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NCLEX-RN critical thinking & clinical JUDGMENT NCLEX-RN
CRITICAL THINKING & CLINICAL JUDGMENT EXAM WITH
RATIONAL-RATIONALES
Nursing
Exam coverage:
I. Section 1: Q1-20 – Prioritization, Delegation & Management of
Care (assignment, delegation, prioritization, client safety, scope of
practice, high-alert medications, critical thinking in assignments)
II. Section 2: Q21-40 – Clinical Judgment & NGN Case Study Format
(CJMM six cognitive skills: Recognize Cues, Analyze Cues, Prioritize
Hypotheses, Generate Solutions, Take Action, Evaluate Outcomes;
unfolding case study structure)
III. Section 3: Q41-60 – Priority Setting & Rapid Assessment (triage,
emergency assessment, post-operative complications, medication
safety, rapid response, chest tube management, fall prevention)
IV. Section 4: Q61-80 – Health Equity & Social Determinants of Health
(health equity framework, cultural competence, health literacy,
food security, transportation access, trauma-informed care,
LGBTQ+ inclusive care)
V. Section 5: Q81-100 – Ethical & Legal Considerations (informed
consent, advance directives, DNR orders, client rights,
documentation standards, professional responsibility, therapeutic
communication, medication error reporting)
SECTION 1: PRIORITIZATION, DELEGATION & MANAGEMENT
OF CARE (Questions 1–20)
Question 1
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The charge nurse is making assignments on a 36-bed medical-
surgical unit with a high-acuity population. The unit has three
RNs (one with 15 years of experience, one float from the ICU
with 5 years of experience, one new graduate with 3 months of
experience), two LPNs, and three UAPs. Which client
assignment is most appropriate for the new graduate RN?
A) A client with acute respiratory distress syndrome requiring
continuous BiPAP and hourly ABG monitoring
B) A client with a new colostomy requiring ostomy teaching and
a newly inserted PICC line
C) ✓ A client with a fractured hip who is 2 days post-operative,
stable, and receiving scheduled pain medications
D) A client receiving IV chemotherapy for newly diagnosed
leukemia with multiple electrolyte abnormalities
CORRECT: C
RATIONALE: The new graduate RN should be assigned to
stable, predictable clients who do not require complex
assessments or interventions. The client with a fractured hip
who is 2 days post-operative is stable and would be an
appropriate assignment for a new graduate. The client requiring
BiPAP with ABG monitoring, the client requiring ostomy
teaching, and the client receiving chemotherapy with electrolyte
abnormalities require more experienced nursing judgment and
advanced assessment skills.
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Question 2
A nurse is caring for a client with a newly inserted chest tube
following a spontaneous pneumothorax. The drainage system is
set to -20 cm H₂O suction. Upon entering the room, the nurse
notes continuous bubbling in the suction control chamber,
intermittent bubbling in the water seal chamber with tidal
fluctuations, and the collection chamber contains 75 mL of
sanguineous drainage. The client reports mild pain at the
insertion site rated 4/10. Which action should the nurse take?
A) Increase the suction to -25 cm H₂O to promote lung re-
expansion
B) Notify the provider immediately about the continuous
bubbling in the suction control chamber
C) Continue to monitor and document these expected findings
D) ✓ Assess the client's oxygen saturation and respiratory
status before taking further action
CORRECT: D
RATIONALE: Continuous bubbling in the suction control
chamber is an expected finding when suction is applied.
Intermittent bubbling in the water seal chamber with tidal
fluctuations indicates normal respiratory variation.
Sanguineous drainage of 75 mL is expected immediately post-
insertion. The nurse should first assess the client's oxygenation
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and respiratory status to ensure stability before considering
other interventions.
Question 3
A client with chronic obstructive pulmonary disease (COPD) has
an oxygen saturation of 88% on 2 L/min via nasal cannula. The
client is awake, alert, and oriented but reports mild dyspnea.
Which action should the nurse take?
