Final Exam NCA1 FT Middlesex Community College
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Free Final Exam NCA1 FT Middlesex Community College Questions
The nurse is conducting an admission of a client diagnosed with schizophrenia to the inpatient psychiatric unit. Which of the following statements about the client's rights is true?
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The client has the right to choose which staff members treat them.
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The client has the right to be released within 48 hours of making a written request.
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The client has the right to a consultation with other mental health professionals at the hospital's expense.
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The client has the right to refuse psychotropic medications.
Explanation
Psychiatric clients retain the fundamental right to refuse medication, including psychotropic medications, unless a court order has determined that the client lacks the capacity to make informed medical decisions. This right is protected under patient autonomy and informed consent laws. The nurse must document the refusal, notify the provider, and continue to monitor the client while respecting this legal right.
Why the other options are incorrect:
A. The client has the right to choose which staff members treat them. While clients have the right to respectful and non-discriminatory care, they do not have the right to select specific individual staff members for their treatment team. Staffing assignments are determined by the facility based on clinical need and availability.
B. The client has the right to be released within 48 hours of making a written request. This right applies specifically to voluntarily admitted psychiatric clients, not to clients who are involuntarily committed. A client admitted involuntarily does not have the right to demand release within 48 hours. The scenario does not specify voluntary admission, and this right is not universal for all psychiatric admissions.
C. The client has the right to a consultation with other mental health professionals at the hospital's expense. While clients have the right to seek second opinions, hospitals are not legally obligated to finance outside consultations. This statement overstates the scope of the client's rights within the inpatient psychiatric setting.
A nurse assists a victim of intimate partner violence in creating an emergency plan. Which information should the nurse include? (Select all that apply.)
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Memorize the phone number for the nearest shelter.
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Pack all toys for the children to keep them occupied.
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Withdraw cash from the family checking account for the "go bag."
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Create a code word to signal when it is time to leave.
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Collect birth certificate(s), social security cards, and licenses for the "go bag."
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Secure a supply of current medications for self and children.
Explanation
Correct Answer: (D) Create a code word to signal when it is time to leave, (E) Collect birth certificate(s), social security cards, and licenses for the "go bag," and (F) Secure a supply of current medications for self and children.
A code word allows the victim to safely communicate to trusted persons that they need to leave without alerting the abuser, which is a critical safety strategy. Gathering essential identity documents ensures the victim and children can access services, housing, and financial resources after leaving. Securing medications ensures continuity of healthcare for both the victim and children during the transition, preventing dangerous lapses in treatment.
Why Other Options are Incorrect:
A. Memorize the phone number for the nearest shelter. While knowing shelter resources is helpful, memorizing a number alone is not a standard formal component of an emergency safety plan. Writing the number down in a safe, hidden location is more practical and reliable. Additionally, this is not among the priority elements compared to documents, medications, and code words.
B. Pack all toys for the children to keep them occupied. Packing all toys is impractical during an emergency escape and is not a recommended component of a safety plan. Only essential, easily portable items should be included to ensure rapid departure.
C. Withdraw cash from the family checking account for the "go bag." Withdrawing large sums from a shared account could alert the abuser and escalate danger. The safer approach recommended in safety planning is to set aside small amounts of cash gradually over time without detection.
A client on the inpatient unit frequently approaches staff with somatic symptoms of body aches. Which of the following should the nurse do when interacting with the client? (Select all that apply.)
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Redirect conversation away from physical symptoms but show interest toward the client.
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Suggest the client direct questions to multiple staff members to avoid compassion fatigue.
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Educate the client that their pain is not real to orient them to reality.
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Ignore any physical symptoms to avoid promoting progression of the disorder.
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Encourage the use of coping skills to reduce anxiety.
Explanation
Redirecting conversation away from somatic complaints while maintaining genuine interest in the client as a person reduces reinforcement of somatic focusing behavior without rejecting the client. This therapeutic approach discourages excessive symptom reporting while preserving the therapeutic relationship. Encouraging coping skills addresses the underlying anxiety that drives somatic symptoms in clients with somatic symptom disorder, which is the root cause of the behavior.
Why the other options are incorrect:
B. Suggest the client direct questions to multiple staff members to avoid compassion fatigue. This is nontherapeutic because it fragments the client's care and can increase anxiety and somatic focus. Consistent assignment to the same nurse provides structure and reduces attention-seeking behavior.
C. Educate the client that their pain is not real to orient them to reality. Telling a client their symptoms are not real is nontherapeutic and invalidating. Somatic symptoms are genuinely experienced by the client, even when there is no organic cause. Dismissing them damages trust and the therapeutic relationship.
