CJE READINESS II EXAM PRACTICE | COMPREHENSIVE STUDY GUIDE |
ADVANCED TESTBANK WITH PRACTICE QUESTIONS & ANSWERS | LATEST
UPDATE 2026/2027
TABLE OF CONTENTS
i. Clinical Judgment and the NCLEX-RN Framework
ii. Management of Care, Delegation, and Prioritization
iii. Safety and Infection Prevention
iv. Pharmacological and Parenteral Therapies
v. Reduction of Risk Potential and Physiological Adaptation
vi. Health Promotion, Psychosocial Integrity, and Communication
vii. Basic Care, Comfort, Nutrition, and Elimination
viii. Clinical Reasoning, Evaluation, and Professional Practice
INTRODUCTION
This comprehensive CJE Readiness II practice examination is designed to strengthen
advanced clinical judgment and prepare nursing students for high-level NCLEX-RN-
style decision making. The questions emphasize recognition and analysis of clinical
cues, prioritization of hypotheses, generation of solutions, implementation of
nursing actions, and evaluation of outcomes. Content integrates management of
care, pharmacology, safety, infection prevention, physiological adaptation,
psychosocial integrity, health promotion, comfort, nutrition, elimination, and
professional nursing practice. Expect complex patient scenarios requiring
prioritization, interpretation of assessment findings, medication safety, delegation,
ethical reasoning, and evaluation of patient responses. The questions are
intentionally challenging and focus on application rather than simple memorization.
Question 1
A nurse receives handoff for four clients. Which client should the nurse assess first?
A. A client with chronic heart failure who has gained 1 kg (2.2 lb) over the past week
B. A client 12 hours after thyroidectomy who reports tingling around the mouth and
has new muscle twitching
C. A client with pneumonia whose temperature is 38.1°C (100.6°F) after receiving
,acetaminophen
D. A client with type 2 diabetes whose premeal glucose is 214 mg/dL (11.9 mmol/L)
🔴 Correct Answer: B. A client 12 hours after thyroidectomy who reports tingling
around the mouth and has new muscle twitching.
🔵 Explanation: Perioral paresthesia and muscle twitching after thyroid surgery
suggest acute hypocalcemia caused by parathyroid injury or dysfunction. Progression
to laryngospasm, seizures, or cardiac dysrhythmias can occur, making this the
highest-priority assessment.
Question 2
A client with septic shock has received a crystalloid bolus and broad-spectrum
antibiotics. The client's blood pressure remains 82/48 mm Hg, and the mean arterial
pressure is 59 mm Hg. Which intervention should the nurse anticipate next?
A. Administer an isotonic fluid bolus indefinitely until blood pressure normalizes
B. Initiate a prescribed vasopressor infusion
C. Administer a loop diuretic to prevent pulmonary edema
D. Place the client in a high-Fowler position and reassess in 30 minutes
🔴 Correct Answer: B. Initiate a prescribed vasopressor infusion.
🔵 Explanation: Persistent hypotension despite appropriate initial fluid resuscitation
in septic shock indicates the need for vasopressor support to restore adequate tissue
perfusion. Delaying vasopressors can worsen organ hypoperfusion.
Question 3
A client receiving a heparin infusion has a platelet count that decreases from
238,000/mm³ to 108,000/mm³ on day 6 of therapy. The client also develops a new
painful swelling in the calf. Which action is the nurse's priority?
A. Increase the heparin infusion because thrombosis is suspected
B. Administer prescribed vitamin K
C. Stop the heparin infusion and notify the provider immediately
D. Apply a warm compress to the affected calf
🔴 Correct Answer: C. Stop the heparin infusion and notify the provider
immediately.
,🔵 Explanation: A substantial platelet decline 5–10 days after heparin exposure
accompanied by new thrombosis strongly suggests heparin-induced
thrombocytopenia. Heparin must be discontinued and an alternative non-heparin
anticoagulant anticipated.
Question 4
A client with diabetic ketoacidosis has received IV fluids and an insulin infusion. The
serum potassium decreases from 5.8 mEq/L to 3.1 mEq/L. Which action is most
appropriate?
A. Continue insulin at the current rate because hyperglycemia remains
B. Administer potassium replacement as prescribed and anticipate temporarily
holding insulin
C. Administer sodium bicarbonate immediately
D. Restrict IV fluids to prevent cardiac overload
🔴 Correct Answer: B. Administer potassium replacement as prescribed and
anticipate temporarily holding insulin.
