Certified Gastroenterology RN General 4 — Questions and Answers
Question 1: A patient with Crohn's disease develops a small bowel obstruction. Which assessment finding is most consistent with this complication?
- High-pitched bowel sounds above the obstruction with abdominal distention (Correct answer)
- Increased flatus and normal bowel movements
- Bradycardia and hypertension
- Painless bright red rectal bleeding
Correct answer: High-pitched bowel sounds above the obstruction with abdominal distention
Early mechanical obstruction produces hyperactive, high-pitched sounds proximal to the blockage along with distention and vomiting.
Question 2: Which patient is at highest risk for developing hepatic encephalopathy?
- A cirrhotic patient with a GI bleed and constipation (Correct answer)
- A patient with cholecystitis awaiting surgery
- A patient with well-controlled GERD
- A patient with irritable bowel syndrome
Correct answer: A cirrhotic patient with a GI bleed and constipation
GI bleeding and constipation both increase ammonia production and absorption, precipitating encephalopathy in cirrhosis.
Question 3: Lactulose is prescribed for a patient with hepatic encephalopathy. The nurse knows the therapeutic goal is which outcome?
- One formed stool per week
- Two to three soft stools daily with improved mentation (Correct answer)
- Complete cessation of bowel movements
- Watery diarrhea 10 times daily
Correct answer: Two to three soft stools daily with improved mentation
Lactulose is titrated to 2-3 soft stools per day to trap and excrete ammonia without causing dehydration.
Question 4: A patient reports dysphagia to solids that has progressed to liquids over 3 months, with a 15-pound weight loss. The nurse recognizes this pattern is most concerning for which condition?
- Globus sensation
- Esophageal malignancy (Correct answer)
- Simple heartburn
- Oral thrush
Correct answer: Esophageal malignancy
Progressive solids-to-liquids dysphagia with weight loss is an alarm pattern suggesting an obstructing esophageal tumor.
Question 5: Which position is generally preferred for initiating a colonoscopy?
- Prone
- Left lateral (Sims) position (Correct answer)
- Supine with legs extended
- High Fowler position
Correct answer: Left lateral (Sims) position
The left lateral position aligns the rectosigmoid colon for easier scope insertion and patient comfort.
Question 6: A patient taking mesalamine for ulcerative colitis asks how the drug helps. What is the best response?
- "It kills the bacteria that cause colitis."
- "It reduces inflammation directly in the lining of the bowel." (Correct answer)
- "It speeds up intestinal motility."
- "It replaces the enzymes your colon can't make."
Correct answer: "It reduces inflammation directly in the lining of the bowel."
Mesalamine is a topical anti-inflammatory (5-ASA) that acts on the colonic mucosa to reduce inflammation.
Question 7: Following ERCP, which symptom combination should prompt evaluation for post-ERCP pancreatitis?
- Mild sore throat and hoarseness
- New epigastric pain radiating to the back with elevated lipase (Correct answer)
- Itching at the IV site
- Single episode of belching
Correct answer: New epigastric pain radiating to the back with elevated lipase
Post-ERCP pancreatitis presents with typical pancreatic pain and lipase elevation, usually within hours of the procedure.
Certified Gastroenterology RN General 4
A patient with Crohn's disease develops a small bowel obstruction.
Which assessment finding is most consistent with this complication?