During EGD on a patient with chronic heartburn, the endoscopist calls out measurements from the incisors for documentation: the squamocolumnar junction (Z-line) and the proximal margin of the gastric folds are both at 36 cm, and the diaphragmatic pinch is at 40 cm. Which finding should the nurse expect the report to describe?

A 4 cm sliding hiatal hernia without a columnar-lined segment

A paraesophageal hernia with the junction fixed below the diaphragm

A normally positioned gastroesophageal junction at 36 cm

A 4 cm columnar-lined segment suspicious for Barrett esophagus

An RN is monitoring a patient under moderate sedation during colonoscopy. The endoscopist finds a large polyp and asks the RN to step to the cart and operate the snare because the technician is assisting in another room. What is the RN's MOST appropriate response?

Remain on monitoring and request that another qualified staff member assist with the snare

Turn up the pulse oximeter alarm volume, then step to the cart to operate the snare

Operate the snare briefly while glancing at the monitor, since sedation is only moderate

Ask the endoscopist to give more sedation first so the patient stays still during snaring

A patient with a left total hip replacement is having hot snare polypectomy in the sigmoid colon with a monopolar electrosurgical unit. Which site is BEST for the dispersive electrode?

Right upper thigh, clean and dry, over a well-vascularized muscle mass

Left upper thigh, because it lies closest to the sigmoid colon polyp site

Right lower calf, because placement far from the abdomen is the safest choice

Over the sacrum, where the patient's weight holds the pad firmly in place

The nurse is preparing four patients for procedures. For which patient should the nurse anticipate an order for a prophylactic antibiotic before the procedure?

A patient scheduled for percutaneous endoscopic gastrostomy (PEG) placement

A patient who had a total knee replacement 3 months ago and is having an EGD

A patient with cirrhosis, no bleeding, scheduled for elective variceal screening EGD

A patient with a prosthetic aortic valve scheduled for colonoscopy with polypectomy

A patient scheduled for ERCP asks why the endoscopist uses a different scope from the one used for a routine upper endoscopy. Which explanation by the nurse is accurate?

The major papilla is on the medial wall of the second part of the duodenum, so a side-viewing scope faces it

The papilla lies beyond the ligament of Treitz, so a longer scope is needed to reach it in the jejunum

The papilla is in the third part of the duodenum behind the SMA, so an angled tip is needed to pass it

The papilla sits on the lateral wall of the duodenal bulb, so a forward-viewing scope cannot pass the pylorus

A patient who had a coronary stent placed 2 months ago takes clopidogrel and aspirin and now needs acid suppression to reduce GI bleeding risk. Which order should the nurse question because of a clinically relevant drug interaction?

Famotidine 20 mg orally twice daily

Pantoprazole 40 mg orally daily

During hot snare polypectomy in a diaphoretic patient, the electrosurgical unit alarms and stops delivering current. The nurse finds one edge of the dispersive electrode lifting from the thigh. What is the MOST appropriate action?

Replace it with a new pad on clean, dry skin over muscle, then reset the unit

Move the same pad to the opposite thigh after drying the skin with a towel

Tape the lifted edge down firmly and resume the procedure at the same setting

Silence the alarm and raise the power setting to make up for the pad contact

After a rapid IV bolus of a large fentanyl dose, the nurse cannot ventilate the patient with a bag-valve-mask; the chest feels stiff and the capnography waveform is absent. Which cause and response are MOST likely?

Opioid chest wall rigidity; call for help and anticipate naloxone or a paralytic

Bronchospasm from histamine release; give inhaled albuterol through the bag

Benzodiazepine overdose; give flumazenil and wait for the chest to relax again

Malignant hyperthermia from fentanyl; begin cooling and prepare dantrolene

CGRN Exam

Free CGRN Practice Questions

10 sample questions for the CGRN Exam, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: GI Anatomy and Physiology, Upper GI Disorders: Esophagus, Stomach and Duodenum, Assessment, Pharmacology, Patient Teaching and Professional Practice, Diagnostic Endoscopy and Bowel Preparation, Infection Prevention and Environmental Safety, Therapeutic and Advanced Endoscopy, Sedation, Monitoring and Emergency Response, Medication and Fluid Administration, Endoscope Reprocessing and High-Level Disinfection.

