Free Samples · CGRN Certification Prep · CE Provider #NV-14175

Try 15 Real CGRN Practice Questions

Three sets of five, pulled straight from our 450-question bank mapped to the 2024–2026 ABCGN test blueprint. Every question includes an evidence-based rationale with guideline citations — exactly what you get in the full bank.

Question 1 of 5 · Domain I: General Nursing Care · Moderate

A patient presents with dysphagia to solids but not liquids, progressive over 6 months with 15-pound weight loss. Which condition is MOST consistent with this presentation?

AEosinophilic esophagitisBEsophageal stricture from chronic GERDCEsophageal malignancyDAchalasia

Correct answer: C. Progressive dysphagia to solids with weight loss over months is the classic presentation of esophageal malignancy. Strictures cause similar dysphagia but typically have a GERD history. Achalasia causes dysphagia to both solids AND liquids. EoE presents in younger patients with intermittent dysphagia and food impaction. (ACG Guidelines on Esophageal Cancer, 2023)

Question 2 of 5 · Domain II: Gastroenterological Procedures · Hard

A radial EUS identifies a 2.5cm hypoechoic, homogeneous subepithelial lesion arising from the fourth echogenic layer (muscularis propria) in the gastric body. The MOST likely diagnosis is:

AGranular cell tumorBGastrointestinal stromal tumor (GIST)CLipomaDCarcinoid tumor

Correct answer: B. A hypoechoic, homogeneous subepithelial mass from the 4th EUS layer (muscularis propria) is the classic presentation of GIST. Lipomas are hyperechoic from the 3rd layer (submucosa). Leiomyomas arise from muscularis propria but are more common in the esophagus. Carcinoids are typically from the 3rd layer. (ASGE Guidelines on Subepithelial Lesions, 2023)

Question 3 of 5 · Domain III: Patient Care Interventions · Moderate

The nurse is managing a patient with acute variceal hemorrhage. A Sengstaken-Blakemore tube is placed as a bridge to definitive therapy. Which nursing intervention is ESSENTIAL during balloon tamponade?

ADeflating the gastric balloon every 4 hoursBContinuous monitoring of balloon pressures and maintaining airway protection, with the patient's head of bed elevatedCMaintaining the patient in a flat supine positionDAdministering lactulose through the tube

Correct answer: B. Balloon tamponade tubes require continuous monitoring of balloon pressures (gastric balloon 250-300 mL air, esophageal balloon 25-45 mmHg if used), airway protection (aspiration risk), and HOB elevation. The esophageal balloon should be deflated every 12 hours to prevent necrosis. This is a temporizing bridge measure only. (AASLD Guidelines on Variceal Hemorrhage)

Question 4 of 5 · Domain IV: Environmental Safety & Infection Prevention · Moderate

Proper drying of reprocessed endoscopes before storage is critical because:

AIt speeds up the reprocessing cycleBResidual moisture promotes microbial growth, including waterborne pathogens and biofilmCIt reduces chemical residue taste during the next procedureDIt prevents damage to the outer sheath

Correct answer: B. Residual moisture in endoscope channels creates an environment for microbial proliferation, including Pseudomonas and atypical mycobacteria. Thorough drying with 70% alcohol flush followed by forced-air drying before storage is essential. Wet storage promotes biofilm formation. (SGNA Standards, 2024; AAMI ST91)

Question 5 of 5 · Domain II: Gastroenterological Procedures · Hard

A patient with a suspected gastrointestinal stromal tumor (GIST) in the gastric wall has EUS showing a 4.5cm hypoechoic mass from the 4th layer with irregular borders. EUS-guided tissue acquisition is planned. Which needle type provides the best diagnostic yield for GIST?

