CH 11

Chapter 11 Intrapartum and Postpartum Care of Cesarean Birth Families
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. A patient who is expecting her first baby tells the nurse, “I am afraid of the whole birth experience
and plan to ask the doctor for a cesarean delivery.” Which response by the nurse is most
appropriate?
1. “I will get you some material about how labor pain is managed.”
2. “Most women avoid cesarean births unless it is an emergency.”
3. “I suggest you talk with the physician and get another opinion.”
4. “Cesarean will cause you issues with additional pregnancies.”
____ 2. The nurse is providing care for a prenatal patient who is told she will require a cesarean delivery
because of cephalopelvic disproportion. Which explanation of the condition will the nurse provide
to the patient?
1. The patient has a preexisting medical condition that supports cesarean birth.
2. The size and/or shape of either the fetal head or patient pelvis is an issue.
3. The placenta is implanted in an unfavorable position in the uterus.
4. The patient had a surgery with an incision through the myometrium of the uterus.
____ 3. The nurses in a labor and delivery unit are concerned about the high incidence of cesarean
deliveries at their facility and initiate an internal study. Which is the most likely condition the
nurses will recognize as a contributor to the rate of cesarean births?
1. The facility has a high rating for managing high-risk pregnancies.
2. Policies and parameters for cesarean need to be reviewed and refined.
3. Community education about the advantages of vaginal birth is deficient.
4. The incidence of maternal requests for cesarean delivery is increasing.
____ 4. The nurse is assisting with the preparation of a patient admitted for a planned cesarean birth. The
patient has signed the consent form and discussed the elected regional anesthesia with the nurse
anesthetist. Which is the most important action for the nurse related to anesthesia?
1. Verify the patient has been NPO for 6 to 8 hours.
2. Start an IV line and administer an IV fluid as ordered.
3. Administer preoperative medications per orders.
4. Obtain a baseline fetal heart rate monitor strip.
____ 5. The nurse is monitoring a patient who has been in prolonged labor. Which assessment finding will
result in the nurse notifying the health care provider about the development of an emergent
situation requiring a cesarean delivery?
1. Maternal blood pressure indicative of hypotension
2. Maternal exhaustion from prolonged uterine activity
3. Recognition of a Category II fetal heart rate pattern
4. Increased maternal temperature related to infection
____ 6. An emergency cesarean is being implemented. The patient describes tingling in her ears and a
metallic taste with the administration of regional anesthesia. The nurse is aware that which
incidence has occurred?
1. Manifestation of maternal respiratory depression related to anesthesia
2. Inadvertent injection of the anesthetic agent into the maternal bloodstream
3. Maternal hypotension is occurring related to administration of anesthesia
4. Expected manifestations related to anesthetic medications are present
____ 7. A patient is being prepared for an unplanned cesarean section. Which pre-procedure information is
most important for the nurse to report before the administration of regional anesthesia?
1. Hypovolemia corrected with IV fluid administration
2. Inability of the patient to sit on the bedside and flex forward
3. Laboratory value indicating a low platelet count
4. History of patient experiencing headaches after a spinal
____ 8. In a research study performed by Schneuder, L., Crenshaw, J., and Gilder, R. (2017), which action
by the nurse will be implemented following a cesarean delivery?
1. Allow the birth partner to hand the neonate to the mother.
2. Assist the mother and partner to cut the umbilical cord.
3. Move the neonate into the visual field of the mother.
4. Encourage skin-to-skin contact between the mother and neonate.
____ 9. The nurse is providing care in PACU for a patient who just delivered a neonate via cesarean
section. The patient reports tightness in her chest. Assessment findings include tachypnea,
hypotension, and decreasing oxygen saturation levels. Which complication does the nurse report to
the health care provider?
1. Pulmonary embolism
2. Postpartum hemorrhage
3. Surgical-site infection
4. Developing endometritis
____ 10. The nurse in the post-delivery unit is encouraging skin-to-skin contact for a mother and neonate
after cesarean delivery. Which action, if noticed by the nurse, requires immediate intervention by
the nurse?
1. Mother is sitting up with the neonate prone on her chest.
2. Mother is supine with the neonate prone on her chest.
3. The neonate is prone on mother’s chest and facing to the side.
4. Neonate is prone with mother resting in semi-Fowler’s position.
Multiple Response
Identify one or more choices that best complete the statement or answer the question.
____ 11. The nurse-manager on a labor and delivery unit is monitoring the reasons for cesarean births at the
facility. Which reasons contribute to the high rates of cesarean births? Select all that apply.
1. Fetuses in breech position unable to deliver vaginally
