Next Generation NCLEX (NGN) questions test clinical judgment, not just recall. Here is every item type and how to approach it.
The 6 clinical judgment steps
Case studies walk you through the NCSBN Clinical Judgment Measurement Model, one question per step:
- Recognize cues: what matters in the data?
- Analyze cues: what could it mean?
- Prioritize hypotheses: which problem is most urgent?
- Generate solutions: what outcomes and actions fit?
- Take action: what do you do first?
- Evaluate outcomes: did it work?
NGN item types
| Item type | What you do |
|---|---|
| Case study | Six linked questions about one client as the story unfolds |
| Matrix / grid | Mark each row (for example, expected vs unexpected, indicated vs not indicated) |
| Drop-down (cloze) | Pick words to complete sentences or a table |
| Highlight | Click findings in a note or table that need follow-up |
| Extended multiple response | SATA with more options, often partial credit |
| Drag-and-drop | Move options into categories or order |
| Bow-tie | Pick 1 condition, 2 actions, and 2 parameters to monitor |
| Trend | Interpret data that changes over time and decide what it means |
Sample bow-tie question
Scenario: A 68-year-old client, 2 days after hip surgery, suddenly reports sharp chest pain and shortness of breath. HR 124/min, RR 30/min, SpO2 86% on room air, BP 104/66 mmHg. The client is anxious.
- Condition most likely (choose 1): pneumonia, pulmonary embolism, myocardial infarction, anxiety attack
- Actions to take (choose 2): apply oxygen, raise the head of the bed, ambulate the client, give a sedative, apply warm compresses to the leg
- Parameters to monitor (choose 2): oxygen saturation, respiratory status, urine specific gravity, bowel sounds, temperature
Show answer
- Condition: pulmonary embolism (sudden onset after orthopedic surgery, pleuritic pain, tachycardia, hypoxemia).
- Actions: apply oxygen; raise the head of the bed.
- Monitor: oxygen saturation; respiratory status.
- Never ambulate or massage the leg when a clot is suspected.
How to answer NGN questions
- Read the whole case before answering. The data you need may be in a different tab.
- Grade each option on its own. Matrix and SATA items are true/false questions in disguise.
- Look for trends, not single values. Getting worse beats one abnormal number.
- Partial credit exists, so answer every part.
Practice: free NCLEX practice questions. Format facts: how many questions are on the NCLEX.
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Frequently asked questions
What are NGN questions?
Next Generation NCLEX (NGN) questions measure clinical judgment using item types such as matrix, drop-down (cloze), highlight, drag-and-drop, bow-tie, and trend items. They launched on April 1, 2023.
How many case studies are on the NCLEX?
Every NCLEX-RN has three scored case studies with six questions each (18 items). You may also see unscored pretest case studies.
Do NGN questions give partial credit?
Yes. Many NGN items use partial credit scoring models such as plus/minus, zero/one, and rationale scoring.