ADULT HEALTH CJE EXAM PRACTICE QUESTIONS 150
MULTIPLE-CHOICE QUESTIONS WITH EXPLANATIONS |
INSTANT PDF DOWNLOAD
This exam focuses on Adult Health content for the Clinical Judgment Exam (CJE).
Questions emphasize priority nursing interventions, clinical judgment, patient safety, and
evidence-based care.
Section 1: Fluid & Electrolytes
1. A nurse is reviewing laboratory results for a client with dehydration. Which finding
is consistent with this condition?
A) Decreased serum osmolality
B) Decreased urine specific gravity
C) Increased serum osmolality
D) Decreased serum sodium
Correct Answer: C
Explanation: Dehydration leads to hemoconcentration, resulting in increased serum
osmolality (concentration of particles in fluid). Increased urine specific gravity and
increased serum sodium are also expected findings .
2. A client has a serum osmolality of 320 mOsm/kg (normal 275-300). The nurse
interprets this finding as:
A) Isotonic state
B) Hypotonic state
C) Hypertonic state
D) Normal finding
Correct Answer: C
Explanation: Hypertonic states occur with high osmolality (>300 mOsm/kg), meaning
there is a higher concentration of particles in the blood. This can occur in dehydration,
hyperglycemia, or excessive sodium intake .
,3. The nurse is teaching a client about fluid balance. Which statement correctly
describes osmosis?
A) "Osmosis is the movement of particles from high to low concentration using energy."
B) "Osmosis is the passive movement of water across a membrane toward higher solute
concentration."
C) "Osmosis is an outward pressing force against a surface."
D) "Osmosis requires energy to move electrolytes across the cell membrane."
Correct Answer: B
Explanation: Osmosis is the passive movement of water across a semipermeable
membrane from an area of low solute concentration to an area of high solute concentration.
It does not require energy. Active transport (D) uses energy, while hydrostatic pressure (C)
is an outward force .
4. Which statement correctly distinguishes hydrostatic pressure from osmotic
pressure?
A) Hydrostatic pressure pulls fluid inward; osmotic pressure pushes fluid outward.
B) Hydrostatic pressure pushes fluid outward; osmotic pressure pulls fluid inward.
C) Both pressures work together to push fluid out of capillaries.
D) Hydrostatic pressure occurs only in arteries; osmotic pressure occurs only in veins.
Correct Answer: B
Explanation: Hydrostatic pressure is an outward pressing force against a surface
(pushes fluid out of capillaries). Osmotic pressure is an inward pulling pressure toward
higher concentration (pulls fluid back into capillaries). These opposing forces maintain fluid
balance .
5. A client is receiving IV fluids. The nurse understands that fluid moves from the
vascular system to the interstitial area and then to the cell membrane. This
describes:
A) The order of fluid movement in the body
B) The inflammatory response
C) The renin-angiotensin-aldosterone system
D) The clotting cascade
,Correct Answer: A
Explanation: Fluid moves in this sequence: Vascular System → Capillary Membrane →
Interstitial Area → Cell Membrane. Understanding this order helps nurses anticipate
where fluid shifts occur in various conditions .
6. A client is diagnosed with hypernatremia. The nurse recognizes this as a condition
of:
A) Low sodium and high osmolality
B) High sodium and high osmolality
C) Low sodium and low osmolality
D) High sodium and low osmolality
Correct Answer: B
Explanation: Hypernatremia (high sodium) increases serum osmolality, creating a
hypertonic state. This causes water to shift from the intracellular space to the extracellular
space, leading to cellular dehydration .
7. The nurse is caring for a client with heart failure who has developed third-space
fluid shifting. Which assessment finding supports this condition?
A) Bounding peripheral pulses
B) Jugular vein distention
C) Crackles in lung bases
D) Decreased urine output with edema
Correct Answer: D
Explanation: Third-space fluid shifting occurs when fluid moves from the vascular space
into interstitial spaces (non-functional areas). This leads to decreased urine output (due to
decreased renal perfusion) and edema (visible swelling). The fluid is "trapped" and not
available for normal physiological function .
8. A client receiving a blood transfusion develops fever, chills, and hypotension. The
nurse stops the transfusion. What is the priority next action?
A) Notify the healthcare provider
B) Send the blood bag to the lab
C) Administer acetaminophen
D) Keep the IV line open with new tubing and normal saline
, Correct Answer: D
Explanation: After stopping a transfusion due to reaction, the priority is to maintain IV
access using new tubing and 0.9% normal saline (never through the existing blood tubing).
This ensures the line remains patent for emergency medication administration while
preventing further blood infusion. The healthcare provider should be notified immediately
after .
9. Which gauge IV catheter is appropriate for an elderly client with small, fragile
veins?
A) 14-gauge
B) 18-gauge
C) 22-gauge
D) 26-gauge
Correct Answer: C
Explanation: A 22-gauge (blue) catheter is appropriate for small veins in children and
elderly clients. It has a flow rate of approximately 56 mL/min. A 24-gauge (yellow) is used
for neonatal/elderly with very small veins (36 mL/min flow rate) .
10. A client has a central line inserted. The nurse understands which is the most
common risk associated with this device?
A) Pneumothorax
B) Bleeding
C) Infection
D) Air embolism
Correct Answer: C
Explanation: Infection is the most common risk associated with central lines. Strict sterile
technique during insertion and dressing changes is essential. While pneumothorax and
bleeding (A, B) are risks during insertion, infection remains the most frequent complication
overall .
11. Before administering medication through a newly inserted central line, what must
the nurse verify?