D. Ignore any physical symptoms to avoid promoting progression of the disorder. While avoiding reinforcement of somatic complaints is appropriate, completely ignoring physical symptoms is unsafe because new symptoms could represent a real medical condition that requires assessment and intervention.
A nurse is reviewing the healthcare record of a client with somatic symptoms. Which finding in the client's history should the nurse identify as a risk factor for somatoform disorders?
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The client has a history of migraine headaches since they were a teenager.
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The client's child died in a car accident 2 months ago.
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The client has gained 15 pounds over the past month.
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The client was laid off from their job 5 years ago.
Explanation
Correct Answer: (B) The client's child died in a car accident 2 months ago.
Somatoform disorders are strongly linked to recent significant psychological trauma and unresolved grief. The death of a child two months ago represents an acute, catastrophic traumatic stressor that overwhelms normal coping mechanisms and can trigger the unconscious conversion of psychological distress into physical symptoms. Recent severe trauma is the most significant and well-recognized psychosocial risk factor for the development of somatic symptom and related disorders.
Why Other Options are Incorrect:
A. The client has a history of migraine headaches since they were a teenager. Chronic migraines are a neurological condition with an established organic basis. Having a medically diagnosed condition is not a risk factor for somatoform disorders.
C. The client has gained 15 pounds over the past month. Rapid weight gain is a physiological finding requiring medical evaluation for causes such as hypothyroidism, fluid retention, or medication effects. It is not a psychosocial risk factor for somatoform disorders.
D. The client was laid off from their job 5 years ago. While job loss can be stressful, an event that occurred five years ago without indication of ongoing acute psychological distress is not a significant current risk factor compared to a recent devastating trauma such as the death of a child.
The nurse provides care to a client diagnosed with type 1 diabetes mellitus (DM). The client's hemoglobin A1C remains elevated despite the client's prescribed sliding scale insulin. The healthcare provider prescribes an insulin pump. The client asks, "Why did my doctor prescribe a pump?" What is the best response by the nurse?
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"The pump is worn continuously."
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"The pump provides more precise dosages of insulin."
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"The pump is more convenient for you."
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"The pump provides better control of your blood sugar."
Explanation
An insulin pump delivers continuous subcutaneous insulin infusion with highly precise, programmable basal rates and bolus doses tailored to the client's individual needs. When a client's hemoglobin A1C remains elevated despite sliding scale insulin, the pump is prescribed because it can deliver insulin with greater accuracy and consistency than sliding scale injections, addressing the inadequacy of the previous regimen. This response directly answers the client's question with a clinically meaningful and specific explanation.
Why the other options are incorrect:
A. "The pump is worn continuously." While it is true that an insulin pump is worn continuously, this statement describes a physical characteristic of the device rather than explaining the therapeutic reason the pump was prescribed. It does not answer why the pump is beneficial for this client's glucose management.
C. "The pump is more convenient for you." Convenience is a secondary benefit and not the primary clinical rationale for prescribing an insulin pump, especially in the context of persistently elevated A1C. This response is vague and does not address the therapeutic purpose of the device.
D. "The pump provides better control of your blood sugar." While this is partially true, it is a vague generalization that does not explain the specific mechanism by which the pump achieves better control. Option B more precisely and accurately explains why the pump is superior in this clinical scenario.
The nurse assesses the stoma of a postoperative client who had the creation of a colostomy. The color of the stoma is dark purple. What action should the nurse take first?
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Assess the appearance of the stoma during the next hourly assessment.
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Notify the surgeon immediately.
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Irrigate the colostomy.
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Change the colostomy bag.
Explanation
A healthy stoma should be beefy red to pink and moist, indicating adequate perfusion. A dark purple stoma is a critical emergency finding indicating vascular compromise, ischemia, or impending necrosis of the stoma tissue. This requires immediate notification of the surgeon for urgent assessment and intervention because irreversible stoma necrosis can lead to peritonitis, systemic infection, and life-threatening sepsis if not addressed without delay.
Why the other options are incorrect:
A. Assess the appearance of the stoma during the next hourly assessment. A dark purple stoma is an emergency that cannot wait for a routine hourly reassessment. Delaying action for an hour risks allowing ischemia to progress to full necrosis, which is irreversible and potentially fatal.
C. Irrigate the colostomy. Irrigating an ischemic or necrotic stoma is dangerous and contraindicated. It does not address the vascular compromise causing the discoloration and could cause further trauma to compromised tissue.
D. Change the colostomy bag. Changing the ostomy appliance is a routine care task that is entirely irrelevant to the emergency vascular finding of a dark purple stoma and would waste critical time needed to notify the surgeon.
A client with rheumatoid arthritis develops Sjogren's Syndrome. Which intervention in the client's plan of care is most effective for this syndrome?
