A 48-year-old man with cirrhosis is hospitalized for treatment of spontaneous bacterial peritonitis. During the morning shift, he suddenly vomits projectile coffee ground–like material; on examination, his blood pressure is low and he has a tachycardia. Which of the following is the most likely explanation for these signs and symptoms?

The Progressive Care Certified Nurse (PCCN) exam is administered by the American Association of Critical-Care Nurses (AACN), which is the largest specialty nursing organization in the world. The PCCN examination tests applicants' knowledge of caring for acutely ill adult patients.

PCCN is a specialty certification for nurses who provide direct care to acutely ill adult patients regardless of their physical location. Nurses interested in this certification may work in areas such as intermediate care, direct observation, stepdown, telemetry, transitional care or emergency departments.