2026 COMPREHENSIVE NCLEX-RN CHALLENGE EXAM 1(Q&A
WITH RATIONALES).
1. Question1 point(s)
Category: Physiological Adaptation
A nurse is assessing a 56-year-old patient who presents with a persistent cough producing copious
thick sputum, noticeable swelling in the lower extremities, and blue-tinged nail beds. The patient has
a detailed smoking history of consuming one to two packs of cigarettes daily for 40 years. Considering
the patient’s history and current symptoms, which of the following conditions does the patient most
likely have?
A. Adult respiratory distress syndrome (ARDS)
B. Asthma
C. Chronic obstructive bronchitis
D. Emphysema
D. Emphysema
E. Pulmonary hypertension
F. Lung cancer
Correct Answer: C. Chronic obstructive bronchitis
The symptoms described for the client, particularly the chronic cough producing thick sputum,
peripheral edema, and cyanotic nail beds, along with the long history of significant smoking, are
indicative of chronic obstructive bronchitis. Chronic obstructive bronchitis is a type of chronic
obstructive pulmonary disease (COPD) characterized by a long-term cough with mucus. Smoking is the
most common cause of COPD.
2. Question1 point(s)
Category: Pharmacological and Parenteral Therapies
A 72-year-old male patient with a history of atrial fibrillation and controlled hypertension has been
initiated on warfarin therapy. Upon assessment of the patient’s history, it was revealed that he has a
,history of peptic ulcer. This patient also has a recent history of a peptic ulcer. Given the client’s
medical history and current medication regimen, which of the following instructions should the nurse
prioritize when providing discharge teaching?
A. Report incidents of diarrhea
B. Avoid foods high in vitamin K
C. Use a straight razor when shaving
D. Take aspirin for pain relief
E. Monitor for signs of bleeding, such as bruising or black tarry stools
F. Check blood pressure regularly at home
G. Inform all healthcare providers about the anticoagulant therapy
Correct Answer: B. Avoid foods high in vitamin K
Clients taking warfarin should be educated about maintaining a consistent intake of vitamin K, as it is
necessary for the clotting cascade, and warfarin works by inhibiting the effects of vitamin K, thereby
reducing the blood’s ability to clot. Sudden increases in vitamin K intake can decrease the effectiveness
of warfarin and increase the risk of clot formation. Clients should also be advised to report any incidents
of diarrhea (A) since it can affect the absorption of the medication and potentially lead to unstable
anticoagulation levels. Using a straight razor (C) is not advised due to the increased risk of bleeding; a
safety razor or electric razor would be safer alternatives. Taking aspirin for pain relief (D) is not
recommended without a physician’s approval because aspirin can increase the risk of bleeding when
taken with an anticoagulant. Monitoring for signs of bleeding (E), checking blood pressure regularly (F),
and informing all healthcare providers about anticoagulant therapy (G) are also important instructions
for a patient on warfarin therapy, but avoiding foods high in vitamin K is directly related to the
effectiveness of the anticoagulant medication and is thus the priority teaching point.
3. Question1 point(s)
Category: Reduction of Risk Potential
In a busy surgical unit, a nurse is preparing to insert an I.V. catheter for a 33-year-old patient who is
scheduled for elective surgery and has a notably hairy forearm where the I.V. is to be placed. The
patient is allergic to a variety of adhesives and has sensitive skin that is prone to irritation. Given
these considerations, how should the nurse manage excess hair at the intended catheter insertion
site?
A. Leaving the hair intact
, B. Shaving the area
C. Clipping the hair in the area
D. Removing the hair with a depilatory
E. Applying a small amount of water-soluble gel to tame the hair without cutting
F. Use a sterile surgical scalpel to trim the hair as close to the skin as possible without causing abrasions
Correct Answer: C. Clipping the hair in the area
Clipping is preferred over shaving in this scenario because it reduces the potential for creating
microabrasions that can increase infection risk, which is especially important in a patient with sensitive
skin. Chemical depilatories (D) are not recommended due to the patient’s history of allergies and
sensitive skin. Leaving the hair intact (A) could interfere with the securement of the I.V. and increase the
risk of infection. Water-soluble gel (E) is not standard practice for managing hair at an I.V. site and does
not address the infection control issue. A sterile surgical scalpel (F) is not typically recommended for hair
removal in preparation for I.V. insertion due to the risk of cuts and abrasions. Clipping is the safest
option that balances the need to reduce infection risk with the patient’s sensitivity and allergy concerns.
4. Question1 point(s)
Category: Health Promotion and Maintenance
A nurse is tasked with the education of an elderly female patient who has been recently diagnosed
with osteoporosis. The patient leads a sedentary lifestyle, has a diet low in calcium, has undergone
menopause ten years prior, and has a visibly kyphotic posture. In planning the education for this
patient, which of the following complications should the nurse emphasize as the most significant risk
associated with osteoporosis, especially considering the patient’s profile?
A. Increased susceptibility to bone fractures from minimal trauma
B. Consequences of long-term estrogen deficiency post-menopause
C. The impact of sustained negative calcium balance on bone density
D. The progression of spinal deformities such as a kyphotic curvature
E. Potential for height loss over time due to vertebral compression
F. Risk of developing chronic pain associated with skeletal weaknes
Correct Answer: A. Increased susceptibility to bone fractures from minimal trauma.