2. Increased number of elective or maternal request cesareans
3. Incidences of women of older maternal age getting pregnant
4. Decreasing rate of malpractice litigation with cesarean birth
5. Presence of nonreassuring fetal tracings during labor
____ 12. The nurse in labor and delivery notices an increase in the number of women requesting cesarean
births. Which are the parameters and criteria used when making the decision to perform a cesarean
delivery on maternal request (CDMR)? Select all that apply.
1. Patient is able to self-pay for the procedure.
2. Patient is willing to defer from legal litigation.
3. Mother is planning to only have one child.
4. Patient is aware of possible neonatal complications.
5. Procedure is performed after 39 weeks gestation.
____ 13. The nurse is aware that there are multiple classifications for cesarean deliveries. Which situations
does the nurse classify as an unscheduled cesarean birth? Select all that apply.
1. Patient had a previous cesarean delivery.
2. There is evidence of a prolapsed cord with membrane rupture.
3. The cervix fails to fully dilate after prolonged labor.
4. Patient has a preexisting cardiac health condition.
5. There is recognition of placenta previa with mild bleeding.
____ 14. In preparation for a cesarean birth, the nurse expects which medical-based preoperative
interventions? Select all that apply.
1. Administration of narrow-spectrum prophylactic antibiotics
2. Verification that the woman has been NPO for 6 to 8 hours before surgery
3. Assessment of the woman’s knowledge and educational needs
4. Assessment for risk of venous thromboembolism (VTE)
5. Prescription for sequential compression devices prior to surgery
____ 15. A nurse has recently transferred to a labor and delivery unit. During a scheduled cesarean, the
nurse notices a prescription for the administration of 1,000 mL of prewarmed IV fluid. For which
reason does the health care provider prescribe the fluid in this manner? Select all that apply.
1. Results in an increased maternal core temperature
2. Results in improved neonatal umbilical arterial pH
3. Results in improved Apgar scores
4. Results in decreased risk for maternal shock
5. Results in lower incidence of post-partum hypothermia
____ 16. Following a cesarean birth, intrathecal morphine is administered to the patient for postoperative
pain management. Of which fact about intrathecal morphine therapy is the nurse aware? Select all
that apply.
1. An anesthesiologist or CRNA administers it intrathecally.
2. The nurse needs to closely monitor for common side effects.
3. The drug produces generalized CNS depression.
4. The recommended dose is 10 to 15 mg.
5. The drug alters perception of and response to painful stimuli.
____ 17. The nurse is providing care for a patient who delivered via cesarean 24 hours ago. Which teaching
does the nurse provide for the patient and family? Select all that apply.
1. Signs and symptoms to report to health care provider
2. Comfortable positions for feeding the newborn
3. Encouragement for early dietary intake of solid foods
4. Encourage family to help with infant care and housework
5. Provide information on nutrition to promote tissue healing
____ 18. The nurse is making a plan of care for a patient who is in the first 24-hour period past a cesarean
delivery. Which interventions will the nurse include in regards to medications? Select all that
apply.
1. Continue a daily stool softener.
2. Manage pain with morphine.
3. Ensure the availability of naloxone.
4. Provide prophylaxis antibiotics.
5. Administer Rhogam if needed.
Completion
Complete each statement.
19. The nurse understands that logically ____________________ cesarean births are an influential
factor related to the overall incidence of cesarean births.
Chapter 11 Intrapartum and Postpartum Care of Cesarean Birth Families
Answer Section
MULTIPLE CHOICE
1. ANS: 4
Chapter: Chapter 11 Intrapartum and Postpartum Care of Cesarean Birth Families
Chapter Learning Objective: 5. Identify potential intraoperative and postoperative complications
related to cesarean birth and nursing actions to reduce risk.
Page: 346
Heading: Introduction
Integrated Processes: Nursing Process
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Analysis [Analyzing]
Concept: Ante/Intra/Post-partum
Difficulty: Moderate
Feedback
1 This is incorrect. It is appropriate for the nurse to supply the patient with
material about pain management during labor and delivery; however, it is most
important for the nurse to explain the risks associated with CDMR.
2 This is incorrect. It is true that most women attempt to avoid cesarean delivery
unless it is an emergency. However, the patient may not be interested in
decisions made by other women.
3 This is incorrect. It is within the scope of practice for the nurse to provide
patient teaching, and the nurse can also suggest the patient explore the topic
further with the health care provider. However, it is most important for the nurse
to explain risks related to CDMR.
4 This is correct. The nurse needs to inform the patient that if additional
pregnancies are desired, cesarean delivery risks increase with each additional
pregnancy. Risk for placenta previa, placenta accreta, and gravid hysterectomy
rises with each cesarean delivery.
PTS: 1 CON: Ante/Intra/Post-partum

