NSG233 / NSG 233 HESI Final Exam 2026 | Medical-Surgical Nursing II | Questions & Answers with Detailed Rationales | Grade A | Med-Surg Nursing & NCLEX-RN® / HESI Prep PDF

INSTANT PDF DOWNLOAD — This is the comprehensive HESI Final Exam preparation guide for NSG233 / NSG 233 - Medical-Surgical Nursing II (2026 Update), featuring questions and answers with detailed rationales. Designed for nursing students preparing for high-stakes HESI and NCLEX-RN® examinations, this resource consolidates the critical medical-surgical nursing concepts required to master the NSG233 HESI Final Exam and excel in Medical-Surgical Nursing II. The guide is meticulously aligned with HESI testing blueprints, NCLEX-RN® test plan, and current evidence-based med-surg nursing practice standards. This verified resource provides comprehensive coverage of key NSG233 Medical-Surgical Nursing II HESI Final Exam topics, including: HESI/NCLEX Test-Taking Strategies (priority setting frameworks—ABCs (Airway, Breathing, Circulation), Maslow's Hierarchy of Needs, safety and risk reduction, least restrictive/least invasive first, acute vs chronic, actual vs potential, unstable vs stable, teaching vs treating, nursing process sequence (assess before implement), pharmacological priority (check allergies first, then vital signs/labs, then administer), delegation (RN cannot delegate assessment, evaluation, teaching, unstable patient care, nursing judgment tasks), communication (therapeutic responses—acknowledge feelings, explore concerns, provide factual information; avoid false reassurance, defensiveness, "why" questions, changing subject), recognizing cues (identify relevant data from case study, distinguish normal vs abnormal, expected vs unexpected, mild vs severe), analyzing cues (cluster related data, identify patterns, link findings to pathophysiology, recognize complications), prioritizing hypotheses (determine which patient problem requires immediate action, use ABCs, safety, Maslow), generating solutions (identify appropriate nursing interventions for each priority problem, distinguish independent vs collaborative vs dependent interventions), taking action (implement highest priority interventions first, verify orders, use clinical judgment), evaluating outcomes (compare patient response to expected outcomes, reassess after interventions, modify plan as needed), HESI question types (multiple choice (single best answer), select all that apply (SATA—treat each option as true/false, no partial credit on HESI, select all correct), ordered response (drag and drop in correct sequence, usually nursing process steps, assessment before implementation, donning/doffing PPE, medication administration steps, wound care steps), fill-in-the-blank (calculation problems—round per instructions, leading zero always (0.5), no trailing zeros (2 not 2.0)), hot spot (point to location on image—anatomy, ECG lead placement, lung auscultation sites, injection sites), chart/exhibit (review tabs for lab values, vital signs, history, provider orders, select best answer), dosage calculation (dimensional analysis, ratio-proportion, formula method—desired over have times volume), medication administration (rights of medication administration, safe dose range, pediatric dosing (weight in kg, mg/kg/dose), IV infusion rate (mL/hr, gtt/min), drop factor (macrodrip 10-20 gtt/mL, microdrip 60 gtt/mL), weight-based heparin/dopamine drips, safe handling of high-alert medications (insulin, heparin, opioids, chemotherapy), insulin administration (regular (clear) before NPH (cloudy)—roll cloudy vial, never shake, draw up clear then cloudy, rotate sites abdomen preferred), heparin (subcutaneous—do not aspirate, do not massage, rotate sites, use 90-degree angle, monitor aPTT, protamine sulfate antidote), warfarin (monitor INR (therapeutic 2-3 for most indications, 2.5-3.5 for mechanical valves), vitamin K antidote, avoid green leafy vegetables (vitamin K) unless consistent daily intake), enoxaparin (Lovenox—subcutaneous, no aspiration, no massage, protamine sulfate partial reversal, monitor for bleeding, spinal/epidural hematoma risk with neuraxial anesthesia), opioid analgesics (monitor respiratory rate (hold if 10-12/min), assess sedation level (Pasero Opioid-Induced Sedation Scale—POSS), naloxone (Narcan) antidote, adverse