The nurse is caring for a client with tension pneumothorax. Which nursing assessment would alert the nurse to the development of a mediastinal shift in this client?

A. Give the client one medicine at a time and observe for allergic reactions: This approach is unsafe and reactive rather than preventive. Administering medications without confirming ingredients risks triggering a serious allergic reaction.
B. Administer the medications that the physician ordered: Medications should never be given without verifying they are safe for the client, especially when allergies are known. Doing so could result in a life-threatening hypersensitivity response.
C. Consult drug references to make sure the medicines do not contain substances to which the client is hypersensitive: This is the safest and most appropriate action. The nurse must verify all ordered medications to ensure they do not contain allergens. Cross-checking with reliable drug references ensures safe administration.
D. Call the pharmacy and let them know the client has several drug allergies: While notifying the pharmacy is helpful, the nurse is still responsible for verifying medication safety before administration. This action alone does not replace the need for direct confirmation of drug components.

A. "What makes you most angry about getting the disease?": This response aligns with the anger stage, which is the second stage in the Kübler-Ross model. It helps validate frustration but is not appropriate in the bargaining phase. At this point, the client is more focused on negotiating for more time or outcomes. Encouraging anger expression may be less helpful now.
B. "Let's review the laboratory results and compare them with the diagnostic tests.": This is a logical, data-focused statement that doesn’t address the client’s emotional needs. During bargaining, clients are seeking emotional reassurance and often making "if only" or "I wish" statements. Reviewing labs lacks therapeutic value in this emotional stage.
C. "I understand that it would be wonderful to see your daughter's graduation.": This statement acknowledges a common bargaining response — hoping to live long enough for an important event. It reflects empathy and connects with the client's emotional state. Supporting these goals helps the client feel heard and validated during this stage.
D. "I like your idea of living for today and enjoying those around you.": This statement reflects the mindset seen in the acceptance stage of grief. While it promotes positivity, it does not resonate with the bargaining phase, where clients are still negotiating with fate or a higher power. It may feel dismissive of the client’s current emotional struggle.