1
2026 MEDICAL-SURGICAL NURSING I | 150 NGN PRACTICE QUESTIONS WITH
DETAILED RATIONALES & PARTIAL CREDIT SCORING | HIGH-YIELD RN & PN
REVIEW
QUESTION 1: PRIMARY SYMPTOM OF ESOPHAGEAL CANCER
• Question: A 68-year-old client with a 40-pack-year smoking history reports progressive
difficulty swallowing solid foods over the past 3 months and recent 12-lb unintentional
weight loss. Which finding is considered the primary symptom of esophageal cancer?
• Options:
A. Jaundice
B. Persistent heartburn
C. Dysphagia
D. Hoarse voice
• Zero-Flip Premium Rationale Box:
o Correct Answer: C
o Pathophysiology Summary: Progressive dysphagia (first solids, then liquids) is
the classic and primary presenting symptom of esophageal cancer due to luminal
obstruction.
o Distractor Pitfalls: Jaundice suggests biliary obstruction; heartburn is more
GERD-related; hoarseness occurs with recurrent laryngeal nerve involvement but
is not primary.
QUESTION 2: ULCER PAIN THAT AWAKENS PATIENT AT NIGHT
• Question: A 45-year-old client reports epigastric pain that is relieved by food but
frequently awakens him at 2 a.m. Which type of ulcer pain is most consistent with this
pattern?
• Options:
A. Gastric ulcer pain
B. Duodenal ulcer pain
C. Nonulcer dyspepsia pain
D. Pain associated with gastric outlet obstruction
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Duodenal ulcer pain typically occurs 2–3 hours
after meals and at night when the stomach is empty, often awakening the patient.
, 2
o Distractor Pitfalls: Gastric ulcer pain is often worsened by food; nonulcer
dyspepsia lacks the classic nocturnal pattern; outlet obstruction causes vomiting
and fullness.
QUESTION 3: MOST COMMON SITE FOR PANCREATIC CANCER
• Question: A 62-year-old client presents with painless jaundice, pruritus, and a palpable
nontender gallbladder. Imaging is ordered. Which is the most common site for cancer of
the pancreas?
• Options:
A. Tail
B. Body
C. Head
D. Head and body equally
• Zero-Flip Premium Rationale Box:
o Correct Answer: C
o Pathophysiology Summary: Approximately 70% of pancreatic cancers arise in
the head, frequently causing early biliary obstruction and jaundice.
o Distractor Pitfalls: Body and tail tumors are less common and often present later
with pain or metastases.
QUESTION 4: CANCER ASSOCIATED WITH HELICOBACTER PYLORI
• Question: A client with chronic H. pylori infection asks about long-term cancer risk.
Which cancer is Helicobacter pylori most strongly associated with?
• Options:
A. Cancer of the colon
B. Cancer of the esophagus
C. Cancer of the pancreas
D. Cancer of the stomach
• Zero-Flip Premium Rationale Box:
o Correct Answer: D
o Pathophysiology Summary: Chronic H. pylori infection is a major risk factor for
gastric adenocarcinoma and MALT lymphoma.
o Distractor Pitfalls: Colon cancer is linked to polyps and diet; esophageal cancer
to Barrett’s; pancreatic cancer has different risk factors.
QUESTION 5: BEST DESCRIPTION OF CONSTIPATION
, 3
• Question: A nurse is teaching a client about bowel habits. Which statement best
describes constipation?
• Options:
A. Less than three bowel movements in a week
B. Less than three bowel movements in a day
C. Lack of bowel movement in a day
D. Pain and presence of blood while passing stool
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: The clinical definition of constipation is fewer than
three bowel movements per week, often accompanied by hard stools or straining.
o Distractor Pitfalls: Daily frequency varies widely; blood suggests other
pathology.
QUESTION 6: MOST IMPORTANT INTERVENTION IN GASTROENTERITIS
• Question: A 28-year-old client with acute gastroenteritis has had 8 watery stools in 12
hours and is mildly dehydrated. Which intervention is the most important in
management?
