NCLEX-RN COMPREHENSIVE CHALLENGE EXAM (30) QUESTIONS WITH CORRECT
AND VERIFIED ANSWERS & DETAILED RATIONALES LATEST UPDATE 2025-2026
1️. Question Category: Pharmacological and Parenteral Therapies
Scenario:
A 65-year-old male with ischemic heart disease is admitted to the ICU after experiencing a
myocardial infarction. He is receiving IV lidocaine to manage persistent ventricular ectopy.
Which factor is the most critical for the nurse to monitor when administering this medication?
A. Decrease in arterial oxygen saturation (SaO2)
B. Increase in systemic blood pressure
C. Presence of premature ventricular contractions (PVCs) on a cardiac monitor
D. Increase in intracranial pressure (ICP)
E. Drop in serum potassium levels
F. Widening QRS complex on the ECG
Answer & Rationale:
Correct Answer: C. Presence of premature ventricular contractions (PVCs) on a cardiac
monitor.
Explanation:
Lidocaine is used for treating ventricular arrhythmias, particularly PVCs, which can escalate into
life-threatening conditions like ventricular tachycardia or fibrillation. Monitoring for PVCs helps
assess the medication's effectiveness and prevents potential cardiac complications.
Key Takeaway:
When administering lidocaine, closely monitor cardiac rhythms to detect arrhythmias early and
intervene promptly.
2. Question Category: Pharmacological and Parenteral Therapies
Scenario:
A 72-year-old male patient with a history of atrial fibrillation and controlled hypertension has
recently been started on warfarin therapy. Upon reviewing his medical history, the nurse
discovers that the patient has a history of peptic ulcer disease. Given the patient’s condition and
prescribed anticoagulant therapy, which discharge instruction should be the highest priority?
,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
Answer & Rationale:
Correct Answer: B. Avoid foods high in vitamin K
Explanation:
Warfarin works by inhibiting vitamin K-dependent clotting factors, making dietary vitamin K
intake a crucial factor in maintaining therapeutic anticoagulation. Sudden increases in vitamin
K-rich foods can reduce the drug’s effectiveness, increasing the risk of clot formation.
• (A) Report diarrhea: Important, as diarrhea can affect medication absorption, but not
the priority.
• (C) Use a straight razor: Not advised due to an increased risk of bleeding; an electric
razor is safer.
• (D) Take aspirin for pain relief: Contraindicated unless prescribed, as aspirin further
increases bleeding risk.
• (E) Monitor for signs of bleeding: Important but not specific to warfarin's dietary
considerations.
• (F) Check blood pressure: Useful for overall health but not directly related to warfarin’s
primary risk.
• (G) Inform healthcare providers: Essential, but dietary management has a more direct
impact on warfarin’s effectiveness.
Key Takeaway:
Encourage consistent vitamin K intake rather than complete avoidance. Fluctuations in dietary
vitamin K can destabilize anticoagulation levels, increasing health risks.
3. Question Category: Reduction of Risk Potential
,Scenario:
A nurse in a busy surgical unit is preparing to insert an I.V. catheter for a 33-year-old patient
scheduled for elective surgery. The patient has a hairy forearm at the intended insertion site
and reports a history of adhesive allergies and sensitive skin prone to irritation. Considering
these factors, what is the best approach for managing excess hair before I.V. insertion?
A. Leave the hair intact
B. Shave the area
C. Clip the hair in the area
D. Use a depilatory (hair removal cream)
E. Apply water-soluble gel to flatten the hair
F. Trim the hair with a sterile surgical scalpel
Answer & Rationale:
Correct Answer: C. Clip the hair in the area
Explanation:
Clipping hair is the preferred method for preparing an I.V. site because it reduces infection risk
while avoiding skin irritation or injury.
• (A) Leaving the hair intact can cause adhesion issues with dressings and may increase
infection risk.
• (B) Shaving the area is not recommended, as it creates microabrasions, increasing the
risk of infection.
• (D) Using a depilatory is inappropriate due to the patient's sensitive skin and allergy
history.
• (E) Applying water-soluble gel is not a standard practice and does not adequately
address infection control.
• (F) Using a sterile surgical scalpel poses a risk of cuts and abrasions, increasing
infection risk.
Key Takeaway:
Always clip hair instead of shaving before procedures to minimize infection risk and prevent
skin irritation.
4️. Question Category: Health Promotion and Maintenance
, Scenario:
A nurse is educating an elderly female patient who has been recently diagnosed with
osteoporosis. The patient:
• Leads a sedentary lifestyle
• Has a diet low in calcium
• Went through menopause 10 years ago
• Has a visibly kyphotic posture
When planning education, 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 weakness
Answer & Rationale:
Correct Answer: A. Increased susceptibility to bone fractures from minimal trauma
Explanation:
The most immediate and severe complication of osteoporosis is the increased risk of
fractures, particularly in the hip, wrist, and spine, which can occur from minor stress or
trauma.
• (B) Estrogen deficiency is a contributing factor to osteoporosis, but it is not the most
critical complication.
• (C) Negative calcium balance leads to bone loss, but it is a cause rather than an
outcome of osteoporosis.
• (D) Spinal deformities (kyphosis) can develop but progress gradually, while fractures
have immediate consequences.
