Chart — NCLEX Success
Clinical Judgment Process Chart
A visual step-by-step reference for the NCSBN Clinical Judgment Measurement Model (CJMM) — the framework behind the NGN NCLEX. Each cognitive skill is shown with key questions, nursing actions, and exam application tips.
Educational use only. This chart reflects the NCSBN Clinical Judgment Measurement Model. Clinical judgment in practice involves integration of evidence-based knowledge, patient context, and professional expertise beyond any framework. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
The Six-Step Clinical Judgment Process
Recognize Cues
Key Question
What information from this situation is important or concerning?
Nurse Does
Filters relevant data from noise; identifies new, unexpected, or changed findings
On the NGN
Highlight or select the relevant cues from the patient scenario; focus on what is new or abnormal
Examples: New tachycardia, falling SpO₂, altered mental status, elevated lactate, new patient complaint
Analyze Cues
Key Question
What do these cues mean? What conditions or causes are consistent with this data?
Nurse Does
Applies pathophysiology to interpret findings; clusters cues into meaningful patterns
On the NGN
Match cues to likely conditions (drop-down or matrix); explain the mechanism connecting the findings
Example: HR 118 + BP 88/54 + oliguria + fever → consistent with sepsis or hemorrhagic shock
Prioritize Hypotheses
Key Question
Which explanation is most urgent? What could kill the patient if missed?
Nurse Does
Ranks hypotheses by urgency + likelihood; prioritizes the most dangerous possibility
On the NGN
Rank-order hypotheses or select the highest-priority concern; weigh danger over statistical probability
Example: PE is less common than anxiety but must be ruled out first because missing it is fatal
Generate Solutions
Key Question
What interventions address the prioritized hypothesis? What outcomes are expected?
Nurse Does
Identifies evidence-based interventions within nursing scope; anticipates provider orders; selects actions by expected outcome
On the NGN
Extended multiple-response; select all appropriate solutions — avoid those outside scope or contraindicated
Example: Sepsis → obtain cultures, notify provider (SBAR), IV access, anticipate antibiotics, fluids, lactate
Take Action
Key Question
What do I do first? In what sequence should interventions be implemented?
Nurse Does
Executes interventions in priority order: life-threatening first, then urgent, then routine; delegates appropriately; notifies provider using SBAR
On the NGN
Prioritize or sequence nursing actions; first action questions require the most urgent intervention to be selected first
Rule: ABCs before documentation; provider notification before independent action beyond standing orders
Evaluate Outcomes
Key Question
Did the interventions work? Is the patient improving, stable, or worsening?
Nurse Does
Reassesses patient after interventions; compares current findings to expected outcomes; modifies plan if not improving; re-enters the cycle
On the NGN
Select expected findings that indicate improvement vs. findings that indicate worsening or no response to treatment
If outcomes not achieved → loop back to Step 1 (recognize new cues) and revise the hypothesis
↺ The CJMM is iterative — if outcomes are not achieved, re-enter the process at Step 1 with new cue recognition
Quick Reference Summary
| Cognitive Skill | What You're Doing | Common NGN Item Type |
|---|---|---|
| 1. Recognize Cues | Identifying relevant, important findings | Highlight in text; select relevant findings |
| 2. Analyze Cues | Interpreting what findings mean (pathophysiology) | Drop-down; matrix matching |
| 3. Prioritize Hypotheses | Ranking possible explanations by urgency | Rank-order; select most urgent hypothesis |
| 4. Generate Solutions | Planning interventions based on hypothesis | Extended multiple response; select all that apply |
| 5. Take Action | Executing interventions in correct priority order | Drag-and-drop; sequencing; “first action” questions |
| 6. Evaluate Outcomes | Assessing whether interventions achieved goals | Select expected outcomes; identify improvement vs. worsening findings |
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with NCSBN Clinical Judgment Measurement Model. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →