Editing NCLEX-RN Exam Blueprint (section)

== Clinical judgment and the Next Generation NCLEX ==

The Next Generation NCLEX (NGN) changes took effect in April 2023 and added item types designed to measure clinical judgment more directly (NCSBN, 2026a). The underlying framework is the NCSBN Clinical Judgment Measurement Model, whose six cognitive steps are:

# '''Recognize cues.''' Identify the relevant and important data in a client scenario.
# '''Analyze cues.''' Link the data to the client's clinical presentation and determine what it means.
# '''Prioritize hypotheses.''' Rank the possible explanations by urgency and likelihood.
# '''Generate solutions.''' Identify expected outcomes and the actions that could achieve them.
# '''Take action.''' Implement the highest-priority interventions.
# '''Evaluate outcomes.''' Compare observed to expected outcomes and decide what to do next.

NGN content appears in two forms: '''unfolding case studies''', in which a client scenario develops across a series of items that follow the six steps, and '''stand-alone items''' such as the bow-tie item and the trend item.

Under the 2026 test plan, clinical judgment is measured explicitly by '''18 case study items''', that is three case study sets of six items each, plus '''approximately 10 percent stand-alone clinical judgment items''', selected depending on exam length. Because clinical judgment is an integrated process, case study items span multiple content areas and are counted independently of the eight content area percentages (NCSBN, 2026a).