2023-2024
ULTIMATE
NEXT GEN
NCLEX
STUDY GUID UIDE
All you need to
know about
CJMM Steps
Case studies
NCLEX NGN Question Types
LAB Values and many
more!
CHANGES!
T G E N P R A C T I C E
NEX
EXAMS INSIDE!
ReMarNurse.com
, Are you ready Top 5 Skills Required
for NCLEX
Changes? to Practice Nursing
1
WHY IS THE CLINICAL JUDGEMENT
NCLEX CHANGING?
2
NGN was developed to strengthen
the linkage between test items and PROBLEM SOLVING
clinical judgment using the Clinical
3
Judgment Model.
CRITICAL - THINKING
PUBLIC SAFETY 4
50% of novice nurses had errors.
ACTIVE LISTENING
65% of the errors were related to 5
some poor judgement of either
a task or an environment. PROFESSIONAL
COMMUNICATION
20% of employers believed they
received novice nurses who
ReMarNurse.com
were effectively prepared to
make clinical decisions.
, ReMarNurse.com
The Clinical Judgment Measurement Model (CJMM) is what the new NCLEX is built on.
Each layer represents the thought process needed to make a correct clinical judgment about a
client who needs nursing care.
Layer 0 represents the nurse determining the client's needs.
Layer 1 represents the entire process of clinical judgment.
According to the client response in layer 2, the nurse then moves through layers 3 and 4.
Layer 3 is the area where testing can take place to determine the education of entry-level
nurses and how they develop clinical judgment over a period of time. The six steps within layer 3
make up a repetitious process the student can improve over time with nursing experience and
clinical exposure. This is considered the “action layer.” Layer 4 creates a realistic client scenario.
The CJMM is appropriate for use in the lab setting, clinical setting, and on a standard written or
computer examination.
Client Clinical
Needs Decisions
Layer 0
Clinical Judgment
Layer 1 Satisfied
Not satisfied
Form Hypotheses Refine Hypotheses Evaluation
Layer 2
Recognize Analyze Prioritize Generate Take Evaluate
Cues Cues Hypotheses Solutions Actions Outcomes
Layer 3
Environmental Factor Examples Individual Factor Examples
Client Medical
Environment Resources Knowledge Skills
Observation Records Specialty
Consequences Time Task Cultural Candidate Prior Level of
& Risks Pressure Complexity Consideration Characteristics Experience Experience
Layer 4
Nursing
Assessment Analysis Planning Implementation Evaluation
Process
THE NCSBN CLINICAL JUDGMENT
MEASUREMENT MODEL
, The “Action Layer of Layer 3” has 6 steps that are important for nursing
students to memorize and understand. Layer 3 is how Case Studies are written.
Review the graph below. There are expected steps that a nursing student must
take based on the information that is presented. Each case study will have 6 ReMarNurse.com
questions as a part of an unfolding case.
Cognitive Operations Factor Conditioning Expected Behaviors /
(NCSBN CJMM Layer 3) (NCSBN CJMM Layer 4) Actions
Environmental cues:
STEP 1
Location : Emergency
RECOGNIZE CUES Department
Parent present
Client observation cues:
Recognize signs/symptoms of
Present age: 8-10 years
dehydration
Present: sign/symptoms of
Identify history of diabetes
dehydration: dry mucous
membranes, cool extremities, Recognize abnormal vital signs
capillary refill 3-4 seconds
Present/imply: lethargy Hypothesize dehydration
Hypothesize diabetes
Medical record cues:
Present/imply: Hx of diabetes
Present/imply: Vital signs
Time pressure cues:
Set time pressure to vary with
onset/acuity of symptoms
STEP 2 Requires knowledge of
pediatric development Describe relationship between
ANALYZE CUES level of blood sugar and
Requires knowledge of
dehydration
dehydration symptoms
Use evidence to determine
Requires knowledge of client issues
diabetes symptoms
ULTIMATE
NEXT GEN
NCLEX
STUDY GUID UIDE
All you need to
know about
CJMM Steps
Case studies
NCLEX NGN Question Types
LAB Values and many
more!
