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CGRN practice questions

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Question 1Gastroenterology Nursing Clinical Practice

A patient newly diagnosed with celiac disease asks which grain must be avoided. Which response by the nurse is correct?

  1. Corn
  2. Barley Correct answer.
  3. Rice
  4. Quinoa

Explanation

Celiac disease requires lifelong avoidance of gluten, which is found in wheat, barley, rye, and their derivatives. Rice, corn, and quinoa are naturally gluten-free grains that are safe to eat.

Question 2Gastroenterology Nursing Clinical Practice

Which instruction best reduces nighttime reflux symptoms in a patient with GERD?

  1. Drink coffee at bedtime
  2. Eat a large meal just before going to bed
  3. Raise the head of the bed 6 to 8 inches Correct answer.
  4. Lie flat on the back right after eating

Explanation

Elevating the head of the bed uses gravity to keep gastric contents from moving into the esophagus during sleep. Meals, lying flat after eating, and caffeine all lower esophageal sphincter tone or increase reflux.

Question 3Gastroenterology Nursing Clinical Practice

Which action is correct when giving medications through a percutaneous endoscopic gastrostomy (PEG) tube?

  1. Give each medication separately while formula infuses rapidly
  2. Mix all of the medications together in one syringe
  3. Flush with 30 mL of water before and after each medication Correct answer.
  4. Crush enteric-coated tablets and flush them with cola

Explanation

Each medication should be given separately with a water flush before and after to prevent clogging and drug interactions within the tube. Enteric-coated and sustained-release forms should not be crushed, and formula should be paused during administration.

Question 4Gastroenterology Nursing Clinical Practice

Which drink is acceptable during a clear-liquid bowel preparation before colonoscopy?

  1. Apple juice Correct answer.
  2. Grape juice
  3. Cream of tomato soup
  4. Tomato juice

Explanation

Clear liquids are those through which light passes, such as water, clear broth, apple juice, and plain tea. Red, purple, and opaque liquids can be mistaken for blood or leave residue and should be avoided.

Question 5Gastroenterology Nursing Clinical Practice

Which stoma appearance indicates adequate blood supply?

  1. Dusky blue and cool
  2. Black and firm
  3. Pale and dry
  4. Beefy red and moist Correct answer.

Explanation

A healthy stoma is beefy red, moist, and rounded, reflecting intact capillary blood flow. Pallor, duskiness, or black discoloration suggest ischemia or necrosis and require prompt evaluation.

Question 6Gastroenterology Nursing Clinical Practice

Hepatitis A virus is transmitted primarily by which route?

  1. Blood transfusion
  2. Fecal-oral Correct answer.
  3. Perinatal exposure
  4. Organ transplantation

Explanation

Hepatitis A is spread by the fecal-oral route, often through contaminated food, water, or poor hand hygiene. Bloodborne and perinatal transmission are characteristic of hepatitis B and C, not hepatitis A.

Question 7Gastroenterology Nursing Clinical Practice

Which dietary instruction is appropriate for a patient with cirrhosis and ascites?

  1. Encourage 4 L of fluid each day
  2. Limit sodium to about 2 g daily Correct answer.
  3. Restrict protein to 20 g daily
  4. Increase sodium to 4 g daily

Explanation

Sodium restriction of about 2 g per day reduces fluid retention in patients with cirrhotic ascites. Protein should not be severely restricted because malnutrition worsens outcomes, and free water is limited only when hyponatremia is present.

Question 8Gastroenterology Nursing Clinical Practice

A patient with peptic ulcer disease has a positive H. pylori stool antigen test and asks why antibiotics were prescribed. Which response is best?

  1. Antibiotics neutralize acid in the stomach
  2. Antibiotics speed emptying of the stomach
  3. Antibiotics treat the infection that causes most ulcers Correct answer.
  4. Antibiotics prevent the ulcer from ever bleeding again in the future

Explanation

H. pylori infection is the leading cause of peptic ulcer disease, and eradication with combination antibiotic therapy promotes healing and reduces recurrence. Antibiotics do not neutralize acid, alter gastric emptying, or independently prevent bleeding.

