NCLEX® Clinical Judgment Model: The 6 Steps
The NCLEX® Clinical Judgment Model has 6 steps: Recognize Cues to Evaluate Outcomes. Learn how the NGN is built on it and how to think through any question.
TL;DR: The NCLEX® Clinical Judgment Measurement Model (CJMM) is the framework the Next Generation NCLEX® is built on, and it breaks safe nursing decisions into 6 steps: Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Action, and Evaluate Outcomes (ATI, 2023). Learn the 6 steps and you understand how the whole exam thinks.
If you have read anything about the Next Generation NCLEX®, you have probably seen the phrase "clinical judgment" a hundred times. There is a reason for that. Clinical judgment is the single thing the exam is trying to measure, and the NCSBN built an entire model to do it. That model is the Clinical Judgment Measurement Model, or CJMM, and the Next Generation NCLEX® launched on April 1, 2023 with it baked into every new item type (NCSBN, 2023).
Here is the good news. The CJMM is not a secret. It is 6 plain-English steps that mirror how a smart nurse thinks at the bedside. Once you can name the steps, the new question formats stop feeling random. You start to see what each question is asking you to do, which is exactly what a confident test-taker does.
This guide walks through all 6 steps with a clinical example for each, shows you which NGN® formats tend to show up where, maps the model to the nursing process you already know, and gives you a repeatable thinking routine you can run on any question. For reassurance up front: first-time, US-educated test-takers passed at 87.1% as of November 1, 2025 (Nurse.org, 2025). The students who pass are the ones who think in steps.
What is the NCLEX® Clinical Judgment Model and why is the NGN built on it?
The Clinical Judgment Measurement Model is the NCSBN's framework for measuring how nurses notice, interpret, and act on patient information. The Next Generation NCLEX® uses it to build and score every new item type, which is why clinical judgment is treated as the number-one skill the exam evaluates (ATI, 2023).
The model exists because traditional multiple-choice questions could not fully test decision-making. A student can memorize that potassium is 3.5 to 5.0 without knowing what to do when a real patient's level is 2.8 and they are on digoxin. The CJMM forces that next step. It asks you to recognize the abnormal value, connect it to the patient's drug, decide it is urgent, choose a safe response, do it, and check whether it worked.
The model has layers, but the part you need to master for the exam is its 6-step action layer (UbiSim, 2023). Those 6 steps are the backbone of every unfolding case study and they shape the standalone NGN items too. Learn them once and the entire exam structure clicks into place.
What are the 6 steps of the Clinical Judgment Model?
The 6 cognitive steps, in order, are Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Action, and Evaluate Outcomes (ATI, 2023). They run in sequence, building on each other the way your thinking does during a real patient encounter. Here is the flow you are about to learn, start to finish.
A quick word on the format pairings you will read below. The NCSBN does not lock one item type to one step. Any format can appear at any step. What follows is what tends to show up, based on how the formats line up with each kind of thinking (Osmosis). Treat it as a map, not a rulebook.
1. Recognize Cues
Recognize Cues is about noticing. You sort through the patient chart, vital signs, labs, history, and what the patient says, then you pull out what matters. The skill is filtering signal from noise. Not every data point is relevant, and part of the test is whether you can tell the difference.
Mini-example: A post-op patient has a heart rate of 118, blood pressure 92/58, a temperature of 101.8 F, and a dressing with a quarter-sized spot of drainage. You flag the tachycardia, low blood pressure, and fever as relevant cues. The small drainage spot is expected and is not your concern right now.
Commonly here you will see Multiple Response or Select All That Apply items, or Highlight items where you click the relevant findings inside a chart or nurse's note. These match the "pick out what matters" nature of the step.
2. Analyze Cues
Analyze Cues is where you connect the dots. You take the relevant findings you just identified and link them to what might be happening with the patient. You are organizing cues into a clinical picture and asking what each one points toward. This is interpretation, not just collection.
Mini-example: With that same post-op patient, you connect the rising heart rate, falling blood pressure, and fever and recognize a pattern that fits early sepsis. You also weigh whether hypovolemia from blood loss could explain the same numbers, so you keep both possibilities open.
Commonly here you will see Matrix or Grid items, where you mark each finding as consistent with one condition or another, or as expected versus unexpected. The grid layout matches the work of sorting cues against possible explanations.
3. Prioritize Hypotheses
Prioritize Hypotheses is ranking. You now have a few possible explanations, so you decide which is most urgent and most likely. You weigh risk, likelihood, and how fast you need to act. The most dangerous and most probable hypothesis rises to the top, and that is what you build your plan around.
Mini-example: For the post-op patient, you rank sepsis above mild dehydration because untreated sepsis can deteriorate fast and the fever plus vital sign trend support it. Sepsis becomes your leading hypothesis and the thing driving your next moves.
Commonly here you will see Drop-down or Cloze items embedded in a sentence ("The client is most likely experiencing ___ as evidenced by ___"), and the Bow-Tie item, which pulls priority condition, actions, and parameters into one picture.
