NURS 217 Fall 25
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Free NURS 217 Fall 25 Questions
1. A nurse is caring for a laboring patient. What pertinent findings would the nurse identify on this fetal monitor strip using the fetal scalp electrode (FSE) and intrauterine pressure catheter (IUPC)?
- A. Early deceleration with decreased variability
- B. Late decelerations with decreased variability
- C. Late deceleration with increased variability
- D. Early deceleration with increased variability
Explanation
An early deceleration on a fetal heart rate (FHR) tracing is a gradual decrease and return to baseline that mirrors the contraction pattern. It begins and ends almost simultaneously with the contraction. Early decelerations are considered benign and are caused by fetal head compression, which stimulates the vagus nerve and temporarily lowers the heart rate. When accompanied by normal or increased baseline variability, it indicates that the fetus is well oxygenated and tolerating labor without distress.
2. Which statements should the nurse include when teaching a pregnant patient newly diagnosed with gestational diabetes mellitus? Select all that apply.
- A. "If diet and exercise do not control your glucose, insulin is the preferred medication in pregnancy."
- B. "Oral hypoglycemic agents such as glyburide and metformin never cross the placenta, so they are preferred."
- C. "You should check fasting and postprandial blood glucose as instructed and record the results."
- D. "Tight glycemic control reduces the risk of neonatal hypoglycemia after birth."
- E. "Babies of mothers with uncontrolled GDM are at increased risk for macrosomia and shoulder dystocia."
Explanation
A. "If diet and exercise do not control your glucose, insulin is the preferred medication in pregnancy."
When dietary modifications and exercise fail to control blood glucose, insulin therapy is the standard and safest option because it does not cross the placenta and effectively maintains euglycemia, reducing maternal and fetal risks.
C. "You should check fasting and postprandial blood glucose as instructed and record the results."
Frequent self-monitoring of blood glucose allows the patient and provider to assess how well the treatment plan is working and make necessary adjustments. Tracking these values helps prevent both hyperglycemia and hypoglycemia.
D. "Tight glycemic control reduces the risk of neonatal hypoglycemia after birth."
Maintaining maternal glucose within target ranges prevents fetal hyperinsulinemia. Poor control can lead to excess fetal insulin production, which persists after birth and causes neonatal hypoglycemia once maternal glucose supply is interrupted.
E. "Babies of mothers with uncontrolled GDM are at increased risk for macrosomia and shoulder dystocia."
Poorly controlled gestational diabetes increases fetal glucose exposure, stimulating insulin production and growth, resulting in macrosomia (large baby). This raises the risk of birth trauma, including shoulder dystocia during vaginal delivery.
When dietary modifications and exercise fail to control blood glucose, insulin therapy is the standard and safest option because it does not cross the placenta and effectively maintains euglycemia, reducing maternal and fetal risks.
C. "You should check fasting and postprandial blood glucose as instructed and record the results."
Frequent self-monitoring of blood glucose allows the patient and provider to assess how well the treatment plan is working and make necessary adjustments. Tracking these values helps prevent both hyperglycemia and hypoglycemia.
D. "Tight glycemic control reduces the risk of neonatal hypoglycemia after birth."
Maintaining maternal glucose within target ranges prevents fetal hyperinsulinemia. Poor control can lead to excess fetal insulin production, which persists after birth and causes neonatal hypoglycemia once maternal glucose supply is interrupted.
E. "Babies of mothers with uncontrolled GDM are at increased risk for macrosomia and shoulder dystocia."
Poorly controlled gestational diabetes increases fetal glucose exposure, stimulating insulin production and growth, resulting in macrosomia (large baby). This raises the risk of birth trauma, including shoulder dystocia during vaginal delivery.
3. Which clinical manifestations should the nurse expect when a child with Sickle Cell Anemia experiences an acute vaso-occlusive crisis?
- A. Circulatory collapse
- B. Hepatomegaly and intrahepatic cholestasis
- C. Cardiomegaly and systolic murmurs
- D. Painful swelling of hands and feet and painful joints
Explanation
A vaso-occlusive crisis (also called a pain crisis) is the most common complication of sickle cell anemia, caused by the sickling of red blood cells that leads to obstruction of blood flow and tissue ischemia. This results in severe pain, often affecting the bones, joints, and extremities. Children may present with painful swelling of the hands and feet (dactylitis) and generalized joint pain due to blocked microcirculation. The pain may last for several days and is often triggered by dehydration, infection, or cold exposure.
4. The nurse locates a small port-wine stain on a newborn's shoulder and points it out to the parents. Which remark by the parents would indicate that they understand and that no further explanation is needed?
- A. "Even though it's permanent, at least it's not too visible."
- B. "I hope it goes away soon, so he isn't marked for life."
- C. "The doctor must have pulled on him too hard."
- D. "My grandmother told me not to drink during my pregnancy!"