AStandard 22-gauge FNA needleB22-gauge FNB (fine needle biopsy) core needle, which preserves tissue architecture needed for immunohistochemistry (CD117/DOG1)CForceps biopsy through the endoscopeD19-gauge Trucut needle only

Correct answer: B. GISTs require immunohistochemistry for CD117 (c-KIT) and DOG1, which needs preserved tissue architecture. FNB (core biopsy) needles maintain histologic architecture superior to FNA cytology smears. The 22G FNB needle balances tissue quality with procedural safety. (ASGE Guidelines on EUS Tissue Acquisition, 2024)

Question 1 of 5 · Domain I: General Nursing Care · Easy

The Rome IV criteria are used to diagnose which category of GI disorders?

AMotility disorders confirmed by manometryBFunctional gastrointestinal disordersCGI malignanciesDInflammatory bowel disease

Correct answer: B. Rome IV criteria are the diagnostic standard for functional GI disorders including IBS, functional dyspepsia, and functional constipation. IBD requires endoscopic/histologic confirmation. Motility disorders require manometry. GI malignancies require tissue diagnosis. (Rome Foundation, Rome IV Criteria, 2016)

Question 2 of 5 · Domain II: Gastroenterological Procedures · Moderate

A patient with achalasia is scheduled for peroral endoscopic myotomy (POEM). The nurse should anticipate that the MOST common adverse event following this procedure is:

ASymptomatic gastroesophageal refluxBDelayed hemorrhage from the submucosal tunnelCEsophageal perforation requiring surgical repairDPneumoperitoneum requiring decompression

Correct answer: A. Symptomatic GERD occurs in 20-50% of patients after POEM due to disruption of the LES without an anti-reflux mechanism. Most patients require long-term PPI therapy. Pneumoperitoneum during POEM is common but usually benign and self-limiting. Perforation requiring surgery is rare (<1%). (ASGE Guidelines on POEM, 2023)

Question 3 of 5 · Domain III: Patient Care Interventions · Easy

The five rights of medication administration include all of the following EXCEPT:

ARight insuranceBRight medicationCRight patientDRight dose

Correct answer: A. The five rights of medication administration are: right patient, right medication, right dose, right route, and right time. Insurance status is an administrative concern, not a safety right. Some frameworks add right documentation and right reason, but the core five do not include insurance. (Institute for Safe Medication Practices)

Question 4 of 5 · Domain IV: Environmental Safety & Infection Prevention · Moderate

Clostridium difficile spores are resistant to alcohol-based hand sanitizers. The nurse should use which hand hygiene method when caring for a C. difficile patient?

ASoap and water handwashing to physically remove sporesBChlorhexidine-based hand scrubCDouble gloving without hand washingDAlcohol-based hand rub for at least 20 seconds

Correct answer: A. C. difficile spores are resistant to alcohol-based hand rubs. Physical removal through friction with soap and water is the recommended hand hygiene method. Contact precautions (gown and gloves) are required for all patient interactions. This is one of the few situations where soap and water is specifically preferred over alcohol-based products. (CDC/HICPAC C. difficile Guidelines, 2023)

Question 5 of 5 · Domain III: Patient Care Interventions · Hard

A patient with decompensated cirrhosis develops acute kidney injury with serum creatinine rising from 1.0 to 2.8 mg/dL over 48 hours. Urine sodium is <10 mEq/L and urine microscopy is bland. After fluid challenge with albumin 1g/kg shows no improvement, the MOST likely diagnosis is:

APost-renal obstructionBAcute tubular necrosisCGlomerulonephritisDHepatorenal syndrome type 1 — functional renal failure from extreme splanchnic vasodilation

Correct answer: D. HRS-AKI (formerly Type 1 HRS) is a functional renal failure caused by extreme splanchnic vasodilation in advanced cirrhosis, leading to renal hypoperfusion. Diagnostic criteria: cirrhosis + ascites + AKI + no response to 48h albumin challenge + no nephrotoxins + no structural kidney disease. Treatment: vasoconstrictors (terlipressin/midodrine+octreotide) + albumin. (AASLD Guidelines on HRS, 2024)

Question 1 of 5 · Domain I: General Nursing Care · Moderate

A patient with newly diagnosed gastroparesis asks about dietary modifications. Which recommendation is MOST appropriate based on current AGA guidelines?

