Comprehensive NCLEX-RN
Challenge Exam Questions
with Rationales | NCLEX-RN
Comprehensive Prep
1. Question
The nurse is managing care for several clients in the outpatient clinic. Among the
following clients who called, which one should the nurse prioritize in responding
to first?
A. A client with hepatitis A who states, “My arms and legs are itching.”
B. A client with a cast on the right leg who states, “I have a funny feeling in
my right leg.”
Correct answer
C. A client with osteomyelitis of the spine who states, “I am so nauseous that
I can’t eat.”
D. A client with rheumatoid arthritis who states, “I am having trouble
sleeping.”
Correct Answer: E. A client with a cast on the right leg who states, “I have a
funny feeling in my right leg.”
It may indicate neurovascular compromise, requiring immediate assessment.
1. 2. Question
A nurse on the surgical floor is prioritizing care for clients after receiving the
report from the previous shift. Which of the following patients should the nurse
assess first?
A. A 35-year-old patient admitted three hours ago for a gunshot wound, with
a 1.5 cm area of dark drainage noted on the dressing.
Page 1 of 43
, B. A 43-year-old patient who underwent a mastectomy two days ago, with 23
ml of serosanguinous fluid in the Jackson-Pratt drain.
C. A 59-year-old patient with a history of a collapsed lung from an accident,
with no drainage noted in the chest tube in the past eight hours.
E. A 54-year-old patient with a total knee replacement two days ago, with
moderate swelling at the surgical site.
E. A 47-year-old patient who had a laparoscopic cholecystectomy yesterday,
complaining of mild pain at the incision site.
F. A 62-year-old patient who had an abdominal-perineal resection three days
ago, now reporting chills.
Correct Answer: F. A 62-year-old patient who had an abdominal-perineal
resection three days ago, now reporting chills.
The client is at risk for peritonitis; should be assessed for further symptoms and
infection.
2. 3. Question
A nurse in a post-surgical unit is monitoring a 46-year-old patient who
underwent a thyroidectomy 12 hours ago for the treatment of Grave’s disease.
Which of the following observations should most concern the nurse?
A. Blood pressure 138/82 mmHg, respirations 16 per minute, oral
temperature 37.2ºC or 99º F.
B. The patient carefully supports their head and neck when turning their head
to the right.
C. The patient expresses difficulty in swallowing but can manage liquids.
D. The patient appears drowsy and complains of a sore throat.
E. The patient shows involuntary flexion of their wrist when blood pressure is
measured.
Correct answer
F. The patient has a hoarse voice when speaking.
Correct Answer: E. The patient shows involuntary flexion of their wrist when
blood pressure is measured.
Page 2 of 43
, Carpal spasms (Trousseau’s sign) indicate hypocalcemia which can occur after
thyroidectomy due to accidental removal or damage to the parathyroid glands.
Hypocalcemia is a serious complication and requires immediate attention. The
other options, while they might warrant monitoring, are not as immediately
concerning as a potential sign of hypocalcemia.
3. 4. Question
A 38-year-old patient is admitted to the emergency department with severe pain
in the lower right quadrant of the abdomen, nausea, and a low-grade fever,
raising concerns about possible appendicitis. The nurse is considering pain relief
strategies. Which of the following actions should the nurse prioritize?
A. Encourage the patient to change positions frequently in bed.
B. Administer Demerol 50 mg IM q 4 hours and PRN, as prescribed.
C. Apply warmth to the abdomen with a heating pad.
D. Use comfort measures and pillows to position the patient comfortably.
Correct answer
E. Administer an antiemetic as prescribed for nausea relief.
Correct Answer: D. Use comfort measures and pillows to position the patient
comfortably.
Using comfort measures and pillows to position the client is a non-
pharmacological method of pain relief.
