Clinical Judgment in NCLEX-RN Exam

Understanding the NCLEX-RN Exam

The National Council Licensure Examination for Registered Nurses (NCLEX-RN Exam) is a standardized examination that every nursing school graduate must pass to obtain their nursing license. This exam is used by all state nursing boards to test the competency and safety of a novice nurse. The NCLEX-RN Exam is designed to ensure that nursing candidates have the necessary knowledge and skills to safely perform their roles as healthcare professionals. Understanding the NCLEX-RN Exam requires an in-depth appreciation of its structure and the areas it covers. The exam uses a complex mathematical system called Computerized Adaptive Testing (CAT) to determine the difficulty of the questions based on the test taker’s ability level.

The number of questions on the NCLEX-RN Exam can range from 75 to 265, with the majority being multiple-choice. However, there are also alternate question formats such as multiple responses, fill-in-the-blank, and hot spot items. The content of the NCLEX-RN Exam can be categorized into four major client needs categories: Safe and Effective Care Environment, Health Promotion and Maintenance, Psychosocial Integrity, and Physiological Integrity. Each of these categories is further divided into subcategories which encompass a wide range of topics related to nursing care. Candidates need to familiarize themselves with these categories and subcategories to adequately prepare for the exam.

The NCLEX-RN Exam is more than just a test; it is a measurement of a nurse’s ability to provide safe and effective care. Understanding the exam requires dedication, meticulous preparation, and a comprehensive understanding of nursing concepts and principles. The NCLEX-RN Exam serves as a benchmark for entry-level nursing competency and plays a critical role in ensuring that our healthcare system is staffed by qualified, competent nurses.

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Importance of Clinical Judgment in Nursing

Clinical judgment is the result of your critical thinking and decision-making. Clinical judgment is a crucial part of your learning, assessment, analysis, and evaluation. NCLEX-RN examination requires a high level of clinical judgment in the delivery of safe client care. It is also important in choosing the correct and incorrect answers in the examination.

NCSBN (National Council of State Board of Nursing) introduced the cognitive skill process which is comprised of six components, recognize, analyze, prioritize, generate, take action, and evaluate. The acronym you can remember is RAG-PET. So to remember these six components of clinical judgment you need to make a mental map. You have to create a unique idea in your mind “pet” Suppose the dog is playing with the “rag”. Let’s make a mind map.

dog playing with piece of cloth

Recognize cues: 

In the cognitive process your first step is to recognize the cues, how you can apply this in your clinical judgment? Your assessment makes you able to identify and recognize the information, based on your assessment your mind identifies the information or data. Your data can be subjective or objective.

Analyze cues: 

When you gather some information your mind works to connect the ideas and information and makes an analysis of whether your outcome is expected or unexpected.


When your mind creates an analysis then you prioritize the client’s concerns and problems by hypothesis or anticipation and you choose those options which are more effective and necessary for the client’s health.

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Generate solutions:

After using your hypotheses and anticipation you plan the client care and determine the expected outcome and select your interventions.

Take Action:

Here comes the implementation of your selected interventions and you take action on your generated hypotheses. You prioritize the client care and implement all the interventions.


After completion of all the steps you evaluate your all plan of care and determine whether your desired outcomes are achieved or not by comparing your observed outcome with your anticipated outcome.

The connection of Clinical Judgment, Critical Thinking, and Decision-Making in Nursing

The connection between clinical judgment, critical thinking, and decision-making is foundational to the practice of nursing. These three elements serve as the pillars that uphold the quality and integrity of patient care. Clinical judgment refers to the nurse’s ability to interpret and understand patient data, while critical thinking is the cognitive process that aids in evaluating and analyzing the information. Decision-making, on the other hand, involves selecting the best course of action based on the information gathered.

Clinical judgment is an integral part of a nurse’s role. It involves making informed decisions about the care of patients based on a comprehensive understanding of their health status. It is through clinical judgment that nurses can make accurate diagnoses, predict potential complications, and plan appropriate interventions. However, it is impossible to exercise sound clinical judgment without the aid of critical thinking. Critical thinking in nursing fosters a deep understanding of patient conditions. It involves questioning, analysis, and reflection. Critical thinking skills enable nurses to examine information from different perspectives, challenge assumptions, and identify inconsistencies. This cognitive process supports clinical judgment by providing a structured approach to problem-solving and decision-making.

Decision-making is the final step in this interconnected process. Informed by clinical judgment and fortified with critical thinking, decision-making in nursing involves choosing the most appropriate actions to enhance patient outcomes. It requires nurses to consider multiple factors such as patient preferences, ethical considerations, and evidence-based practices. In summary, clinical judgment, critical thinking, and decision-making are interconnected elements that form the backbone of nursing practice. Each element feeds into and strengthens the others to create a robust system that supports optimal patient care. Their synergy is vital for nurses who are tasked with making complex decisions in fast-paced and often stressful healthcare environments.

