A 68-year-old patient with a history of peptic ulcer disease presents with hematemesis and hypotension. What is the nurse's immediate priority intervention?

Establishing two large-bore IV lines for fluid resuscitation and blood transfusion.

Positioning the patient in a Trendelenburg position to increase cerebral perfusion.

Administering oral proton pump inhibitors to reduce gastric acidity.

Providing the patient with ice chips to reduce nausea and discomfort.

Answer and Explanation

The Correct Answer is A

Rationale:

A. Establishing two large-bore IV lines is the immediate priority for a patient presenting with hematemesis and hypotension, which are classic signs of an acute upper gastrointestinal bleed with hypovolemic shock. Rapid IV access allows for aggressive fluid resuscitation, administration of blood products, and emergency medications. According to emergency and critical care principles (ABCs and circulation first), restoring intravascular volume is essential to maintain tissue perfusion and prevent organ failure.

B. The Trendelenburg position is not recommended for patients with active GI bleeding. It does not reliably improve cerebral perfusion and may increase the risk of aspiration, especially in a patient with hematemesis. Elevating the legs slightly or keeping the patient supine is safer if positioning is needed while resuscitation is initiated.

C. Oral proton pump inhibitors are not appropriate in the acute setting for a patient with active hematemesis and hypotension. The patient is at high risk for aspiration, and oral medications may not be absorbed effectively during shock. IV PPIs may be administered later after hemodynamic stabilization, but they are not the immediate priority.

D. Providing ice chips is contraindicated in a patient with active upper GI bleeding and hypotension. The patient should be kept NPO in anticipation of possible endoscopy or surgery, and oral intake increases the risk of aspiration and does not address the life-threatening problem of volume loss.

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Correct Answer is D

Explanation

Rationale:

A. Fasting before an MRI is generally not required unless contrast dye is planned. While fasting may prevent nausea, it does not address the critical safety concern related to the Linx device.

B. Administering antacids may help control GERD symptoms but does not impact MRI safety. The primary risk involves the magnetic properties of the Linx device, not reflux.

C. Requesting a CT scan instead of an MRI is not necessary if the Linx device is confirmed to be MRI-compatible. Substituting imaging modalities without verifying safety may delay needed diagnostic evaluation.

D. Informing the radiologist about the Linx device and confirming MRI compatibility is the most appropriate action. The Linx device, which is a magnetic ring placed around the lower esophageal sphincter, contains metal and magnets, which can interact with MRI machines. Some newer Linx devices are conditional for MRI under specific parameters, so verification with the radiology team ensures patient safety, prevents device displacement, and avoids injury or malfunction during imaging.

A. Advise the patient to use an over-the-counter antidiarrheal medication. B. Assess the patient for signs of Clostridium difficile infection C. Instruct the patient to discontinue the PPI immediately. D. Recommend increasing fiber intake to manage diarrhea symptoms.

Correct Answer is B

Explanation

Rationale:

A. Advising the patient to use over-the-counter antidiarrheal medication may mask symptoms but does not address the underlying cause. If the diarrhea is due to an infection, particularly Clostridium difficile, using antidiarrheals could worsen the condition by retaining toxins in the colon.

B. Assessing the patient for signs of Clostridium difficile (C. difficile) infection is the priority. PPIs reduce gastric acidity, which can alter gut flora and increase susceptibility to C. difficile overgrowth, especially in patients with new-onset diarrhea and abdominal pain. Early recognition is critical to prevent severe colitis, dehydration, sepsis, or toxic megacolon. The nurse should monitor for frequent watery stools, fever, abdominal tenderness, and laboratory confirmation through stool testing.

C. Instructing the patient to discontinue the PPI immediately is not recommended without provider guidance. Abrupt cessation may worsen GERD symptoms, and the underlying cause of diarrhea must first be evaluated.

D. Recommending increased fiber intake may help manage some types of diarrhea, but in the presence of possible C. difficile infection, this approach is not appropriate and could exacerbate discomfort or bloating.

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A 68-year-old patient with a history of peptic ulcer disease presents with hematemesis and hypotension. What is the nurse's immediate priority intervention?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient with GERD who underwent a Linx procedure is scheduled for an MRI. As the nurse, what is the most appropriate action to ensure patient safety during the MRI?

Correct Answer is D

Explanation

A patient with gastroesophageal reflux disease (GERD) is being managed with a proton pump inhibitor (PPI). During a follow-up visit, the patient reports new- onset diarrhea and abdominal pain. What is the nurse's priority action in this scenario?

Correct Answer is B

Explanation

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