The Next Generation NCLEX (NGN) represents the most significant change to the nursing licensure exam in decades. Launched on April 1, 2023, the NGN was developed by the National Council of State Boards of Nursing (NCSBN) to better measure clinical judgment—a critical skill that research shows is essential for safe nursing practice.
If you’re preparing for the NCLEX-RN or NCLEX-PN exam, understanding the NGN format is crucial for your success. This comprehensive guide covers everything you need to know about the Next Generation NCLEX, including the new question types, the Clinical Judgment Measurement Model, and proven strategies to help you pass on your first attempt.
What is the Next Generation NCLEX (NGN)?
The Next Generation NCLEX is an enhanced version of the traditional NCLEX exam that places greater emphasis on measuring clinical judgment and decision-making abilities. While the core purpose remains the same—to determine if candidates are safe to practice as entry-level nurses—the NGN uses innovative item types and scoring methods to assess higher-order thinking skills.
Key Changes from the Previous NCLEX
- New Question Types: The NGN introduces several new item formats including case studies, bow-tie items, trend items, and matrix multiple-response questions
- Clinical Judgment Focus: Questions are designed around the NCSBN Clinical Judgment Measurement Model (NCJMM)
- Partial Credit Scoring: Unlike traditional NCLEX questions, many NGN items award partial credit for partially correct answers
- Unfolding Case Studies: Six-question case studies that follow a patient through a clinical scenario
Understanding the NCSBN Clinical Judgment Measurement Model (NCJMM)
The NCJMM is the framework that underlies all NGN questions. It was developed through extensive research involving over 100 nursing experts and data from more than 200,000 NCLEX candidates. The model identifies six cognitive skills essential for clinical judgment:
The 6 Cognitive Skills of Clinical Judgment
- Recognize Cues: Identifying relevant patient data from assessment findings, history, and diagnostic results
- Analyze Cues: Connecting the data to determine what it means for the patient’s condition
- Prioritize Hypotheses: Ranking potential problems based on urgency and likelihood
- Generate Solutions: Identifying interventions that address the prioritized problems
- Take Action: Implementing the most appropriate interventions
- Evaluate Outcomes: Assessing the effectiveness of nursing actions
Each case study on the NGN contains six questions—one measuring each cognitive skill. Understanding how these skills interconnect will help you approach NGN questions more strategically.
New NGN Question Types Explained
The NGN introduces several innovative question formats. Here’s what you need to know about each:
1. Unfolding Case Studies
These are sets of six questions that follow a single patient scenario as it evolves. You’ll receive clinical information and answer questions that progress through the clinical judgment process. The case “unfolds” as you move through the questions, with new information presented at each stage.
2. Bow-Tie Items
Bow-tie questions require you to identify conditions, actions, and parameters for a clinical situation. The format resembles a bow-tie shape, with:
- Potential conditions on the left
- Actions to take in the middle
- Parameters to monitor on the right
3. Trend Items
These questions present data over time (such as vital signs or lab values) and ask you to identify trends or changes that require nursing action.
4. Matrix Multiple-Response
An expanded version of select-all-that-apply questions presented in a table format where you select responses in multiple categories.
5. Extended Drag-and-Drop
Enhanced drag-and-drop questions with more complex scenarios and multiple correct placements.
6. Drop-Down Cloze
Fill-in-the-blank questions with dropdown menus for selecting the correct response from a list of options.
7. Highlight Text
Questions that require you to highlight specific information within a passage of text, such as identifying relevant assessment findings or concerning symptoms.
How Partial Credit Scoring Works
One of the most significant changes in the NGN is the introduction of partial credit scoring for certain question types. This means you can earn points for partially correct answers rather than receiving zero credit for any incorrect selection.
Scoring Methods:
- 0/1 Scoring: Traditional all-or-nothing scoring (still used for standard multiple-choice questions)
- +/- Scoring: Points added for correct selections, points deducted for incorrect selections
- Rationale Scoring: Based on the clinical appropriateness of your answer combination
This scoring approach rewards partial knowledge and clinical reasoning, even if you don’t select every correct option.
NCLEX Exam Structure in 2025
The current NCLEX-RN exam includes:
- Minimum questions: 85
- Maximum questions: 150
- Time limit: 5 hours (including breaks and tutorial)
- Case studies: 3 unfolding case studies (18 questions total)
- Standalone items: Mix of traditional and NGN question types
The exam uses Computerized Adaptive Testing (CAT), which adjusts question difficulty based on your performance. The exam ends when the computer determines with 95% confidence whether you’re above or below the passing standard.
Strategies for NGN Success
1. Master the Clinical Judgment Process
Practice thinking through clinical scenarios using the six cognitive skills. For each patient situation, ask yourself:
- What cues am I seeing?
- What do these cues mean together?
- What are the possible problems?
- What interventions address the priority problem?
- What should I do first?
- How will I know if my intervention worked?
2. Practice with NGN-Style Questions
Familiarize yourself with all the new question formats. The more you practice with case studies, bow-tie items, and trend questions, the more comfortable you’ll be on exam day.
3. Focus on Clinical Reasoning, Not Memorization
The NGN is designed to test your ability to think like a nurse, not just recall facts. Understand the “why” behind nursing interventions and prioritization decisions.
4. Use the ABCs and Maslow’s Hierarchy
For prioritization questions:
- ABCs: Airway, Breathing, Circulation
- Maslow’s Hierarchy: Physiological needs first, then safety, then psychosocial
5. Read Case Studies Carefully
Pay attention to how information changes throughout the case. New data may completely shift your priorities.
Common Mistakes to Avoid
- Rushing through case studies: Take time to absorb new information as the case unfolds
- Selecting too many or too few options: Think critically about each choice
- Ignoring partial credit opportunities: Even if you’re unsure, make educated selections
- Focusing only on content: NGN tests clinical reasoning, not just knowledge
- Not practicing with NGN formats: The new question types require familiarity
Start Your NGN Preparation Today
Success on the Next Generation NCLEX requires a combination of solid nursing knowledge, clinical judgment skills, and familiarity with the new question formats. Start your preparation early, practice consistently, and focus on understanding rather than memorization.
Ready to begin your NCLEX preparation? Explore our comprehensive study programs designed specifically for the NGN format, with thousands of practice questions and case studies that mirror the actual exam.
Last updated: January 2025