A) Increase the oxygen to 4 L/min immediately to achieve a
saturation of 95%
B) ✓ Maintain the current oxygen rate and reassess the client's
respiratory status
C) Place the client in a supine position to improve lung
expansion
D) Notify the healthcare provider immediately for a change in
oxygen order
CORRECT: B
RATIONALE: Clients with COPD may have a hypoxic drive to
breathe. Increasing oxygen too rapidly can suppress the
respiratory drive and lead to respiratory failure. The target SpO₂
for clients with COPD is typically 88-92%. The nurse should
NCLEX-RN critical thinking & clinical JUDGMENT NCLEX-RN
CRITICAL THINKING & CLINICAL JUDGMENT EXAM WITH
RATIONAL-RATIONALES
Nursing
Exam coverage:
I. Section 1: Q1-20 – Prioritization, Delegation & Management of
Care (assignment, delegation, prioritization, client safety, scope of
practice, high-alert medications, critical thinking in assignments)
II. Section 2: Q21-40 – Clinical Judgment & NGN Case Study Format
(CJMM six cognitive skills: Recognize Cues, Analyze Cues, Prioritize
Hypotheses, Generate Solutions, Take Action, Evaluate Outcomes;
unfolding case study structure)
III. Section 3: Q41-60 – Priority Setting & Rapid Assessment (triage,
emergency assessment, post-operative complications, medication
safety, rapid response, chest tube management, fall prevention)
IV. Section 4: Q61-80 – Health Equity & Social Determinants of Health
(health equity framework, cultural competence, health literacy,
food security, transportation access, trauma-informed care,
LGBTQ+ inclusive care)
V. Section 5: Q81-100 – Ethical & Legal Considerations (informed
consent, advance directives, DNR orders, client rights,
documentation standards, professional responsibility, therapeutic
communication, medication error reporting)
SECTION 1: PRIORITIZATION, DELEGATION & MANAGEMENT
OF CARE (Questions 1–20)
Question 1
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The charge nurse is making assignments on a 36-bed medical-
surgical unit with a high-acuity population. The unit has three
RNs (one with 15 years of experience, one float from the ICU
with 5 years of experience, one new graduate with 3 months of
experience), two LPNs, and three UAPs. Which client
assignment is most appropriate for the new graduate RN?
A) A client with acute respiratory distress syndrome requiring
continuous BiPAP and hourly ABG monitoring
B) A client with a new colostomy requiring ostomy teaching and
a newly inserted PICC line
C) ✓ A client with a fractured hip who is 2 days post-operative,
stable, and receiving scheduled pain medications
D) A client receiving IV chemotherapy for newly diagnosed
leukemia with multiple electrolyte abnormalities
CORRECT: C
RATIONALE: The new graduate RN should be assigned to
stable, predictable clients who do not require complex
assessments or interventions. The client with a fractured hip
who is 2 days post-operative is stable and would be an
appropriate assignment for a new graduate. The client requiring
BiPAP with ABG monitoring, the client requiring ostomy
teaching, and the client receiving chemotherapy with electrolyte
abnormalities require more experienced nursing judgment and
advanced assessment skills.
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Question 2
A nurse is caring for a client with a newly inserted chest tube
following a spontaneous pneumothorax. The drainage system is
set to -20 cm H₂O suction. Upon entering the room, the nurse
notes continuous bubbling in the suction control chamber,
intermittent bubbling in the water seal chamber with tidal
fluctuations, and the collection chamber contains 75 mL of
sanguineous drainage. The client reports mild pain at the
insertion site rated 4/10. Which action should the nurse take?
A) Increase the suction to -25 cm H₂O to promote lung re-
expansion
B) Notify the provider immediately about the continuous
bubbling in the suction control chamber
C) Continue to monitor and document these expected findings
D) ✓ Assess the client's oxygen saturation and respiratory
status before taking further action
CORRECT: D
RATIONALE: Continuous bubbling in the suction control
chamber is an expected finding when suction is applied.
Intermittent bubbling in the water seal chamber with tidal
fluctuations indicates normal respiratory variation.
Sanguineous drainage of 75 mL is expected immediately post-
insertion. The nurse should first assess the client's oxygenation
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and respiratory status to ensure stability before considering
other interventions.
Question 3
A client with chronic obstructive pulmonary disease (COPD) has
an oxygen saturation of 88% on 2 L/min via nasal cannula. The
client is awake, alert, and oriented but reports mild dyspnea.
Which action should the nurse take?
A) Increase the oxygen to 4 L/min immediately to achieve a
saturation of 95%
B) ✓ Maintain the current oxygen rate and reassess the client's
respiratory status
C) Place the client in a supine position to improve lung
expansion
D) Notify the healthcare provider immediately for a change in
oxygen order
CORRECT: B
RATIONALE: Clients with COPD may have a hypoxic drive to
breathe. Increasing oxygen too rapidly can suppress the
respiratory drive and lead to respiratory failure. The target SpO₂
for clients with COPD is typically 88-92%. The nurse should
