CJE READINESS II EXAM STUDY GUIDE
2026/2027 | CLINICAL JUDGMENT PRACTICE
Q&A WITH RATIONALES
CJE READINESS II EXAM STUDY GUIDE 2026/2027
CLINICAL JUDGMENT PRACTICE Q&A WITH RATIONALES
DOCUMENT OVERVIEW
• This comprehensive study guide contains evidence-based clinical judgment
practice questions designed to strengthen decision-making skills, critical thinking,
and patient safety awareness across diverse healthcare scenarios
• Study strategically by completing questions in sections, reviewing detailed
rationales for every answer, and identifying knowledge gaps to focus your
preparation for the CJE exam
1. A 65-year-old patient admitted with acute myocardial infarction (AMI)
presents with chest pain radiating to the left arm, dyspnea, and diaphoresis.
The cardiac monitor shows ST-segment elevation in leads II, III, and aVF. What
is the priority nursing intervention?
A) Administer oxygen at 2L via nasal cannula and monitor vital signs every 4 hours
B) Obtain a 12-lead ECG immediately and notify the healthcare provider of the
findings
C) Administer aspirin and prepare for possible percutaneous coronary intervention
(PCI)
D) Start an IV line and draw blood for troponin levels only
E) Place the patient on continuous cardiac monitoring and keep NPO status
CORRECT ANSWER: C) Administer aspirin and prepare for possible
percutaneous coronary intervention (PCI)
,RATIONALE: In acute ST-elevation myocardial infarction (STEMI), time is
myocardium—early intervention is critical. Aspirin should be administered
immediately as an antiplatelet agent to prevent thrombus formation. PCI is the gold
standard reperfusion therapy for STEMI when available within 120 minutes of first
medical contact. While obtaining an ECG (option B) is important, it should not delay
treatment. Options A and D are insufficient in acuity, and NPO status (option E) is
appropriate but not the priority intervention. The focus must be on rapid
reperfusion and antiplatelet therapy.
2. A 28-year-old primigravida at 32 weeks gestation presents to the
emergency department with a severe headache, epigastric pain, and blood
pressure of 165/110 mmHg. Urine dipstick shows 3+ proteinuria. What clinical
diagnosis should the nurse suspect?
A) Gestational diabetes mellitus with hypertensive crisis
B) Preeclampsia with severe features, progressing toward eclampsia
C) Chronic hypertension exacerbated by pregnancy
D) Migraine headache unrelated to pregnancy status
E) Hellp syndrome (hemolysis, elevated liver enzymes, low platelets)
CORRECT ANSWER: B) Preeclampsia with severe features, progressing toward
eclampsia
RATIONALE: The classic triad of preeclampsia includes hypertension (≥140/90
mmHg), proteinuria (≥1+ on dipstick or ≥300 mg/24 hours), and edema. This patient
demonstrates severe features: BP 165/110 (severe range), 3+ proteinuria, severe
headache (neurological symptom), and epigastric pain (indicates hepatic
involvement). These are warning signs of progression toward eclampsia. While
HELLP syndrome (option E) can coexist with severe preeclampsia, the presentation
is most consistent with preeclampsia with severe features. Immediate interventions
include antihypertensive therapy, magnesium sulfate for seizure prophylaxis, and
delivery planning.
,3. A 72-year-old male with COPD presents with acute dyspnea, increased
sputum production, and purulent sputum. His oxygen saturation is 88% on
room air. What is the nurse's priority assessment before administering
oxygen therapy?
A) Verify the patient's preferred oxygen concentration and delivery device
B) Assess arterial blood gas (ABG) values to determine baseline CO2 levels and
oxygen saturation
C) Immediately apply high-flow oxygen at 10L/min to achieve SpO2 >94%
D) Check lung sounds bilaterally and assess work of breathing
E) Obtain a chest X-ray to confirm the diagnosis of acute exacerbation
CORRECT ANSWER: B) Assess arterial blood gas (ABG) values to determine
baseline CO2 levels and oxygen saturation
RATIONALE: In patients with chronic COPD, baseline CO2 levels are often elevated,
and the respiratory drive is hypoxia-driven rather than hypercapnia-driven. High-
flow oxygen can suppress this hypoxic drive and cause respiratory depression or
CO2 retention. ABG assessment is critical to establish baseline values and guide
oxygen titration. While assessing lung sounds (option D) is important, it does not
address the specific risk of oxygen-induced hypercapnia. Option C is
contraindicated without knowing baseline ABG values. Safe oxygen therapy in
COPD typically targets SpO2 of 88-92% to maintain adequate oxygenation while
preserving respiratory drive.