Question 9Gastroenterology Nursing Clinical Practice

A patient arrives vomiting large amounts of coffee-ground material and is pale and diaphoretic. Which action should the nurse take first?

  1. Insert two large-bore IV catheters and infuse fluids Correct answer.
  2. Send the patient for an immediate upper endoscopy
  3. Obtain a detailed history of NSAID use
  4. Insert a nasogastric tube and irrigate with iced saline

Explanation

The priority in acute upper GI bleeding is hemodynamic stabilization, beginning with large-bore IV access and volume resuscitation. History, endoscopy, and lavage follow once the airway and circulation are addressed.

Question 10Gastroenterology Nursing Clinical Practice

A patient with cirrhosis has active bleeding from esophageal varices. Which medication order should the nurse anticipate?

  1. Oral ferrous sulfate
  2. IV ketorolac
  3. IV octreotide infusion Correct answer.
  4. Subcutaneous heparin

Explanation

Octreotide is a somatostatin analog that splanchnic vasoconstricts, lowering portal pressure and variceal bleeding. Antibiotics are also given, but NSAIDs, iron, and anticoagulants do not stop acute variceal hemorrhage.

Question 11Gastroenterology Nursing Clinical Practice

Following an ERCP with sphincterotomy, which finding should be reported to the provider immediately?

  1. Mild throat irritation
  2. Drowsiness that resolves within one hour of recovery
  3. Severe epigastric pain radiating to the back Correct answer.
  4. Passing flatus two hours after the procedure

Explanation

Severe epigastric pain radiating to the back after ERCP suggests pancreatitis or perforation and requires urgent evaluation. Mild throat irritation, transient sedation, and passing flatus are expected findings.

Question 12Gastroenterology Nursing Clinical Practice

Which nursing action is the priority for a patient admitted with acute pancreatitis and severe pain?

  1. Administer IV fluids and opioid analgesia as ordered Correct answer.
  2. Place a heating pad on the abdomen
  3. Encourage ambulation every hour
  4. Provide a low-fat oral diet as soon as the patient can tolerate it

Explanation

Early aggressive IV fluid resuscitation and adequate analgesia are the cornerstones of acute pancreatitis management. Oral intake is withheld initially, heat is avoided, and activity is advanced as tolerated rather than forced.

Question 13Gastroenterology Nursing Clinical Practice

Which finding is most characteristic of ulcerative colitis rather than Crohn disease?

  1. Perianal fistulas and abscesses
  2. Continuous mucosal inflammation beginning in the rectum Correct answer.
  3. Granulomas found on biopsy
  4. Skip lesions with transmural inflammation in any part of the GI tract

Explanation

Ulcerative colitis involves continuous, superficial inflammation that always begins in the rectum and extends proximally. Skip lesions, transmural disease, fistulas, and granulomas are features of Crohn disease.

Question 14Gastroenterology Nursing Clinical Practice

A patient with a small bowel obstruction has a nasogastric tube to low intermittent suction. Which assessment finding requires immediate follow-up?

  1. Serum potassium of 3.9 mEq/L
  2. Urine output of 15 mL over the past 4 hours Correct answer.
  3. Nasogastric drainage of 200 mL over 8 hours
  4. Abdominal girth unchanged since admission

Explanation

Urine output below 30 mL per hour suggests hypovolemia or inadequate perfusion and requires urgent intervention in bowel obstruction. A normal potassium, stable girth, and modest NG output are expected findings.

Question 15Gastroenterology Nursing Clinical Practice

After a percutaneous liver biopsy, in which position should the nurse place the patient initially?

  1. Left side-lying with the bed flat
  2. Prone with a pillow under the abdomen
  3. Right side-lying with a small pillow under the biopsy site Correct answer.
  4. Supine with the head of the bed elevated 45 degrees

Explanation

Right side-lying position applies pressure over the biopsy site and limits bleeding by compressing the liver capsule. Vital signs are monitored closely for signs of hemorrhage during the post-procedure period.

Question 16Gastroenterology Nursing Clinical Practice

During moderate sedation for colonoscopy, which assessment is the most sensitive indicator of adequate ventilation?

