,NUR 221 Clinical Judgment Exam (CJE) Nursing II Questions And
Answers 2026/2027 Jersey College
TABLE OF CONTENTS
CASE STUDY 1 — Acute Decompensated Heart Failure
CASE STUDY 2 — Pneumonia Progressing to Sepsis
CASE STUDY 3 — Acute Kidney Injury and Hyperkalemia
CASE STUDY 4 — Cirrhosis with Acute Gastrointestinal Hemorrhage
CASE STUDY 5 — Diabetic Ketoacidosis
CASE STUDY 6 — Leukemia, Neutropenia, and Infection
CASE STUDY 7 — Major Burn and Inhalation Injury
CASE STUDY 8 — Deep Vein Thrombosis and Pulmonary Embolism
CLINICAL JUDGMENT — Prioritization and Delegation
CASE STUDY 1 — ACUTE DECOMPENSATED HEART FAILURE
A 72-year-old with chronic heart failure and hypertension reports worsening
shortness of breath over three days. Findings include oxygen saturation 86%
on room air, respiratory rate 30/min, bilateral crackles, jugular venous
distention, 3+ leg edema, and a 3.2-kg weight gain in four days.
Q1. Which finding is the strongest cue that the patient's condition
has acutely worsened?
A) Oxygen saturation of 86% with bilateral crackles and increasing dyspnea
B) History of hypertension
C) Age of 72 years
D) Chronic diagnosis of heart failure
Correct Answer: A) Oxygen saturation of 86% with bilateral crackles and
increasing dyspnea
Rationale: Hypoxemia accompanied by pulmonary crackles and worsening
respiratory distress indicates active pulmonary congestion and impaired gas
exchange.
Q2. Which mechanism best explains the patient's pulmonary
findings?
A) Reduced systemic venous pressure
B) Increased left-sided filling pressure causing fluid movement into lung
tissue
C) Decreased pulmonary blood flow from dehydration
D) Upper-airway obstruction
,Correct Answer: B) Increased left-sided filling pressure causing fluid
movement into lung tissue
Rationale: Left ventricular dysfunction increases pulmonary venous and
capillary pressure, promoting interstitial and alveolar fluid accumulation.
Q3. Which problem should receive the highest priority?
A) Impaired mobility related to leg edema
B) Long-term sodium intake
C) Impaired oxygenation caused by pulmonary congestion
D) Knowledge deficit regarding daily weight
Correct Answer: C) Impaired oxygenation caused by pulmonary congestion
Rationale: Acute impairment of breathing and oxygenation takes priority
over chronic management and educational needs.
Q4. Which set of interventions is most appropriate initially?
A) Increase oral fluids and place the patient flat
B) Encourage ambulation before treatment
C) Delay therapy until an echocardiogram is completed
D) Position upright, provide prescribed oxygen, and prepare to administer
ordered diuretic therapy
Correct Answer: D) Position upright, provide prescribed oxygen, and prepare
to administer ordered diuretic therapy
Rationale: Upright positioning supports ventilation, oxygen treats
hypoxemia, and diuresis helps reduce pulmonary and systemic congestion.
Q5. Which laboratory value requires particularly close monitoring
during IV loop-diuretic therapy?
A) Amylase
B) Potassium
C) Hemoglobin A1C
D) Bilirubin
Correct Answer: B) Potassium
Rationale: Loop diuretics increase urinary potassium losses and can
produce clinically important hypokalemia and dysrhythmias.
Q6. Which outcome best indicates that the treatment plan is
effective?
, A) Increasing weight and edema
B) Persistent oxygen saturation of 86%
C) Improved oxygenation with reduced crackles, increased urine output, and
less dyspnea
D) Increasing jugular venous distention
Correct Answer: C) Improved oxygenation with reduced crackles, increased
urine output, and less dyspnea
Rationale: Improvement in pulmonary congestion, oxygenation, and fluid
removal demonstrates an effective response.
CASE STUDY 2 — PNEUMONIA PROGRESSING TO SEPSIS
A 68-year-old presents with fever, productive cough, weakness, and
increasing shortness of breath. Temperature is 39.2°C (102.6°F), heart rate
118/min, respiratory rate 28/min, blood pressure 104/62 mm Hg, and oxygen
saturation 89% on room air. Crackles are present over the right lower lung.
Q7. Which change would be most concerning for progression from
localized infection to systemic deterioration?
A) Continued productive coughing
B) Temperature remaining elevated
C) Persistent focal crackles
D) Falling blood pressure with worsening confusion and decreased urine
output
Correct Answer: D) Falling blood pressure with worsening confusion and
decreased urine output
Rationale: Hypotension, altered mental status, and oliguria indicate
systemic hypoperfusion and possible sepsis-related organ dysfunction.
Q8. Which mechanism best explains the patient's initial hypoxemia?
A) Inflamed and fluid-filled alveoli create ventilation-perfusion mismatch
B) Increased hemoglobin prevents oxygen transport
C) Excessive ventilation eliminates pulmonary blood flow
D) Pneumonia increases alveolar oxygen diffusion
Correct Answer: A) Inflamed and fluid-filled alveoli create ventilation-
perfusion mismatch
Rationale: Pneumonia reduces ventilation to affected alveoli while perfusion
may continue, impairing oxygen transfer.
