CGFNS

1. CGFNS

2. The nurse suspects an elderly client has become impacted when the client says: • I have a lot of gas pains • I don’t have much of an appetite • I felt like I have to go and just can’t • I haven’t had a bowel movement for 2 days • Because of the presence of feces in the colon, a client with a fecal impaction has the urge to defecate but is unable to. Flatulence may occur as a result of immobility not just obstruction. Anorexia may occur with a fecal impaction but may also be caused by outer conditions. The frequency of bowel movements varies for individuals. It may be normal for this individual. It may be normal for this individual not to have bowel movement for several days The answer is C

3. A client hepatic cirrhosis begins to develop slurred speech, confusion, drowsiness, and a flapping tremor. With this evidence of impending hepatic coma, the diet would probably be changed to : • 20 g protein, 2000 calories • 70 g protein, 1200 calories • 80 g protein, 2500 calories • 100 g protein, 1500 calories Rationale : Because the liver is unable to detoxify ammonia to urea, and when hepatic coma is inevitable, protein intake should be restricted (20 g proteins and 2000 calories). The other options have relatively high intake of protein, which will increase blood ammonia levels. The answer is A

4. After a partial gastrectomy is performed, a client is returned to the unit with an iv solution infusing and a a nasogastric tube in place. The nurse notes that there has been no drainage from nasogastric tube for an hour. There is an order to irrigate the nasogastric tube prn. The nurse should insert: • 30 ml of normal saline and withdraw slowly • 20 ml of air and clamp off suction for 1 hour • 50 ml of saline and increase pressure of suctionj • 15 ml of distilled water and disconnect suction for 30 mts Normal saline is used in irrigtion to prevent electrolyte imbalance. Because of the fresh gastric sutures slow and gentle irrigation should be performed. Most surgeons, however prefer gastric instillation. The purpose of irrigation is to maintain the patency of the tube for gastric decompression. Pushing air and clamping the suction tube can result in blocking the nasogastric tube by viscous drainage. Increasing the pressure or disconnecting suction may cause damage to the suture line. The answer is A

5. When performing a colostomy irrigation the nurse inserts the catheter into the stoma upto • 5 cm (2inches) • 10 cm (4 Inches) • 15 cm (6 inches) • 20 cm ( 8 inches) 10 cm is far enough to direct the flow of solution into the bowel. Insertion of 5 cm is inadequate fluid may leak back around the catheter. An insertion of 15 cm may cause trauma to the mucosa. An insertion of 8 inches may cause trauma to the mucosa. The answer is B

6. When teaching a client to irrigate a colostomy, the nurse indicates that the distance of the container above the stoma should be no more than: • 15 cm (6 inches) • 25 cm (10 inches) • 30 cm (12 inches) • 45 cm (18 inches) A colostomy irrigation is much like a tap water enema. The solution must be held at 45 cm above the stoma, which is high enough to allow flow into the bowel, but not so high that it flows rapidly, or it can cause cramping or mucosal injury. The other potions do not represent maximum height permitted and may not ensure flow of solution into the bowel. The answer is D

7. The physician has ordered a rectal tube to help a client relieve abdominal distention following surgery. To achieve maximum effectiveness, the nurse should leave it in place for a period of • 15 minutes • 30 minutes • 45 minutes • 60 minutes A rectal tube promotes maximum benefits in 30 minutes. This allows adequate time for gas to escape. 15 minutes is not adequate time to permit removal of flatus. Beyond 30 minutes there would be minimal release of flatus. The answer is B

8. While administering an enema, the maximum safe height at which the container of fluid can be held is : • 30 cm (12 inches) • 37 cm • 45 cm (18 inches) • 66 cm (26 inches) If the height of the enema fluid container above the anus in increased, the force and rate of flow also icrease if the containeer is raised excessively, damage to the mucosa may and the procedure will be much more difficult for the client to tolerate. The enema container can be held up to 45 cm above the anus. Upto 37 cm is still be considered within safe limits, 66 cm would be too high and could cause mucosal injury. The answer is C

9. A client has peptic ulcer in the duodenum. He would probably describe the associated pain as: • An ache radiating to the left side • An intermittent colicky flank pain • A gnawing sensation relieved by food • A generalized abdominal pain intensified by moving Eating food relieves the gnawing sensation. Because the acid secretions in the stomach is neutralized by food rather than irritate the intestinal mucosa. An ache radiating to the left side is not specific to duodenal ulcers. An intermittent colicky flank pain may indicate renal colic. A generalized abdominal pain intensified by moving is a generalized symptoms not specific to duodenal ulcers. The answer is C