  1. Presence of a gag reflex
  2. Pulse oximetry readings taken every 5 minutes
  3. Capnography tracing and end-tidal CO2 Correct answer.
  4. Blood pressure readings taken every 5 minutes

Explanation

Capnography detects hypoventilation and apnea before oxygen desaturation occurs with supplemental oxygen. Pulse oximetry lags behind changes in ventilation, and blood pressure and gag reflex do not measure breathing.

Question 17Gastroenterology Nursing Clinical Practice

A patient is scheduled for capsule endoscopy. Which instruction is essential?

  1. Avoid drinking any fluids or eating food for 24 hours after the capsule is swallowed
  2. Return to the clinic to have the capsule removed with an enema after 8 hours
  3. Report abdominal pain or vomiting after swallowing the capsule Correct answer.
  4. Schedule an MRI of the abdomen for the next morning

Explanation

The capsule can be retained in a stricture, and pain or vomiting may signal obstruction requiring imaging or retrieval. Clear liquids are resumed after a few hours, MRI is avoided until the capsule passes, and the capsule exits naturally in the stool.

Question 18Gastroenterology Nursing Clinical Practice

Lactulose is prescribed for a patient with hepatic encephalopathy. The nurse should titrate the dose to achieve which outcome?

  1. Two to three soft stools per day Correct answer.
  2. Complete cessation of bowel movements
  3. One formed stool every other day
  4. Six to eight watery stools per day

Explanation

Lactulose traps ammonia in the colon and is titrated to two to three soft stools daily for effective ammonia clearance. Overdosing causes dehydration and electrolyte loss, while underdosing fails to lower ammonia.

Question 19Gastroenterology Nursing Clinical Practice

A 46-year-old patient with no symptoms and no family history of colorectal cancer asks when screening should begin. Which response is correct?

  1. Begin screening only if a first-degree relative is diagnosed
  2. Begin screening now because average-risk screening starts at age 45 Correct answer.
  3. Wait until age 50 and then have a colonoscopy
  4. Start with an annual fecal occult blood test at age 60

Explanation

Average-risk colorectal cancer screening begins at age 45 in current guidelines, so this patient is already due. Earlier or more intensive screening is reserved for people with family history or other high-risk features.

Question 20Gastroenterology Nursing Clinical Practice

A patient with acute uncomplicated diverticulitis is being discharged. Which instruction is appropriate?

  1. Follow a clear liquid or low-fiber diet until symptoms improve Correct answer.
  2. Eat a high-fiber diet with raw vegetables right away
  3. Stop all antibiotics because they are not needed
  4. Take a daily stimulant laxative to prevent recurrence

Explanation

During acute diverticulitis, the bowel is rested with clear liquids or a low-fiber diet, then fiber is advanced gradually as symptoms resolve. Long-term high-fiber intake reduces recurrence but is not started during acute inflammation.

Question 21Gastroenterology Nursing Clinical Practice

Which finding in ascitic fluid confirms spontaneous bacterial peritonitis?

  1. Ascitic fluid glucose level greater than 100 mg/dL
  2. Ascitic fluid total protein level greater than 2.5 g/dL with a positive culture
  3. Serum-ascitic albumin gradient less than 1.1 g/dL
  4. Ascitic fluid polymorphonuclear cell count of 250 cells/mm3 or higher Correct answer.

Explanation

Spontaneous bacterial peritonitis is diagnosed when the ascitic fluid polymorphonuclear cell count is at least 250 cells/mm3, and treatment with a third-generation cephalosporin plus albumin should begin promptly. A high protein level or low SAAG does not establish the diagnosis.

Question 22Gastroenterology Nursing Clinical Practice

A patient receiving total parenteral nutrition after 10 days of poor oral intake develops weakness and confusion on the third day of therapy. Which laboratory abnormality is most likely?

  1. Serum sodium 150 mEq/L
  2. Serum calcium 11.4 mg/dL
  3. Serum potassium 5.6 mEq/L
  4. Serum phosphorus 1.2 mg/dL Correct answer.

