Nursing Process
A patient with melena and falling hemoglobin is diagnosed with Deficient Fluid Volume. What is an appropriate expected outcome for the next 24 hours?
Patient will maintain stable vital signs with no further episodes of bleeding. Planning
A nurse reviews labs for a patient with suspected upper GI bleeding. Which lab result best reflects blood loss and why?
What is Hemoglobin/hematocrit, as they indicate the degree of anemia from bleeding.
A patient with upper GI bleeding is started on IV pantoprazole. What is the nurse’s clinical reasoning for this medication?
What is It reduces gastric acid, stabilizes clots, and helps prevent further bleeding.
A patient with a history of peptic ulcer disease tells the nurse they have had black, tarry stools for two days and feel slightly dizzy when standing. Vital signs are within normal limits. What critical‑thinking judgment should guide the nurse’s next action?
Recognize early upper GI bleeding and notify the provider while closely monitoring vital signs and labs.
Which finding most strongly indicates upper GI bleeding?
A. Bright red blood in stool
B. Coffee‑ground emesis
C. Left lower quadrant pain
D. Mucus in stool
What is B. Coffee‑ground emesis
The nurse is planning care for a patient with acute upper GI bleeding. Which expected outcome best reflects effective planning?
What is Hemoglobin and hematocrit will remain stable or improve within 24–48 hours. (Planning)
A patient with active vomiting of blood has a normal hemoglobin level on admission. How should the nurse interpret this finding?
What is Hemoglobin may initially appear normal because lab values lag behind acute blood loss.
A patient with esophageal varices receives octreotide. How does this medication help control bleeding?
What is It decreases portal hypertension and blood flow to varices.
A patient arrives in the ED after vomiting dark, coffee‑ground material. The provider places the patient NPO. Based on clinical judgment, what intervention should the nurse anticipate and prepare the patient for?
Endoscopy to identify and control the source of upper GI bleeding.
A patient with suspected upper GI bleeding is hypotensive. Which order should the nurse implement first?
A. Administer IV pantoprazole
B. Prepare for endoscopy
C. Start large‑bore IV access
D. Obtain stool specimen
What is C. Start large‑bore IV access
During routine monitoring, the patient becomes pale, hypotensive, and tachycardic. Which nursing interventions should be implemented first?
What is Maintain airway, start IV fluids, and notify the provider. Implementation
Lab results show elevated BUN with normal creatinine. Using critical thinking, what does this suggest about the bleeding source?
What is Upper GI bleeding due to digestion and absorption of blood.
Before administering a blood transfusion, what critical teaching should the nurse provide to ensure patient safety?
What is Explain the purpose of transfusion and instruct the patient to report symptoms of a transfusion reaction.
Four hours after admission, the patient’s heart rate increases to 118 bpm, blood pressure drops to 88/54 mmHg, and urine output decreases. How should the nurse interpret these findings using critical thinking?
What is Indicators of hypovolemia and possible hemorrhagic shock from ongoing blood loss.
(Select All That Apply):
Which factors increase the risk for upper GI bleeding?
A. Chronic NSAID use
B. Liver cirrhosis
C. Diverticulosis
D. Alcohol use disorder
E. Helicobacter pylori infection
What is A, B, D, E
After receiving IV fluids and a blood transfusion, which findings indicate the nursing interventions were effective?
What is Improved blood pressure, heart rate, urine output, and stabilized hemoglobin.
A patient with liver disease has an elevated INR and active GI bleeding. What is the clinical significance for nursing care?
What is The patient has impaired clotting and a higher risk for continued bleeding.
The patient asks why NSAIDs are no longer recommended after discharge. How should the nurse explain this using critical thinking?
What is NSAIDs damage the gastric lining and significantly increase the risk of recurrent bleeding.
A patient with known esophageal varices suddenly vomits a large amount of bright red blood and becomes anxious and restless. What clinical judgment supports the nurse’s immediate response?
What is This is a life‑threatening emergency requiring airway protection and activation of rapid response.
Correct order of nursing actions for a patient actively vomiting blood:
What is 2 → 1 → 4 → 3
Despite treatment, the patient’s hemoglobin continues to decline. How should the nurse use critical thinking to modify the plan of care?
What is Reassess the patient, notify the provider, and anticipate further interventions such as repeat endoscopy or ICU transfer.
Serial hemoglobin levels continue to decrease despite IV fluids. What conclusion should the nurse make?
What is Bleeding is ongoing and treatment must be escalated.
The nurse is preparing discharge teaching for a patient recovering from upper GI bleeding. How should education be tailored to prevent recurrence?
What is Emphasize medication adherence, avoidance of NSAIDs and alcohol, diet modifications, and follow‑up care.
Following endoscopic band ligation, the patient reports increasing chest pain and shortness of breath. How should the nurse prioritize this situation?
What is Following endoscopic band ligation, the patient reports increasing chest pain and shortness of breath. How should the nurse prioritize this situation?
THemoglobin drops from 11.2 to 8.6 g/dL in 6 hours with tachycardia and hypotension. What is the best conclusion?
A. Expected IV fluid response
B. Lab error
C. Ongoing acute blood loss
D. Chronic anemia
What is C. Ongoing acute blood loss