A client with esophageal varices is admitted with acute upper gastrointestinal bleeding.
Which medication should the nurse anticipate administering to reduce portal hypertension and prevent further bleeding?

Evaluating a patient with liver failure involves understanding the biosynthetic pathways of coagulation. The liver produces vitamin K dependent clotting factors, and monitoring laboratory trends is essential to assess the severity of coagulopathy and the risk for spontaneous internal bleeding.

Choice A rationale

Urine output monitoring assesses renal perfusion and fluid balance, which is important in liver failure due to the risk of hepatorenal syndrome. However, it does not directly measure the liver ability to synthesize the essential factors needed for clotting.

Choice B rationale

Oxygen saturation measures the percentage of hemoglobin bound to oxygen in the blood. While respiratory status is important, it is not the priority assessment for a patient specifically at risk for hemorrhage due to impaired clotting factor synthesis.

Choice C rationale

Blood pressure can indicate hemodynamic stability and signs of shock if a bleed has already occurred. However, it is a late indicator of hemorrhage and does not provide information regarding the actual physiological capacity for blood coagulation.

Choice D rationale

The liver synthesizes factors I, II, VII, IX, and X. PT and INR directly measure the extrinsic pathway of coagulation. A normal PT is 11 to 13.5 seconds, and a normal INR is 0.8 to 1.1.

This scenario focuses on acute fluid resuscitation following thermal injury. Knowledge of fluid shift dynamics during the emergent phase of burns is essential to prevent hypovolemic shock. Crystalloid selection must prioritize electrolyte balance and volume expansion to maintain organ perfusion.

Choice A rationale

Albumin is a colloid used for volume expansion but is generally avoided in the first 24 hours of burn care. Increased capillary permeability allows large molecules to leak into interstitium, worsening edema rather than maintaining intravascular volume.

Choice B rationale

This isotonic crystalloid is the gold standard for burn resuscitation. It closely mimics extracellular fluid and provides essential electrolytes. The lactate is metabolized into bicarbonate, which helps buffer the metabolic acidosis commonly seen in major thermal injuries.

Choice C rationale

Dextrose in water is a hypotonic solution once glucose is metabolized. It does not stay in the intravascular space and can lead to cellular edema. It is ineffective for volume resuscitation and may cause dangerous electrolyte imbalances.

Choice D rationale

While normal saline is isotonic, adding potassium is contraindicated in the emergent burn phase. Damaged cells release intracellular potassium into the bloodstream, making hyperkalemia a significant risk. Normal range for potassium is 3.5 to 5.0 mEq/L.