Explanation

Refeeding syndrome occurs when rapid carbohydrate reintroduction drives insulin release, shifting phosphate, potassium, and magnesium intracellularly; hypophosphatemia is the hallmark. Electrolytes should be checked frequently and corrected during the first days of feeding.

Question 23Gastroenterology Nursing Clinical Practice

Which intervention reduces the risk of post-ERCP pancreatitis in a high-risk patient?

  1. Pancreatic enzyme supplements before the procedure
  2. Rectal indomethacin with lactated Ringer's hydration Correct answer.
  3. Prophylactic nasogastric decompression after the procedure
  4. Prophylactic IV antibiotics for 24 hours

Explanation

Periprocedural rectal NSAIDs plus aggressive lactated Ringer's hydration are evidence-based measures that lower the incidence and severity of post-ERCP pancreatitis. Antibiotics, enzyme supplements, and NG decompression have no preventive role.

Question 24Gastroenterology Nursing Clinical Practice

Which nursing action is the priority for a patient with acute liver failure and grade III encephalopathy?

  1. Keep the head of the bed flat and the room dark
  2. Restrict all visitors and apply soft wrist restraints
  3. Perform frequent neurologic checks with painful stimulation and restraints
  4. Elevate the head of the bed 30 degrees and limit stimulation Correct answer.

Explanation

Cerebral edema and elevated intracranial pressure are leading causes of death in acute liver failure, so the head is elevated about 30 degrees and stimulation is minimized to avoid ICP spikes. Painful stimulation and restraints increase intracranial pressure.

Question 25Gastroenterology Nursing Clinical Practice

A patient with refractory ascites undergoes a transjugular intrahepatic portosystemic shunt (TIPS). Which complication should the nurse monitor for most closely?

  1. Splenic rupture
  2. Biliary stricture
  3. Hypoglycemia
  4. Hepatic encephalopathy Correct answer.

Explanation

TIPS shunts portal blood past the liver, reducing portal pressure but also decreasing hepatic clearance of ammonia and other toxins, which commonly precipitates hepatic encephalopathy. Glucose, splenic integrity, and the biliary tree are not the primary concerns after TIPS.

Question 26Gastroenterology Nursing Clinical Practice

A patient newly diagnosed with celiac disease asks which food must be permanently eliminated from the diet. Which item should the nurse identify?

  1. Grilled chicken breast
  2. Whole-wheat bread Correct answer.
  3. Steamed white rice
  4. Baked sweet potato

Explanation

Celiac disease is an immune-mediated intolerance to gluten, found in wheat, barley, and rye, so wheat-based bread must be avoided. Rice, unseasoned meat, and potatoes are naturally gluten-free and remain acceptable.

Question 27Gastroenterology Nursing Clinical Practice

A patient reports stools that are black, tarry, and foul-smelling. The nurse documents this finding as:

  1. Steatorrhea from fat malabsorption
  2. Melena from an upper GI source Correct answer.
  3. Clay-colored stool from biliary obstruction
  4. Hematochezia from a lower GI source

Explanation

Melena results when blood from an upper GI source is digested during transit, producing black, tarry, sticky stool with a characteristic odor. Hematochezia is bright red blood, steatorrhea is greasy and pale, and clay-colored stool reflects absent bile pigment.

Question 28Gastroenterology Nursing Clinical Practice

A patient with chronic pancreatitis is prescribed pancrelipase. Which instruction should the nurse include in teaching?

  1. Take the entire daily dose at bedtime.
  2. Take the capsules with each meal and snack. Correct answer.
  3. Take the capsules only when abdominal pain occurs.
  4. Take the capsules on an empty stomach one hour before eating.

Explanation

Pancrelipase replaces pancreatic enzymes that normally mix with food in the duodenum, so it must be taken with every meal and snack to support digestion. Timing it away from food leaves nothing for the enzymes to act on.

Question 29Gastroenterology Nursing Clinical Practice

When preparing to insert a nasogastric tube, the nurse measures the intended insertion length from the tip of the nose to which landmarks?