effects (constipation (stimulant laxative), nausea/vomiting (antiemetic), pruritus (antihistamine), urinary retention, respiratory depression), benzodiazepines (flumazenil (Romazicon) antidote—can precipitate seizures in chronic benzodiazepine users), neuromuscular blockers (monitor neuromuscular function (train-of-four), mechanical ventilation required, no antidote), electrolyte replacement (IV potassium—never push, maximum 10 mEq/hr peripheral, 20 mEq/hr central line, cardiac monitoring, dilute in appropriate fluid, never add to IV bag already hanging, assess urine output 0.5 mL/kg/hr before administration), IV calcium (monitor for bradycardia, hypotension, extravasation (tissue necrosis), magnesium sulfate (monitor deep tendon reflexes (DTRs), respiratory rate, urine output, calcium gluconate antidote for magnesium toxicity), digoxin (therapeutic level 0.5-0.8 ng/mL for heart failure, 0.8-2.0 ng/mL for arrhythmias, hold if apical pulse 60 bpm (adults) or 70 bpm (infants/children), monitor for toxicity (nausea, vomiting, visual changes (yellow-green halos, blurry vision), bradycardia, arrhythmias—digoxin immune fab (Digibind/DigiFab) antidote, monitor potassium (hypokalemia potentiates toxicity), amiodarone (monitor pulmonary toxicity (cough, dyspnea), thyroid dysfunction, corneal microdeposits, hepatotoxicity, photosensitivity (wear sunscreen), IV administration (use glass bottle or non-PVC tubing, filter, monitor for hypotension), Cardiovascular HESI High-Yield Topics (heart failure exacerbation triggers (non-adherence with medications/diet, increased sodium/fluid intake, infection, anemia, arrhythmias, uncontrolled hypertension, pregnancy), acute decompensated heart failure management (IV furosemide (Lasix)—monitor urine output, electrolytes (hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia), hearing loss (ototoxicity), IV vasodilators (nitroglycerin, nitroprusside—monitor for hypotension, thiocyanate toxicity with prolonged nitroprusside infusion), inotropes (dobutamine, milrinone—monitor for hypotension, arrhythmias), vasopressors (dopamine, norepinephrine for cardiogenic shock—central line, titrate to MAP 65 mm Hg), afterload reduction (ACE inhibitors, ARBs, hydralazine, sacubitril/valsartan), beta-blockers (carvedilol, metoprolol succinate—do not initiate in acute decompensated HF, hold for HR 50-60, systolic BP 90-100), SGLT2 inhibitors (dapagliflozin, empagliflozin—reduce HF hospitalizations, monitor for genitourinary infections, euglycemic DKA), hypertension urgency vs emergency (urgency: severely elevated BP (180/120) without target organ damage—oral antihypertensives (clonidine, captopril, labetalol) over 24-48 hours, avoid rapid reduction to prevent cerebral ischemia; emergency: severely elevated BP with acute target organ damage (hypertensive encephalopathy, intracerebral hemorrhage, acute MI, acute heart failure, aortic dissection, acute kidney injury, eclampsia, retinopathy)—IV antihypertensives (labetalol, nicardipine, clevidipine, sodium nitroprusside) with controlled reduction (20-25% reduction over first hour, then to 160/100-110 over next 6 hours, avoid excessive drop to prevent end-organ hypoperfusion)), myocardial infarction complications (arrhythmias (V-fib most common cause of death prehospital, V-tach, heart block, atrial fibrillation, PVCs), cardiogenic shock (hypotension, tachycardia, cool clammy extremities, altered mental status, oliguria, pulmonary edema—urgent revascularization (PCI/CABG), inotropes, vasopressors, mechanical circulatory support (IABP, Impella, ECMO)), papillary muscle rupture (acute severe mitral regurgitation—pulmonary edema, holosystolic murmur, hypotension, cardiogenic shock—emergency surgery), ventricular septal rupture (holosystolic murmur, thrill, acute heart failure, pulmonary edema, cardiogenic shock—emergency surgery), free wall rupture (hemopericardium, cardiac tamponade, pulseless electrical activity (PEA), sudden death—emergency pericardiocentesis, surgery), pericarditis (Dressler's syndrome—post-MI or post-cardiac injury pericarditis weeks to months later: fever, pleuritic chest pain, pericardial friction rub, diffuse ST elevation—NSAIDs, colchicine, avoid anticoagulation due to hemopericardium risk), left ventricular aneurysm (persistent ST elevation after MI, heart