A patient receiving palliative care for end-stage cancer experiences intractable pain despite receiving opioid medications. What intervention should the palliative nurse prioritize to address the patient's pain?

Correct Answer: D

Rationale: The correct answer is D because referring the patient to a pain management specialist for evaluation is essential in this scenario. The specialist can conduct a comprehensive assessment to identify the underlying causes of the intractable pain and recommend a tailored pain management plan. This approach ensures a multidisciplinary approach to address the complex nature of the patient's pain. Choice A is incorrect because simply increasing the dosage of the current opioid medication may not effectively address the underlying cause of the pain and can lead to potential side effects or opioid tolerance. Choice B is incorrect as switching to a different opioid medication without a thorough evaluation may not guarantee better pain control and can increase the risk of adverse effects or inadequate pain relief. Choice C is incorrect as administering adjuvant analgesic medications without addressing the root cause of the pain may not provide adequate pain relief and does not address the need for a specialized pain management plan.

Correct Answer: D

Rationale: The correct answer is D because a journal article about a study using large, previously unpublished databases is a primary source as it presents original research findings firsthand. It contributes new knowledge to the field. A textbook (A) compiles existing information, not original research. A doctoral dissertation (B) critiques research but is not a primary source. A published commentary (C) interprets others' findings, making it a secondary source.

Correct Answer: A

Rationale: The correct immediate action is to inform the surgeon and anesthesiologist (Choice A) because a sudden decrease in oxygen saturation during surgery is a critical situation that requires prompt attention from the entire surgical team. The surgeon and anesthesiologist need to be made aware of the situation so that they can assess the patient's condition and make any necessary adjustments to the surgical procedure or anesthesia delivery. Increasing the flow rate of oxygen (Choice B) may help temporarily but does not address the underlying cause of the oxygen desaturation. Checking the endotracheal tube placement (Choice C) is important but may not be the immediate priority in this critical situation. Assessing the patient's respiratory status (Choice D) is important but should be done after informing the surgeon and anesthesiologist to ensure coordinated and timely interventions.

Correct Answer: A

Rationale: The correct response is A because it addresses the patient's concerns about potential discrimination. This shows empathy and understanding towards the patient's emotional well-being. Choices B, C, and D are incorrect because they do not directly address the patient's reasons for seeking an abortion. Choice B imposes moral and legal judgments, which can be insensitive. Choice C is not relevant to the patient's stated reason. Choice D imposes religious beliefs, which may not align with the patient's own beliefs.

Correct Answer: C

Rationale: The correct answer is C: Nasal polyps. Nasal polyps are benign growths that form in the nasal cavity and sinuses, leading to symptoms such as chronic nasal congestion, hyposmia, and anosmia. The presence of polypoid masses seen on nasal endoscopy is characteristic of nasal polyps. Rationale: 1. Chronic nasal congestion, hyposmia, and anosmia are common symptoms of nasal polyps. 2. Nasal endoscopy revealing polypoid masses confirms the presence of nasal polyps. 3. Allergic rhinitis may cause nasal congestion but does not typically present with polypoid masses. 4. Chronic sinusitis can cause nasal congestion but is usually associated with inflammation of the sinuses, not just polypoid masses. 5. A deviated nasal septum can lead to nasal congestion but does not typically cause polypoid masses obstructing the nasal cavity and sinuses.

Correct Answer: C

Rationale: The correct answer is C: Durable power of attorney. This legal document allows Mr. M to appoint his daughter as his healthcare proxy, granting her the authority to make medical decisions on his behalf if he becomes incapacitated. A: Expressed contract involves clear terms agreed upon by both parties, not relevant here. B: Implied contract arises from actions rather than explicit agreement, not applicable in this situation. D: A living will outlines an individual's medical treatment preferences, but does not grant decision-making authority to another person.

Correct Answer: A

Rationale: The correct answer is A: Rotator cuff tear. The presentation of acute shoulder pain and limited range of motion after a fall onto an outstretched hand, along with tenderness over the greater tuberosity and pain with passive abduction and external rotation, is classic for a rotator cuff tear. The mechanism of injury and physical exam findings are consistent with this condition. B: Glenohumeral dislocation typically presents with a visibly deformed shoulder and loss of normal shoulder contour. C: Acromioclavicular joint separation would present with tenderness over the AC joint rather than the greater tuberosity, and typically involves a history of direct trauma to the shoulder. D: Proximal humerus fracture would present with more diffuse shoulder pain and swelling, and not specific tenderness over the greater tuberosity.

Correct Answer: C

Rationale: Rationale: - ARDS is characterized by severe hypoxemia and respiratory distress. - Tachypnea is a hallmark sign of ARDS due to the body's compensatory mechanism to increase oxygenation. - Hypoxemia refractory to supplemental oxygen signifies the inability to improve oxygen levels despite intervention. - Choices A, B, and D do not align with typical manifestations of ARDS, as they do not directly reflect severe hypoxemia or respiratory distress.

Correct Answer: D

Rationale: The correct answer is D: Trigeminal neuralgia. This condition is characterized by recurrent, severe, stabbing pain in the trigeminal nerve distribution triggered by touch, chewing, or cold exposure. The key feature is the characteristic lancinating pain, which is not typical of migraine (choice A), cluster headache (choice B), or tension-type headache (choice C). Migraine typically presents with pulsating, moderate to severe headache associated with nausea and sensitivity to light and sound. Cluster headache is characterized by severe, unilateral pain around the eye associated with autonomic symptoms. Tension-type headache presents with bilateral, pressing or tightening pain without specific triggers. Therefore, based on the description of the symptoms in the question, trigeminal neuralgia is the most likely diagnosis.