N455B Module 2 Reflection on the First Proctored Exam Example

Strong at Noticing, Weak at Deciding: A Reflection on My First Proctored Exam and a Plan Built Around Clinical Judgment Steps

Student Name

Pre-licensure BSN Program, Aspen University

N455B: Transition to Professional Practice

Instructor Name

Month Day, Year

Strong at Noticing, Weak at Deciding: A Reflection on My First Proctored Exam and a Plan Built Around Clinical Judgment Steps

My first proctored exam in this course was the first to report results by clinical judgment step as well as by content category. This reflection uses those results, composite figures for this sample, to understand how I think under test conditions, and it replaces my earlier plan, which was organized by content, with one organized around the steps where I lose points.

What the Results Showed

My overall score was 67%. By content category, my results were close to my last exam in the previous course. By clinical judgment step, a clearer pattern appeared.

Reading the Pattern

My scores fall as the steps move from noticing to deciding. I am reasonably good at picking out relevant information and connecting it, but I lose points when I must choose expected outcomes and interventions, and most of all when I must judge whether an intervention worked. The blueprint asks candidates, when generating solutions, to name expected outcomes and pick interventions that follow from their hypotheses, and, when evaluating outcomes, to set what they observe against what they expected (National Council of State Boards of Nursing [NCSBN], 2026). Both require me to know what a good result looks like, which is exactly where my knowledge is thinnest. The gradient also matches what my clinical instructors have said about my practice: I notice changes in patients quickly, but I ask for help deciding what to do about them more often than my classmates.

Why Generate Solutions Lagged

Reviewing my missed items, I found that I often chose interventions that were reasonable but not linked to the specific problem I had identified. On a case of suspected sepsis, for example, I selected turning the client every two hours alongside fluids and cultures, which is good care but not a solution to the prioritized problem. On select-all items, I added extra options that seemed helpful, which under plus/minus scoring cost points. My studying had focused on what to do for diseases, not on how to match actions to a specific hypothesis.

Why Evaluate Outcomes Lagged

Evaluation items asked whether a client's condition had improved, stayed the same or worsened after an intervention. I missed items when a mixed picture appeared, such as better breathing but worse kidney function, because I looked for a single answer. I also missed items where the right comparison was with the client's own baseline, not with normal ranges. Evaluation is where the clinical judgment model loops back to the start, and I had been treating it as the end.

An Example From the Exam Review

One case I reviewed after the exam described a client with pneumonia treated overnight with antibiotics and fluids. The evaluation item listed findings the next morning: temperature down from 39.1 to 37.8, breathing rate down from 28 to 22, oxygen saturation unchanged at 91% on 3 liters, new confusion and urine output of 20 mL an hour. I chose improved because the fever and breathing rate had fallen. The correct answer separated the findings: fever and breathing improved, oxygenation was unchanged, and the new confusion and low urine output suggested worsening perfusion. I had anchored on the first two numbers. Rewriting the item afterward with a column for each expected outcome made the mixed picture obvious, and that exercise became the model for my revised plan.

How I Felt During the Exam

I felt confident during the early case studies and increasingly unsure in the later ones, where I changed several answers. I noticed that I rushed the evaluation items at the end of each case, as if the case were already solved. Anxiety did not stop me from answering, but it made me less careful with mixed pictures, which require slow reading.

What This Says About How I Studied

Content review improved my knowledge of diseases and drugs, and my noticing scores show it. But studying disease by disease does not teach me to set expected outcomes or to judge mixed results. Educators who map the clinical judgment model onto nursing courses emphasize that each step needs its own practice (Dickison et al., 2019). My plan should therefore practice steps, not only topics.

Revised Plan

For the next four weeks, each study session will include a case where I write, before reading the options, the expected outcomes for my top hypothesis in measurable terms, such as a heart rate below 100 or urine output above 30 mL an hour. For every evaluation item, I will compare each finding with the expected outcome and label it improved, unchanged or worse before choosing an answer. On select-all items, I will choose only options I can link to the prioritized problem. Each week I will complete 12 case studies and log my errors by step, and I will space these sessions through the week rather than doing them in one sitting, since spaced practice improves retention (Cepeda et al., 2006).

Checking Whether the Plan Works

The second proctored exam in Module 4 will report the same step-level scores. My targets are to raise generate solutions and evaluate outcomes to at least 65% while keeping the noticing steps where they are. If evaluation does not improve, I will ask faculty to review three of my cases with me to find where my reasoning goes off track. I will also keep a short journal after each practice session, noting which step felt hardest, because my own sense of difficulty may point to problems before scores do.

Conclusion

This exam showed that I notice well and decide less well. The pattern makes sense given how I studied, and it points to a specific change: practice setting expected outcomes and judging results against them, case by case. A reflection that leads to a different way of studying is worth more than one that only records disappointment.

References

Cepeda, N. J., Pashler, H., Vul, E., Wixted, J. T., & Rohrer, D. (2006). Distributed practice in verbal recall tasks: A review and quantitative synthesis. Psychological Bulletin, 132(3), 354-380. https://doi.org/10.1037/0033-2909.132.3.354

Dickison, P., Haerling, K. A., & Lasater, K. (2019). Integrating the National Council of State Boards of Nursing clinical judgment model into nursing educational frameworks. Journal of Nursing Education, 58(2), 72-78. https://doi.org/10.3928/01484834-20190122-03

National Council of State Boards of Nursing. (2026). 2026 NCLEX-RN test plan. https://www.nclex.com/files/2026_RN_Test%20Plan_English-F.pdf