  1. The earlobe and then to the xiphoid process Correct answer.
  2. The umbilicus directly
  3. The sternal notch directly
  4. The mid-clavicle directly

Explanation

The nose-earlobe-xiphoid (NEX) measurement estimates the distance to the stomach and is the standard pre-insertion landmark technique. Measuring only to chest or abdominal surface points underestimates or overestimates tube depth.

Question 30Gastroenterology Nursing Clinical Practice

A patient with Clostridioides difficile infection has frequent diarrhea. Which infection-control measure is most important for the nurse to use?

  1. Placing the patient in a positive-pressure room
  2. Wearing a gown only when handling stool
  3. Using an alcohol-based hand rub before and after care
  4. Washing hands with soap and water Correct answer.

Explanation

C. difficile forms spores that alcohol does not reliably kill, so mechanical handwashing with soap and water is required. Contact precautions with gown and gloves for all patient contact are used in addition to sporicidal environmental cleaning.

Question 31Gastroenterology Nursing Clinical Practice

Which instruction should the nurse give a patient with gastroesophageal reflux disease to reduce nighttime symptoms?

  1. Elevate the head of the bed on blocks. Correct answer.
  2. Eat a bedtime snack each night.
  3. Drink coffee with dinner.
  4. Lie flat for 30 minutes after each meal.

Explanation

Raising the head of the bed uses gravity to keep gastric contents below the lower esophageal sphincter during sleep. Late meals, caffeine, and recumbency after eating all promote reflux.

Question 32Gastroenterology Nursing Clinical Practice

A patient is admitted with acute calculous cholecystitis. Which assessment finding should the nurse expect?

  1. Epigastric pain that is relieved by eating
  2. Painless jaundice with a palpable gallbladder
  3. Diffuse periumbilical pain that migrates to the right lower quadrant
  4. Right upper quadrant pain worsened by deep breathing during palpation Correct answer.

Explanation

Inflamed, distended gallbladder tissue produces a positive Murphy sign: right upper quadrant tenderness with inspiratory arrest when the area is palpated. Pain typically follows fatty meals and may radiate to the right scapula, accompanied by fever and nausea.

Question 33Gastroenterology Nursing Clinical Practice

Which action is correct when administering medications through a percutaneous endoscopic gastrostomy (PEG) tube?

  1. Crush sustained-release tablets and mix them with formula.
  2. Stop tube feedings for four hours after giving medications.
  3. Combine all scheduled medications in one syringe.
  4. Flush with water before and after each medication. Correct answer.

Explanation

Flushing before and after each medication clears the tube, prevents drug interactions within the lumen, and keeps the tube patent. Medications are given separately, and sustained-release or enteric-coated forms are never crushed.

Question 34Gastroenterology Nursing Clinical Practice

A patient with cirrhosis has just undergone a large-volume paracentesis. Which finding should the nurse report to the provider?

  1. Abdominal girth decreased by 4 cm from baseline
  2. Serum albumin level of 2.8 g/dL drawn this morning
  3. A small circle of serous drainage on the puncture-site dressing
  4. Heart rate 118 beats/min with blood pressure 88/54 mm Hg Correct answer.

Explanation

Removing a large volume of ascitic fluid can shift fluid out of the intravascular space, producing hypovolemia and hypotension with compensatory tachycardia. These vital-sign changes require prompt reporting and possible albumin or fluid replacement.

Question 35Gastroenterology Nursing Clinical Practice

Twelve hours after creation of an ileostomy, the nurse notes that the stoma is dark blue-black and dry. What is the appropriate action?

  1. Document the finding as a normal postoperative appearance.
  2. Reassess the stoma in 24 hours.
  3. Notify the surgeon immediately. Correct answer.
  4. Massage the stoma with warm compresses.

Explanation

A healthy stoma is beefy red to pink and moist; a dark blue-black, dry stoma indicates ischemia or necrosis and threatens bowel viability. The surgeon must be notified at once while the nurse continues to monitor and keeps the stoma visible.

Question 36Gastroenterology Nursing Clinical Practice

A patient with ulcerative colitis is beginning sulfasalazine therapy. Which instruction should the nurse include?

  1. Avoid all dairy products while taking the drug.
  2. Report fever or sore throat promptly. Correct answer.
  3. Take the medication on an empty stomach for best absorption.
  4. Stop the medication as soon as stools return to normal.