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How to develop your Clinical Judgment for the NCLEX-RN Exam

Developing your clinical judgment is a crucial step in preparing for the NCLEX-RN Exam. This skill refers to the ability to make informed decisions based on an understanding of the client’s health status. It involves critical thinking, problem-solving capabilities, and the ability to prioritize tasks effectively. Clinical judgment is not simply about knowledge recall, it’s about applying that knowledge in different situations and making the best decision for patient care.

The first step in enhancing your clinical judgment is to understand the concept of the nursing process, which includes assessment, diagnosis, planning, implementation, and evaluation. This process is the foundation of all nursing actions and should be thoroughly understood. Studying case studies and clinical scenarios related to this can help you apply theoretical knowledge to practice. Next, engage in active learning strategies that promote critical thinking. These strategies may include concept mapping, reflective journaling, and simulation exercises. Simulation exercises are particularly effective as they mimic real-life scenarios and provide an opportunity to make clinical decisions in a safe environment.

Practice is key when it comes to mastering clinical judgment for the NCLEX-RN Exam. Make use of NCLEX-RN practice questions and exams that are designed to test clinical judgment. These resources provide a variety of patient scenarios and require you to select the best response based on your understanding of the situation.

Lastly, always maintain a learner’s attitude. Be open to feedback and learn from your mistakes. Reflect on your experiences and think about how you could improve your decision-making in future scenarios. Developing clinical judgment is a continuous process that requires ongoing learning and practice. In summary, building clinical judgment for the NCLEX-RN Exam requires a combination of theoretical understanding, active learning strategies, extensive practice, and a commitment to continuous improvement. By focusing on these areas, you will be better prepared to make informed decisions in diverse clinical situations, ultimately improving patient outcomes.

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Test Taking Strategies

One thing which candidates must consider that with a very simple approach and knowledge, you can never win the game. Simple tips that you can follow can improve your overall performance in the exam. Think in a systemic way and select your answer with rationale.

nurse writing on notebook

How to Understand the Questions?

  1. In the NCLEX-RN exam, always use the six cognitive skills to determine and plan the answer to your question. Above mentioned acronym “RAG-PET” will help you to remember six components of cognitive skills.
  2. You should have a clear idea of what kind of domain is being asked which means you have to identify the client need category “safe and effective care environment, health promotion and maintenance, psychosocial integrity, and physiological integrity” 
  3. In the case study questions, focus on the available data focus on every word, and recognize what your question is asking about. If you are confused about your decision, think from a different angle and re-read the question to select the right answer.
  4. Determine whether your question is about positive or negative inquiry.
  5. Look for strategic words or keywords to determine what kind of information is being asked in the question.
  6. For traditional questions like multiple choice or multiple responses, first, focus on the elimination process of the incorrect answers. Recognize and eliminate the incorrect answers first, and then chose a correct answer.
  7. Think about both positive and negative aspects of the question and ask yourself the question “What if”.
  8. Determine the conditions of the clients in question then identify and prioritize the client’s needs.

Look for the hints and cues in the data and find any abnormality that exists in the information.

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How to Choose the Options?

someone writing on writing pad
  1. For medication questions, use the pharmacology guidelines to choose the correct answer.
  2. For priority questions, use multiple approaches to choose the correct answer. If a question is about client needs, use Maslow’s Hierarchy of Needs and the ABC (airway, breathing, and circulation) approach. Use the nursing process to manage patient care.
  3. For cardiopulmonary resuscitation (CPR) use CAB (compression, airway, and breathing) approach.
  4. Find out the hint if there is any umbrella option in the question if there is it could be the correct option.
  5. In delegation and assignment questions, first, think about the safe delivery of client care and use the delegation and assignment guidelines to meet the client’s needs.
  6. Find out if there is any close-ended word in the options if so the option might be incorrect.
  7. Use the process of elimination by eliminating incorrect options. Reread your options and select the correct option.
  8. Look for the alike and comparable options if there are so eliminate them through the elimination process.

For communication questions always use a therapeutic technique to choose the correct option. Determine the close-ended and open-ended options and chose the open-ended option as correct.

Strategic Words to Remember:

In every question, you will find some words which can lead you to the correct answer. You just need to focus on these word to identify the category of the question. Use your cognitive skills to eliminate the wrong answer and find out the right answer.

finding words from NCLEX book

1. Priority of Needs Words:

For the priority of needs questions, use Maslow’s Hierarchy of Needs, ABC approach, Nursing Process, and CAB for cardiopulmonary resuscitation.

  1. FirstIn these questions, mostly the discussion about the steps of your actions take place, all the options might be correct but you need to prioritize the option to choose the correct answer.
  2. EssentialThis strategic word shows the most important action to be selected. Determine the most relevant and important option and choose it as your correct option.
  3. NextIn these kinds of questions, basic steps are mostly explained but it inquires about the most important step after the completion of the basic steps.
  4. Most: In these questions, the word “most” inquires about the prioritization of need.
  5. Best: The word “best” indicates the most suitable condition or option for the presented scenario.
  6. Highest Priority: These strategic words indicate the basic needs of the client. Remember the Maslow’s Hierarchy of Needs.
  7. Priority:This strategic word also indicates toward prioritization of needs.
  8. Early or Late: These strategic words show the time orientation and effects of any process.
  9. Primary: This word indicates the core responsibilities of the care provider and the sequence of actions.
  10. Immediate: This word tells about the quick action to take in critical situations; remember the ABC, CAB, and Maslow’s Hierarchy of Needs.
  11. Most Appropriate: These strategic words emphasize choosing the most suitable option or action.
  12. Initial: The word indicates the first reaction or action of the care provider in patient care and management.
  13. Most Likely: These words show the possibility of the most possible action to be chosen.
  14. Most Important: These words also indicate the priority of actions.

