CGRN - Certified Gastroenterology Registered Nurse Cgrn/Questions/Mcq 1 — Questions and Answers
Question 1: A patient undergoing upper endoscopy is found to have Barrett's esophagus without dysplasia. What is the recommended surveillance interval?
- Every 6 months
- Every 1 year
- Every 3–5 years (Correct answer)
- No further surveillance needed
Correct answer: Every 3–5 years
Non-dysplastic Barrett's esophagus carries a low risk of progression to adenocarcinoma. Current guidelines (ACG/AGA) recommend surveillance endoscopy every 3–5 years rather than more frequent intervals, which are reserved for low-grade or high-grade dysplasia.
Question 2: Which finding on liver biopsy is most characteristic of nonalcoholic steatohepatitis (NASH) compared to simple steatosis?
- Macrovesicular fat deposition
- Lobular inflammation with hepatocyte ballooning (Correct answer)
- Periportal fibrosis alone
- Bile duct proliferation
Correct answer: Lobular inflammation with hepatocyte ballooning
NASH is distinguished from simple steatosis by the presence of lobular inflammation and hepatocyte ballooning injury, often with pericellular fibrosis. These features indicate active liver injury and progression risk, whereas steatosis alone lacks these inflammatory components.
Question 3: A nurse is preparing a patient for a colonoscopy who takes warfarin for atrial fibrillation. The planned procedure includes polypectomy. What is the most appropriate anticoagulation management?
- Continue warfarin at current dose throughout
- Hold warfarin 5 days before the procedure (Correct answer)
- Switch to heparin infusion the morning of procedure
- Administer vitamin K the night before
Correct answer: Hold warfarin 5 days before the procedure
For high-risk procedures such as polypectomy, warfarin should be held approximately 5 days prior to allow the INR to normalize. This is standard peri-procedural management to minimize bleeding risk while the half-life of warfarin clears.
Question 4: Which complication is most associated with prolonged use of proton pump inhibitors (PPIs)?
- Hyperkalemia
- Iron overload
- Clostridium difficile infection (Correct answer)
- Hypercalcemia
Correct answer: Clostridium difficile infection
Long-term PPI use is associated with an increased risk of Clostridium difficile infection due to the reduction of gastric acid, which normally serves as a barrier to colonization. Other associations include hypomagnesemia and vitamin B12 deficiency, but C. diff is a well-documented infectious complication.
Question 5: A patient with Crohn's disease presents with a new perianal fistula. Which medication class is most effective for inducing closure of perianal fistulas in Crohn's disease?
- 5-aminosalicylates (5-ASA)
- Corticosteroids
- Anti-TNF biologics (Correct answer)
- Azathioprine monotherapy
Correct answer: Anti-TNF biologics
Anti-TNF agents such as infliximab have demonstrated efficacy specifically for inducing and maintaining perianal fistula closure in Crohn's disease in landmark trials. 5-ASA agents are not effective for fistulizing disease, and corticosteroids may worsen fistulas.
Question 6: During a colonoscopy, the nurse notices the patient's oxygen saturation drops to 88% and the patient becomes difficult to arouse. What is the priority nursing intervention?
- Administer flumazenil immediately
- Increase the flow of CO2 insufflation
- Stop the procedure, stimulate the patient, and apply supplemental oxygen (Correct answer)
- Administer naloxone and continue the procedure
Correct answer: Stop the procedure, stimulate the patient, and apply supplemental oxygen
The priority intervention for hypoxia and decreased level of consciousness during endoscopy is to stop the procedure, stimulate the patient, and provide supplemental oxygen. Reversal agents such as flumazenil or naloxone may be considered if sedation-induced respiratory depression is confirmed, but airway support and oxygenation come first.
CGRN - Certified Gastroenterology Registered Nurse Cgrn/Questions/Mcq 1
A patient undergoing upper endoscopy is found to have Barrett's esophagus without dysplasia.
What is the recommended surveillance interval?