A client with chronic pain asks the nurse why the pain medication makes the client feel sleepy. What would be the basis of the nurse's response?

Correct Answer: B

Rationale: The basis of the nurse's response is the effect on the brain, as opioid pain medications (e.g., morphine) depress the central nervous system, slowing activity in areas like the reticular formation, causing drowsinessa common side effect tied to their mechanism. This explains sleepiness consistently. Choice A, reduced pain perception, is the goal, not the causepain relief doesn't inherently sedate; CNS depression does. Choice C, increased metabolism, is falseopioids slow processes (e.g., gut), not hasten them, and metabolism doesn't drive sedation. Choice D, allergic reaction, is incorrect; sleepiness is pharmacological, not anaphylactic. Choice B is correct, enabling nurses to clarify this CNS effect, suggesting timing (e.g., bedtime dosing) to use sleepiness beneficially, reassuring clients it's normal while monitoring for excess sedation in chronic pain care.

Correct Answer: A

Rationale: A central venous catheter (CVC) is inserted to deliver fluids, medications, or nutrition directly into large veins near the heart, and its tip placement is critical for safety and efficacy. The superior vena cava (Choice A) is the correct location, specifically near its junction with the right atrium but without crossing into it, ensuring rapid dilution of infused substances into central circulation. The basilica vein (Choice B) is a peripheral vein in the arm, unsuitable for a CVC's central purpose. The jugular vein (Choice C) and subclavian vein (Choice D) are common insertion sites, but the catheter's tip must advance beyond these entry points to the superior vena cava for proper function. Misplacement (e.g., too far into the right atrium) risks arrhythmias or perforation, while too proximal a position reduces effectiveness. Imaging (e.g., chest X-ray) confirms placement in the superior vena cava, balancing efficacy and safety. This anatomical precision makes Choice A the correct answer, reflecting standard practice in critical care nursing.

Correct Answer: D

Rationale: For a postoperative diabetic client reporting impotence and marital concerns, the most appropriate intervention is suggesting referral to a sex counselor or professional (Choice D). Diabetes and surgery can cause erectile dysfunction (ED) via neuropathy, vascular damage, or psychological stress, requiring specialized expertise beyond general nursing. Encouraging questions (Choice A) fosters discussion but doesn't address the issue's complexity. Providing privacy (Choice B) supports dignity but doesn't resolve ED or marital strain. Supporting the spouse (Choice C) is secondary without addressing the client's primary concern. A sex counselor can assess physical and emotional factors, offer tailored therapies (e.g., medication, counseling), and involve the spouse, aligning with holistic care. Nurses facilitate referrals when issues exceed their scope, ensuring comprehensive management. Choice D directly tackles the client's stated worry, making it the correct and most effective intervention.

Correct Answer: A

Rationale: Blunt chest trauma from a motor vehicle accident can compromise airway, breathing, or circulation (ABCs), the nurse's top priorities. Assessing the client's airway (Choice A) is first because obstruction (e.g., from blood, swelling, or foreign objects) or injury (e.g., pneumothorax) threatens life within minutes. Signs like stridor, cyanosis, or absent breath sounds demand immediate actione.g., suctioning or intubation. Pain relief (Choice B) is vital but secondary, as unrelieved pain won't kill instantly, unlike airway loss. Encouraging deep breathing and coughing (Choice C) risks worsening injuries like rib fractures or flail chest if airway isn't secured. Splinting the chest (Choice D) aids breathing but assumes airway patency. For example, a tracheal deviation from tension pneumothorax detected during airway assessment takes precedence over pain. ABC prioritization ensures survival, making Choice A the correct first step.

Correct Answer: A

Rationale: Waking from sleep due to abdominal pain involves the body's arousal system responding to internal signals. 'Stimuli from peripheral organs to the RAS' explains this: the reticular activating system (RAS) in the brainstem regulates sleep-wake transitions, and visceral pain (e.g., from gastric distension) sends afferent signals via the vagus nerve to the RAS, triggering arousal. Choice B, 'stimuli to the wake center in the cerebral cortex,' is vague; no specific 'wake center' exists, and cortical activation follows RAS stimulation, not direct peripheral input. Choice C, 'messages from chemoreceptors to the brain,' applies to respiratory stressors (e.g., low oxygen), not abdominal pain, which lacks a chemical trigger like hypoxia. Choice D, 'messages from baroreceptors to the spinal cord,' relates to blood pressure regulation (e.g., carotid sinus), not visceral pain perception. For instance, appendicitis pain activates nociceptors, relaying signals through spinal pathways to the RAS, overriding sleep's inhibition. This aligns with sleep physiology, where the RAS filters stimuli, awakening the individual only for significant threats, making Choice A correct.