ASmall, frequent, low-fat, low-fiber meals with well-cooked foodsBHigh-fiber diet to promote gastric motilityCClear liquid diet until symptoms resolveDHigh-protein, high-fat diet to maintain nutritional status

Correct answer: A. AGA 2024 guidelines recommend small, frequent, low-fat, low-fiber meals for gastroparesis. Fat delays gastric emptying and fiber can form bezoars. High-fiber diets are contraindicated. Liquid supplements may be better tolerated than solid foods. (AGA Clinical Practice Update on Gastroparesis, 2024)

Question 2 of 5 · Domain II: Gastroenterological Procedures · Moderate

A patient with chronic pancreatitis undergoes ERCP for pancreatic duct stone clearance. The nurse observes the endoscopist performing pancreatic sphincterotomy. Which post-procedure instruction is ESSENTIAL?

AMonitor for signs of pancreatitis, bleeding, and perforation; report severe abdominal pain immediatelyBRemain NPO for 48 hoursCReturn for repeat ERCP in 24 hoursDLimit activity for 2 weeks

Correct answer: A. Post-ERCP monitoring for pancreatitis (severe epigastric pain, nausea/vomiting), bleeding (hematemesis, melena, hemodynamic changes), and perforation (severe pain, fever, peritoneal signs) is essential. Patients should understand warning signs and when to seek emergency care. NPO for 48 hours is no longer routine. (ASGE Post-Procedure Instructions, 2023)

Question 3 of 5 · Domain III: Patient Care Interventions · Hard

During recovery from endoscopy, a patient reports severe retrosternal pain. CT chest reveals pneumomediastinum and left pleural effusion. The nurse recognizes these findings are consistent with:

AAcute coronary syndromeBPulmonary embolismCAspiration pneumoniaDBoerhaave syndrome (transmural esophageal perforation)

Correct answer: D. Boerhaave syndrome refers to transmural esophageal perforation with contamination of the mediastinum and pleural space. Post-dilation chest pain with pneumomediastinum and pleural effusion is classic for iatrogenic esophageal perforation, which is the procedural equivalent. Retrosternal pain with these imaging findings requires immediate surgical or interventional management. (ASGE Management of Perforation, 2023)

Question 4 of 5 · Domain IV: Environmental Safety & Infection Prevention · Moderate

A nurse handling glutaraldehyde for HLD develops contact dermatitis and respiratory irritation. Per OSHA guidelines, the employer must ensure:

AThe nurse continues work with additional glovesBAnnual tuberculosis testing for the affected nurseCAdequate ventilation, exposure monitoring at or below 0.05 ppm ceiling limit, and provision of appropriate PPEDThe nurse switches to OPA without further evaluation

Correct answer: C. OSHA sets a ceiling limit of 0.05 ppm for glutaraldehyde exposure. Employers must ensure adequate ventilation (local exhaust, general room ventilation), provide appropriate PPE, and monitor airborne concentrations. Symptomatic employees require medical evaluation. Alternative HLD agents (OPA, peracetic acid) may reduce chemical exposure. (OSHA Chemical Safety Guidelines; SGNA Standards, 2024)

Question 5 of 5 · Domain II: Gastroenterological Procedures · Moderate

During endoscopic hemostasis, the nurse notes the endoscopist using a heater probe at a setting of 30 watts with firm pressure applied to the bleeding vessel. This 'coaptive coagulation' technique works by:

ADirect thermal sealing — the probe compresses the vessel walls together while heat denatures tissue proteins, creating a coagulum that seals the vesselBChemical cauterization of the vesselCStimulating platelet plug formationDFreezing the tissue to stop blood flow

Correct answer: A. Coaptive coagulation uses direct probe pressure to compress (coapt) bleeding vessel walls together while heat seals them. The combination of mechanical compression and thermal protein denaturation creates a lasting seal. Firm pressure with a 7-10 second application at moderate power (15-30W) is recommended per ASGE. (ASGE Guidelines on Thermal Hemostasis, 2024)

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MilenAi Digestive Health Consulting · Nevada Board of Nursing CE Provider #NV-14175 · consult@milenai.health