NR324 CJE EXAM PRACTICE | COMPREHENSIVE STUDY GUIDE | ADVANCED
TESTBANK | PRACTICE QUESTIONS & ANSWERS | EXAM PREPARATION | LATEST
UPDATE 2026/2027
TABLE OF CONTENTS
i. Clinical Judgment, Prioritization & Patient Safety — Questions 1–5
ii. Cardiovascular & Hemodynamic Disorders — Questions 6–10
iii. Respiratory Disorders & Oxygenation — Questions 11–15
iv. Renal, Fluid, Electrolyte & Acid–Base Disorders — Questions 16–20
v. Neurologic, Endocrine & Metabolic Emergencies — Questions 21–25
vi. Infection, Perioperative Care, Pharmacology & Professional Decision-Making —
Questions 26–30
INTRODUCTION
This NR324 CJE practice set emphasizes advanced clinical judgment, prioritization,
assessment interpretation, safety, pathophysiology, pharmacologic decision-making,
and evidence-based nursing interventions. The questions are designed to challenge
learners beyond factual recall by requiring interpretation of clinical findings,
recognition of deterioration, identification of the highest-priority intervention,
evaluation of treatment effectiveness, and selection of the safest nursing response.
Students should expect realistic clinical scenarios containing competing priorities,
subtle changes in patient status, abnormal laboratory findings, medication
considerations, and situations requiring professional judgment. The set is intended for
advanced preparation and should be used to strengthen reasoning processes, connect
assessment findings with pathophysiology, and practice selecting the most appropriate
nursing action in complex patient-care situations.
QUESTION 1
A nurse is caring for four hospitalized adults. Which patient should the nurse
assess first?
A. A patient with heart failure who reports a 2-kg weight gain over the past week and
has bilateral ankle edema
B. A patient with pneumonia whose oxygen saturation decreased from 95% to 90%
while receiving oxygen at 2 L/min via nasal cannula
C. A patient with diabetes mellitus whose blood glucose is 68 mg/dL and who is awake,
diaphoretic, and able to swallow
,D. A patient 12 hours after abdominal surgery who reports incisional pain of 7/10
despite receiving prescribed analgesia
🔴 Correct Answer: B. A patient with pneumonia whose oxygen saturation decreased
from 95% to 90% while receiving oxygen at 2 L/min via nasal cannula.
🔵 Explanation: The acute decline in oxygenation in a patient with pneumonia may
indicate worsening gas-exchange impairment and requires immediate respiratory
assessment. The nurse should first evaluate airway, breathing, respiratory effort, lung
sounds, and oxygen delivery. The other patients require intervention, but the potential for
acute respiratory deterioration takes priority.
QUESTION 2
A patient admitted with sepsis becomes increasingly confused. The nurse notes a
respiratory rate of 28/min, blood pressure of 86/52 mmHg, heart rate of 124/min, cool
extremities, and urine output of 15 mL/hr. Which finding is the most significant
indicator of worsening systemic perfusion?
A. Heart rate of 124/min
B. Respiratory rate of 28/min
C. Urine output of 15 mL/hr
D. New-onset confusion
🔴 Correct Answer: C. Urine output of 15 mL/hr.
🔵 Explanation: Markedly decreased urine output indicates reduced renal perfusion and
is an important marker of worsening circulatory failure. Tachycardia, tachypnea, and
altered mental status are also concerning, but oliguria provides direct evidence of
inadequate renal blood flow and declining systemic perfusion.
QUESTION 3
A nurse receives a prescription to administer an IV medication to a patient whose renal
function has deteriorated significantly since admission. Which action demonstrates the
best clinical judgment?
A. Administer the medication because the prescription has already been entered
B. Ask another nurse to administer the medication instead
C. Review renal dosing requirements and clarify the prescription if necessary
D. Withhold all medications until the patient's renal function returns to baseline
🔴 Correct Answer: C. Review renal dosing requirements and clarify the prescription
if necessary.
,🔵 Explanation: Acute changes in renal function can substantially alter medication
clearance and increase toxicity risk. The nurse should assess the medication's renal
considerations and communicate with the prescriber or pharmacist when dose
modification may be necessary. Automatically administering or withholding therapy
without assessment is unsafe.
QUESTION 4
A postoperative patient suddenly develops restlessness, tachycardia, dyspnea, and
oxygen saturation of 86%. The patient reports sharp chest pain that worsens with
inspiration. Which nursing action is the priority?
A. Encourage the patient to ambulate to improve circulation
B. Place the patient in an appropriate position and administer oxygen while initiating
urgent evaluation
C. Administer the prescribed oral opioid for chest discomfort
D. Encourage coughing and deep breathing before reassessing the patient
🔴 Correct Answer: B. Place the patient in an appropriate position and administer
oxygen while initiating urgent evaluation.
