NR324 CJE Exam – 2026/2027 Complete (150) Current Testing
Q&A Comprehensive Assessment
2026-2027
150 Questions
100% VERIFIED
Introduction
The NR324 Clinical Judgment Evaluation assesses the ability to recognize, analyze, and respond to
clinical situations using disciplined reasoning in the style of the Clinical Judgment Measurement
Model. The assessment is organized around eight key domains: Clinical Judgment Measurement
Model; Adult Health Nursing; Medical-Surgical Concepts; Pharmacological Therapies; Safety and
Infection Control; Physiological Adaptation; Reduction of Risk Potential; and Management of Care.
Mastery of these domains supports academic progression and underpins safe nursing clinical
execution, from interpreting assessment cues and prioritizing interventions to preventing
complications and coordinating care across settings. The following question bank reflects the
domain blueprint, with each item assessing a distinct sub-topic and paired with a rationale that
reinforces evidence-based professional judgment in clinical decision making.
1. On the first postoperative day after abdominal surgery, a patient has a heart rate of 112,
blood pressure 102/64 mm Hg, a dressing with a 6 cm area of serosanguinous drainage, pain
rated 3 of 10, and urine output of 25 mL/hr. Which cue requires the most immediate action?
A. Heart rate of 112
B. Blood pressure of 102/64 mm Hg
C. Urine output of 25 mL/hr
D. Pain rated 3 of 10
Correct Answer: C. Urine output of 25 mL/hr
Rationale: Urine output below 30 mL/hr signals reduced renal perfusion and possible occult
hemorrhage, making it the most urgent finding. Mild tachycardia and borderline pressure
warrant monitoring but are less specific, and a low pain score is reassuring.
2. During shift handoff, which reported patient should the nurse assess first?
A. A patient with COPD whose oxygen saturation is 90 percent on room air, consistent with
baseline
B. A patient requesting pain medication before ambulation
C. A patient with diabetes whose premeal glucose is 180 mg/dL
D. A postoperative patient with sudden dyspnea and pleuritic chest pain
Correct Answer: D. A postoperative patient with sudden dyspnea and pleuritic chest pain
, Rationale: Sudden dyspnea with pleuritic pain after surgery suggests pulmonary embolism, an
immediate threat to life. A baseline saturation for COPD, mild hyperglycemia, and an analgesia
request are important but stable compared with suspected embolism.
3. A patient with heart failure has bilateral crackles, jugular venous distention, a 2 kg weight
gain over two days, and peripheral edema. These cues cluster most strongly to support which
conclusion?
A. Deficient fluid volume
B. Systemic infection
C. Hypokalemia
D. Fluid volume excess
Correct Answer: D. Fluid volume excess
Rationale: The findings reflect venous congestion and fluid retention characteristic of volume
overload in heart failure. Dehydration would show dry membranes and concentrated urine,
hypokalemia produces weakness and arrhythmias, and infection would present with fever or
leukocytosis.
4. Which patient is at greatest risk for a fall?
A. A 30-year-old ambulating independently with a sprained ankle
B. A 40-year-old awaiting discharge instructions
C. A 55-year-old recovering from minor hand surgery
D. An 82-year-old with new confusion, taking a diuretic and a newly added antihypertensive,
with a history of falls
Correct Answer: D. An 82-year-old with new confusion, taking a diuretic and a newly
added antihypertensive, with a history of falls
Rationale: Advanced age, acute confusion, urgency from diuresis, new antihypertensive effects,
and prior falls combine into the highest risk profile. The other patients lack multiple interacting
fall risk factors.
5. After hip surgery, a patient becomes hypotensive and tachycardic with moderate
serosanguinous drainage on the dressing. The nurse considers pain, anxiety, positioning, and
bleeding. Which hypothesis should be prioritized?
A. Pain-induced vasovagal response
B. Anxiety about surgery
C. Hemorrhage causing hypovolemia
D. Improper positioning
Correct Answer: C. Hemorrhage causing hypovolemia
Rationale: The combination of hypotension, tachycardia, and wound drainage most strongly
suggests bleeding and must be ruled out first. Pain, anxiety, and positioning rarely produce this
hemodynamic pattern without other explanations.
6. Fifteen minutes into a blood transfusion, a patient develops fever, chills, and flank pain.
The nurse prioritizes hypotheses. Which conclusion requires immediate action?
