CJE Benchmark Clinical Judgment
Exam #1: 200 Practice Questions,
Answers, and Rationales for the
2026/2027 Academic Year
Section 1: Clinical Judgment & NCJMM Framework (Questions
1-25)
Q1: A nurse is caring for a client with pneumonia. Which assessment finding is the
most important for the nurse to recognize as a cue for potential sepsis?
A) Temperature 38.3°C (100.9°F)
B) Respiratory rate 22/min
C) Heart rate 110/min and blood pressure 98/62 mm Hg
D) Oxygen saturation 91% on room air
Correct Answer: C
Rationale: Tachycardia with borderline hypotension are early signs of sepsis (warm
shock), indicating a critical, systemic response that requires immediate attention.
Q2: The NCSBN Clinical Judgment Measurement Model (NCJMM) identifies how
many cognitive skills?
A) 4
B) 5
C) 6
D) 8
Correct Answer: C
Rationale: The NCJMM identifies 6 cognitive skills: Recognize Cues, Analyze Cues,
Prioritize Hypotheses, Generate Solutions, Take Action, and Evaluate Outcomes.
,Q3: A nurse is caring for a client with suspected hypoxia. Which early sign should the
nurse anticipate?
A) Cyanosis
B) Restlessness
C) Bradycardia
D) Hypoventilation
Correct Answer: B
Rationale: Restlessness and anxiety are early manifestations of hypoxia due to
cerebral compensation; cyanosis is a late sign.
Q4: A client with heart failure and an ejection fraction of 30% is started on carvedilol.
The nurse understands that the primary benefit of this medication is:
A) Reduced afterload
B) Decreased heart rate only
C) Blockade of the harmful effects of chronic sympathetic overstimulation on the
heart
D) Increased cardiac contractility
Correct Answer: C
Rationale: In heart failure, beta-blockers block the detrimental effects of chronic
sympathetic activation, reducing morbidity and mortality.
Q5: A nurse assesses a client with sudden onset of chest pain radiating to the jaw.
Which cue is most critical?
A) Pain rated 4/10
B) Jaw radiation
C) Client states “I feel anxious”
D) Heart rate 88 bpm
Correct Answer: B
Rationale: Jaw radiation is a classic sign of myocardial ischemia and requires
immediate action.
,Q6: A postoperative client’s vital signs: BP 90/50, HR 110, RR 24, O2 94%. Which cue
indicates possible shock?
A) RR 24
B) O2 94%
C) BP 90/50
D) HR 110
Correct Answer: C
Rationale: Hypotension (BP 90/50) is a late but critical sign of hypovolemic shock.
Q7: A client with new-onset confusion and fever is being evaluated. The nurse
recognizes this as most likely:
A) Dementia
B) Delirium from infection
C) Medication side effect
D) Anxiety
Correct Answer: B
Rationale: New confusion in an older adult with infection is often delirium, not
dementia. Hypoxia and sepsis can cause acute encephalopathy.
Q8: A nurse notes that a client’s urinary output is 20 mL over the last 2 hours. This
cue indicates:
A) Normal output
B) Dehydration
C) Possible acute kidney injury
D) Bladder distention
Correct Answer: C
Rationale: Output <0.5 mL/kg/hour for 2 hours suggests AKI risk. Minimum
expected output is 30 mL/hour.
Q9: A client post-hip replacement has redness and warmth in the calf. What does the
nurse recognize?
A) Normal healing
, B) Superficial bruising
C) Possible deep vein thrombosis
D) Muscle strain
Correct Answer: C
Rationale: Unilateral calf redness/warmth is a classic DVT cue.
Q10: A client on furosemide reports dizziness when standing. Which cue is most
relevant?
A) Fatigue
B) Orthostatic hypotension
C) Dry mouth
D) Nausea
Correct Answer: B
Rationale: Dizziness when standing is a classic symptom of orthostatic hypotension,
a common side effect of furosemide.
Q11: A nurse on a medical-surgical unit receives report on four clients. Which client
should the nurse assess first?
A) Client with COPD and O2 saturation of 89% on 2 L nasal cannula
B) Client post-appendectomy day 2 with temperature 100.9°F (38.3°C)
C) Client with diabetes mellitus and blood glucose of 65 mg/dL
D) Client with pneumonia and pulse 110/min, respirations 28/min, and crackles
Correct Answer: C
Rationale: A blood glucose of 65 mg/dl indicates hypoglycemia, which can rapidly
progress to unconsciousness or seizures.
Q12: A client with heart failure reports sudden onset of dyspnea and cough with
pink, frothy sputum. Which intervention should the nurse implement first?