WITH RATIONALES).
1. Question1 point(s)
Category: Physiological Adaptation
A nurse is assessing a 56-year-old patient who presents with a persistent cough producing copious
thick sputum, noticeable swelling in the lower extremities, and blue-tinged nail beds. The patient has
a detailed smoking history of consuming one to two packs of cigarettes daily for 40 years. Considering
the patient’s history and current symptoms, which of the following conditions does the patient most
likely have?
A. Adult respiratory distress syndrome (ARDS)
B. Asthma
C. Chronic obstructive bronchitis
D. Emphysema
D. Emphysema
E. Pulmonary hypertension
F. Lung cancer
Correct Answer: C. Chronic obstructive bronchitis
The symptoms described for the client, particularly the chronic cough producing thick sputum,
peripheral edema, and cyanotic nail beds, along with the long history of significant smoking, are
indicative of chronic obstructive bronchitis. Chronic obstructive bronchitis is a type of chronic
obstructive pulmonary disease (COPD) characterized by a long-term cough with mucus. Smoking is the
most common cause of COPD.
2. Question1 point(s)
Category: Pharmacological and Parenteral Therapies
A 72-year-old male patient with a history of atrial fibrillation and controlled hypertension has been
initiated on warfarin therapy. Upon assessment of the patient’s history, it was revealed that he has a
,history of peptic ulcer. This patient also has a recent history of a peptic ulcer. Given the client’s
medical history and current medication regimen, which of the following instructions should the nurse
prioritize when providing discharge teaching?
A. Report incidents of diarrhea
B. Avoid foods high in vitamin K
C. Use a straight razor when shaving
D. Take aspirin for pain relief
E. Monitor for signs of bleeding, such as bruising or black tarry stools
F. Check blood pressure regularly at home
G. Inform all healthcare providers about the anticoagulant therapy
Correct Answer: B. Avoid foods high in vitamin K
Clients taking warfarin should be educated about maintaining a consistent intake of vitamin K, as it is
necessary for the clotting cascade, and warfarin works by inhibiting the effects of vitamin K, thereby
reducing the blood’s ability to clot. Sudden increases in vitamin K intake can decrease the effectiveness
of warfarin and increase the risk of clot formation. Clients should also be advised to report any incidents
of diarrhea (A) since it can affect the absorption of the medication and potentially lead to unstable
anticoagulation levels. Using a straight razor (C) is not advised due to the increased risk of bleeding; a
safety razor or electric razor would be safer alternatives. Taking aspirin for pain relief (D) is not
recommended without a physician’s approval because aspirin can increase the risk of bleeding when
taken with an anticoagulant. Monitoring for signs of bleeding (E), checking blood pressure regularly (F),
and informing all healthcare providers about anticoagulant therapy (G) are also important instructions
for a patient on warfarin therapy, but avoiding foods high in vitamin K is directly related to the
effectiveness of the anticoagulant medication and is thus the priority teaching point.
3. Question1 point(s)
Category: Reduction of Risk Potential
In a busy surgical unit, a nurse is preparing to insert an I.V. catheter for a 33-year-old patient who is
scheduled for elective surgery and has a notably hairy forearm where the I.V. is to be placed. The
patient is allergic to a variety of adhesives and has sensitive skin that is prone to irritation. Given
these considerations, how should the nurse manage excess hair at the intended catheter insertion
site?
A. Leaving the hair intact
, B. Shaving the area
C. Clipping the hair in the area
D. Removing the hair with a depilatory
E. Applying a small amount of water-soluble gel to tame the hair without cutting
F. Use a sterile surgical scalpel to trim the hair as close to the skin as possible without causing abrasions
Correct Answer: C. Clipping the hair in the area
Clipping is preferred over shaving in this scenario because it reduces the potential for creating
microabrasions that can increase infection risk, which is especially important in a patient with sensitive
skin. Chemical depilatories (D) are not recommended due to the patient’s history of allergies and
sensitive skin. Leaving the hair intact (A) could interfere with the securement of the I.V. and increase the
risk of infection. Water-soluble gel (E) is not standard practice for managing hair at an I.V. site and does
not address the infection control issue. A sterile surgical scalpel (F) is not typically recommended for hair
removal in preparation for I.V. insertion due to the risk of cuts and abrasions. Clipping is the safest
option that balances the need to reduce infection risk with the patient’s sensitivity and allergy concerns.
4. Question1 point(s)
Category: Health Promotion and Maintenance
A nurse is tasked with the education of an elderly female patient who has been recently diagnosed
with osteoporosis. The patient leads a sedentary lifestyle, has a diet low in calcium, has undergone
menopause ten years prior, and has a visibly kyphotic posture. In planning the education for this
patient, which of the following complications should the nurse emphasize as the most significant risk
associated with osteoporosis, especially considering the patient’s profile?
A. Increased susceptibility to bone fractures from minimal trauma
B. Consequences of long-term estrogen deficiency post-menopause
C. The impact of sustained negative calcium balance on bone density
D. The progression of spinal deformities such as a kyphotic curvature
E. Potential for height loss over time due to vertebral compression
F. Risk of developing chronic pain associated with skeletal weaknes
Correct Answer: A. Increased susceptibility to bone fractures from minimal trauma.