, A. A possible acute hemolytic transfusion reaction requiring the transfusion to be stopped at
once
B. A mild febrile reaction requiring only an antipyretic
C. Anxiety about the transfusion
D. Fluid overload
Correct Answer: A. A possible acute hemolytic transfusion reaction requiring the
transfusion to be stopped at once
Rationale: Fever with chills and flank pain early in a transfusion suggests hemolysis, so the
transfusion is stopped immediately and the line kept open with saline. Mild febrile reactions
lack flank pain, anxiety does not cause fever, and overload develops more gradually with
respiratory signs.
7. For a patient admitted with fluid volume excess, which statement represents a
measurable, appropriate outcome?
A. The patient will maintain oxygen saturation of at least 94 percent with clear lung sounds
within 24 hours
B. The patient will feel better soon
C. The nurse will administer diuretics as ordered
D. The patient will understand heart failure
Correct Answer: A. The patient will maintain oxygen saturation of at least 94 percent
with clear lung sounds within 24 hours
Rationale: Outcomes must be patient-centered, measurable, and time-limited, and this
statement meets all criteria. Vague goals, nursing actions, and unmeasurable understanding
statements are not valid outcome criteria.
8. A patient with vomiting for two days has tachycardia, dry mucous membranes, and
concentrated urine. Which intervention best matches the supported hypothesis?
A. Restrict oral and intravenous fluids
B. Administer a sodium-restricted diet
C. Administer isotonic intravenous fluids as prescribed
D. Encourage bed rest without fluid replacement
Correct Answer: C. Administer isotonic intravenous fluids as prescribed
Rationale: The cues support hypovolemia, so isotonic fluid replacement restores circulating
volume. Restriction or withholding fluids worsens the deficit, and sodium restriction addresses
overload rather than depletion.
9. A conscious patient who can swallow has a point-of-care glucose of 58 mg/dL. Taking
action according to clinical judgment, the nurse should first:
A. Administer the scheduled insulin dose
B. Recheck the glucose in one hour without intervening
C. Notify the provider before taking any action
D. Give 15 grams of fast-acting carbohydrate
Correct Answer: D. Give 15 grams of fast-acting carbohydrate
, Rationale: Mild hypoglycemia in a conscious patient is treated immediately with fast-acting
carbohydrate followed by recheck. Additional insulin deepens hypoglycemia, waiting risks
deterioration, and notification should not delay treatment.
10. Which action is most appropriate to delegate to unlicensed assistive personnel for a
stable postoperative patient?
A. Interpreting the significance of the intake and output record
B. Evaluating response to a new analgesic
C. Assessing the surgical incision
D. Measuring and recording intake and output
Correct Answer: D. Measuring and recording intake and output
Rationale: Measuring and recording intake and output is a routine, defined task suitable for
unlicensed staff when the patient is stable. Interpretation, assessment, and evaluation require
licensed nursing judgment and cannot be delegated.
11. Which finding best indicates that fluid resuscitation for a patient in septic shock has been
effective?
A. Complaint of thirst
B. Heart rate rising from 110 to 120
C. Temperature of 36.0 C
D. Urine output of 45 mL/hr with a mean arterial pressure of 70 mm Hg
Correct Answer: D. Urine output of 45 mL/hr with a mean arterial pressure of 70 mm Hg
Rationale: Restored perfusion is reflected by adequate urine output and a mean arterial
pressure of at least 65 mm Hg. Rising heart rate, hypothermia, and thirst suggest inadequate
resuscitation or other problems rather than improvement.
12. Which finding in a patient being treated for heart failure indicates that the current plan
requires revision?
A. Weight down 1 kg with improved breathing
B. Stable vital signs with decreased edema
C. Increasing crackles, oxygen saturation falling to 89 percent, and new confusion
D. Two liters of urine output after diuretic therapy
Correct Answer: C. Increasing crackles, oxygen saturation falling to 89 percent, and new
confusion
Rationale: Worsening pulmonary congestion with hypoxemia and altered mentation shows
treatment failure and demands escalation. Weight loss, stable vitals, and diuresis all indicate
the plan is working.
13. A nurse reviews assessment data and identifies which findings deviate from normal
limits. This activity corresponds to which component of the clinical judgment measurement
model?