🔵 Explanation: Insulin shifts potassium intracellularly and can cause life-threatening
hypokalemia during DKA treatment. When potassium becomes significantly low,
potassium replacement is prioritized and insulin may need to be temporarily withheld
until potassium is corrected.
Question 5
A nurse is caring for a client with an acute ischemic stroke who has facial weakness
and difficulty swallowing. Which action should the nurse take before administering
oral medications?
A. Offer water to determine whether swallowing is intact
B. Place the client in Trendelenburg position
C. Verify that a swallowing evaluation has been completed
D. Crush all medications and mix them with water
🔴 Correct Answer: C. Verify that a swallowing evaluation has been completed.
🔵 Explanation: Dysphagia is common after stroke and creates a major aspiration
risk. Oral intake and medications should be withheld until swallowing safety has been
assessed.
, Question 6
A client receiving digoxin has an apical pulse of 48/min and reports nausea,
anorexia, and yellow-green visual disturbances. Which action should the nurse take?
A. Administer the medication with food
B. Hold digoxin and notify the provider
C. Administer the next dose early
D. Encourage increased potassium restriction
🔴 Correct Answer: B. Hold digoxin and notify the provider.
🔵 Explanation: Bradycardia, gastrointestinal symptoms, and visual disturbances are
classic findings associated with digoxin toxicity. The medication should be withheld
and the client evaluated for toxicity and electrolyte abnormalities.
Question 7
A client with chronic obstructive pulmonary disease is receiving oxygen at 2 L/min
by nasal cannula. The client becomes increasingly somnolent and difficult to arouse.
Which assessment is most important?
A. Capillary refill
B. Arterial blood gas results
C. Bowel sounds
D. Urine specific gravity
🔴 Correct Answer: B. Arterial blood gas results.
🔵 Explanation: Increasing somnolence in a client with COPD receiving oxygen may
indicate worsening hypercapnia and respiratory acidosis. ABG analysis helps
determine ventilation and acid-base status.
Question 8
A postoperative client suddenly develops dyspnea, pleuritic chest pain, tachycardia,
and oxygen saturation of 84%. Which intervention should the nurse implement
first?
A. Encourage ambulation
B. Apply oxygen and rapidly assess respiratory status
ADVANCED TESTBANK WITH PRACTICE QUESTIONS & ANSWERS | LATEST
UPDATE 2026/2027
TABLE OF CONTENTS
i. Clinical Judgment and the NCLEX-RN Framework
ii. Management of Care, Delegation, and Prioritization
iii. Safety and Infection Prevention
iv. Pharmacological and Parenteral Therapies
v. Reduction of Risk Potential and Physiological Adaptation
vi. Health Promotion, Psychosocial Integrity, and Communication
vii. Basic Care, Comfort, Nutrition, and Elimination
viii. Clinical Reasoning, Evaluation, and Professional Practice
INTRODUCTION
This comprehensive CJE Readiness II practice examination is designed to strengthen
advanced clinical judgment and prepare nursing students for high-level NCLEX-RN-
style decision making. The questions emphasize recognition and analysis of clinical
cues, prioritization of hypotheses, generation of solutions, implementation of
nursing actions, and evaluation of outcomes. Content integrates management of
care, pharmacology, safety, infection prevention, physiological adaptation,
psychosocial integrity, health promotion, comfort, nutrition, elimination, and
professional nursing practice. Expect complex patient scenarios requiring
prioritization, interpretation of assessment findings, medication safety, delegation,
ethical reasoning, and evaluation of patient responses. The questions are
intentionally challenging and focus on application rather than simple memorization.
Question 1
A nurse receives handoff for four clients. Which client should the nurse assess first?
A. A client with chronic heart failure who has gained 1 kg (2.2 lb) over the past week
B. A client 12 hours after thyroidectomy who reports tingling around the mouth and
has new muscle twitching
C. A client with pneumonia whose temperature is 38.1°C (100.6°F) after receiving
,acetaminophen
D. A client with type 2 diabetes whose premeal glucose is 214 mg/dL (11.9 mmol/L)
🔴 Correct Answer: B. A client 12 hours after thyroidectomy who reports tingling
around the mouth and has new muscle twitching.
🔵 Explanation: Perioral paresthesia and muscle twitching after thyroid surgery
suggest acute hypocalcemia caused by parathyroid injury or dysfunction. Progression
to laryngospasm, seizures, or cardiac dysrhythmias can occur, making this the
highest-priority assessment.
