,NUR 224 Medical-Surgical Clinical Judgment Examination Exam (CJE)
Questions And Answers 2026/2027 Jersey College
TABLE OF CONTENTS
CASE STUDY 1 — Acute Ischemic Stroke
CASE STUDY 2 — Septic Shock and ARDS
CASE STUDY 3 — Spinal Cord Injury and Autonomic Dysreflexia
CASE STUDY 4 — Acute Leukemia and Tumor Lysis Syndrome
CASE STUDY 5 — Crush Injury, Rhabdomyolysis, and Compartment Syndrome
CASE STUDY 6 — Anaphylactic Shock
CASE STUDY 7 — Acute Vision and Sensory Emergencies
CASE STUDY 8 — Major Trauma and Hemorrhagic Shock
CLINICAL JUDGMENT — Prioritization and Delegation
CASE STUDY 1 — ACUTE ISCHEMIC STROKE
A 69-year-old with hypertension and atrial fibrillation suddenly develops right
facial droop, right arm weakness, aphasia, and gaze deviation. Symptoms
were first noticed 35 minutes ago. Blood pressure is 178/96 mm Hg, glucose
is 112 mg/dL, and oxygen saturation is 95%.
Q1. Which finding is most important for determining eligibility for
time-sensitive stroke treatment?
A) History of hypertension
B) Oxygen saturation of 95%
C) Exact time the patient was last known neurologically normal
D) Age of 69 years
Correct Answer: C) Exact time the patient was last known neurologically
normal
Rationale: Reperfusion eligibility depends heavily on stroke onset or last-
known-well time.
Q2. Which cerebral circulation is most likely affected by this
presentation?
A) Left middle cerebral artery territory
B) Right posterior cerebral artery territory
C) Right cerebellar circulation
D) Left vertebral artery only
Correct Answer: A) Left middle cerebral artery territory
,Rationale: Aphasia with right-sided weakness strongly suggests dominant
left-hemisphere involvement, commonly within the middle cerebral artery
distribution.
Q3. Which hypothesis should receive the highest priority?
A) Bell palsy
B) Hypoglycemia
C) Chronic neurologic disease
D) Acute ischemic stroke causing focal cerebral hypoperfusion
Correct Answer: D) Acute ischemic stroke causing focal cerebral
hypoperfusion
Rationale: Sudden focal deficits with normal glucose strongly support an
acute cerebrovascular event.
Q4. Which diagnostic action should occur urgently before
thrombolytic therapy is considered?
A) Lumbar puncture
B) Noncontrast head CT to exclude intracranial hemorrhage
C) Electromyography
D) Carotid massage
Correct Answer: B) Noncontrast head CT to exclude intracranial hemorrhage
Rationale: Intracranial bleeding must be excluded before thrombolytic
treatment for presumed ischemic stroke.
Q5. While awaiting definitive treatment, which nursing action is
appropriate?
A) Give oral fluids immediately
B) Encourage independent ambulation
C) Maintain NPO status until swallowing safety is established
D) Place the patient flat and feed through a straw
Correct Answer: C) Maintain NPO status until swallowing safety is established
Rationale: Acute stroke can impair swallowing and airway protection,
creating substantial aspiration risk.
Q6. Which finding best indicates successful reperfusion treatment?
A) Improvement in aphasia and motor strength without evidence of
intracranial bleeding
, B) Increasing headache and vomiting
C) New decline in consciousness
D) Progressive unilateral weakness
Correct Answer: A) Improvement in aphasia and motor strength without
evidence of intracranial bleeding
Rationale: Neurologic improvement without hemorrhagic complications
indicates a favorable treatment response.
CASE STUDY 2 — SEPTIC SHOCK AND ARDS
A 73-year-old hospitalized with pneumonia becomes increasingly confused.
Temperature is 39.4°C, heart rate 126/min, respiratory rate 32/min, blood
pressure 82/48 mm Hg, oxygen saturation 87% on supplemental oxygen, and
lactate is 5.2 mmol/L. Urine output is 15 mL/hr.
Q7. Which findings most strongly indicate systemic hypoperfusion?
A) Fever and productive cough
B) Hypotension, elevated lactate, confusion, and oliguria
C) Tachypnea and crackles only
D) Temperature of 39.4°C alone
Correct Answer: B) Hypotension, elevated lactate, confusion, and oliguria
Rationale: These findings indicate impaired blood flow and oxygen delivery
to multiple organs.
Q8. Which pathophysiologic process is most responsible for the
hypotension in early septic shock?
A) Increased systemic vascular resistance
B) Severe isolated left ventricular obstruction
C) Reduced circulating volume from hemorrhage alone
D) Widespread vasodilation and increased capillary permeability
Correct Answer: D) Widespread vasodilation and increased capillary
permeability
Rationale: Sepsis causes inflammatory vasodilation and vascular leak,
reducing effective circulating volume and vascular tone.
Q9. Which hypothesis has the highest priority?
