Question 1

The nurse is caring for a patient recovering from a cesarean birth. Which assessment should the nurse make a priority for this patient?&#10;A) Breast filling&#10;B) Plan to breastfeed&#10;C) Abdominal texture&#10;D) Perineum for edema

Accepted Answer

After a cesarean birth, the nurse should assess the abdomen for softness. A hard, "guarded" abdomen is one of the first signs of peritonitis, a complication that may occur with any abdominal surgical procedure. Although important, breast filling does not lead to a life-threatening complication. Plans to breastfeed could have been determined prior to the cesarean birth. Because the baby was delivered through the abdomen, the perineum should not be edematous.

Question 2

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?

A) "All future births must be done through cesarean."
B) "Not if you fulfill the criteria for vaginal birth after cesarean."
C) "Your health care provider will let you know what kind of birth you can have."
D) "Most women prefer cesarean births because they are quicker and cause less pain."

"Not if you fulfill the criteria for vaginal birth after cesarean."

Accepted Answer

To fulfill the 2020 National Health Goals regarding cesarean births and answer the patient's question, the nurse should respond that patients who fulfill the criteria for vaginal birth after cesarean should attempt a vaginal birth with subsequent children. All future births do not need to be done through cesarean. The patient has a voice with deciding the type of birth that she would prefer with each pregnancy. Most women do not prefer cesarean births. This type of birth might not take as long; however, it is a painful surgical procedure.

Question 3

A patient whose fetus is presenting breech is scheduled to have a cesarean birth. What should the nurse anticipate this patient will need to ensure maximum postoperative care?&#10;A) Bed rest for the first 4 days&#10;B) Insertion of a nasogastric tube&#10;C) Maintenance of an indwelling catheter&#10;D) Separation from the infant for 72 hours

Accepted Answer

To reduce bladder size and keep the bladder away from the surgical field, an indwelling urinary catheter may be prescribed before transport for surgery or after arrival in the surgical suite. Because the bladder was handled and displaced during surgery, its tone or ability to sense filling may be inadequate to initiate voiding for the first postoperative day. For this reason, the indwelling catheter placed before surgery is usually left in place for 4 to 24 hours to ensure good urine drainage. The patient will not be on bed rest for 4 days after a cesarean birth. A nasogastric tube is not indicated for a cesarean birth. The infant will not be separated from the mother for 72 hours after a cesarean birth.

Question 4

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?&#10;A) Encouraging her to ambulate&#10;B) Administering an oral antacid&#10;C) Administering morphine sulfate&#10;D) Keeping in a side-lying position

Accepted Answer

The side-lying position helps prevent supine hypotension syndrome, and epidural anesthesia is usually administered with the patient lying on the side. Ambulation prior to anesthesia may or may not be indicated for the patient. Oral antacids and morphine sulfate are not a part of preparation for epidural anesthesia.

Question 5

A patient scheduled for a cesarean birth asks if there are any difficulties with breastfeeding after this type of delivery. What should the nurse include when responding to this patient?&#10;A) Breastfeeding is not recommended after a cesarean birth.&#10;B) It is hard to find a comfortable position to hold a newborn to breastfeed.&#10;C) A comfortable position can be found to support breastfeeding the infant.&#10;D) The patient will have too much analgesia postoperatively to make breastfeeding safe.

Accepted Answer

The nurse can help the patient with breastfeeding by placing a pillow over the lap while the infant nurses. This position can deflect the weight of the infant from the suture line and lessen pain. The use of the football hold for breastfeeding is another way to keep the infant's weight off the incision. Breastfeeding is recommended after a cesarean birth. It is not difficult to find a comfortable position to hold a newborn to breastfeed. The patient will not have too much analgesia postoperatively for safe breastfeeding.

Question 6

A patient, preparing for patient-controlled analgesia for pain relief after a cesarean birth, asks if this is an effective way to control pain. What should the nurse respond to the patient?&#10;A) &#34;It is effective, but the amount of analgesic used will preclude breastfeeding.&#34;&#10;B) &#34;Every woman reacts differently to pain, so it would be impossible to predict.&#34;&#10;C) &#34;Not only is it effective but it also will reduce the amount of narcotic needed.&#34;&#10;D) &#34;Most women do not feel well enough after surgery to want control of their own pain relief.&#34;

Accepted Answer

With patient-controlled analgesia, a constant level of pain relief can be maintained, and pain and fear of injections are eliminated. This approach works well with postcesarean patients because the narcotic is injected in such small amounts; patients tend to use less analgesia with this approach than they would receive with intramuscular injections.
Breastfeeding is not contraindicated with patient-controlled analgesia. Patient-controlled analgesia has proven to be an effective method to control pain. Most patients like patient-controlled analgesia because they are able to control their own pain relief.

