Final Exam NCA1 FT Middlesex Community College
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Free Final Exam NCA1 FT Middlesex Community College Questions
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The client has gained 15 pounds over the past month.
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The client's child died in a car accident 2 months ago.
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The client has a history of migraine headaches since they were a teenager.
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The client was laid off from their job 5 years ago.
Explanation
Somatoform disorders, now classified under somatic symptom and related disorders, are strongly associated with recent significant psychological trauma and unprocessed grief. The death of a child two months ago represents a profound acute traumatic stressor that can trigger the conversion of overwhelming psychological distress into physical symptoms. Recent major life trauma is one of the most significant risk factors for the development of somatoform presentations.
Why the other options are incorrect:
A. The client has gained 15 pounds over the past month. Rapid weight gain is a physiological finding that warrants medical investigation for causes such as hypothyroidism, fluid retention, or medication side effects. It is not a recognized psychosocial risk factor for somatoform disorders.
C. The client has a history of migraine headaches since they were a teenager. Chronic migraine headaches are a neurological condition with an organic basis and are not a risk factor for somatoform disorders. Having a history of a diagnosed medical condition does not predispose a client to somatic symptom disorder.
D. The client was laid off from their job 5 years ago. While job loss can be a stressor, an event that occurred five years ago with no indication of ongoing acute psychological distress is not as significant a risk factor as a recent catastrophic trauma such as the death of a child.
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Bariatric patients need no special accommodations for this surgery.
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The surgery will involve removing a portion of the intestine.
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Laparoscopic surgery should not be done in an outpatient center.
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This type of surgery will involve multiple small incisions.
Explanation
Correct Answer: (D) This type of surgery will involve multiple small incisions.
Laparoscopic surgery is a minimally invasive surgical technique in which a small camera and specialized instruments are inserted through multiple small incisions, typically measuring less than one centimeter each, rather than one large open incision. For a laparoscopic cholecystectomy, this approach allows the surgeon to visualize and remove the gallbladder while minimizing tissue trauma, reducing recovery time, and lowering the risk of postoperative complications compared to open surgery.
Why the other options are incorrect:
A. Bariatric patients need no special accommodations for this surgery. Bariatric or obese patients do require special accommodations for laparoscopic surgery, including equipment sized appropriately for their body habitus, longer specialized instruments to reach deeper anatomical structures, and careful positioning to prevent complications. This statement is clinically inaccurate.
B. The surgery will involve removing a portion of the intestine. Laparoscopic cholecystectomy involves removal of the gallbladder, not any portion of the intestine. This statement reflects a fundamental misunderstanding of the anatomy and purpose of the procedure.
C. Laparoscopic surgery should not be done in an outpatient center. Laparoscopic cholecystectomy is one of the most commonly performed outpatient surgical procedures. Most patients are discharged the same day or within 23 hours, making outpatient surgical centers entirely appropriate for this procedure.
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"It inhibits the production of estrogen in the ovaries."
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"It works by blocking estrogen receptors in breast cancer cells."
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"It works by interfering with DNA replication causing cell death."
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"It works by increasing contact inhibition within the cells."
Explanation
Correct Answer: (B) "It works by blocking estrogen receptors in breast cancer cells."
Tamoxifen is a selective estrogen receptor modulator used primarily in the treatment of estrogen receptor-positive breast cancer. Its mechanism of action involves competitively binding to estrogen receptors on breast cancer cells, blocking estrogen from attaching and stimulating cancer cell growth. This statement accurately reflects how Tamoxifen works at the cellular level.
Why the other options are incorrect:
A. "It inhibits the production of estrogen in the ovaries." This describes the mechanism of aromatase inhibitors such as anastrozole or letrozole, which reduce estrogen production. Tamoxifen does not inhibit estrogen production but instead blocks estrogen from binding to its receptors.
C. "It works by interfering with DNA replication causing cell death." This describes the mechanism of cytotoxic chemotherapy agents such as alkylating agents or antimetabolites, not Tamoxifen, which is a hormone therapy that works through receptor blockade.