A) Septic shock with evolving organ dysfunction
B) Stable pneumonia
Questions And Answers 2026/2027 Jersey College
TABLE OF CONTENTS
CASE STUDY 1 — Acute Ischemic Stroke
CASE STUDY 2 — Septic Shock and ARDS
CASE STUDY 3 — Spinal Cord Injury and Autonomic Dysreflexia
CASE STUDY 4 — Acute Leukemia and Tumor Lysis Syndrome
CASE STUDY 5 — Crush Injury, Rhabdomyolysis, and Compartment Syndrome
CASE STUDY 6 — Anaphylactic Shock
CASE STUDY 7 — Acute Vision and Sensory Emergencies
CASE STUDY 8 — Major Trauma and Hemorrhagic Shock
CLINICAL JUDGMENT — Prioritization and Delegation
CASE STUDY 1 — ACUTE ISCHEMIC STROKE
A 69-year-old with hypertension and atrial fibrillation suddenly develops right
facial droop, right arm weakness, aphasia, and gaze deviation. Symptoms
were first noticed 35 minutes ago. Blood pressure is 178/96 mm Hg, glucose
is 112 mg/dL, and oxygen saturation is 95%.
Q1. Which finding is most important for determining eligibility for
time-sensitive stroke treatment?
A) History of hypertension
B) Oxygen saturation of 95%
C) Exact time the patient was last known neurologically normal
D) Age of 69 years
Correct Answer: C) Exact time the patient was last known neurologically
normal
Rationale: Reperfusion eligibility depends heavily on stroke onset or last-
known-well time.
Q2. Which cerebral circulation is most likely affected by this
presentation?
A) Left middle cerebral artery territory
B) Right posterior cerebral artery territory
C) Right cerebellar circulation
D) Left vertebral artery only
Correct Answer: A) Left middle cerebral artery territory
,Rationale: Aphasia with right-sided weakness strongly suggests dominant
left-hemisphere involvement, commonly within the middle cerebral artery
distribution.
Q3. Which hypothesis should receive the highest priority?
A) Bell palsy
B) Hypoglycemia
C) Chronic neurologic disease
D) Acute ischemic stroke causing focal cerebral hypoperfusion
Correct Answer: D) Acute ischemic stroke causing focal cerebral
hypoperfusion
Rationale: Sudden focal deficits with normal glucose strongly support an
acute cerebrovascular event.
Q4. Which diagnostic action should occur urgently before
thrombolytic therapy is considered?
A) Lumbar puncture
B) Noncontrast head CT to exclude intracranial hemorrhage
C) Electromyography
D) Carotid massage
Correct Answer: B) Noncontrast head CT to exclude intracranial hemorrhage
Rationale: Intracranial bleeding must be excluded before thrombolytic
treatment for presumed ischemic stroke.
Q5. While awaiting definitive treatment, which nursing action is
appropriate?
A) Give oral fluids immediately
B) Encourage independent ambulation
C) Maintain NPO status until swallowing safety is established
D) Place the patient flat and feed through a straw
Correct Answer: C) Maintain NPO status until swallowing safety is established
Rationale: Acute stroke can impair swallowing and airway protection,
creating substantial aspiration risk.
Q6. Which finding best indicates successful reperfusion treatment?
A) Improvement in aphasia and motor strength without evidence of
intracranial bleeding
, B) Increasing headache and vomiting
C) New decline in consciousness
D) Progressive unilateral weakness
Correct Answer: A) Improvement in aphasia and motor strength without
evidence of intracranial bleeding
Rationale: Neurologic improvement without hemorrhagic complications
indicates a favorable treatment response.
CASE STUDY 2 — SEPTIC SHOCK AND ARDS
A 73-year-old hospitalized with pneumonia becomes increasingly confused.
Temperature is 39.4°C, heart rate 126/min, respiratory rate 32/min, blood
pressure 82/48 mm Hg, oxygen saturation 87% on supplemental oxygen, and
lactate is 5.2 mmol/L. Urine output is 15 mL/hr.
Q7. Which findings most strongly indicate systemic hypoperfusion?
A) Fever and productive cough
B) Hypotension, elevated lactate, confusion, and oliguria
C) Tachypnea and crackles only
D) Temperature of 39.4°C alone
Correct Answer: B) Hypotension, elevated lactate, confusion, and oliguria
Rationale: These findings indicate impaired blood flow and oxygen delivery
to multiple organs.
Q8. Which pathophysiologic process is most responsible for the
hypotension in early septic shock?
A) Increased systemic vascular resistance
B) Severe isolated left ventricular obstruction
C) Reduced circulating volume from hemorrhage alone
D) Widespread vasodilation and increased capillary permeability
Correct Answer: D) Widespread vasodilation and increased capillary
permeability
Rationale: Sepsis causes inflammatory vasodilation and vascular leak,
reducing effective circulating volume and vascular tone.
Q9. Which hypothesis has the highest priority?
A) Septic shock with evolving organ dysfunction
B) Stable pneumonia
