Free CGRN Exam Flashcards

Ring of smooth muscle at the gastroesophageal junction that prevents reflux of gastric contents into the esophagus. A weak or chronically relaxed LES is the primary mechanism of GERD, not simply acid overproduction.

The shared opening into the duodenum where the common bile duct and pancreatic duct converge, surrounded by the sphincter of Oddi. It is the target the endoscopist cannulates during ERCP, so its anatomy is central to biliary intervention.

Bile is produced by the liver, stored and concentrated in the gallbladder, and emulsifies dietary fat so pancreatic lipase can digest it. Obstruction of bile flow causes pale stools, dark urine, and jaundice.

Ulcerative colitis causes continuous mucosal inflammation limited to the colon, usually starting in the rectum. Crohn's disease produces transmural, skip-pattern lesions anywhere from mouth to anus. This distinction guides surveillance colonoscopy and biopsy strategy.

Progressive difficulty swallowing solids with unintentional weight loss in an older adult suggests esophageal malignancy and warrants prompt EGD with biopsy. Intermittent dysphagia to solids and liquids together points more toward a motility disorder.

EGD evaluates the esophagus, stomach, and duodenum for bleeding, dysphagia, ulcers, varices, suspected malignancy, and persistent dyspepsia. It also permits therapy such as biopsy, dilation, hemostasis, and foreign-body retrieval in a single exam.

The left lateral decubitus position lets secretions and any vomitus pool in the dependent cheek and drain out of the mouth rather than down the airway, reducing aspiration risk during upper endoscopy with the bite block in place.

When topical pharyngeal anesthetic is used, the gag reflex must return before the patient eats or drinks. Offering food too early risks aspiration because protective airway reflexes are still blunted.

Complete colon cleansing is essential because residual stool obscures small polyps and flat lesions, lowering adenoma detection. Inadequate prep often forces an earlier repeat exam. A split-dose regimen with the second dose closer to the procedure improves right-colon cleansing.

Dividing the laxative so part is taken the evening before and part 4-6 hours before the procedure produces a cleaner right colon and better mucosal visualization than taking the entire dose the night before.

Large-volume polyethylene glycol is generally preferred over phosphate-based preps in patients with renal disease, heart failure, or on diuretics/ACE inhibitors, because phosphate preps can cause dangerous fluid shifts and acute phosphate nephropathy.

Patients may have clear liquids such as water, broth, apple juice, and gelatin but must avoid red or purple dyes, which can mimic blood on the mucosa, and avoid solid food, milk, and pulp that obscure the view.

Endoscopic retrograde cholangiopancreatography combines endoscopy and fluoroscopy to diagnose and treat biliary and pancreatic duct disease, including stone removal, stricture dilation, and stent placement. It is therapeutic far more often than purely diagnostic today.

The most common serious ERCP complication is pancreatitis. Suspect it when the patient develops new persistent epigastric or back pain with nausea after the procedure; rising serum amylase/lipase confirms it. Early recognition and IV fluids are key nursing priorities.

Aggressive periprocedural lactated Ringer's hydration, rectal NSAID prophylaxis when not contraindicated, and pancreatic duct stenting in high-risk patients lower the incidence of post-ERCP pancreatitis. The nurse monitors for early abdominal pain in recovery.

Charcot's triad of fever, right-upper-quadrant pain, and jaundice signals ascending cholangitis, often from an obstructing stone or failed biliary drainage. It is a medical emergency requiring antibiotics and urgent biliary decompression.

Sedation is a continuum: minimal (anxiolysis), moderate ('conscious'—purposeful response to voice/touch, airway maintained), deep (purposeful response only to repeated/painful stimulus, airway support may be needed), and general anesthesia. Patients can drift deeper than intended.

In moderate sedation the patient responds purposefully to verbal or light tactile stimulation and maintains a patent airway and adequate spontaneous ventilation without intervention. Loss of purposeful response means the patient has progressed to deep sedation.

Capnography measures end-tidal CO2 and detects hypoventilation or apnea before pulse oximetry shows desaturation, because oxygen saturation lags—especially with supplemental oxygen. It provides the earliest warning of respiratory depression during sedation.

Supplemental oxygen keeps SpO2 high even while the patient is hypoventilating and retaining CO2, delaying recognition of respiratory depression. This is why capnography and direct observation of respiratory effort are essential, not just the pulse oximeter.

Naloxone reverses opioid-induced respiratory depression. Its duration is shorter than that of many opioids, so the patient can re-sedate after it wears off and must be monitored for a prolonged period; repeat dosing may be required.

Flumazenil reverses benzodiazepine sedation but can precipitate seizures in benzodiazepine-dependent patients and has a short duration with re-sedation risk. It is not a routine substitute for airway management and continued monitoring.

If the sedated patient develops snoring respirations or obstruction, the immediate action is an airway-opening maneuver (chin lift/jaw thrust) and stimulation, plus oxygen—before reaching for reversal agents. Most sedation airway problems are positional and respond to repositioning.

The ASA class summarizes a patient's systemic disease burden and predicts sedation risk. Higher ASA class (III or above) signals greater likelihood of adverse events and may warrant anesthesia involvement rather than nurse-administered moderate sedation.

Before discharge the patient should have stable vital signs, baseline mental status, intact protective reflexes, controlled pain, and a responsible adult escort. Standardized post-anesthesia scoring helps document recovery; patients must not drive for the rest of the day.

