Certified Gastroenterology RN Intra-Procedure Complication Management 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?

Accepted Answer

Administer naloxone (Narcan).

Answer

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?

Accepted Answer

Atropine

Answer

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?

Accepted Answer

Bowel perforation

Answer

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?

Accepted Answer

Ensure hemostatic clips are immediately available.

Answer

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:

Accepted Answer

Apply suction to the patient's oropharynx.

Answer

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.

Certified Gastroenterology RN Practice Test

Certified Gastroenterology RN Practice Test

Certified Gastroenterology RN Intra-Procedure Complication Management Questions and Answers