Progressive Care Nursing Certification (PCCN) Practice Exam

A patient is admitted with GI bleeding. What is the most critical action the nurse should take immediately?

1. Adenosine administration

2. Aggressive fluid resuscitation

3. Transfusion of 3 units PRBCs

4. Dopamine (Intropin) administration

The correct answer is: Aggressive fluid resuscitation

In a patient with gastrointestinal bleeding, immediate action is crucial to stabilize the patient and prevent further complications. Aggressive fluid resuscitation is the most critical action because it addresses potential hypovolemia due to blood loss. By restoring intravascular volume, fluid resuscitation helps maintain adequate organ perfusion and blood pressure, which is essential in managing shock that may arise from significant hemorrhage. Administering fluids, such as isotonic saline or balanced crystalloid solutions, can help prevent the deterioration of the patient’s condition while preparing for further interventions like blood transfusions or surgical consultation. The emphasis on fluid resuscitation is supported by the understanding that rapid volume replacement is often necessary to counteract the effects of blood loss and ensure vital organs continue to receive adequate oxygen and nutrients. Other interventions, like transfusions of packed red blood cells or the use of medications such as adenosine or dopamine, may be appropriate in specific contexts but are secondary to the immediate need for volume replacement in this situation. Transfusions, for instance, may not be administered until sufficient volume is restored, and the use of inotropes is generally reserved for cases of heart failure or when cardiac support is required, rather than for correcting hypovolemia caused by