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KAPLAN CLINICAL JUDGMENT ASSESSMENT 2026/2027
COMPLETE (100) CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED RATIONALES.
CLINICAL
Prepare for the Kaplan Clinical Judgment Assessment with a focused study resource
designed to strengthen essential clinical reasoning and decision-making skills. It
supports review of patient assessment, recognizing relevant cues, prioritizing needs,
analyzing clinical information, selecting appropriate interventions, and evaluating
outcomes. Use the material to practice applying nursing knowledge to clinical
scenarios and identify areas that may require additional review. This resource is best
suited for nursing students and NCLEX candidates preparing for clinical judgment
assessments.
MULTIPLE CHOICE.
SECTION 1: CLINICAL JUDGMENT & PRIORITIZATION (Questions 1-15)
1. A nurse is caring for four clients. Which client should the nurse assess
first?
a) A client with a fractured femur who rates pain as 7 on a scale of 0-10
b) A client with heart failure who has crackles in the lungs and is dyspneic
c) A client with diabetes who has a blood glucose of 140 mg/dL
d) A client with a urinary tract infection who has a temperature of 100.2°F
Answer: b) A client with heart failure who has crackles in the lungs and is
dyspneic
Rationale: The client with heart failure and crackles with dyspnea shows
signs of fluid overload and potential respiratory compromise. This is the most
unstable client and should be assessed first. The fractured femur client has
pain that can be addressed after airway and breathing concerns. The diabetes
and UTI clients have stable findings.
2. The nurse is caring for a client who was admitted with chest pain. The
client's vital signs are: blood pressure 98/62 mmHg, heart rate 118 bpm,
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respiratory rate 22/min, and oxygen saturation 90% on room air. Which
action should the nurse take first?
a) Administer sublingual nitroglycerin
b) Apply oxygen via nasal cannula at 2 L/min
c) Obtain a 12-lead ECG
d) Notify the healthcare provider
Answer: b) Apply oxygen via nasal cannula at 2 L/min
Rationale: The client is showing signs of respiratory compromise (SpO2 90%)
with tachycardia and hypotension. The priority is to address oxygenation first.
The ABCs (Airway, Breathing, Circulation) guide care. After applying oxygen,
the nurse can obtain an ECG and notify the provider.
3. A client is 1 day post-operative following abdominal surgery. The
client's vital signs are: temperature 101.2°F (38.4°C), heart rate 112 bpm,
respiratory rate 24/min, and blood pressure 100/68 mmHg. The surgical
incision is red, swollen, and has purulent drainage. Which action should
the nurse take first?
a) Administer prescribed antipyretic
b) Notify the healthcare provider
c) Obtain a wound culture
d) Apply a sterile dressing
Answer: b) Notify the healthcare provider
Rationale: The client shows signs of a surgical site infection (fever,
tachycardia, redness, swelling, purulent drainage). The provider must be
notified immediately for antibiotic orders. Obtaining a wound culture, applying
a sterile dressing, and administering an antipyretic are appropriate but should
occur after notifying the provider.
4. A client with chronic obstructive pulmonary disease (COPD) has an
oxygen saturation of 86% on room air. The nurse administers oxygen via
nasal cannula at 2 L/min. Fifteen minutes later, the client's oxygen
saturation is 90%. The client reports feeling drowsy. Which action should
the nurse take?
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a) Increase the oxygen to 4 L/min
b) Continue the current oxygen flow rate
c) Decrease the oxygen to 1 L/min
d) Notify the provider immediately
Answer: c) Decrease the oxygen to 1 L/min
Rationale: Clients with COPD may have a hypoxic drive and can experience
respiratory depression with high-flow oxygen. The oxygen saturation improved
to 90%, but the client is now drowsy, which may indicate CO2 retention. The
nurse should decrease the oxygen to 1 L/min and assess further. The provider
should be notified, but decreasing the oxygen is the priority action.
5. A client is receiving a blood transfusion. The client reports chills, low
back pain, and difficulty breathing. What is the nurse's priority action?
a) Slow the transfusion rate and assess vital signs
b) Stop the transfusion immediately and maintain IV access with normal
saline
c) Administer prescribed antihistamine
d) Notify the provider
Answer: b) Stop the transfusion immediately and maintain IV access with
normal saline
Rationale: These findings are indicative of a hemolytic transfusion reaction.
