CJE READINESS II EXAM 2026 – STUDY
QUESTIONS, VERIFIED ANSWERS &
DETAILED RATIONALES
CJE READINESS II EXAM 2026 – STUDY QUESTIONS, VERIFIED ANSWERS &
DETAILED RATIONALES
DOCUMENT OVERVIEW
• This comprehensive study guide contains carefully crafted clinical judgment exam
questions designed to prepare you for the NR 452 Capstone Clinical Judgment
Exam (CJE Readiness II) and NCLEX-RN certification, covering all essential nursing
domains and clinical scenarios.
• Study this material by reviewing 10-15 questions daily, focusing on understanding
the rationale behind each answer to develop clinical judgment skills and critical
thinking abilities necessary for safe, effective patient care.
QUESTION 1
A 65-year-old male patient presents to the emergency department with chest
pain, shortness of breath, and diaphoresis. His vital signs are: BP 150/90
mmHg, HR 102 bpm, RR 24, and O2 saturation 92% on room air. An EKG shows
ST-segment elevation in leads II, III, and aVF. What is the priority nursing
action?
A) Administer aspirin and arrange for immediate cardiac catheterization
B) Start oxygen therapy and establish IV access
C) Obtain a detailed history of chest pain characteristics
D) Administer nitroglycerin sublingual tablet
E) Transfer patient to a monitored bed and observe
CORRECT ANSWER: B) Start oxygen therapy and establish IV access
,RATIONALE: This patient is experiencing an acute myocardial infarction (AMI) with
ST-segment elevation in the inferior wall. The priority nursing action is to stabilize
the patient's oxygenation status and establish vascular access for medication
administration. While aspirin and nitroglycerin are important interventions, oxygen
therapy addresses the immediate hypoxemia (O2 sat 92%), and IV access is
essential for emergency medications and interventions. The nurse must establish
basic life support measures before other interventions. Immediate cardiac
catheterization (PCI) is the definitive treatment but requires physician orders and
coordination. Obtaining a detailed history delays critical interventions.
QUESTION 2
A 42-year-old female patient with type 2 diabetes mellitus presents with a
fasting blood glucose of 285 mg/dL and HbA1c of 9.2%. She reports poor
medication adherence due to cost. Which nursing intervention demonstrates
the best clinical judgment in this situation?
A) Scold the patient about the importance of medication compliance
B) Assess barriers to medication adherence and explore resources such as patient
assistance programs, generic alternatives, and community health centers
C) Recommend the patient increase exercise and dietary modifications alone
without medication
D) Refer the patient to endocrinology without addressing current concerns
E) Document the non-adherence and continue current treatment plan
CORRECT ANSWER: B) Assess barriers to medication adherence and explore
resources such as patient assistance programs, generic alternatives, and
community health centers
RATIONALE: Clinical judgment requires identifying the root cause of non-
adherence (cost) and collaboratively solving the problem. The nurse should assess
,barriers to medication adherence and work with the patient to identify practical
solutions. Many pharmaceutical companies offer patient assistance programs for
those who cannot afford medications, and generic alternatives are often available
at reduced cost. Community health centers may provide medications at reduced
rates. This patient-centered approach demonstrates therapeutic communication,
advocacy, and problem-solving. Scolding creates a non-therapeutic relationship.
Recommending exercise and diet alone without medication management is unsafe
for this patient with significantly elevated glucose levels. Referral without
addressing current barriers may not resolve the issue. Non-adherence
documentation without intervention enables poor outcomes.
QUESTION 3
A 28-year-old primigravida at 32 weeks gestation presents with complaints of
sudden severe headache, visual disturbances, and right upper quadrant pain.
Her BP is 168/105 mmHg. Which clinical judgment best reflects appropriate
nursing action?
