Priority Decision: A postoperative patient has a nursing diagnosis of pain related to effects of medication and decreased GI motility as evidenced by abdominal pain and distention and inability to pass flatus. Which nursing intervention is most appropriate for this patient?

Correct Answer: A

Rationale: Rationale for Correct Answer (A): Ambulating the patient more frequently helps to stimulate GI motility, reduce abdominal distention, and promote passage of flatus. Movement aids in peristalsis, which can alleviate postoperative GI issues. Summary of Incorrect Choices: B: Assessing bowel sounds is important but does not directly address the issue of stimulating GI motility or addressing the patient's pain and distention. C: Placing the patient in a high Fowler's position may improve respiratory function but does not specifically target GI motility or pain relief. D: Withholding opioids may be necessary in some cases, but pain management is crucial for postoperative care. There are other ways to address decreased GI motility without completely withholding pain medications.

Correct Answer: C

Rationale: The correct answer is C: HCV genotyping. Before prescribing treatment for a patient with positive HCV testing, genotyping is essential to determine the specific strain of HCV present. This information guides treatment decisions as different HCV genotypes respond differently to antiviral medications. Anti-HCV (choice A) is used for initial screening but does not provide genotype information. HCV RNA quantitation (choice B) measures viral load but does not identify the genotype. Recombinant immunoblot assay (RIBA) (choice D) is an older confirmatory test and is not typically used for initial treatment decision-making.

Correct Answer: D

Rationale: The correct answer is D: Improved hemodynamic function and renal perfusion. A portacaval shunt is a surgical procedure that diverts blood flow from the portal vein directly into the vena cava, reducing portal hypertension. This leads to improved hemodynamic function by decreasing pressure in the portal system, which can improve renal perfusion. Choices A, B, and C are incorrect because a portacaval shunt may not necessarily improve survival rate, decrease serum ammonia levels, or improve metabolism of nutrients.

Correct Answer: C

Rationale: The correct answer is C: Gender (female). Women have a higher risk of developing gallstones due to hormonal factors, such as estrogen increasing cholesterol levels in bile. This imbalance can lead to gallstone formation. Advanced age (B) is a risk factor but not as common as gender. While a high-fat diet (A) can contribute to gallstone formation, it is not a primary risk factor. Family history (D) can increase the likelihood of gallstones, but it is not as common as being female.