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Endorphins enhance the release of serotonin, leading to pain reduction. Although serotonin plays a role in pain modulation, TENS primarily works through endorphin and enkephalin release, not via serotonin enhancement.

Endorphins increase the production of norepinephrine to reduce pain. Norepinephrine also plays a role in descending pain inhibition, but this is not the main mechanism triggered by TENS.

Endorphins stimulate nerve cells to increase pain sensation. This is the opposite of their function-endorphins reduce pain perception, not increase it.

Ignore the confabulation and continue with care. Ignoring may increase agitation or anxiety. The client requires supportive communication.

Dispute the client's statements to ensure reality orientation. Confrontation increases distress and worsens sundowning symptoms.

Correct the false statements immediately. Direct correction causes agitation in dementia and is not therapeutic.

Administer an additional dose of the prescribed analgesic. Safety first-giving an extra dose without reassessment risks overdose and ignores potential red-flag symptoms (e.g., new onset severe pain).

Recommend the client try relaxation techniques. Complementary techniques are helpful but not a priority before reassessment when pain is severe or worsening.

Consult with a pain management specialist immediately. This may be needed later, but not before a focused reassessment.

Complete the transfer documentation. Essential but should occur after acceptance is confirmed so documentation matches the receiving facility’s requirements (e.g., transfer summary, recent labs, medication list, advanced directives). Documentation is important but should only start after confirmation from the receiving facility.

Ensure the client is dressed appropriately for transfer. Important for comfort, dignity, and identification, but subservient to confirming acceptance and arranging transport. Dressing is one of the last preparatory steps once logistics are confirmed and timing is set.

Meet with the client's family to explain the transfer process. Family communication is crucial for consent, expectations, and emotional support; however, this discussion ideally follows confirmation of destination, timing, and transport logistics so the nurse can provide accurate, actionable information.

Encourage napping in the afternoon to compensate for lost sleep: Short, early-afternoon naps (20–30 minutes) can temporarily relieve sleepiness without significantly affecting nocturnal sleep, but they risk reducing sleep pressure and worsening delayed sleep onset if too long or too late. For adolescents with chronic insufficient sleep, promoting regular nocturnal sleep is preferable to habitual napping.

Allow sleeping in on weekends to catch up on lost sleep: Sleeping in on weekends (social jetlag) can shift circadian timing and impair Monday morning functioning, worsening overall sleep regularity. While occasional catch-up may reduce acute sleep debt, it promotes inconsistent sleep–wake timing and perpetuates circadian misalignment.

Increase caffeine intake in the evening to stay awake longer:Caffeine is a stimulant with a half-life of ~3–7 hours in adolescents and interferes with sleep onset and quality, increasing sleep latency and reducing slow-wave sleep. Using caffeine to push wakefulness later compounds the underlying circadian delay and sleep deprivation and is not a recommended strategy.

Encourage the client to sleep in a communal area: Sleeping in a busy communal space increases noise and stimulation, which can worsen sundowning; a quiet, familiar, low-stimulus sleeping environment is preferred.

Schedule all caregiving activities for the evening hours: Concentrating activities in the evening creates overstimulation and disturbs the wind-down routine; spread care through the day and preserve a calm pre-bed routine.

Provide a bright and stimulating environment: Bright/stimulating environments in the evening tend to increase confusion and agitation; dusk-appropriate soft lighting and consistent routines better support circadian cues.

Prevent the client from leaving until the provider arrives: Forcibly preventing a competent adult from leaving is legally risky; interventions should start with assessment and communication, not physical restraint (unless the client lacks capacity or is a danger).

Notify the client's family about the decision: Family can be informed, but notifying family before assessing capacity and informing the provider fails to address immediate clinical and legal responsibilities.

Ask the client to sign an AMA form and let them leave: Obtaining a signed AMA form may be part of the process, but it is not the first step - assessment of decision-making capacity and informing the provider must be done first.

Pushing my residual limb down on a soft pillow can help with the pain: Gentle pressure/positioning of the residual limb may relieve residual limb discomfort and sometimes reduce phantom sensations; appropriate comfort measures are reasonable.

Medications can help reduce the sensations of phantom limb pain: Pharmacologic agents (anticonvulsants, TCAs, SNRIs, and others) are commonly used as part of multimodal management for phantom limb pain.

I can use TENS to help manage my phantom limb pain: TENS and other noninvasive modalities (mirror therapy, desensitization) have evidence for benefit in some patients and are reasonable adjuncts in a multimodal plan.

Providing acetaminophen for pain relief: Acetaminophen is not effective for neuropathic pain mechanisms and is not considered first-line for diabetic peripheral neuropathic pain.

Recommending a diet change to lower blood sugar levels: Improving glycaemic control is essential for long-term diabetic neuropathy management and prevention of progression, but it is not an immediate first-line analgesic for neuropathic pain symptoms.

Administering oral opioids for pain control: Opioids are not recommended as first-line therapy for chronic neuropathic pain because of limited long-term benefit and high risk of adverse effects; they may be reserved for selected refractory cases under specialist supervision.

Store them in the facility's safe until the client returns. Using the facility safe can be appropriate, but only if the client is staying and the receiving facility agrees; unilateral storage without documentation or transfer may risk loss or legal issues.

Give them to a family member to hold during the transfer. Handing valuables to family is acceptable only if the family is present, willing, and this is documented; it’s not always possible or safe to assume family can/should take custody.

Leave them in the client's room until the transfer is complete. Leaving valuables unsecured increases the risk of loss or theft during transfer; unsecured items also complicate chain-of-custody and liability.