A 76-yr-old patient with obstipation has a fecal impaction and is incontinent of liquid stool. Which action should the nurse take first?

Correct Answer: C

Rationale: The correct action is C: Manually remove the impacted stool. This is the first priority to relieve the impaction causing incontinence. Administering laxatives (choice A) may worsen incontinence. Assisting the patient to sit on the toilet (choice B) will not address the impaction. Increasing oral fluid intake (choice D) may help prevent future impactions but will not address the urgent need to relieve the current impaction.

Correct Answer: C

Rationale: The correct answer is C: pepsin. Pepsin is an enzyme that works in the stomach to break down proteins. It is not active in the duodenum because the duodenum is the first part of the small intestine where the acidic chyme from the stomach is neutralized by bicarbonate and digestive enzymes including amylase, enterokinase, and nuclease become active. Amylase breaks down carbohydrates, enterokinase activates trypsinogen, and nuclease breaks down nucleic acids. Thus, pepsin is the correct answer as it is not active in the duodenum, unlike the other enzymes listed.

Correct Answer: B

Rationale: Step 1: Water-soluble vitamins dissolve in water, are not stored in the body, and need to be replenished daily. Step 2: Vitamin C fits these criteria as it dissolves in water, is not stored in the body, and needs daily intake. Step 3: Vitamin D, E, and K are fat-soluble vitamins, stored in the body, and do not need daily replenishment. Summary: Choice B (Vitamin C) is the correct answer as it is water-soluble, while choices A (Vitamin D), C (Vitamin E), and D (Vitamin K) are fat-soluble vitamins and do not meet the criteria of water solubility.

Correct Answer: C

Rationale: The correct answer is C: amylase. Amylase is an enzyme that specifically breaks down carbohydrates into simple sugars like glucose. It is produced in the salivary glands and pancreas, aiding in the digestion process. Lipase (choice A) digests fats, pepsin (choice B) digests proteins, and trypsin (choice D) also digests proteins in the small intestine. However, amylase is the only enzyme responsible for the digestion of carbohydrates, making it the correct choice in this scenario.

Correct Answer: B

Rationale: The correct answer is B because administering a sedative before the colonoscopy will help the client relax and reduce anxiety. Sedatives are commonly used to ensure the client is comfortable during the procedure. This approach addresses the client's fear of feeling pain and helps ensure a successful and tolerable experience. Choice A is incorrect because dismissing the client's concerns may increase anxiety. Choice C is incorrect as it does not offer a solution to alleviate the client's anxiety. Choice D is also incorrect because discussing the procedure after signing the consent form may not address the client's immediate anxiety about pain during the procedure.