Free BCEN Certified Emergency Nurse (CEN) Practice Question

The correct answer is to administer octreotide. In patients with suspected variceal bleeding due to cirrhosis, octreotide is a crucial early intervention. It's a vasoconstrictor that reduces splanchnic blood flow and portal pressure, helping to control acute variceal hemorrhage.

While endoscopy is essential for definitive diagnosis and treatment, it's not typically the immediate next step after initial stabilization. Endoscopy is usually performed within 12-24 hours, after the patient is hemodynamically stable and medical management has been initiated.

Transfusion to a hemoglobin of 10 g/dL is not recommended in this scenario. Current guidelines suggest a restrictive transfusion strategy (target Hgb 7-8 g/dL) in most patients with acute upper GI bleeding, as higher levels may increase portal pressure and potentially worsen bleeding.

Administering propranolol, while useful for long-term management and prevention of variceal bleeding, is not appropriate in the acute setting. Beta-blockers can potentially worsen hemodynamic instability in actively bleeding patients.

Emergency nurses should be aware of the importance of early octreotide administration in suspected variceal bleeding, along with other critical interventions such as fluid resuscitation, airway management, and preparation for potential massive transfusion.