Certified Gastroenterology RN Intra-Procedure Complication Management 2 — Questions and Answers
Question 1: During a colonoscopy, the patient suddenly develops abdominal distension, tachycardia, and shoulder pain. What complication should the GI nurse suspect first?
- Bowel perforation (Correct answer)
- Vasovagal reaction
- Splenic flexure spasm
- Oversedation
Correct answer: Bowel perforation
Distension with tachycardia and referred shoulder pain from diaphragmatic irritation by free air suggests perforation.
Question 2: A patient receiving midazolam and fentanyl during EGD becomes apneic with oxygen saturation of 82%. After stimulating the patient and applying oxygen, which reversal agent should be prepared first to address the opioid component?
- Naloxone (Correct answer)
- Flumazenil
- Atropine
- Epinephrine
Correct answer: Naloxone
Naloxone reverses opioid-induced respiratory depression, the most likely driver of apnea with fentanyl on board.
Question 3: During polypectomy, immediate arterial spurting is noted at the resection site. Which intervention is typically attempted first?
- Endoscopic hemoclip or coagulation at the bleeding site (Correct answer)
- Emergency laparotomy
- Systemic IV vasopressin
- Immediate blood transfusion
Correct answer: Endoscopic hemoclip or coagulation at the bleeding site
Immediate post-polypectomy bleeding is usually controlled endoscopically with clips, coagulation, or epinephrine injection.
Question 4: A patient develops sudden bradycardia (HR 38) and hypotension during colonoscope insertion through the sigmoid colon. What is the most likely cause?
- Vasovagal response to bowel stretching (Correct answer)
- Air embolism
- Anaphylaxis to lubricant
- Hypoglycemia
Correct answer: Vasovagal response to bowel stretching
Mesenteric stretching during scope advancement commonly triggers a vagal response with bradycardia and hypotension.
Question 5: During ERCP, the patient becomes hypoxic and the nurse notes crepitus over the neck and chest. What complication does this finding suggest?
- Perforation with subcutaneous emphysema (Correct answer)
- Laryngospasm
- Pulmonary embolism
- Aspiration pneumonia
Correct answer: Perforation with subcutaneous emphysema
Crepitus indicates air tracking into subcutaneous tissue from a perforation, often duodenal or esophageal.
Question 6: Which action by the GI nurse best reduces the risk of aspiration in a patient who begins vomiting during an upper endoscopy?
- Turn the patient to the left lateral position and suction the oropharynx (Correct answer)
- Place the patient supine and elevate the legs
- Increase the sedation depth
- Administer an antiemetic and continue
Correct answer: Turn the patient to the left lateral position and suction the oropharynx
Left lateral positioning with prompt suctioning lets secretions drain and protects the airway.
Question 7: A patient on room air under moderate sedation shows an ETCO2 waveform that flattens on capnography before any change in SpO2. What should the nurse do first?
- Stimulate the patient and assess airway patency (Correct answer)
- Wait for the pulse oximeter to confirm desaturation
- Increase IV fluid rate
- Administer flumazenil immediately
Correct answer: Stimulate the patient and assess airway patency
Loss of ETCO2 waveform indicates apnea or obstruction and warrants immediate stimulation and airway assessment, since capnography detects hypoventilation before SpO2 falls.
Certified Gastroenterology RN Intra-Procedure Complication Management 2
During a colonoscopy, the patient suddenly develops abdominal distension, tachycardia, and shoulder pain.
What complication should the GI nurse suspect first?