2. ANS: 2
Chapter Learning Objective: 1. Identify factors that place a woman at risk for cesarean birth.
Page: 346
Heading: Box 11-1: Indications for Cesarean Birth
Difficulty: Difficult
Feedback
1 This is incorrect. A preexisting medical condition may be reason for a cesarean,
but it does not fit with the cephalopelvic disproportion condition diagnosed.
2 This is correct. The patient requires a definition of cephalopelvic disproportion,
which prior to labor includes the determination that the size and/or shape of
either the fetal head or patient pelvis is an issue.
3 This is incorrect. The location of the placenta in the uterus can be a reason for a
cesarean; however, it does not fit with the cephalopelvic disproportion condition
diagnosed.
4 This is incorrect. Previous surgery with an incision through the myometrium of
the uterus can be a reason for a cesarean. However, it does not fit with the
cephalopelvic disproportion condition diagnosed.

3. ANS: 2
Page: 347
Heading: Indications for Cesarean Birth > Preventing the First Cesarean Birth
Feedback
1 This is incorrect. The high rating of the facility for management of high-risk
pregnancies may or may not impact the number of cesareans performed; not
every high-risk pregnancy ends with a cesarean birth.
2 This is correct. Review of the current literature demonstrates the importance of
adhering to appropriate definitions for failed induction and arrest of labor
progress as a means to reduce the numbers of cesarean births. Clinical
improvement strategies with careful examination of labor management practices
is important.
3 This is incorrect. It is important that community education be provided
explaining the advantages of vaginal births. However, this is not the lone action
that will reduce the numbers of cesarean births.
4 This is incorrect. Cesarean delivery by maternal request (CDMR) accounts for
only 3% of cesarean births in the United States.

4. ANS: 4
Chapter Learning Objective: 2. Discuss the preoperative nursing care and medical and anesthesia
management for cesarean births.
Page: 348
Heading: Perioperative Care:
Feedback
1 This is incorrect. Verifying the patient has been NPO for 6 to 8 hours before
surgery is important; however, there is another more important nursing action.
2 This is incorrect. Starting an IV line and administering an IV fluid as ordered is
important; however, there is another more important nursing action.
3 This is incorrect. Administering preoperative medications per orders is
important; however, there is another more important nursing action.
4 This is correct. Obtaining a baseline fetal heart rate monitor strip for at least 20
minutes before the administration of anesthesia is the most important nursing
action. Another 20-minute strip will be obtained after the administration of the
anesthesia. This comparison makes fetal monitoring more effective.

5. ANS: 3
Page: 350
Heading: Perioperative Care > Unscheduled Cesarean Birth > Nursing Actions
Feedback
1 This is incorrect. After a prolonged labor, the maternal blood pressure may be
low (hypotension) due to dehydration. This finding alone does not warrant the
nurse notifying the health care provider of a developing emergent situation. The
nurse will initiate fluid replacement protocol.
2 This is incorrect. Maternal exhaustion related to a prolonged labor is not
unexpected. However, this finding alone does not warrant the nurse notifying
the health care provider of a developing emergent situation.
3 This is correct. The nurse will notify the health care provider about recognition
of a Category II fetal heart rate pattern, which is an indication of fetal
intolerance of labor.
4 This is incorrect. The increase in temperature for the patient in prolonged labor
may be related to dehydration, and not infection. This finding alone does not
warrant the nurse notifying the health care provider of a developing emergent
situation. The nurse will initiate fluid replacement protocol.