4. 5. Question
A 56-year-old patient, recently diagnosed with end-stage renal disease, is
preparing for their first peritoneal dialysis session in a clinic. The patient has a
history of diabetes and hypertension, and has been experiencing increasing
fatigue and fluid retention. Upon arrival, the nurse notes that the patient appears
anxious about the procedure. The patient’s vital signs are stable, with a blood
pressure of 150/90 mmHg, pulse 78 bpm, and respiratory rate 16 breaths per
minute. The nurse reviews the physician’s orders, which indicate the type and
volume of dialysate to be used. The peritoneal dialysis catheter had been placed
a week earlier, and there’s no sign of infection at the site. The patient is settled in
a comfortable position in the dialysis room, which is equipped with all necessary
Page 3 of 43
, emergency equipment. Considering this scenario, which of the following actions
should the nurse prioritize?
A. Assess for a bruit and a thrill.
B. Warm the dialysate solution.
Correct answer
C. Position the client on the left side.
D. Insert a Foley catheter
E. Assess the patient's understanding of the peritoneal dialysis procedure.
F. Address the patient's anxiety and provide emotional support.
Correct Answer: B. Warm the dialysate solution.
Cold dialysate increases discomfort. The solution should be warmed to body
temperature in a warmer or heating pad; don’t use a microwave oven.
5. 6. Question
A 75-year-old male patient with a history of right-sided hemiplegia due to a
recent stroke is learning how to use a cane under the guidance of the nurse. The
patient expresses a desire to be as independent as possible in mobility. During
the teaching session, the nurse observes the patient’s ability to use the cane
correctly. Which of the following behaviors, if demonstrated by the patient,
indicates that the teaching was effective?
A. The client holds the cane with his right hand, moves the cane forward
followed by the right leg, and then moves the left leg.
B. The client holds the cane with his right hand, moves the cane forward
followed by his left leg, and then moves the right leg.
C. The client holds the cane with his left hand, moves the cane forward
followed by the right leg, and then moves the left leg.
Correct answer
D. The client holds the cane with his left hand, moves the cane forward
followed by his left leg, and then moves the right leg.
Correct Answer: C. The client holds the cane with his left hand, moves the
cane forward followed by the right leg, and then moves the left leg.
Page 4 of 43
Challenge Exam Questions
with Rationales | NCLEX-RN
Comprehensive Prep
1. Question
The nurse is managing care for several clients in the outpatient clinic. Among the
following clients who called, which one should the nurse prioritize in responding
to first?
A. A client with hepatitis A who states, “My arms and legs are itching.”
B. A client with a cast on the right leg who states, “I have a funny feeling in
my right leg.”
Correct answer
C. A client with osteomyelitis of the spine who states, “I am so nauseous that
I can’t eat.”
D. A client with rheumatoid arthritis who states, “I am having trouble
sleeping.”
Correct Answer: E. A client with a cast on the right leg who states, “I have a
funny feeling in my right leg.”
It may indicate neurovascular compromise, requiring immediate assessment.
1. 2. Question
A nurse on the surgical floor is prioritizing care for clients after receiving the
report from the previous shift. Which of the following patients should the nurse
assess first?
A. A 35-year-old patient admitted three hours ago for a gunshot wound, with
a 1.5 cm area of dark drainage noted on the dressing.
Page 1 of 43
, B. A 43-year-old patient who underwent a mastectomy two days ago, with 23
ml of serosanguinous fluid in the Jackson-Pratt drain.
C. A 59-year-old patient with a history of a collapsed lung from an accident,
with no drainage noted in the chest tube in the past eight hours.
E. A 54-year-old patient with a total knee replacement two days ago, with
moderate swelling at the surgical site.
E. A 47-year-old patient who had a laparoscopic cholecystectomy yesterday,
complaining of mild pain at the incision site.
F. A 62-year-old patient who had an abdominal-perineal resection three days
ago, now reporting chills.
Correct Answer: F. A 62-year-old patient who had an abdominal-perineal
resection three days ago, now reporting chills.
The client is at risk for peritonitis; should be assessed for further symptoms and
infection.
2. 3. Question
A nurse in a post-surgical unit is monitoring a 46-year-old patient who
underwent a thyroidectomy 12 hours ago for the treatment of Grave’s disease.
