lOMoARcPSD|61392011
✅ 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, decision- Judgment Measurement Model process, red flag recognition, and
making (CJMM) response
Prioritization of care ABCs, Maslow, Safety, Infection
Often scenario-based
(sickest first) Control
Think “What would I do first as a
Nurse's action in a What to assess, what to report,
nurse?” not “What would the
scenario what to teach
doctor do?”
Evidence-based, safe, May involve charts, labs, orders, Interpret lab results, meds, and
patient-centered care 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
Especially: K+, Na+, Hgb/Hct, WBC, ABGs, glucose, creatinine
Values
📈 Review Common
CHF, COPD, Pneumonia, DKA, Stroke, Sepsis, AKI, GI Bleed
Conditions
💊 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
Downloaded by Eva Makena. ()
, lOMoARcPSD|61392011
🧩 Step 4: Practice Clinical Judgment Logic
Scenario Tip Think Like This
New post-op pt with HR 130, BP
Hypovolemic shock → IV fluids, call MD
80/60, pale
Pt with wheezing, O₂ sat 89% on
Airway problem → Sit up, O₂, assess lungs
RA
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 outcomes,
Delegation question
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
Downloaded by Eva Makena. ()
, lOMoARcPSD|61392011
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, rest
Red Flags
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
Downloaded by Eva Makena. ()
, lOMoARcPSD|61392011
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
Downloaded by Eva Makena. ()
✅ 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, decision- Judgment Measurement Model process, red flag recognition, and
making (CJMM) response
Prioritization of care ABCs, Maslow, Safety, Infection
Often scenario-based
(sickest first) Control
Think “What would I do first as a
Nurse's action in a What to assess, what to report,
nurse?” not “What would the
scenario what to teach
doctor do?”
Evidence-based, safe, May involve charts, labs, orders, Interpret lab results, meds, and
patient-centered care 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
Especially: K+, Na+, Hgb/Hct, WBC, ABGs, glucose, creatinine
Values
📈 Review Common
CHF, COPD, Pneumonia, DKA, Stroke, Sepsis, AKI, GI Bleed
Conditions
💊 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
Downloaded by Eva Makena. ()
, lOMoARcPSD|61392011
🧩 Step 4: Practice Clinical Judgment Logic
Scenario Tip Think Like This
New post-op pt with HR 130, BP
Hypovolemic shock → IV fluids, call MD
80/60, pale
Pt with wheezing, O₂ sat 89% on
Airway problem → Sit up, O₂, assess lungs
RA
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 outcomes,
Delegation question
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
Downloaded by Eva Makena. ()
, lOMoARcPSD|61392011
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, rest
Red Flags
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
Downloaded by Eva Makena. ()
, lOMoARcPSD|61392011
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
Downloaded by Eva Makena. ()
