Before cholecystectomy, the physician orders vitamin K. The nurse understands that this is administered because it is used in the formation of?

Appeared in: DSSSB Public Health Nurse - 2015

Explanation

Vitamin K is a fat-soluble vitamin that is essential for the synthesis of several clotting factors in the liver.
These vitamin K-dependent factors include Factor II (Prothrombin), Factor VII, Factor IX, and Factor X.
In conditions like obstructive biliary disease, which may necessitate a cholecystectomy, the absorption of fat-soluble vitamins like K is impaired, increasing bleeding risk.
Administering vitamin K pre-operatively helps restore the body's ability to produce prothrombin, thereby reducing the risk of hemorrhage during and after surgery.

Option A: Bilirubin is a byproduct of red blood cell breakdown and is excreted by the liver; it is not a clotting factor and its formation is not dependent on vitamin K.
Option C: Thromboplastin, also known as tissue factor, is an enzyme that initiates the extrinsic pathway of coagulation but its synthesis is not dependent on vitamin K.
Option D: Cholecystokinin is a digestive hormone that stimulates gallbladder contraction. It is related to the biliary system but has no function in the blood coagulation process.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Role of Vitamin K in Coagulation in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Nurses must assess for signs of bleeding (e.g., petechiae, ecchymosis, bleeding gums) in patients with liver or biliary tract disease, as this can indicate a vitamin K deficiency.
Monitoring coagulation studies, specifically the Prothrombin Time (PT) and International Normalized Ratio (INR), is essential for patients at risk for bleeding. A prolonged PT/INR indicates impaired clotting.
Patient education is important. The nurse should explain to the patient and family why vitamin K is being given and the importance of preventing injury to reduce bleeding risk.

How to Approach the Question

First, identify the key elements in the question: the medication (vitamin K), the clinical context (pre-cholecystectomy), and the physiological process (formation of a substance).
Recall the primary function of vitamin K. It is most famously associated with blood clotting.
Connect the clinical context to the medication's function. A cholecystectomy involves the gallbladder, which is part of the biliary system. Biliary obstruction can impair the absorption of fat-soluble vitamins, including vitamin K.
Evaluate the options based on vitamin K's role in coagulation. Prothrombin (Factor II) is a well-known clotting factor whose synthesis is dependent on vitamin K.
Eliminate the other options by identifying their functions: Bilirubin is a waste product, Thromboplastin is an initiator but not K-dependent, and Cholecystokinin is a digestive hormone.

Concept Tested & Keywords

QeloTAqY-9rGQxVcUQEJiC

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 840-842

E6 Medicine Harrison 22e Part 1 p. 976-978

E6 Textbook of Biochemistry for medical StudentsDM Vasudevan Part 2 — Subpart A (pp 1-239 of 478) p. 66-68

Practise the full DSSSB Public Health Nurse - 2015

Attempt every question from this paper in a timed mock, then review the full solution for each one.