Understanding the Next Gen NCLEX (NGN): What to Expect and Question Types

The NCLEX exam plays a crucial role in the journey of every nursing student, serving as the final hurdle before entering professional practice.

As of April 2023, the National Council Licensure Examination (NCLEX) updated their exam to the Next Gen NCLEX or NGN.

But it’s more than just a name change.

The NGN includes an updated scoring system and new question types that focus on your clinical judgment and decision-making skills, making NCLEX prep even more important than ever.

This guide will provide a comprehensive overview of the changes to the NGN NCLEX, a breakdown of the new next gen NCLEX questions with examples, and how to study for the NCLEX NGN moving forward.

What is the Next Generation NCLEX (NGN)?

The NGN is a result of changing demands in the nursing profession. As a result, the NCSBN re-evaluates the NCLEX exam every three years to ensure those who pass are ready for nursing.

This new NCLEX rolled out in April 2023, and no doubt will change again in the future.

What is still the same on the next gen NCLEX?

The NCLEX exam evaluates if a post-grad nursing student is ready to begin making crucial decisions affecting clients. So to keep up with constant changes in the medical field, the exam has also recently undergone a substantial change.

The NGN has many new changes, but a lot remains the same from the previous NCLEX.

Computer Adaptive Testing

One thing that remains the same in the NGN is that the exam still uses computer adaptive testing (CAT). This means that the answer for each question determines the difficulty of the next question you get.

A correct answer makes the following question harder, while an incorrect answer makes it easier. The goal is to achieve and maintain a certain difficulty level so that the computer algorithm can evaluate your knowledge level.

Existing Question Types

All the old question types are still used on the NGN. The types of questions that you may see on the NGN (and old NCLEX) include:

• Multiple choice – The most common form of NCLEX question, multiple choice questions, provide multiple answers to a question from which you must select the correct one.
• Select all that apply – Select all that apply questions are considered relatively difficult. For these questions, you need to select each of the answers that apply to the question.
• Hot spot – While less common, hot spot questions have you select a particular area in a graphic that answers the question.
• Fill in the blank – Fill in the blank questions require you to enter a free text answer that must be correct. This is often a number, such as a dose calculation.
• Drag and drop – This question format is normally used to have the test taker order the answers in the correct order, such as sequentially describing steps in a procedure.
• Chart or graphics question – These questions consist of an image and text. An example of this type of question could be a question asking you to name a heart rhythm based on its appearance.
• Graphic answer multiple choice – This is the same as normal multiple choice questions, but uses graphics or images as answers instead of text.
• Audio or video – These questions require you to listen to a sound or watch a video, then answer a question about the audio or video.

What’s new on the next gen NCLEX?

While the NGN incorporates many existing NCLEX features, it’s different in the following ways:

Harder Question Content

One of the NCSBN’s findings when evaluating the NCLEX is that nurses are more often caring for critically ill clients than has traditionally been the case. This increased client acuity means that new NCLEX questions are more difficult, with an increased focus on caring for more critically ill clients.

New Question Types on the NGN

While all the existing NCLEX question types are retained, there are multiple new question types in the NGN that are significantly different from what nursing students have been accustomed to. Some of these new question types include:

• Case Scenario – NCLEX questions have traditionally been standalone questions, each question unrelated to others. In the new NCLEX, two to eight questions may be derived from a single case. These cases provide a client record with multiple tabs and a split screen. The client record is on one side, and questions appear on the other, with multiple, non-adaptive questions.
• Extended multiple choice – A significant difference with these questions is that partial credit is given for answers that are close to correct.
• Cloze (drop-down) – Essentially a cross between multiple choice and fill in the blank, these questions provide a drop-down list of possible answers to complete a sentence.
• Extended drag-and-drop – This question type is like the traditional drag-and-drop, except that there are more answers than spaces, and some answers need to be excluded.
• Highlight text – These questions are answered by highlighting an area of text from a given passage.
• Matrix/grid – Seen on multiple response questions, these are like a “select all that apply,” question, but with more than just a, “select or don’t select,” option. For example, there may be a list of eight different interventions you have to choose if they are anticipated, nonessential, or contraindicated based on the question stem.
• Trend – This question type tests knowledge of the NCJMM, which is a series of steps for measuring clinical judgment.

Number of Scored Questions

The new NCLEX has 85-150 scored questions (including fifteen pretest questions), which increased the max number of NCLEX questions (previously 60-130 on the old NCLEX). The unscored questions won’t contribute to the overall score, but will be used for future exam development.

