Correct Verified Answers| Adult Health Clinical
Judgement Exam (CJE) 2025
The nurse is assessing a client who is receiving warfarin (Coumadin). Assessment findings
include increased drowsiness, blood pressure 90/57 mmHg, pulse 108 beats/minute, and
respirations 22 breaths/min. What medication should the nurse prepare to administer?
1
Vitamin K.
2
Metoprolol.
3
Protamine sulfate.
4
Amiodarone. - Answer- Vitamin K.
The nurse is preparing to teach a client on preventing the spread of methicillin-resistant staph
areus (MRSA). Which statement by the client causes concern?
1
"I need to tell my spouse to sleep in the guest bedroom until my wound heals."
2
"I should wash my hands before and after changing the bandage."
3
"I will stop by the store to buy some bleach before I go home."
4
"I should bathe daily with antibacterial soap." - Answer- "I should bathe daily with antibacterial
soap."
"I need to tell my spouse to sleep in the guest bedroom until my wound heals." Client should
sleep in separate bed from others until infection has cleared
"I should wash my hands before and after changing the bandage." Client should wash hands
before and after wound care
"I will stop by the store to buy some bleach before I go home." Surfaces that come in contact
with infection should be cleaned with bleach water
"I should bathe daily with antibacterial soap." Correct - Showering rather than bathing is
recommended
,Review the chart below. After completing the admission assessment, which prescription does the
nurse identify as a priority?
1
Oxygen
2
NG tube
3
Morphine
4
Normal saline - Answer- Oxygen - Indicated to improve oxygen saturation
NG tube - Required to decompress abdomen, which helps to relieve pain
Morphine - Correct - Pain control is a priority to prevent hemodynamic instability
Normal saline - Indicated to prevent fluid volume deficit because client will be NPO
The nurse is caring for a client who is being treated for diabetes insipidus (DI). Which statements
by the client indicate treatment has been effective? Select all that apply
1
"My skin is so dry."
2
"I feel like I'm drooling."
3
"My heart is beating so fast."
4
"I urinated yellow urine 3 hours ago."
5
"I don't have to drink as much water anymore." - Answer- "I urinated yellow urine 3 hours ago."
"I don't have to drink as much water anymore."
The nurse is caring for a client with lung cancer who had a right pneumonectomy 2 days ago.
After lunch, the nurse finds the client lying in bed on the left side. What is an appropriate action
by the nurse?
1
Reposition the client on the right side and inform client to avoid lying on the left side.
2
Raise the head of the bed and continue to monitor client.
3
Apply oxygen and suction the client.
, 4
Perform chest physiotherapy and apply oxygen. - Answer- Reposition the client on the right side
and inform client to avoid lying on the left side.
Reposition the client on the right side and inform client to avoid lying on the left side. Correct -
Client should be positioned on the operative side to facilitate expansion of remaining lung
The nurse is assessing a client in the emergency department who was involved in a motor vehicle
accident. Assessment findings include periorbital ecchymosis, bruising behind the ears, and
leakage of clear fluid from the nose. What is an appropriate action by the nurse?
1
Instruct the client to apply firm pressure to the nose.
2
Obtain a specimen of the fluid for culture and sensitivity.
3
Obtain a specimen of the fluid for presence of glucose.
4
Prepare to administer a broad-spectrum antibiotic. - Answer- Obtain a specimen of the fluid for
presence of glucose.
The nurse is providing discharge instructions for a client who has been prescribed prednisone for
pneumonia. Which response by the client indicates the need for further teaching?
1
"I may eat more food than usual."
2
"I need to take the medication on an empty stomach."
3
"I need to gradually decrease the dose."
4
"I should notify my doctor is my urine has a foul odor." - Answer- "I need to take the
medication on an empty stomach."
"I need to take the medication on an empty stomach." Correct - Should be taken with meals to
minimize gastric irritation
The nurse is caring for a client who is scheduled to have a paracentesis. Which assessment is
most important for the nurse to perform before the procedure?