Certified Gastroenterology RN Pre and Post-Procedure Care 3 — Questions and Answers
Question 1: A diabetic patient taking insulin is NPO for a morning colonoscopy. Which pre-procedure action is most appropriate?
- Administer the full usual insulin dose
- Hold or reduce insulin per provider orders and monitor blood glucose (Correct answer)
- Give double insulin to counteract prep stress
- Have the patient eat a light breakfast with insulin
Correct answer: Hold or reduce insulin per provider orders and monitor blood glucose
Fasting patients on insulin need dose adjustment and glucose monitoring to prevent hypoglycemia.
Question 2: Which statement by a patient indicates informed consent for ERCP may be inadequate?
- "The doctor said pancreatitis is a possible complication"
- "I can withdraw my consent at any time"
- "I'm not sure what procedure I'm actually having done" (Correct answer)
- "They will use X-ray and a scope to look at my bile ducts"
Correct answer: "I'm not sure what procedure I'm actually having done"
A patient who cannot describe the planned procedure does not demonstrate understanding, so the provider must re-educate before proceeding.
Question 3: After ERCP, a patient reports severe epigastric pain radiating to the back with nausea. The nurse should suspect which complication?
- Post-ERCP pancreatitis (Correct answer)
- Normal post-procedure gas pain
- Esophageal stricture
- Dumping syndrome
Correct answer: Post-ERCP pancreatitis
Epigastric pain radiating to the back with nausea after ERCP is the classic presentation of post-ERCP pancreatitis.
Question 4: Following an EGD with topical throat anesthetic, when may the patient safely resume oral intake?
- Immediately upon waking
- After the gag reflex returns (Correct answer)
- After 24 hours NPO
- Only after passing flatus
Correct answer: After the gag reflex returns
Oral intake must wait until the gag reflex returns to prevent aspiration.
Question 5: A patient reports shoulder pain after a colonoscopy in which CO2 insufflation was used. What is the best nursing response?
- Prepare for emergency laparotomy
- Explain that referred pain from retained gas is common and usually resolves quickly (Correct answer)
- Administer naloxone for opioid reaction
- Place the patient flat and immobile for 6 hours
Correct answer: Explain that referred pain from retained gas is common and usually resolves quickly
Insufflated gas can irritate the diaphragm causing referred shoulder pain, which typically resolves as gas is absorbed or passed.
Question 6: Which pre-procedure assessment finding most increases a patient's risk of airway compromise during moderate sedation?
- History of seasonal allergies
- Obstructive sleep apnea with high BMI (Correct answer)
- Well-controlled hypertension
- Remote history of appendectomy
Correct answer: Obstructive sleep apnea with high BMI
Sleep apnea and obesity predict airway obstruction and desaturation under sedation, requiring heightened monitoring.
Question 7: A patient scheduled for capsule endoscopy should be screened for which contraindication during pre-procedure assessment?
- Lactose intolerance
- Known or suspected bowel obstruction or stricture (Correct answer)
- History of GERD
- Prior colonoscopy within 5 years
Correct answer: Known or suspected bowel obstruction or stricture
A stricture or obstruction can cause capsule retention, so it must be ruled out before administration.
Certified Gastroenterology RN Pre and Post-Procedure Care 3
A diabetic patient taking insulin is NPO for a morning colonoscopy.
Which pre-procedure action is most appropriate?