Med Surg 1 CJE - Notes
Step 1: Understand the Lippincott Clinical Judgment Exam
(LCJR)
What It Tests How It Works How to Prepare
Clinical judgment, Based on NCSBN’s Clinical Focus on patient safety, nursing
prioritization, Judgment Measurement process, red flag recognition, and
decision- making Model (CJMM) response
Prioritization of ABCs, Maslow, Safety, Infection
care (sickest first) Often scenario-based Control
Nurse's action in a Think “What would I do first as a
scenario What to assess, what to
nurse?” not “What would the
report, what to teach
doctor do?”
Evidence-based,
safe, patient-centered May involve charts, labs, Interpret lab results, meds, and
care orders, patient statements vitals in context
Step 2: Use the Clinical Judgment Model (CJMM)
Lippincott questions follow 6 layers of decision-making:
1. Recognize Cues: What data matters?
2. Analyze Cues: What’s going wrong?
3. Prioritize Hypotheses: What’s the most likely issue?
4. Generate Solutions: What can I do?
5. Take Action: What’s the best immediate nursing intervention?
6. Evaluate Outcomes: Did it work?
Step 3: Study Smart — Not Just Hard
Do This How
Use red flag charts (like from your Maternal-Newborn Toolkit)
Master Red Flags — same logic applies
Know Critical
Lab Values Especially: K+, Na+, Hgb/Hct, WBC, ABGs, glucose, creatinine
Review Common
Conditions CHF, COPD, Pneumonia, DKA, Stroke, Sepsis, AKI, GI Bleed
Know Key Meds Lasix, insulin, nitro, heparin, digoxin, opioids,
antibiotics Learn Safety/Delegation Know what UAPs/LPNs can and cannot do
Think "Who Dies First?" Practice prioritizing: unstable, post-op, red flag changes
, Step 4: Practice Clinical Judgment Logic
Scenario Tip Think Like This
New post-op pt with HR 130,
BP 80/60, pale Hypovolemic shock → IV fluids, call MD
Pt with wheezing, O₂ sat 89% on
RA Airway problem → Sit up, O₂, assess lungs
Lab: K+ = 2.8, pt on Lasix Hypokalemia risk → Check ECG, notify HCP, give
K+ Pt says “I feel like I’m dying” Red flag → Stop and assess now, call rapid
Unstable pt = RN only, LPN = stable w/ expected
Delegation question outcomes, UAP = routine tasks only
Step 5: Practice NCLEX-Style Questions with CJ Logic
Do questions that:
• Use realistic nursing scenarios
• Ask “What would the nurse do FIRST?”
• Include labs, vitals, meds, orders
• Require applying clinical judgment, not just
recall Try:
• Lippincott PrepU (if assigned)
• LaCharity's Prioritization, Delegation, and Assignment
• NCLEX-RN Mastery app (filter: Med-Surg, Prioritization)
Sample Study Routine (ADHD-Friendly)
Time Focus
20 min Review 1 condition (CHF → S/S → meds → red flags → interventions)
5 min Break (walk/stretch)
15 min Practice 5 questions on that topic
10 min Teach that topic aloud (self or peer)
Repeat with a new system or disorder.
Day-Before + Day-Of Exam Tips
,Day Before:
• Review Red Flag & Priority Charts
• Focus on labs, meds, and interventions
• Sleep 7–8 hrs minimum
Exam Day:
• Brain dump: lab values + ABCs
• Flag confusing Qs, move on
• Eliminate unsafe or passive answers
• Think “What would keep my patient alive right now?”
