Tips and Question Types for the Next Generation NCLEX (NGN) Exam

The NCLEX has officially been updated! As of April 1, 2023, the Next Generation NCLEX exam is in use. In today's Osmosis blog, Senior Content Manager of Nursing, Liz Lucas, and Nursing Editor, Paige Randall, discuss the new NCLEX question types, differences between the old and new versions of the exam, and tips to help you pass the exam.

The NCLEX is a licensing examination created by the National Council of State Boards of Nursing (NCSBN) for the United States and Canada. The examination is taken after graduation from an accredited nursing school and is required to obtain a license to work as a nurse. 

The NCLEX tests knowledge and critical thinking skills at the entry level using computerized adaptive testing (CAT), which selects your next question based on your answer to the previous question. Basically, the computer constantly selects questions that match your ability and estimates your ability after each question until a pass or fail decision can be made. 

NCLEX: Next Generation (NGN) 

Now, let’s discuss Next Generation NCLEX, which is highly anticipated by both students and faculty! Next Generation NCLEX, also known as Next Gen or just NGN, is the latest version of the NCLEX, released on April 1, 2023. 

The three key differences between the traditional NCLEX and NGN are the inclusion of the Clinical Judgment Measurement Model or CJMM, the addition of a new scoring system, and new types of questions.

The NCSBN created the CJMM to measure a test-taker's clinical judgment ability. According to this model, several layers make up clinical judgment for nurses, but we will focus on layer three because this is the layer of the model that some of the NGN questions come from. In this layer, the six steps of clinical judgment are: (1) recognize cues, (2) analyze cues, (3) prioritize hypotheses, (4) generate solutions, (5) take actions, and (6) evaluate outcomes.

Next, the new scoring system includes partial credit for some question types. This may sound confusing, but the good news is that it doesn’t change the way you should answer questions. Just like you’ve always done, choose the best answer (or answers!) for each question.

Lastly, NGN now has several new question types! First, let’s talk about case studies that involve real-world situations. In a case study, you will get six questions that test the six steps of the CJMM, and all connect back to one scenario. Case study question types include matrix multiple choice, matrix multiple response, multiple response select all that apply, multiple response select N, multiple response grouping, drag and drop cloze, drag and drop rationale, dropdown cloze, dropdown rationale, dropdown table, highlight text, and highlight table. Whew! There are also items that stand alone, meaning they assess clinical judgment using individual questions not tied to a particular scenario. Stand-alone question types include bow-tie and trend. 

NCLEX-NGN Question Types and Tips

That many new question types may seem overwhelming. However, the good news is none of the questions on the NGN are meant to trick you! In fact, the NCSBN works to ensure the questions and instructions are clear and completes years of research to accomplish this. The best thing you can do is read each question and the instructions carefully before answering. Other suggestions are to look at the NGN item types and visit the Osmosis events page to watch recorded webinars about NGN and how to answer different questions. You can also go to nclex.com/prepare to do some practice questions! Let’s review some of these new question types and share some tips to give you confidence when you encounter them!

Multiple Response
While no one loves the “select all that apply” questions, it doesn’t mean you can’t train to be a pro when answering them. The NGN has five types of multiple-response questions, but you can approach each one the same way. When you encounter a multiple-response question, take each option individually and ask yourself if that option is correct or incorrect for that question. Don’t fret about how many of the responses have been selected or not selected. 

Drag and Drop
Drag and drop is next, which has a few different types, but both are similar to fill-in-the-blank questions where you select the correct option out of a list of potential options, drag it to the correct spot, and drop it into place. After carefully reading the question, paying close attention to keywords and the question stem, look at the list of options. Prioritize crucial options while eliminating options you know for certain to be wrong.  Before moving on to your next question, consider if your chosen options make sense together. 

Drop Down
Drop-down questions aren’t too different from drag and drop, as they’re similar to a fill-in-the-blank format. Begin by reading the entire question thoroughly, then prioritize the options that are crucial. Then you can again eliminate options you know for sure to be incorrect. Once you’ve selected all of your options, review the entire question with your selected options while looking for consistency and meaning. Be sure to ask yourself, “Do any of my selected options contradict each other?” and, “Do  these make sense together?” 

Highlight
Lastly, highlight questions provide you with text where you must highlight parts of that text crucial for the nursing action. There are two types of highlight questions; you can approach them the same way. First, read all the text thoroughly. Next, review the question paying close attention to what the question is asking. Then, take the provided text sentence-by-sentence, highlighting each appropriate part for the action. Before moving on, review your answers to ensure you’ve highlighted text correctly and didn’t miss anything.

 

A Final Word from the Osmosis Nursing Team

Taking the NCLEX is stressful for everyone, no matter how prepared you may be. Remember to be kind to yourself, including your body, mind, and spirit, as your test date gets closer. Whether you pass or don’t pass the NCLEX your first, second, or third time, remember this one standardized examination does not equate to your worth as a nursing student, future nurse, or person. Who you are as a student, nurse, and person is based on your hunger for knowledge, drive to gain clinical skills, and empathy for those around you. We wish you the best of luck and are here to help you to the finish line and beyond. 

About the Authors

Liz Lucas has been an RN since 2008 and has an Ed.D. with Emphasis in Nursing and Health Professions Education. Liz’s clinical background is in oncology, and she later transitioned into nursing academia where she taught in a pre-licensure nursing program for several years. Liz feels passionate about building a strong nursing workforce through increasing education accessibility and believes in the role of technology in that pursuit. At Osmosis, Liz manages the nursing assessment and scripting teams. Liz currently lives near Baltimore, MD with her husband, two sons, and dog.

Paige Randall MS, RN, CEN, CNE has been a Registered Nurse for ten years with a clinical background in cardiac, emergency nursing, and nursing education. Paige is currently working on her PhD in nursing at Duke University. At Osmosis, Paige works as a script writer and editor. She lives in Raleigh, NC with her husband and their dog, Bocelli.

Resources

Nurse.org: https://nurse.org/education/next-generation-nclex-ngn/

Elsevier: https://evolve.elsevier.com/education/next-generation-nclex/

ATI: https://www.atitesting.com/educator/next-gen-nclex

UWorld: https://nursing.uworld.com/educators/next-gen-nclex/

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