10. Diagnosis of malabsorption syndrome is made in a client. Striking clinical improvement should be noted after administration of : • Folic acid • Vitamin B12 • Corticotropin • A gluten free diet Gluten a cereal protein appears to be responsible for morphologic changes of the intestinal mucosa in individuals with nontropical sprue (adult celiac disease). Folic acid, along with antimicrobial agents is used to treat tropical sprue it causes dramatic improvement. Vitamin B12 may be administered if macroccytic anemia or achlorhydria develop, however, it does not correct the major pathology. The use of corticosteroids may be advantageous with either form of sprue; however, this does not produce the same effect as specific treatment already described. The answer is D

11. A flat plate X-ray of the abdomen is ordered for a client. The nurse recognizes that the client should receive: • No special preparation • A low soapsuds enema • Nothing by mouth for 8 hours • A laxative the evening before the X-ray A flat plate film of the abdomen visualizes abdominal organs as they are. No bowel preparation is indicated. The client may eat and drink as tolerated. Preparation is not required. The answer is A

12. A pancreatic pseudocyst is: • Generally a malignant growth • Filled with pancreatic enzymes • Cyst containing necrotic tissue and blood • A pouch of undigested food particles The pancreatic pseudocyst is an abnormally dilated space that contains blood, necrotic tissue, and enzymes, which is surrounded by connective tissue. The other options are incorrect definitions of a pseudocyst. The answer is C

13. When teaching a client about intussusception, the nurse explains that it is : • Kinking of the bowel onto itself • A band of connective tissue compressing the bowel • Telescoping of a proximal loop of bowel into a distal loop • A protrusion of an organ or part of an organ through the wall that contains it Intussusception is the telescoping of prolapse of a segment of the bowel within the lumen of an immediately connecting part. Kinking of the bowel onto itself is volvulus. Adhesions are ands of scar tissue that can compress the bowel. Protrusion of na organ through the wall that cdontain it is called herniation. The answer is C

14. Health teaching program for a client who has had a gastrectomy should include: • A warning to avoid all gas forming foods • An explanationof the therapeutic client of a high roughage • Encouragement toresume previous eating habits as soon as possible • A thorough explanation of the dumping syndrome and how to limit or prevent it. Dumping syndrome occur in about 50% of all individuals who have undergone a gastrectomy. The symproms include weakness, heart palpitations, and diaphoresis. It is therefore, important to explain to the client that such symptoms can be minimized by resting after meals in the semi0Fowler position, eating small meals, and omitting concentrated and highly refined carbohydrates. Gas forming foods (option A ) affect rather thean gastric disorders. Option C is inappropriate , because in order to prevent rapid emptying of the stomach eating habits should be modified. The answer is D

15. Barium salts used for GI series and barium enemas serves to: • Fluoresce and thus illuminate the alimentary tract • Give off visible light and illuminate the alimentary tract • Dye the alimentary tract and thus provide for color contrast • Absorb X-rays and this give contrast to the soft tissues of the alimentary tract Barium salts used in a GI series and barium enemas coat the inner lining of the GI tract and then absorb X-rays passing through. Thus, they outline the surface features of the tract on photographic plate. Barium does not fluoresce. It has no light emiting properties, nor has any properties f a dye. The answer is D

16. A client with a hiatus hernia complains about having difficulty sleeping at night. The appropriate nursing interention would be: • Make the client sleep on two or three pillows • Eliminate carbohydrates from client’s diet • Suggest drinking a large glass of milk before retiring • Administer antacids such as sodium bicarbonate Sleeping on pillows raises the upper torso and prevents feflex of the gastric contents through theheria. Eliminating carbohydrates from diet gave have no effect on the mechanical problem of the stomach’s contents entering the thoracic cavity. Drinking a large glass of milk before retiring would increase the content of the stomach before lying down, which would aggravate the symptoms associated with a hiatal hernia. The effect of antacids is not long lasting enough to promote a fuill night’s sleep, sodium bicarbonate is not the antacid of choice’ The answer is A

