The document discusses building clinical judgment questions for the NCLEX licensure exam, which is changing its format. It will now include 3 clinical case studies and 10% next generation questions. The document outlines these changes and provides resources for creating clinical judgment questions, including a test bank project from Maryland that has developed case studies and questions covering various nursing specialties. It also provides an example of how to create a "bow tie" clinical judgment question involving a patient case.

1. Build Your Own
Nursing Clinical
Judgment
Question
Faith Andrews MSN, RN, CNE
Mary Beverly Gallagher MS, RN, CNE
Harford Community College

2. Objectives:
• Discuss of the upcoming changes to the
NCLEX licensure examination
• Utilize the clinical judgement test bank
created by the MD NGN Test Bank Project
• Identify resources available for creating
clinical judgment questions
• Write a clinical judgment question using the
available resources

3. Changes to
NCLEX
licensure
examination
• Goal: Improved method for measuring clinical
judgment
• Clinical judgement: the observed outcome of
critical thinking and decision-making. It is an
iterative process that uses nursing knowledge
to observe and access presenting situations,
identify a prioritized client concern, and
generate the best possible evidence-based
solutions in order to deliver safe client care
(NCSBN)
• 85 questions (minimum) - 150 (maximum)
• 70-135 are scored since 15 questions are
unscored.

4. Changes to NCLEX licensure
examination
• 3 clinical judgement case studies
• Involve: recognizing cues, analyzing
cues, prioritizing hypotheses,
generating solutions, taking action,
and evaluating outcomes.
• Remaining Test Items:
• Stand-alone test questions
• Traditional – 90% of remaining
test questions
• NGN questions- 10% of
remaining test questions
• Bow tie or trend questions

5. Maryland NextGen
Test Bank Project
• Purpose: To develop an open test bank of
NGN items for all Maryland faculty and
students
• Items written and peer reviewed by 20
faculty from institutions throughout
Maryland under consultation of Desirée
Hensel and Diane Billings
• Currently includes 41 6-question case
studies
• Each case study is followed by a related
standalone item – either bowtie or trend

6. Using
the Test
Bank
• Case studies are Word documents
• Author
• Overview
• Objectives
• URL and QR code to access questions
• References
• 6 NGN questions and related
standalone item
• Answers
• Scoring rule
• Rationales
• Website being developed for faculty to
directly access documents

9. Fundamentals
1. Catheter associated
urinary tract infection
2. Deep vein thrombosis I
3. Home safety/fall risk
4. Postoperative atelectasis
5. Pressure Injury
6. Transfusion reaction
7. Urinary tract infection in older adult

10. Medical Surgical
1. Acute respiratory failure
2. Asthma
3. Burns (second and third degree)
4. Chest pain (MI)
5. Compartment syndrome
6. Chronic obstructive pulmonary
disease
7. Deep vein thrombosis II
8. End stage renal disease and dialysis
9. Gastroesophageal reflux disease
10. HIV with an opportunistic infection
11. Type II diabetes & ketoacidosis
12. Liver failure
13. Prostate cancer with prostatectomy
14. Stroke
15. Tension pneumothorax
16. Thyroid storm
17. Tuberculosis
10

11. Obstetrics
1. Ectopic pregnancy
2. Gestational diabetes
3. Neonatal jaundice
4. Neonatal respiratory distress
syndrome
5. Postpartum hemorrhage
6. Pre-eclampsia with
magnesium toxicity

12. Pediatric
1. Attention deficit hyperactivity disorder
2. Febrile seizures
3. Pediatric diabetes with hypoglycemia
4. Pediatric anaphylaxis
5. Pediatric diarrhea and dehydration
6. Post-strep glomerulonephritis

13. Mental Health
1. Attention deficit hyperactivity disorder
2. Febrile seizures
3. Pediatric diabetes with hypoglycemia
4. Pediatric anaphylaxis
5. Pediatric diarrhea and dehydration
6. Post-strep glomerulonephritis

14. Using the Case Studies
1. Select a case and provide students access
a. Determine how it will be used
2. Students access the site and take the quiz
3. Students download responses
4. Provide students with correct answers

15. Ideas for Use
1. Use a case study in class related
to lecture content.
2. Use as a pre-class
assignment/entry ticket
How might you utilize the database?

16. Resources available for
creating clinical judgment
questions
o NCSBN newsletters and webinars
o Sample NGN Exam Items
o Updated NCLEX Tutorial
o Overview of the NGN Project
o NGN Candidate and Educator FAQs
o NGN Resources
o NCSBN Clinical Judgement Measurement Model
(NCJMM) Information
o NGN Talks and Videos
o 2023 NCLEX test plan
o Nurse Achieve-free NCSBN NGN-RN Sample Pack
o Clinical judgement case study template and
booklet

17. How to Create a Bow Tie NGN Question

18. How to Create a Bow Tie NGN Question

19. Here is our example:
Nurses’ Notes
1000: Client received for routine checkup accompanied by mother with whom he lives. Client has
paraplegia secondary to spinal cord injury. Client is alert and oriented X3. Denies pain or any
problems. Mother is concerned about “red area on his left heel.” VS: T – 97.9 F (36.6 C), P – 76,
RR – 16, BP – 112/68. Lungs clear, S1S2 audible with no murmurs, gallops, rubs. Bowel sounds
hypoactive. Client has full active range of motion in bilateral upper extremities with light touch
sensation intact in fingers. No feeling or movement below waist. Full passive range of motion
bilaterally in lower extremities. Open area noted on left heel. Skin otherwise intact.
1015: Left heel wound measures 3.5cm X 4cm X 0.5cm. No undermining present. Wound bed is
pink. No odor or drainage noted. Skin surrounding injury pink, warm, and dry.
The nurse cares for a 19-year-old wheelchair bound male who has come to the clinic with his mother
for a routine checkup.

20. Bow Tie Example

21. Your turn!

23. Questions?