A patient with a history of NSAID use presents with black/tarry stools and abdominal pain. What nursing actions are indicated?

• A. Monitor for GI bleeding; hold NSAIDs if ordered; notify provider; educate on GI risk and alternatives.
• B. Continue NSAIDs regardless
• C. Switch to opioid medication
• D. Educate on GI risk and alternatives and hold NSAIDs if ordered

Answer: (A)

When a patient with NSAID use presents with black, tarry stools and abdominal pain, the priority is to assess for and intervene in a suspected upper GI bleed. NSAIDs increase the risk of peptic ulcers and GI bleeding by inhibiting prostaglandins that protect the stomach lining, so this presentation strongly suggests ongoing mucosal injury.

The best nursing actions are to monitor for signs of bleeding and hemodynamic instability, hold the NSAID if ordered to prevent further bleeding, notify the provider promptly for urgent evaluation and possible GI workup (such as labs to check hemoglobin/hematocrit and potential endoscopy), and educate the patient about GI risk and safer pain-management alternatives. Ongoing monitoring—vital signs, mental status, and lab values—helps detect deterioration early. Holding the NSAID reduces ongoing mucosal injury, and provider guidance will determine the next steps, which may include IV fluids, acid suppression, or other interventions. Educating the patient about GI risk and alternatives (for example, using acetaminophen for pain when appropriate and avoiding NSAIDs) helps prevent recurrence.

Continuing NSAIDs would worsen bleeding; simply switching to an opioid addresses pain but not the bleeding risk; and education alone without stopping the NSAID and notifying the provider would miss the urgent need to assess and manage a potential GI bleed.