• Options:
A. Administering antibiotics
B. Prescribing antiviral medication
C. Maintaining adequate hydration
D. Providing a diet high in carbohydrates
• Zero-Flip Premium Rationale Box:
o Correct Answer: C
o Pathophysiology Summary: Fluid and electrolyte replacement is the cornerstone
of gastroenteritis management to prevent hypovolemia and shock.
o Distractor Pitfalls: Antibiotics are reserved for specific bacterial cases; antivirals
are rarely indicated; diet is secondary.
QUESTION 7: REBOUND TENDERNESS DIAGNOSIS
• Question: During abdominal examination, the nurse notes rebound tenderness in the
right lower quadrant. Which is the most probable diagnosis?
• Options:
A. Chronic peptic ulcer disease
, 4
B. Ulcerative colitis
C. Gastritis
D. Peritonitis
• Zero-Flip Premium Rationale Box:
o Correct Answer: D
o Pathophysiology Summary: Rebound tenderness indicates peritoneal irritation
and is a classic sign of peritonitis.
o Distractor Pitfalls: Peptic ulcer and gastritis cause epigastric pain without
rebound; UC presents with bloody diarrhea.
QUESTION 8: COMPLICATION OF CHOLELITHIASIS
• Question: A client with known gallstones develops severe epigastric pain radiating to the
back and elevated lipase. Which is a recognized complication of cholelithiasis?
• Options:
A. Acute pancreatitis
B. Appendicitis
C. Colon cancer
D. Gallbladder cancer only
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: Gallstones can obstruct the common bile duct or
pancreatic duct, triggering acute pancreatitis.
o Distractor Pitfalls: Appendicitis is unrelated; colon cancer has different etiology;
gallbladder cancer is less common.
QUESTION 9: DISTINCTIVE SYMPTOM OF ULCERATIVE COLITIS
• Question: A client reports frequent bloody diarrhea with mucus. Which finding is most
distinctive of ulcerative colitis?
• Options:
A. Patchy inflammation of the small intestine
B. Bloody diarrhea and mucus in the stool
C. Skip lesions throughout the gastrointestinal tract
D. Transmural involvement of the intestinal wall
• Zero-Flip Premium Rationale Box:
2026 MEDICAL-SURGICAL NURSING I | 150 NGN PRACTICE QUESTIONS WITH
DETAILED RATIONALES & PARTIAL CREDIT SCORING | HIGH-YIELD RN & PN
REVIEW
QUESTION 1: PRIMARY SYMPTOM OF ESOPHAGEAL CANCER
• Question: A 68-year-old client with a 40-pack-year smoking history reports progressive
difficulty swallowing solid foods over the past 3 months and recent 12-lb unintentional
weight loss. Which finding is considered the primary symptom of esophageal cancer?
• Options:
A. Jaundice
B. Persistent heartburn
C. Dysphagia
D. Hoarse voice
• Zero-Flip Premium Rationale Box:
o Correct Answer: C
o Pathophysiology Summary: Progressive dysphagia (first solids, then liquids) is
the classic and primary presenting symptom of esophageal cancer due to luminal
obstruction.
o Distractor Pitfalls: Jaundice suggests biliary obstruction; heartburn is more
GERD-related; hoarseness occurs with recurrent laryngeal nerve involvement but
is not primary.
QUESTION 2: ULCER PAIN THAT AWAKENS PATIENT AT NIGHT
• Question: A 45-year-old client reports epigastric pain that is relieved by food but
frequently awakens him at 2 a.m. Which type of ulcer pain is most consistent with this
pattern?
• Options:
A. Gastric ulcer pain
B. Duodenal ulcer pain
C. Nonulcer dyspepsia pain
D. Pain associated with gastric outlet obstruction
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Duodenal ulcer pain typically occurs 2–3 hours
after meals and at night when the stomach is empty, often awakening the patient.
, 2
o Distractor Pitfalls: Gastric ulcer pain is often worsened by food; nonulcer
dyspepsia lacks the classic nocturnal pattern; outlet obstruction causes vomiting
and fullness.
QUESTION 3: MOST COMMON SITE FOR PANCREATIC CANCER
• Question: A 62-year-old client presents with painless jaundice, pruritus, and a palpable
nontender gallbladder. Imaging is ordered. Which is the most common site for cancer of
the pancreas?
