Certified Gastroenterology RN GI Bleeding Management 3

Question 1

A Sengstaken-Blakemore tube is used as a temporizing measure for:

Accepted Answer

Balloon tamponade of actively bleeding esophageal or gastric varices

Answer

Decompressing a large bowel obstruction

Answer

Nasogastric lavage in peptic ulcer hemorrhage

Answer

Providing enteral nutrition during acute GI bleeding

Question 2

A patient with active GI bleeding is anticoagulated with warfarin and has an INR of 4.8. The most appropriate reversal strategy is:

Accepted Answer

Vitamin K plus fresh frozen plasma or 4-factor prothrombin complex concentrate (PCC)

Answer

Protamine sulfate IV

Answer

Andexanet alfa IV

Answer

Idarucizumab IV

Question 3

Which finding most reliably indicates hemodynamic instability in a patient with suspected GI bleeding?

Accepted Answer

Orthostatic hypotension with a systolic drop greater than 20 mmHg upon standing

Answer

Heart rate of 82 bpm with blood pressure 130/80 mmHg

Answer

Respiratory rate of 18 breaths per minute

Answer

Oxygen saturation of 96% on room air

Question 4

Angiographic embolization is most commonly used in GI bleeding management when:

Accepted Answer

Endoscopic hemostasis has failed and the patient is not a surgical candidate

Answer

The bleeding source is clearly identified and treated during colonoscopy

Answer

The patient has a severe coagulation disorder limiting procedural options

Answer

Variceal bleeding has been controlled with band ligation

Question 5

A GI nurse observes that a patient's nasogastric aspirate has changed from bloody to bilious/clear. This most appropriately indicates:

Accepted Answer

The upper GI bleeding source may have temporarily slowed or stopped, requiring continued close monitoring

Answer

The bleeding has definitively ceased and the NG tube should be removed immediately

Answer

A new lower GI bleed has developed

Answer

The NG tube has migrated into the duodenum

Question 6

Which of the following is a primary indication for emergency surgical intervention in a patient with upper GI bleeding?

Accepted Answer

Failed endoscopic hemostasis with persistent hemorrhage and hemodynamic instability

Answer

A single episode of hematemesis with stable vital signs

Answer

A BUN-to-creatinine ratio of 25:1 on initial labs

Answer

Coffee-ground emesis with no active bleeding found on endoscopy

Question 7

When educating a patient who has recovered from an NSAID-induced GI bleed, which discharge instruction is most important?

Accepted Answer

Discuss alternative analgesics and the need for a PPI if NSAIDs cannot be avoided

Answer

Avoid all dietary fiber for 6 weeks following discharge

Answer

Take NSAIDs with milk to reduce gastric irritation

Answer

Resume NSAID use after 48 hours if no recurrent bleeding is noted