NURS 217 Fall 25 at Baton Rouge Community College
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Free NURS 217 Fall 25 at Baton Rouge Community College Questions
1. A newborn is 12 hours old and is being assessed in the nursery. The nurse is reviewing risk factors for hyperbilirubinemia and preparing to educate the parents. Which infant is at highest risk for developing hyperbilirubinemia?
- Breastfed immediately after birth
- Mother is Rh positive
- Developed a cephalhematoma during delivery
- Delivered at 39 weeks gestation
Explanation
A cephalhematoma is a collection of blood between the skull and the periosteum that results from birth trauma. As the pooled blood breaks down, excess bilirubin is released into the bloodstream, increasing the risk for hyperbilirubinemia. The immature newborn liver may be unable to process this large bilirubin load, leading to visible jaundice. These infants require close monitoring for rising bilirubin levels and may need phototherapy if bilirubin becomes excessive.
2. Prescribed: Cefotaxime 350 mg IVPB is ordered twice a day for a patient weighing 45 pounds (round kg to the nearest hundredth place). The recommended dose is Cefotaxime 75–100 mg/kg/day. What is the safe maximum amount the child would receive per dose? Record your answer as a whole number.
- 750 mg
- 900 mg
- 1023 mg
- 525 mg
Explanation
Step 1: Convert weight to kg.
45 lb ÷ 2.2 = 20.45 kg (rounded to the nearest hundredth).
Step 2: Calculate the maximum safe daily dose using the upper limit (100 mg/kg/day).
100 mg × 20.45 kg = 2045 mg/day.
Step 3: The medication is ordered twice a day, so divide by 2 to get the maximum safe amount per dose.
2045 mg/day ÷ 2 = 1022.5 mg.
Round to a whole number: 1023 mg per dose.
45 lb ÷ 2.2 = 20.45 kg (rounded to the nearest hundredth).
Step 2: Calculate the maximum safe daily dose using the upper limit (100 mg/kg/day).
100 mg × 20.45 kg = 2045 mg/day.
Step 3: The medication is ordered twice a day, so divide by 2 to get the maximum safe amount per dose.
2045 mg/day ÷ 2 = 1022.5 mg.
Round to a whole number: 1023 mg per dose.
3. When the nurse is communicating with pediatric patients, which factor is important to consider?
- Presence or absence of the child’s parent
- Nonverbal behaviors of the child
- The child’s physical condition
- Developmental level of the child
Explanation
When communicating with children, the developmental level is the most important factor to consider because it determines the child’s ability to understand language, express needs, and interpret information. Communication strategies must be tailored to match the child’s cognitive, emotional, and language abilities. For example, a toddler requires simple words and play-based interaction, while a school-age child benefits from concrete explanations and reassurance. Adolescents, on the other hand, need respect for privacy and opportunities for autonomy.
4. 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)?
- Early deceleration with decreased variability
- Late decelerations with decreased variability
- Late deceleration with increased variability
- 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.
5. A nurse is caring for a patient during the first trimester of pregnancy. After reviewing the patient’s blood work, the nurse notices she does not have immunity to rubella. Which of the following is the appropriate time for the mother to receive a rubella immunization?
- Immediately
- In the third trimester
- Shortly after giving birth
- During her next attempt to get pregnant
Explanation
The rubella (MMR) vaccine is a live attenuated vaccine and therefore contraindicated during pregnancy because it poses a potential risk of fetal infection and congenital rubella syndrome. If a pregnant woman is found to be non-immune, she should be vaccinated postpartum—shortly after delivery and before hospital discharge. This ensures immunity before subsequent pregnancies. Women are advised to avoid pregnancy for at least 1 month after vaccination.
6. The nurse has received the morning report on a group of pediatric patients. Which pediatric patient should the nurse prioritize care for?
- School-age child with dysphagia, drooling, and a hoarse voice
- Toddler with a temperature of 100.4°F (38°C) and a harsh, barking cough
- Infant with rhinorrhea, coughing, and oxygen saturation of 92%
- 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. After an emergency cesarean, which maternal and fetal assessments should the nurse prioritize immediately?
- Maternal blood pressure only; Neonatal temperature only.
- Maternal diet preference; Neonatal weight only.
- Maternal ambulation readiness; Neonatal formula selection.
- Maternal blood pressure, bleeding, fundus firmness; Neonatal APGAR, heart rate, oxygenation.
Explanation
Following an emergency cesarean section, both the mother and newborn are at increased risk for life-threatening complications, making immediate maternal and neonatal stabilization the top priority.
For the mother, the nurse must:
• Monitor blood pressure to detect hypotension or hemorrhagic shock.
• Assess vaginal bleeding for signs of postpartum hemorrhage.
• Check fundus firmness to ensure the uterus is contracting properly and to prevent excessive bleeding.
For the newborn, the nurse must:
• Perform an APGAR assessment at 1 and 5 minutes to evaluate overall adaptation.
• Assess heart rate, color, and oxygenation to ensure effective respiration and circulation, especially since cesarean births may delay fluid clearance from the lungs.
For the mother, the nurse must:
• Monitor blood pressure to detect hypotension or hemorrhagic shock.
• Assess vaginal bleeding for signs of postpartum hemorrhage.
• Check fundus firmness to ensure the uterus is contracting properly and to prevent excessive bleeding.
