General Nursing Care
21%of exam
GI Procedures
35%of exam
Patient Care Interventions
25%of exam
Safety + Infection Control
19%of exam
Quick Facts
- Exam
- CGRN
- Body
- ABCGN / Prometric
- Questions
- 175 (150 scored)
- Time
- 3 hours
- Pass
- 450 scaled score
- Valid
- 5 years
- Fee
- $430-$520
- Blueprint
- ABCGN 2026
Crohn's vs Ulcerative Colitis
Crohn's
- Transmural
- Skip lesions
- Mouth to anus
UC
- Mucosa only
- Continuous
- Colon/rectum
Patchy depth vs continuous mucosa
GI Anatomy
- LES
- Esophagus-stomach sphincter
- Pylorus
- Stomach-duodenum valve
- Duodenum
- First small intestine
- Ampulla of Vater
- Bile/pancreatic duct outlet
- Sphincter of Oddi
- Controls ampulla flow
- Ileocecal valve
- Ileum-to-colon junction
- Bile
- Emulsifies dietary fat
GI Conditions
- GERD
- Acid reflux esophagitis
- Barrett's
- Precancerous esophageal metaplasia
- PUD
- Gastric/duodenal ulcer
- Ulcerative colitis
- Continuous colonic mucosa
- Crohn's
- Transmural, skip lesions
- Cirrhosis
- Liver scarring, varices
- Pancreatitis
- Elevated lipase/amylase
- Dysphagia + weight loss
- Red-flag malignancy
Assessment
- Allergy check
- Latex, contrast, drugs
- Anticoagulants
- Bleeding risk review
- NPO status
- Confirm aspiration risk
- Baseline vitals
- Pre-sedation reference
- ASA class
- Sedation risk stratifier
- Time-out
- Verify patient/procedure
GI Pharmacology
- PPI
- Blocks acid pump
- H2 blocker
- Reduces gastric acid
- Simethicone
- Reduces bowel gas
- PEG solution
- Colonoscopy bowel prep
- 5-ASA
- IBD anti-inflammatory
- Octreotide
- Reduces splanchnic flow
Professional Issues
- HIPAA
- Protects patient privacy
- Informed consent
- Provider obtains; nurse witnesses
- Scope of practice
- State/role limits
- Advance directive
- Patient care wishes
- Documentation
- Objective, timely, accurate
- Patient advocacy
- Protect patient interests
Moderate vs Deep Sedation
Moderate
- Purposeful response
- Airway maintained
- RN may monitor
Deep
- Repeated stimulus
- Airway risk
- Anesthesia provider
Responsive vs anesthesia-led
Sedation Level Picker
- Routine EGD/colonoscopy→Moderate sedation(Midazolam + fentanyl)
- Anxiety/anxiolysis only→Minimal sedation(Responds normally)
- Long/complex ERCP→Deep sedation(Anesthesia-administered)
- Propofol ordered→Anesthesia provider(Not RN-pushed)
- High ASA/airway risk→Anesthesia consult(Plan escalation)
- Patient unarousable→Stop + support airway(Oversedation)
Endoscopic Procedures
- EGD
- Upper GI scope
- Colonoscopy
- Full colon exam
- ERCP
- Biliary/pancreatic duct access
- EUS
- Ultrasound staging/sampling
- Sigmoidoscopy
- Distal colon only
- Capsule endoscopy
- Small-bowel imaging
- Polypectomy
- Removes colon polyp
- Variceal banding
- Ligates esophageal varices
EGD vs Colonoscopy
EGD
- Upper GI tract
- NPO prep
- Bite block
Colonoscopy
- Colon
- Bowel prep
- Left lateral
Upper scope vs lower scope
Scope + Accessories
- Insertion tube
- Flexible scope shaft
- Air/water channel
- Insufflation + lens rinse
- Biopsy channel
- Suction + accessories
- Elevator
- Duodenoscope accessory guide
- Biopsy forceps
- Obtains tissue sample
- Snare
- Polyp resection loop
- Cytology brush
- Cellular sampling tool
- Hemoclip
- Mechanical bleeding control
EGD Path
- Step 1
- Mouth + oropharynx
- Step 2
- Esophagus
- Step 3
- Stomach
- Step 4
- Pylorus
- Step 5
- Duodenum
- Bite block
- Protects scope/teeth
Specimen Handling
- Formalin
- Routine histology fixative
- Saline
- H. pylori rapid test
- Label at bedside
- Two patient identifiers
- Site labeling
- Document biopsy location
- Cytology
- Brushings/fluid analysis
- Chain of custody
- Tracked specimen handoff
Sedation Agents
- Midazolam
- Benzodiazepine, amnesia/anxiolysis
- Fentanyl
- Opioid analgesia
- Propofol
- Deep sedation, anesthesia-led
- Flumazenil
- Reverses benzodiazepine
- Naloxone
- Reverses opioid
- Topical anesthetic
- Suppresses gag reflex
- Capnography
- Monitors exhaled CO2
Perforation Triad
Pain + Fever + Leukocytosis = perforation
Severe painFeverRising WBCNotify provider
Flumazenil vs Naloxone
Flumazenil
- Reverses benzodiazepine
- Midazolam antidote
- Seizure caution
Naloxone
- Reverses opioid
- Fentanyl antidote
- Re-sedation watch
Benzo reversal vs opioid reversal
Complication Response Picker
- Pain, fever, leukocytosis→Suspect perforation(Notify provider, NPO)
- Hypoxia post-sedation→Airway + oxygen(Reversal if opioid/benzo)
