Editing Medical-Surgical Nursing – RN Practice Questions (section)

==Question 11==
A patient with cirrhosis and known esophageal varices suddenly vomits a large volume of bright red blood. The blood pressure is 84/50 mm Hg and the pulse is 128 beats per minute. Which action should the nurse take first?
# Position the patient with the head of the bed elevated and the head turned to the side.
# Insert a large-bore intravenous catheter and begin fluid resuscitation.
# Obtain a stat type and crossmatch and hemoglobin level.
# Administer the prescribed lactulose to reduce ammonia levels.

'''Answer:''' Option 1, position the patient with the head of the bed elevated and the head turned to the side.

''Rationale:'' Airway protection comes first. A patient actively vomiting large volumes of blood is at immediate risk for aspiration, so positioning to protect the airway with suction available precedes circulatory support. Fluid resuscitation (option 2) and laboratory studies (option 3) follow rapidly and are essential, but they come after the airway is secured. Option 4 addresses hepatic encephalopathy, not acute hemorrhage, and giving oral medication to an actively vomiting patient is unsafe.