The Next Generation NCLEX (NGN) changed how nursing candidates are tested. Instead of relying only on multiple-choice questions, the exam uses new item types that measure clinical judgment. Here is what each question type looks like and how to approach it.
The Clinical Judgment Measurement Model
NGN questions follow six cognitive steps: recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action and evaluate outcomes. Case studies walk you through these steps with one client over six questions.
1. Unfolding Case Studies
A case study presents a client scenario with a nurse’s notes, vital signs, labs and orders. Six questions follow, and the scenario may change over time. The NCLEX-RN includes three case studies.
2. Bowtie Questions
A bowtie item asks you to pick the condition the client is most likely experiencing (center), two actions to take (left) and two parameters to monitor (right). Tip: identify the condition first, then choose actions and monitoring that match it.
3. Matrix / Grid Questions
You classify several options in a table, for example marking each finding as “expected” or “requires follow-up.” Evaluate each row independently.
4. Extended Multiple Response (SATA)
Select all that apply questions may have up to 10 options. Treat each option as a true/false statement about the client.
5. Drop-Down (Cloze) Questions
Complete a sentence or table by choosing from drop-down menus. Read the entire sentence before selecting so each choice fits the clinical picture.
6. Highlight Questions
Click words or phrases in a nurse’s note or chart that are relevant, such as findings that need immediate follow-up.
7. Drag-and-Drop Questions
Drag options into ordered steps or categories. These often test prioritization or sequencing of care.
8. Trend Items
You review data across several time points and interpret whether the client is improving or worsening.
How NGN Questions Are Scored
Many NGN items use partial-credit scoring. Depending on the item, you may earn points for each correct selection, and in some formats incorrect selections subtract points. Careful, deliberate choices matter more than ever.
How to Prepare for NGN Questions
- Practice case studies weekly, not just stand-alone questions.
- Always ask: what is the most important cue and what problem does it point to?
- Review rationales for every option in SATA and matrix items.
- Use our free NCLEX practice questions and study plan.
Master NGN Question Types
Practice case studies, bowtie and matrix questions with detailed rationales.
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Looking for help with Next Generation NCLEX question types? You are in the right place. This guide gives nursing candidates across the USA and Canada clear, practical steps to prepare for the NCLEX with confidence.
How many case studies are on the NCLEX-RN?
The NCLEX-RN includes three unfolding case studies with six questions each, for 18 case study items.
Is there partial credit on the Next Gen NCLEX?
Yes. Many NGN item types use partial-credit scoring models.
Official exam information: NCLEX.com and NCSBN. Always confirm current details with your board of nursing or provincial regulator.