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Thirty minutes after a large-volume paracentesis removing 6.0 L, a patient with cirrhosis reports lightheadedness when turning in bed. Orders: vitals every 15 minutes for 1 hour, strict I&O, occlusive dressing, bedrest 1 hour, albumin 25% IV now, and 500 mL normal saline IV bolus only if systolic BP < 90 mmHg. Vitals: BP 94/56, HR 112, RR 18, SpO₂ 98% on room air. The dressing is dry with minimal serous strike-through. What is the nurse’s priority actioN?

A 56-year-old with cirrhosis arrives with large-volume hematemesis and pallor. Two large-bore IVs are placed. Orders pending include: octreotide infusion, pantoprazole IV bolus, ceftriaxone IV, and propranolol PO when stable. Which medication should the nurse administer immediately to help control the bleeding?

A 62-year-old adult arrives to the ED with 24 hours of abdominal pain, low-grade fever, and constipation. Pain began as a dull ache that localizes and worsens with movement. Vitals: T 100.8°F (38.2°C), HR 102, BP 138/82, RR 18, SpO2 99% room air. On exam, the abdomen is soft with localized tenderness and guarding in one quadrant; bowel sounds are normal. Based on this presentation, which finding is most consistent with acute diverticulitis?  

A patient with a history of ulcerative colitis presents with worsening abdominal pain and fatigue. Which assessment finding is most characteristic of an acute ulcerative colitis flare?

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?