Med-Surg GI Bleeding Management 2025/2026
answers and rationales.
1. A patient presents with hematemesis and melena. What is the
priority initial nursing action?
Assess vital signs and initiate IV access
Rationale: Hemodynamic stability is the priority. Rapid
assessment and IV access allow for fluid resuscitation if needed.
2. Which laboratory test is most useful in assessing the severity of
acute GI bleeding?
Hemoglobin and hematocrit
Rationale: Hemoglobin and hematocrit indicate blood loss
severity, guiding transfusion needs.
3. A patient with suspected upper GI bleeding is NPO. What is the
rationale?
To prepare for potential endoscopy and reduce risk of aspiration
Rationale: NPO status prevents complications during diagnostic
procedures like endoscopy.
4. Which medication is commonly used to decrease gastric acid
secretion in acute GI bleeding?
Proton pump inhibitors (PPIs)
Rationale: PPIs reduce gastric acidity, promoting clot stability
and healing of ulcers.
5. A patient with esophageal varices begins to vomit bright red
blood. What is the immediate intervention?
Call for emergency assistance and prepare for airway
management
, Rationale: Massive variceal bleeding can compromise airway;
rapid intervention is essential.
6. Which diagnostic procedure is first-line for identifying the source
of upper GI bleeding?
Esophagogastroduodenoscopy (EGD)
Rationale: EGD allows direct visualization, diagnosis, and
therapeutic intervention for upper GI bleeding.
7. A patient with cirrhosis develops GI bleeding. Which medication
may be used to reduce portal hypertension?
Octreotide
Rationale: Octreotide reduces splanchnic blood flow, lowering
portal pressure and controlling variceal bleeding.
8. The nurse monitors a patient post-endoscopy for signs of
perforation. Which symptom is most concerning?
Severe abdominal pain and rigidity
Rationale: These are classic signs of perforation, a serious
complication requiring immediate attention.
9. Which type of shock is most commonly associated with massive GI
bleeding?
Hypovolemic shock
Rationale: Blood loss leads to decreased circulating volume,
resulting in hypovolemic shock.
10. A patient is on continuous NG suction after a GI bleed. What
is a key nursing priority?
Monitor NG output and assess for ongoing bleeding
Rationale: NG output indicates the presence and severity of
ongoing bleeding and guides treatment.
, 11. Which type of transfusion is most appropriate for a patient
with acute GI bleeding and hemoglobin <7 g/dL?
Packed red blood cells
Rationale: PRBCs restore oxygen-carrying capacity in significant
blood loss.
12. A patient with a history of NSAID use presents with upper GI
bleeding. What is the likely cause?
Peptic ulcer disease
Rationale: NSAIDs inhibit prostaglandin synthesis, reducing
mucosal protection and increasing ulcer risk.
13. Which sign indicates that a patient is compensating for acute
blood loss?
Tachycardia with normal blood pressure
Rationale: Early hypovolemia triggers sympathetic responses,
maintaining blood pressure temporarily.
14. For a patient with variceal bleeding, what is the purpose of a
Sengstaken-Blakemore tube?
To tamponade bleeding varices
Rationale: The balloon compresses varices to control
hemorrhage when endoscopic therapy is not immediately
available.
15. Which lab abnormality is expected in chronic GI bleeding?
Iron deficiency anemia
Rationale: Chronic blood loss depletes iron stores, leading to
microcytic, hypochromic anemia.
16. The nurse notes bright red blood in stool. What is the likely
source?
Lower GI tract
answers and rationales.
1. A patient presents with hematemesis and melena. What is the
priority initial nursing action?
Assess vital signs and initiate IV access
Rationale: Hemodynamic stability is the priority. Rapid
assessment and IV access allow for fluid resuscitation if needed.
2. Which laboratory test is most useful in assessing the severity of
acute GI bleeding?
Hemoglobin and hematocrit
Rationale: Hemoglobin and hematocrit indicate blood loss
severity, guiding transfusion needs.
3. A patient with suspected upper GI bleeding is NPO. What is the
rationale?
To prepare for potential endoscopy and reduce risk of aspiration
Rationale: NPO status prevents complications during diagnostic
procedures like endoscopy.
4. Which medication is commonly used to decrease gastric acid
secretion in acute GI bleeding?
Proton pump inhibitors (PPIs)
Rationale: PPIs reduce gastric acidity, promoting clot stability
and healing of ulcers.
5. A patient with esophageal varices begins to vomit bright red
blood. What is the immediate intervention?
Call for emergency assistance and prepare for airway
management
, Rationale: Massive variceal bleeding can compromise airway;
rapid intervention is essential.
6. Which diagnostic procedure is first-line for identifying the source
of upper GI bleeding?
Esophagogastroduodenoscopy (EGD)
Rationale: EGD allows direct visualization, diagnosis, and
therapeutic intervention for upper GI bleeding.
7. A patient with cirrhosis develops GI bleeding. Which medication
may be used to reduce portal hypertension?
Octreotide
Rationale: Octreotide reduces splanchnic blood flow, lowering
portal pressure and controlling variceal bleeding.
8. The nurse monitors a patient post-endoscopy for signs of
perforation. Which symptom is most concerning?
Severe abdominal pain and rigidity
Rationale: These are classic signs of perforation, a serious
complication requiring immediate attention.
9. Which type of shock is most commonly associated with massive GI
bleeding?
Hypovolemic shock
Rationale: Blood loss leads to decreased circulating volume,
resulting in hypovolemic shock.
10. A patient is on continuous NG suction after a GI bleed. What
is a key nursing priority?
Monitor NG output and assess for ongoing bleeding
Rationale: NG output indicates the presence and severity of
ongoing bleeding and guides treatment.
, 11. Which type of transfusion is most appropriate for a patient
with acute GI bleeding and hemoglobin <7 g/dL?
Packed red blood cells
Rationale: PRBCs restore oxygen-carrying capacity in significant
blood loss.
12. A patient with a history of NSAID use presents with upper GI
bleeding. What is the likely cause?
Peptic ulcer disease
Rationale: NSAIDs inhibit prostaglandin synthesis, reducing
mucosal protection and increasing ulcer risk.
13. Which sign indicates that a patient is compensating for acute
blood loss?
Tachycardia with normal blood pressure
Rationale: Early hypovolemia triggers sympathetic responses,
maintaining blood pressure temporarily.
14. For a patient with variceal bleeding, what is the purpose of a
Sengstaken-Blakemore tube?
To tamponade bleeding varices
Rationale: The balloon compresses varices to control
hemorrhage when endoscopic therapy is not immediately
available.
15. Which lab abnormality is expected in chronic GI bleeding?
Iron deficiency anemia
Rationale: Chronic blood loss depletes iron stores, leading to
microcytic, hypochromic anemia.
16. The nurse notes bright red blood in stool. What is the likely
source?
Lower GI tract
