Certified Gastroenterology RN General 3 — Questions and Answers
Question 1: A patient receiving a PEG tube feeding suddenly develops coughing, dyspnea, and crackles. What is the nurse's priority action?
- Increase the feeding rate to finish quickly
- Stop the feeding and assess for aspiration (Correct answer)
- Reposition the patient flat
- Flush the tube with water
Correct answer: Stop the feeding and assess for aspiration
Coughing and crackles during enteral feeding suggest aspiration, so feeding must stop immediately while the patient is assessed.
Question 2: Which patient statement indicates correct understanding of proton pump inhibitor (PPI) therapy for GERD?
- "I take it 30 to 60 minutes before my first meal of the day." (Correct answer)
- "I take it only when I feel heartburn."
- "I take it at bedtime with a snack."
- "I take it with antacids for better absorption."
Correct answer: "I take it 30 to 60 minutes before my first meal of the day."
PPIs work best when taken 30-60 minutes before a meal so peak drug levels coincide with active proton pumps.
Question 3: A patient with ulcerative colitis is started on infliximab. Which pre-treatment screening is essential?
- Colonoscopy repeat within 24 hours
- Tuberculosis screening (Correct answer)
- 24-hour urine collection
- Pulmonary function testing
Correct answer: Tuberculosis screening
Anti-TNF agents like infliximab can reactivate latent tuberculosis, so TB screening is required before starting therapy.
Question 4: During an EGD, the nurse notes the patient's heart rate drop from 78 to 42 beats/min as the scope is advanced. What is the most likely cause?
- Vasovagal response to esophageal stimulation (Correct answer)
- Fentanyl allergy
- Hyperthyroid crisis
- Malignant hyperthermia
Correct answer: Vasovagal response to esophageal stimulation
Scope passage can trigger a vagal response causing bradycardia, requiring close monitoring and possible atropine.
Question 5: Which finding in a patient with acute pancreatitis indicates possible retroperitoneal hemorrhage?
- Rovsing sign
- Grey Turner sign (flank ecchymosis) (Correct answer)
- Murphy sign
- McBurney point tenderness
Correct answer: Grey Turner sign (flank ecchymosis)
Grey Turner sign, bruising of the flanks, suggests retroperitoneal bleeding in severe hemorrhagic pancreatitis.
Question 6: A patient is being discharged after variceal band ligation. Which instruction is most important?
- Resume aspirin the next morning
- Report black tarry stools or vomiting blood immediately (Correct answer)
- Eat a high-fiber, rough-textured diet today
- Avoid all fluids for 48 hours
Correct answer: Report black tarry stools or vomiting blood immediately
Melena or hematemesis after banding signals rebleeding, which is life-threatening and needs emergency care.
Question 7: What is the correct reprocessing sequence for a flexible endoscope after a procedure?
- High-level disinfection, then bedside pre-cleaning, then leak testing
- Bedside pre-cleaning, leak testing, manual cleaning, high-level disinfection, drying and storage (Correct answer)
- Manual cleaning only, then immediate reuse
- Sterilization in a steam autoclave
Correct answer: Bedside pre-cleaning, leak testing, manual cleaning, high-level disinfection, drying and storage
Reprocessing must follow the sequence of pre-cleaning, leak test, manual cleaning, high-level disinfection, then drying to prevent infection transmission.
Certified Gastroenterology RN General 3
A patient receiving a PEG tube feeding suddenly develops coughing, dyspnea, and crackles.
What is the nurse's priority action?