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. Establish a patent airway: Severe head trauma with active nasal bleeding raises concern for airway obstruction from blood pooling, impaired consciousness, or loss of protective reflexes. Ensuring a patent airway prevents hypoxia, which can rapidly worsen neurologic injury. Early airway control is the priority because compromised breathing poses an immediate threat to life

B. Prepare for a CT scan: A CT scan is essential for diagnosing intracranial injuries, fractures, and sources of bleeding, but the client must first have a stable airway and adequate oxygenation. Imaging cannot safely proceed until airway patency is confirmed, since deterioration during transport is a major risk.

C. Insert a peripheral IV line: IV access is necessary for fluid resuscitation and medication administration, but it is not the most urgent action when airway compromise is suspected. The risk of hypoxia outweighs the risk of delayed IV access, and airway management must occur before secondary stabilization steps. Once the airway is secured, IV access can be safely done.

D. Apply direct pressure to the nose: Direct pressure is generally used to control epistaxis, but in severe head trauma, nasal bleeding may indicate a basilar skull fracture, and pressure could worsen underlying injury or dislodge clots. Additionally, controlling bleeding is secondary to securing the airway, as blood flow can interfere with breathing.

Rationale:

A. Instruct the client to remain on bed rest for the first 24 hr: Strict bed rest is not recommended after a laparoscopic cholecystectomy because early ambulation helps reduce the risk of atelectasis, venous thromboembolism, and postoperative gas pain. Keeping the client immobile can delay recovery and contribute to complications.

B. Instruct the client to consume foods high in fat: High-fat foods can trigger abdominal discomfort and diarrhea after gallbladder removal because bile secretion is no longer regulated. Clients are advised to begin with low-fat meals to prevent gastrointestinal distress while the body adjusts to continuous bile flow.

C. Instruct the client to cough and breathe deep every hour: Deep breathing and coughing exercises help prevent postoperative pulmonary complications, especially atelectasis from anesthesia and reduced mobility. Encouraging these exercises hourly promotes lung expansion, clears secretions, and supports optimal respiratory function during recovery.

D. Instruct the client to avoid taking a shower for 1 week: Most clients may shower within 24–48 hours after a laparoscopic procedure once dressings are removed, provided incisions are clean and dry. Restricting showers for an entire week is unnecessary and may hinder comfort and hygiene without providing additional protection to the incision sites.