Questions: The nurse is reinforcing discharge instructions to a client who has had a total gastrectomy. The nurse instructs the client about the importance of returning as scheduled to the health care clinic for which priority assessment? (1) Renal function studies (2) Gastric analysis studies (3) Vital sign measurements (4) Vitamin B12 and folic acid studies

The answer is the fourth one (4): Vitamin \( B_{12} \) and folic acid studies.

Explanation for each option:

1. Renal function studies: While renal function is important, it is not directly related to a total gastrectomy. A gastrectomy primarily affects the digestive system and nutrient absorption, not the kidneys.

2. Gastric analysis studies: After a total gastrectomy, the stomach is removed, so gastric analysis studies are not applicable. There is no stomach to analyze for gastric secretions.

3. Vital sign measurements: Although monitoring vital signs is important for overall health, it is not the priority assessment related to the specific complications of a total gastrectomy.

4. Vitamin \( B_{12} \) and folic acid studies: This is the correct answer. After a total gastrectomy, the patient is at risk for vitamin \( B_{12} \) deficiency because the stomach is responsible for producing intrinsic factor, which is necessary for vitamin \( B_{12} \) absorption. Folic acid levels may also be affected. Therefore, regular monitoring of these vitamins is crucial to prevent deficiencies and associated complications.

In summary, the priority assessment for a client who has had a total gastrectomy is to monitor vitamin \( B_{12} \) and folic acid levels to prevent deficiencies.