CJE BENCHMARK EXAMS CLINICAL JUDGMENT EXAM
1, 2 & 3 NEWEST 2026 PACKAGE DEAL| NURS 3251
CJE EXAM REVIEWS WITH COMPLETE REAL EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) ALREADY GRADED A+ (MOST
RECENT!!)
1. 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. This is
a priority over the other options, which are stable or expected
findings. Use the "safety and urgency" framework.
1
,2. 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
Correct Answer: B
Rationale: High-Fowler’s position reduces preload and promotes
ventilation, improving oxygenation immediately. Airway and
positioning are always first before medications in pulmonary
edema.
3. A client is prescribed warfarin for atrial fibrillation. Which
laboratory value requires immediate notification to the
provider?
A. INR 2.8
B. INR 4.5
C. PT 18 seconds
D. Platelets 180,000/mm³
2
,Correct Answer: B
Rationale: Therapeutic INR for atrial fibrillation is 2.0–3.0. INR
4.5 significantly increases bleeding risk and requires possible
dose adjustment or holding warfarin.
4. A nurse is providing discharge teaching for a client with a
new colostomy. Which statement indicates understanding?
A. "I can use enteric-coated aspirin if I have pain."
B. "I should avoid carbonated beverages to reduce gas."
C. "I will irrigate my colostomy every morning."
D. "I can eat raw vegetables immediately."
Correct Answer: B
Rationale: Carbonated beverages increase gas and should be
minimized. Enteric-coated aspirin may not be absorbed;
irrigation not needed for all colostomies; raw vegetables should
be introduced gradually.
5. A client on a psychiatric unit suddenly becomes agitated
and yells, "Everyone is poisoning my food!" Which response
is most therapeutic?
A. "That's not true. No one is poisoning you."
3
, B. "I understand you are frightened. Tell me more about that."
C. "You need to calm down or I will give you medication."
D. "Let's go to the quiet room."
Correct Answer: B
Rationale: Validating feelings without agreeing with delusion
promotes trust and therapeutic communication. Option A is
confrontational; C is threatening; D may be appropriate later
but not first.
6. A postoperative client has an order for morphine 2 mg IV
every 2 hours PRN pain. The client reports pain 8/10. The
nurse notes respirations 12/min and oxygen saturation 92%.
What should the nurse do first?
A. Administer morphine as ordered
B. Call the provider to request a lower dose
C. Encourage deep breathing and reassess
D. Administer naloxone per protocol
Correct Answer: C
Rationale: Respiratory rate 12/min is borderline; encourage
deep breathing first. Administering morphine could worsen
respiratory depression. Naloxone is for overdose.
4
1, 2 & 3 NEWEST 2026 PACKAGE DEAL| NURS 3251
CJE EXAM REVIEWS WITH COMPLETE REAL EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) ALREADY GRADED A+ (MOST
RECENT!!)
1. 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. This is
a priority over the other options, which are stable or expected
findings. Use the "safety and urgency" framework.
1
,2. 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
Correct Answer: B
Rationale: High-Fowler’s position reduces preload and promotes
ventilation, improving oxygenation immediately. Airway and
positioning are always first before medications in pulmonary
edema.
3. A client is prescribed warfarin for atrial fibrillation. Which
laboratory value requires immediate notification to the
provider?
A. INR 2.8
B. INR 4.5
C. PT 18 seconds
D. Platelets 180,000/mm³
2
,Correct Answer: B
Rationale: Therapeutic INR for atrial fibrillation is 2.0–3.0. INR
4.5 significantly increases bleeding risk and requires possible
dose adjustment or holding warfarin.
4. A nurse is providing discharge teaching for a client with a
new colostomy. Which statement indicates understanding?
A. "I can use enteric-coated aspirin if I have pain."
B. "I should avoid carbonated beverages to reduce gas."
C. "I will irrigate my colostomy every morning."
D. "I can eat raw vegetables immediately."
Correct Answer: B
Rationale: Carbonated beverages increase gas and should be
minimized. Enteric-coated aspirin may not be absorbed;
irrigation not needed for all colostomies; raw vegetables should
be introduced gradually.
5. A client on a psychiatric unit suddenly becomes agitated
and yells, "Everyone is poisoning my food!" Which response
is most therapeutic?
A. "That's not true. No one is poisoning you."
3
, B. "I understand you are frightened. Tell me more about that."
C. "You need to calm down or I will give you medication."
D. "Let's go to the quiet room."
Correct Answer: B
Rationale: Validating feelings without agreeing with delusion
promotes trust and therapeutic communication. Option A is
confrontational; C is threatening; D may be appropriate later
but not first.
6. A postoperative client has an order for morphine 2 mg IV
every 2 hours PRN pain. The client reports pain 8/10. The
nurse notes respirations 12/min and oxygen saturation 92%.
What should the nurse do first?
A. Administer morphine as ordered
B. Call the provider to request a lower dose
C. Encourage deep breathing and reassess
D. Administer naloxone per protocol
Correct Answer: C
Rationale: Respiratory rate 12/min is borderline; encourage
deep breathing first. Administering morphine could worsen
respiratory depression. Naloxone is for overdose.
4