- Delayed rectal bleeding→Post-polypectomy bleed(Assess hemodynamics)
- Pain + lipase post-ERCP→Suspect pancreatitis(Monitor, IV fluids)
- Bradycardia + hypotension→Vasovagal response(Stop, position, fluids)
- Apneic + pulseless→Begin CPR(Activate code)
Procedure Complications
- Perforation
- Pain, fever, leukocytosis
- Post-polypectomy bleed
- Delayed hematochezia
- Post-ERCP pancreatitis
- Pain, elevated lipase
- Aspiration
- Gastric contents, hypoxia
- Oversedation
- Hypoventilation, hypoxemia
- Vasovagal
- Bradycardia, hypotension
- Cholangitis
- Fever, jaundice, RUQ pain
Reversal Pairing
Flumazenil = benzo | Naloxone = opioid
Flumazenil: midazolamNaloxone: fentanylWatch re-sedation
Upper vs Lower GI Bleed
Upper
- Hematemesis
- Melena
- Above ligament Treitz
Lower
- Hematochezia
- Bright red
- Below ligament Treitz
Black/vomited vs bright rectal
Emergency Response
- Unresponsive + apneic
- Start CPR
- Stop procedure
- First with instability
- Airway first
- Reposition, oxygen, suction
- Reversal agents
- Naloxone/flumazenil ready
- Crash cart
- Defibrillator + emergency drugs
- Trendelenburg
- Hypotension positioning
GI Bleeding + Therapy
- Hematemesis
- Upper GI bleed
- Melena
- Upper GI bleed
- Hematochezia
- Lower GI bleed
- Octreotide
- Variceal bleed adjunct
- Epinephrine injection
- Endoscopic hemostasis
- Large-bore IV
- Rapid volume access
IV + Nutrition
- Isotonic crystalloid
- Initial volume replacement
- NS / LR
- First-line resuscitation fluids
- Hypokalemia
- Vomiting/diarrhea risk
- Enteral nutrition
- Gut works first
- TPN
- Nonfunctional GI tract
- Refeeding risk
- Monitor phosphate/potassium
Reprocessing Order
Preclean | Leak | Clean | HLD | Dry | Store
Preclean: bedsideLeak: detect damageHLD: disinfectDry: alcohol/air
HLD vs Sterilization
HLD
- Semicritical items
- Flexible endoscopes
- Kills most microbes
Sterilization
- Critical items
- Biopsy forceps
- Kills all spores
Contacts mucosa vs sterile tissue
Reprocessing Level Picker
- Flexible endoscope→High-level disinfection(Semicritical)
- Biopsy forceps→Sterilization(Critical, breaks mucosa)
- Snare/cytology brush→Sterilize or single-use(Critical)
- BP cuff/stethoscope→Low-level disinfection(Noncritical)
- Visibly soiled scope→Manual clean first(Before HLD)
- Reprocessing failed→Repeat full cycle(Do not use)
Scope Reprocessing
- Step 1: Precleaning
- Bedside wipe, channel flush
- Step 2: Leak test
- Detect scope damage
- Step 3: Manual clean
- Brush + enzymatic detergent
- Step 4: HLD
- High-level disinfection
- Step 5: Rinse/dry
- Alcohol flush, forced air
- Step 6: Storage
- Hang vertical, ventilated
C. diff Hygiene
C. diff = soap and water, not gel
Spore-formingAlcohol failsContact precautions
Disinfection Levels
- Critical item
- Sterilization required
- Semicritical item
- High-level disinfection minimum
- Noncritical item
- Low-level disinfection
- Flexible endoscope
- Semicritical = HLD
- Biopsy forceps
- Critical = sterilize
- Spaulding system
- Classifies reprocessing level
Infection Control
- C. difficile
- Soap and water
- Alcohol gel
- Ineffective on spores
- Contact precautions
- Gown + gloves
- MDRO
- Multidrug-resistant organism
- Standard precautions
- All patients, all time
- Single-use accessory
- Do not reprocess
PPE + Chemical Safety
- PPE
- Gloves, gown, eye/face
- Glutaraldehyde
- Respiratory/skin irritant
- OPA
- Stains skin gray
- SDS
- Chemical hazard reference
- Ventilation
- Limits vapor exposure
- Body mechanics
- Prevents staff injury
Common Traps
HLD vs sterilize
Scope = HLD ≠ Forceps = sterilize
Wrong reversal agent
Flumazenil = benzo ≠ Naloxone = opioid
C. diff hand hygiene
Soap and water ≠ Not alcohol gel
Consent responsibility
Provider obtains ≠ Nurse witnesses only
Crohn's vs UC
Crohn's transmural skip ≠ UC continuous mucosa
Bleed location
Melena = upper ≠ Hematochezia = lower
RN propofol limit
Propofol = anesthesia ≠ Not RN-administered
Last Minute
- 1.Weights: 21 / 35 / 25 / 19
- 2.GI Procedures = largest domain
- 3.Scope = HLD; forceps = sterilize
- 4.Flumazenil = benzo; naloxone = opioid
- 5.C. diff = soap and water
- 6.Perforation = pain, fever, WBC
- 7.Provider obtains consent; nurse witnesses
- 8.Propofol = anesthesia provider only
- 9.Melena = upper; hematochezia = lower
- 10.Preclean before high-level disinfection
- 11.Unstable = stop procedure first
Buy on Amazon
Study guide on Mometrix