Next Gen NCLEX · Clinical reasoning
Six steps to reason through an NGN case
The NCSBN Clinical Judgment Measurement Model describes six cognitive operations. Practice following them as a patient's condition changes; do not jump to a treatment before identifying the relevant cues.
Recognize cues
What changed?
New confusion, oxygen saturation 88% on oxygen, and falling urine output are not isolated details.
Analyze cues
What do the findings mean together?
Low oxygenation and reduced perfusion may be worsening despite treatment for pneumonia.
Prioritize hypotheses
Which explanation is most urgent?
Possible deterioration with impaired oxygenation or sepsis is more urgent than an expected cough.
Generate solutions
What options address the priority?
Consider immediate reassessment, support of oxygenation, and escalation to the care team within your role.
Take action
What should happen first?
Act on the unstable findings promptly rather than waiting for the next routine observation.
Evaluate outcomes
Did the response help?
Recheck vital signs, mental status, oxygenation and urine output; report persistent deterioration.
This is an illustrative study scenario, not an individual care instruction or a recalled exam item. Always apply local protocols and your professional scope in practice.
Source: NCSBN, Next Generation NCLEX. NCLEXVault is independent of NCSBN.