Question 1 · GI Anatomy and Physiology
During EGD on a patient with chronic heartburn, the endoscopist calls out measurements from the incisors for documentation: the squamocolumnar junction (Z-line) and the proximal margin of the gastric folds are both at 36 cm, and the diaphragmatic pinch is at 40 cm. Which finding should the nurse expect the report to describe?
- A.A paraesophageal hernia with the junction fixed below the diaphragm
- B.A 4 cm sliding hiatal hernia without a columnar-lined segment
- C.A normally positioned gastroesophageal junction at 36 cm
- D.A 4 cm columnar-lined segment suspicious for Barrett esophagus
Show answer and explanation
Answer: B. A 4 cm sliding hiatal hernia without a columnar-lined segment
The gastroesophageal junction is marked by the proximal end of the gastric folds; when it sits 4 cm above the diaphragmatic pinch, the stomach has slid into the chest as a sliding hiatal hernia. Because the Z-line coincides with the top of the gastric folds, there is no columnar-lined segment to suggest Barrett esophagus. A paraesophageal hernia keeps the junction at the diaphragm while the fundus herniates alongside it.
Question 2 · Assessment, Pharmacology, Patient Teaching and Professional Practice
An RN is monitoring a patient under moderate sedation during colonoscopy. The endoscopist finds a large polyp and asks the RN to step to the cart and operate the snare because the technician is assisting in another room. What is the RN's MOST appropriate response?
- A.Turn up the pulse oximeter alarm volume, then step to the cart to operate the snare
- B.Operate the snare briefly while glancing at the monitor, since sedation is only moderate
- C.Ask the endoscopist to give more sedation first so the patient stays still during snaring
- D.Remain on monitoring and request that another qualified staff member assist with the snare
Show answer and explanation
Answer: D. Remain on monitoring and request that another qualified staff member assist with the snare
SGNA's position is that the RN monitoring a patient receiving moderate sedation must have no other responsibilities that would interrupt continuous monitoring, so a second qualified person must assist with the snare. Splitting attention, even briefly or with louder alarms, delays detection of hypoventilation and airway obstruction, and deepening sedation to compensate for staffing increases the risk.
Question 3 · Infection Prevention and Environmental Safety
A patient with a left total hip replacement is having hot snare polypectomy in the sigmoid colon with a monopolar electrosurgical unit. Which site is BEST for the dispersive electrode?
- A.Left upper thigh, because it lies closest to the sigmoid colon polyp site
- B.Right upper thigh, clean and dry, over a well-vascularized muscle mass
- C.Right lower calf, because placement far from the abdomen is the safest choice
- D.Over the sacrum, where the patient's weight holds the pad firmly in place
Show answer and explanation
Answer: B. Right upper thigh, clean and dry, over a well-vascularized muscle mass
The dispersive electrode belongs on clean, dry skin over a well-vascularized muscle mass reasonably close to the operative site, away from metal implants, bony prominences, scar tissue and dense hair. The left thigh sits near the hip prosthesis, the sacrum is a bony prominence, and placing the pad far from the site lengthens the current path through the body.
Question 4 · Sedation, Monitoring and Emergency Response
A 71-year-old man is scheduled for colonoscopy with moderate sedation. The nurse reviews his medication list and the sedation orders before the procedure. Home medications: phenelzine 15 mg three times daily, metformin 500 mg twice daily, simvastatin 20 mg nightly. Allergies: none known. ASA class II. Last solid food more than 8 hours ago.
Order Detail
1 Meperidine 25 mg IV, may repeat in 25 mg increments
2 Midazolam 1 mg IV, may repeat in 0.5-1 mg increments
3 Naloxone 0.4 mg diluted, titrate per protocol
4 Flumazenil 0.2 mg IV per protocol
Which order should the nurse question?
- A.Flumazenil 0.2 mg IV per protocol
- B.Midazolam 1 mg IV, may repeat in 0.5-1 mg increments
- C.Naloxone 0.4 mg diluted, titrate per protocol
- D.Meperidine 25 mg IV, may repeat in 25 mg increments
Show answer and explanation
Answer: D. Meperidine 25 mg IV, may repeat in 25 mg increments
Meperidine combined with a monoamine oxidase inhibitor such as phenelzine can cause serotonin syndrome or severe blood pressure instability, so the nurse questions it and the provider selects an alternative. Midazolam in small increments suits an older adult, and having both reversal agents ordered and available is appropriate.
Question 5 · Medication and Fluid Administration
The nurse is preparing four patients for procedures. For which patient should the nurse anticipate an order for a prophylactic antibiotic before the procedure?
- A.A patient who had a total knee replacement 3 months ago and is having an EGD
- B.A patient with cirrhosis, no bleeding, scheduled for elective variceal screening EGD
- C.A patient with a prosthetic aortic valve scheduled for colonoscopy with polypectomy
- D.A patient scheduled for percutaneous endoscopic gastrostomy (PEG) placement
Show answer and explanation
Answer: D. A patient scheduled for percutaneous endoscopic gastrostomy (PEG) placement