4. A 45-year-old patient with uncontrolled hypertension is prescribed an ACE
inhibitor. The patient reports a persistent dry cough that began 3 days after
starting the medication. What is the most appropriate nursing action?
A) Discontinue the medication immediately and report to the healthcare provider
B) Reassure the patient that the cough will resolve within 2 weeks and encourage
adherence
, C) Suggest the patient use over-the-counter cough suppressants to manage the
symptom
D) Contact the healthcare provider to discuss the cough and potential medication
adjustment
E) Increase fluid intake to help suppress the cough reflex
CORRECT ANSWER: D) Contact the healthcare provider to discuss the cough
and potential medication adjustment
RATIONALE: A persistent dry cough is a well-documented side effect of ACE
inhibitors, occurring in 10-20% of patients due to accumulation of bradykinin in the
lungs. While the cough is typically benign and harmless, it significantly impacts
medication adherence and quality of life. The appropriate intervention is to notify
the healthcare provider, who may consider switching to an alternative
antihypertensive class such as an ARB (angiotensin II receptor blocker), which has a
much lower incidence of cough. The cough typically resolves within days to weeks
of discontinuation but may persist in some patients. Option A (discontinuing
without provider contact) and option B (false reassurance about resolution) are
inappropriate. Options C and E do not address the underlying issue.
5. A 55-year-old patient admitted with acute pancreatitis presents with severe
epigastric pain, elevated lipase levels, and mild fever. Which nursing
intervention is most critical in the initial management?
A) Provide oral nutrition with clear liquids to maintain caloric intake
B) Keep the patient NPO and initiate IV fluid replacement to maintain hydration
C) Administer prophylactic antibiotics to prevent secondary infection
D) Position the patient supine and apply a heating pad to the epigastric area
E) Encourage ambulation to promote pancreatic drainage
CORRECT ANSWER: B) Keep the patient NPO and initiate IV fluid replacement
to maintain hydration
2026/2027 | CLINICAL JUDGMENT PRACTICE
Q&A WITH RATIONALES
CJE READINESS II EXAM STUDY GUIDE 2026/2027
CLINICAL JUDGMENT PRACTICE Q&A WITH RATIONALES
DOCUMENT OVERVIEW
• This comprehensive study guide contains evidence-based clinical judgment
practice questions designed to strengthen decision-making skills, critical thinking,
and patient safety awareness across diverse healthcare scenarios
• Study strategically by completing questions in sections, reviewing detailed
rationales for every answer, and identifying knowledge gaps to focus your
preparation for the CJE exam
1. A 65-year-old patient admitted with acute myocardial infarction (AMI)
presents with chest pain radiating to the left arm, dyspnea, and diaphoresis.
The cardiac monitor shows ST-segment elevation in leads II, III, and aVF. What
is the priority nursing intervention?
A) Administer oxygen at 2L via nasal cannula and monitor vital signs every 4 hours
B) Obtain a 12-lead ECG immediately and notify the healthcare provider of the
findings
C) Administer aspirin and prepare for possible percutaneous coronary intervention
(PCI)
D) Start an IV line and draw blood for troponin levels only
E) Place the patient on continuous cardiac monitoring and keep NPO status
CORRECT ANSWER: C) Administer aspirin and prepare for possible
percutaneous coronary intervention (PCI)
,RATIONALE: In acute ST-elevation myocardial infarction (STEMI), time is
myocardium—early intervention is critical. Aspirin should be administered
immediately as an antiplatelet agent to prevent thrombus formation. PCI is the gold
standard reperfusion therapy for STEMI when available within 120 minutes of first
medical contact. While obtaining an ECG (option B) is important, it should not delay
treatment. Options A and D are insufficient in acuity, and NPO status (option E) is
appropriate but not the priority intervention. The focus must be on rapid
reperfusion and antiplatelet therapy.
2. A 28-year-old primigravida at 32 weeks gestation presents to the
emergency department with a severe headache, epigastric pain, and blood
pressure of 165/110 mmHg. Urine dipstick shows 3+ proteinuria. What clinical
diagnosis should the nurse suspect?
