A nurse assigned to care for a postoperative male client who has diabetes mellitus. During the assessment interview, the client reports that he's impotent and says that he's concerned about its effect on his marriage. In planning this client's care, the most appropriate intervention would be to:

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: 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.

Correct Answer: D

Rationale: Diet influences sleep via neurotransmitter and blood sugar effects. 'A carbohydrate snack' promotes sleep by raising tryptophan levels, a serotonin and melatonin precursore.g., a banana or crackers 1-2 hours before bed stabilizes glucose, easing sleep onset. 'One cup of hot chocolate' has caffeine (e.g., 5-20 mg), a stimulant delaying sleep, despite warmth's relaxation. 'Three glasses of red wine' sedates initially but disrupts REM sleep latere.g., alcohol metabolism at 3 a.m. causes awakeningsper sleep studies. 'A high-protein snack' , like turkey, has tryptophan but digestion (e.g., tyrosine release) can stimulate, not sedate. Nursing, per Taylor, favors carbs for their insulin-mediated tryptophan boost, avoiding stimulants or heavy meals. Choice D is the correct, evidence-based recommendation.

Correct Answer: B

Rationale: Cataplexy, tied to narcolepsy, involves muscle weakness triggered by emotions. 'Sudden loss of motor tone that may cause the person to fall asleep; usually experienced during a period of strong emotion' is correcte.g., laughter drops a patient's jaw or knees, lasting seconds, per AASM. Choice A, 'irresistible urge to sleep,' is narcolepsy's sleep attacks, not cataplexye.g., no muscle loss. Choice C, 'nightmare or vivid hallucinations,' fits hypnagogic events, not cataplexy's waking state. Choice D, 'skeletal paralysis during transition,' describes sleep paralysis, not emotion-driven cataplexye.g., no falling asleep. A nurse might see a patient slump during joy, per Taylor's neurology. Choice B precisely defines this feature.

Correct Answer: D

Rationale: Sleep drugs vary in mechanism. 'Ramelton (Rozerem)' normalizes cycles by mimicking melatonin, binding MT1/MT2 receptorse.g., aligning sleep to 11 p.m.per Taylor's pharmacology. 'Flurazepam (Dalmane)' and 'temazepam (Restoril)' , benzodiazepines, sedate via GABAe.g., 15 mg knocks out, not syncing cycles. 'Eszopiclone (Lunesta)' , a non-benzodiazepine, enhances GABA tooe.g., 3 mg aids sleep onsetbut doesn't target melatonin. Ramelton's unique actione.g., no tolerance vs. others' 2-week fademimics the body's clock, making Choice D correct.