Explanation
A port-wine stain (nevus flammeus) is a permanent congenital vascular malformation consisting of dilated capillaries that appear as a flat, red to purple birthmark. It does not fade over time and is not related to trauma or maternal behavior during pregnancy. The parents’ statement in option A shows accurate understanding that the mark is benign, permanent, and only a cosmetic concern unless associated with certain syndromes (such as Sturge-Weber).
5. A patient reports abdominal cramping due to dysmenorrhea. Which analgesic would the nurse expect the physician to prescribe?
- A. Demerol
- B. Ibuprofen
- C. Acetaminophen
- D. Aspirin
Explanation
The drug of choice for dysmenorrhea (painful menstruation) is an NSAID such as ibuprofen. Ibuprofen works by inhibiting prostaglandin synthesis, which decreases uterine contractions and relieves cramping and pain. It is most effective when taken at the onset of menstrual discomfort or before symptoms begin.
6. The nurse has received the morning report on a group of pediatric patients. Which pediatric patient should the nurse prioritize care for?
- A. School-age child with dysphagia, drooling, and a hoarse voice
- B. Toddler with a temperature of 100.4°F (38°C) and a harsh, barking cough
- C. Infant with rhinorrhea, coughing, and oxygen saturation of 92%
- D. Preschool-aged child with crackles in the right lower lobe and chest pain
Explanation
A school-age child presenting with dysphagia (difficulty swallowing), drooling, and a hoarse voice is exhibiting classic signs of acute epiglottitis, a life-threatening airway emergency. The inflamed epiglottis can rapidly swell and obstruct the airway. This child must be prioritized immediately to maintain airway patency. The nurse should avoid examining the throat or using a tongue depressor and should notify the provider immediately while preparing for possible intubation or tracheostomy.
7. A patient 10 weeks pregnant states, "It seems like I have to go to the bathroom every five minutes." Which explanation would the nurse provide?
- A. The bladder capacity increases throughout pregnancy.
- B. Women often are preoccupied with body functions during pregnancy.
- C. You probably have a kidney infection.
- D. The growing uterus puts pressure on the bladder.
Explanation
During the first trimester of pregnancy, the uterus enlarges and remains within the pelvis, where it presses directly on the bladder. This causes increased urinary frequency and urgency, even though the bladder is not full. This is a normal physiologic change, not a sign of infection. The frequency often decreases in the second trimester when the uterus rises into the abdomen but may recur late in pregnancy as the fetus descends.
8. The nurse walks into a room and the patient is sitting up listening to a tape that describes a very peaceful place. What relaxation technique is the patient using?
- A. Focal point
- B. Music
- C. Imagery
- D. Effleurage
Explanation
Imagery, also called guided imagery or visualization, is a relaxation technique in which a person focuses their mind on calm, peaceful mental images—such as a beach, forest, or other serene setting—to promote relaxation, reduce anxiety, and decrease pain perception. The patient listening to a tape that describes a peaceful place is using guided imagery to create a sense of calm and control, which can help reduce stress and tension during labor or other procedures.
9. When IV magnesium sulfate is administered to a patient with severe pregnancy-induced hypertension, what is the rationale the nurse can explain for this treatment?
- A. Magnesium sulfate is a CNS depressant that blocks neuromuscular transmission, thereby preventing seizures.
- B. Magnesium sulfate is an antihypertensive that relaxes smooth muscle and lowers blood pressure.
- C. Magnesium sulfate is a CNS stimulant that increases the quantity of ACTH, thereby preventing coma.
- D. Magnesium sulfate is a muscle relaxant that decreases the intensity of uterine contractions.
Explanation
Magnesium sulfate is used in the management of severe preeclampsia primarily as a seizure prophylactic agent, not as a direct antihypertensive. It acts as a central nervous system (CNS) depressant by blocking neuromuscular transmission and reducing acetylcholine release at the neuromuscular junction. This decreases CNS irritability and the risk of eclamptic seizures, which are life-threatening complications of pregnancy-induced hypertension. The nurse should closely monitor deep tendon reflexes, respiratory rate, urine output, and serum magnesium levels to detect early signs of toxicity.
10. Which neonatal complication would the nurse monitor for after the birth of the infant of a diabetic mother?
- A. Hypercalcemia
- B. Hypoinsulinemia
- C. Hypobilirubinemia
- D. Hypoglycemia
Explanation
After birth, infants of diabetic mothers (IDMs) are at high risk for hypoglycemia because they are exposed to high maternal glucose levels in utero, which stimulate excessive fetal insulin production (hyperinsulinemia). Once the umbilical cord is cut, the maternal glucose supply abruptly stops, but the infant’s insulin levels remain high, leading to a rapid drop in blood glucose. The nurse should closely monitor the infant’s blood sugar and provide early feedings or IV glucose if necessary.
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