The nurse is caring for client who has had a stroke and who received tissue plasminogen activator(t-PA) 6 hours ago. The nurse identifies which of the following symptoms are indications of an intracerebral hemorrhage post thrombolytic therapy?

A) Begins training to prepare to run a marathon next year:
This response is not characteristic of the stage of anger. Instead, this behavior suggests denial or possibly bargaining, as the client may be attempting to maintain a sense of normalcy or even hope in the face of a terminal illness like Amyotrophic Lateral Sclerosis (ALS).

B) Refuses to attend church and states that "his faith has failed him":
This statement reflects the anger stage of Kubler-Ross’s five stages of grief. During the anger stage, individuals often experience intense feelings of frustration, helplessness, and resentment about their situation. They may direct these emotions towards others, including higher powers or themselves. In this case, the client is expressing anger by blaming his circumstances and feeling abandoned by his faith, a common reaction when facing an irreversible condition like ALS.

C) Promises God to give up smoking if allowed to live until their children are married:
This behavior represents the bargaining stage of grief, not anger. In the bargaining phase, individuals may attempt to negotiate with a higher power or themselves, making promises or deals in exchange for a prolongation of life or a desired outcome. The client is trying to strike a "deal" by making promises for future behavior in exchange for a specific wish, reflecting bargaining rather than anger.

D) Gathers the family together in order to discuss what their last wishes are:
This scenario aligns more with the acceptance stage of grief. In the acceptance stage, individuals come to terms with their diagnosis and begin to make plans for the end of their life. The act of discussing last wishes indicates that the client is accepting the reality of their condition and preparing for what is to come.

A) IM epinephrine is the fastest route of administration:
While epinephrine is often administered intramuscularly in cases of anaphylaxis and allergic reactions, the speed of action is not the primary reason for choosing this route over intravenous (IV) administration in this situation. Intramuscular administration of epinephrine allows for a rapid onset of action, but it is not necessarily the fastest route compared to IV. IV administration would act more quickly in an emergency setting where immediate blood circulation is critical, but IM is preferred in allergic reactions to prevent excessive systemic effects and to avoid rapid peaks in plasma levels.

B) IV epinephrine is only administered during cardiac arrest:
Epinephrine is generally administered intravenously during life-threatening situations such as cardiac arrest or severe shock, where immediate circulatory effects are needed. In cases of anaphylaxis, however, intramuscular (IM) administration of epinephrine is the preferred route because it allows for a more controlled absorption rate and reduces the risk of excessive blood pressure and other adverse cardiovascular effects. This is the correct rationale for why epinephrine is administered IM in the context of an allergic reaction.

C) Epinephrine would not be administered in this situation:
Epinephrine is the first-line treatment for severe allergic reactions and anaphylaxis, especially in cases where symptoms like wheezing, shortness of breath, urticaria, and itching are present. Therefore, withholding epinephrine is not an appropriate response in this situation. Immediate intervention with epinephrine is critical to reverse the symptoms of anaphylaxis and prevent further respiratory distress or cardiovascular collapse.

D) IM epinephrine is less concentrated than IV:
The concentration of epinephrine used for IM and IV administration is the same. The primary reason for choosing the IM route over the IV route is the slower absorption and the fact that it minimizes the risk of a rapid increase in systemic blood pressure and other adverse reactions. While IM epinephrine may be absorbed more slowly than IV, its concentration is appropriate for treating anaphylaxis effectively. The choice of IM is based on safety and controlled response, not on the concentration of the drug.