Certified Gastroenterology RN Intra-Procedure Complication Management 4 — Questions and Answers
Question 1: During PEG tube placement, the patient's abdomen becomes rigid and the transillumination point is lost. What should the team suspect?
- Malposition with possible injury to an interposed organ or peritoneal leakage (Correct answer)
- Normal gastric insufflation
- Expected post-placement ileus
- Simple wound-site bleeding
Correct answer: Malposition with possible injury to an interposed organ or peritoneal leakage
Loss of transillumination and a rigid abdomen suggest the tract is misplaced or another organ, such as the colon, is interposed.
Question 2: A patient becomes hypotensive (BP 78/40) during colonoscopy after moderate sedation. After stopping scope advancement, what is the nurse's first intervention?
- Open IV fluids and place the patient flat while assessing responsiveness (Correct answer)
- Administer IV metoprolol
- Sit the patient upright
- Give a second dose of midazolam to reduce anxiety
Correct answer: Open IV fluids and place the patient flat while assessing responsiveness
Sedation-related hypotension is first managed with positioning and a fluid bolus while assessing the patient.
Question 3: Cautery is about to be used during polypectomy, but the nurse learns the patient had an inadequate bowel prep. Why is this a safety concern?
- Residual colonic gases from poor prep can ignite during electrocautery (Correct answer)
- Poor prep increases sedation requirements
- Stool interferes with grounding pad function
- Cautery is ineffective in an unprepped colon
Correct answer: Residual colonic gases from poor prep can ignite during electrocautery
Combustible hydrogen and methane concentrations in a poorly prepped colon create an explosion risk with cautery.
Question 4: During ERCP, the patient develops severe epigastric pain radiating to the back before leaving the procedure room. Which lab values should the nurse anticipate the provider ordering to evaluate the most common ERCP complication?
- Serum amylase and lipase (Correct answer)
- Troponin and CK-MB
- TSH and free T4
- Ammonia and AFP
Correct answer: Serum amylase and lipase
Post-ERCP pancreatitis is the most common ERCP complication and is assessed with amylase and lipase.
Question 5: A patient with an implanted cardiac defibrillator (ICD) requires snare cautery during colonoscopy. What intra-procedure precaution is most appropriate?
- Follow the pre-arranged plan for magnet use or device reprogramming and monitor cardiac rhythm continuously (Correct answer)
- Use higher cautery settings to shorten exposure
- Place the grounding pad over the device
- No precautions are needed with bipolar or monopolar cautery
Correct answer: Follow the pre-arranged plan for magnet use or device reprogramming and monitor cardiac rhythm continuously
Electrocautery can cause an ICD to misinterpret interference as an arrhythmia, so device management and continuous monitoring are required.
Question 6: Midway through a colonoscopy, the patient begins moving and reports pain despite moderate sedation. What is the most appropriate nursing response?
- Pause the procedure, assess the patient, and titrate analgesia per orders before continuing (Correct answer)
- Physically restrain the patient so the scope can advance
- Tell the patient the discomfort is normal and continue
- Immediately administer flumazenil
Correct answer: Pause the procedure, assess the patient, and titrate analgesia per orders before continuing
Pain and movement require pausing to assess and titrate medication rather than forcing the procedure onward.
Question 7: During a procedure, blood-tinged fluid is continuously suctioned from the stomach and the patient's heart rate climbs from 72 to 118. Which additional finding would most support developing hypovolemia?
- Narrowing pulse pressure with falling blood pressure (Correct answer)
- Bounding peripheral pulses
- Flushed warm skin
- Bradypnea
Correct answer: Narrowing pulse pressure with falling blood pressure
Tachycardia with narrowed pulse pressure and hypotension reflects progressive volume loss from bleeding.
Certified Gastroenterology RN Intra-Procedure Complication Management 4
During PEG tube placement, the patient's abdomen becomes rigid and the transillumination point is lost.
What should the team suspect?