Clinical Reasoning Cases in Nursing 7th Edition Test Bank

Clinical Reasoning Cases in Nursing 7th Edition Test Bank Chapter 1.Perfusion MULTIPLE CHOICE 1. A 3-month-old infant is at increased risk for developing anemia. The nurse would identify which principle contributing to this risk? a. The infant is becoming more active. b. There is an increase in intake of breast milk or formula. c. The infant is unable to maintain an adequate iron intake. d. A depletion of fetal hemoglobin occurs. ANS: D Fetal hemoglobin is present for about 5 months. The fetal hemoglobin begins deteriorating, and around 2 to 3 months the infant is at increased risk of developing an anemia due to decreasing levels of hemoglobin. Breast milk or formula is the primary food intake up to around 6 months. Often iron supplemented formula is offered, and/or an iron supplement is given if the infant is breastfed. REF: 162 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance 1. A female college student is planning to become sexually active. She is considering birth control options and desires a method in which ovulation will be prevented. To prevent ovulation while reaching 99% effectiveness in preventing pregnancy, which option should be given the strongest consideration? a. Intrauterine device b. Coitus interruptus c. Natural family planning d. Oral contraceptive pills ANS: D Oral contraceptive pills prevent ovulation and are 99% effective in preventing pregnancy when taken as directed. Intrauterine devices, coitus interruptus, and natural family planning will not prevent ovulation while reaching 99% effectiveness in preventing pregnancy,so they are not recommended for this college student. 2. The RN at the Preconception Counseling Clinic takes a male history for infertility evaluation. Which finding has the greatest implication for this patients care? a. Practice of nightly masturbation b. Primary anovulation c. High testosterone levels d. Impotence due to alcohol ingestion ANS: D Factors affecting male infertility include impotence due to alcohol. Nightly masturbation and high testosterone levels do not have the greatest implication on male infertility in a patient with admitted alcohol issues. Primary anovulation refers to female infertility, so it is not a consideration for this question about male infertility. 3. Many females experience problems achieving and maintaining a pregnancy. The ER nursing assessment of a child bearing age female shows back pain, elevated blood pressure, and leaking of clear fluid from the vagina. Maternal-fetal complications described above are most often associated with which child-bearing stage? a. Preconception b. First trimester c. Second-third trimester d. Postpartum ANS: C Second and third trimester complications include anencephalus, chromosomal anomalies, gestational diabetes, group B strep, cystitis, pyelonephritis, cholecystitis, hypertension, preeclampsia, oligohydramnios, polyhydramnios, and premature rupture of membranes, etc. Leaking of clear fluid from the vagina with back pain and elevated BP is associated with premature rupture of membranes, a second trimester complication of pregnancy. Preconception is prior to becoming pregnant; postpartum is after delivery of the infant; and first trimester is not associated with premature rupture of the membranes usually.