A. Generate solutions
B. Recognize cues
Q&A Comprehensive Assessment
2026-2027
150 Questions
100% VERIFIED
Introduction
The NR324 Clinical Judgment Evaluation assesses the ability to recognize, analyze, and respond to
clinical situations using disciplined reasoning in the style of the Clinical Judgment Measurement
Model. The assessment is organized around eight key domains: Clinical Judgment Measurement
Model; Adult Health Nursing; Medical-Surgical Concepts; Pharmacological Therapies; Safety and
Infection Control; Physiological Adaptation; Reduction of Risk Potential; and Management of Care.
Mastery of these domains supports academic progression and underpins safe nursing clinical
execution, from interpreting assessment cues and prioritizing interventions to preventing
complications and coordinating care across settings. The following question bank reflects the
domain blueprint, with each item assessing a distinct sub-topic and paired with a rationale that
reinforces evidence-based professional judgment in clinical decision making.
1. On the first postoperative day after abdominal surgery, a patient has a heart rate of 112,
blood pressure 102/64 mm Hg, a dressing with a 6 cm area of serosanguinous drainage, pain
rated 3 of 10, and urine output of 25 mL/hr. Which cue requires the most immediate action?
A. Heart rate of 112
B. Blood pressure of 102/64 mm Hg
C. Urine output of 25 mL/hr
D. Pain rated 3 of 10
Correct Answer: C. Urine output of 25 mL/hr
Rationale: Urine output below 30 mL/hr signals reduced renal perfusion and possible occult
hemorrhage, making it the most urgent finding. Mild tachycardia and borderline pressure
warrant monitoring but are less specific, and a low pain score is reassuring.
2. During shift handoff, which reported patient should the nurse assess first?
A. A patient with COPD whose oxygen saturation is 90 percent on room air, consistent with
baseline
B. A patient requesting pain medication before ambulation
C. A patient with diabetes whose premeal glucose is 180 mg/dL
D. A postoperative patient with sudden dyspnea and pleuritic chest pain
Correct Answer: D. A postoperative patient with sudden dyspnea and pleuritic chest pain
, Rationale: Sudden dyspnea with pleuritic pain after surgery suggests pulmonary embolism, an
immediate threat to life. A baseline saturation for COPD, mild hyperglycemia, and an analgesia
request are important but stable compared with suspected embolism.
3. A patient with heart failure has bilateral crackles, jugular venous distention, a 2 kg weight
gain over two days, and peripheral edema. These cues cluster most strongly to support which
conclusion?
A. Deficient fluid volume
B. Systemic infection
C. Hypokalemia
D. Fluid volume excess
Correct Answer: D. Fluid volume excess
Rationale: The findings reflect venous congestion and fluid retention characteristic of volume
overload in heart failure. Dehydration would show dry membranes and concentrated urine,
hypokalemia produces weakness and arrhythmias, and infection would present with fever or
leukocytosis.
4. Which patient is at greatest risk for a fall?
A. A 30-year-old ambulating independently with a sprained ankle
B. A 40-year-old awaiting discharge instructions
C. A 55-year-old recovering from minor hand surgery
D. An 82-year-old with new confusion, taking a diuretic and a newly added antihypertensive,
with a history of falls
Correct Answer: D. An 82-year-old with new confusion, taking a diuretic and a newly
added antihypertensive, with a history of falls
Rationale: Advanced age, acute confusion, urgency from diuresis, new antihypertensive effects,
and prior falls combine into the highest risk profile. The other patients lack multiple interacting
fall risk factors.
5. After hip surgery, a patient becomes hypotensive and tachycardic with moderate
serosanguinous drainage on the dressing. The nurse considers pain, anxiety, positioning, and
bleeding. Which hypothesis should be prioritized?
A. Pain-induced vasovagal response
B. Anxiety about surgery
C. Hemorrhage causing hypovolemia
D. Improper positioning
Correct Answer: C. Hemorrhage causing hypovolemia
Rationale: The combination of hypotension, tachycardia, and wound drainage most strongly
suggests bleeding and must be ruled out first. Pain, anxiety, and positioning rarely produce this
hemodynamic pattern without other explanations.
6. Fifteen minutes into a blood transfusion, a patient develops fever, chills, and flank pain.
The nurse prioritizes hypotheses. Which conclusion requires immediate action?
