Question 1 of 9
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Which patient data would the nurse validate as part of routine preparation for cesarean delivery to determine adequate fetal maturity?
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- Rh-positive antibody test performed 4 weeks before surgeryAlthough Rh antibody screening is routinely performed early in the pregnancy, these findings do not indicate gestational age.
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- Negative rubella titer performed 6 weeks before surgeryAlthough a rubella vaccine administration is recommended early in the pregnancy, these findings do not indicate gestational age.
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- Positive serum pregnancy test performed at least 36 weeks before surgeryPositive serum pregnancy test, performed at least 36 weeks before the date of cesarean delivery, can be used to verify gestational age.
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- High serum alpha-fetoprotein (AFP) level performed 26 weeks before surgeryAlthough high serum AFP may indicate fetal abnormalities, such as neural tube defects, these findings do not indicate gestational age.
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- Ultrasound examination between 6 and 11 weeks of pregnancyAn early ultrasound is one of the most reliable and accurate ways to date a pregnancy.
Question 2 of 9
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Which statement indicates a need for further teaching regarding cesarean delivery?
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- “I might need a blood transfusion after the surgery.”Maternal risks of cesarean delivery include hemorrhage and possible transfusion.
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- “Having a C-section might make my hospital stay longer.”Patients who have a cesarean delivery may require longer hospital stays.
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- “Because I am not having a vaginal birth, my babies can’t be harmed during delivery.”Cesarean delivery carries risk for injury to the newborn, such as bruising, fractures, or other trauma.
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- “Depending on how they do the incision, I may be able to have a vaginal delivery if I become pregnant again.”Classical uterine incisions eliminate the likelihood of vaginal delivery after a cesarean delivery, but a low transverse uterine incision makes vaginal delivery after a cesarean delivery possible.
Question 3 of 9
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When witnessing informed consent for cesarean delivery, which risks to the patient is the nurse acknowledging the patient understands?
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- Urinary tract infection or trauma to the bladderAn indwelling catheter increases the risk for urinary tract infection, and there is risk for trauma to the bladder during the procedure.
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- Cervical laceration or traumaTrauma to the cervix is not a risk for cesarean delivery because the incision is performed on the uterus.
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- Increased risk for blood clots, which can be in the legs or can travel to the heart or lungsMajor surgery such as cesarean section increases a patient’s risk for thrombophlebitis and thromboembolism.
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- Injury to the newborn including lacerations, bruising, or fracturesCesarean delivery can be traumatic for the newborn, especially if the delivery is complicated by malpresentation, macrosomia, or other factors.
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- The need for cesarean birth with every delivery after this procedure regardless of the incision typeIt is possible for patients to have vaginal births after a cesarean birth with certain uterine incision types.
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- The risk that the baby’s lungs might be compromised or need extra support at birthThere is risk for inadvertent fetal lung immaturity or transient tachypnea of the newborn with cesarean delivery.
Question 4 of 9
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Which explanation of cesarean delivery incisions would a nurse provide to a patient?
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- “There are a total of three incisions that will be made in your body by the surgeon.”There are two incisions made during cesarean delivery: the skin incision and the uterine incision.
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- “The surgeon may make a vertical incision or a transverse incision on your skin.”A transverse (Pfannenstiel) incision or vertical incision may be made on the skin at the discretion of the surgeon based on various considerations.
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- “You will not be able to the see the incision once it is fully healed if the surgeon makes a Pfannenstiel incision on your skin.”Regardless of the incision type, the incision site will still be visible. The site will be less visible, however, with a Pfannenstiel incision.
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- “If you have a transverse incision on your uterus, you can never have a vaginal birth.”Women cannot have a vaginal birth after a vertical uterine incision, but it is still possible after a transverse incision.
Question 5 of 9
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Which advantages of a low transverse skin incision would a nurse explain to a patient?
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- Less visibility when healedThe low transverse incision is less visible because it sits at or below the bikini line.
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- Less chance of wound dehiscenceThere is less chance of wound dehiscence with low transverse skin incisions.
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- Pubic hair will grow backPubic hair will grow back with a low transverse incision. This helps hide the scar.
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- Works well with obese patientsVertical skin incisions allow for better visualization of the uterus with obese patients.