D. "It works by increasing contact inhibition within the cells." Contact inhibition is a normal cellular process that prevents overcrowding of cells. This is not the mechanism of action of Tamoxifen and is not relevant to its use in breast cancer treatment.
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Encourage patient to get out of bed for meals.
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Place a pillow under the knee to allow for bending of the knee.
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Request a physical therapy consult.
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Conduct incentive spirometry teaching as soon as awake.
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Administer diazepam 5 mg every 4 hours for phantom limb pain.
Explanation
Early mobilization promotes circulation and prevents complications such as DVT. Physical therapy is essential post-amputation for strengthening, rehabilitation, and eventual prosthetic fitting. Incentive spirometry prevents postoperative atelectasis and pneumonia, which are common after general anesthesia.
Why the other options are incorrect:
B. Placing a pillow under the knee to allow for bending is contraindicated after BKA. Flexion contractures of the residual limb are a major complication that impairs prosthetic fitting. The limb should be kept in extension and elevation to prevent contracture formation.
E. Diazepam is a benzodiazepine sedative not typically indicated as a first-line treatment for phantom limb pain. Phantom limb pain is more appropriately managed with agents such as gabapentin, pregabalin, tricyclic antidepressants, or mirror therapy. Scheduled benzodiazepines carry risks of sedation, respiratory depression, and dependence in postoperative patients.
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The risk of cervical cancer decreases with safe sexual practices.
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Receiving four human papilloma virus (HPV) vaccine doses over 6 months decreases the risk of cervical cancer.
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Healthy nutrition choices decrease the risk of cervical cancer.
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The use of oral contraceptives over the long term decreases the risk of cervical cancer.
Explanation
Correct Answer Is:
(A) The risk of cervical cancer decreases with safe sexual practices.
Human papillomavirus is the primary cause of cervical cancer and is transmitted through sexual contact. Safe sexual practices such as using condoms and limiting the number of sexual partners significantly reduce HPV exposure and therefore lower the risk of cervical cancer. This is accurate and evidence-based prevention education.
Why the other options are incorrect:
B. Receiving four human papilloma virus (HPV) vaccine doses over 6 months decreases the risk of cervical cancer. The HPV vaccine series does reduce cervical cancer risk, however the standard schedule is typically two to three doses, not four doses over six months. The incorrect dosing information makes this statement inaccurate for community education.
C. Healthy nutrition choices decrease the risk of cervical cancer. While overall health and a strong immune system support cancer prevention in general, healthy nutrition is not a specifically established primary prevention measure for cervical cancer in the same direct way that safe sexual practices and HPV vaccination are.
D. The use of oral contraceptives over the long term decreases the risk of cervical cancer. This is incorrect and actually the opposite is true. Long-term use of oral contraceptives has been associated with a slightly increased risk of cervical cancer, not a decreased risk.
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Place the bag of parenteral nutrition in the warmer to decrease waiting time for the refrigerated bag to warm up.
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Delegate fingerstick glucose checks to the unlicensed assistive personnel.
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Replace parenteral nutrition tubing every 72 hours to prevent central line associated bloodstream infection.
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Delegate notifying the provider about abnormal vital signs to the unit secretary.
Explanation
Parenteral nutrition bags are stored refrigerated and must be warmed before administration. Using a warmer is an efficient and safe practice to reduce waiting time. Notifying the provider about abnormal vital signs can be delegated to the unit secretary as a communication task, making care more efficient.
Why the other options are incorrect:
B. Delegate fingerstick glucose checks to the unlicensed assistive personnel is incorrect because glucose monitoring requires clinical judgment and interpretation, which must be performed by licensed nursing staff.
C. Replace parenteral nutrition tubing every 72 hours is incorrect because parenteral nutrition tubing should be replaced every 24 hours, not 72 hours, to prevent infection.
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"You are in good hands; even if it is positive, your doctor is the best."
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"You sound concerned about the results of this test."
