Certified Gastroenterology RN Endoscopic Procedures and Equipment 5 — Questions and Answers
Question 1: A patient with a permanent pacemaker is scheduled for snare polypectomy. Which electrosurgical precaution is most appropriate?
- Use bipolar cautery or short bursts of monopolar current with cardiology consultation (Correct answer)
- Cancel the procedure permanently
- Place the grounding pad over the pacemaker
- Use only cold biopsy forceps for all polyps regardless of size
Correct answer: Use bipolar cautery or short bursts of monopolar current with cardiology consultation
Bipolar current or brief monopolar bursts with device interrogation planning minimizes electromagnetic interference with pacemakers.
Question 2: Which finding indicates the bowel preparation is adequate before colonoscopy begins?
- Rectal effluent is clear or light yellow liquid without solid stool (Correct answer)
- Stool is brown and formed
- The patient completed only half the prep but feels empty
- The patient has had no bowel movement since starting the prep
Correct answer: Rectal effluent is clear or light yellow liquid without solid stool
Clear liquid effluent indicates the colon is sufficiently cleansed for mucosal visualization.
Question 3: During endoscopic mucosal resection (EMR), why is saline with dilute epinephrine injected submucosally before resection?
- To lift the lesion away from the muscularis and reduce perforation and bleeding risk (Correct answer)
- To sterilize the resection field
- To anesthetize the bowel wall
- To shrink the polyp before removal
Correct answer: To lift the lesion away from the muscularis and reduce perforation and bleeding risk
The submucosal cushion separates the lesion from deeper layers, lowering the chance of perforation and vessel injury.
Question 4: A patient becomes agitated with a heart rate of 130 and rigidity after receiving sedation, and the endoscopy suite thermometer shows a rapidly rising temperature. Which emergency medication should be ready?
- Dantrolene (Correct answer)
- Naloxone
- Atropine
- Protamine sulfate
Correct answer: Dantrolene
Rapid temperature rise with rigidity suggests malignant hyperthermia, treated with dantrolene.
Question 5: Which instruction is correct for a patient after esophageal stent placement for a malignant stricture?
- Eat soft foods, chew thoroughly, and remain upright during and after meals (Correct answer)
- Resume a regular diet including tough meats immediately
- Lie flat for 30 minutes after each meal
- Avoid all oral intake permanently
Correct answer: Eat soft foods, chew thoroughly, and remain upright during and after meals
Soft, well-chewed food and upright positioning reduce the risk of stent occlusion and reflux aspiration.
Question 6: What distinguishes endoscopic submucosal dissection (ESD) from standard EMR?
- ESD allows en bloc removal of larger lesions using an electrosurgical knife to dissect the submucosa (Correct answer)
- ESD uses no electrocautery at all
- ESD is limited to lesions under 5 mm
- ESD removes lesions piecemeal with a cold snare
Correct answer: ESD allows en bloc removal of larger lesions using an electrosurgical knife to dissect the submucosa
ESD dissects beneath the lesion with specialized knives, enabling en bloc resection of large or early malignant lesions.
Question 7: The nurse notes the endoscopy light source alarm indicates lamp failure mid-procedure. What is the appropriate response?
- Switch to the backup light source or scope per facility protocol while the physician holds the scope stable (Correct answer)
- Continue the procedure using room lighting
- Withdraw the scope rapidly without visualization
- Turn the unit off and on repeatedly to reset the lamp
Correct answer: Switch to the backup light source or scope per facility protocol while the physician holds the scope stable
Backup equipment must be immediately available and exchanged safely; the scope should never be advanced or withdrawn blindly.
Certified Gastroenterology RN Endoscopic Procedures and Equipment 5
A patient with a permanent pacemaker is scheduled for snare polypectomy.
Which electrosurgical precaution is most appropriate?