# A client with an upper GI bleed is started on pantoprazole 80 mg IV bolus followed by 8 mg/hr continuous infusion. Which is the nurse's priority assessment during therapy?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391804&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A client with an upper GI bleed is started on pantoprazole 80 mg IV bolus followed by 8 mg/hr continuous infusion. Which is the nurse's priority assessment during therapy?

## Option

1. Plan for outpatient discharge in 4 hours
2. Monitor hemoglobin, hematocrit, hemodynamics, and signs of continued bleeding (melena, hematemesis); reassess the need for IV therapy at 72 hours **✔ Correct answer**
3. Encourage 3 liters of free water daily
4. Check for sun-sensitivity rash

**Correct answer: 2**

## Explanation

Correct (2): IV PPI suppresses gastric acid to promote clot stability after endoscopic hemostasis of bleeding ulcers. The nurse monitors Hgb/Hct, hemodynamics, ongoing bleeding signs, and transfusion needs. After 72 hours of stability, switch to oral PPI is typical. (1,3,4) Unrelated/inappropriate.

## In-depth explanation

Memory Tip IV PPI for UGIB = "Stop Acid, Stop Bleed." 72 hours infusion then oral conversion. Endoscopy is first-line, IV PPI adjunctive.

## Clinical scenario

Scenario 58-year-old male with active upper GI bleed from a peptic ulcer; pantoprazole 80 mg IV bolus → 8 mg/hr continuous IV. Hgb 8.5, ongoing transfusion.

## Key concepts

- **Upper GI bleed** — Hematemesis, melena, hemodynamic instability from peptic ulcer or varices.
- **IV PPI bolus protocol** — 80 mg IV bolus → 8 mg/hr × 72 hours after endoscopic hemostasis.
- **Step-down therapy** — IV PPI → oral PPI once stable; consider H. pylori testing.

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