4. Generate Solutions
Generate Solutions is planning. You take your top hypothesis and decide what good care would look like. You set goals and list the interventions that would address the priority problem. You are also screening out actions that are unhelpful or unsafe, not just collecting every option that sounds reasonable.
Mini-example: For your suspected-sepsis patient, you plan to obtain blood cultures, start ordered IV fluids, anticipate antibiotics, and monitor lactate and urine output. You set the goal that the patient's blood pressure and perfusion improve within the hour.
Commonly here you will see Matrix items or Select All That Apply, where you choose which interventions are indicated, which are contraindicated, and which are nonessential for this specific patient and goal.
5. Take Action
Take Action is implementation. You carry out the interventions you planned, in the right order, using the right technique. On the exam this often means choosing which actions to do, how to do them, or what to do first. It is the doing step, and prioritization shows up again because order matters.
Mini-example: You administer the ordered IV fluid bolus, draw the blood cultures before the first antibiotic dose, position the patient for perfusion, and notify the provider of the changing status. You sequence cultures before antibiotics so the results stay accurate.
Commonly here you will see Select All That Apply or Cloze items that ask you to assemble the correct set or sequence of actions for the situation in front of you.
6. Evaluate Outcomes
Evaluate Outcomes is the check. After you act, you reassess to see whether the patient is getting better, getting worse, or staying the same. You compare what is happening now against the goals you set, and you decide whether to continue, adjust, or escalate. This step often loops you back to the start with fresh cues.
Mini-example: One hour after fluids, your post-op patient's blood pressure is 108/66, heart rate is down to 96, and urine output has picked up. You judge the interventions as effective and you keep monitoring, while staying alert for any new decline.
Commonly here you will see Matrix items that ask you to mark each finding as improved, unchanged, or worsened, or trend-style items comparing values over time.
How does the Clinical Judgment Model map to the nursing process (ADPIE)?
The 6 CJMM steps map cleanly onto the nursing process you already learned in school. Recognize Cues is Assessment, Analyze Cues and Prioritize Hypotheses together make up Analysis and Diagnosis, Generate Solutions is Planning, Take Action is Implementation, and Evaluate Outcomes is Evaluation (ATI, 2023).
If ADPIE already lives in your head, you are most of the way there. The NCLEX® model just splits the "diagnosis" phase into two clearer actions: linking cues and then ranking your hypotheses. That split is helpful, because deciding what is wrong and deciding what is most urgent are two different jobs. Here is the side-by-side.
| CJMM step | Nursing process (ADPIE) | Commonly paired NGN formats |
|---|---|---|
| 1. Recognize Cues | Assessment | Multiple Response / SATA, Highlight |
| 2. Analyze Cues | Analysis / Diagnosis | Matrix / Grid |
| 3. Prioritize Hypotheses | Analysis / Diagnosis | Drop-down / Cloze, Bow-Tie |
| 4. Generate Solutions | Planning | Matrix, SATA |
| 5. Take Action | Implementation | SATA, Cloze |
| 6. Evaluate Outcomes | Evaluation | Matrix / trend |
Format pairings are illustrative and come from how the item types line up with each step (Osmosis). They are not fixed by the NCSBN, so do not panic if you see a Matrix item testing Recognize Cues. The step is what matters, not the wrapper.
How does the model show up in unfolding case studies?
An unfolding case study follows one patient through 6 questions, and each of the 6 questions targets one CJMM step in order (Osmosis). A typical NCLEX® includes roughly 2 to 5 of these case studies, so they make up a meaningful chunk of your test (NCSBN, 2026).
This is the most direct place you will feel the model. You open a tabbed patient chart with a history, nurses' notes, vital signs, and labs. Question 1 asks you to recognize the relevant cues. Question 2 asks you to analyze them. By question 6 you are evaluating whether your earlier interventions worked, sometimes with new data the case revealed along the way.
Here is the part students miss: the 6 questions stand alone for scoring. If you get the priority wrong on question 3, the case does not collapse. Question 4 still presents the chart and a fresh prompt, and you can earn full credit on it. So if one part rattles you, reset and answer the next part on its own merits. The case is forgiving by design.
The takeaway is simple. When a case study opens, name the step each question is testing. The moment you realize "this is the Take Action question" or "this is the Evaluate Outcomes question," you know what kind of thinking the item wants from you. For a full step-by-step walkthrough, see our NGN Case Study Walkthrough.
How do you run the 6 steps as a thinking routine on any question?
You can run the CJMM as a quick mental checklist on almost any item, standalone or case study, by walking the same 6 questions in order. The model describes how nurses reason, so using it as a routine keeps you from jumping straight to an answer before you have understood the patient (UbiSim, 2023).
Here is the routine. Practice it until it runs on autopilot.
- Recognize. What in this stem matters? Pull the abnormal vitals, labs, and statements. Ignore the noise.
- Analyze. What do those cues point to? Link them into a pattern and name one or two possible explanations.
- Prioritize. What is the most urgent and most likely problem here? Pick your lead hypothesis.
- Generate. What would good care look like? Decide which actions help, which hurt, and which are filler.
- Act. What do I do, and in what order? Choose the safe, in-scope first action.