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- Allows the surgeon to extend the incision upwardVertical skin incisions, not transverse incisions, allow the surgeon to extend the incision upward.
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- Quicker to performVertical skin incisions are quicker to perform than transverse incisions.
Question 6 of 9
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The nurse caring for a patient with a history of a previous cesarean delivery notes a small incision scar on the patient’s bikini line (transverse). The patient asks the nurse if a trial of labor will be possible. Which response would the nurse provide?
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- “Transverse uterine incisions allow for vaginal births, but the skin and uterine incisions do not always match, so we will have to verify.”The nurse needs to verify the type of incision on the uterus because it may not match the skin incision.
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- “You have a transverse skin incision, so that means you also have a transverse uterine incision and a trial of labor is possible.”Skin incisions and uterine incisions may be different. It is important to verify before labor onset.
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- “Because you have a transverse skin incision, there is a greater chance of having a uterine incision rupture with labor.”Vertical skin and uterine incisions have a greater risk for uterine incision rupture.
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- “It is never safe to have a vaginal birth after a cesarean delivery.”If the conditions are favorable, it is possible to have a safe vaginal birth after cesarean delivery.
Question 7 of 9
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The nurse is checking the pad of a patient recovering from a cesarean delivery who has called out, “I just had a large gush of blood!” The nurse does not note an abnormal amount of blood under the patient’s legs. Which action would the nurse take next?
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- Request that the health care provider evaluate the patient for possible postpartum hemorrhage.The nurse would evaluate the patient before calling the health care provider to the bedside.
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- Administer the as-needed (PRN) dose of methylergonovine.Methylergonovine may be indicated, but it is important that the nurse complete an assessment before administering a PRN medication.
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- Check for pooling of blood under the patient’s buttocks and back.Significant amounts of blood can pool under a patient’s buttocks or even up the back when the patient is bedbound. It is important to immediately evaluate this patient’s concern.
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- Explain that this can be normal and evaluate with the next scheduled fundal check.Blood can pool under and behind a patient. The nurse would roll the patient to check for pooling and should not wait for the next fundal check to evaluate the patient’s concern.
Question 8 of 9
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During fundal assessment 30 minutes after a cesarean delivery, the patient reports discomfort and exhaustion and asks the nurse, “Why do you keep poking at me?” Which response from the nurse is appropriate?
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- “I’ll wait until you’re on the postpartum floor to assess you again.”Fundal assessment after cesarean delivery should not be delayed until the patient is transferred to the postpartum unit.
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- “I need to do this assessment to make sure your incision is healing correctly.”Fundal assessment after cesarean delivery is performed to assess for uterine atony, not to ensure healing of the incision.
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- “This assessment must be done every 30 minutes until you transfer out of the recovery room.”Fundal assessment should be performed every 15 minutes for the first hour after delivery, every 30 minutes for the second hour, and then hourly until the patient transfers to the postpartum unit.
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- “A cesarean delivery puts you at risk for excessive bleeding, so it’s important to assess you frequently.”Fundal assessment must be performed frequently after cesarean delivery to assess for uterine atony, which can lead to hemorrhage. Postpartum hemorrhage and uterine atony are risks of cesarean delivery.
Question 9 of 9
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The nurse caring for a patient in the postanesthesia care unit (PACU) notes that a patient is having bradypnea after general anesthesia. Which immediate interventions are indicated to determine the next actions by the nurse?
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- Assess the patient’s level of consciousness.Assessing the patient’s level of consciousness is correct. Sometimes general anesthesia can make a patient sleepy, but by gently waking the patient, the respiratory rate may return to normal.
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- Ensure the pulse oximeter is on and within normal limits.Whenever the patient’s respiratory status is compromised, a pulse oximeter is indicated.
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- Call the anesthesiologist for possible intubation.Intubation may not be indicated. The nurse would assess level of consciousness first and see if the patient awakens with stimulation.
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- Administer the prescribed dose of naloxone.General anesthesia is not reversed with naloxone.
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- Continue to monitor the patient, as bradypnea is a normal response to general anesthesia.Bradypnea is not an expected finding in a patient. If the patient does not respond to gentle stimulation, the anesthesia health care provider should be called immediately.