The Next Generation NCLEX (NGN) Test Design

This cognitive skill make nurses enable to identify the most essential data in question. The cues are the client’s current and previous findings and assessment data that lead nurses to make decisions in a clinical environment.

In unfolding case studies you will be given a scenario and you need to find out the more relevant information which is directly related to the client’s clinical needs and priorities or you need to identify the irrelevant information which is not directly related to the client’s needs and priorities.

Analysis of cues, help nurses to find out the actual or potential meaning of all the data. This cognitive skill guides nurses to identify the most immediate concerns and priority actions in a clinical setup. 

In some scenarios, you can find out more than one client’s condition then you need to link the conditions to identify the most concerning condition and plan your nursing care as per the client’s need.

In some cases, there could be some potential complications rather than actual which can affect the client’s condition in the future. Identify those conditions and anticipate possible complications and prioritize client care accordingly.

The center of your nursing practice is that you need to anticipate and make hypotheses about the priority needs and take decisions in more complex situations according to client needs and problems. In this cognitive skill, you review the client’s problems and needs and link them with the client’s actual or potential conditions. 

After all, you make a hypothesis about the prioritization of client needs and you perform the most crucial and necessary step first. Consider this clinical scenario.

A 43-year-old client presents in the emergency department complaining of loose stool 20 episodes from the previous day, vomiting, and abdominal pain. On examination nurse notes a low blood pressure of 100/60 mmHg. 

What the nurse will anticipate priority action according to the client’s actual or potential clinical condition. In this scenario, the patient has four main problems loose stool, vomiting, abdominal pain, and low blood pressure. What could be the most alarming problem that the nurse should anticipate to treat first?

1. Start intravenous fluids.
2. Administer pain medicines.
3. Administer antibiotics.
4. Provide oral rehydration solution.

In this scenario, the alarming potential condition is that the patient can develop hypovolemia which can be life-threatening. So the first action of the nurse should start intravenous fluids. 

The patient is not tolerating oral fluids so the oral rehydration solution should be avoided. Low blood pressure and abdominal pain are related to low body fluid volume, electrolyte imbalance, and smooth muscles spasm. They all can be treated after starting the intravenous fluids.

In this cognitive skill, nurses develop a plan of care by anticipating client needs and actual or potential conditions. Nurses rank the priority actions on evidence-based nursing interventions and solutions for client safety by providing safe delivery of nursing care.

When making a plan of care for Generate Solutions you need to identify the outcome criteria on the client’s priority needs. Nurses should know when they are required to Generate Solutions. 

Nurses should consider themselves as problem solver and should make a hypothesis based on current condition, actual and potential risk, prioritizing client needs and revising the plan of care if needed.

• To identify the current condition efficiently.
• To identify the actual and potential risks for client health and safety.
• To prioritize the client’s needs.
• To make a hypothesis.
• To develop a plan of care.
• To evaluate the plan of care.

Making a plan of care and generating solutions guide the nurses to take action accordingly. Implementation of nursing actions is a practical approach to evaluating a plan of care. Undertaking necessary actions can prevent the client’s deterioration and improve the client’s health. 

To maintain safe client care nurses must be able to use their clinical judgment according to the client’s health status. In critical situations, nursing knowledge and clinical judgment play an important role to take action immediately and effectively.

• C= Clinical condition of the client provides a broad view of the current situation, so nurses should assess the clinical condition of the client very carefully.
• R= Recognizing the cues, client’s clinical history and assessment data provides the base to make a care plan for nurses.
• I= Investigations guide the nurses about actual and potential risks and problems.
• T= Critical thinking is the most important factor in the assessment, prioritization of client needs, planning, and implementation of nursing actions.
• I= Initiate the nursing actions to execute the plan of care.
• C= Collect the data after initiation of the care plan.
• A= Analysis of findings and collected data help nurse to make an evaluation and to make a better judgment that nursing interventions worked or not,
• L= List all the collected data and make an evolution. This determines that the how care plan was effective. Your outcome goals are achieved or you need to modify your care plan.

Evaluation of outcomes is the process of determining whether your care plan is effective or not. This is an ongoing process that helps nurses to look back on all the steps for the continuation or modification of the nursing care plan. 

Nurses set their expected outcome goals and compare them with actual client outcomes and make an evaluation for the care plan. This cognitive skill requires good communication skills to identify the client’s findings, document of client’s response, and report the client’s findings, response, and investigations in the care plan. 

Evaluate Outcome Cognitive skill guide nurses to move forward or to revise their nursing care plan according to client response and actual outcome goals.

• Client’s previous and current condition.
•  Any change in the client’s condition.
• Factors influencing the care plan.
• Is there any new client need if so prioritize according to the client’s needs.
• What else needs to be done to achieve optimal results?
• The care plan is effective or needs to be revised based on client needs.