Clinical judgement and

test taking strategies

Clinical Judgement
 Six cognitive skills – model by NCSBN
1.Recognize clue
2.Analyze cues
3.Prioritize Hypothesis
4.Generate solutions
5.Take action
6.Evaluate outcomes
Parts of question

1. Case event: provides relevant and irrelevant

information that you need to think.
2. Question query: ask something specific about case
event. 4
3. Options: What are the options?
Test Taking strategies
 1.Do not read into the question- never assume anything that has not been specifically
mentioned (in the question) and do not add extra meaning or history to the question—do not
make up a story to validate choosing an answer
 2) NCLEX land is set at Utopia General Hospital- you have all the time, all the resources,
and all the staff you need!
 3) Least invasive to most invasive – least restrictive to most restrictive (restraints are rarely a
good choice)
 4) Avoid using absolutes- always, never, must, etc.
 5) Assess the client first before implementing a treatment or action—if there’s a choice that
pertains to assessment of the patient—it is usually the answer – assess unless in distress
 6) Priority goes to assessments and answers that deal with the patient (patient-focused)
directly and not with machines/monitors/equipment (unless the question is specifically
asking about them) a. Ex: Auscultate fetal heart rate before checking the monito
7. If it is the FIRST time doing something for or with the patient (such as vital signs
upon admission to the floor/unit, or when a transfer is involved), the NURSE must
complete the assessment- including vital signs
8) If patient is an adult, answers with family options can be ruled out (unless patient
is not competent to make own decisions)
9) In emergency situations (mass casualty), patients with greater chance to live are
treated first
10) If you are asked about the FIRST action you would take in a
prioritization/discrimination question think: “If I can only do one action, and then I
must go home, what will the outcome be?”
11) Therapeutic communication- reflect feelings and provide correct information
12) Do not ask “why” questions (or yes/no) and do not say “I understand”
13) An answer that delays care or treatment is usually wrong (Ex: reassess in 15
minutes, monitor the patient for a continuation of symptoms)
14. When determining interventions to enhance a client’s wellness, consider options that promote
healthy nutrition, regular exercise, proper weight maintenance, proper rest, and avoidance of
harmful chemicals (nicotine) and risk-taking behaviors (not wearing a seat belt)
15) If two of the answer choices are the exact opposite, one is probably the answer (ie.
bradycardia, tachycardia).
16. If two or three answers are similar, none are correct (*be careful—sometimes answers may
seem similar but in fact are saying something different)
17) Always look for the UMBRELLA option—one that is a broad universal statement and usually
contains the concepts of the other options with it—often the correct answer
18) If you have never heard of an answer—do not eliminate it—work around it…if you can safely
eliminate all other answers, that is your answer—if you are down to two answers and you know
one answer is right, go with what you know
19. Prioritize actual problems over potential problems
20) DO NOT leave the patient – think safety
21) DO NOT “do nothing”- you always have to do something
22) If the question is about endorsement—always report anything new or different to the next shift
23) Only select “document” if the assessment is normal
24) Put patients with the same or similar diagnoses in the same room-clean vs. dirty patients
25) Never increase a patient’s fluids to “catch up”
26) Answer SATA questions as true or false for each answer option
27) Rephrase the question in your own words—this ensures you understand what the question is asking
—if you cannot rephrase the question, you do not know what the topic is
 28. If you cannot determine the topic of the question, read all answer choices
to help you understand the problem (look for patterns)
 29) Try not to determine the answer before reading the answer choices—
NCLEX uses traps and answers that scream “pick me” but are wrong
 30) More often than not, pain will not be your answer -- pain is considered
psychosocial—exception to this rule are signs and symptoms of compartment
syndrome
 31) Try to focus on the here and now as much as possible
 32) With positioning questions- you are trying to prevent or promote
something—evaluate the outcome of each option 33) When the question asks
what is ESSENTIAL—think SAFETY.
34. If you do not know what a word means, try to break it down using
medical terminology a.
Ex: Rhabdomyosarcoma – muscle (myo), tumor (sarcoma) → tumor of
the muscle tissue b. Same idea applies to medications- use suffixes and
prefixes to recognize classifications
35) Make an educated guess—if you can’t make the best answer for a
question after carefully reading it, choose the answer with the most
information
36) When in doubt, SAFETY
“Keep them breathing, keep them safe
 Prioritization Techniques
1. Prioritize systemic vs. local (life before limb)
2. Prioritize acute before chronic
3. Prioritize actual before potential future problems
4. Prioritize according to Maslow’s- physiological needs before psychosocial (acute
safety can take priority- ATI)
5. Recognize and respond to trends vs. transient findings (recognizing a gradual
deterioration)
6. Recognize signs of emergencies and complications vs. “expected client findings”
7. Apply clinical knowledge to procedural standards to determine the priority action-
recognizing that the timing of administration of antidiabetic and antimicrobial
medications is more important than administration of some other medications.
 How to tackle- WHO DO YOU SEE
FIRST- questions:
1. Who is your most stable patient? ELIMINATE ANSWER
2. Who is your most stable patient (of the 3 remaining)?
ELIMINATE ANSWER
3. Who is your most unstable patient (of the 2 remaining)?
Airway? Breathing? Circulation? SELECT ANSWER
Practice questions