Certified Gastroenterology RN Intra-Procedure Complication Management 3 — Questions and Answers
Question 1: During esophageal dilation, the patient develops sudden chest pain, tachycardia, and subcutaneous crepitus. What is the priority nursing action?
- Stop the procedure and notify the physician of suspected esophageal perforation (Correct answer)
- Administer sublingual nitroglycerin
- Reposition the patient and continue dilation
- Give an oral analgesic and observe
Correct answer: Stop the procedure and notify the physician of suspected esophageal perforation
Chest pain with crepitus after dilation strongly suggests esophageal perforation, requiring immediate cessation and physician notification.
Question 2: Which patient is at highest risk for post-polypectomy electrocoagulation syndrome during hot snare polypectomy?
- A patient with a large sessile polyp removed from the thin-walled right colon (Correct answer)
- A patient with a small pedunculated polyp in the sigmoid
- A patient with a hyperplastic rectal polyp
- A patient undergoing cold snare removal of a 4 mm polyp
Correct answer: A patient with a large sessile polyp removed from the thin-walled right colon
Large sessile lesions in the thin-walled cecum and ascending colon carry the greatest transmural burn risk.
Question 3: A patient develops stridor and facial swelling minutes after IV antibiotic prophylaxis during a GI procedure. After stopping the infusion, which medication is the priority?
- Intramuscular epinephrine (Correct answer)
- IV diphenhydramine alone
- Oral corticosteroids
- Nebulized normal saline
Correct answer: Intramuscular epinephrine
Stridor with angioedema indicates anaphylaxis, and epinephrine is the first-line life-saving treatment.
Question 4: During colonoscopy with CO2 insufflation unavailable, prolonged room-air insufflation increases the risk of which intra-procedure problem?
- Painful luminal distension and vasovagal events from slowly absorbed gas (Correct answer)
- Hypercapnia from rapid CO2 absorption
- Methane combustion during cautery in a prepped colon
- Immediate tension pneumothorax
Correct answer: Painful luminal distension and vasovagal events from slowly absorbed gas
Room air absorbs far more slowly than CO2, causing painful distension that can provoke vagal reactions.
Question 5: A patient under propofol sedation for colonoscopy develops rigidity and masseter spasm with a rapidly rising ETCO2 and temperature. The nurse should anticipate preparing which drug?
- Dantrolene (Correct answer)
- Naloxone
- Flumazenil
- Succinylcholine
Correct answer: Dantrolene
Rising ETCO2, rigidity, and hyperthermia suggest malignant hyperthermia, treated with dantrolene.
Question 6: During an EGD, the endoscopist encounters an actively bleeding esophageal varix. Which pharmacologic agent should the nurse anticipate administering as an IV infusion?
- Octreotide (Correct answer)
- Heparin
- Pantoprazole bolus only
- Metoclopramide
Correct answer: Octreotide
Octreotide reduces splanchnic blood flow and portal pressure, supporting endoscopic control of variceal bleeding.
Question 7: The nurse notes new-onset oxygen desaturation and unilateral diminished breath sounds in a patient after difficult upper endoscope passage. Which complication should be reported?
- Possible aspiration or airway compromise requiring immediate evaluation (Correct answer)
- Expected finding after air insufflation
- Normal response to moderate sedation
- Gastric distension with no clinical significance
Correct answer: Possible aspiration or airway compromise requiring immediate evaluation
Desaturation with unilateral diminished breath sounds suggests aspiration or another airway event and needs immediate evaluation.
Certified Gastroenterology RN Intra-Procedure Complication Management 3
During esophageal dilation, the patient develops sudden chest pain, tachycardia, and subcutaneous crepitus.
What is the priority nursing action?