Certified Gastroenterology RN Intra-Procedure Complication Management Questions and Answers — Questions and Answers
Question 1: During a colonoscopy with moderate sedation using midazolam and fentanyl, the nurse observes the patient's respiratory rate has dropped to 6 breaths/minute and SpO2 is 84% on 2L nasal cannula. What is the nurse's priority action?
- Notify the endoscopist immediately.
- Increase the oxygen flow rate to 4L/min.
- Administer a sternal rub.
- Administer naloxone (Narcan). (Correct answer)
Correct answer: Administer naloxone (Narcan).
The patient is exhibiting signs of opioid-induced respiratory depression from the fentanyl. The priority is to reverse the effects of the opioid. Naloxone is a competitive opioid antagonist that rapidly reverses respiratory depression. While stimulating the patient, increasing oxygen, and notifying the physician are all important supportive measures, they do not address the root cause as directly and rapidly as administering the reversal agent.
Question 2: During a colonoscopy, a patient suddenly becomes pale, diaphoretic, and hypotensive, with a heart rate of 45 bpm. The nurse recognizes these signs as a vasovagal response. Which medication should the nurse anticipate administering immediately?
- Epinephrine
- Flumazenil
- Atropine (Correct answer)
- Ondansetron
Correct answer: Atropine
A vasovagal response is characterized by a sudden drop in heart rate (bradycardia) and blood pressure due to stimulation of the vagus nerve. Atropine is an anticholinergic drug that is the first-line medication to treat symptomatic bradycardia by blocking vagal nerve effects on the heart's sinoatrial node, thereby increasing the heart rate. Flumazenil reverses benzodiazepines, epinephrine is for anaphylaxis or cardiac arrest, and ondansetron is an antiemetic.
Question 3: A nurse is assisting with a difficult colonoscopy on a patient with severe diverticulosis. The patient suddenly complains of severe, sharp abdominal pain, and the nurse notes increasing abdominal distention and firmness. Which of the following complications is MOST likely occurring?
- Bowel perforation (Correct answer)
- Post-polypectomy bleeding
- Splenic injury
- Acute pancreatitis
Correct answer: Bowel perforation
The classic signs of bowel perforation during a colonoscopy are sudden, severe pain and a rigid, distended abdomen. These symptoms are caused by the leakage of air and bowel contents into the peritoneal cavity, leading to peritonitis. Post-polypectomy bleeding would present with visible blood loss. Splenic injury is rare and may present with left upper quadrant pain and hemodynamic instability. Pancreatitis is a complication more commonly associated with ERCP.
Question 4: During an EGD with polypectomy, the endoscopist removes a large, sessile polyp from the gastric antrum. Immediately following removal, brisk, pulsatile bleeding is observed. Which of the following is the MOST appropriate initial nursing intervention?
- Administer a proton pump inhibitor (PPI) intravenously.
- Ensure hemostatic clips are immediately available. (Correct answer)
- Place the patient in the Trendelenburg position.
- Prepare for an emergent blood transfusion.
Correct answer: Ensure hemostatic clips are immediately available.
When active bleeding occurs post-polypectomy, the immediate priority is to assist the endoscopist in controlling the bleed at its source. The nurse's role is to anticipate and provide the necessary equipment. Hemostatic clips are a primary method for mechanically closing a bleeding vessel. While a blood transfusion or PPI may be needed later, and positioning can help with hypotension, the critical first step is to have the tools ready to stop the bleeding endoscopically.
Question 5: A patient undergoing an upper endoscopy (EGD) begins to cough persistently and develops audible wheezing. The monitor shows a rapid drop in oxygen saturation. The nurse's immediate priority is to:
- Apply suction to the patient's oropharynx. (Correct answer)
- Turn the patient to the right lateral decubitus position.
- Administer a bronchodilator.
- Prepare for endotracheal intubation.
Correct answer: Apply suction to the patient's oropharynx.
The patient's symptoms are classic for aspiration of gastric contents or secretions. The first and most critical action according to airway management principles is to clear the airway of any fluid or particulate matter. Suctioning the oropharynx is the most direct intervention to prevent further material from entering the lower respiratory tract and to facilitate breathing. While other actions may be necessary, clearing the airway is the first priority.
Question 6: During an ERCP, a patient suddenly becomes hypotensive and develops cyanosis. The endoscopist reports hearing a 'mill-wheel' murmur on auscultation. The nurse should immediately place the patient in which position?
- Reverse Trendelenburg
- Prone
- Right lateral decubitus
- Left lateral decubitus with Trendelenburg (Correct answer)
Correct answer: Left lateral decubitus with Trendelenburg
This is the classic presentation of a venous air embolism, a rare but life-threatening complication. The immediate life-saving intervention is to position the patient to trap the air in the right ventricle. Placing the patient in the left lateral decubitus (Durant's maneuver) and Trendelenburg position causes the air to rise and become trapped in the right ventricle, preventing it from entering the pulmonary artery and causing a fatal outflow obstruction.
Certified Gastroenterology RN Intra-Procedure Complication Management Questions and Answers
During a colonoscopy with moderate sedation using midazolam and fentanyl, the nurse observes the patient's respiratory rate has dropped to 6 breaths/minute and SpO2 is 84% on 2L nasal cannula.
What is the nurse's priority action?