Next Generation NCLEX

Clinical Judgment Measurement Model (CJMM)

The 6 cognitive levels NCSBN uses to measure clinical judgment on the NGN exam

Level 1
Recognize cues
Identify relevant and important information from multiple sources. Filter out irrelevant data and notice changes in patient status.
Sources of cues
Vital signs Lab values Assessment findings Nurses notes Medication history
Key action verbs on exam
identify · notice · select · recognize · which finding · highlight
Level 2
Analyze cues
Connect recognized cues to the client's clinical presentation. Determine the significance of findings and how they relate to potential conditions.
What to connect
Pathophysiology Risk factors Medical history Medications
Key action verbs on exam
relate · interpret · connect · determine significance · consistent with
Level 3
Prioritize hypotheses
Rank possible explanations for the client's condition from most to least urgent. Consider life-threatening conditions first.
Priority framework
ABCs Maslow's hierarchy Acute vs chronic Life-threatening
Key action verbs on exam
prioritize · rank · most urgent · most likely · first concern · order
Level 4
Generate solutions
Identify expected outcomes and determine the interventions needed to achieve them. Consider evidence-based options for each prioritized hypothesis.
Solution types
Nursing interventions Expected outcomes Collaborative care
Key action verbs on exam
plan · select interventions · indicate · appropriate · should include
Level 5
Take actions
Implement the selected nursing interventions. Apply clinical knowledge to carry out individualized care based on the client's specific needs and situation.
Action categories
Medication admin Patient teaching Safety measures Communication
Key action verbs on exam
implement · perform · administer · initiate · instruct · notify
Level 6
Evaluate outcomes
Compare the client's observed outcomes against the expected outcomes. Determine whether interventions were effective and whether the care plan needs modification.
Evaluate for
Improvement Adverse effects Goal met/not met Plan modification
Key action verbs on exam
evaluate · determine effectiveness · indicates improvement · reassess

NGN question types and which CJMM levels they target

🔘
Multiple choice (MCQ)
Single best answer. Used across all levels but most common for L3–L5.
All levels
☑️
Select all that apply (SATA)
Multiple correct answers. Requires analysis of each option independently. Tests comprehensive clinical knowledge.
L2 AnalyzeL4 GenerateL5 Act
⊞
Matrix / Grid
Rows = clinical items, columns = responses (e.g. Indicated/Contraindicated/Non-essential). Tests multi-dimensional analysis.
L2 AnalyzeL3 PrioritizeL4 Generate
🎀
Bow-tie
Three-column diagram: Condition | Nursing actions | Parameters to monitor. Tests holistic clinical judgment in one item.
L3 PrioritizeL4 GenerateL6 Evaluate
↕️
Drag and drop / Ordering
Sequence nursing interventions or clinical steps in correct order. Tests prioritization and procedural knowledge.
L3 PrioritizeL5 Act
✏️
Cloze / Drop-down
"The nurse should administer [dropdown] because the client is experiencing [dropdown]." Tests precise clinical reasoning.
L4 GenerateL5 Act
🖊️
Highlight
Highlight words in a clinical passage (nurses notes, EHR). Tests ability to identify relevant cues from real documentation.
L1 RecognizeL2 Analyze
📋
Unfolding case study
6-question set sharing one evolving patient scenario. Questions reveal new data as the case progresses, testing all 6 CJMM levels.
All 6 levels

Exam-day strategy for NGN questions

1️⃣
Read the stem carefully. Identify which CJMM level is being tested — the verb tells you (highlight = L1, prioritize = L3, evaluate = L6). Match your thinking to the level.
2️⃣
For case studies, read the scenario first. The shared patient context is the anchor for all 6 questions. New information gets added with each question — pay attention to changes.
3️⃣
For matrix questions, evaluate each row independently. Don't let one correct row anchor your thinking on the others — treat each row as a separate mini-question.
4️⃣
For bow-tie questions, work from the center outward. Identify the condition first (center-left), then determine the most appropriate nursing actions, then the parameters to monitor.
5️⃣
For SATA, treat each option as true/false. Never eliminate an option because you think "there can only be 2 correct" — SATA can have 2–6 correct answers.
6️⃣
The adaptive engine targets your ability level. If questions feel hard, that's a good sign — it means the engine estimates you're performing well and is challenging you appropriately.