17. Postoperative care for a client who has had a hemorrhoidectomy should include • Occlusive dressings to the area • Encouraging showers when needed • Administration of laxatives and stool softeners • Administration of enemas to promote defecation Stool softeners and laxatives are administered to avoid straining and constipation. Light dressing are used to promote drainage and healing. Baths are advised to promote healing and cleaning of the area. Enemas may be ordered several days after surgery if the client has not had a bowel movement. The answer is C

18. a client complains of abdominal cramps during a colostomy irrigation, the nurse should: • Discontinue the irrigation • Lower the container of fluid • Clamp the catheter for a few minutes • Advance the catheter about 2.5 cm (1 inch) The rapid rate of enema administration or ostomy irrigation often causes abdominal cramping. Additional fluid leads to more discomfort. Cramping will generally subside if the enema tubing is clamped for a few minutes; the procedure can then be continued. Discontinuing the irrigation could lead to ineffective cvacuation of the colon. Lowering the container will decreaqse the rate of flow, but fluid will continue to enter the colon if the container remains above the stoma, indiscriminate advancing of the catheter can injure the mucosa but not relieve the cramping The answer is C

19. Twenty amino acids are involved in body metabolism, building of various tissues. Of these, 8 are essential amino acids. This means that : • These 8 amino acids can be made by the body because they are essential to life. • These 8 amino acids are essential in body processes and the remainig 14 are not. • The body cannot synthesize these 8 amino acids and thus they must be obtained form the diet • After synthesizing these 8 amino acids, the body uses them in key processes essential for growth Essential amino acids are needed to maintain life, but are not synthesized by the body. Option A,B and D are incorrect according to the defination of essential aminoacid. C

20. The laboratory test that would indicate that the liver of a client with cirrhosis is compromised and Neomycin enemas might be helpful is : • Ammonia level • White blood count • Culture and sensitivity • Alanine aminotransaminase level Increased ammonia level indicate that the liver is unable to detoxify protein by products. Neomycin reduces the amount of ammonia forming bacteria in the intestine. White bolld cell may indicate infection, however this would have no relationshipto the need for neomycin enema. Culture and sensitivity testing would identify the presence of a microorganism and the medicatio that would be effective in its eradification. It would not be indicated in cirrhosis. Alanine aminotransferase (ALT) is a test to assess for disease but has no relationship to the need for Neomycin enemas The answer is A

21. An acute attack of pancreatitis may be precipitated by heavy drinking. Because: • Promotes the formation of calculi in the cystic duct • The pancreas is stimulated to secrete more of insulin than it can immediately produce • The alcohlo alters the composition of enzymes so they aare capable of damaging pancreas • Alcohol increases enzymes secretion and pancreatic duct pressure, which cause bakcflowof enzymes into the pancreas. Alcohol stimulates pancreatic enzyme secretion and an increase in pressure in the pancreatic duct The ackflow of enzymes into th epancreatic interstitial spaces results in partial digestion and inflammation of the pancreatic tissue. Alcohol is not associated with formation of calculi. The demand for insulin is unrelated to pancreatitis. Although the volume of secretions increases, the composition remains unchanged. The answer is D

22. When caring for a client with a nasogastric tube attached to suction, the nurse should: • Irrigate the tube with normal saline • Use sterile technique when irrigating the tube • Withdraw the tube quickly when decompression is terminated • Allow the client to have small chips of ice or sips of water unless nauseated. To ensure continued suction, ther patency of the tube should be maintained. Normal saline is used to prevent fluid and electrolyte disturbance during irrigation. Option B is not correct because the stomach is not considered a sterile body cavity, so medical asepsis not indicated. Option c is inappropriate, care must be taken to avoid traumatizing the mucosa. Option D is inappriate. Ice chips and water represent fluid intake, which must be approved by the physician. Ice chips and water being hypotonic in nature may lower the serum electrolytes. The answer is A

23. For an elderly client who has had a subtotal gastrectomy, the wisest dietary guidance would be to : • Increase intake of dietary roughage • Avoid oral feedings for a prolonged period • Gradually resume small easily digestable feedings • Allow the selection of personally preferred foods Small frequent feedings are tolerated best after a subtotal gastrectomy. Option A is inappropriate because roughage may be irritating to the GI tract after surgery. Option B is wrong, because the individual is generally given small amounts of fluid as soon as oedema subsides and then the diet is gradually progressed. Option D is also inappropriate because allowing only food preferences does not ensure inclusion of nutrients necessary for recovery. The answer is C

