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A nurse is reinforcing preoperative teaching with a client who is scheduled for a cesarean birth. Which of the following client statements indicates an understanding of the teaching?

A.

"I can have regular food once I am able to swallow safely.”.

B.

"I will need to stay flat on my back in bed for the first 24 hours after surgery.”.

C.

"The nurse will take out my urinary catheter 48 hours after surgery.”.

D.

"The nurse might need to massage my uterus frequently after surgery.”.

Answer and Explanation

The Correct Answer is D

Choice A rationale

 

This statement is incorrect because after a cesarean birth, clients are usually started on clear liquids and then gradually progress to regular food as tolerated. Swallowing safety is related to anesthesia recovery, not cesarean birth recovery.

 

Choice B rationale

 

This statement is incorrect because the client does not need to stay flat on their back for 24 hours. Early ambulation is encouraged to prevent complications such as deep vein thrombosis and promote recovery.

 

Choice C rationale

 

This statement is incorrect because the urinary catheter is typically removed within 24 hours after surgery to reduce the risk of urinary tract infections and encourage normal bladder function.

 

Choice D rationale

 

This statement is correct because after a cesarean birth, the nurse will frequently assess the uterus for firmness and massage it as needed to prevent postpartum hemorrhage.


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Correct Answer is A

Explanation

Choice A rationale

Amniocentesis is used to detect fetal genetic abnormalities, such as Down syndrome, by analyzing the amniotic fluid for genetic markers.

Choice B rationale

An empty bladder is required for the test only in late pregnancy to prevent bladder injury; however, in early pregnancy, a full bladder may be required to better visualize the uterus and amniotic fluid.

Choice C rationale

An x-ray is not typically used during the needle placement for amniocentesis. Ultrasound is the preferred method to guide the needle to avoid harm to the fetus and mother.

Choice D rationale

The test does not determine the volume of amniotic fluid; it is used primarily for genetic analysis, assessing fetal lung maturity, and diagnosing certain fetal infections.

Correct Answer is A

Explanation

Choice A rationale

This finding indicates fetal distress. Recurrent variable decelerations in the fetal heart rate (FHR) can be a sign of umbilical cord compression, which can compromise fetal oxygenation.

Choice B rationale

Uterine contractions every 6 minutes are within the normal range for the latent phase of labor and do not indicate fetal risk.

Choice C rationale

Moderate variability of the FHR is a reassuring sign and suggests that the fetus is well-oxygenated and neurologically intact.

Choice D rationale

Uterine contractions lasting 30 to 45 seconds are typical for the latent phase of labor and do not indicate fetal distress.

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