🔵 Explanation: Sudden pleuritic chest pain, hypoxemia, dyspnea, tachycardia, and
postoperative status are concerning for pulmonary embolism. The immediate priority is
stabilization of oxygenation and urgent escalation of care. Ambulation and delaying
assessment could worsen the patient's condition.
QUESTION 5
A nurse is preparing to administer several medications to an older adult with multiple
chronic conditions. Which finding should prompt the nurse to perform the most
immediate medication-safety review?
A. The patient takes medications at different times throughout the day
B. The patient reports difficulty remembering whether doses were taken
C. The patient has developed new dizziness and confusion after a recent medication
addition
D. The patient requests that medications be administered with meals
🔴 Correct Answer: C. The patient has developed new dizziness and confusion after
a recent medication addition.
🔵 Explanation: New symptoms occurring after initiation of a medication may represent
an adverse drug effect, interaction, excessive drug exposure, or another clinically
, significant complication. Immediate assessment and medication reconciliation are
warranted before additional doses are administered.
QUESTION 6
A patient with acute decompensated heart failure develops severe dyspnea, bilateral
crackles, diaphoresis, and an oxygen saturation of 82%. Which intervention should the
nurse implement first?
A. Place the patient in a high-Fowler position and provide supplemental oxygen
B. Encourage oral fluid intake to improve circulating volume
C. Place the patient supine to improve venous return
D. Obtain the patient's daily weight before initiating treatment
🔴 Correct Answer: A. Place the patient in a high-Fowler position and provide
supplemental oxygen.
🔵 Explanation: The immediate priorities are improving ventilation and oxygenation and
reducing the work of breathing. High-Fowler positioning promotes lung expansion and
can decrease venous return, while supplemental oxygen addresses hypoxemia. Other
interventions may follow after stabilization.
QUESTION 7
A patient receiving IV therapy for acute heart failure is prescribed a loop diuretic. Which
finding requires the nurse's greatest concern before administering the next dose?
A. Blood pressure of 108/64 mmHg
B. Potassium level of 2.8 mEq/L
C. Urine output of 900 mL over 8 hours
D. Mild bilateral lower-extremity edema
🔴 Correct Answer: B. Potassium level of 2.8 mEq/L.
🔵 Explanation: Loop diuretics increase urinary potassium loss. A potassium level of 2.8
mEq/L represents significant hypokalemia and increases the risk of dysrhythmias,
particularly in a patient with cardiovascular disease. The nurse should assess the
prescription and notify the appropriate provider before proceeding as indicated.
QUESTION 8
A patient with atrial fibrillation is receiving anticoagulant therapy. Which assessment
finding requires immediate follow-up?
TESTBANK | PRACTICE QUESTIONS & ANSWERS | EXAM PREPARATION | LATEST
UPDATE 2026/2027
TABLE OF CONTENTS
i. Clinical Judgment, Prioritization & Patient Safety — Questions 1–5
ii. Cardiovascular & Hemodynamic Disorders — Questions 6–10
iii. Respiratory Disorders & Oxygenation — Questions 11–15
iv. Renal, Fluid, Electrolyte & Acid–Base Disorders — Questions 16–20
v. Neurologic, Endocrine & Metabolic Emergencies — Questions 21–25
vi. Infection, Perioperative Care, Pharmacology & Professional Decision-Making —
Questions 26–30
INTRODUCTION
This NR324 CJE practice set emphasizes advanced clinical judgment, prioritization,
assessment interpretation, safety, pathophysiology, pharmacologic decision-making,
and evidence-based nursing interventions. The questions are designed to challenge
learners beyond factual recall by requiring interpretation of clinical findings,
recognition of deterioration, identification of the highest-priority intervention,
evaluation of treatment effectiveness, and selection of the safest nursing response.
Students should expect realistic clinical scenarios containing competing priorities,
subtle changes in patient status, abnormal laboratory findings, medication
considerations, and situations requiring professional judgment. The set is intended for
advanced preparation and should be used to strengthen reasoning processes, connect
assessment findings with pathophysiology, and practice selecting the most appropriate
nursing action in complex patient-care situations.
QUESTION 1
A nurse is caring for four hospitalized adults. Which patient should the nurse
assess first?
A. A patient with heart failure who reports a 2-kg weight gain over the past week and
has bilateral ankle edema
B. A patient with pneumonia whose oxygen saturation decreased from 95% to 90%
while receiving oxygen at 2 L/min via nasal cannula
C. A patient with diabetes mellitus whose blood glucose is 68 mg/dL and who is awake,
diaphoretic, and able to swallow
,D. A patient 12 hours after abdominal surgery who reports incisional pain of 7/10
despite receiving prescribed analgesia
🔴 Correct Answer: B. A patient with pneumonia whose oxygen saturation decreased
from 95% to 90% while receiving oxygen at 2 L/min via nasal cannula.
🔵 Explanation: The acute decline in oxygenation in a patient with pneumonia may
indicate worsening gas-exchange impairment and requires immediate respiratory
assessment. The nurse should first evaluate airway, breathing, respiratory effort, lung
sounds, and oxygen delivery. The other patients require intervention, but the potential for
acute respiratory deterioration takes priority.
