Cesarean Birth Practice Exam

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1. What is an important measure to reduce the size of the bladder and keep it away from the surgical field during cesarean birth?

1. Administer an oxytocic to contract the bladder.
2. Restrict fluids in the woman for 4 hours before surgery.
3. Insert a urinary catheter to drain the bladder and decrease its size.
4. Give a diuretic to reduce the bladder to its smallest size.

2. The nurse administers ranitidine (Zantac) as ordered prior to a planned cesarean birth to:

1. Promote uterine contractions.
2. Decrease gastric secretions.
3. Delay uterine contractions.
4. Neutralize urine acidity.

3. The nurse instructs Mrs. Smith on deep breathing exercises as part of the preoperative teaching plan. The rationale for this exercise is to:

1. Stimulate the diaphragm to contract.
2. Promote involution on a traumatized uterus.
3. Prevent stasis of mucus in the lungs.
4. Prevent pulmonary edema.

4. What is the most important responsibility of the healthcare team before surgery starts?

1. Assessing the woman’s hygiene.
2. Inserting a urinary catheter.
3. Decreasing the stomach secretions.
4. Securing an informed consent and ensuring that it is obtained.

5. The nurse administers Ringer’s solution intravenously for what purpose?

1. To avoid urinary tract infection.
2. To ensure that the woman is fully hydrated.
3. To reduce bladder size.
4. To decrease urine specific gravity.

6. The surgeon plans to perform a low segment incision rather than a classic incision. This type of incision is more advantageous because:

1. The procedure is faster with the incision being made simultaneously through the abdomen and uterus.
2. The procedure is made with a vertical incision to decrease the chances of reopening.
3. It is made horizontally and high on the woman’s abdomen.
4. The likelihood of a postpartal uterine infection is decreased.

7. If oxytocin is ordered postoperatively for the client who has had a cesarean birth, the most important nursing intervention would be to:

1. Monitor the woman’s blood pressure.
2. Prevent infection at the incision site.
3. Implement measures to promote comfort.
4. Assess for increased lochia discharge.

8. Which of the following interventions would be most helpful to assist a woman to void after a cesarean birth?

1. Withholding prescribed analgesic.
2. Letting the woman void every 4 hours.
3. Running water from the tap within woman’s hearing distance.
4. Pouring cold water over her perineal area.

9. A woman has undergone a cesarean birth is to be discharged. The nurse would instruct the woman to notify her health care provider if she develops which of the following?

1. Drainage at her incision line.
2. No bowel movement for 2 days.
3. Decrease in lochia.
4. Pain on the incision site.

10. Which of the following is a complication of pain that occurs postoperatively?

1. Constipation
2. Pneumonia
3. Hypotension
4. Fever

Answers and Rationale

1. Answer: C. Insert a urinary catheter to drain the bladder and decrease its size. 

• C: Inserting a urinary catheter would drain the urine from the bladder and decrease its size.
• A: Oxytocin would contract the uterus and not the bladder.
• B: Fluids will be restricted but this could not decrease the size of the bladder especially if the bladder is already full.
• D: The woman may have difficulty in voiding even if a diuretic is administered.

2. Answer: B. Decrease gastric secretions. 

• B: Zantac decreases gastric secretions to decrease the risk for esophageal reflux and aspiration.
• A: Uterine contractions are promoted by oxytocic agents.
• C: Uterine contractions are delayed by uterine relaxants such as magnesium sulfate.
• D: Zantac could not neutralize urine acidity.

3. Answer: C. Prevent stasis of mucus in the lungs.

• C: Periodic deep breathing exercises fully aerate the lungs to prevent stasis of mucus.
• A: The uterus should be stimulated to contract and not the diaphragm.
• B: Involution is promoted by breastfeeding the infant.
• D: Pulmonary edema cannot be prevented by deep breathing exercises.

4. Answer: D. Securing an informed consent and ensuring that it is obtained.

• D: Informed consent is the most important responsibility because the patient must provide consent for the surgeons to operate on his body before they can start the procedure.
• A: The woman’s hygiene must be checked thoroughly, yet it is not on the top of the list of responsibilities for healthcare providers before surgery.
• B: The urinary catheter is inserted to reduce bladder size and keep the bladder away from the surgical field.
• C: Decreasing stomach secretions is not a primary responsibility yet a part of preoperative measures.

5. Answer: B. To ensure that the woman is fully hydrated.

• B: Intravenous fluid helps hydrating the woman and avoids hypotension or extreme blood loss.
• A: UTI can be prevented by drinking a large amount of water every day.
• C: Bladder size can be reduced by inserting a catheter.
• D: Urine specific gravity can be decreased by drinking large amount of matter.

6. Answer: D. The likelihood of a postpartal uterine infection is decreased.

• D: Uterine infection is less likely in a low segment incision because the incision is made horizontally across the uterus.
• A: The incision is not done simultaneously through the abdomen and uterus.
• B: A classic incision is made vertically.
• C: Low segment incision is made horizontally just below the symphysis pubis.

7. Answer: A. Monitor the woman’s blood pressure.

• A: Oxytocin can increase blood pressure so it must be monitored conscientiously.
• B: Oxytocin causes the uterus to contract and it does not predispose the woman to infection.
• C: Measures for comfort can be implemented, however it is not a priority i=during oxytocin administration.
• D: Lochia discharge might increase if oxytocin is administered because it evacuates the remaining contents inside the uterus.

8. Answer: C. Running water from the tap within woman’s hearing distance.

• C: Urinary elimination can be stimulated when the woman hears running water so she can void.
• A: Prescribed analgesic should not be withheld because it might cause discomfort to the woman.
• B: The woman should void every 2 hours.
• D: Warm water can be used to stimulate urination.

9. Answer: A. Drainage at her incision line.

• A: Drainage at the incision line might lead to infection at the site.
• B: Having no bowel movement 2 or 3 days postoperatively is normal.
• C: Lochia normally decreases until it stops flowing.
• D: Pain on the incision site is normal after surgery.

10. Answer: B. Pneumonia

• B: Pain may interfere with the woman’s mobility and the ability to deep breathe so pneumonia might become a complication.
• A: Constipation is not a complication; it may develop if the woman’s diet is inappropriate.
• C: Hypotension must be prevented postoperatively.
• D: Fever is a complication of infection.