Clinical judgment has become an increasingly important aspect of modern health service professionals. To ensure public safety, licensure exams must go beyond assessing only knowledge and skills when evaluating entry-level professions to evaluating clinical judgment. This importance necessitates licensure and certification examinations in these professions to evaluate the extent to which this domain can be measured. This study will provide background of a large-scale licensure examination's process for measuring clinical judgment in entry-level nursing. As clinical judgment is seen to be a higher-order, more complex construct than measuring basic knowledge, an outline of the process that was used to develop the construct and build items to a specific task model will be highlighted. In accordance with existing adult learning theories and contemporary nurse program delivery, the process of specifying the requisite cognitive theories guiding nursing practice will be elucidated and interwoven with the item development discussion. The item writing and review process will be described in detail and would be generalizable to professions outside of nursing.