NR341 Final Exam Study Guide – GI Bleeds, Emergency
Management & Priority Nursing Care|Questions Verified
provided with A+ Graded Rationales Latest Updated 2026
where does an Upper GI bleed occur
Above the ligament of Treitz (esophagus, stomach, duodenum)
where does a lower GI bleed occur?
Below the ligament of Treitz (jejunum, ileum, colon, rectum)
causes of upper GI bleed
-peptic ulcers
-esophageal varices
-gastritis
-Mallory-weiss tear
-NSAID use
-Portal hypertension (Cirrhosis)
causes of lower GI bleed
-diverticulosis
-hemorrhoids
-inflammatory bowel disease
-colon cancer
-infection (C-diff)
-polyups
what diagnostic testing is need for an UPPER GI bleed
Endoscopy
what diagnostic test is used for w LOWER GI bleed?
colonoscopy
what labs do you draw for a GI bleed
-↓ Hemoglobin and hematocrit
-↑ BUN (with upper GI bleed due to protein breakdown)
-Coagulation panel (PT/INR, aPTT)
-Liver enzymes (ALT, AST) if liver-related
,-Occult blood test (guaiac test)
-ABGs: May show metabolic acidosis if in shock
Signs and Symptoms of an UPPER GI bleed
-hypovolemia (low BP, elevated HR, low Urine output, dizzy, pallor)
-fatigue, weakness, confusion
-hematemesis ( vomiting blood, bright red of coffee ground like)
melena (black tarry stools)
signs and symptoms of a LOWER GI bleed
-hypovolemia (low BP, elevated HR, low Urine output, dizzy, pallor)
-fatigue, weakness, confusion
-hematochezia (bright red or marron blood in stool)
Emergency assessment for GI bleed
vital signs (hypotension, tachycardia low SpO2)
urine output <30 mL/hr and low perfusion
skin (cool, clammy)
Neuro (Restless, confused)
Abd (distended, tenderness, hypoactive or absent bowel sounds)
Priority treatment for GI bleed
-Airway, breathing, circulation
-O2 (nasal cannula or nn rebreather if unstable
-fluids( NS or LR bolus)
-establish 2 large bore IV's
-Blood products or platelets or FFP
-(proton pump inhibitors (pantoprazole)
-Octreotide) (for variceal bleeds
-Vasopressin and nitroglycerin (for varices)
If Gi bleed is uncontrolled what is needed?
SURGERY
what is pantoprazole used for ?
Reduce stomach acid & prevent rebleed
what is octreotide used for ?
low portal pressure in variceal bleed
,what is Vasopressin and nitro used for ?
Constrict bleeding vessels
what is lactulose used for?
low ammonia buildup from GI bleeding
CLINICAL JUDGEMENT TIPS FOR GI BLEED
-Prioritize ABC: airway/breathing always come first
-Rapid blood loss → think hypovolemic shock
-Elderly patients may have subtle signs
-NG tube: if bright red blood returns, bleeding is active
-Monitor for signs of rebleeding post-procedure
1. A patient presents with coffee-ground emesis and hypotension. Which priority intervention
should the nurse perform first?
Begin fluid resuscitation with NS→ Priority is circulation—supporting perfusion with fluids is
urgent in hypovolemic shock.
2. Which lab value is most concerning in a patient with suspected upper GI bleeding?
Hgb 8.2 g/dL→ Hgb <9 is concerning in GI bleed patients. BUN may be elevated due to blood
digestion but is not an immediate threat.
A patient with a known history of cirrhosis presents with hematemesis. Which of the following
is the nurse's priority action?
Elevate HOB and administer O2→ Maintain airway and oxygenation in a patient with
hematemesis; other interventions follow after stabilization.
The nurse receives a report on a patient with lower GI bleeding. Which finding requires
immediate intervention?
Heart rate of 122 bpm→ Tachycardia may indicate active bleeding or hypovolemia. Needs
immediate attention.
A patient with esophageal varices is ordered octreotide. What is the intended effect of this
medication?
Reduce portal hypertension→ Octreotide is used to decrease portal pressure, especially in
variceal bleeds.
Which of the following tasks can be delegated to a nursing assistant (NAP) for a patient with
active GI bleeding?
, Measuring vital signs every 15 minutes→ Vital signs are within scope for NAP; the rest require
RN-level critical thinking or sterile skill.
What is Addisonian Crisis?
An Addisonian crisis is a life-threatening emergency that occurs due to a sudden and severe
deficiency of cortisol and aldosterone, often in patients with Addison's disease.
how can addisonian crisis be triggered?
-infection
-stress
-sudden withdrawal of steroids
-adrenal gland damage or failure
what does cortisol do ?
helps manage stress, glucose metabolism, and inflammation
what do aldosterone do?
helps with fluid and sodium retention
addisonian crisis causes
- vasodilation (hypotension)
- low sodium
-high vitamin K
-low glucose
-volume depletion (SHOCK)
signs and symptoms of Addisonian crisis
LOW
-cortisol
-blood pressure
-blood sugar
-sodium
-fluid volume-
-aldosterone
HIGHS
-tachycardia
-nausea, vomiting, diarrhea
-potassium
Management & Priority Nursing Care|Questions Verified
provided with A+ Graded Rationales Latest Updated 2026
where does an Upper GI bleed occur
Above the ligament of Treitz (esophagus, stomach, duodenum)
where does a lower GI bleed occur?