Which of the following observations should most concern the nurse?
A. Blood pressure 138/82 mmHg, respirations 16 per minute, oral
temperature 37.2ºC or 99º F.
B. The patient carefully supports their head and neck when turning their head
to the right.
C. The patient expresses difficulty in swallowing but can manage liquids.
D. The patient appears drowsy and complains of a sore throat.
E. The patient shows involuntary flexion of their wrist when blood pressure is
measured.
Correct answer
F. The patient has a hoarse voice when speaking.
Correct Answer: E. The patient shows involuntary flexion of their wrist when
blood pressure is measured.
Page 2 of 43
, Carpal spasms (Trousseau’s sign) indicate hypocalcemia which can occur after
thyroidectomy due to accidental removal or damage to the parathyroid glands.
Hypocalcemia is a serious complication and requires immediate attention. The
other options, while they might warrant monitoring, are not as immediately
concerning as a potential sign of hypocalcemia.
3. 4. Question
A 38-year-old patient is admitted to the emergency department with severe pain
in the lower right quadrant of the abdomen, nausea, and a low-grade fever,
raising concerns about possible appendicitis. The nurse is considering pain relief
strategies. Which of the following actions should the nurse prioritize?
A. Encourage the patient to change positions frequently in bed.
B. Administer Demerol 50 mg IM q 4 hours and PRN, as prescribed.
C. Apply warmth to the abdomen with a heating pad.
D. Use comfort measures and pillows to position the patient comfortably.
Correct answer
E. Administer an antiemetic as prescribed for nausea relief.
Correct Answer: D. Use comfort measures and pillows to position the patient
comfortably.
Using comfort measures and pillows to position the client is a non-
pharmacological method of pain relief.
4. 5. Question
A 56-year-old patient, recently diagnosed with end-stage renal disease, is
preparing for their first peritoneal dialysis session in a clinic. The patient has a
history of diabetes and hypertension, and has been experiencing increasing
fatigue and fluid retention. Upon arrival, the nurse notes that the patient appears
anxious about the procedure. The patient’s vital signs are stable, with a blood
pressure of 150/90 mmHg, pulse 78 bpm, and respiratory rate 16 breaths per
minute. The nurse reviews the physician’s orders, which indicate the type and
volume of dialysate to be used. The peritoneal dialysis catheter had been placed
a week earlier, and there’s no sign of infection at the site. The patient is settled in
a comfortable position in the dialysis room, which is equipped with all necessary
Page 3 of 43
, emergency equipment. Considering this scenario, which of the following actions
should the nurse prioritize?
A. Assess for a bruit and a thrill.
B. Warm the dialysate solution.
Correct answer
C. Position the client on the left side.
D. Insert a Foley catheter
E. Assess the patient's understanding of the peritoneal dialysis procedure.
F. Address the patient's anxiety and provide emotional support.
Correct Answer: B. Warm the dialysate solution.
Cold dialysate increases discomfort. The solution should be warmed to body
temperature in a warmer or heating pad; don’t use a microwave oven.
5. 6. Question
A 75-year-old male patient with a history of right-sided hemiplegia due to a
recent stroke is learning how to use a cane under the guidance of the nurse. The
patient expresses a desire to be as independent as possible in mobility. During
the teaching session, the nurse observes the patient’s ability to use the cane
correctly. Which of the following behaviors, if demonstrated by the patient,
indicates that the teaching was effective?
A. The client holds the cane with his right hand, moves the cane forward
followed by the right leg, and then moves the left leg.
B. The client holds the cane with his right hand, moves the cane forward
followed by his left leg, and then moves the right leg.
C. The client holds the cane with his left hand, moves the cane forward
followed by the right leg, and then moves the left leg.
Correct answer
D. The client holds the cane with his left hand, moves the cane forward
followed by his left leg, and then moves the right leg.
Correct Answer: C. The client holds the cane with his left hand, moves the
cane forward followed by the right leg, and then moves the left leg.
Page 4 of 43
