Certified Gastroenterology RN Certified Gastroenterology RN MCQ 4 — Questions and Answers
Question 1: During moderate sedation with midazolam and fentanyl, a patient becomes unresponsive with a respiratory rate of 6. After supporting ventilation, which reversal agent sequence is appropriate?
- Naloxone for the opioid, then flumazenil for the benzodiazepine if needed (Correct answer)
- Flumazenil only, since midazolam causes all respiratory depression
- Epinephrine followed by atropine
- No reversal agents; sedation always self-resolves
Correct answer: Naloxone for the opioid, then flumazenil for the benzodiazepine if needed
Opioid reversal with naloxone is typically given first because opioids are the primary driver of respiratory depression, with flumazenil added if needed.
Question 2: A patient with suspected achalasia asks what test confirms the diagnosis. Which study should the nurse identify as the gold standard?
- Esophageal manometry (Correct answer)
- Abdominal ultrasound
- Stool guaiac testing
- Hydrogen breath test
Correct answer: Esophageal manometry
Esophageal manometry demonstrating absent peristalsis and impaired LES relaxation is the definitive test for achalasia.
Question 3: Which patient is at highest risk for developing Clostridioides difficile infection?
- An 82-year-old on day 10 of broad-spectrum antibiotics and a proton pump inhibitor (Correct answer)
- A 30-year-old taking a daily probiotic
- A 45-year-old on a gluten-free diet
- A 25-year-old who completed a bowel prep last month
Correct answer: An 82-year-old on day 10 of broad-spectrum antibiotics and a proton pump inhibitor
Advanced age, prolonged broad-spectrum antibiotics, and acid suppression are the strongest combined risk factors for C. difficile.
Question 4: After a percutaneous endoscopic gastrostomy (PEG) placement, when is it generally acceptable to begin tube feedings per current guidelines?
- Within 4 hours after placement if no complications (Correct answer)
- No sooner than 72 hours after placement
- Only after the first dressing change on day 7
- Immediately during the procedure
Correct answer: Within 4 hours after placement if no complications
Evidence supports safely starting feedings within 4 hours of uncomplicated PEG placement.
Question 5: A patient with GERD has failed lifestyle changes and once-daily PPI therapy. Before escalating therapy, which nursing assessment is most important?
- Verifying the PPI is taken 30-60 minutes before the first meal (Correct answer)
- Confirming the patient sleeps flat without pillows
- Checking whether the patient drinks milk at bedtime
- Asking if the patient chews gum after meals
Correct answer: Verifying the PPI is taken 30-60 minutes before the first meal
PPIs work on actively secreting proton pumps, so incorrect timing relative to meals is the most common cause of apparent treatment failure.
Question 6: Which finding during a routine screening colonoscopy carries the highest risk of progression to colorectal cancer?
- A 15 mm sessile serrated lesion with dysplasia (Correct answer)
- A 4 mm hyperplastic polyp in the rectum
- Scattered diverticula in the sigmoid colon
- Small internal hemorrhoids
Correct answer: A 15 mm sessile serrated lesion with dysplasia
Large sessile serrated lesions with dysplasia are advanced precancerous lesions with significant malignant potential.
Question 7: A patient receiving high-volume paracentesis for tense ascites should be monitored for which complication when more than 5 liters are removed without albumin replacement?
- Post-paracentesis circulatory dysfunction with hypotension (Correct answer)
- Fluid overload and pulmonary edema
- Severe hypertension
- Hyperalbuminemia
Correct answer: Post-paracentesis circulatory dysfunction with hypotension
Removing more than 5 liters without albumin can cause circulatory dysfunction, hypotension, and renal impairment.
Certified Gastroenterology RN Certified Gastroenterology RN MCQ 4
During moderate sedation with midazolam and fentanyl, a patient becomes unresponsive with a respiratory rate of 6.
After supporting ventilation, which reversal agent sequence is appropriate?