6. ANS: 2
Chapter Learning Objective: 3. Describe the intraoperative nursing care and medical and
anesthesia management for cesarean births.
Page: 350
Heading: Intraoperative Care > Complications
Feedback
1 This is incorrect. The patient is not exhibiting manifestations of maternal
respiratory depression related to anesthesia. Respiratory depression is not
expected with regional anesthesia.
2 This is correct. The patient is exhibiting cardinal signs related to inadvertent
injection of the anesthetic agent into the maternal bloodstream. The patient may
also exhibit hypotension that can lead to loss of consciousness and cardiac
arrest.
3 This is incorrect. The presence of maternal hypotension occurring during the
administration is not alone an indication of an incident associated with the
administration of anesthesia.
4 This is incorrect. The patient is not exhibiting expected manifestations related to
the anesthetic medications. The symptoms are indicative of a medical
emergency.

7. ANS: 3
Page: 351
Heading: Intraoperative Care > Anesthesia Management
Feedback
1 This is incorrect. The nurse will review laboratory results in order to report the
correction of hypovolemia through IV fluid administration. This information is
important, but other information is more important.
2 This is incorrect. The patient’s inability to sit on the side of the bed and flex
forward is important; however, the anesthesia can still be administered with the
patient in a side-lying position. This is not the most important information to be
reported.
3 This is correct. The most important information to be reported by the nurse is
the laboratory value that indicates a low platelet count. It is the most common
contraindication, especially with women who have preeclampsia and/or HELLP
(hemolysis, elevated liver enzymes, and low platelets) syndrome.
4 This is incorrect. The fact that the patient experienced headaches after a spinal is
information most likely ascertained by the anesthesiologist during
pre-anesthesia assessment. Interventions will be initiated to help avoid the same
manifestation.

8. ANS: 4
Page: 354
Heading: Intraoperative Care > Anesthesia Management > Nursing Actions
Cognitive Level: Comprehension [Understanding]
Feedback
1 This is incorrect. Evidence-based practice from a research study performed by
Schneuder, L., Crenshaw, J., and Gilder, R. (2017) does not support allowing
the partner to hand the neonate to the mother.
Schneuder, L., Crenshaw, J., and Gilder, R. (2017) does not support assisting the
mother and partner to cut the umbilical cord.
Schneuder, L., Crenshaw, J., and Gilder, R. (2017) does not support moving the
neonate into the visual field of the mother.
4 This is correct. Evidence-based practice from a research study performed by
Schneuder, L., Crenshaw, J., and Gilder, R. (2017) strongly supports
skin-to-skin contact between the mother and neonate in the operating room. The
action significantly decreases the percentage of newborns who are separated
from their parents due to transfers to the NICU for observation.

9. ANS: 1
Page: 355
Heading: Postoperative Care > Complications
Feedback
1 This is correct. The patient’s manifestations are classic for pulmonary embolus.
Other assessment findings will include dyspnea, shortness of breath, and
hypotension.
2 This is incorrect. The patient’s manifestations are not indicative of postpartum
hemorrhage. Symptoms would be hypotension, tachycardia, and probable
evidence of bleeding.
3 This is incorrect. Surgical site infection is indicated by serous or purulent
drainage, erythema, fever, pain, and wound dehiscence. However, the time line
is incorrect; infection would not be evident in PACU.
4 This is incorrect. Endometritis is usually diagnosed within the first few days
after delivery. Fever is the most common sign. Other signs include chills,
uterine tenderness, and foul-smelling lochia.