Explanation

Sulfasalazine can cause blood dyscrasias, so fever or sore throat should be reported promptly for a CBC evaluation. The drug is taken with food, continued as maintenance therapy, and may harmlessly discolor urine orange-yellow.

Question 37Gastroenterology Nursing Clinical Practice

A patient with a history of gallstones presents with a temperature of 39°C (102.2°F), jaundice, and right upper quadrant pain. Which complication should the nurse suspect?

  1. Perforated peptic ulcer
  2. Acute pancreatitis
  3. Acute hepatitis A
  4. Ascending cholangitis Correct answer.

Explanation

The combination of fever, jaundice, and right upper quadrant pain is Charcot triad, the hallmark of ascending cholangitis from an obstructed, infected biliary tree. It is a medical emergency requiring antibiotics and biliary drainage.

Question 38Gastroenterology Nursing Clinical Practice

A patient with cirrhosis who began furosemide and spironolactone two weeks ago is now confused and disoriented. Which factor most likely precipitated the encephalopathy?

  1. Hypokalemia from diuretic use Correct answer.
  2. A decrease in dietary protein
  3. A mild increase in serum transaminases
  4. A rise in serum albumin

Explanation

Hypokalemia increases renal ammonia production and worsens hepatic encephalopathy, and diuretics are a common reversible trigger. Other frequent precipitants include GI bleeding, infection, constipation, and dehydration.

Question 39Gastroenterology Nursing Clinical Practice

A patient who had a partial gastrectomy reports palpitations, diaphoresis, and abdominal cramping about 20 minutes after eating. Which instruction should the nurse give?

  1. Drink 8 ounces of fluid with each meal.
  2. Lie down for 20 to 30 minutes after eating. Correct answer.
  3. Eat three large meals each day.
  4. Increase the amount of simple carbohydrates in the diet.

Explanation

These are signs of early dumping syndrome, caused by rapid emptying of hyperosmolar chyme that draws fluid into the bowel. Lying down after meals slows transit, and the diet should feature small, frequent, low-carbohydrate meals with fluids taken between meals.

Question 40Gastroenterology Nursing Clinical Practice

A patient with a 24-hour history of hematemesis has a BUN of 42 mg/dL and a creatinine of 1.0 mg/dL. How should the nurse interpret this finding?

  1. It indicates chronic kidney disease.
  2. It reflects hemoconcentration from dehydration alone.
  3. It is expected with an upper GI bleed. Correct answer.
  4. It suggests that the bleeding has stopped.

Explanation

Blood protein absorbed from an upper GI bleed raises the BUN out of proportion to creatinine, often producing a ratio greater than 20:1. The normal creatinine makes intrinsic renal failure unlikely.

Question 41Patient Assessment and Monitoring

To document that bowel sounds are absent, the nurse should auscultate each abdominal quadrant for at least how long?

  1. 5 minutes Correct answer.
  2. 30 seconds
  3. 15 seconds
  4. 2 minutes

Explanation

Bowel sounds are intermittent, so brief auscultation cannot establish absence. Standard practice is to listen for a full 5 minutes in each quadrant before documenting absent bowel sounds.

Question 42Patient Assessment and Monitoring

A patient presents with fever and chills, right upper quadrant pain, and jaundice. This constellation of findings is most consistent with which condition?

  1. Perforated peptic ulcer
  2. Acute cholecystitis
  3. Ascending cholangitis Correct answer.
  4. Acute pancreatitis

Explanation

Fever with chills, right upper quadrant pain, and jaundice constitute Charcot triad, which classically signals infection of an obstructed biliary tree. The combination of obstruction and infection defines ascending cholangitis and warrants urgent biliary drainage.

Question 43Patient Assessment and Monitoring

Orthostatic vital signs are considered positive when, within 3 minutes of standing, the blood pressure drops by at least which amount?

