A nurse in an emergency department is caring for a client who is actively bleeding from a stab wound to the thigh.
Which of the following actions should the nurse take?

Choice A rationale:

After a total gastrectomy, the client lacks the intrinsic factor necessary for the absorption of vitamin B12 in the terminal ileum. Therefore, vitamin B12 supplementation is essential to prevent pernicious anemia, a condition caused by vitamin B12 deficiency. The absence of intrinsic factor hinders the absorption of vitamin B12 from dietary sources, making it necessary to provide this vitamin through injections or high-dose oral supplements. Vitamin B12 supplementation is a standard practice following a total gastrectomy.

Choice B rationale:

Ranitidine is a histamine-2 (H2) receptor antagonist used to reduce stomach acid production. It is not directly related to vitamin B12 deficiency and is not typically prescribed following a total gastrectomy. Vitamin B12 supplementation, on the other hand, addresses the specific deficiency caused by the absence of intrinsic factor.

Choice C rationale:

Vitamin K is essential for blood clotting and bone health. However, it is not the primary concern following a total gastrectomy. Vitamin B12 deficiency leading to pernicious anemia is the major focus of post-gastrectomy supplementation. While vitamin K may be important for overall health, it is not the immediate priority in this scenario.

Choice D rationale:

Metoclopramide is a medication used to treat gastrointestinal disorders, including gastroparesis and gastroesophageal reflux disease (GERD). It does not directly address the vitamin B12 deficiency resulting from the absence of intrinsic factor. Vitamin B12 supplementation is specifically indicated to prevent pernicious anemia in this context.

The correct answer is B. The nurse should encourage the family to express their feelings of loss and provide emotional support and comfort during this difficult time. The nurse should also respect their cultural and religious beliefs and practices regarding death and dying, and allow them to spend as much time as they need with their loved one's body, unless there are infection control issues or legal requirements that prevent it. The other options are incorrect because they are insensitive and disrespectful to the family's needs and wishes.