failure, arrhythmias, thromboembolism—anticoagulation for thrombus, surgery for refractory HF/arrhythmias), Respiratory HESI High-Yield Topics (COPD exacerbation—triggers (respiratory infection (most common), air pollution, non-adherence with medications, heart failure, pulmonary embolism), signs (increased dyspnea, increased sputum purulence and volume, increased cough, wheezing, accessory muscle use, pursed-lip breathing, tripod position, confusion, drowsiness (hypercapnia)), ABG findings (acute respiratory acidosis (pH 7.35, PaCO2 45) with or without metabolic compensation, hypoxemia (PaO2 60, SpO2 88-90%)), management (controlled oxygen therapy to target SpO2 88-92% (titrate to lowest FiO2 achieving goal, avoid excessive O2—can worsen hypercapnia by reducing hypoxic drive and increasing V/Q mismatch), bronchodilators (nebulized albuterol/ipratropium every 2-4 hours, continuous albuterol for severe exacerbation), systemic corticosteroids (IV methylprednisolone or oral prednisone 40-60 mg/day for 5-7 days, taper not necessary if 7-10 days), antibiotics (if signs of infection—change in sputum characteristics, fever, leukocytosis, purulent sputum—amoxicillin-clavulanate, doxycycline, macrolides, respiratory fluoroquinolones), noninvasive positive pressure ventilation (NIPPV—BiPAP) for hypercapnic respiratory failure (improves pH, reduces PaCO2, decreases intubation rates and mortality), intubation and mechanical ventilation for severe exacerbation (unable to tolerate NIPPV, deteriorating mental status, respiratory arrest, hemodynamic instability, severe hypercapnia with acidosis pH 7.25), asthma exacerbation (severe: PEF 50% predicted, respiratory rate 30, HR 120, accessory muscle use, unable to speak full sentences, O2 sat 90%—continuous nebulized albuterol, ipratropium, IV corticosteroids, magnesium sulfate, terbutaline or epinephrine subcutaneous, BiPAP, intubation for impending respiratory failure (silent chest, exhaustion, confusion, cyanosis, PaCO2 45 with normal or low pH—hypercapnia is late ominous sign in asthma, normal PaCO2 with severe work of breathing is also concerning as asthmatics typically hypocapnic)), pulmonary embolism (massive PE—hypotension (SBP 90 or drop 40 for 15 min, or requiring vasopressors), right ventricular dysfunction on echocardiography, elevated troponin/BNP, management (oxygen, IV access, thrombolytics (tPA) if no contraindications—bleeding risk (intracranial hemorrhage 2%, major bleeding 20%), embolectomy (surgical or catheter) if thrombolytics contraindicated or failed, anticoagulation (IV heparin or LMWH), sub-massive PE (normotensive but RV dysfunction on imaging or elevated biomarkers)—anticoagulation alone (no routine thrombolytics due to bleeding risk), low-risk PE (stable, no RV dysfunction)—oral anticoagulation (rivaroxaban, apixaban) or LMWH bridge to warfarin, DVT prophylaxis (sequential compression devices (SCDs), anticoagulation for high-risk patients, early ambulation)), pneumonia (CAP severity scores (CURB-65, PSI/PORT score), antibiotic selection (outpatient: amoxicillin, doxycycline, macrolides (if resistance low), respiratory fluoroquinolones; inpatient non-ICU: beta-lactam + macrolide or respiratory fluoroquinolone alone; ICU: beta-lactam + macrolide or beta-lactam + respiratory fluoroquinolone; aspiration pneumonia: amoxicillin-clavulanate, clindamycin, piperacillin-tazobactam, carbapenems—anaerobic coverage), MRSA coverage (vancomycin, linezolid) if risk factors (previous MRSA infection/colonization, recent hospitalization/antibiotics, severe illness, necrotizing pneumonia), Pseudomonas coverage (antipseudomonal beta-lactam (piperacillin-tazobactam, cefepime, imipenem, meropenem) plus antipseudomonal fluoroquinolone or aminoglycoside) if risk factors (bronchiectasis, cystic fibrosis, structural lung disease, recent hospitalization/antibiotics, immunocompromised), clinical stability criteria (afebrile 37.8°C for 48 hours, HR 100, RR 24, SBP 90, SpO2 90% on room air, normal mental status, able to take oral medications), switch from IV to oral when stable, total duration 5-7 days (longer if bacteremia, cavitary, MRSA, Pseudomonas, immunocompromised), Renal/Urinary HESI High-Yield Topics (acute kidney injury (AKI) prevention (avoid nephrotoxins (NSAIDs, aminoglycosides, amphotericin, contrast media, IV contrast—use