Question 7

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?&#10;A) Provide with a clear liquid tray.&#10;B) Encourage intake with ice chips.&#10;C) Initial intravenous fluid therapy.&#10;D) Administer an antiemetic as prescribed.

Accepted Answer

A patient who enters surgery with a lower than usual blood volume will experience the effect of surgical blood loss more than a patient who has a normal blood volume. A patient who has had a long labor before a cesarean birth is scheduled may fall into this category, because the patient may have had little to eat or drink for almost 24 hours.
Intravenous fluid replacement needs to be initiated preoperatively and continued postoperatively to prevent a serious fluid or electrolyte imbalance. Since surgery is imminent, the patient should be kept at "nothing by mouth" status, which means no ice chips or clear liquids. An antiemetic is not indicated for the patient at this time.

Question 8

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?&#10;A) 24 hours postprocedure&#10;B) 48 hours postprocedure&#10;C) When bladder tone returns&#10;D) When bowel sounds return

Accepted Answer

Patients are kept at "nothing by mouth" status for a period of time after surgery until intestinal peristalsis has returned. To establish this is returning, the patient's abdomen should be assessed at least once every 8 hours for bowel sounds because this demonstrates air and fluid are moving through the intestines. As soon as bowel sounds return, IV fluid therapy is usually discontinued and the patient can slowly begin oral intake with fluids. Oral intake may or may not be permitted 24 to 48 hours after the procedure. Oral intake is not contingent on bladder tone.

Question 9

The nurse encourages a patient recovering from a cesarean birth to begin early ambulation. For which outcome would this action be indicated?&#10;A) Patient will tolerate clear liquids.&#10;B) Patient will have no evidence of wound infection.&#10;C) Patient will successfully begin breastfeeding the infant.&#10;D) Patient will not develop manifestations of thrombophlebitis.

Accepted Answer

Early ambulation is an intervention to avoid lower extremity circulatory problems such as thrombophlebitis. Early ambulation is not an intervention to improve tolerance for clear liquids, prevent wound infection, or have success with breastfeeding.

Question 10

The fetus of a patient 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 patient asks why this approach is preferred over a vaginal delivery. What should the nurse respond to the patient?

A) "You will have reduced pain afterward."
B) "There's not an advantage; it's just more convenient."
C) "Cesarean birth allows the placenta to deliver easier."
D) "Cesarean birth will reduce pressure on the immature head."

Accepted Answer

A cesarean delivery may be advantageous for a preterm birth to avoid pressure on the fetal head. A cesarean birth does not reduce the amount of postpartum pain. The health care provider does not want to use a cesarean birth because it is more convenient. A cesarean birth does not necessarily allow the placenta to deliver easier.

Question 11

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?&#10;A) The uterine incision will be vertical.&#10;B) Vaginal deliveries can occur with future births.&#10;C) Because the cervix is cut, the operation proceeds rapidly.&#10;D) Because the fundus of the uterus is cut, the infant can be resuscitated rapidly.

Accepted Answer

The answer of A patient having a cesarean birth will...

Question 12

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?

A) Fear related to impending surgery
B) Risk for infection related to a surgical incision
C) Powerlessness related to medical need for cesarean birth
D) Risk for impaired parent/infant attachment related to unplanned method of birth

Accepted Answer

The answer of After learning about the need for a...

Question 13

The nurse assists while a pregnant patient has an amniotomy. Which action should the nurse take immediately at the conclusion of the procedure?&#10;A) Assess fetal heart rate.&#10;B) Adjust intravenous fluid infusion rate.&#10;C) Assist the patient to wash the perineum.&#10;D) Provide clean gown and linens for the patient.

Accepted Answer

The answer of The nurse assists while a pregnant patient...

Question 14

The nurse is concerned that a pregnant patient will have a complication from a medication after a cesarean birth. For which prescribed medications are complications most likely to occur? (Select all that apply.)

A) Insulin
B) Anticoagulant
C) Antihypertensive
D) Antianxiety agent
E) Beta₂-adrenergic blocker

Accepted Answer

The answer of The nurse is concerned that a pregnant...

Question 15

The nurse is preparing a teaching plan for a patient recovering from a cesarean birth. What should the nurse instruct the patient to help improve stamina and energy after the procedure?&#10;A) Drink at least six glasses of fluid each day.&#10;B) Limit social events to family and close friends.&#10;C) Rest twice a day for at least one-half hour each time.&#10;D) Slowly increase the amount of weight carried each day.&#10;E) Structure the day so that house cleaning and shopping is completed.

Accepted Answer

The answer of The nurse is preparing a teaching plan...

Deck 24: Nursing Care of a Family During a Surgical Intervention for Birth