A) Reassure the patient that these symptoms are normal in pregnancy and
recommend rest
B) Obtain baseline vital signs, perform a rapid assessment, and notify the
healthcare provider immediately of suspected preeclampsia with severe features
C) Administer acetaminophen for headache and schedule an office visit for next
week
D) Start an IV and administer magnesium sulfate without provider orders
E) Place the patient on bed rest and monitor blood pressure daily
CORRECT ANSWER: B) Obtain baseline vital signs, perform a rapid assessment,
and notify the healthcare provider immediately of suspected preeclampsia
with severe features
, RATIONALE: This patient presents with classic signs of preeclampsia with severe
features: hypertension (168/105), severe headache, visual disturbances (indicating
cerebral involvement), and right upper quadrant pain (suggesting hepatic
involvement). Immediate notification of the healthcare provider is critical as this
condition can rapidly progress to eclampsia with seizures, stroke, or maternal/fetal
death. The nurse must act quickly to assess and report findings, allowing the
provider to determine appropriate interventions. Reassuring the patient without
evaluation is dangerous and delays critical care. Acetaminophen and scheduling
office visit delays necessary treatment. Administering medications without orders
violates scope of practice. While bed rest may be ordered, it does not address the
urgent clinical situation requiring immediate provider notification.
QUESTION 4
A 55-year-old patient with COPD is admitted with acute exacerbation. ABG
values show: pH 7.32, PaCO2 58 mmHg, HCO3- 28 mEq/L, and PaO2 65 mmHg.
Which interpretation of these values is correct?
A) Respiratory alkalosis with metabolic compensation
B) Metabolic acidosis with respiratory compensation
C) Respiratory acidosis with metabolic compensation
D) Respiratory acidosis with metabolic alkalosis
E) Mixed metabolic and respiratory acidosis
CORRECT ANSWER: C) Respiratory acidosis with metabolic compensation
RATIONALE: Analysis of the ABG values shows: pH 7.32 (acidemia, normal 7.35-
7.45), elevated PaCO2 58 mmHg (respiratory component causing acidosis), and
elevated HCO3- 28 mEq/L (metabolic compensation attempting to normalize pH). In
respiratory acidosis from COPD exacerbation, the primary problem is inadequate
ventilation (elevated CO2). The kidneys respond by retaining bicarbonate (HCO3-) to
QUESTIONS, VERIFIED ANSWERS &
DETAILED RATIONALES
CJE READINESS II EXAM 2026 – STUDY QUESTIONS, VERIFIED ANSWERS &
DETAILED RATIONALES
DOCUMENT OVERVIEW
• This comprehensive study guide contains carefully crafted clinical judgment exam
questions designed to prepare you for the NR 452 Capstone Clinical Judgment
Exam (CJE Readiness II) and NCLEX-RN certification, covering all essential nursing
domains and clinical scenarios.
• Study this material by reviewing 10-15 questions daily, focusing on understanding
the rationale behind each answer to develop clinical judgment skills and critical
thinking abilities necessary for safe, effective patient care.
QUESTION 1
A 65-year-old male patient presents to the emergency department with chest
pain, shortness of breath, and diaphoresis. His vital signs are: BP 150/90
mmHg, HR 102 bpm, RR 24, and O2 saturation 92% on room air. An EKG shows
ST-segment elevation in leads II, III, and aVF. What is the priority nursing
action?
A) Administer aspirin and arrange for immediate cardiac catheterization
B) Start oxygen therapy and establish IV access
C) Obtain a detailed history of chest pain characteristics
D) Administer nitroglycerin sublingual tablet
E) Transfer patient to a monitored bed and observe
CORRECT ANSWER: B) Start oxygen therapy and establish IV access
,RATIONALE: This patient is experiencing an acute myocardial infarction (AMI) with
ST-segment elevation in the inferior wall. The priority nursing action is to stabilize
the patient's oxygenation status and establish vascular access for medication
administration. While aspirin and nitroglycerin are important interventions, oxygen
therapy addresses the immediate hypoxemia (O2 sat 92%), and IV access is
essential for emergency medications and interventions. The nurse must establish
basic life support measures before other interventions. Immediate cardiac
catheterization (PCI) is the definitive treatment but requires physician orders and
coordination. Obtaining a detailed history delays critical interventions.