  1. 20 mm Hg systolic or 10 mm Hg diastolic Correct answer.
  2. 10 mm Hg systolic or 5 mm Hg diastolic
  3. 15 mm Hg systolic or 5 mm Hg diastolic
  4. 30 mm Hg systolic or 15 mm Hg diastolic

Explanation

A fall of at least 20 mm Hg systolic or 10 mm Hg diastolic within 3 minutes of assuming an upright position defines orthostatic hypotension. It suggests volume depletion or autonomic impairment and is a useful screening finding in patients with GI blood loss.

Question 44Patient Assessment and Monitoring

Black, tarry, foul-smelling stool most likely indicates bleeding from which source?

  1. Stomach Correct answer.
  2. Splenic flexure
  3. Sigmoid colon
  4. Rectum

Explanation

Melena results when blood is exposed to gastric acid and intestinal bacteria long enough to be digested, so the bleeding source must be proximal. A minimum of roughly 50 to 100 mL of blood and prolonged transit time are required to produce black tarry stool.

Question 45Patient Assessment and Monitoring

Which item is essential before beginning moderate sedation for an endoscopic procedure?

  1. A signed consent form
  2. A patent IV line Correct answer.
  3. An indwelling urinary catheter
  4. An arterial line

Explanation

Moderate sedation requires reliable IV access so that sedatives, fluids, and reversal agents can be given promptly if a complication develops. Access must be verified and functioning before the first dose of sedation is administered.

Question 46Patient Assessment and Monitoring

Which pain assessment tool is most appropriate for a patient with advanced dementia who cannot self-report pain?

  1. PAINAD behavioral scale Correct answer.
  2. Visual analog scale
  3. Wong-Baker FACES scale
  4. 0-to-10 numeric rating scale

Explanation

The PAINAD scale scores observable behaviors such as breathing, vocalization, facial expression, body language, and consolability, making it suitable for patients who cannot report pain. All of the other listed tools depend on the patient's own numerical or pictorial self-report.

Question 47Patient Assessment and Monitoring

A patient with a 3-month history of intermittent rectal bleeding has a hemoglobin of 9 g/dL and a low mean corpuscular volume. This pattern is most consistent with which condition?

  1. Megaloblastic anemia
  2. Acute blood loss anemia
  3. Hemolytic anemia
  4. Iron deficiency anemia Correct answer.

Explanation

Chronic, slow blood loss depletes iron stores over time, producing a microcytic, hypochromic anemia. The long history and low mean corpuscular volume point to iron deficiency rather than an acute dilutional drop in hemoglobin.

Question 48Patient Assessment and Monitoring

Which measurement is the most reliable indicator of fluid status in a patient with ascites?

  1. Intake and output
  2. Daily weight Correct answer.
  3. Abdominal girth
  4. Serum sodium

Explanation

Daily weight measured at the same time on the same scale reflects total body fluid balance more accurately than any other single measure. Girth and intake-output records are useful adjuncts but are subject to measurement error and incomplete recording.

Question 49Patient Assessment and Monitoring

During moderate sedation, pulse oximetry reads 97% on 2 L of nasal oxygen while capnography shows a rising end-tidal carbon dioxide and a respiratory rate of 6 breaths per minute. What is the best interpretation?

  1. The nasal cannula is skewing the capnography reading
  2. Hypoventilation is developing and precedes desaturation Correct answer.
  3. Oxygenation is adequate, so ventilation is adequate
  4. The oxygen flow rate should be increased to correct this trend

Explanation

Capnography measures ventilation directly, so a rising end-tidal carbon dioxide with a falling respiratory rate shows hypoventilation even while oxygen saturation remains normal. Supplemental oxygen can keep saturation falsely reassuring until apnea is well established, which is why capnography detects respiratory depression earlier.

Question 50Patient Assessment and Monitoring

Six hours after ERCP, a patient develops severe epigastric pain radiating to the back, nausea, and a lipase level four times the upper limit of normal. What is the most likely cause?

  1. Perforation
  2. Cholangitis
  3. Pancreatitis Correct answer.
  4. Biliary colic

Explanation

Post-ERCP pancreatitis typically presents within hours with epigastric pain radiating to the back, nausea, and a lipase rise greater than three times the upper limit of normal. The timing and enzyme elevation distinguish it from other post-procedure complications.