Certified Gastroenterology RN GI Bleeding Management 1 — Questions and Answers
Question 1: Which of the following is the most common cause of upper GI bleeding in adults?
- Esophageal varices
- Peptic ulcer disease (Correct answer)
- Mallory-Weiss tear
- Gastric cancer
Correct answer: Peptic ulcer disease
Peptic ulcer disease accounts for approximately 50% of all upper GI bleeding cases, making it the leading cause.
Question 2: A patient presents with hematemesis and coffee-ground emesis. These findings are most consistent with bleeding that originates:
- In the sigmoid colon
- Proximal to the ligament of Treitz (Correct answer)
- From internal hemorrhoids
- In the terminal ileum
Correct answer: Proximal to the ligament of Treitz
Hematemesis and coffee-ground emesis indicate upper GI bleeding originating proximal to the ligament of Treitz, where blood is partially digested before being expelled.
Question 3: The Rockall score is primarily used to:
- Grade the severity of inflammatory bowel disease
- Predict rebleeding risk and mortality in upper GI bleeding (Correct answer)
- Determine the need for bowel preparation before colonoscopy
- Classify the degree of esophageal varices
Correct answer: Predict rebleeding risk and mortality in upper GI bleeding
The Rockall score stratifies risk and predicts rebleeding and mortality in patients with upper GI bleeding, guiding triage decisions.
Question 4: Which IV access is most appropriate for the initial resuscitation of a patient with active GI bleeding?
- Single 22-gauge peripheral IV
- Two large-bore (16-gauge or larger) peripheral IVs (Correct answer)
- Single central venous catheter only
- PICC line for rapid fluid administration
Correct answer: Two large-bore (16-gauge or larger) peripheral IVs
Two large-bore peripheral IVs allow the fastest rates of fluid and blood product administration needed for hemodynamic resuscitation in active GI bleeding.
Question 5: A patient with liver cirrhosis presents with acute variceal hemorrhage. Which vasoactive medication is most commonly administered as a continuous infusion to reduce portal pressure?
- Pantoprazole
- Octreotide (Correct answer)
- Metoclopramide
- Neostigmine
Correct answer: Octreotide
Octreotide, a somatostatin analogue, reduces splanchnic blood flow and portal pressure and is the first-line vasoactive agent for acute variceal bleeding.
Question 6: Which laboratory finding is most indicative of significant upper GI bleeding?
- Hemoglobin of 11 g/dL
- INR of 1.2
- BUN-to-creatinine ratio greater than 20:1 (Correct answer)
- Platelet count of 200,000/μL
Correct answer: BUN-to-creatinine ratio greater than 20:1
A BUN:creatinine ratio >20:1 indicates digested blood being absorbed from the GI tract, which significantly raises blood urea nitrogen levels.
Question 7: The Glasgow-Blatchford score is used in the management of upper GI bleeding to:
- Predict mortality from lower GI hemorrhage
- Identify low-risk patients who may be safely managed as outpatients (Correct answer)
- Assess sedation depth during emergency endoscopy
- Grade the severity of portal hypertension
Correct answer: Identify low-risk patients who may be safely managed as outpatients
The Glasgow-Blatchford score identifies patients with upper GI bleeding at sufficiently low risk to avoid hospital admission and urgent endoscopy.
Certified Gastroenterology RN GI Bleeding Management 1
Which of the following is the most common cause of upper GI bleeding in adults?