The nurse is caring for a client who reports chronic pain that is not relieved by medication. What would the nurse do next?

Correct Answer: B

Rationale: The nurse would assess for other pain relief methods when chronic pain persists despite medication, as unrelieved pain may need multimodal approachesnonpharmacological (e.g., heat, TENS) or adjuvants (e.g., gabapentin)tailored to pain type or tolerance. Assessment explores alternatives. Choice A, telling the client to try harder, is dismissive and unhelpfuleffort doesn't overcome ineffective treatment. Choice C, administering a placebo, is unethical and delays real care; it's not a clinical solution. Choice D, suggesting to ignore the pain, neglects the client's sufferingchronic pain demands action, not avoidance. Choice B is correct, reflecting nursing's proactive stanceassessing pain characteristics (e.g., neuropathic) or barriers (e.g., dose limits) ensures comprehensive management, potentially adding therapies to enhance relief, addressing the complexity of chronic pain beyond single-drug failure.

Correct Answer: D

Rationale: Deep-vein thrombosis (DVT) involves a blood clot in a deep vein, typically in the leg, obstructing venous return and causing impaired blood flow. The nursing diagnosis 'Altered peripheral tissue perfusion related to venous congestion' (Choice D) takes priority because it directly addresses the primary pathophysiological issue: reduced circulation distal to the clot, risking tissue ischemia or infarction. Impaired gas exchange (Choice A) is incorrect because DVT primarily affects venous, not arterial, flow, and gas exchange relates to pulmonary issues like embolism, not the initial DVT state. Fluid volume excess (Choice B) isn't indicated, as DVT doesn't inherently cause systemic fluid overload; edema is localized. Risk for injury related to edema (Choice C) is a concern but secondary, as it's a symptom rather than the core problem. Prioritizing tissue perfusion aligns with the ABCs (airway, breathing, circulation) and Maslow's hierarchy, where physiological needs like circulation supersede safety risks. If untreated, poor perfusion can lead to tissue damage or pulmonary embolism, making Choice D the most urgent and correct diagnosis.

Correct Answer: C

Rationale: Under the False Claims Act, billing for a higher level of service than provided is illegal. Using a CPT code for a 50-minute psychotherapy session when only 30 minutes were delivered is upcoding (Choice C), as it inflates reimbursement by misrepresenting the service's intensity or duration. Unbundling (Choice A) involves billing separate components of a bundled service individually, not applicable here. Overbilling (Choice B) is a broader term for excessive charges but doesn't specifically describe coding mismatches. Misrepresentation (Choice D) is vague and not a legal term in this context. Upcoding violates federal regulations, risking penalties, because it falsely claims more resources were used. For example, CPT code 90834 (45-50 minutes) pays more than 90832 (30 minutes), and choosing the former for a shorter session is fraudulent. Accurate coding ensures ethical billing, making Choice C the precise and correct answer.

Correct Answer: A

Rationale: A high-protein diet emphasizes foods rich in amino acids for tissue repair, muscle maintenance, or recovery. Baked beans, hamburger, and milk (Choice A) are protein powerhouses: beans (7-10 g/cup), hamburger (20-25 g/patty), and milk (8 g/cup) total over 35 g per meal, far exceeding others. Spaghetti with cream sauce, broccoli, and tea (Choice B) leans carbohydrate-heavy (pasta), with broccoli offering minimal protein (3 g/cup) and tea none. Bouillon, spinach, and soda (Choice C) provide negligible proteinspinach has 5 g/cup, but bouillon and soda contribute little. Chicken cutlet, spinach, and soda (Choice D) include protein from chicken (25-30 g), but spinach and soda add little, totaling less than Choice A. For a client needing 50-60 g daily, Choice A's variety and quantity signal successful teaching, making it the correct answer.

Correct Answer: B

Rationale: Sleep is a natural, recurring state distinct from wakefulness, and its definition hinges on physiological and perceptual changes. 'Altered consciousness, relative inactivity' best captures this, reflecting sleep's reduced awareness and minimal physical movement, as seen in EEG shifts from beta to delta waves during non-REM stages. Choice A, 'decreased state of activity, refreshed,' partially appliesactivity drops, and waking often refreshesbut it omits the critical consciousness shift, making it incomplete. Choice C, 'comatose, immobility,' describes a pathological state, not normal sleep; coma lacks the reversibility and cycles (REM/NREM) of sleep. Choice D, 'alert, responsive,' defines wakefulness, the opposite of sleep. For example, during NREM stage 3, a sleeper's consciousness alters (less responsive to stimuli), and muscle tone decreases, yet they can awakenunlike coma. Nursing texts like Taylor's Fundamentals emphasize sleep as a dynamic state of altered consciousness with reduced, not absent, activity, aligning with circadian biology. Thus, Choice B is the most accurate and comprehensive descriptor.