A) Administer furosemide IV push
B) Place the client in high-Fowler’s position
C) Apply oxygen at 4 L per nasal cannula
D) Morphine sulfate 2 mg IV
Exam #1: 200 Practice Questions,
Answers, and Rationales for the
2026/2027 Academic Year
Section 1: Clinical Judgment & NCJMM Framework (Questions
1-25)
Q1: A nurse is caring for a client with pneumonia. Which assessment finding is the
most important for the nurse to recognize as a cue for potential sepsis?
A) Temperature 38.3°C (100.9°F)
B) Respiratory rate 22/min
C) Heart rate 110/min and blood pressure 98/62 mm Hg
D) Oxygen saturation 91% on room air
Correct Answer: C
Rationale: Tachycardia with borderline hypotension are early signs of sepsis (warm
shock), indicating a critical, systemic response that requires immediate attention.
Q2: The NCSBN Clinical Judgment Measurement Model (NCJMM) identifies how
many cognitive skills?
A) 4
B) 5
C) 6
D) 8
Correct Answer: C
Rationale: The NCJMM identifies 6 cognitive skills: Recognize Cues, Analyze Cues,
Prioritize Hypotheses, Generate Solutions, Take Action, and Evaluate Outcomes.
,Q3: A nurse is caring for a client with suspected hypoxia. Which early sign should the
nurse anticipate?
A) Cyanosis
B) Restlessness
C) Bradycardia
D) Hypoventilation
Correct Answer: B
Rationale: Restlessness and anxiety are early manifestations of hypoxia due to
cerebral compensation; cyanosis is a late sign.
Q4: A client with heart failure and an ejection fraction of 30% is started on carvedilol.
The nurse understands that the primary benefit of this medication is:
A) Reduced afterload
B) Decreased heart rate only
C) Blockade of the harmful effects of chronic sympathetic overstimulation on the
heart
D) Increased cardiac contractility
Correct Answer: C
Rationale: In heart failure, beta-blockers block the detrimental effects of chronic
sympathetic activation, reducing morbidity and mortality.
Q5: A nurse assesses a client with sudden onset of chest pain radiating to the jaw.
Which cue is most critical?
A) Pain rated 4/10
B) Jaw radiation
C) Client states “I feel anxious”
D) Heart rate 88 bpm
Correct Answer: B
Rationale: Jaw radiation is a classic sign of myocardial ischemia and requires
immediate action.
,Q6: A postoperative client’s vital signs: BP 90/50, HR 110, RR 24, O2 94%. Which cue
indicates possible shock?
A) RR 24
B) O2 94%
C) BP 90/50
D) HR 110
Correct Answer: C
Rationale: Hypotension (BP 90/50) is a late but critical sign of hypovolemic shock.
Q7: A client with new-onset confusion and fever is being evaluated. The nurse
recognizes this as most likely:
A) Dementia
B) Delirium from infection
C) Medication side effect
D) Anxiety
Correct Answer: B
Rationale: New confusion in an older adult with infection is often delirium, not
dementia. Hypoxia and sepsis can cause acute encephalopathy.
Q8: A nurse notes that a client’s urinary output is 20 mL over the last 2 hours. This
cue indicates:
A) Normal output
B) Dehydration
C) Possible acute kidney injury
D) Bladder distention
Correct Answer: C
Rationale: Output <0.5 mL/kg/hour for 2 hours suggests AKI risk. Minimum
expected output is 30 mL/hour.
Q9: A client post-hip replacement has redness and warmth in the calf. What does the
nurse recognize?
A) Normal healing
, B) Superficial bruising
C) Possible deep vein thrombosis
D) Muscle strain
Correct Answer: C
Rationale: Unilateral calf redness/warmth is a classic DVT cue.
Q10: A client on furosemide reports dizziness when standing. Which cue is most
relevant?
A) Fatigue
B) Orthostatic hypotension
C) Dry mouth
D) Nausea
Correct Answer: B
Rationale: Dizziness when standing is a classic symptom of orthostatic hypotension,
a common side effect of furosemide.
Q11: A nurse on a medical-surgical unit receives report on four clients. Which client
should the nurse assess first?
A) Client with COPD and O2 saturation of 89% on 2 L nasal cannula
B) Client post-appendectomy day 2 with temperature 100.9°F (38.3°C)
C) Client with diabetes mellitus and blood glucose of 65 mg/dL
D) Client with pneumonia and pulse 110/min, respirations 28/min, and crackles
Correct Answer: C
Rationale: A blood glucose of 65 mg/dl indicates hypoglycemia, which can rapidly
progress to unconsciousness or seizures.
Q12: A client with heart failure reports sudden onset of dyspnea and cough with
pink, frothy sputum. Which intervention should the nurse implement first?
A) Administer furosemide IV push
B) Place the client in high-Fowler’s position
C) Apply oxygen at 4 L per nasal cannula
D) Morphine sulfate 2 mg IV