Question 2
A client with septic shock has received a crystalloid bolus and broad-spectrum
antibiotics. The client's blood pressure remains 82/48 mm Hg, and the mean arterial
pressure is 59 mm Hg. Which intervention should the nurse anticipate next?
A. Administer an isotonic fluid bolus indefinitely until blood pressure normalizes
B. Initiate a prescribed vasopressor infusion
C. Administer a loop diuretic to prevent pulmonary edema
D. Place the client in a high-Fowler position and reassess in 30 minutes
🔴 Correct Answer: B. Initiate a prescribed vasopressor infusion.
🔵 Explanation: Persistent hypotension despite appropriate initial fluid resuscitation
in septic shock indicates the need for vasopressor support to restore adequate tissue
perfusion. Delaying vasopressors can worsen organ hypoperfusion.
Question 3
A client receiving a heparin infusion has a platelet count that decreases from
238,000/mm³ to 108,000/mm³ on day 6 of therapy. The client also develops a new
painful swelling in the calf. Which action is the nurse's priority?
A. Increase the heparin infusion because thrombosis is suspected
B. Administer prescribed vitamin K
C. Stop the heparin infusion and notify the provider immediately
D. Apply a warm compress to the affected calf
🔴 Correct Answer: C. Stop the heparin infusion and notify the provider
immediately.
,🔵 Explanation: A substantial platelet decline 5–10 days after heparin exposure
accompanied by new thrombosis strongly suggests heparin-induced
thrombocytopenia. Heparin must be discontinued and an alternative non-heparin
anticoagulant anticipated.
Question 4
A client with diabetic ketoacidosis has received IV fluids and an insulin infusion. The
serum potassium decreases from 5.8 mEq/L to 3.1 mEq/L. Which action is most
appropriate?
A. Continue insulin at the current rate because hyperglycemia remains
B. Administer potassium replacement as prescribed and anticipate temporarily
holding insulin
C. Administer sodium bicarbonate immediately
D. Restrict IV fluids to prevent cardiac overload
🔴 Correct Answer: B. Administer potassium replacement as prescribed and
anticipate temporarily holding insulin.
🔵 Explanation: Insulin shifts potassium intracellularly and can cause life-threatening
hypokalemia during DKA treatment. When potassium becomes significantly low,
potassium replacement is prioritized and insulin may need to be temporarily withheld
until potassium is corrected.
Question 5
A nurse is caring for a client with an acute ischemic stroke who has facial weakness
and difficulty swallowing. Which action should the nurse take before administering
oral medications?
A. Offer water to determine whether swallowing is intact
B. Place the client in Trendelenburg position
C. Verify that a swallowing evaluation has been completed
D. Crush all medications and mix them with water
🔴 Correct Answer: C. Verify that a swallowing evaluation has been completed.
🔵 Explanation: Dysphagia is common after stroke and creates a major aspiration
risk. Oral intake and medications should be withheld until swallowing safety has been
assessed.
, Question 6
A client receiving digoxin has an apical pulse of 48/min and reports nausea,
anorexia, and yellow-green visual disturbances. Which action should the nurse take?
A. Administer the medication with food
B. Hold digoxin and notify the provider
C. Administer the next dose early
D. Encourage increased potassium restriction
🔴 Correct Answer: B. Hold digoxin and notify the provider.
🔵 Explanation: Bradycardia, gastrointestinal symptoms, and visual disturbances are
classic findings associated with digoxin toxicity. The medication should be withheld
and the client evaluated for toxicity and electrolyte abnormalities.
Question 7
A client with chronic obstructive pulmonary disease is receiving oxygen at 2 L/min
by nasal cannula. The client becomes increasingly somnolent and difficult to arouse.
Which assessment is most important?
A. Capillary refill
B. Arterial blood gas results
C. Bowel sounds
D. Urine specific gravity
🔴 Correct Answer: B. Arterial blood gas results.
🔵 Explanation: Increasing somnolence in a client with COPD receiving oxygen may
indicate worsening hypercapnia and respiratory acidosis. ABG analysis helps
determine ventilation and acid-base status.
Question 8
A postoperative client suddenly develops dyspnea, pleuritic chest pain, tachycardia,
and oxygen saturation of 84%. Which intervention should the nurse implement
first?
A. Encourage ambulation
B. Apply oxygen and rapidly assess respiratory status