For the newborn, the nurse must:
• Perform an APGAR assessment at 1 and 5 minutes to evaluate overall adaptation.
• Assess heart rate, color, and oxygenation to ensure effective respiration and circulation, especially since cesarean births may delay fluid clearance from the lungs.
8. A 2-year-old sustains a traumatic injury secondary to a motor vehicle accident. The client is in a coma. Which interventions should be included in the plan of care? Select all that apply.
- Assess and manage pain
- Liquid tears to maintain eye moisture
- Splinting to prevent contractures
- Encouraging coughing and deep breathing
- Turn and position to prevent skin breakdown
- Stool softeners to prevent constipation
Explanation
A. Assess and manage pain
Even though the child is comatose, pain perception may still occur. Subtle signs such as changes in heart rate, blood pressure, or facial grimacing may indicate discomfort. Pain management helps reduce physiologic stress and supports recovery.
B. Liquid tears to maintain eye moisture
A comatose patient cannot blink adequately to protect the corneas. Artificial tears or ophthalmic lubricants help prevent corneal dryness and ulceration, which are common complications in unconscious patients.
C. Splinting to prevent contractures
Prolonged immobility can lead to muscle shortening and joint contractures. Using splints and performing gentle range-of-motion exercises help preserve mobility and musculoskeletal alignment.
E. Turn and position to prevent skin breakdown
Frequent repositioning, at least every 2 hours, improves circulation and pressure relief, preventing pressure ulcers. Skin care and clean linens are essential to maintain tissue integrity.
F. Stool softeners to prevent constipation
Due to immobility, altered nutrition, and medications (like opioids), the comatose child is at risk for constipation. Stool softeners help maintain regular bowel function and prevent complications such as fecal impaction.
Even though the child is comatose, pain perception may still occur. Subtle signs such as changes in heart rate, blood pressure, or facial grimacing may indicate discomfort. Pain management helps reduce physiologic stress and supports recovery.
B. Liquid tears to maintain eye moisture
A comatose patient cannot blink adequately to protect the corneas. Artificial tears or ophthalmic lubricants help prevent corneal dryness and ulceration, which are common complications in unconscious patients.
C. Splinting to prevent contractures
Prolonged immobility can lead to muscle shortening and joint contractures. Using splints and performing gentle range-of-motion exercises help preserve mobility and musculoskeletal alignment.
E. Turn and position to prevent skin breakdown
Frequent repositioning, at least every 2 hours, improves circulation and pressure relief, preventing pressure ulcers. Skin care and clean linens are essential to maintain tissue integrity.
F. Stool softeners to prevent constipation
Due to immobility, altered nutrition, and medications (like opioids), the comatose child is at risk for constipation. Stool softeners help maintain regular bowel function and prevent complications such as fecal impaction.
9. An infant with Tetralogy of Fallot is experiencing a tet spell involving cyanosis and dyspnea. Which position should the infant be placed in?
- Fowler’s
- Prone
- Knee-chest
- Trendelenburg’s
Explanation
During a tet spell (hypercyanotic episode), the infant experiences severe hypoxia due to increased right-to-left shunting of blood through the ventricular septal defect. The knee-chest position increases systemic vascular resistance, which decreases the right-to-left shunt and improves pulmonary blood flow and oxygenation. This position also helps calm the infant and facilitates venous return to the heart, reducing cyanosis and dyspnea.
10. Which respiratory changes are normal during pregnancy? Select all that apply.
- Shortness of breath in the third trimester.
- Elevated diaphragm.
- Respiratory alkalosis from hyperventilation.
- Decreased tidal volume.
- Increased oxygen consumption.
Explanation
A. Shortness of breath in the third trimester
As the uterus enlarges, it pushes upward against the diaphragm, causing dyspnea (shortness of breath), especially when lying flat or during exertion. This is a normal physiological change due to mechanical pressure and increased oxygen demand.
B. Elevated diaphragm
The diaphragm rises by about 4 cm during pregnancy as the uterus grows. This upward displacement decreases total lung capacity but does not impair ventilation because other adaptations (like increased tidal volume) compensate.
C. Respiratory alkalosis from hyperventilation
Pregnancy increases progesterone, which stimulates the respiratory center, causing mild hyperventilation and leading to a slight respiratory alkalosis. This facilitates oxygen and carbon dioxide exchange between mother and fetus.
E. Increased oxygen consumption
Oxygen consumption increases by about 20–30% during pregnancy to meet the metabolic demands of the fetus, placenta, and maternal tissues.
As the uterus enlarges, it pushes upward against the diaphragm, causing dyspnea (shortness of breath), especially when lying flat or during exertion. This is a normal physiological change due to mechanical pressure and increased oxygen demand.
B. Elevated diaphragm
The diaphragm rises by about 4 cm during pregnancy as the uterus grows. This upward displacement decreases total lung capacity but does not impair ventilation because other adaptations (like increased tidal volume) compensate.
C. Respiratory alkalosis from hyperventilation
Pregnancy increases progesterone, which stimulates the respiratory center, causing mild hyperventilation and leading to a slight respiratory alkalosis. This facilitates oxygen and carbon dioxide exchange between mother and fetus.
E. Increased oxygen consumption
Oxygen consumption increases by about 20–30% during pregnancy to meet the metabolic demands of the fetus, placenta, and maternal tissues.
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