Tracy is receiving combination chemotherapy for treatment of metastatic carcinoma. Nurse Ruby should monitor the client for the systemic side effect of:

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: 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.

Correct Answer: B

Rationale: The correct answer is B: Release of tissue thromboplastin. In the extrinsic pathway of blood coagulation, tissue thromboplastin (also known as tissue factor) is released in response to tissue injury, initiating the clotting cascade. This leads to the activation of factor VII and subsequent steps in the coagulation process. A: Release of Calcium is not specific to the extrinsic pathway and does not directly initiate the clotting cascade. C: Conversion of factors XII to factor XIIa is part of the intrinsic pathway, not the extrinsic pathway. D: Conversion of factor VIII to factor VIIIa is part of the intrinsic pathway, not the extrinsic pathway.

Correct Answer: A

Rationale: The correct answer is A because it demonstrates a clear understanding of the importance of hydration and monitoring symptoms in managing HHNS. By recognizing the signs of dehydration and the need to drink more fluids, the client can prevent complications. Choice B is incorrect because consuming soda with sugar can worsen the condition by raising blood glucose levels. Choice C is incorrect as it focuses solely on monitoring blood glucose levels without addressing the crucial aspect of hydration. Choice D is incorrect because eating a snack high in carbohydrates can exacerbate hyperglycemia, leading to further complications.