2. Assessment Based Words:

For the assessment-based questions, use the nursing process to choose the correct option. These words emphasize the first step “Assessment” of the nursing process. Your data could be subjective or objective.

  1. Identify: This word indicates the recognition of the problem by collecting information.
  2. Recognize: This word shows the identification of a current problem by assessment.
  3. Find out: This word tells us to inquire about the most appropriate information.
  4. Determine: This strategic word also indicates the identification of the problem or action.
  5. Ascertain: This word shows the authenticity and validity of the action.
  6. Monitor: This word reflects the continuous observation of any condition.
  7. Obtain Information: These strategic words emphasize finding out the conclusion of your assessment.
  8. Gather: The word asks you to collect the information.
  9. Collect: In the same way this word asks you to gather the information from your objective or subjective data.
  10. Assess: This word commands you to look for the information by assessment.
  11. Observe: In the same manner this word asks you to find out any information by assessment.
  12. Check: This word emphasizes the go through all the information to find out the most appropriate information.

3. Advance Approach Based Words:

  1. Need for Further Education: These words inquire about your further action during the application of your action. The words ask you to provide further information in a specific situation. It could be a positive or a negative query.
  2. Need for Further Teaching: These words also guide you to provide or not to provide further instructions to the subject. It also could be a positive or negative query.
  3. Need for Follow-up: These words require continuous observation after the completion of your task.

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Resources and tools to improve Clinical Judgment for NCLEX-RN Exam

The National Council Licensure Examination for Registered Nurses (NCLEX-RN Exam) is a critical assessment that nurses must pass to demonstrate their competence and readiness for safe and effective entry-level nursing practice. A significant part of this exam involves testing the candidate’s clinical judgment. As such, several resources and tools are available to help candidates improve their clinical judgment skills in preparation for the NCLEX-RN Exam.

Firstly, study guides and textbooks like “Lippincott Q&A Review for NCLEX-RN” and “Saunders Comprehensive Review for the NCLEX-RN Examination” are invaluable resources. These texts provide extensive review materials, practice questions, and detailed rationales designed to enhance critical thinking and clinical judgment skills.

Secondly, online learning platforms can be particularly beneficial. Websites such as Khan Academy and UWorld offer NCLEX-RN prep courses with interactive, scenario-based questions designed to replicate the actual exam’s complexity and format. These tools help to develop a candidate’s ability to analyze and interpret patient information, make nursing judgments, and manage patient care. Simulation labs are another essential tool available to nursing students. They provide a safe, controlled environment where candidates can practice clinical scenarios, decision-making processes, and patient interactions. Simulation exercises are designed to enhance clinical judgment by promoting critical thinking, problem-solving, and the application of theoretical knowledge to practical situations.

Finally, mentoring or coaching from experienced nurses or educators can provide personalized guidance. They can offer feedback on strengths and areas for improvement and provide strategies to enhance clinical judgment skills.

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Conclusion: The Key to Passing the NCLEX-RN with Strong Clinical Judgment Skills

In conclusion, passing the NCLEX-RN exam is a significant milestone that marks the transition from being a nursing student to becoming a professional nurse. It is a rigorous and challenging test that requires not only a comprehensive understanding of medical knowledge but also the ability to apply this knowledge in real-life scenarios. The key to success lies in the development and application of strong clinical judgment skills.

Clinical judgment refers to the critical thinking process that nurses use to evaluate and make decisions about patient care. It involves synthesizing information, making inferences, and drawing conclusions based on the available evidence. This ability to analyze complex situations and make appropriate decisions is an essential competency for any nurse and is heavily tested in the NCLEX-RN exam.

Candidates preparing for the exam should focus on honing their clinical judgment skills. This can be achieved through various strategies such as case studies, simulation exercises, and reflective practice. These methods provide opportunities for candidates to practice making decisions in a safe environment, receive feedback on their performance, and learn from their mistakes. Moreover, test-takers should familiarize themselves with the format of the exam and the types of questions they will encounter. The NCLEX-RN incorporates different types of questions aimed at testing clinical judgment, including multiple-choice, select all that apply, and ordered response items. Understanding how to navigate these question types effectively can significantly boost a candidate’s confidence and performance on the exam.

To sum up, passing the NCLEX-RN exam requires more than just memorization of facts and figures. It demands a deep understanding of nursing concepts and principles, as well as the ability to apply this knowledge in the context of patient care. Therefore, developing strong clinical judgment skills is crucial for success in this exam and beyond professional nursing practice.


  • Silvestri, L.A. and Silvestri, A.E., 2019. Saunders Comprehensive Review for the NCLEX-RN® Examination-E-Book.

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