Med-Surg I Clinical Judgment Master
Chart
Lippincott Clinical Judgment Exam Focused
Includes Red Flags, Interventions, Meds, Labs, CJMM Thinking (Cue → Action →
Evaluate)
HEART FAILURE (CHF)
Patho Weak heart muscle → ↓ perfusion → fluid backs up in lungs/body
Fatigue, edema, crackles, SOB, JVD, weight ↑,
Cues (Recognize) orthopnea, ↓ output
Sudden weight gain >2–3 lb/day, new crackles,
Red Flags rest dyspnea, ↓ O₂
Hypothesis Fluid overload, ↓ cardiac output
Actions
• HOB ↑
• O₂
• Daily weights
• Diuretics (furosemide)
• ↓ fluids/salt
• Notify HCP if weight ↑
| | Evaluate | ↓ crackles, ↑ O₂ sat, weight stabilized, improved output | | Meds |
• Furosemide: watch K+, BP, UO
• ACE inhibitors: dry cough, angioedema, ↓ BP
, • Digoxin: apical HR >60, toxicity (vision, N/V)
| | Labs | BNP ↑, K+ (↓ if on diuretics), BUN/Cr, Na+ | | Patient Teaching | Daily weights,
low Na+ diet, avoid NSAIDs, report SOB, leg swelling, fatigue |
Clinical Judgment Tip:
• SOB + crackles + weight gain? → Fluid overload
• “What to do?” = elevate HOB, give O₂, give Lasix
• Do NOT give more fluids or encourage ambulation until breathing improves
MYOCARDIAL INFARCTION (MI)
Patho Coronary artery blocked → tissue death (STEMI or NSTEMI)
| Cues (Recognize) | Chest pain, pressure, left arm/jaw pain, SOB, N/V, diaphoretic, EKG changes | |
Red Flags | Unrelieved pain, ST elevation, ↓ BP, cold/clammy skin | | Hypothesis | Cardiac
ischemia or infarct | | Actions |
• MONA (Morphine, O₂, Nitro, Aspirin)
• 12-lead EKG
• Cardiac enzymes (troponin)
• Prepare for cath lab
| | Evaluate | ↓ pain, ST resolved, enzymes trend ↓, VS stabilize | | Meds |
• Aspirin: prevents clot growth
• Nitro: ↓ preload, HA, ↓ BP
• Morphine: ↓ pain and workload
• Beta-blockers: ↓ HR, BP
| | Labs | Troponin I/T, CK-MB, EKG, K+, Mg+ | | Teaching | Heart-healthy diet, med
adherence, smoking cessation, cardiac rehab |
Clinical Judgment Tip:
• If pt says “I feel like I’m dying” → recognize cue
• Action = 12-lead EKG, give aspirin, start O₂
• NEVER delay — even if labs not back yet
Step 1: Understand the Lippincott Clinical Judgment Exam
(LCJR)
What It Tests How It Works How to Prepare
Clinical judgment, Based on NCSBN’s Clinical Focus on patient safety, nursing
prioritization, Judgment Measurement process, red flag recognition, and
decision- making Model (CJMM) response
Prioritization of ABCs, Maslow, Safety, Infection
care (sickest first) Often scenario-based Control
Nurse's action in a Think “What would I do first as a
scenario What to assess, what to
nurse?” not “What would the
report, what to teach
doctor do?”
Evidence-based,
safe, patient-centered May involve charts, labs, Interpret lab results, meds, and
care orders, patient statements vitals in context
Step 2: Use the Clinical Judgment Model (CJMM)
Lippincott questions follow 6 layers of decision-making:
1. Recognize Cues: What data matters?
2. Analyze Cues: What’s going wrong?
3. Prioritize Hypotheses: What’s the most likely issue?
4. Generate Solutions: What can I do?
5. Take Action: What’s the best immediate nursing intervention?
6. Evaluate Outcomes: Did it work?
Step 3: Study Smart — Not Just Hard
Do This How
Use red flag charts (like from your Maternal-Newborn Toolkit)
Master Red Flags — same logic applies
Know Critical
Lab Values Especially: K+, Na+, Hgb/Hct, WBC, ABGs, glucose, creatinine
Review Common
Conditions CHF, COPD, Pneumonia, DKA, Stroke, Sepsis, AKI, GI Bleed
Know Key Meds Lasix, insulin, nitro, heparin, digoxin, opioids,
antibiotics Learn Safety/Delegation Know what UAPs/LPNs can and cannot do
Think "Who Dies First?" Practice prioritizing: unstable, post-op, red flag changes
, Step 4: Practice Clinical Judgment Logic
Scenario Tip Think Like This
New post-op pt with HR 130,
BP 80/60, pale Hypovolemic shock → IV fluids, call MD
Pt with wheezing, O₂ sat 89% on
RA Airway problem → Sit up, O₂, assess lungs
Lab: K+ = 2.8, pt on Lasix Hypokalemia risk → Check ECG, notify HCP, give
K+ Pt says “I feel like I’m dying” Red flag → Stop and assess now, call rapid
Unstable pt = RN only, LPN = stable w/ expected
Delegation question outcomes, UAP = routine tasks only
Step 5: Practice NCLEX-Style Questions with CJ Logic
Do questions that:
• Use realistic nursing scenarios
• Ask “What would the nurse do FIRST?”
