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. Contact: Contact precautions are used for infections transmitted by direct or indirect contact with the client or their environment, such as MRSA or C. difficile. Erythema migrans, associated with Lyme disease, is not spread through contact.

B. Droplet: Droplet precautions are for infections transmitted through large respiratory droplets, such as influenza or pertussis. Lyme disease does not spread via respiratory secretions, so droplet precautions are unnecessary.

C. Airborne: Airborne precautions apply to infections transmitted via small particles that remain suspended in the air, such as tuberculosis or measles. Lyme disease is not airborne, so this precaution is not required.

D. Standard: Standard precautions are appropriate for Lyme disease, including erythema migrans. These precautions involve routine hand hygiene, use of gloves when in contact with body fluids, and proper handling of contaminated materials, which are sufficient since the disease is transmitted via tick bites, not person-to-person.

Rationale for correct choices

• Report to the provider immediately if a dry cough develops: ACE inhibitors or similar antihypertensive medications can cause a persistent dry cough as a side effect. Early reporting allows the provider to evaluate the need for medication adjustment or substitution to prevent further complications, such as noncompliance or worsening respiratory symptoms.

• Report to the provider immediately if the client experiences muscle aches: Muscle aches or myalgia can indicate statin-induced myopathy or rhabdomyolysis, particularly with elevated LDL and prescription of statins such as rosuvastatin. Early detection prevents severe muscle breakdown, renal impairment, or other complications.

Rationale for incorrect choices

• Increase sodium intake: The client has hypertension, and increasing sodium intake would exacerbate elevated blood pressure and increase the risk of cardiovascular complications, including heart failure and stroke. Sodium restriction is essential to support blood pressure control and overall cardiovascular health.

• Take rosuvastatin only in the morning: Rosuvastatin can be taken at any time of day, unlike some other statins that are recommended in the evening. Restricting it to the morning is unnecessary and may reduce adherence if it conflicts with the client’s routine. Emphasis should be on consistent daily intake rather than timing.