A) Patient consent for the medication
B) Chest x-ray confirmation of placement
MULTIPLE-CHOICE QUESTIONS WITH EXPLANATIONS |
INSTANT PDF DOWNLOAD
This exam focuses on Adult Health content for the Clinical Judgment Exam (CJE).
Questions emphasize priority nursing interventions, clinical judgment, patient safety, and
evidence-based care.
Section 1: Fluid & Electrolytes
1. A nurse is reviewing laboratory results for a client with dehydration. Which finding
is consistent with this condition?
A) Decreased serum osmolality
B) Decreased urine specific gravity
C) Increased serum osmolality
D) Decreased serum sodium
Correct Answer: C
Explanation: Dehydration leads to hemoconcentration, resulting in increased serum
osmolality (concentration of particles in fluid). Increased urine specific gravity and
increased serum sodium are also expected findings .
2. A client has a serum osmolality of 320 mOsm/kg (normal 275-300). The nurse
interprets this finding as:
A) Isotonic state
B) Hypotonic state
C) Hypertonic state
D) Normal finding
Correct Answer: C
Explanation: Hypertonic states occur with high osmolality (>300 mOsm/kg), meaning
there is a higher concentration of particles in the blood. This can occur in dehydration,
hyperglycemia, or excessive sodium intake .
,3. The nurse is teaching a client about fluid balance. Which statement correctly
describes osmosis?
A) "Osmosis is the movement of particles from high to low concentration using energy."
B) "Osmosis is the passive movement of water across a membrane toward higher solute
concentration."
C) "Osmosis is an outward pressing force against a surface."
D) "Osmosis requires energy to move electrolytes across the cell membrane."
Correct Answer: B
Explanation: Osmosis is the passive movement of water across a semipermeable
membrane from an area of low solute concentration to an area of high solute concentration.
It does not require energy. Active transport (D) uses energy, while hydrostatic pressure (C)
is an outward force .
4. Which statement correctly distinguishes hydrostatic pressure from osmotic
pressure?
A) Hydrostatic pressure pulls fluid inward; osmotic pressure pushes fluid outward.
B) Hydrostatic pressure pushes fluid outward; osmotic pressure pulls fluid inward.
C) Both pressures work together to push fluid out of capillaries.
D) Hydrostatic pressure occurs only in arteries; osmotic pressure occurs only in veins.
Correct Answer: B
Explanation: Hydrostatic pressure is an outward pressing force against a surface
(pushes fluid out of capillaries). Osmotic pressure is an inward pulling pressure toward
higher concentration (pulls fluid back into capillaries). These opposing forces maintain fluid
balance .
5. A client is receiving IV fluids. The nurse understands that fluid moves from the
vascular system to the interstitial area and then to the cell membrane. This
describes:
A) The order of fluid movement in the body
B) The inflammatory response
C) The renin-angiotensin-aldosterone system
D) The clotting cascade
,Correct Answer: A
Explanation: Fluid moves in this sequence: Vascular System → Capillary Membrane →
Interstitial Area → Cell Membrane. Understanding this order helps nurses anticipate
where fluid shifts occur in various conditions .
6. A client is diagnosed with hypernatremia. The nurse recognizes this as a condition
of:
A) Low sodium and high osmolality
B) High sodium and high osmolality
C) Low sodium and low osmolality
D) High sodium and low osmolality
Correct Answer: B
Explanation: Hypernatremia (high sodium) increases serum osmolality, creating a
hypertonic state. This causes water to shift from the intracellular space to the extracellular
space, leading to cellular dehydration .
7. The nurse is caring for a client with heart failure who has developed third-space
fluid shifting. Which assessment finding supports this condition?
A) Bounding peripheral pulses
B) Jugular vein distention
C) Crackles in lung bases
D) Decreased urine output with edema
Correct Answer: D
Explanation: Third-space fluid shifting occurs when fluid moves from the vascular space
into interstitial spaces (non-functional areas). This leads to decreased urine output (due to
decreased renal perfusion) and edema (visible swelling). The fluid is "trapped" and not
available for normal physiological function .
8. A client receiving a blood transfusion develops fever, chills, and hypotension. The
nurse stops the transfusion. What is the priority next action?
A) Notify the healthcare provider
B) Send the blood bag to the lab
C) Administer acetaminophen
D) Keep the IV line open with new tubing and normal saline
, Correct Answer: D
Explanation: After stopping a transfusion due to reaction, the priority is to maintain IV
access using new tubing and 0.9% normal saline (never through the existing blood tubing).
This ensures the line remains patent for emergency medication administration while
preventing further blood infusion. The healthcare provider should be notified immediately
after .
9. Which gauge IV catheter is appropriate for an elderly client with small, fragile
veins?
A) 14-gauge
B) 18-gauge
C) 22-gauge
D) 26-gauge
Correct Answer: C
Explanation: A 22-gauge (blue) catheter is appropriate for small veins in children and
elderly clients. It has a flow rate of approximately 56 mL/min. A 24-gauge (yellow) is used
for neonatal/elderly with very small veins (36 mL/min flow rate) .
10. A client has a central line inserted. The nurse understands which is the most
common risk associated with this device?
A) Pneumothorax
B) Bleeding
C) Infection
D) Air embolism
Correct Answer: C
Explanation: Infection is the most common risk associated with central lines. Strict sterile
technique during insertion and dressing changes is essential. While pneumothorax and
bleeding (A, B) are risks during insertion, infection remains the most frequent complication
overall .
11. Before administering medication through a newly inserted central line, what must
the nurse verify?
A) Patient consent for the medication
B) Chest x-ray confirmation of placement