, A. A possible acute hemolytic transfusion reaction requiring the transfusion to be stopped at
once
B. A mild febrile reaction requiring only an antipyretic
C. Anxiety about the transfusion
D. Fluid overload
Correct Answer: A. A possible acute hemolytic transfusion reaction requiring the
transfusion to be stopped at once
Rationale: Fever with chills and flank pain early in a transfusion suggests hemolysis, so the
transfusion is stopped immediately and the line kept open with saline. Mild febrile reactions
lack flank pain, anxiety does not cause fever, and overload develops more gradually with
respiratory signs.
7. For a patient admitted with fluid volume excess, which statement represents a
measurable, appropriate outcome?
A. The patient will maintain oxygen saturation of at least 94 percent with clear lung sounds
within 24 hours
B. The patient will feel better soon
C. The nurse will administer diuretics as ordered
D. The patient will understand heart failure
Correct Answer: A. The patient will maintain oxygen saturation of at least 94 percent
with clear lung sounds within 24 hours
Rationale: Outcomes must be patient-centered, measurable, and time-limited, and this
statement meets all criteria. Vague goals, nursing actions, and unmeasurable understanding
statements are not valid outcome criteria.
8. A patient with vomiting for two days has tachycardia, dry mucous membranes, and
concentrated urine. Which intervention best matches the supported hypothesis?
A. Restrict oral and intravenous fluids
B. Administer a sodium-restricted diet
C. Administer isotonic intravenous fluids as prescribed
D. Encourage bed rest without fluid replacement
Correct Answer: C. Administer isotonic intravenous fluids as prescribed
Rationale: The cues support hypovolemia, so isotonic fluid replacement restores circulating
volume. Restriction or withholding fluids worsens the deficit, and sodium restriction addresses
overload rather than depletion.
9. A conscious patient who can swallow has a point-of-care glucose of 58 mg/dL. Taking
action according to clinical judgment, the nurse should first:
A. Administer the scheduled insulin dose
B. Recheck the glucose in one hour without intervening
C. Notify the provider before taking any action
D. Give 15 grams of fast-acting carbohydrate
Correct Answer: D. Give 15 grams of fast-acting carbohydrate
, Rationale: Mild hypoglycemia in a conscious patient is treated immediately with fast-acting
carbohydrate followed by recheck. Additional insulin deepens hypoglycemia, waiting risks
deterioration, and notification should not delay treatment.
10. Which action is most appropriate to delegate to unlicensed assistive personnel for a
stable postoperative patient?
A. Interpreting the significance of the intake and output record
B. Evaluating response to a new analgesic
C. Assessing the surgical incision
D. Measuring and recording intake and output
Correct Answer: D. Measuring and recording intake and output
Rationale: Measuring and recording intake and output is a routine, defined task suitable for
unlicensed staff when the patient is stable. Interpretation, assessment, and evaluation require
licensed nursing judgment and cannot be delegated.
11. Which finding best indicates that fluid resuscitation for a patient in septic shock has been
effective?
A. Complaint of thirst
B. Heart rate rising from 110 to 120
C. Temperature of 36.0 C
D. Urine output of 45 mL/hr with a mean arterial pressure of 70 mm Hg
Correct Answer: D. Urine output of 45 mL/hr with a mean arterial pressure of 70 mm Hg
Rationale: Restored perfusion is reflected by adequate urine output and a mean arterial
pressure of at least 65 mm Hg. Rising heart rate, hypothermia, and thirst suggest inadequate
resuscitation or other problems rather than improvement.
12. Which finding in a patient being treated for heart failure indicates that the current plan
requires revision?
A. Weight down 1 kg with improved breathing
B. Stable vital signs with decreased edema
C. Increasing crackles, oxygen saturation falling to 89 percent, and new confusion
D. Two liters of urine output after diuretic therapy
Correct Answer: C. Increasing crackles, oxygen saturation falling to 89 percent, and new
confusion
Rationale: Worsening pulmonary congestion with hypoxemia and altered mentation shows
treatment failure and demands escalation. Weight loss, stable vitals, and diuresis all indicate
the plan is working.
13. A nurse reviews assessment data and identifies which findings deviate from normal
limits. This activity corresponds to which component of the clinical judgment measurement
model?
A. Generate solutions
B. Recognize cues
