Mixed Deck — All CGRN Topics Flashcards

Which diabetes medications should be held on the morning of endoscopy?

Answer: Sulfonylureas and prandial insulin doses

Sulfonylureas and prandial insulin stimulate insulin release or cover meals, risking hypoglycemia during fasting.

Which complication is most associated with prolonged use of proton pump inhibitors (PPIs)?

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.

The landmark 1932 paper first describing regional ileitis — now called Crohn's disease — was authored by how many physicians?

Answer: Three

The 1932 JAMA paper was co-authored by three physicians: Burrill Crohn, Leon Ginzburg, and Gordon Oppenheimer. The disease was named after Crohn because his name appeared first alphabetically.

A 58-year-old male is scheduled for an EGD to evaluate dysphagia. He has a history of type 2 diabetes and takes metformin. Which pre-procedure instruction by the CGRN is most appropriate?

Answer: "You must arrange for a responsible adult to drive you home after the procedure."

Due to the administration of sedation during an EGD, the patient's judgment and reflexes will be impaired. It is a standard safety protocol that the patient must have a responsible adult to drive them home. Patients are typically NPO for 6-8 hours for solids and at least 2 hours for clear liquids. Instructions regarding medications like metformin and aspirin require specific physician orders based on the patient's condition.

What is the recommended hand hygiene practice immediately before and after every endoscopic procedure?

Answer: Alcohol-based hand rub or handwashing with antimicrobial soap for at least 20 seconds

CDC and WHO recommend alcohol-based hand rub or antimicrobial soap handwashing for at least 20 seconds before and after patient contact.

A 65-year-old patient is in the recovery area 30 minutes after a colonoscopy with a difficult polypectomy. The patient complains of severe, worsening abdominal pain and the nurse notes a rigid, board-like abdomen and tachycardia. What is the most likely complication the nurse should suspect?

Answer: Perforation

The combination of severe, worsening abdominal pain, a rigid or board-like abdomen, and systemic signs like tachycardia are classic indicators of a bowel perforation. This constitutes a medical emergency as leakage of bowel contents into the abdominal cavity causes peritonitis. Post-polypectomy bleeding typically presents with hematochezia or signs of hypovolemia without the pronounced abdominal rigidity. A vasovagal response involves bradycardia and hypotension. Oversedation would present with respiratory depression.

A CGRN is preparing reusable biopsy forceps for the next procedure. According to the Spaulding classification system, what is the required level of reprocessing for this accessory?

Answer: Sterilization

The Spaulding classification categorizes medical devices based on infection risk. Biopsy forceps are considered 'critical' items because they break the mucosal barrier and enter sterile tissue. Critical items require sterilization, which is the complete destruction of all microbial life, including bacterial spores.

What is the purpose of performing a leak test on an endoscope before reprocessing?

Answer: To detect damage to the endoscope's internal channels and outer sheath

Leak testing detects holes or cracks that could allow fluid infiltration and damage internal components or harbor microorganisms.

What is the recommended storage method for reprocessed endoscopes to prevent recontamination?

Answer: Hung vertically in a ventilated cabinet with valves removed

Reprocessed endoscopes should be stored vertically in a ventilated cabinet with all valves and caps removed to facilitate drying.

Which organ produces approximately 1-1.5 liters of bile per day?

Answer: Liver

The liver produces 500-1,500 mL of bile daily. The gallbladder only stores and concentrates bile.

What is the origin of the term 'endoscopy'?

Answer: Greek: 'endon' (within) + 'skopein' (to look)

From Greek 'endon' (within) and 'skopein' (to look at/examine).

Which finding on liver biopsy is most characteristic of nonalcoholic steatohepatitis (NASH) compared to simple steatosis?

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.

A patient scheduled for endoscopy has a known history of Creutzfeldt-Jakob disease (CJD). What is the recommended approach?

Answer: Use a disposable endoscope or quarantine the scope after use

Prions are resistant to standard disinfection. Guidelines recommend disposable endoscopes or quarantining/destroying the scope.

Which segment of the colon lacks a mesentery and is therefore retroperitoneal?

Answer: Ascending colon

The ascending colon is retroperitoneal and lacks a mesentery, making it relatively fixed in position.

During EGD, a Forrest Ia bleeding ulcer is identified. What does this classification indicate?

Answer: Active spurting arterial hemorrhage

Forrest Ia indicates active spurting hemorrhage, carrying the highest rebleeding risk.

What is the most common indication for performing an EGD?

Answer: Evaluation of persistent upper GI symptoms refractory to medical therapy

EGD is most commonly indicated for upper GI symptoms that persist despite appropriate medical therapy or present with alarm features.

Why is a colon prepped with mannitol, or poorly prepped, dangerous when argon plasma coagulation (APC) or electrocautery is used?

Answer: Colonic gases such as hydrogen and methane can build up and ignite, causing a colonic explosion

Bacteria ferment mannitol and residual stool, producing flammable hydrogen and methane. Electrosurgical energy can ignite these gases. Adequate non-fermentable bowel prep and gas exchange lower the risk.

During colonoscopy, a 1.5 cm sessile polyp is encountered. Which removal technique is most appropriate?

Answer: Endoscopic mucosal resection (EMR)

For sessile polyps 10-20 mm, EMR using submucosal injection and snare is preferred.

Which statement about probiotics in GI nursing is most accurate?

Answer: Probiotics have strong evidence for preventing C. difficile-associated diarrhea

Evidence supports probiotic use (especially Saccharomyces boulardii and Lactobacillus) for reducing antibiotic-associated and C. difficile diarrhea.

A patient develops acute cholangitis after failed ERCP. What is the management priority?

Answer: Urgent biliary drainage with IV antibiotics

Acute cholangitis requires urgent biliary drainage combined with IV antibiotics.