fundus of the uterus is cut, the infant can be resuscitated rapidly.
Vaginal deliveries can occur with future births.
Following a cesarean birth, a patient is prescribed to receive intravenous fluids. At which time should the nurse anticipate that this patient will be able to resume an oral intake? 24 hours postprocedure 48 hours postprocedure When bladder tone returns When bowel sounds return
When bowel sounds return
The maternal health nurse is assisting a birth attendant in the use of low-outlet forceps for a forceps-assisted birth. At which point of the birth will the nurse expect the use of the device? When the fetus requires rotation to an anterior position When the fetal head can be seen in the introitus When the fetal station is equal or greater than +2 When the fetal head is well engaged but station is less than +2
When the fetal head is well engaged but station is less than +2
What is the most effective way to stimulate circulation after cesarean birth? ambulation within 4 hours of birth ambulation within 8 hours of birth Venodyne boots TEDS stockings
ambulation within 4 hours of birth
A nurse correctly recognizes which of the following as a current trend within the population of birthing women? more natural births with fewer medical interventions increased public funds for using doulas increased rates of cesarean sections decreased use of epidurals
increased rates of cesarean sections
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? encouraging her to ambulate administering an oral antacid administering morphine sulfate IM keeping her turned on her side
keeping her turned on her side
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 rlsk for rectal mucosal tear easier healing less blood loss less postpartal discomfort
lower rlsk for rectal mucosal tear
A client is being admitted at 41-weeks gestation with a cervix which is not ready for labor and delivery. Which procedure might the nurse prepare the client for? (Select all that apply.) membrane stripping mechanical dilation locally applied prostaglandins artificial rupture of membranes episiotomy
membrane stripping mechanical dilation locally applied prostaglandins artificial rupture of membranes
A nursing student correctly identifies which of the following as medical reasons to induce labor? Select all that apply. postdate pregnancy pregnancy that persists beyond the due date gestational hypotension premature rupture of membranes without spontaneous labor preeclampsia
postdate pregnancy pregnancy that persists beyond the due date premature rupture of membranes without spontaneous labor preeclampsia
Eight hours after a cesarean section, a postpartum woman is having heavy lochia. She informs the nurse, who suspects which of the following causes? normal for a cesarean section postpartum hemorrhage infection another cause other than the birth
postpartum hemorrhage
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: is larger than a classical incision and will allow for easier delivery. reduces the risk of uterine rupture. is less complicated to perform. has a lower risk of maternal injury.
reduces the risk of uterine rupture.
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 24 hours post-procedure until 48 hours post-procedure until bowel sounds have returned until her bladder tone has returned
until bowel sounds have returned
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 transverse abdominal incision ("bikini cut") has been made previously when a classical uterine incision has been made previously when a vertical abdominal incision has been made previously when a low cervical uterine incision has been made previously
when a classical uterine incision has been made previously
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 whether her perineum is edematous if her breasts fill by the third day if she wants to breastfeed or not
whether her abdomen is soft or not
After learning about the need for a cesarean birth, the pregnant patient begins to cry and hyperventilate. Which nursing diagnosis should the nurse use to guide the care that the patient needs at this time? Fear related to impending surgery Risk for infection related to a surgical incision Powerlessness related to medical need for cesarean birth Risk for impaired parent/infant attachment related to unplanned method of birth
Fear related to impending surgery
A patient who had a previous cesarean birth asks the nurse if all future births must occur the same way. Which response should the nurse make to support the 2020 National Health Goals regarding cesarean births? "All future births must be done through cesarean." "Not if you fulfill the criteria for vaginal birth after cesarean." "Your health care provider will let you know what kind of birth you can have." "Most women prefer cesarean births because they are quicker and cause less pain."
"Not if you fulfill the criteria for vaginal birth after cesarean."
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? membrane stripping artificial rupture of membranes mechanical dilatation none of the above
Artificial rupture of membranes
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. fetal distress. maternal hypertension. spontaneous rupture of membranes.
uterine hyperstimulation.
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? Braden scale Bishop score Norton scale Apgar score
Bishop scale