A) Gestational diabetes mellitus with hypertensive crisis
B) Preeclampsia with severe features, progressing toward eclampsia
C) Chronic hypertension exacerbated by pregnancy
D) Migraine headache unrelated to pregnancy status
E) Hellp syndrome (hemolysis, elevated liver enzymes, low platelets)
CORRECT ANSWER: B) Preeclampsia with severe features, progressing toward
eclampsia
RATIONALE: The classic triad of preeclampsia includes hypertension (≥140/90
mmHg), proteinuria (≥1+ on dipstick or ≥300 mg/24 hours), and edema. This patient
demonstrates severe features: BP 165/110 (severe range), 3+ proteinuria, severe
headache (neurological symptom), and epigastric pain (indicates hepatic
involvement). These are warning signs of progression toward eclampsia. While
HELLP syndrome (option E) can coexist with severe preeclampsia, the presentation
is most consistent with preeclampsia with severe features. Immediate interventions
include antihypertensive therapy, magnesium sulfate for seizure prophylaxis, and
delivery planning.
,3. A 72-year-old male with COPD presents with acute dyspnea, increased
sputum production, and purulent sputum. His oxygen saturation is 88% on
room air. What is the nurse's priority assessment before administering
oxygen therapy?
A) Verify the patient's preferred oxygen concentration and delivery device
B) Assess arterial blood gas (ABG) values to determine baseline CO2 levels and
oxygen saturation
C) Immediately apply high-flow oxygen at 10L/min to achieve SpO2 >94%
D) Check lung sounds bilaterally and assess work of breathing
E) Obtain a chest X-ray to confirm the diagnosis of acute exacerbation
CORRECT ANSWER: B) Assess arterial blood gas (ABG) values to determine
baseline CO2 levels and oxygen saturation
RATIONALE: In patients with chronic COPD, baseline CO2 levels are often elevated,
and the respiratory drive is hypoxia-driven rather than hypercapnia-driven. High-
flow oxygen can suppress this hypoxic drive and cause respiratory depression or
CO2 retention. ABG assessment is critical to establish baseline values and guide
oxygen titration. While assessing lung sounds (option D) is important, it does not
address the specific risk of oxygen-induced hypercapnia. Option C is
contraindicated without knowing baseline ABG values. Safe oxygen therapy in
COPD typically targets SpO2 of 88-92% to maintain adequate oxygenation while
preserving respiratory drive.
4. A 45-year-old patient with uncontrolled hypertension is prescribed an ACE
inhibitor. The patient reports a persistent dry cough that began 3 days after
starting the medication. What is the most appropriate nursing action?
A) Discontinue the medication immediately and report to the healthcare provider
B) Reassure the patient that the cough will resolve within 2 weeks and encourage
adherence
, C) Suggest the patient use over-the-counter cough suppressants to manage the
symptom
D) Contact the healthcare provider to discuss the cough and potential medication
adjustment
E) Increase fluid intake to help suppress the cough reflex
CORRECT ANSWER: D) Contact the healthcare provider to discuss the cough
and potential medication adjustment
RATIONALE: A persistent dry cough is a well-documented side effect of ACE
inhibitors, occurring in 10-20% of patients due to accumulation of bradykinin in the
lungs. While the cough is typically benign and harmless, it significantly impacts
medication adherence and quality of life. The appropriate intervention is to notify
the healthcare provider, who may consider switching to an alternative
antihypertensive class such as an ARB (angiotensin II receptor blocker), which has a
much lower incidence of cough. The cough typically resolves within days to weeks
of discontinuation but may persist in some patients. Option A (discontinuing
without provider contact) and option B (false reassurance about resolution) are
inappropriate. Options C and E do not address the underlying issue.
5. A 55-year-old patient admitted with acute pancreatitis presents with severe
epigastric pain, elevated lipase levels, and mild fever. Which nursing
intervention is most critical in the initial management?
A) Provide oral nutrition with clear liquids to maintain caloric intake
B) Keep the patient NPO and initiate IV fluid replacement to maintain hydration
C) Administer prophylactic antibiotics to prevent secondary infection
D) Position the patient supine and apply a heating pad to the epigastric area
E) Encourage ambulation to promote pancreatic drainage
CORRECT ANSWER: B) Keep the patient NPO and initiate IV fluid replacement
to maintain hydration
