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A 64-year-old with portal hypertension is admitted for coffee-ground emesis. After 1 L crystalloid and starting octreotide/ceftriaxone: BP 92/58 mm Hg, HR 126/min, RR 22/min, mentation intact, urine output 25 mL over 2 hours. Which measurement best indicates the patient is worsening and requires immediate escalation?

A patient with ascites due to cirrhosis is due for morning medications: furosemide 40 mg PO and spironolactone 100 mg PO. Potassium this morning is 3.1 mEq/L. Which single medication should the nurse hold?

A 32-year-old patient presents with painless oral ulcers, photosensitive rash, and morning stiffness in the hands. Urinalysis shows trace protein. The clinician wants one laboratory test to screen for suspected systemic lupus erythematosus before ordering more specific assays. Which test should be ordered first?  

An adult collapses on the step-down unit. Assessment reveals no pulse and no respirations. The rhythm strip shows a rapid, wide-complex waveform with no discernible P waves or organized QRS complexes (pulseless ventricular tachycardia). What is the priority action?

A client with known cirrhosis arrives with profuse hematemesis, cool clammy skin, and BP 82/48 mm Hg. The provider suspects bleeding esophageal varices. Which action should the nurse implement first?

Two hours after an open cholecystectomy, a patient becomes restless and says, “I feel weird.” Skin is cool and clammy. The abdominal dressing shows a rapidly enlarging area of sanguineous drainage, and the Jackson-Pratt drain has filled with 200 mL of bright red fluid in the past 30 minutes. Vitals: BP 82/48 mm Hg, HR 128/min, RR 24/min, SpO₂ 93% on 2 L/min nasal cannula. Urine output in the last hour is 12 mL via Foley. What is the nurse’s immediate action?

At the first post-discharge clinic visit after liver transplant, you review self-management. Which instructions are appropriate to include now? Select all that apply.

A 31-year-old with known SLE is seen for follow-up after a flare treated with prednisone. She reports decreased appetite, nausea, and swelling in both lower legs. Today’s results: urine dipstick 3+ protein, trace blood; serum creatinine increased from 0.8 to 1.5 mg/dL in 10 days; BP 148/94. Which complication should the nurse suspect as the priority concern?  

A client with cirrhosis had endoscopic band ligation for bleeding esophageal varices 3 hours ago and is now returning to the unit, NPO with vital signs stable. On entering the room, which action should the nurse take first?

A 56-year-old with known cirrhosis is admitted with jaundice, tense ascites, and confusion. Labs show elevated bilirubin and ammonia. Which assessment or lab findings are consistent with hepatic encephalopathy and decompensated liver disease? Select all that apply.