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Ep167: Critical Thinking in Nursing (Cognitive Levels of NCLEX® Questions)

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Critical thinking . . . schmritical thinking

The term gets tossed around so much in nursing education now that it has really lost all value.  In fact, I think that rather than teaching students HOW to critically think . . . many schools are just using the word because they HAVE to.

This episode discusses what critical thinking is, what the cognitive levels of NCLEX questions are, and how to combine that knowledge to answer the questions AND be an amazing nurse.

Cognitive Levels of NCLEX Questions

We’ve talked about this a few times on the blog HERE and HERE but I think that understanding what you are up against is essential.

The NCSBN who write the NCLEX exam uses Blooms Taxonomy  to develop questions.  Essentially Blooms Taxonomy is:

A continuum of increasing cognitive complexityfrom remember to create.

blooms taxonomy nclex question

As you can see from the image, it is made up of 6 cognitive levels that increase in complexity as you move “up” the pyramid.

In other words, it is much easier to remember a fact than it is too create a concept . . . from a cognitive standpoint.

If you learn that the normal lab value range for sodium is 135-145 . . . all you have to do is remember that fact to get a remember question right.

Pretty simple . . . however, if you are given a question about a patient with a deteriorating neuro status and are ask what the best action would be for this patient . . . would you be able to analyze the situation and determine that a sodium level needs to be checked?

The second question takes you to a much deeper level of understanding and requires you to actually APPLY the knowledge and ANALYZE previous knowledge to best care for the patient.

This is where you need to be hanging out. . . forget simply remembering facts . . . you need to be critically thinking about patient care in order to best care for patients.

In reality, I don’t give a damn if you can tell me a sodium level is low AFTER THE FACT . . . its a bit late by then.  Can you recognize the signs of SIADH and prompt the physician to run a Na level before the patient starts declining neurologically due to hyponatremia . . . see where I went there . . . ?  Can you see the difference in the two situations?

nursing school critical thinking


What is Critical Thinking?

So let’s talk about critical thinking and how it applies to everything we are talking about here.

The NCSBN website states the following:

Since the practice of nursing requires you to apply knowledge, skills and abilities, the majority of questions on the NCLEX are written at the cognitive level of apply or higher. And these questions, by nature, require critical thinking.

Answering these correctly will require you to do something with what you have learned, to manipulate previously learned material in new ways or find connections between many facts.

Again, since the majority of NCLEX questions fall into this category, this is exactly the type of questions you need to practice answering!

There it is again . . . the BUZZ word (critical thinking) . . . but once again no tips or information on what that means or how to develop it is given.

4 Steps to Critical Thinking in Nursing

Essentially there are 4 steps to critical thinking . . . in nursing and in life . . . and developing the ability to critically think will work wonders in your life.

  • Suspend ALL Judgement
  • Collect ALL Information
  • Balance ALL Information
  • Make a Complete and Holistic Decision

critical thinking in nursing care

You have to start by suspending all judgement.  In other words, if you walk into a patients room and see them tachycardic and armature decision would be to run and grab the metoprolol to try to drop the heart rate.

An advanced clinician will WAIT until they have more information . . . not leaving the patient untreated . . . but not jumping freakishly into the WRONG treatment because they learned that tachycardia is bad . . .

Now you must collect ALL information.  This is clutch! Don’t make a decision until you have collected every piece of data that you need to collect . . . on a tachycardic patient you can check BP, temp, run an EKG, check urine output.

Now, balance all information.  This means take all the data that you have and start weighing it to find out what is pertenant and what you can ignore.  If the temp is 98.9 . . . it’s probably not the cause.  If the BP is 74/56 are we looking at a volume issue?

Finally, make your decision . . . with all the data in and after looking over it all very closely you can begin to make your decision.

Critical Thinking in Nursing and on the NCLEX®

Lastly, I just want to talk briefly about how this applies to NCLEX questions . . .

Here is an actual practice NCLEX question from our Nursing Practice Questions Program (or NPQ, as we like to call it)!

A 56-year-old male patient has been admitted to the cardiac unit with exacerbation of heart failure symptoms. The nurse has given him a nursing diagnosis of decreased cardiac output related to heart failure, as evidenced by a poor ejection fraction, weakness, edema, and decreased urinary output. Which of the following nursing interventions are most appropriate in this situation?

42% of the students that have taken this question have selected this answer:

Administer IV fluid boluses to increase urinary output

The problem with that answer is that it is thinking at a REMEMBERING level when this question requires ANALYSIS level comprehension.