Antibiotic prophylaxis before PEG placement reduces peristomal wound infection and is recommended. Routine prophylaxis to prevent endocarditis is not recommended for GI endoscopy, even with a prosthetic valve, and it is not recommended for prosthetic joints. Patients with cirrhosis receive antibiotics, such as ceftriaxone, when they have acute GI bleeding, not for an elective screening exam.
Question 6 · GI Anatomy and Physiology
A patient scheduled for ERCP asks why the endoscopist uses a different scope from the one used for a routine upper endoscopy. Which explanation by the nurse is accurate?
- A.The papilla lies beyond the ligament of Treitz, so a longer scope is needed to reach it in the jejunum
- B.The major papilla is on the medial wall of the second part of the duodenum, so a side-viewing scope faces it
- C.The papilla is in the third part of the duodenum behind the SMA, so an angled tip is needed to pass it
- D.The papilla sits on the lateral wall of the duodenal bulb, so a forward-viewing scope cannot pass the pylorus
Show answer and explanation
Answer: B. The major papilla is on the medial wall of the second part of the duodenum, so a side-viewing scope faces it
The ampulla of Vater opens through the major duodenal papilla on the medial wall of the descending (second) part of the duodenum, so a side-viewing duodenoscope with an elevator gives an en face view for cannulation. The ligament of Treitz marks the duodenojejunal junction, well beyond the papilla, and the bulb (first part) and the third part crossed by the SMA do not hold the major papilla.
Question 7 · Assessment, Pharmacology, Patient Teaching and Professional Practice
A patient who had a coronary stent placed 2 months ago takes clopidogrel and aspirin and now needs acid suppression to reduce GI bleeding risk. Which order should the nurse question because of a clinically relevant drug interaction?
- A.Omeprazole 20 mg orally daily
- B.Rabeprazole 20 mg orally daily
- C.Famotidine 20 mg orally twice daily
- D.Pantoprazole 40 mg orally daily
Show answer and explanation
Answer: A. Omeprazole 20 mg orally daily
Omeprazole (like esomeprazole) inhibits CYP2C19, the enzyme that converts clopidogrel to its active metabolite, so FDA labeling advises avoiding the combination; pantoprazole and rabeprazole have much weaker effects on this pathway. Famotidine does not reduce clopidogrel activation, although it protects against ulcers less effectively than a PPI.
Question 8 · Infection Prevention and Environmental Safety
During hot snare polypectomy in a diaphoretic patient, the electrosurgical unit alarms and stops delivering current. The nurse finds one edge of the dispersive electrode lifting from the thigh. What is the MOST appropriate action?
- A.Move the same pad to the opposite thigh after drying the skin with a towel
- B.Tape the lifted edge down firmly and resume the procedure at the same setting
- C.Replace it with a new pad on clean, dry skin over muscle, then reset the unit
- D.Silence the alarm and raise the power setting to make up for the pad contact
Show answer and explanation
Answer: C. Replace it with a new pad on clean, dry skin over muscle, then reset the unit
The return electrode monitoring alarm signals poor pad contact, which concentrates current over a smaller area and can cause a burn, so the pad is replaced with a new one on a clean, dry, well-vascularized site. Taping the edge does not restore full contact, raising power increases burn risk, and dispersive pads are single-use and lose adhesion once removed.
Question 9 · Sedation, Monitoring and Emergency Response
After a rapid IV bolus of a large fentanyl dose, the nurse cannot ventilate the patient with a bag-valve-mask; the chest feels stiff and the capnography waveform is absent. Which cause and response are MOST likely?
- A.Bronchospasm from histamine release; give inhaled albuterol through the bag
- B.Benzodiazepine overdose; give flumazenil and wait for the chest to relax again
- C.Opioid chest wall rigidity; call for help and anticipate naloxone or a paralytic
- D.Malignant hyperthermia from fentanyl; begin cooling and prepare dantrolene
Show answer and explanation
Answer: C. Opioid chest wall rigidity; call for help and anticipate naloxone or a paralytic
Rapid high-dose fentanyl can cause rigidity of the chest wall and glottic muscles that prevents ventilation; treatment is naloxone and, if needed, a neuromuscular blocker with airway management by an anesthesia professional. Flumazenil does not reverse opioids, fentanyl releases little histamine, and malignant hyperthermia is triggered by volatile anesthetic gases and succinylcholine, not opioids.
Question 10 · Medication and Fluid Administration
A patient arrives with acute pancreatitis, heart rate 112, and dry mucous membranes, and has no history of heart or kidney failure. Which IV solution should the nurse anticipate for initial fluid resuscitation?
- A.0.45% sodium chloride
- B.Dextrose 5% in water
- C.Lactated Ringer's solution
- D.3% sodium chloride
Show answer and explanation
Answer: C. Lactated Ringer's solution
Isotonic crystalloid is used for early resuscitation in acute pancreatitis, and lactated Ringer's is generally preferred, given at a moderate rate with close reassessment. D5W and 0.45% saline are hypotonic in the body and shift water into cells rather than expanding the intravascular volume. Hypertonic 3% saline is reserved for severe symptomatic hyponatremia.

Order	Detail
1	Meperidine 25 mg IV, may repeat in 25 mg increments
2	Midazolam 1 mg IV, may repeat in 0.5-1 mg increments
3	Naloxone 0.4 mg diluted, titrate per protocol
4	Flumazenil 0.2 mg IV per protocol

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