Among the scores on a minimum length test, test-takers should expect to see three case studies with eighteen questions, which make up 21% of the overall score.

The New NCLEX Scoring System

Traditional NCLEX questions are either right (counting as one point) or wrong (counting as zero points). This is referred to as dichotomous scoring.

The new NGN-style items have new scoring methods to allow for partial credit: +- scoring, Dyad scoring, and Triad scoring.

All of the items will be either correct or incorrect, and some will have partial credit. This is referred to as polytomous scoring.

+/- Scoring

Test-takers earn one point for each correct response, and lose one point for each incorrect response. If the total score is negative, the final score will be reduced to 0. Points are not deleted for incorrect responses.

Dyad and Triad Scoring

In a dyad scoring system, if both answers in a paired set are correct, you get one point. In a triad scoring system, you get one point for each correct answer. If you get all three correct, you get two points.

Standard items (Fill-in-the-blank numeric, Multiple choice, Multiple-response select all that apply, Hot spot, and Ordered response) will continue to be worth 1 point. Multiple-response items will receive partial scoring.

Breaking Down the Next Gen NCLEX questions with Examples?

Questions (items) are standalone items or unfolding (case studies).

Case studies reflect real-world scenarios based on the six functions of clinical judgment in the Clinical Judgment Measurement Model. Stand-alone items are similar to case study questions, but are not a part of them. They are introduced after the minimum number of items.

These new question types (as both case studies and standalones) include:

Extended Drag-and-Drop

Purpose: Items that require placing answers in the correct order or categorizing them appropriately.

Test-takers can choose a response to drag a choice to, but there might be more than one answer that could be correct. You can either drag the choice back to the list or remove it from the question entirely.

Drop Down Cloze

Purpose: To assess knowledge in context.

This includes a paragraph with one or more drop‐down options from which to complete the paragraph, each option having three to five possible answers.

Drag-and-Drop Rationale

Purpose: To evaluate understanding of cause-and-effect relationships.

This question is made up of one sentence with one cause, one effect, or two causes. Test-takers can select a choice on top of a target and remove it by either dragging it back to the choice list or just removing it.

This can be a dyad (two sentences with one target) or a triad (three sentences with one target).

Drop Down Rationale & Table

Purpose: To test logical reasoning and the ability to identify relationships within the provided information.

This question type includes one sentence with one cause, one effect and another effect. The answer can be a dyad (one sentence with two drop‐downs) or a triad (one sentence with three drop-downs each).

Matrix Multiple Choice/Grid

Purpose: To evaluate the ability to analyze and correlate data.

These questions have four to ten rows with two or three options. Each row must have one response selected. A test-taker can only continue to the next question once responding to all rows.

Multiple Response Select N

Purpose: To test the ability to prioritize and select the most relevant answers from a set of possibilities.

This differs from other multiple response item types in that the test-taker may not select all but is limited to a certain number of keys.

Multiple Response Grouping

Purpose: To assess the ability to categorize information appropriately.

The multiple-choice question has a table with two to five groupings, each with two to four options. The number of options is the same for all groupings, so test-takers must select at least one option from each grouping.

Highlight Text & Table

Purpose: To test attention to detail and the ability to identify key information.

Test-takers must select parts of the text to determine what is critical for the action. Responses are tokenized, and there can be no more than ten options. Test-takers can choose and deselect options as they see fit.

Bowtie

Purpose: To assess the ability to choose the most appropriate action or intervention from a list of options, helping to achieve desired outcomes or prevent adverse outcomes. Test-takers must correctly drag and drop an item onto a series of targets within the bowtie diagram.

Bowtie questions present a graphic representation of a clinical situation as a bowtie diagram with a central problem and various possible outcomes or actions.

Trend

Purpose: To evaluate the ability to recognize and interpret patterns over time.

This question type tests knowledge of the NCJMM, which is a series of steps for measuring clinical judgment.

Prep for the Next Gen NCLEX Questions Here

The New NCLEX exam, Next Gen NCLEX (NGN), is here to stay. The most significant changes include new question types and a scoring system that considers not just your correct answers, but also the ones you got wrong.

It requires a lot of preparation. But with the right study tools, including an NCLEX study plan and sample NCLEX question practice, you can claim back your time and understand nursing concepts with ease.

SimpleNursing NCLEX Review Course equips you with lecture series, question banks, cheat sheets, adaptive exams, study guides, and much more.

Ace the new NCLEX, starting with a free trial today.