Test takers see urine output as low . . . and want to correct that quickly with fluids.

However, this is a CHFer . . . you can’t (shouldn’t) bolus your CHF patient especially during an exacerbation . . . you could send the patient into pulmonary edema and drastically impact their respiratory status.

So the lesson here. . . . in school, on the NCLEX, and on the clinical floor . . . slow down, stay calm and start thinking at an analysis level.

And I promise you this helps in “REAL” life too . . . not just in nursing.

How to Develop Critical Thinking Skills

Here are two articles and websites that talk about the development of critical thinking that will help you get to the analysis level and feel more confident with NCLEX style questions and remain calm on the nursing floor.

And as always . . . check out our NursingPracticeQuestions.com site to take a few practice NCLEX questions.


Your Thoughts

Ok . . . enough from me.  I want to hear your thoughts.  What are you doing to improve your critical thinking skills?

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Date Published - Jan 15, 2016
Date Modified - Jun 25, 2018

Jon Haws RN

Written by Jon Haws RN

Jon Haws RN began his nursing career at a Level I Trauma ICU in DFW working as a code team nurse, charge nurse, and preceptor. Frustrated with the nursing education process, Jon started NRSNG in 2014 with a desire to provide tools and confidence to nursing students around the globe. When he's not busting out content for NRSNG, Jon enjoys spending time with his two kids and wife.


  1. susanmccoy69

    I paid tje $1 trial and tje box turned green with a check mark but im unable to load questions . it just keeps giving me practice ortiins not the purchased ortions of this site. I hate email communication it feels like i dont get a timely answer can someone call me? 330-685-1557

  2. kishabrown1987

    Is this for RN, PN or BOTH?

  3. mina shehata

    Very good Job John,
    I thank you so much. I am in the first semester in nursing school and i started to have the feeling that graduation will be a miracle for me 😉 but i still believe in miracles. my question is do you have any website to recommend for practicing question to help in exams?.

    • Jon Haws

      Jon Haws

      we’ve got a test taking webinar that will really help your with that. nrsng.com/11-steps-in-demand as well as our questions site: nursingpracticequestions.com

  4. Cathy Morrison

    I just signed up and to answer your email. I have taken the HESI exit at school twice. First time 846, second time 826. My weak areas are critical thinking and pharmacology. I have two chances left to retake again next month. My score requires a 925 to get your paperwork for NCLEX. I am hoping I have enough time to learn some things before next month from your sight that will rocket my score.

  5. Nadya

    I’m a first semester nursing student and along with feeling totally out of my element with nursing exams I also feel completely and utterly lost when it comes to thinking critically. I feel that if I cannot recall the why and how right off the bat then I am not cut out for this. Your article broke down how to think basically and in a way I can understand and hopefully use to grow my critical thinking skills. Instead of jumping on the first critical symptoms I may come across I will stop and think for a short minute about the whole picture (unless of course my patient cannot breathe or isn’t breathing). Thank you for this. I will be referring back to this article often!

    –Nadya C. SN

    • Jon Haws RN CCRN

      Jon Haws RN CCRN

      Please know that you are not the only nursing student feeling this way. Thinking “like a nurse” is hard. The moment you think you have it down . . . you’re thrown a curve ball.

      I am glad this podcast was able to help. We are currently working on much larger resources to help with the critical thinking process.

      For now, this post might be helpful too . . . https://www.nrsng.com/dissect-nclex-questions/

      Keep in touch! Jon RN CCRN

  6. Sean

    Great article Jon! Thank you for sharing.

    I wonder… nothing mentions the effect of cumulative experience. Critical thinking skills are developed and sharpened by the cumulative effect of exposing yourself to experiences that require you to think critically.

    At it’s basic level, we all posses the ability to think critically. It’s a protective mechanism (that pan is hot – therefore don’t touch it)…. but when applied to our profession and our responsibilities it now affects the lives of other human beings (our patients).

    It’s why the seasoned individuals possess sharper critical thinking skills. Which parlays off the idea of subjecting yourself to the ‘stressor’ so that eventually the ‘stressor’ is not stressful anymore.

    Things that make you go hmm..

    Thanks again for the thought provoking post.

    • Jon Haws RN CCRN

      Jon Haws RN CCRN

      Thanks Sean . . . I think your right. It helps to continually expose yourself to difficult situations and uncomfortable scenarios . . . this will only make us stronger and wiser.