• Include labs, vitals, meds, orders
• Require applying clinical judgment, not just
recall Try:
• Lippincott PrepU (if assigned)
• LaCharity's Prioritization, Delegation, and Assignment
• NCLEX-RN Mastery app (filter: Med-Surg, Prioritization)
Sample Study Routine (ADHD-Friendly)
Time Focus
20 min Review 1 condition (CHF → S/S → meds → red flags → interventions)
5 min Break (walk/stretch)
15 min Practice 5 questions on that topic
10 min Teach that topic aloud (self or peer)
Repeat with a new system or disorder.
Day-Before + Day-Of Exam Tips
,Day Before:
• Review Red Flag & Priority Charts
• Focus on labs, meds, and interventions
• Sleep 7–8 hrs minimum
Exam Day:
• Brain dump: lab values + ABCs
• Flag confusing Qs, move on
• Eliminate unsafe or passive answers
• Think “What would keep my patient alive right now?”
Med-Surg I Clinical Judgment Master
Chart
Lippincott Clinical Judgment Exam Focused
Includes Red Flags, Interventions, Meds, Labs, CJMM Thinking (Cue → Action →
Evaluate)
HEART FAILURE (CHF)
Patho Weak heart muscle → ↓ perfusion → fluid backs up in lungs/body
Fatigue, edema, crackles, SOB, JVD, weight ↑,
Cues (Recognize) orthopnea, ↓ output
Sudden weight gain >2–3 lb/day, new crackles,
Red Flags rest dyspnea, ↓ O₂
Hypothesis Fluid overload, ↓ cardiac output
Actions
• HOB ↑
• O₂
• Daily weights
• Diuretics (furosemide)
• ↓ fluids/salt
• Notify HCP if weight ↑
| | Evaluate | ↓ crackles, ↑ O₂ sat, weight stabilized, improved output | | Meds |
• Furosemide: watch K+, BP, UO
• ACE inhibitors: dry cough, angioedema, ↓ BP
, • Digoxin: apical HR >60, toxicity (vision, N/V)
| | Labs | BNP ↑, K+ (↓ if on diuretics), BUN/Cr, Na+ | | Patient Teaching | Daily weights,
low Na+ diet, avoid NSAIDs, report SOB, leg swelling, fatigue |
Clinical Judgment Tip:
• SOB + crackles + weight gain? → Fluid overload
• “What to do?” = elevate HOB, give O₂, give Lasix
• Do NOT give more fluids or encourage ambulation until breathing improves
MYOCARDIAL INFARCTION (MI)
Patho Coronary artery blocked → tissue death (STEMI or NSTEMI)
| Cues (Recognize) | Chest pain, pressure, left arm/jaw pain, SOB, N/V, diaphoretic, EKG changes | |
Red Flags | Unrelieved pain, ST elevation, ↓ BP, cold/clammy skin | | Hypothesis | Cardiac
ischemia or infarct | | Actions |
• MONA (Morphine, O₂, Nitro, Aspirin)
• 12-lead EKG
• Cardiac enzymes (troponin)
• Prepare for cath lab
| | Evaluate | ↓ pain, ST resolved, enzymes trend ↓, VS stabilize | | Meds |
• Aspirin: prevents clot growth
• Nitro: ↓ preload, HA, ↓ BP
• Morphine: ↓ pain and workload
• Beta-blockers: ↓ HR, BP
| | Labs | Troponin I/T, CK-MB, EKG, K+, Mg+ | | Teaching | Heart-healthy diet, med
adherence, smoking cessation, cardiac rehab |
Clinical Judgment Tip:
• If pt says “I feel like I’m dying” → recognize cue
• Action = 12-lead EKG, give aspirin, start O₂
• NEVER delay — even if labs not back yet
