During chemotherapy for lymphocytic leukemia, Mathew develops abdominal pain, fever, and "horse barn" smelling diarrhea. It would be most important for the nurse to advise the physician to order:

Correct Answer: C

Rationale: The correct answer is C: stool for Clostridium difficile test. Rationale: 1. Abdominal pain, fever, and "horse barn" smelling diarrhea can indicate Clostridium difficile infection. 2. Clostridium difficile is a common cause of diarrhea in patients receiving chemotherapy. 3. Early detection and treatment of Clostridium difficile infection are crucial to prevent complications. 4. Stool test for Clostridium difficile can confirm the diagnosis and guide appropriate treatment. Incorrect choices: A: ELISA test - Not indicated for the symptoms described. B: Electrolyte panel and hemogram - Important but not the most immediate concern in this case. D: Flat plate X-ray of the abdomen - Unlikely to provide relevant information for the symptoms presented.

Correct Answer: C

Rationale: The correct answer is C: Leukopenia. Combination chemotherapy often leads to low white blood cell counts, known as leukopenia, which increases the risk of infection. Nurse Ruby should monitor Tracy for signs of infection such as fever, chills, and weakness. Ascites (A) is an accumulation of fluid in the abdomen, not a systemic side effect of chemotherapy. Nystagmus (B) is an involuntary eye movement and not typically associated with chemotherapy. Polycythemia (D) is an excessive production of red blood cells, which is not a common side effect of chemotherapy. Monitoring for leukopenia is critical to prevent infections and ensure Tracy's safety during treatment.

Correct Answer: B

Rationale: Step 1: Fowler's position elevates the head of the bed and flexes the knees, which helps expand the chest for better lung ventilation. Step 2: In a partial pneumonectomy, lung function is compromised, so optimal ventilation of the remaining lung is crucial. Step 3: By placing Tonny in Fowler's position, the diaphragm descends, allowing for better expansion of the left lung. Step 4: This position facilitates ventilation of the left lung, aiding in oxygenation and preventing complications like atelectasis. Summary: Choice B is correct as Fowler's position helps improve ventilation of the remaining lung. Choices A, C, and D are incorrect as they do not directly relate to the specific benefits of Fowler's position for post-pneumonectomy care.

Correct Answer: A

Rationale: The correct answer is A: Auscultate bowel sounds. This is the first nursing action because the client is experiencing abdominal pressure and nausea, which could indicate postoperative ileus. Auscultating bowel sounds helps assess if there is normal bowel function and potential complications. Palpating the abdomen (B) can be uncomfortable for the client post-surgery, and it may not provide immediate information on bowel function. Changing the client's position (C) may not address the underlying issue and can be done after assessing bowel sounds. Inserting a rectal tube (D) is not indicated unless there is a specific medical reason for it, which is not evident in this case.

Correct Answer: D

Rationale: Step-by-step rationale: 1. Inotropic agents directly increase the force of cardiac muscle contraction, leading to improved ventricular contractility in heart failure. 2. Beta-adrenergic blockers reduce the heart rate and contractility, opposite of the desired effect. 3. Calcium channel blockers primarily affect vascular smooth muscle and do not directly enhance cardiac contractility. 4. Diuretics help reduce fluid overload in heart failure but do not directly impact ventricular contractility. Summary: A: Beta-adrenergic blockers decrease contractility. B: Calcium channel blockers do not enhance contractility. C: Diuretics help with fluid overload but do not improve contractility. D: Inotropic agents directly increase ventricular contractility, making them the correct choice.