10. ANS: 2
Page: 356
Heading: Postoperative Care > First 24 Hours After Birth
Integrated Process: Nursing Process
Feedback
1 This is incorrect. There is no need to intervene if the mother is sitting up with
the neonate prone on her chest.
2 This is correct. Neonates are susceptible to sudden respiratory and cardiac arrest
during the first few hours of life. Newborns in prone position on the mother’s
chest, especially if the mother is on her back, are especially susceptible to
sudden unexpected newborn collapse (SUNC). The nurse will intervene
immediately.
3 This is incorrect. There is no need to intervene if the neonate is prone on
mother’s chest and facing to the side.
4 This is incorrect. There is no need to intervene if the neonate is prone with the
mother resting in semi-Fowler’s position.
MULTIPLE RESPONSE
11. ANS: 1, 2, 3, 5
Page: 346
Feedback
1 This is correct. Fetuses in breech position that cannot be delivered vaginally are
delivered by cesarean, which accounts for 17% of the cesarean births in the United
States.
2 This is correct. Increase in the number of cesarean deliveries on maternal request
increases the overall rate; however, this reason accounts for only 3% of the cesarean
births in the United States.
3 This is correct. Increase in the maternal age at delivery increases the rate of cesarean
births. However, this reason accounts for between 4% and 5% of cesarean births.
4 This is incorrect. Cesarean births have the potential of increasing malpractice litigation
because of the high-risk causes and general risks related to surgery.
5 This is correct. The presence of nonreassuring fetal tracings during labor accounts for
23% of cesarean births.

12. ANS: 4, 5
Page: 346
Heading: Introduction
Feedback
1 This is incorrect. The ability to self-pay for a cesarean delivery is not part of the
parameters and criteria relative to a CDMR.
2 This is incorrect. The willingness of a patient and partner to defer from legal litigation is
not part of the parameters and criteria relative to a CDMR.
3 This is incorrect. The risk for complications increases with each cesarean birth. However,
the intention of the mother to have only one child is not part of the parameters and
criteria relative to a CDMR.
4 This is correct. Part of the parameters and criteria relative to a CDMR is that the patient
recognizes that the fetus is at risk for respiratory distress, hypothermia, hypoglycemia,
and/or NICU admission.
5 This is correct. Because of the increased risk for neonatal complications, the patient
needs to understand that CDMR does not occur before 39 weeks gestation.

13. ANS: 2, 3, 4, 5
Pages: 347
Heading: Classification of Cesarean Births
Feedback
1 This is incorrect. When a patient has a cesarean, a repeat cesarean is commonly
scheduled for any additional pregnancies.
2 This is correct. Evidence of a prolapsed cord with membrane rupture is a complication
requiring an emergent cesarean delivery.
3 This is correct. When the cervix fails to fully dilate after prolonged labor, an unplanned
nonurgent cesarean birth is performed.
4 This is correct. The patient with a preexisting cardiac health condition is usually
scheduled for a planned cesarean delivery. The patient is at risk during labor and/or
vaginal birth.
5 This is correct. Recognition of placenta previa with mild bleeding is a reason for an
urgent cesarean birth because of need for rapid delivery of the fetus.

14. ANS: 1, 4, 5
Page: 349
Heading: Perioperative Care > Scheduled Cesarean Birth
Feedback
1 This is correct. Administration of narrow-spectrum prophylactic antibiotics should
occur within 60 minutes prior to the skin incision for any cesarean. If the cesarean is
emergent, the antibiotics can be administered during or immediately after the procedure.
Prescription of medications is a medical-based intervention.
2 This is incorrect. Verification that the woman has been NPO for 6 to 8 hours before
cesarean surgery is obtained only if the cesarean is a planned procedure. The
verification is a nursing-based intervention.
3 This is incorrect. Assessment of the woman’s knowledge and educational needs is
performed primarily for the planned or non-urgent cesarean. The assessment is
primarily a nursing-based intervention.
4 This is correct. Performing an assessment for risk of venous thromboembolism (VTE)
and classifying the woman based on VTE classification guidelines is a medical-based
intervention. Preoperative anticoagulant therapy may be necessary for women classified
as moderate or high risk or with a history of recurrent thrombosis.
5 This is correct. Application of sequential compression devices prior to surgery is to
promote lower extremity circulation and aid in the prevention of blood clots. The nurse
performs the action based on a medical prescription.

15. ANS: 1, 2, 3
Page: 349
Heading: Perioperative Care > Scheduled Cesarean Birth
Feedback
1 This is correct. Prewarmed IV fluid administration in women with cesarean births results
in an increased maternal core temperature.
in improved neonatal umbilical arterial pH.
in improved Apgar scores.
4 This is incorrect. Prewarmed IV fluid administration in women with cesarean births does
not result in decreased risk for maternal shock.
5 This is incorrect. Prewarmed IV fluid administration in women with cesarean births does
not result lower incidence of postpartum hypothermia.

