GI Answers and Rationale

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Answer:  D. Vitamin K

Rationale:

• Vitamin K is essential for the synthesis of clotting factors (II, VII, IX, and X) in the liver. Clients with liver dysfunction may have impaired synthesis or storage of these clotting factors, leading to bleeding tendencies, such as spontaneous gum bleeding and petechiae (small hemorrhagic lesions). 
• Deficiency of Vitamin K results in coagulopathy, making bleeding more likely even without injury.
   

• A. Vitamin B12: Needed for red blood cell formation and neurological function. Deficiency causes anemia and neuropathy, not bleeding.
• B. Vitamin D: Important for calcium absorption and bone health, not coagulation.
• C. Vitamin E: An antioxidant; large doses can impair clotting, but its deficiency doesn't cause bleeding directly.

Answer:  A. Moist and formed

Rationale:

• A colostomy on the left side of the abdomen typically involves the descending or sigmoid colon, where most water has already been absorbed from the stool.
   
• Therefore, stool in this area is usually moist and formed, similar to normal bowel movements.
   

• B. Pencil shaped: This may indicate bowel obstruction or a constricted rectum, not typical for a well-functioning colostomy.
   
• C. Cola drinks: This is unrelated to stool description and appears to be an incorrect or misleading option.
   
• D. Dark brown or black: Black stool may suggest upper GI bleeding (due to digested blood), which is not expected from a left-sided colostomy.

 Answer: A. Notify the health care provider (HCP).
Rationale:
On the basis of the signs and symptoms presented in the question, the nurse should suspect peritonitis and notify the HCP. Administering pain medication is not an appropriate intervention. Heat should never be applied to the abdomen of a client with suspected appendicitis because of the risk of rupture. Scheduling surgical time is not within the scope of nursing practice, although the HCP probably would perform the surgery earlier than the prescheduled time. 

Answers: 

A. Administer stool softeners as prescribed.
C. Encourage a high-fiber diet to promote bowel movements without straining.
D. Apply cold packs to the anal-rectal area over the dressing until the packing is removed.

Rationale:
Nursing interventions after a hemorrhoidectomy are aimed at management of pain and avoidance of bleeding and incision rupture. Stool softeners and a high-fiber diet will help the client to avoid straining, thereby reducing the chances of rupturing the incision. An ice pack will increase comfort and decrease bleeding. Options 2 and 5 are incorrect interventions.

Answers: 

 A. Coffee
B. Chocolate
C. Peppermint
E. Fried chicken

Rationale:
Foods that decrease lower esophageal sphincter (LES) pressure and irritate the esophagus will increase reflux and exacerbate the symptoms of GERD and therefore should be avoided. Aggravating substances include coffee, chocolate, peppermint, fried or fatty foods, carbonated beverages, and alcohol. Options 4 and 6 do not promote this effect. 

 Answer: D. Assessing for the return of the gag reflex

Rationale:
The nurse places highest priority on assessing for return of the gag reflex. This assessment addresses the client's airway. The nurse also monitors the client's vital signs and for a sudden increase in temperature, which could indicate perforation of the gastrointestinal tract. This complication would be accompanied by other signs as well, such as pain. Monitoring for sore throat and heartburn are also important; however, the client's airway is the priority.