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Restrict activity in the later part of the day.
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Encourage fluids to prevent constipation.
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Lubricate the eyes with artificial tears.
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Educate the client on relaxation techniques.
Explanation
Correct Answer: (C) Lubricate the eyes with artificial tears.
Sjogren's Syndrome is an autoimmune condition commonly associated with rheumatoid arthritis that causes the immune system to attack moisture-producing glands, resulting in severe dryness of the eyes and mouth. The most effective and direct intervention is lubricating the eyes with artificial tears to relieve the hallmark symptom of dry eyes and prevent corneal damage.
Why the other options are incorrect:
A. Restrict activity in the later part of the day. Activity restriction in the afternoon is a management strategy for rheumatoid arthritis fatigue and morning stiffness, not a specific intervention for Sjogren's Syndrome.
B. Encourage fluids to prevent constipation. While adequate hydration is generally beneficial and can help with dry mouth in Sjogren's Syndrome, it is not the most targeted or effective intervention compared to artificial tears for the primary symptom of dry eyes.
D. Educate the client on relaxation techniques. Relaxation techniques support stress management and overall well-being but do not directly address the specific symptoms of Sjogren's Syndrome such as eye dryness.
The client receiving treatment for complications from anorexia is prescribed supplemental enteral nutrition. The infusion is to start at 20mL/hr and increase by 10mL every 6 hours to a goal rate of 50mL/hr. What is the total intake of enteral nutrition after 24 hours? (Round the answer to the nearest whole number.)
Explanation
Correct Answer Is:
840 mL
The infusion begins at 20 mL/hr and increases by 10 mL every 6 hours until reaching the goal rate of 50 mL/hr. The calculation is as follows:
Hours 0 to 6: 20 mL/hr for 6 hours = 120 mL
Hours 6 to 12: 30 mL/hr for 6 hours = 180 mL
Hours 12 to 18: 40 mL/hr for 6 hours = 240 mL
Hours 18 to 24: 50 mL/hr for 6 hours = 300 mL
Total intake after 24 hours = 120 + 180 + 240 + 300 = 840 mL
Note: Once the goal rate of 50 mL/hr is reached at hour 18, the rate does not increase further. The total enteral nutrition intake after 24 hours is 840 mL.
The nurse is providing care to a patient who is diagnosed with irritable bowel syndrome. Which drug prescription should the nurse anticipate to relieve diarrhea?
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Tegaserod.
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Lubiprostone.
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Loperamide.
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Amitriptyline.
Explanation
Correct Answer: (C) Loperamide
Loperamide is an opioid receptor agonist that acts on the mu-opioid receptors in the gut wall, slowing intestinal motility and reducing stool frequency and urgency. It is a well-established antidiarrheal agent commonly used in the management of IBS with predominant diarrhea (IBS-D) to provide symptomatic relief.
Why the other options are incorrect:
A. Tegaserod is a serotonin 5-HT4 receptor agonist that accelerates gastrointestinal motility and is used for IBS with predominant constipation (IBS-C), not diarrhea. Using it in a patient with diarrhea would worsen symptoms.
B. Lubiprostone is a chloride channel activator that increases intestinal fluid secretion and promotes bowel movements. It is indicated for IBS-C and chronic idiopathic constipation, not for the relief of diarrhea.
D. Amitriptyline is a tricyclic antidepressant that can slow gut motility as a side effect of its anticholinergic properties and may be used off-label in IBS-D, but it is not the primary or first-line anticipated prescription specifically for diarrhea relief in IBS compared to loperamide.
The nurse is caring for a postoperative geriatric client who is confused. Which factor(s) may be the cause of this post-op delirium? (Select all that apply.)
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Family presence
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Low albumin
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Electrolyte abnormalities
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Early ambulation
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Opioids
Explanation
Correct Answer: (B) Low albumin, (C) Electrolyte abnormalities, and (E) Opioids.
Low albumin indicates poor nutritional status and can impair drug metabolism, increasing the risk of toxic drug levels that contribute to confusion. Electrolyte abnormalities such as hyponatremia, hypernatremia, or hypercalcemia directly affect neurological function and are well-known causes of postoperative delirium in elderly clients. Opioids cause central nervous system depression and are a leading pharmacological cause of postoperative delirium, particularly in geriatric clients who metabolize medications more slowly.
Why the other options are incorrect:
A. Family presence is actually a protective factor against delirium. Familiar faces and voices help orient confused clients and reduce anxiety, making family presence a therapeutic intervention rather than a cause of delirium.
D. Early ambulation is a recommended postoperative intervention that reduces delirium risk by promoting circulation, orientation, and normal physiological function. It is a preventive measure, not a causative factor.
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