• (E) Height loss is a secondary effect of vertebral compression but does not carry the
same level of risk as fractures.
AND VERIFIED ANSWERS & DETAILED RATIONALES LATEST UPDATE 2025-2026
1️. Question Category: Pharmacological and Parenteral Therapies
Scenario:
A 65-year-old male with ischemic heart disease is admitted to the ICU after experiencing a
myocardial infarction. He is receiving IV lidocaine to manage persistent ventricular ectopy.
Which factor is the most critical for the nurse to monitor when administering this medication?
A. Decrease in arterial oxygen saturation (SaO2)
B. Increase in systemic blood pressure
C. Presence of premature ventricular contractions (PVCs) on a cardiac monitor
D. Increase in intracranial pressure (ICP)
E. Drop in serum potassium levels
F. Widening QRS complex on the ECG
Answer & Rationale:
Correct Answer: C. Presence of premature ventricular contractions (PVCs) on a cardiac
monitor.
Explanation:
Lidocaine is used for treating ventricular arrhythmias, particularly PVCs, which can escalate into
life-threatening conditions like ventricular tachycardia or fibrillation. Monitoring for PVCs helps
assess the medication's effectiveness and prevents potential cardiac complications.
Key Takeaway:
When administering lidocaine, closely monitor cardiac rhythms to detect arrhythmias early and
intervene promptly.
2. Question Category: Pharmacological and Parenteral Therapies
Scenario:
A 72-year-old male patient with a history of atrial fibrillation and controlled hypertension has
recently been started on warfarin therapy. Upon reviewing his medical history, the nurse
discovers that the patient has a history of peptic ulcer disease. Given the patient’s condition and
prescribed anticoagulant therapy, which discharge instruction should be the highest priority?
,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
Answer & Rationale:
Correct Answer: B. Avoid foods high in vitamin K
Explanation:
Warfarin works by inhibiting vitamin K-dependent clotting factors, making dietary vitamin K
intake a crucial factor in maintaining therapeutic anticoagulation. Sudden increases in vitamin
K-rich foods can reduce the drug’s effectiveness, increasing the risk of clot formation.
• (A) Report diarrhea: Important, as diarrhea can affect medication absorption, but not
the priority.
• (C) Use a straight razor: Not advised due to an increased risk of bleeding; an electric
razor is safer.
• (D) Take aspirin for pain relief: Contraindicated unless prescribed, as aspirin further
increases bleeding risk.
• (E) Monitor for signs of bleeding: Important but not specific to warfarin's dietary
considerations.
• (F) Check blood pressure: Useful for overall health but not directly related to warfarin’s
primary risk.
• (G) Inform healthcare providers: Essential, but dietary management has a more direct
impact on warfarin’s effectiveness.
Key Takeaway:
Encourage consistent vitamin K intake rather than complete avoidance. Fluctuations in dietary
vitamin K can destabilize anticoagulation levels, increasing health risks.
3. Question Category: Reduction of Risk Potential
,Scenario:
A nurse in a busy surgical unit is preparing to insert an I.V. catheter for a 33-year-old patient
scheduled for elective surgery. The patient has a hairy forearm at the intended insertion site
and reports a history of adhesive allergies and sensitive skin prone to irritation. Considering
these factors, what is the best approach for managing excess hair before I.V. insertion?
A. Leave the hair intact
B. Shave the area
C. Clip the hair in the area
D. Use a depilatory (hair removal cream)
E. Apply water-soluble gel to flatten the hair
F. Trim the hair with a sterile surgical scalpel
Answer & Rationale:
Correct Answer: C. Clip the hair in the area
Explanation:
Clipping hair is the preferred method for preparing an I.V. site because it reduces infection risk
while avoiding skin irritation or injury.
• (A) Leaving the hair intact can cause adhesion issues with dressings and may increase
infection risk.
• (B) Shaving the area is not recommended, as it creates microabrasions, increasing the
risk of infection.
• (D) Using a depilatory is inappropriate due to the patient's sensitive skin and allergy
history.
• (E) Applying water-soluble gel is not a standard practice and does not adequately
address infection control.
• (F) Using a sterile surgical scalpel poses a risk of cuts and abrasions, increasing
infection risk.
Key Takeaway:
Always clip hair instead of shaving before procedures to minimize infection risk and prevent
skin irritation.
4️. Question Category: Health Promotion and Maintenance
, Scenario:
A nurse is educating an elderly female patient who has been recently diagnosed with
osteoporosis. The patient:
• Leads a sedentary lifestyle
• Has a diet low in calcium
• Went through menopause 10 years ago
• Has a visibly kyphotic posture
When planning education, 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 weakness
Answer & Rationale:
Correct Answer: A. Increased susceptibility to bone fractures from minimal trauma
Explanation:
The most immediate and severe complication of osteoporosis is the increased risk of
fractures, particularly in the hip, wrist, and spine, which can occur from minor stress or
trauma.
• (B) Estrogen deficiency is a contributing factor to osteoporosis, but it is not the most
critical complication.
• (C) Negative calcium balance leads to bone loss, but it is a cause rather than an
outcome of osteoporosis.
• (D) Spinal deformities (kyphosis) can develop but progress gradually, while fractures
have immediate consequences.
• (E) Height loss is a secondary effect of vertebral compression but does not carry the
same level of risk as fractures.