16. ANS: 1, 2, 3, 5
Page: 355
Heading: Postoperative Care > First 24 Hours After Birth > Anesthesia Management
Feedback
1 This is correct. Intrathecal morphine is always administered to the patient by an
anesthesiologist or CRNA (certified registered nurse anesthetist).
2 This is correct. The nurse will need to closely monitor for side effects of the drug.
Common side effects include respiratory depression, itching, hypotension, nausea and
vomiting, and urinary retention.
3 This is correct. The nurse needs to be aware that intrathecal morphine will cause
generalized CNS depression.
4 This is incorrect. Recommended dose of intrathecal morphine is 5 to 10 mg.
5 This is incorrect. Intrathecal morphine is effective because it alters perception of and
response to painful stimuli.

17. ANS: 1, 2
Chapter Learning Objective: 4. Discuss the postoperative nursing care of cesarean birth with
women and their families.
Page: 357
Heading: Postoperative Care > 24 Hours Postoperative to Discharge
Cognitive Level: Analyze [Analyzing]
Feedback
1 This is correct. The nurse teaches the patient and family about the signs and symptoms
that need to be reported to the health care provider. Patients with cesarean deliveries are
more prone to infection.
2 This is correct. Due to abdominal tenderness related to cesarean birth, the nurse will
need to teach the mother and family about comfortable positions for feeding the
newborn. Breastfeeding mothers may be more comfortable in a side-lying position.
3 This is correct. Following a cesarean, patients who eat solid foods early rather than
waiting for the presence of bowel sounds have shown an earlier return of bowel
function.
4 This is correct. Because the recovery for a cesarean will be 6 weeks or longer, the nurse
will encourage family to help with infant care and housework.
5 This is correct. Because the patient has an abdominal incision, the nurse needs to
provide teaching for a diet that will promote healing.

18. ANS: 1, 2, 3, 5
Page: 360
Heading: Clinical Pathway for Scheduled Cesarean Birth: Medication
Feedback
1 This is correct. Within the first 24 hours and beyond, the nurse will continue
administration of a daily stool softener. Constipation related to opiate pain control is
common.
2 This is correct. Following a cesarean, morphine is administered for management of
post-surgery pain.
3 This is correct. Naloxone is administered for any signs of morphine overdose.
4 This is incorrect. Prophylaxis antibiotics are administered prior to the cesarean delivery
to prevent infection.
5 This is correct. If the mother is Rh-negative, Rhogam is given within the first 24 hours.
COMPLETION
19. ANS:
previous
Page: 346
Feedback: The incidence of cesarean births in 2016 reflects a 54% increase over a 19-year period
between 1996 and 2016. Logically, the nurse understands that previous cesarean births is an
influential factor related to the overall incidence of cesarean births. As nonmedical and elective
cesareans decrease, the overall incidence should also decrease.

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Chapter 11 Intrapartum and Postpartum Care of Cesarean Birth Families

PTS: 1 CON: Ante/Intra/Post-partum

PTS: 1 CON: Ante/Intra/Post-partum

PTS: 1 CON: Ante/Intra/Post-partum

PTS: 1 CON: Ante/Intra/Post-partum

PTS: 1 CON: Ante/Intra/Post-partum

PTS: 1 CON: Ante/Intra/Post-partum

PTS: 1 CON: Ante/Intra/Post-partum

PTS: 1 CON: Ante/Intra/Post-partum

PTS: 1 CON: Ante/Intra/Post-partum

PTS: 1 CON: Ante/Intra/Post-partum

PTS: 1 CON: Ante/Intra/Post-partum

PTS: 1 CON: Ante/Intra/Post-partum

PTS: 1 CON: Ante/Intra/Post-partum

PTS: 1 CON: Ante/Intra/Post-partum

PTS: 1 CON: Ante/Intra/Post-partum

PTS: 1 CON: Ante/Intra/Post-partum

PTS: 1 CON: Ante/Intra/Post-partum

PTS: 1 CON: Ante/Intra/Post-partum

PTS: 1 CON: Ante/Intra/Post-partum

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