Certified Gastroenterology RN Patient Assessment and Education Questions and Answers — Questions and Answers
Question 1: A patient with newly diagnosed GERD receives education from the gastroenterology nurse. Which statement by the patient indicates a need for further teaching?
- "I will try to eat my dinner right before I go to bed to prevent nighttime hunger." (Correct answer)
- "I should elevate the head of my bed by 6 to 8 inches."
- "I'm going to avoid coffee, chocolate, and peppermint to see if that helps my symptoms."
- "I will try eating smaller, more frequent meals instead of three large ones."
Correct answer: "I will try to eat my dinner right before I go to bed to prevent nighttime hunger."
Patients with GERD should avoid lying down for at least 2 to 3 hours after eating to prevent reflux. Eating immediately before bed is contraindicated. The other statements demonstrate correct understanding of lifestyle modifications for GERD management.
Question 2: A 58-year-old male is scheduled for his first screening colonoscopy. During the pre-procedure assessment call, which of the following is the MOST critical piece of information for the nurse to verify?
- That the patient has a designated driver for after the procedure. (Correct answer)
- The patient's preferred brand of clear liquid for the bowel prep.
- Whether the patient has any cultural objections to the procedure.
- The patient's work schedule for the week following the procedure.
Correct answer: That the patient has a designated driver for after the procedure.
Because the patient will receive sedation for the colonoscopy, they will be unable to drive or operate machinery for the remainder of the day. Ensuring they have arranged for a responsible adult to drive them home is essential for their safety and to prevent a last-minute cancellation of the procedure. While other assessments are important, the lack of a driver is an immediate safety risk and procedural barrier.
Question 3: When developing a plan of care for a patient with an acute exacerbation of Crohn's disease, which assessment finding requires the nurse's immediate attention?
- A rigid, board-like abdomen with rebound tenderness. (Correct answer)
- Reports of 5-6 loose, non-bloody stools in the past 24 hours.
- A low-grade fever and a C-reactive protein of 15 mg/L.
- Patient states they feel fatigued and have a poor appetite.
Correct answer: A rigid, board-like abdomen with rebound tenderness.
A rigid, board-like abdomen with rebound tenderness are classic signs of peritonitis, a life-threatening complication of Crohn's disease that can result from a bowel perforation. This finding requires immediate notification of the physician and intervention. The other findings are common during a flare-up but do not signify the same level of acuity.
Question 4: A nurse is providing discharge instructions to a patient who just underwent an upper endoscopy (EGD) with biopsy. Which of the following should the nurse instruct the patient to report immediately?
- Vomiting material that looks like coffee grounds. (Correct answer)
- A mild sore throat and a feeling of bloating.
- Drowsiness for several hours after the procedure.
- One small streak of blood in the saliva shortly after the procedure.
Correct answer: Vomiting material that looks like coffee grounds.
Vomiting material that looks like coffee grounds (hematemesis) is a sign of a significant upper GI bleed, a potential complication of an EGD, especially after a biopsy. A mild sore throat, bloating, and drowsiness are expected side effects from the procedure and sedation. A small streak of blood can be normal from minor irritation.
Question 5: During an initial assessment of a patient with cirrhosis, which of the following signs and symptoms would be most indicative of hepatic encephalopathy?
- Asterixis and confusion. (Correct answer)
- Jaundice and pruritus.
- Ascites and peripheral edema.
- Palmar erythema and spider angiomas.
Correct answer: Asterixis and confusion.
Hepatic encephalopathy is a decline in brain function that occurs as a result of severe liver disease. The classic signs are changes in mental status, such as confusion, and the presence of asterixis (a flapping tremor of the hands). The other options are signs of cirrhosis but are not specific to encephalopathy.
Question 6: Which of the following topics is essential for the nurse to include in the education of a patient being discharged with a new diagnosis of ulcerative colitis?
- Medication adherence and signs of a flare-up. (Correct answer)
- The need for annual liver enzyme monitoring.
- Instructions for daily parenteral nutrition.
- The benefits of a high-fiber diet during an exacerbation.
Correct answer: Medication adherence and signs of a flare-up.
For chronic conditions like ulcerative colitis, it is crucial that patients understand the importance of taking their medications as prescribed to maintain remission and know the signs and symptoms of a flare-up (e.g., increased stool frequency, blood in stool, abdominal pain) so they can seek timely medical care. Liver monitoring is more common with certain medications, parenteral nutrition is for severe cases, and a low-residue/low-fiber diet is typically recommended during a flare-up.
Certified Gastroenterology RN Patient Assessment and Education Questions and Answers
A patient with newly diagnosed GERD receives education from the gastroenterology nurse.
Which statement by the patient indicates a need for further teaching?