The priority action is to stop the transfusion immediately, maintain IV access
with normal saline, and then notify the provider. Slowing the rate is not
appropriate for a suspected reaction.
6. A nurse is caring for a client who is receiving a continuous heparin
infusion. The client's aPTT is 110 seconds. Which action should the nurse
take?
a) Continue the current infusion rate
b) Decrease the infusion rate
c) Stop the infusion and notify the provider
d) Increase the infusion rate
Answer: c) Stop the infusion and notify the provider
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Rationale: The therapeutic aPTT for heparin therapy is typically 1.5-2.5 times
the normal value (approximately 60-80 seconds). An aPTT of 110 seconds
indicates the client is at high risk for bleeding. The infusion should be
stopped, and the provider should be notified immediately.
7. A client with a new tracheostomy is coughing and has bloody
secretions. The client's oxygen saturation is decreasing. Which action
should the nurse take first?
a) Suction the tracheostomy
b) Call the rapid response team
c) Administer oxygen via the tracheostomy
d) Assess the tracheostomy tube placement
Answer: d) Assess the tracheostomy tube placement
Rationale: A decrease in oxygen saturation with coughing and bloody
secretions may indicate tracheostomy tube dislodgement or obstruction. The
priority is to assess the tube placement and patency. Suctioning and oxygen
administration should follow after tube placement is confirmed.
8. The nurse is caring for a client who is on a ventilator. The high-pressure
alarm sounds. Which action should the nurse take first?
a) Call the respiratory therapist
b) Assess the client's respiratory status
c) Check the ventilator tubing for kinks or condensate
d) Suction the client's airway
Answer: b) Assess the client's respiratory status
Rationale: The first action when a ventilator alarm sounds is to assess the
client. The high-pressure alarm may indicate increased airway resistance,
coughing, or secretions. After assessing the client, the nurse should check the
tubing and suction if needed. Calling the respiratory therapist may be
necessary but is not the first action.
KAPLAN CLINICAL JUDGMENT ASSESSMENT 2026/2027
COMPLETE (100) CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED RATIONALES.
CLINICAL
Prepare for the Kaplan Clinical Judgment Assessment with a focused study resource
designed to strengthen essential clinical reasoning and decision-making skills. It
supports review of patient assessment, recognizing relevant cues, prioritizing needs,
analyzing clinical information, selecting appropriate interventions, and evaluating
outcomes. Use the material to practice applying nursing knowledge to clinical
scenarios and identify areas that may require additional review. This resource is best
suited for nursing students and NCLEX candidates preparing for clinical judgment
assessments.
MULTIPLE CHOICE.
SECTION 1: CLINICAL JUDGMENT & PRIORITIZATION (Questions 1-15)
1. A nurse is caring for four clients. Which client should the nurse assess
first?
a) A client with a fractured femur who rates pain as 7 on a scale of 0-10
b) A client with heart failure who has crackles in the lungs and is dyspneic
c) A client with diabetes who has a blood glucose of 140 mg/dL
d) A client with a urinary tract infection who has a temperature of 100.2°F
Answer: b) A client with heart failure who has crackles in the lungs and is
dyspneic
Rationale: The client with heart failure and crackles with dyspnea shows
signs of fluid overload and potential respiratory compromise. This is the most
unstable client and should be assessed first. The fractured femur client has
pain that can be addressed after airway and breathing concerns. The diabetes
and UTI clients have stable findings.
2. The nurse is caring for a client who was admitted with chest pain. The
client's vital signs are: blood pressure 98/62 mmHg, heart rate 118 bpm,
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respiratory rate 22/min, and oxygen saturation 90% on room air. Which
action should the nurse take first?
a) Administer sublingual nitroglycerin
b) Apply oxygen via nasal cannula at 2 L/min
c) Obtain a 12-lead ECG
d) Notify the healthcare provider
Answer: b) Apply oxygen via nasal cannula at 2 L/min
Rationale: The client is showing signs of respiratory compromise (SpO2 90%)
with tachycardia and hypotension. The priority is to address oxygenation first.
