Next Generation NCLEX: How It Works and How to Practice

Since April 2023, the NCLEX-RN measures clinical judgment directly. Here is what the new item types look like, how they're scored, and how to practice them.

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The clinical judgment model

NGN items are built on the NCSBN Clinical Judgment Measurement Model. Each unfolding case study walks through six steps, one item per step:

Step	What you're asked to do
Recognize cues	Pick out the findings that matter from the chart.
Analyze cues	Connect findings to what could be happening.
Prioritize hypotheses	Decide which problem is most likely or most urgent.
Generate solutions	Identify the actions and outcomes that fit.
Take action	Choose what to do now.
Evaluate outcomes	Judge whether the client improved, stayed the same, or declined.

NGN item types

MatrixRows of findings or actions, columns of choices. Select one or more per row.

Drop-down clozeComplete sentences by choosing from drop-down lists.

HighlightSelect the parts of a note or chart that answer the question.

Drag and dropMove options into the right spots in a sentence or table.

Extended multiple responseSelect all that apply, scored for each option.

BowtieA stand-alone item: the condition in the center, actions on one side, parameters to monitor on the other.

Partial credit

Many NGN items earn partial credit. Depending on the item, the NCLEX uses 0/1 scoring, plus/minus scoring (a point for each correct choice and a point off for each wrong one), or rationale scoring (paired answers must both be right). Guessing on select-all items can cost points, so choose only what you can justify.

How the exam is built

The NCLEX-RN gives between 85 and 150 items in up to 5 hours, including 15 unscored pretest items. Every exam includes three scored case studies of six items each. The test ends when the computer is 95% confident you are above or below the passing standard, when you reach the maximum number of items, or when time runs out.

Try a matrix item

Management of Care · Matrix

The RN is planning care for a medical-surgical unit with an LPN and an assistive personnel (AP). For each task, select the most appropriate team member.

	RN	LPN	AP
Initial assessment of a newly admitted client
Giving scheduled oral medications to a stable client
Measuring vital signs on a stable client
Discharge teaching on a new insulin regimen
Reinforcing low-sodium diet teaching that the RN has already done
Helping a client with a bed bath

Show answer and rationale

Initial assessment of a newly admitted client: RN
Giving scheduled oral medications to a stable client: LPN
Measuring vital signs on a stable client: AP
Discharge teaching on a new insulin regimen: RN
Reinforcing low-sodium diet teaching that the RN has already done: LPN
Helping a client with a bed bath: AP

The RN keeps initial assessment and initial teaching. LPNs give medications to stable clients and reinforce teaching the RN has started. AP perform routine hygiene and vital signs on stable clients.

Source: NCSBN & ANA. National Guidelines for Nursing Delegation (2019)

Practice NGN in NCLEXSim

NCLEXSim includes 8 unfolding case studies and 83 NGN-style items, with partial-credit scoring like the real exam. Case studies appear inside the full adaptive exam, the same way they do on test day.

Practice the way the NCLEX tests you

1,059 fact-checked questions, a full adaptive exam that stops by the real rules, a proctored test-day mode with an integrity report, 8 NGN case studies, bedside simulations, and ACLS megacodes. Free.

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