Below the ligament of Treitz (jejunum, ileum, colon, rectum)
causes of upper GI bleed
-peptic ulcers
-esophageal varices
-gastritis
-Mallory-weiss tear
-NSAID use
-Portal hypertension (Cirrhosis)
causes of lower GI bleed
-diverticulosis
-hemorrhoids
-inflammatory bowel disease
-colon cancer
-infection (C-diff)
-polyups
what diagnostic testing is need for an UPPER GI bleed
Endoscopy
what diagnostic test is used for w LOWER GI bleed?
colonoscopy
what labs do you draw for a GI bleed
-↓ Hemoglobin and hematocrit
-↑ BUN (with upper GI bleed due to protein breakdown)
-Coagulation panel (PT/INR, aPTT)
-Liver enzymes (ALT, AST) if liver-related
,-Occult blood test (guaiac test)
-ABGs: May show metabolic acidosis if in shock
Signs and Symptoms of an UPPER GI bleed
-hypovolemia (low BP, elevated HR, low Urine output, dizzy, pallor)
-fatigue, weakness, confusion
-hematemesis ( vomiting blood, bright red of coffee ground like)
melena (black tarry stools)
signs and symptoms of a LOWER GI bleed
-hypovolemia (low BP, elevated HR, low Urine output, dizzy, pallor)
-fatigue, weakness, confusion
-hematochezia (bright red or marron blood in stool)
Emergency assessment for GI bleed
vital signs (hypotension, tachycardia low SpO2)
urine output <30 mL/hr and low perfusion
skin (cool, clammy)
Neuro (Restless, confused)
Abd (distended, tenderness, hypoactive or absent bowel sounds)
Priority treatment for GI bleed
-Airway, breathing, circulation
-O2 (nasal cannula or nn rebreather if unstable
-fluids( NS or LR bolus)
-establish 2 large bore IV's
-Blood products or platelets or FFP
-(proton pump inhibitors (pantoprazole)
-Octreotide) (for variceal bleeds
-Vasopressin and nitroglycerin (for varices)
If Gi bleed is uncontrolled what is needed?
SURGERY
what is pantoprazole used for ?
Reduce stomach acid & prevent rebleed
what is octreotide used for ?
low portal pressure in variceal bleed
,what is Vasopressin and nitro used for ?
Constrict bleeding vessels
what is lactulose used for?
low ammonia buildup from GI bleeding
CLINICAL JUDGEMENT TIPS FOR GI BLEED
-Prioritize ABC: airway/breathing always come first
-Rapid blood loss → think hypovolemic shock
-Elderly patients may have subtle signs
-NG tube: if bright red blood returns, bleeding is active
-Monitor for signs of rebleeding post-procedure
1. A patient presents with coffee-ground emesis and hypotension. Which priority intervention
should the nurse perform first?
Begin fluid resuscitation with NS→ Priority is circulation—supporting perfusion with fluids is
urgent in hypovolemic shock.
2. Which lab value is most concerning in a patient with suspected upper GI bleeding?
Hgb 8.2 g/dL→ Hgb <9 is concerning in GI bleed patients. BUN may be elevated due to blood
digestion but is not an immediate threat.
A patient with a known history of cirrhosis presents with hematemesis. Which of the following
is the nurse's priority action?
Elevate HOB and administer O2→ Maintain airway and oxygenation in a patient with
hematemesis; other interventions follow after stabilization.
The nurse receives a report on a patient with lower GI bleeding. Which finding requires
immediate intervention?
Heart rate of 122 bpm→ Tachycardia may indicate active bleeding or hypovolemia. Needs
immediate attention.
A patient with esophageal varices is ordered octreotide. What is the intended effect of this
medication?
Reduce portal hypertension→ Octreotide is used to decrease portal pressure, especially in
variceal bleeds.
Which of the following tasks can be delegated to a nursing assistant (NAP) for a patient with
active GI bleeding?
, Measuring vital signs every 15 minutes→ Vital signs are within scope for NAP; the rest require
RN-level critical thinking or sterile skill.
What is Addisonian Crisis?
An Addisonian crisis is a life-threatening emergency that occurs due to a sudden and severe
deficiency of cortisol and aldosterone, often in patients with Addison's disease.
how can addisonian crisis be triggered?
-infection
-stress
-sudden withdrawal of steroids
-adrenal gland damage or failure
what does cortisol do ?
helps manage stress, glucose metabolism, and inflammation
what do aldosterone do?
helps with fluid and sodium retention
addisonian crisis causes
- vasodilation (hypotension)
- low sodium
-high vitamin K
-low glucose
-volume depletion (SHOCK)
signs and symptoms of Addisonian crisis
LOW
-cortisol
-blood pressure
-blood sugar
-sodium
-fluid volume-
-aldosterone
HIGHS
-tachycardia
-nausea, vomiting, diarrhea
-potassium