24. A client has taken mega doses of Vitamin A. the nurse questions this practice because: • This vitamin is highly toxic even in small amounts • The liver has great storage capacity for the vitamin, even to toxic amounts • This vitamin cannot be stored, and the excess anount sould saturate the general body tissues. • Although the body’s requirement for the vitamin is very large, the cells can synthesise more as needed Vitamin A is a fat soluble vitamin that accumulates in the body and is not significantly excreted even if extremely large amounts are ingested. After prolonged ingestion of extremely large doses toxic effects (irritability, increased intracranial pressure, fatigue, night sweats, and severe headache) can occur. Option A is wrong because vitamin A is toxic only after prolonged large dosages. optionC is wrong because Vitamin A can be stored in the liver. Option D is wrong because Vitamin A cannot be synthesized in the body. The answer is B

25. A client with liver canceer complains of fatigue because a readily available form of energy although limited in amount, is stored in the liver by conversion of glucose to: • Glycerol • glycogen • Tissue fat • Amino acids The liver stores carbohydrates as glycogen which is a polymer of glucose for future energy needs. Glycerol a byproduct of lipids, which combines with three fatty acids to form a triglyceride. Fat is not saved in the liver. Amino acids are not a ready form of energy. Polymer of amino acids form protein. The answer is B

26. Which of the following is essential for absorption of fat soluble vitamins in the intestine? • Hydrochloric acid • Bile salts • Lipase • Amylase Bile salts are surfactants that help in absorption and transport of lipids and lipid soluble vitamins across the cells lining the GI tract. Hydrochloric acid is secreated by the stomach and has no role in absorption fats and fat soluble vitamins. Lipas and amylase are enzyme that are involved in digestion of fats and carbohydrates respectively The answer is B

27. The nurse would expect a client with cancer of the liver to have difficulty digesting fatty foods because the liver is involved in the production of : • Bile • Lipase • Cholesterol • Amylase Fatty acids are insoluble in water dn must combine with bile to form water solble substances for digestion and absorption. Lipase is pancreatic enzyme. Amylase which digests starch is found in saliva and pancreatic juice. Cholesterol is not required for emulsification of fats The answer is A

28. A client complains of abdominal discomfort following ingestion of milk. The nurse reconizes that this may be the result of a genetic deficiency of the enzyme • Lactase • Maltase • Sucrase • amylase Milk and milk products are not tolerated well because they contain lactose; a disaccharide that is broken down by the enzyme lactase to yield to galactose and glucose. Lactose intolerance is commonin theose of afroamerican heritage. Who lack in lactase. Maltase is an enzyme that assists the digestion of maltose, which is not a milk sugar. Sucrase is an enzyme that assists he digestion of sucrose, which is not a milk sugar. Amylase is an enzyme that assists the digestion of starch, which is not a milk sugar. The answer is A

29. A client with ???ng ??? • 20 g protein, 2000 calories • 70 g protein, 1200 calories • 80 g protein, 2500 calories • 100 g protein, 1500 calories ??? be ???od ammonia levels. The answer is A

30. The earliest indication of parenchymal damage to the liver in clients with hepatitis B is usually : • A rise in bilirubin • An alteration in proteins • A rise in alanine aminotrasferase (ALT) • An elevation of alkaline phosphatase ALT is also known as glutamate pyruvate transaminase GPT, that is released early in the course of liver damage. A rise in bilirubin, an alteration in proteins, or an elevation of alkaline phosphatase are not early signs liver damage. The answer is C

31. When caring for a client with an ileostomy the nurse would: • Encourage the client to eat foods high in residue • Explain that th4e drainage can be controlled with daily irrigation • Expect the stoma to start draining on the third postoperative day • Anticipate that emotional stress can increase intestinal peristalsis. Emotional stress of any kind can stimulate peristalsis and thereby increase the volume of drainage. The client should be encouraged t eat a diet as normal as possible. Ileostomy drainage is liquefied and continuous, so irrigations are not indicated. The stoma will start to drain within the first 24 hours after surgery. The answer is D

33. A client who has had a colostomy should follow a diet that is : • Rich in protein • Low in fiber content • High in carbohydrate • As close to normal as possible The answer is D Although foods that produce gas are generally avoided, the diet of an individual with a colostomy should be as close to normal as possible for optimal physiologic and psychologic adaptation. A high protein diet is important until healing occurs, but a balanced diet generally meets nutritional needs for protein. There is no need to limit fibre, it provides bulk necessary for unconstipated stools. Because absorption of nutrients is unaffected, there is no need to increase carrbohydrate intake.