- Evaluate. How will I know it worked? Name the finding that would tell you the patient improved.
Even on a plain multiple-choice question, this routine slows you down at the right moments. Most wrong answers come from skipping straight to step 5 without doing steps 1 through 3. When you anchor on cues first, the safe answer usually becomes obvious. This is exactly the muscle Study With Lily helps you build, since adaptive practice repeats the routine until it feels automatic.
How are these questions scored, and is it all-or-nothing?
No, the Next Generation NCLEX® is not all-or-nothing on most new item types. The NGN uses 3 scoring rules, the 0/1 rule, the +/- rule, and the rationale rule, and many items award partial credit, which is called polytomous scoring (Nurse Plus, 2023). You can get part of an item right and still earn points.
This changes how you should approach a hard NGN question. On a Select All That Apply item under the +/- rule, each correct selection helps you and each wrong selection can hurt you, so you do not guess wildly, but you also do not freeze. On a 0/1 item you need the exact set, which is the stricter case (NCSBN, 2023).
The practical mindset: answer what you are confident about and do not let one shaky item wreck your momentum. Partial credit means progress, not perfection. For context on the rest of the exam, including length and the pass/fail logic, see How Many Questions Is the NCLEX in 2026?.
Frequently Asked Questions
What are the 6 steps of the NCLEX® Clinical Judgment Model in order? The 6 steps are Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Action, and Evaluate Outcomes (ATI, 2023). They run in order and each one builds on the last, mirroring how a nurse reasons through a real patient situation from noticing findings to checking results.
Is the Clinical Judgment Model the same as the nursing process? They line up closely. Recognize Cues equals Assessment, Analyze Cues and Prioritize Hypotheses cover Analysis and Diagnosis, Generate Solutions is Planning, Take Action is Implementation, and Evaluate Outcomes is Evaluation (ATI, 2023). The model just splits the diagnosis phase into two clearer steps.
How many questions are in an NGN case study? Each unfolding case study contains 6 questions, with one question targeting each step of the Clinical Judgment Model, all following the same patient (Osmosis). A typical NCLEX® includes roughly 2 to 5 case studies (NCSBN, 2026).
Does every clinical judgment step use one specific question format? No. The NCSBN does not lock one item type to one step, so any format can appear at any step. The pairings you read about, like Matrix for Analyze Cues, are common tendencies based on how formats fit the thinking, not fixed rules (Osmosis).
Do NGN questions give partial credit? Yes, many do. The Next Generation NCLEX® uses 3 scoring rules, and several item types award partial credit through polytomous scoring, so you can earn points without getting every part of an item perfect (Nurse Plus, 2023). The 0/1 rule is the exception that requires an exact match.
Is the NGN harder because of the Clinical Judgment Model? It tests deeper thinking, but the pass rate is reassuring. First-time, US-educated test-takers passed at 87.1% as of November 1, 2025 (Nurse.org, 2025). Students who learn to think in the 6 steps tend to find the new formats more approachable, not less.
Related Articles
- How to Answer Select All That Apply (SATA) NCLEX Questions
- How to Answer Bow-Tie Questions
- NGN Case Study Walkthrough
- How to Study for NCLEX 2026
- How Many Questions Is the NCLEX in 2026?
Ready to put the 6 steps into practice? Practice clinical judgment free. Study With Lily builds adaptive NCLEX® practice from your own class notes, so you drill the same Recognize-to-Evaluate routine on content that matches what you are learning.
Sources
- ATI, "What Are the NCSBN's 6 Functions of Clinical Judgment?" (2023): https://www.atitesting.com/educator/blog/knowledge/2023/10/01/6-functions-next-gen-nclex
- Osmosis, "Tips and question types for the Next Generation NCLEX (NGN) exam": https://www.osmosis.org/blog/tips-and-question-types-for-the-next-generation-nclex-ngn-exam
- NCSBN, "Are traditional NCLEX Multiple Response (Select all that Apply, SATA) items scored with partial credits?" (2023): https://ncsbn.zendesk.com/hc/en-us/articles/7807555764631-Are-traditional-NCLEX-Multiple-Response-Select-all-that-Apply-SATA-items-scored-with-partial-credits
- Nurse Plus, "NGN Score" (2023): https://nurse.plus/become-a-nurse/ngn-score/
- NCSBN, "2026 NCLEX-RN Test Plan" (2026): https://www.ncsbn.org/publications/2026-nclex-rn-test-plan
- Nurse.org, "NCLEX Pass Rates Decline, Remote Testing Update" (2025): https://nurse.org/news/nclex-pass-rates-decline-remote-testing-update/
- UbiSim, "What is the NCSBN Clinical Judgment Measurement Model?" (2023): https://www.ubisimvr.com/blog/what-is-ncsbn-clinical-judgment-measurement-model
About the Author
Harrison is the founder of Study With Lily. He built the platform after watching his wife and her nursing school classmates wrestle with expensive, outdated prep tools. He writes about NCLEX® strategy, test-plan changes, and evidence-based study methods, drawing on NCSBN primary sources.
Last updated: June 21, 2026 · 11 min read