• Options:
A. Tail
B. Body
C. Head
D. Head and body equally
• Zero-Flip Premium Rationale Box:
o Correct Answer: C
o Pathophysiology Summary: Approximately 70% of pancreatic cancers arise in
the head, frequently causing early biliary obstruction and jaundice.
o Distractor Pitfalls: Body and tail tumors are less common and often present later
with pain or metastases.
QUESTION 4: CANCER ASSOCIATED WITH HELICOBACTER PYLORI
• Question: A client with chronic H. pylori infection asks about long-term cancer risk.
Which cancer is Helicobacter pylori most strongly associated with?
• Options:
A. Cancer of the colon
B. Cancer of the esophagus
C. Cancer of the pancreas
D. Cancer of the stomach
• Zero-Flip Premium Rationale Box:
o Correct Answer: D
o Pathophysiology Summary: Chronic H. pylori infection is a major risk factor for
gastric adenocarcinoma and MALT lymphoma.
o Distractor Pitfalls: Colon cancer is linked to polyps and diet; esophageal cancer
to Barrett’s; pancreatic cancer has different risk factors.
QUESTION 5: BEST DESCRIPTION OF CONSTIPATION
, 3
• Question: A nurse is teaching a client about bowel habits. Which statement best
describes constipation?
• Options:
A. Less than three bowel movements in a week
B. Less than three bowel movements in a day
C. Lack of bowel movement in a day
D. Pain and presence of blood while passing stool
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: The clinical definition of constipation is fewer than
three bowel movements per week, often accompanied by hard stools or straining.
o Distractor Pitfalls: Daily frequency varies widely; blood suggests other
pathology.
QUESTION 6: MOST IMPORTANT INTERVENTION IN GASTROENTERITIS
• Question: A 28-year-old client with acute gastroenteritis has had 8 watery stools in 12
hours and is mildly dehydrated. Which intervention is the most important in
management?
• Options:
A. Administering antibiotics
B. Prescribing antiviral medication
C. Maintaining adequate hydration
D. Providing a diet high in carbohydrates
• Zero-Flip Premium Rationale Box:
o Correct Answer: C
o Pathophysiology Summary: Fluid and electrolyte replacement is the cornerstone
of gastroenteritis management to prevent hypovolemia and shock.
o Distractor Pitfalls: Antibiotics are reserved for specific bacterial cases; antivirals
are rarely indicated; diet is secondary.
QUESTION 7: REBOUND TENDERNESS DIAGNOSIS
• Question: During abdominal examination, the nurse notes rebound tenderness in the
right lower quadrant. Which is the most probable diagnosis?
• Options:
A. Chronic peptic ulcer disease
, 4
B. Ulcerative colitis
C. Gastritis
D. Peritonitis
• Zero-Flip Premium Rationale Box:
o Correct Answer: D
o Pathophysiology Summary: Rebound tenderness indicates peritoneal irritation
and is a classic sign of peritonitis.
o Distractor Pitfalls: Peptic ulcer and gastritis cause epigastric pain without
rebound; UC presents with bloody diarrhea.
QUESTION 8: COMPLICATION OF CHOLELITHIASIS
• Question: A client with known gallstones develops severe epigastric pain radiating to the
back and elevated lipase. Which is a recognized complication of cholelithiasis?
• Options:
A. Acute pancreatitis
B. Appendicitis
C. Colon cancer
D. Gallbladder cancer only
• Zero-Flip Premium Rationale Box:
o Correct Answer: A
o Pathophysiology Summary: Gallstones can obstruct the common bile duct or
pancreatic duct, triggering acute pancreatitis.
o Distractor Pitfalls: Appendicitis is unrelated; colon cancer has different etiology;
gallbladder cancer is less common.
QUESTION 9: DISTINCTIVE SYMPTOM OF ULCERATIVE COLITIS
• Question: A client reports frequent bloody diarrhea with mucus. Which finding is most
distinctive of ulcerative colitis?
• Options:
A. Patchy inflammation of the small intestine
B. Bloody diarrhea and mucus in the stool
C. Skip lesions throughout the gastrointestinal tract
D. Transmural involvement of the intestinal wall
• Zero-Flip Premium Rationale Box:
