Next Generation NCLEX (NGN)
Key Takeaways
NGN was launched in April 2023 to better assess clinical judgment skills
NCSBN's new NGN item types are extended multiple response, extended drag and drop (including bowtie), cloze (drop-down), matrix/grid, highlighting, and trend items
Partial credit scoring applies to items with more than one key, using plus/minus, zero/one, or rationale scoring
Case studies present six sequential questions following the NCJMM framework
NGN items simulate real-world clinical decision-making using EHR-style interfaces
The Next Generation NCLEX (NGN) represents a fundamental shift in how nursing competency is assessed. Launched in April 2023, NGN moves beyond testing "what you know" to testing "how you think."
Why NGN Was Developed
NCSBN's 2013-2014 Strategic Practice Analysis showed that newly licensed nurses are increasingly expected to make complex decisions while caring for patients. NGN launched on April 1, 2023 to better measure candidates' clinical judgment and decision making through new item types.
NGN Item Types
NCSBN lists these new item types for case studies and stand-alone items: highlighting, cloze (pull-down menu), matrix/grid, extended multiple response, trend items, and extended drag and drop, including bowtie. Many present information like an electronic health record (EHR):
Extended Multiple Response
An extended version of the multiple-response ("Select All That Apply") item. Tests your ability to distinguish relevant from irrelevant clinical cues.
Matrix / Grid
A grid format where you select options across rows and columns. Used for comparing multiple diseases, drug classes, or patient assignments simultaneously.
Cloze (Drop-Down)
Select words or phrases from dropdown menus embedded in sentences, charts, or nurse's notes. Simulates clinical documentation.
Highlighting
Highlight the words or phrases in a client record or nurse's note that answer the question (for example, the findings that need follow-up).
Extended Drag and Drop
Drag response options (tokens) into place to complete the item; the bowtie below is a form of extended drag and drop.
Bowtie
A complex standalone item where you identify:
- A condition (center)
- Two actions to take
- Two parameters to monitor
Tests synthesis of assessment, diagnosis, planning, and evaluation in one visual structure.
Trend Items
Presents data (vital signs, labs) across multiple time points. Tests your ability to recognize deterioration or improvement over time.
Partial Credit Scoring
NCSBN uses partial credit scoring for items with more than one key. An item with a single key is scored correct or incorrect. There are three partial-credit methods:
| Scoring Method | How It Works |
|---|---|
| Plus/minus | Used when you may select an unspecified number of options: a point for each correct option, a point deducted for each incorrect option; the minimum item score is zero |
| Zero/one | Used when you are told how many responses to choose: a point for each correct response and none for an incorrect one; on multipoint items the correct responses are added up |
| Rationale | Used for closely linked pairs of information (for example, a cause and its effect): both parts of the pair must be correct to earn the point |
This acknowledges that clinical decision-making is rarely binary—you may correctly identify a condition but select suboptimal interventions.
Case Studies
NGN Case Studies present six sequential questions that follow the NCSBN Clinical Judgment Measurement Model. Each case study walks you through:
- Recognizing cues from patient data
- Analyzing what those cues mean
- Prioritizing which hypothesis is most concerning
- Generating solutions
- Taking action
- Evaluating outcomes
What is the key difference between traditional NCLEX scoring and NGN scoring?
NGN questions are worth more points
NGN allows partial credit for partially correct answers
NGN uses a higher passing standard
NGN only uses multiple-choice questions
Which NGN item type requires you to identify a condition, actions to take, and parameters to monitor in a single visual structure?
Matrix/Grid
Cloze (Drop-Down)
Bowtie
Trend Items
How many questions are included in an NGN case study?
Three sequential questions
Four sequential questions
Six sequential questions
Ten sequential questions
Sections you finish are checked off in the contents.