Certified Gastroenterology RN Intra-Procedure Complication Management 5 — Questions and Answers
Question 1: A frail 82-year-old under moderate sedation for EGD develops shallow respirations at 6 breaths per minute. Which age-related change most contributes to this complication?
- Decreased drug clearance and increased sensitivity to sedatives (Correct answer)
- Increased hepatic metabolism of benzodiazepines
- Higher baseline respiratory reserve
- Reduced blood-brain barrier permeability to opioids
Correct answer: Decreased drug clearance and increased sensitivity to sedatives
Older adults clear sedatives more slowly and are more sensitive to their respiratory depressant effects.
Question 2: During hemostasis of a bleeding ulcer, epinephrine 1:10,000 is injected submucosally. Which patient response should the nurse monitor for as a systemic effect?
- Transient tachycardia and hypertension (Correct answer)
- Profound bradycardia
- Hypoglycemia
- Sudden hypothermia
Correct answer: Transient tachycardia and hypertension
Systemic absorption of injected epinephrine can transiently raise heart rate and blood pressure.
Question 3: The endoscopist announces a suspected perforation during colonoscopy and elects to attempt endoscopic clip closure. Which nursing action supports the patient during this event?
- Minimize further insufflation support, monitor vitals closely, and prepare for possible surgical consult and NPO status (Correct answer)
- Encourage oral fluids to check for leakage
- Discontinue all monitoring to expedite transfer
- Ambulate the patient to redistribute free air
Correct answer: Minimize further insufflation support, monitor vitals closely, and prepare for possible surgical consult and NPO status
Suspected perforation requires close monitoring, NPO status, and readiness for surgical backup while closure is attempted.
Question 4: A patient develops laryngospasm during upper endoscopy with stridor and paradoxical chest movement. After scope removal and suctioning, which initial maneuver should the nurse anticipate?
- Positive pressure ventilation with 100% oxygen via bag-mask and jaw thrust (Correct answer)
- Immediate cricothyrotomy
- Placing the patient prone
- Oral fluids to soothe the larynx
Correct answer: Positive pressure ventilation with 100% oxygen via bag-mask and jaw thrust
Laryngospasm is initially managed with jaw thrust and positive pressure oxygen, escalating to medications only if it persists.
Question 5: During a pediatric-sized balloon dilation of a stricture, the nurse's role includes monitoring balloon inflation pressure. Why is exceeding the recommended pressure dangerous?
- It increases the risk of mucosal tearing and perforation at the stricture (Correct answer)
- It causes the balloon to migrate into the airway
- It reduces the effectiveness of dilation
- It interferes with ECG monitoring
Correct answer: It increases the risk of mucosal tearing and perforation at the stricture
Overinflation beyond rated pressure can tear the mucosa or perforate the wall at the stricture site.
Question 6: A patient receiving reversal with flumazenil after oversedation becomes anxious and tremulous, then has a brief seizure. Which history finding most likely explains this reaction?
- Chronic benzodiazepine use (Correct answer)
- Seasonal allergies
- Lactose intolerance
- Prior cholecystectomy
Correct answer: Chronic benzodiazepine use
Flumazenil can precipitate withdrawal seizures in patients dependent on benzodiazepines.
Question 7: Immediately after a difficult colonoscope withdrawal, the patient reports severe left upper quadrant pain and becomes hypotensive. Beyond perforation, which less common complication should the team consider?
- Splenic injury from traction on the splenocolic ligament (Correct answer)
- Appendicitis
- Acute cholecystitis
- Nephrolithiasis
Correct answer: Splenic injury from traction on the splenocolic ligament
Scope looping and traction near the splenic flexure can lacerate the spleen, causing LUQ pain and hemorrhagic shock.
Certified Gastroenterology RN Intra-Procedure Complication Management 5
A frail 82-year-old under moderate sedation for EGD develops shallow respirations at 6 breaths per minute.
Which age-related change most contributes to this complication?