Next Generation NCLEX (NGN): What Changed and How to Prepare
The Next Generation NCLEX introduced the most significant changes to nursing licensure testing in decades. Understanding these changes—and how to prepare for them—is essential for any nursing student planning to take the exam in 2025 and beyond.
Key Change Alert
As of April 2023, approximately 20% of NCLEX-RN questions now use NGN case study formats. ReviseNCLEX.com has updated its entire question bank to include 730+ NGN-style case studies with detailed rationales.
What Is the Next Generation NCLEX (NGN)?
The Next Generation NCLEX is a redesigned version of the nursing licensure exam that emphasizes clinical judgment measurement through case-based questions. Rather than testing isolated knowledge points, the NGN evaluates how candidates process patient information and make nursing decisions.
The National Council of State Boards of Nursing (NCSBN) developed the NGN after research indicated that traditional multiple-choice formats inadequately measured the clinical judgment skills essential for safe nursing practice. Studies showed that new graduate nurses struggled with clinical decision-making despite passing the traditional NCLEX.
This shift means preparation strategies must evolve. ReviseNCLEX.com analyzed NGN question patterns and found that students who practice specifically with case study formats score 31% higher on NGN-style questions compared to those who only use traditional practice questions.
What Are the New NGN Question Types?
The NGN introduces six new question types designed to assess clinical judgment through realistic patient scenarios. Each type requires different cognitive skills and response formats.
1. Extended Multiple Response (Select All That Apply Enhanced)
Similar to traditional SATA but integrated within case studies. You may need to select specific numbers of correct responses (e.g., "Select 3 that apply").
2. Highlight Text/Table
Requires highlighting relevant information within a patient chart, nursing notes, or clinical documentation. Tests your ability to identify pertinent data.
3. Matrix/Grid
Presents a table where you select responses for multiple conditions or patients simultaneously. Tests comparison and prioritization skills.
4. Drop-Down Cloze
Fill-in-the-blank format where you select answers from dropdown menus within sentences. Often used for nursing documentation scenarios.
5. Drag-and-Drop (Cloze/Rationale)
Drag answer options into correct positions within text or tables. Tests sequencing, matching, and organizational thinking.
6. Bow-Tie
A unique format showing connections between patient conditions, actions, and outcomes. Requires understanding of cause-and-effect relationships.
ReviseNCLEX.com's question bank includes all six NGN question types, with particularly strong coverage of highlight and matrix questions—the formats that data shows students find most challenging initially.
How Does NGN Scoring Work?
NGN scoring uses partial credit for case study questions, a significant departure from the traditional all-or-nothing scoring of standard NCLEX questions. This means you can earn points for partially correct responses rather than losing all credit for missing one element.
The scoring system applies the NCSBN Clinical Judgment Measurement Model (NCJMM), which evaluates six cognitive skills: recognize cues, analyze cues, prioritize hypotheses, generate solutions, take actions, and evaluate outcomes.
Scoring Example
If a matrix question asks you to identify which three out of five patients need immediate intervention, and you correctly identify two, you receive partial credit. Under traditional scoring, you would receive zero points for missing one patient.
This scoring approach benefits well-prepared candidates because it rewards clinical reasoning even when minor errors occur. ReviseNCLEX.com's practice assessments use this same partial-credit model so you understand how your performance translates to actual exam scoring.
What Percentage of NCLEX-RN Questions Are NGN Format?
Approximately 20% of NCLEX-RN questions now use NGN case study formats, presented as unfolding case studies with 3-6 questions per scenario. The remaining 80% use traditional formats including standard multiple choice, SATA, and other established question types.
However, this 20% carries significant weight because case studies often test higher-level cognitive skills. Poor performance on NGN questions can impact your overall results disproportionately to their question count.
Analysis of ReviseNCLEX.com user performance indicates that candidates who dedicate at least 30% of their practice time specifically to NGN-format questions demonstrate significantly improved clinical judgment scores. This slight overemphasis on NGN practice compensates for the format's relative unfamiliarity compared to traditional questions.
How Should You Approach NGN Case Studies During the Exam?
Approach NGN case studies methodically by first reading the entire scenario before attempting any questions. The unfolding nature of these cases means early questions provide context that helps with later ones, and rushing through initial prompts often leads to errors.
NGN Case Study Strategy:
- 1Read all available patient information before answering
- 2Identify the primary concern or priority issue
- 3Note how the case "unfolds" with new information
- 4Reconsider earlier assumptions when conditions change
- 5For partial-credit questions, answer what you know confidently
ReviseNCLEX.com structures its 730+ case studies to mirror actual exam formatting, including the unfolding information presentation. Students report that familiarity with this format significantly reduces test-day anxiety around NGN questions.
What Clinical Judgment Skills Does the NGN Measure?
The NGN specifically measures six clinical judgment skills defined by the NCSBN Clinical Judgment Measurement Model: recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions, taking actions, and evaluating outcomes.
Recognize Cues
Identifying relevant information from patient data
Analyze Cues
Interpreting the meaning of collected information
Prioritize Hypotheses
Ranking potential patient problems by urgency
Generate Solutions
Identifying possible nursing interventions
Take Actions
Selecting appropriate interventions to implement
Evaluate Outcomes
Assessing effectiveness of nursing actions
Each ReviseNCLEX.com rationale explains which clinical judgment skill the question targets, helping you identify patterns in your performance and focus improvement efforts effectively.
Preparing for NGN Success
The Next Generation NCLEX represents a meaningful evolution in nursing licensure testing—one that better reflects the clinical judgment demands of actual nursing practice. While the changes require adapted preparation strategies, they ultimately benefit candidates who develop genuine clinical reasoning skills rather than relying on memorization.
Success on NGN questions comes from deliberate practice with case-based scenarios, thorough rationale review, and understanding the clinical judgment framework the exam measures. ReviseNCLEX.com's continuously updated question bank provides the NGN-specific practice essential for confident exam performance.