Next Generation NCLEX question types explained

Case studies and stand-alone items

This guide walks through the question types you will see on the Next Generation NCLEX (NGN). Most of the clinical judgment questions come in case studies. Each case study is one patient scenario followed by six linked questions. At the minimum exam length, the test plan includes 18 case study items, which is three case studies. About 10 percent of the exam is stand-alone questions that aren't part of a case study.

Each case study presents the patient's information in tabs, such as nurse's notes, vital signs and lab results. The exam doesn't force you to open every tab, but the clue you need could be in one you skipped. Check them all before you answer.

The six questions in a case study follow the six steps of clinical judgment: recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action and evaluate outcomes.

The question formats

NCSBN does not publish a fixed share for each format, so expect a mix. These are the formats to recognize:

• Multiple choice. One correct answer. It is scored right or wrong.
• Select all that apply (multiple response). One or more options may be correct. Read the directions, because some questions ask for a set number of answers.
• Matrix or grid. You choose an answer for each row or column in a table.
• Drop-down (cloze). You pick the right word or phrase from lists inside a sentence, chart or table.
• Bow-tie. You connect the patient's condition to the actions you would take and what you would monitor.
• Extended drag-and-drop. You move options into the right order or into spaces. You may not need every option.
• Highlight (enhanced hot spot). You click words or phrases in a passage or chart to select them.
• Trend. A stand-alone format that asks you to read information over time.

How partial credit works

Some items have more than one correct answer, and for those you can earn partial credit. Items with a single correct answer are scored right or wrong. NCSBN uses three scoring methods for items that have more than one key:

• Plus/minus. Used when you can choose an unspecified number of options. You earn points for correct picks and lose points for incorrect ones.
• Zero/one. Used when you are told to choose a specific number of responses. You earn points only for correct picks.
• Rationale. Used when you evaluate a pair of closely linked pieces of information. Both parts of the pair must be correct to earn points.

Practice before exam day

Because plus/minus scoring can take points away for wrong picks, don't select extra options just to be safe. Answer the question as written.

NCSBN's tutorial shows each format with the actual on-screen controls. Work through it before your exam so the drag, drop and highlight tools don't slow you down on test day.