A pt is admitted with GI bleeding and a 3 day history of melena. The pt is unresponsive but is breathing spontaneously. Urine output is 15 ml in 8 hours, and skin is cool to the touch. Assessment data include BP 86/54, HR 138, RR 30, T 99.3 (37.3) CVP 3 The nurse should anticipate immediate administration of which of the following A. adenosine B. aggressive fluid resuscitation C. 3 units PRBCs D. dopamine (intropin)

Given the patient's symptoms of severe GI bleeding, melena, and signs of shock, the nurse should anticipate immediate administration of aggressive fluid resuscitation to restore the circulating blood volume, improve blood pressure, organ perfusion, and the patient's overall condition.

Explanation:

Given the patient's symptoms of GI bleeding, a 3-day history of melena (black, tarry stools indicating bleeding in the upper GI tract), and vital signs suggestive of shock (low BP, high HR, rapid respirations, and low CVP indicating low blood volume), the nurse should anticipate immediate administration of B. aggressive fluid resuscitation.

These symptoms indicate that the patient is in hypovolemic shock due to significant blood loss, leading to decreased circulation, and impaired organ perfusion, evident in the low urine output and cool skin. Aggressive fluid resuscitation can help restore the patient's circulating blood volume and improve blood pressure, organ perfusion and overall condition.

Transfusion with 3 units PRBCs (packed red blood cells; option C) might also be considered, often administered concurrently with fluid resuscitation in severe blood loss. Dopamine (D), a vasopressor, and Adenosine (A), a heart rhythm regulator, are usually reserved for other specific indications.

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