A nurse is teaching a newly licensed nurse about telephone prescriptions. Which of the following information should the nurse include?

Choice A Reason:
The patient should be elevated 45-90° before inserting a nasogastric tube helps prevent aspiration and facilitates tube insertion.
Choice B Reason:
Assisting the client into a fetal position on his side in preparation for a lumbar puncture is a proper positioning technique to facilitate the procedure and minimize discomfort for the client.
Choice C Reason:
Assessing the client's gag reflex following an esophagogastroduodenoscopy (EGD) is standard practice to ensure the client's safety and ability to protect their airway after the procedure.
Choice D Reason:
Maintains the chest tube collection device below the level of the insertion site when ambulating the client is correct. Chest tube management is critical to prevent complications such as air leaks, tension pneumothorax, and tube dislodgement. When ambulating a client with a chest tube, it's essential to keep the collection device below the level of the insertion site to ensure proper drainage and prevent air from entering the pleural space. If the collection device is positioned above the insertion site, it could result in fluid or air backflow into the patient's chest cavity, which can lead to complications.

Choice A Reason:
White blood cell count (WBC) is incorrect. Melena, which is the passage of black, tarry stools, is typically associated with upper gastrointestinal bleeding rather than an infection. While changes in WBC count might occur in response to infection or inflammation, it is not the primary laboratory test to monitor in response to melena.
Choice B Reason:
Glucose is incorrect.
Glucose monitoring is important for assessing blood sugar levels, particularly in diabetic patients or those at risk of hypoglycemia or hyperglycemia. However, it is not directly related to the presence of melena, which indicates gastrointestinal bleeding.
Choice C Reason:
Blood urea nitrogen (BUN) is incorrect. Blood urea nitrogen (BUN) levels can indicate renal function and hydration status, but they are not specifically related to the presence of melena. Monitoring BUN may be relevant in other clinical contexts, such as assessing kidney function or dehydration, but it's not the primary laboratory test to monitor in response to melena.
Choice D Reason:
Hematocrit is correct. Melena indicates upper gastrointestinal bleeding, which can lead to a significant loss of blood. Monitoring the hematocrit level is crucial in this context because it helps assess the severity of bleeding and guide appropriate interventions such as blood transfusions if necessary. A decrease in hematocrit indicates a decrease in the volume of red blood cells, which reflects blood loss and the need for further evaluation and management.