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"Most biopsies end up being negative, so don't worry about it."
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"It's not good for you to worry."
Explanation
This response uses the therapeutic communication technique of reflection, acknowledging and validating the client's expressed emotional state without dismissing, minimizing, or redirecting their feelings. It opens the door for the client to continue expressing their concerns and demonstrates empathy, which is the foundation of a therapeutic nurse-client relationship. Reflecting feelings back to the client is the most appropriate response when a client expresses fear and uncertainty.
Why the other options are incorrect:
A. "You are in good hands; even if it is positive, your doctor is the best." This is false reassurance that redirects the conversation away from the client's emotional needs and toward praise of the physician. It does not validate the client's fears or address their psychological distress.
C. "Most biopsies end up being negative, so don't worry about it." This is false reassurance that minimizes the client's legitimate anxiety with a statistical generalization that may not apply to their individual situation. Telling a client not to worry dismisses their feelings and closes down therapeutic communication.
D. "It's not good for you to worry." This is a nontherapeutic response that judges the client's emotional reaction and implies their feelings are inappropriate. It invalidates the client's experience and does not acknowledge or address their fear.
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"I take ibuprofen for the pain as needed."
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"I find it difficult to move when I first get up in the morning."
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"My joints are stiffest at night before I go to sleep."
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"I seem to get tired early in the day and have to leave work early."
Explanation
Activity Intolerance is defined as insufficient physiological or psychological energy to endure or complete required or desired daily activities. The statement about becoming fatigued early in the day to the point of being unable to complete a full workday is the most direct evidence that the client cannot sustain normal daily activities due to disease-related fatigue, which is the defining characteristic of the nursing diagnosis of Activity Intolerance.
Why the other options are incorrect:
A. "I take ibuprofen for the pain as needed." This statement describes pain management behavior and supports the nursing diagnosis of Chronic Pain, not Activity Intolerance. It does not reflect an inability to sustain or complete daily activities.
B. "I find it difficult to move when I first get up in the morning." Morning stiffness upon waking is a hallmark symptom of rheumatoid arthritis and best supports the nursing diagnosis of Impaired Physical Mobility rather than Activity Intolerance, as it describes difficulty with movement rather than insufficient energy to sustain activity.
C. "My joints are stiffest at night before I go to sleep." Nighttime joint stiffness reflects the pattern of RA symptoms and more closely supports the diagnoses of Chronic Pain or Impaired Physical Mobility. It does not describe the inability to sustain daily activities that defines Activity Intolerance.
Explanation
Using the standard drug calculation formula:
Desired dose ÷ Available dose = Number of tablets
144 mg ÷ 48 mg = 3 tablets
The nurse will administer 3 tablets of Fenofibrate 48 mg to deliver the prescribed dose of 144 mg per day.
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The pyloric sphincter.
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The lower esophageal sphincter (LES).
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The ileocecal valve.
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The upper esophageal sphincter (UES).
Explanation
The primary cause of GERD is dysfunction of the lower esophageal sphincter, located at the junction where the esophagus meets the stomach. Normally the LES acts as a one-way valve, opening to allow food into the stomach and closing tightly to prevent gastric acid from flowing back upward. When the LES is weakened or inappropriately relaxes, acidic stomach contents reflux into the esophagus, causing the burning and irritation characteristic of GERD. On the anatomical diagram, this structure is found at the point where the esophagus connects to the stomach.
Why the other options are incorrect:
A. The pyloric sphincter sits between the stomach and the duodenum. Its dysfunction is associated with pyloric stenosis or delayed gastric emptying, not the backward flow of acid into the esophagus seen in GERD.
C. The ileocecal valve is located between the small and large intestine in the lower abdomen. It has no involvement in the upper GI tract mechanics responsible for GERD.
D. The upper esophageal sphincter is located at the top of the esophagus near the throat and controls the entry of food from the pharynx into the esophagus. Its dysfunction is associated with swallowing difficulties, not gastric acid reflux into the esophagus.
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