low- or iso-osmolar contrast, IV fluid hydration (0.9% NS or sodium bicarbonate) before contrast, N-acetylcysteine (NAC) controversial), maintain adequate hydration and renal perfusion, monitor urine output and creatinine in high-risk patients), hyperkalemia management (ECG changes (peaked T waves → wide QRS → sine wave → V-fib/asystole), emergency: calcium gluconate/calcium chloride (cardioprotection, onset 1-3 minutes, duration 30-60 minutes), shift K+ intracellular: insulin regular IV with D50 (onset 15-30 minutes, duration 4-6 hours), albuterol nebulized (onset 30-90 minutes, duration 2-4 hours), sodium bicarbonate (if metabolic acidosis), remove K+: loop diuretics (furosemide), potassium-binding resins (patiromer (Veltassa), sodium zirconium cyclosilicate (Lokelma), sodium polystyrene sulfonate (kayexalate—not first-line due to intestinal necrosis risk, particularly post-op or with ileus)), hemodialysis (if severe (K+ 6.5 with ECG changes, refractory to medical therapy, severe renal failure, oliguria/anuria)), CKD complications (anemia—erythropoiesis-stimulating agents (ESA—epoetin alfa, darbepoetin alfa) when Hgb 10 g/dL, target 10-11.5 g/dL (avoid 12 g/dL due to cardiovascular risk), iron supplementation (IV iron preferred in CKD on dialysis, oral iron for earlier stages), metabolic acidosis—oral sodium bicarbonate to maintain serum bicarbonate 22 mEq/L, mineral bone disorder (hyperphosphatemia—phosphate binders (calcium acetate (PhosLo), sevelamer (Renagel), lanthanum (Fosrenol), take with meals, calcium-based binders risk of vascular calcification; hypocalcemia—calcium supplements; secondary hyperparathyroidism—vitamin D analogs (calcitriol, paricalcitol), cinacalcet (Sensipar—calcimimetic, reduces PTH), monitor PTH, calcium, phosphorus, cardiovascular disease (accelerated atherosclerosis, left ventricular hypertrophy, heart failure, sudden cardiac death—BP control (130/80), statins, antiplatelet agents (aspirin), glycemic control in diabetics, smoking cessation, nutritional management (protein restriction (0.6-0.8 g/kg/day if not on dialysis, higher if on dialysis to prevent malnutrition), sodium restriction (2g/day), potassium restriction (avoid high-potassium foods—bananas, oranges, potatoes, tomatoes, avocados, dried fruits, beans, nuts, salt substitutes), phosphorus restriction (avoid dairy, nuts, beans, colas, processed meats), fluid restriction (usually 1-2 L/day based on urine output and edema), nutrition supplements (nepro for dialysis patients), patient education (medication adherence (phosphate binders, antihypertensives, erythropoiesis-stimulating agents, vitamin D analogs), dietary restrictions, daily weight, report signs of complications (shortness of breath (fluid overload), bleeding/bruising (anemia or platelet dysfunction), bone pain (renal osteodystrophy), seizure or altered mental status (uremia, electrolyte disturbances), access care for hemodialysis (AV fistula or graft—check thrill and bruit daily, no BP or venipuncture in access arm, no tight clothing/jewelry, clean site before each dialysis, report signs of infection (redness, warmth, swelling, drainage), bleeding, decreased thrill, signs of steal syndrome (cold/pale hand, numbness, pain)), peritoneal dialysis (monitor for peritonitis (fever, abdominal pain, cloudy effluent, nausea/vomiting—send effluent for cell count with differential (WBC 100 with 50% PMNs), culture, Gram stain, start empiric intraperitoneal antibiotics (vancomycin + ceftazidime or gentamicin), catheter care (exit site cleansing, daily inspection for erythema, crusting, drainage, tunnel infection), flow problems (constipation most common cause—treat with stool softeners/laxatives, position changes, gentle irrigation as last resort), Endocrine HESI High-Yield Topics (diabetes mellitus type 1 vs type 2 (type 1: autoimmune beta-cell destruction, absolute insulin deficiency, prone to DKA, younger onset, lean, acute symptoms; type 2: insulin resistance with relative deficiency, not prone to DKA (but can occur under extreme stress), older onset, overweight/obese, gradual onset, strong genetic component, acanthosis nigricans), DKA (diabetic ketoacidosis)—precipitating factors (infection (most common), missed insulin doses, new-onset type 1, MI, stroke, pancreatitis, medications (steroids, atypical