Certified Gastroenterology RN GI Bleeding Management 2

Question 1

A Dieulafoy lesion is best characterized as:

Accepted Answer

An ectatic submucosal artery that erodes through the overlying mucosa without an ulcer

Answer

A linear mucosal tear at the gastroesophageal junction

Answer

Multiple small angiodysplasias scattered throughout the colon

Answer

A perforated gastric ulcer with active arterial hemorrhage

Question 2

For endoscopic hemostasis of an actively bleeding peptic ulcer, which approach is considered most effective by current guidelines?

Accepted Answer

Combination of injection therapy plus a second modality such as thermal or mechanical clips

Answer

Epinephrine injection therapy alone

Answer

Thermal therapy alone with a heater probe

Answer

Argon plasma coagulation as the sole treatment

Question 3

A patient with known diverticulosis presents with sudden, painless, large-volume bright red rectal bleeding. This presentation is most consistent with:

Accepted Answer

Diverticular bleeding

Answer

Colorectal adenocarcinoma

Answer

Ischemic colitis

Answer

Infectious colitis from Clostridioides difficile

Question 4

Which patient position is recommended for a patient actively vomiting blood to minimize the risk of aspiration?

Accepted Answer

Left lateral decubitus (left-side down)

Answer

Supine with legs elevated 30 degrees

Answer

Prone position

Answer

High Fowler's at 90 degrees

Question 5

A restrictive transfusion threshold (hemoglobin <7 g/dL) is appropriate for most GI bleeding patients, but a HIGHER threshold is recommended for patients with:

Accepted Answer

Acute coronary syndrome or significant cardiac disease

Answer

Peptic ulcer disease without cardiac history

Answer

Variceal bleeding from compensated cirrhosis

Answer

Diverticular bleeding with stable vital signs

Question 6

Following successful endoscopic hemostasis of a bleeding peptic ulcer, the recommended proton pump inhibitor regimen is:

Accepted Answer

High-dose IV PPI bolus (80 mg) followed by continuous infusion (8 mg/hr) for 72 hours

Answer

Oral PPI once daily for 2 weeks

Answer

Oral PPI twice daily for 7 days only

Answer

IV PPI once every 24 hours for 48 hours

Question 7

Which endoscopic finding on a peptic ulcer (Forrest classification) carries the highest risk of rebleeding and mandates immediate hemostasis?

Accepted Answer

Actively spurting arterial hemorrhage

Answer

Clean-based ulcer with no stigmata

Answer

Flat pigmented spot within the ulcer base

Answer

Adherent clot overlying the ulcer without a visible vessel