A nurse is caring for an adolescent who has a brain tumor and is receiving hospice care. The nurse is providing counseling regarding the stages of grief, which of the following statements by the adolescent is an example of the bargaining stage?

Rationale:

A. A newborn who has forceful vomiting with feedings: Forceful vomiting in a newborn may indicate pyloric stenosis, gastrointestinal obstruction, or other serious conditions that can quickly lead to dehydration and electrolyte imbalance. This is an urgent finding requiring immediate assessment to prevent rapid deterioration.

B. A newborn who has a heart rate of 160/min while crying: A heart rate of 160/min is within the expected range for a newborn (120–160/min) during activity or crying. While monitoring is necessary, this finding is not immediately concerning and does not require urgent intervention.

C. A newborn who is 24 hr of age and has blood-tinged vaginal discharge: A small amount of blood-tinged vaginal discharge (pseudomenstruation) is a normal hormonal response in female newborns due to maternal estrogen withdrawal. This is an expected finding and does not require urgent assessment.

D. A newborn who is 12 hr of age and has not voided: While monitoring urinary output is important, a newborn may normally not void within the first 12 hours of life. Assessment is needed, but it is not as urgent as forceful vomiting, which can quickly cause serious complications.

Rationale:

A. Forearm: The forearm is generally used for intradermal injections, such as tuberculin or allergy testing, rather than subcutaneous injections. It has limited subcutaneous tissue and is not ideal for medications requiring slower absorption.

B. Vastus lateralis: The vastus lateralis is a preferred site for intramuscular injections, particularly in infants and young children, due to its large muscle mass. It is not the first choice for subcutaneous injections because absorption dynamics differ.

C. Ventrogluteal: The ventrogluteal site is a preferred intramuscular injection site in adults and children but is not commonly used for subcutaneous injections. Its depth and tissue composition make it less suitable for subcutaneous administration.

D. Abdomen: The abdomen is a recommended site for subcutaneous injections because it has a layer of subcutaneous fat that allows for consistent absorption. Areas at least 2 inches away from the umbilicus are preferred to avoid irritation and ensure proper medication delivery.