antipsychotics, SGLT2 inhibitors—euglycemic DKA), pregnancy), diagnostic criteria (hyperglycemia 250 mg/dL, metabolic acidosis (pH 7.3, HCO3 15), ketonemia (beta-hydroxybutyrate 3 mmol/L) or ketonuria), signs/symptoms (polyuria, polydipsia, dehydration (poor skin turgor, dry mucous membranes, tachycardia, hypotension), Kussmaul respirations (deep rapid breathing), fruity breath odor (acetone), nausea/vomiting, abdominal pain (can mimic acute abdomen), altered mental status (lethargy to coma)), management (IV fluids (0.9% NS 15-20 mL/kg first hour, then based on corrected sodium, transition to 0.45% NS when hemodynamically stable and hypernatremia resolved), insulin (IV regular insulin continuous infusion 0.1 unit/kg/hour, no bolus dose, goal decrease glucose 50-70 mg/dL/hour, when glucose 200 mg/dL, add D5-10% to IV fluids to prevent hypoglycemia while continuing insulin until anion gap closed and pH 7.30, transition to subcutaneous insulin when patient stable and eating—overlap IV insulin with subcutaneous insulin 1-2 hours, discontinue IV insulin after subcutaneous insulin given and absorbed), potassium (if K+ 3.3, hold insulin and give potassium before insulin to prevent life-threatening hypokalemia; if K+ 3.3-5.0, add 20-30 mEq potassium to each liter IV fluid; if K+ 5.0, hold potassium but recheck q2h), bicarbonate (not routinely recommended—can worsen hypokalemia, decrease tissue oxygen delivery, risk of cerebral edema, consider only if pH 6.9 with severe acidosis after fluids and insulin not improving—give 50-100 mEq NaHCO3 over 60 minutes), monitor (hourly glucose, electrolytes (K+, Na+, Cl-, HCO3) q2-4h, ABG/VBG, beta-hydroxybutyrate, renal function, mental status, cardiac monitoring, I&O), complications (cerebral edema (children adults, younger, new-onset, severe DKA, rapid correction of hyperglycemia or sodium, symptoms: headache, vomiting, altered mental status, seizures, bradycardia, hypertension, abnormal pupillary response—treat with mannitol 0.5-1 g/kg or hypertonic saline (3%)), hypokalemia, hypoglycemia, hypophosphatemia, hypomagnesemia, thrombosis, acute respiratory distress syndrome (ARDS)), HHS (hyperglycemic hyperosmolar state)—precipitating factors (infection, non-adherence, new-onset type 2, medications (steroids, thiazides, SGLT2 inhibitors), acute illness (MI, CVA, pancreatitis), older adults with type 2 diabetes), diagnostic criteria (severe hyperglycemia 600 mg/dL, hyperosmolality (serum osmolality 320 mOsm/kg), no significant ketosis/acidosis (pH 7.3, HCO3 15, small or no ketones), signs/symptoms (profound dehydration, altered mental status (confusion to coma), focal neurological deficits (hemiparesis, aphasia), seizures, polyuria, polydipsia, weakness, weight loss, absence of Kussmaul respirations and fruity breath), management (IV fluids (even more aggressive than DKA due to more severe dehydration—1-1.5 L 0.9% NS first hour, then 0.45% NS at 250-500 mL/hour, goal replace half of fluid deficit in first 12 hours, replace remaining in next 12-24 hours, correct free water deficit (hypernatremia, hyperosmolality) with hypotonic fluids (0.45% NS, D5W) or enteral water), insulin (lower doses than DKA, 0.05-0.1 unit/kg/hour IV continuous, goal decrease glucose 50-70 mg/dL/hour, when glucose ~250 mg/dL, add D5-10% to IV fluids, transition to subcutaneous when patient stable, eating, and mental status improved), potassium (similar to DKA—if K+ 3.3, hold insulin and give potassium, if K+ 3.3-5.0, add 20-30 mEq potassium to each liter, if K+ 5.0, hold potassium but recheck q2h), monitor (glucose hourly, electrolytes q2-4h, osmolality, renal function, mental status, neurological checks, cardiac monitoring, I&O, vital signs), complications (cerebral edema (less common than DKA but can occur), thrombosis (higher risk than DKA due to severe hyperosmolality and dehydration—consider anticoagulation with low-dose unfractionated heparin or LMWH unless contraindicated), rhabdomyolysis (monitor CK, treat with aggressive fluids), aspiration pneumonia, pressure injuries due to immobility), diabetes management in hospitalized patients (target blood glucose 140-180 mg/dL (ADA), more stringent targets 110-140 mg/dL in critically ill but controversial due to hypoglycemia risk, basal-bolus insulin regimen (long-acting (glargine, detemir, degludec) + rapid-acting (lispro, aspart, glulisine) before meals and as needed (correctional/sliding scale)) preferred over sliding scale insulin alone (ineffective, reactive, leads to hyperglycemia and hypoglycemia), correctional insulin (supplemental insulin for hyperglycemia based on current glucose, usually rapid-acting, given q4-6h, sliding scale, but should never be used without basal insulin in insulin-naïve or insulin-deficient patients except for mild hyperglycemia in NPO patients with no history of diabetes), NPO patients (give basal insulin at reduced dose (75-80%) to prevent hypoglycemia, continue correctional insulin q4-6h based on glucose, hold prandial insulin, if NPO 24 hours, start IV insulin or D5-10% IV fluids to prevent hypoglycemia and ketosis), steroid-induced hyperglycemia (common with high-dose glucocorticoids (prednisone, dexamethasone, methylprednisolone), effects peak 4-8 hours after morning dose, typically requires NPH insulin at lunchtime or scheduled short-acting insulin, monitor post-prandial glucose, may need basal insulin increase), hypoglycemia in hospitalized patients (definition: glucose 70 mg/dL, severe 54 mg/dL, treat with 15-20g oral carbohydrate (4 oz juice/soda, 3-4 glucose tablets, 8 oz milk, 1 tbsp honey/sugar) if conscious and able to swallow, recheck in 15 minutes, repeat if still 70, if severe (54) or patient NPO/unconscious: IV dextrose (D50 25-50 mL IV push), or glucagon 1 mg IM/SubQ (if no IV access, onset 5-15 minutes, may cause nausea/vomiting), treat underlying cause (reduce insulin or sulfonylurea dose, provide scheduled meals/snacks, hold oral diabetes agents if NPO), monitor for recurrence (especially if long-acting insulin or sulfonylurea—may need admission for observation), patient education (sick day rules: never omit insulin when sick (may need to increase doses due to stress hyperglycemia, but risk of DKA if insulin omitted), check glucose q2-4h, check urine or blood ketones if glucose 250 mg/dL, stay hydrated (sugar-free fluids if glucose high, if unable to keep fluids down seek medical care), have glucagon kit at home and family trained on use, follow up with provider after illness), Gastrointestinal HESI High-Yield Topics (upper GI bleeding—causes (peptic ulcer disease (most common), esophageal varices, gastritis, Mallory-Weiss tear (retching/vomiting after alcohol binge), esophagitis, arteriovenous malformations, Dieulafoy lesion, malignancy), signs (hematemesis (bright red blood or coffee-ground emesis), melena (black tarry stool), hematochezia (bright red blood per rectum—massive upper bleed or lower source), symptoms of hypovolemia (tachycardia, hypotension, orthostasis, syncope, dizziness, pallor, diaphoresis, oliguria, confusion, chest pain in CAD patients)), initial management (ABCs, two large-bore IVs, IV fluids (0.9% NS or lactated Ringer's), blood transfusion (target Hgb 7-8 g/dL, higher threshold for patients with CAD (10 g/dL)), reversal of anticoagulation (vitamin K, fresh frozen plasma, prothrombin complex concentrate (PCC) for warfarin; andexanet alfa (Andexxa) or PCC for factor Xa inhibitors (rivaroxaban, apixaban); idarucizumab (Praxbind) for dabigatran; platelet transfusion for antiplatelet agents (aspirin, clopidogrel) if severe bleeding), proton pump inhibitor (IV PPI (pantoprazole, omeprazole) bolus then continuous infusion for suspected ulcer bleed), nasogastric tube (controversial, may help confirm diagnosis and guide endoscopy, but does not improve outcomes, risks aspiration, not indicated for variceal bleed), urgent upper endoscopy (within 24 hours, sooner if hemodynamically unstable), variceal bleed (portal hypertension, cirrhosis, signs: hematemesis (brisk bright red blood), melena, hemorrhagic shock, no abdominal pain, history of liver disease (jaundice, ascites, spider angiomas, palmar erythema, gynecomastia, caput medusae), management (ABCs, large-bore IVs, IV fluids, blood products (target Hgb 7-8), octreotide (somatostatin analog—splanchnic vasoconstriction, decreases portal pressure, given IV bolus then continuous infusion for 2-5 days), antibiotics (prophylaxis against spontaneous bacterial peritonitis (SBP)—ceftriaxone or norfloxacin), terlipressin (not FDA approved in US, but used in other countries), urgent endoscopy within 12 hours (preferably 6 hours) for band lig