The ABCs (Airway, Breathing, Circulation) guide care. After applying oxygen,
the nurse can obtain an ECG and notify the provider.
3. A client is 1 day post-operative following abdominal surgery. The
client's vital signs are: temperature 101.2°F (38.4°C), heart rate 112 bpm,
respiratory rate 24/min, and blood pressure 100/68 mmHg. The surgical
incision is red, swollen, and has purulent drainage. Which action should
the nurse take first?
a) Administer prescribed antipyretic
b) Notify the healthcare provider
c) Obtain a wound culture
d) Apply a sterile dressing
Answer: b) Notify the healthcare provider
Rationale: The client shows signs of a surgical site infection (fever,
tachycardia, redness, swelling, purulent drainage). The provider must be
notified immediately for antibiotic orders. Obtaining a wound culture, applying
a sterile dressing, and administering an antipyretic are appropriate but should
occur after notifying the provider.
4. A client with chronic obstructive pulmonary disease (COPD) has an
oxygen saturation of 86% on room air. The nurse administers oxygen via
nasal cannula at 2 L/min. Fifteen minutes later, the client's oxygen
saturation is 90%. The client reports feeling drowsy. Which action should
the nurse take?
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a) Increase the oxygen to 4 L/min
b) Continue the current oxygen flow rate
c) Decrease the oxygen to 1 L/min
d) Notify the provider immediately
Answer: c) Decrease the oxygen to 1 L/min
Rationale: Clients with COPD may have a hypoxic drive and can experience
respiratory depression with high-flow oxygen. The oxygen saturation improved
to 90%, but the client is now drowsy, which may indicate CO2 retention. The
nurse should decrease the oxygen to 1 L/min and assess further. The provider
should be notified, but decreasing the oxygen is the priority action.
5. A client is receiving a blood transfusion. The client reports chills, low
back pain, and difficulty breathing. What is the nurse's priority action?
a) Slow the transfusion rate and assess vital signs
b) Stop the transfusion immediately and maintain IV access with normal
saline
c) Administer prescribed antihistamine
d) Notify the provider
Answer: b) Stop the transfusion immediately and maintain IV access with
normal saline
Rationale: These findings are indicative of a hemolytic transfusion reaction.
The priority action is to stop the transfusion immediately, maintain IV access
with normal saline, and then notify the provider. Slowing the rate is not
appropriate for a suspected reaction.
6. A nurse is caring for a client who is receiving a continuous heparin
infusion. The client's aPTT is 110 seconds. Which action should the nurse
take?
a) Continue the current infusion rate
b) Decrease the infusion rate
c) Stop the infusion and notify the provider
d) Increase the infusion rate
Answer: c) Stop the infusion and notify the provider
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Rationale: The therapeutic aPTT for heparin therapy is typically 1.5-2.5 times
the normal value (approximately 60-80 seconds). An aPTT of 110 seconds
indicates the client is at high risk for bleeding. The infusion should be
stopped, and the provider should be notified immediately.
7. A client with a new tracheostomy is coughing and has bloody
secretions. The client's oxygen saturation is decreasing. Which action
should the nurse take first?
a) Suction the tracheostomy
b) Call the rapid response team
c) Administer oxygen via the tracheostomy
d) Assess the tracheostomy tube placement
Answer: d) Assess the tracheostomy tube placement
Rationale: A decrease in oxygen saturation with coughing and bloody
secretions may indicate tracheostomy tube dislodgement or obstruction. The
priority is to assess the tube placement and patency. Suctioning and oxygen
administration should follow after tube placement is confirmed.
8. The nurse is caring for a client who is on a ventilator. The high-pressure
alarm sounds. Which action should the nurse take first?
a) Call the respiratory therapist
b) Assess the client's respiratory status
c) Check the ventilator tubing for kinks or condensate
d) Suction the client's airway
Answer: b) Assess the client's respiratory status
Rationale: The first action when a ventilator alarm sounds is to assess the
client. The high-pressure alarm may indicate increased airway resistance,
coughing, or secretions. After assessing the client, the nurse should check the
tubing and suction if needed. Calling the respiratory therapist may be
necessary but is not the first action.