QUESTION 2
A patient admitted with sepsis becomes increasingly confused. The nurse notes a
respiratory rate of 28/min, blood pressure of 86/52 mmHg, heart rate of 124/min, cool
extremities, and urine output of 15 mL/hr. Which finding is the most significant
indicator of worsening systemic perfusion?
A. Heart rate of 124/min
B. Respiratory rate of 28/min
C. Urine output of 15 mL/hr
D. New-onset confusion
🔴 Correct Answer: C. Urine output of 15 mL/hr.
🔵 Explanation: Markedly decreased urine output indicates reduced renal perfusion and
is an important marker of worsening circulatory failure. Tachycardia, tachypnea, and
altered mental status are also concerning, but oliguria provides direct evidence of
inadequate renal blood flow and declining systemic perfusion.
QUESTION 3
A nurse receives a prescription to administer an IV medication to a patient whose renal
function has deteriorated significantly since admission. Which action demonstrates the
best clinical judgment?
A. Administer the medication because the prescription has already been entered
B. Ask another nurse to administer the medication instead
C. Review renal dosing requirements and clarify the prescription if necessary
D. Withhold all medications until the patient's renal function returns to baseline
🔴 Correct Answer: C. Review renal dosing requirements and clarify the prescription
if necessary.
,🔵 Explanation: Acute changes in renal function can substantially alter medication
clearance and increase toxicity risk. The nurse should assess the medication's renal
considerations and communicate with the prescriber or pharmacist when dose
modification may be necessary. Automatically administering or withholding therapy
without assessment is unsafe.
QUESTION 4
A postoperative patient suddenly develops restlessness, tachycardia, dyspnea, and
oxygen saturation of 86%. The patient reports sharp chest pain that worsens with
inspiration. Which nursing action is the priority?
A. Encourage the patient to ambulate to improve circulation
B. Place the patient in an appropriate position and administer oxygen while initiating
urgent evaluation
C. Administer the prescribed oral opioid for chest discomfort
D. Encourage coughing and deep breathing before reassessing the patient
🔴 Correct Answer: B. Place the patient in an appropriate position and administer
oxygen while initiating urgent evaluation.
🔵 Explanation: Sudden pleuritic chest pain, hypoxemia, dyspnea, tachycardia, and
postoperative status are concerning for pulmonary embolism. The immediate priority is
stabilization of oxygenation and urgent escalation of care. Ambulation and delaying
assessment could worsen the patient's condition.
QUESTION 5
A nurse is preparing to administer several medications to an older adult with multiple
chronic conditions. Which finding should prompt the nurse to perform the most
immediate medication-safety review?
A. The patient takes medications at different times throughout the day
B. The patient reports difficulty remembering whether doses were taken
C. The patient has developed new dizziness and confusion after a recent medication
addition
D. The patient requests that medications be administered with meals
🔴 Correct Answer: C. The patient has developed new dizziness and confusion after
a recent medication addition.
🔵 Explanation: New symptoms occurring after initiation of a medication may represent
an adverse drug effect, interaction, excessive drug exposure, or another clinically
, significant complication. Immediate assessment and medication reconciliation are
warranted before additional doses are administered.
QUESTION 6
A patient with acute decompensated heart failure develops severe dyspnea, bilateral
crackles, diaphoresis, and an oxygen saturation of 82%. Which intervention should the
nurse implement first?
A. Place the patient in a high-Fowler position and provide supplemental oxygen
B. Encourage oral fluid intake to improve circulating volume
C. Place the patient supine to improve venous return
D. Obtain the patient's daily weight before initiating treatment
🔴 Correct Answer: A. Place the patient in a high-Fowler position and provide
supplemental oxygen.
🔵 Explanation: The immediate priorities are improving ventilation and oxygenation and
reducing the work of breathing. High-Fowler positioning promotes lung expansion and
can decrease venous return, while supplemental oxygen addresses hypoxemia. Other
interventions may follow after stabilization.
QUESTION 7
A patient receiving IV therapy for acute heart failure is prescribed a loop diuretic. Which
finding requires the nurse's greatest concern before administering the next dose?
A. Blood pressure of 108/64 mmHg
B. Potassium level of 2.8 mEq/L
C. Urine output of 900 mL over 8 hours
D. Mild bilateral lower-extremity edema
🔴 Correct Answer: B. Potassium level of 2.8 mEq/L.
🔵 Explanation: Loop diuretics increase urinary potassium loss. A potassium level of 2.8
mEq/L represents significant hypokalemia and increases the risk of dysrhythmias,
particularly in a patient with cardiovascular disease. The nurse should assess the
prescription and notify the appropriate provider before proceeding as indicated.
QUESTION 8
A patient with atrial fibrillation is receiving anticoagulant therapy. Which assessment
finding requires immediate follow-up?