QUESTION 2
A 42-year-old female patient with type 2 diabetes mellitus presents with a
fasting blood glucose of 285 mg/dL and HbA1c of 9.2%. She reports poor
medication adherence due to cost. Which nursing intervention demonstrates
the best clinical judgment in this situation?
A) Scold the patient about the importance of medication compliance
B) Assess barriers to medication adherence and explore resources such as patient
assistance programs, generic alternatives, and community health centers
C) Recommend the patient increase exercise and dietary modifications alone
without medication
D) Refer the patient to endocrinology without addressing current concerns
E) Document the non-adherence and continue current treatment plan
CORRECT ANSWER: B) Assess barriers to medication adherence and explore
resources such as patient assistance programs, generic alternatives, and
community health centers
RATIONALE: Clinical judgment requires identifying the root cause of non-
adherence (cost) and collaboratively solving the problem. The nurse should assess
,barriers to medication adherence and work with the patient to identify practical
solutions. Many pharmaceutical companies offer patient assistance programs for
those who cannot afford medications, and generic alternatives are often available
at reduced cost. Community health centers may provide medications at reduced
rates. This patient-centered approach demonstrates therapeutic communication,
advocacy, and problem-solving. Scolding creates a non-therapeutic relationship.
Recommending exercise and diet alone without medication management is unsafe
for this patient with significantly elevated glucose levels. Referral without
addressing current barriers may not resolve the issue. Non-adherence
documentation without intervention enables poor outcomes.
QUESTION 3
A 28-year-old primigravida at 32 weeks gestation presents with complaints of
sudden severe headache, visual disturbances, and right upper quadrant pain.
Her BP is 168/105 mmHg. Which clinical judgment best reflects appropriate
nursing action?
A) Reassure the patient that these symptoms are normal in pregnancy and
recommend rest
B) Obtain baseline vital signs, perform a rapid assessment, and notify the
healthcare provider immediately of suspected preeclampsia with severe features
C) Administer acetaminophen for headache and schedule an office visit for next
week
D) Start an IV and administer magnesium sulfate without provider orders
E) Place the patient on bed rest and monitor blood pressure daily
CORRECT ANSWER: B) Obtain baseline vital signs, perform a rapid assessment,
and notify the healthcare provider immediately of suspected preeclampsia
with severe features
, RATIONALE: This patient presents with classic signs of preeclampsia with severe
features: hypertension (168/105), severe headache, visual disturbances (indicating
cerebral involvement), and right upper quadrant pain (suggesting hepatic
involvement). Immediate notification of the healthcare provider is critical as this
condition can rapidly progress to eclampsia with seizures, stroke, or maternal/fetal
death. The nurse must act quickly to assess and report findings, allowing the
provider to determine appropriate interventions. Reassuring the patient without
evaluation is dangerous and delays critical care. Acetaminophen and scheduling
office visit delays necessary treatment. Administering medications without orders
violates scope of practice. While bed rest may be ordered, it does not address the
urgent clinical situation requiring immediate provider notification.
QUESTION 4
A 55-year-old patient with COPD is admitted with acute exacerbation. ABG
values show: pH 7.32, PaCO2 58 mmHg, HCO3- 28 mEq/L, and PaO2 65 mmHg.
Which interpretation of these values is correct?
A) Respiratory alkalosis with metabolic compensation
B) Metabolic acidosis with respiratory compensation
C) Respiratory acidosis with metabolic compensation
D) Respiratory acidosis with metabolic alkalosis
E) Mixed metabolic and respiratory acidosis
CORRECT ANSWER: C) Respiratory acidosis with metabolic compensation
RATIONALE: Analysis of the ABG values shows: pH 7.32 (acidemia, normal 7.35-
7.45), elevated PaCO2 58 mmHg (respiratory component causing acidosis), and
elevated HCO3- 28 mEq/L (metabolic compensation attempting to normalize pH). In
respiratory acidosis from COPD exacerbation, the primary problem is inadequate
ventilation (elevated CO2). The kidneys respond by retaining bicarbonate (HCO3-) to