Immediately after the procedure, the scope is bedside-precleaned by wiping the insertion tube and flushing/suctioning channels with detergent. This prevents organic debris from drying and forming biofilm before transport to the reprocessing room.

A leak test is performed before manual cleaning to detect damage to the scope's internal channels or outer sheath. Reprocessing a leaking scope can let fluid and contamination penetrate the interior, so a failed leak test removes the scope from service for repair.

Thorough manual cleaning with channel brushing and detergent must precede high-level disinfection. Disinfectants cannot penetrate retained organic soil or biofilm, so skipping or shortcutting cleaning is the single biggest cause of disinfection failure.

Flexible endoscopes are semicritical devices and at minimum require high-level disinfection, which kills all microorganisms except large numbers of bacterial spores. Manufacturer-specified contact time and solution concentration must be met for HLD to be effective.

Channels are purged with forced air (often alcohol-assisted) and the scope is hung vertically in a ventilated cabinet. Residual moisture promotes waterborne bacterial growth such as Pseudomonas, so effective drying is part of preventing patient infection.

Duodenoscopes have a complex elevator mechanism that is difficult to clean and has been linked to CRE transmission. Strict step-by-step reprocessing, attention to the elevator channel, and use of disposable-component or single-use designs reduce this risk.

Critical items entering sterile tissue require sterilization (e.g., biopsy forceps). Semicritical items contacting mucous membranes require high-level disinfection (flexible endoscopes). Noncritical items contacting intact skin need low-level disinfection.

C. difficile spores resist alcohol, so alcohol-based hand rub is inadequate—soap-and-water handwashing and contact precautions are required. Spore-killing agents such as sodium hypochlorite are needed for surface disinfection in affected rooms.

Standard precautions treat all blood and body fluids as potentially infectious for every patient, requiring hand hygiene and PPE such as gloves, gown, mask, and eye protection during procedures because endoscopy routinely generates splash and aerosol.

Glutaraldehyde HLD solution is a respiratory and mucous-membrane irritant. Use it only in a ventilated, enclosed reprocessing area with appropriate PPE and exposure monitoring; symptoms of overexposure include eye, nose, and throat irritation and asthma-like reactions.

Bleeding is the most common complication after polypectomy and can be immediate or delayed by days. The nurse teaches the patient to report rectal bleeding, dizziness, or melena after discharge and monitors for tachycardia and hypotension in recovery.

Perforation presents as severe persistent abdominal pain, abdominal distention/rigidity, subcutaneous emphysema, fever, or tachycardia after the procedure. It is a surgical emergency—stop oral intake, notify the provider immediately, and prepare for imaging and possible surgery.

Variceal banding places elastic bands at the base of esophageal varices to obliterate them and is first-line endoscopic therapy for variceal bleeding. Post-procedure the patient may have transient dysphagia/chest discomfort and should avoid foods that could dislodge bands.

Airway, breathing, and circulation come first: ensure airway protection, give oxygen, establish large-bore IV access, and begin fluid resuscitation while monitoring for hypovolemic shock. Hemodynamic stabilization precedes definitive endoscopic therapy.

Tachycardia and narrowing pulse pressure appear before frank hypotension because compensatory vasoconstriction maintains pressure initially. Restlessness, cool clammy skin, and decreased urine output are early warnings that demand rapid intervention.

Each biopsy or polyp specimen must be labeled at the point of collection with the patient's identifiers and the precise anatomic site. Mislabeled or unlabeled specimens can lead to a wrong diagnosis or repeat procedure and are a serious patient-safety event.

Routine biopsy tissue is placed in formalin promptly to preserve cellular architecture; delay or drying degrades the sample. Certain specimens (e.g., for specific microbiology or research) require different handling, so the nurse confirms requirements before collection.

Gastric biopsies for a rapid urease test are placed directly into the test medium rather than formalin, because formalin destroys the urease activity needed to detect Helicobacter pylori. Knowing the test ordered determines correct specimen handling.

A pre-procedure time-out verifies correct patient with two identifiers, correct procedure, consent, allergies, and anticoagulation status. This universal-protocol step prevents wrong-patient and wrong-procedure events and is documented before sedation begins.

The provider performing the procedure explains the risks, benefits, and alternatives; the nurse witnesses the signature and confirms the patient understands and is not over-sedated. Consent must be obtained before any sedation is administered.

Patients on warfarin, DOACs, or antiplatelet agents need individualized periprocedural instructions balancing bleeding risk against thromboembolic risk. The nurse confirms the plan was given by the provider and never independently tells a patient to stop these drugs.

Teach the patient that mild bloating and cramping from insufflated gas are expected and relieved by ambulation and passing flatus, but severe abdominal pain, fever, or significant rectal bleeding must be reported immediately as they may signal perforation or bleeding.

Keep the percutaneous endoscopic gastrostomy site clean and dry and avoid excess tension on the tube. If a newly placed PEG is dislodged before the tract matures, the nurse must notify the provider promptly because blind reinsertion risks misplacement into the peritoneum.

Adherence to fasting guidelines reduces the risk of aspiration of gastric contents during sedation when protective reflexes are blunted. A patient who did not follow NPO instructions may need the procedure rescheduled or anesthesia consultation rather than proceeding.

Simethicone is an antifoaming agent that reduces bubbles and foam to improve mucosal visualization. When introduced through the endoscope, channels and water bottles require careful cleaning afterward, since residue has been associated with reprocessing concerns.