34. A client with ascites has been ordered paracentesis. Before the procedure the nurse should instruct the client to: • Empty the bladder • Eat foods low in fat • Remain npo for 24 hours • Assume the supine position The bladder must be empty to decrease the chance of puncturing it during the paracentesis. Option B and C are not necessary. Paracentesis is usually peerformed in the Fowler position to assist the flow of fluid by gravity, and not in supine position. The answer is A

35. A typical food combination that can be served to a client with malabsorption syndrome is : • Roast beef, baked potato, carrot, and tea. • Cheese omelet, noodles, green beans, coffee • Creamed turkey o toast, tice, green peas, milk • Baked chicken, mashed potatoes with gravy zucchini, and postum Roast beef, baked potato, carrot and tea ae low in gluten, hence this combination can be served. Flours used in the oroduction of noodle and bread are high in gluten. Popstum is a cereal drink, which is high in gluten. The answer is A

36. The nurse explains that visualization of the GI tract after a barium enema is made possible because: • Barium physically colors the intestinal wall. • Barium has the X-ray absorbing properties • Barium has X-ray transmitting properties • Barium chemical interacts with electrolytes. Because the soft tissues of the GI tract lack sufficient quantities of X-ray absorbing atoms (as are naturally present in the dense calcium salts of bone) an X-ray absorbing coating of barium is used for radiologic studies. Barium does not colour the intestinal wall or absorbs X-rays, or interact with electrolytes. The answer is B

37. When teaching a client to care for a new colostomy, the nurse should advice the client that the irrigations be done at the same time every time every day. The time selected should: • Be approximately 1 hour before breakfast • Provide ample uninterrupted bath room use at home • Approximate the client’s usual daily time for elimination • Be about halfway between the two large meals of the day Ample time in the bathroom must be ensured for the actual irrigation process and fecal returns, which may not be immediate option A and D The availability of adquate time takes precedence ; this would not use the gastrocolic reflex that would occur after eating. Option C This is important; but the availability of adequate time takes precedence. The answer is B

38. If intubation is indicated in a client with bleeding oesophageal varices, the type of tube most likely to be used would be a (an) • Levin tube • Salem sump • Miller-Abbott tube • Blakemore-Sengstaken tube Blakemore-Sengstaken tube includes an oesophageal balloon that on inflation exerts pressure, which retards hemorrhage. Option A is used for gastric decompression or lavage. It has one lumen. Option B is used for gastric decompression. It has two lumens, one for decompression and one for an air vent. Option C is used for intestinal decompression. The answer is D

39. When teaching a client at discharge with a permanent colostomy, the nurse is expected to discuss the : • Need for special clothing • Importance of limiting activity • Periodic dilation of the stoma • Bland, low residue diet regimen The stoma of a colostomy must be dilated with a lubricated, gloved finger to prevent strictures and subsequent obstruction. Clothing need not be special but should be nonconstricting. Once healing has occurred, activity need not be limited. Diet should be as close to normal for the individual as possible; but gas forming foods should be avoided. The answer is C

40. The chief complaint in clients with Vincent’s angina is : • Chest pain • Shortness of breath • Shoulder discomfort • Bleeding oral ulceration Vincent’s angina (trenchmouth) is an infection of themouth resulting in bleeeding gums, pain on swallowing and talking, and fever. Option A is a symptom related to angina pectoris, resulting from insufficient oxygenation of myocardial tissue, not Vincent’s angina. Option B and C are symptoms related to angina pectoris, and not related to Vincent’s angina The answer is D

41. Before scheduling a client for endoscopic retrograde cholangiopancreatography (ERCP) the nurse should assess the client’s : • Urine output • Bilirubin level • Serum glucose • Blood pressure ERCP involves the insertion of a cannula into panceratic and common bile ducts during endoscopy. The test is not performed if the client’s serum bilirubin is greater than 5 mg/dL, because cannulization may cause oedema which would further increase obstruction to bile flow. Option A, C and D are not related to performing ERCP. The answer is B

42. A client with ???ng ??? • 20 g protein, 2000 calories • 70 g protein, 1200 calories • 80 g protein, 2500 calories • 100 g protein, 1500 calories ??? be ???od ammonia levels. The answer is A

43. A client with ???ng ??? • 20 g protein, 2000 calories • 70 g protein, 1200 calories • 80 g protein, 2500 calories • 100 g protein, 1500 calories ??? be ???od ammonia levels. The answer is A