CHANGES!
T G E N P R A C T I C E
NEX
EXAMS INSIDE!
ReMarNurse.com
, Are you ready Top 5 Skills Required
for NCLEX
Changes? to Practice Nursing
1
WHY IS THE CLINICAL JUDGEMENT
NCLEX CHANGING?
2
NGN was developed to strengthen
the linkage between test items and PROBLEM SOLVING
clinical judgment using the Clinical
3
Judgment Model.
CRITICAL - THINKING
PUBLIC SAFETY 4
50% of novice nurses had errors.
ACTIVE LISTENING
65% of the errors were related to 5
some poor judgement of either
a task or an environment. PROFESSIONAL
COMMUNICATION
20% of employers believed they
received novice nurses who
ReMarNurse.com
were effectively prepared to
make clinical decisions.
, ReMarNurse.com
The Clinical Judgment Measurement Model (CJMM) is what the new NCLEX is built on.
Each layer represents the thought process needed to make a correct clinical judgment about a
client who needs nursing care.
Layer 0 represents the nurse determining the client's needs.
Layer 1 represents the entire process of clinical judgment.
According to the client response in layer 2, the nurse then moves through layers 3 and 4.
Layer 3 is the area where testing can take place to determine the education of entry-level
nurses and how they develop clinical judgment over a period of time. The six steps within layer 3
make up a repetitious process the student can improve over time with nursing experience and
clinical exposure. This is considered the “action layer.” Layer 4 creates a realistic client scenario.
The CJMM is appropriate for use in the lab setting, clinical setting, and on a standard written or
computer examination.
Client Clinical
Needs Decisions
Layer 0
Clinical Judgment
Layer 1 Satisfied
Not satisfied
Form Hypotheses Refine Hypotheses Evaluation
Layer 2
Recognize Analyze Prioritize Generate Take Evaluate
Cues Cues Hypotheses Solutions Actions Outcomes
Layer 3
Environmental Factor Examples Individual Factor Examples
Client Medical
Environment Resources Knowledge Skills
Observation Records Specialty
Consequences Time Task Cultural Candidate Prior Level of
& Risks Pressure Complexity Consideration Characteristics Experience Experience
Layer 4
Nursing
Assessment Analysis Planning Implementation Evaluation
Process
THE NCSBN CLINICAL JUDGMENT
MEASUREMENT MODEL
, The “Action Layer of Layer 3” has 6 steps that are important for nursing
students to memorize and understand. Layer 3 is how Case Studies are written.
Review the graph below. There are expected steps that a nursing student must
take based on the information that is presented. Each case study will have 6 ReMarNurse.com
questions as a part of an unfolding case.
Cognitive Operations Factor Conditioning Expected Behaviors /
(NCSBN CJMM Layer 3) (NCSBN CJMM Layer 4) Actions
Environmental cues:
STEP 1
Location : Emergency
RECOGNIZE CUES Department
Parent present
Client observation cues:
Recognize signs/symptoms of
Present age: 8-10 years
dehydration
Present: sign/symptoms of
Identify history of diabetes
dehydration: dry mucous
membranes, cool extremities, Recognize abnormal vital signs
capillary refill 3-4 seconds
Present/imply: lethargy Hypothesize dehydration
Hypothesize diabetes
Medical record cues:
Present/imply: Hx of diabetes
Present/imply: Vital signs
Time pressure cues:
Set time pressure to vary with
onset/acuity of symptoms
STEP 2 Requires knowledge of
pediatric development Describe relationship between
ANALYZE CUES level of blood sugar and
Requires knowledge of
dehydration
dehydration symptoms
Use evidence to determine
Requires knowledge of client issues
diabetes symptoms