Answers 2026/2027 Jersey College
TABLE OF CONTENTS
CASE STUDY 1 — Acute Decompensated Heart Failure
CASE STUDY 2 — Pneumonia Progressing to Sepsis
CASE STUDY 3 — Acute Kidney Injury and Hyperkalemia
CASE STUDY 4 — Cirrhosis with Acute Gastrointestinal Hemorrhage
CASE STUDY 5 — Diabetic Ketoacidosis
CASE STUDY 6 — Leukemia, Neutropenia, and Infection
CASE STUDY 7 — Major Burn and Inhalation Injury
CASE STUDY 8 — Deep Vein Thrombosis and Pulmonary Embolism
CLINICAL JUDGMENT — Prioritization and Delegation
CASE STUDY 1 — ACUTE DECOMPENSATED HEART FAILURE
A 72-year-old with chronic heart failure and hypertension reports worsening
shortness of breath over three days. Findings include oxygen saturation 86%
on room air, respiratory rate 30/min, bilateral crackles, jugular venous
distention, 3+ leg edema, and a 3.2-kg weight gain in four days.
Q1. Which finding is the strongest cue that the patient's condition
has acutely worsened?
A) Oxygen saturation of 86% with bilateral crackles and increasing dyspnea
B) History of hypertension
C) Age of 72 years
D) Chronic diagnosis of heart failure
Correct Answer: A) Oxygen saturation of 86% with bilateral crackles and
increasing dyspnea
Rationale: Hypoxemia accompanied by pulmonary crackles and worsening
respiratory distress indicates active pulmonary congestion and impaired gas
exchange.
Q2. Which mechanism best explains the patient's pulmonary
findings?
A) Reduced systemic venous pressure
B) Increased left-sided filling pressure causing fluid movement into lung
tissue
C) Decreased pulmonary blood flow from dehydration
D) Upper-airway obstruction
,Correct Answer: B) Increased left-sided filling pressure causing fluid
movement into lung tissue
Rationale: Left ventricular dysfunction increases pulmonary venous and
capillary pressure, promoting interstitial and alveolar fluid accumulation.
Q3. Which problem should receive the highest priority?
A) Impaired mobility related to leg edema
B) Long-term sodium intake
C) Impaired oxygenation caused by pulmonary congestion
D) Knowledge deficit regarding daily weight
Correct Answer: C) Impaired oxygenation caused by pulmonary congestion
Rationale: Acute impairment of breathing and oxygenation takes priority
over chronic management and educational needs.
Q4. Which set of interventions is most appropriate initially?
A) Increase oral fluids and place the patient flat
B) Encourage ambulation before treatment
C) Delay therapy until an echocardiogram is completed
D) Position upright, provide prescribed oxygen, and prepare to administer
ordered diuretic therapy
Correct Answer: D) Position upright, provide prescribed oxygen, and prepare
to administer ordered diuretic therapy
Rationale: Upright positioning supports ventilation, oxygen treats
hypoxemia, and diuresis helps reduce pulmonary and systemic congestion.
Q5. Which laboratory value requires particularly close monitoring
during IV loop-diuretic therapy?
A) Amylase
B) Potassium
C) Hemoglobin A1C
D) Bilirubin
Correct Answer: B) Potassium
Rationale: Loop diuretics increase urinary potassium losses and can
produce clinically important hypokalemia and dysrhythmias.
Q6. Which outcome best indicates that the treatment plan is
effective?
, A) Increasing weight and edema
B) Persistent oxygen saturation of 86%
C) Improved oxygenation with reduced crackles, increased urine output, and
less dyspnea
D) Increasing jugular venous distention
Correct Answer: C) Improved oxygenation with reduced crackles, increased
urine output, and less dyspnea
Rationale: Improvement in pulmonary congestion, oxygenation, and fluid
removal demonstrates an effective response.
CASE STUDY 2 — PNEUMONIA PROGRESSING TO SEPSIS
A 68-year-old presents with fever, productive cough, weakness, and
increasing shortness of breath. Temperature is 39.2°C (102.6°F), heart rate
118/min, respiratory rate 28/min, blood pressure 104/62 mm Hg, and oxygen
saturation 89% on room air. Crackles are present over the right lower lung.
Q7. Which change would be most concerning for progression from
localized infection to systemic deterioration?
A) Continued productive coughing
B) Temperature remaining elevated
C) Persistent focal crackles
D) Falling blood pressure with worsening confusion and decreased urine
output
Correct Answer: D) Falling blood pressure with worsening confusion and
decreased urine output
Rationale: Hypotension, altered mental status, and oliguria indicate
systemic hypoperfusion and possible sepsis-related organ dysfunction.
Q8. Which mechanism best explains the patient's initial hypoxemia?
A) Inflamed and fluid-filled alveoli create ventilation-perfusion mismatch
B) Increased hemoglobin prevents oxygen transport
C) Excessive ventilation eliminates pulmonary blood flow
D) Pneumonia increases alveolar oxygen diffusion
Correct Answer: A) Inflamed and fluid-filled alveoli create ventilation-
perfusion mismatch
Rationale: Pneumonia reduces ventilation to affected alveoli while perfusion
may continue, impairing oxygen transfer.