44. Fractured mandible is usually immobilized with wires. The life threatening postoperative problem that can develop with this pocedure is : • Infection • Vomiting • Reflux of intestinal contents into the oesophagus • Build up of feces and gas within the large intestine. • Vomiting may result in aspiration of vomitus because it cannot be expelled, this could cause pneumonia or asphyxia. Infection is not a life threatening problem. Osteomylitis is not life threatening. Bronchospasm is also not life-threatening. The answer is B

45. A subtotal gastrectomy is performed to treat a client with cancer of the stomach. This client develops dumping syndrome. The dumping syndrome refers to : • Nausea due to a full stomach • Rapid passage of osmotic fluid into the jejunum • Reflux of intestinal contents into the esophagus • Buildup of faeces and gas within the large intestine The answer is B When high osmotic fluid passes rapidly into the small intestine, it causes hypovolemia. This results in a sympathetic response with tachycardia diaphoresis. The symptoms are also attributed to a sudden rise and subsequent fall in blood sugar. The stomach is not full. Its contents are rapidly emptied into the jejunum. Reflux of intestinal contents would need reverse peristalsis, which could occur with intestinal obstruction; dumping syndrome is associated with increased motility originating in the jejunum. Build up of feces and gas within the large intestine is usually associated with paralytic ileus; dumping syndrome leads to increased intestinal motility.

46. Phospho-soda is cathartic, classified as : • saline • Emollient • stimulant • Bulk-forming The answer is A Phospho-soda is a saline cathartic, which increases the osmotic pressure within the intestine so that body fluids are drawn into the bowel stimulating bowel stretching, peristalsis and defaecation. Emollients have a detergent action softening the stool by facilitating its absrption of water. Stimulants irritate the mucosa so that peristalsis is increased. Bulk-forming laxatives are cellulose derivatives that remain in the intestinal trace and absorb water, they cause bulk, which stimulates peristalsis.

47. When a client has extensive carcinoma of the descending portion of colon with metastasis to the lymph nodes the operative prodedure that would probably be performed is a (an) : • Ileostomy • Colectomy • Colostomy • Caecostomy The location of the tumour will usually indicate whether a colostomy (creation of an opening) proximal to the tumour between the colon and the skin surface is needed. An ileostomy is the creation of an opening between the ileum and the skin surface, it would not be done in this condition. A colectomy is the surgical removal of a portion of the colon, with creation of an anstomosis it is generally used in less extensive carcinoma. A cecostomy is the creation of an opening between the caecum and the skin surface; it is usually a temporary procedure. The answer is C

48. Clients with gastrectomy may develop pernicious anaemia because: • Vitamin B 12 is only absorbed in the stomach • The haemopoietic factor is secreted in the stomach • The parietal cell of the gastric mucosa secrete intrinsic factor • Chief cells in the stomach secrete the extrinsic factor. Pernicious anaemia is caused by a lack of intrinsic factor produced by the parietal cells of the gastric mucosa that is necessary for B12 to be absorbed in the ileum. Haemopoitic factor is the combination of B12 and intrinsic factor. Chief cells in the stomach secrete the enzymes of the gastric juice, and not extrinsic factor. The answer is C

49. In clients with cholecystitis the utilization of bile is interfered with. The ejection of bile into the alimentary tract is controlled by the hormone: • Gastrin • Secretin • Enterocrinin • Cholecystokinin Cholecystokinin is a widely distributed hormone whose functions include stimulation of gallbladder contraction and release of pancreatic enzymes. It also functions as a neurotransmitter in the CNS. Gastrine stimulates the secretion of gastric juice, secretin promotes the production of bile by the liver and the secretion of pancreatic juice, and enterocrinin stimilates the secretion intestinal juice (succus entericus) The answer is D

50. Before a cholecystectomy a physician order vitamin K . Vitamin K is required for the synthesis of : • Bilirubin • Prothrombin • Thromboplastin • Cholescystokinin Vitamin K is required for the synthesis of prothrombin. It is a fat-soluble vitamin and is not absorbed from the GI tract in the absence of bile. Bilirubin is the bile pigment formed by the breakdown of erythrocytes. Thromboplastin converts prothrombin to thrombin during the normal coagulation process. Cholecystokinin is the hormone that stimulates pancreatic secretion anti contraction of the gallbladder. The answer is B