Next Generation NCLEX: What Changed

The Next Generation NCLEX (NGN) is the version of the licensing exam that NCSBN (the National Council of State Boards of Nursing) launched in April 2023 for both the NCLEX-RN and the NCLEX-PN. The biggest changes are a sharper focus on clinical judgment, unfolding case studies, several new question formats and partial credit scoring. The basics of how you apply, register and sit for the exam stayed the same.

Why the exam changed

NCSBN redesigned the exam to better measure clinical judgment: how a new nurse takes in information about a patient, makes sense of it and decides what to do. The new questions are built on NCSBN's Clinical Judgment Measurement Model, which breaks clinical judgment into six cognitive steps:

1. Recognize cues: what information matters?
2. Analyze cues: what does it mean, and how does it connect?
3. Prioritize hypotheses: which problems are most likely and most urgent?
4. Generate solutions: what outcomes do you want, and what could get you there?
5. Take action: which interventions do you carry out?
6. Evaluate outcomes: did the interventions work?

If that sounds like how you already think on the unit, that's the point. Our article on how nurses prioritize care covers the same kind of reasoning at the bedside.

Case studies and standalone items

The NGN mixes two kinds of questions.

Unfolding case studies present a patient through a mock chart, with tabs such as nurses' notes, vital signs, lab results and orders. Each case study has six questions, one for each step of the model, and the patient's situation develops as you move through them.

Standalone items are single questions. These include familiar multiple choice and select-all-that-apply items, plus two newer formats: bow-tie and trend items.

The new item types

Case study questions use several of the formats below, and bow-tie and trend items appear as standalone questions:

• Extended multiple response: select all that apply, often with more options than before.
• Extended drag and drop: move options into place, such as matching findings to categories.
• Drop-down (cloze): choose words or phrases from menus to complete sentences or tables.
• Enhanced hot spot (highlight): highlight the relevant parts of a note or report.
• Matrix or grid: check boxes across rows and columns, for example marking each finding as expected or unexpected.
• Bow-tie: identify the condition the patient is most likely experiencing, the actions to take and the parameters to monitor.
• Trend: review data over time, such as vital signs across several hours, to answer a question.

Partial credit scoring

Before NGN, items were scored right or wrong. A select-all-that-apply item with one wrong choice earned no credit. Now many items award partial credit, using a few methods:

• Plus/minus scoring: you earn a point for each correct choice and lose one for each incorrect choice, with a floor of zero.
• Zero/one scoring: each correct response earns a point, with no penalty for wrong ones.
• Rationale scoring: for paired answers that depend on each other, both parts must be correct to earn the point.

The practical takeaway: on items scored with plus/minus, adding options you're unsure of can cost you. Choose what you can justify.

Exam length and format

The exam still uses computerized adaptive testing (CAT), which picks each question based on how you've done so far and stops once it can determine with confidence whether you're above or below the passing standard. What changed is the length. For the NCLEX-RN:

The exam still includes unscored pretest questions that look like the rest, so you can't tell which ones count. Check NCSBN's website for current details on both the RN and PN exams.

What stayed the same

A lot of familiar territory carries over:

• The test plan is still organized around client needs categories: Safe and Effective Care Environment, Health Promotion and Maintenance, Psychosocial Integrity and Physiological Integrity.
• You still apply to your board of nursing, register with Pearson VUE and wait for your Authorization to Test. Our guide on registering for the NCLEX-RN walks through those steps, and the process works the same way for PN candidates.
• Official results still come from your board of nursing.

Common misunderstandings

A few ideas about the NGN come up often and are worth clearing up:

• "The number of questions tells you whether you passed." It doesn't. The exam can stop at the minimum for a candidate who clearly passed or clearly failed, and it can run to the maximum for either outcome too.
• "Partial credit means select-all-that-apply items are easy points." Plus/minus scoring penalizes wrong choices, so overselecting can wipe out the credit you earned.
• "Case studies are just long reading passages." They test the six steps of clinical judgment, and later questions build on the patient's changing condition.
• "Old question banks are good enough." Older practice questions still help with content, but you also need practice with the new formats.

How to adjust your studying

Content knowledge still matters, but you now need to practice applying it.

1. Practice with NGN-style questions. Use resources built for the current format. NCSBN publishes information about the item types on its website.
2. Read the whole chart. In case studies, the answer often depends on a detail in the notes or labs, so practice checking every tab.
3. Say why. For each practice question, explain why each option is right or wrong. That habit builds the reasoning the exam measures.
4. Learn the formats before test day. You don't want to spend exam time figuring out how a bow-tie item works.
5. Study with others. Talking through case studies out loud helps you spot gaps. You can compare notes with nurses who recently tested in the new grad nurses group.

If you don't pass on your first try, you'll get a report showing where to focus. Our article on what happens if you fail the NCLEX explains the retake process. Once you pass, our guide to new grad interview questions can help you get ready for job interviews, and you can browse registered nurse jobs that show the pay.

Next step

Find people to study with. Join the nursing students study group to trade practice strategies for the Next Generation NCLEX.

General information for nurses, not medical, legal, tax or financial advice. Follow your facility's policies, your state board of nursing and the terms of your employer or contract.