NGN NCLEX Questions Explained

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The Next Generation NCLEX (NGN) launched in April 2023, and it changed how the exam tests nursing competency. If you’re taking the NCLEX now, you’ll encounter these new question types.

Here’s what you need to know—and how to prepare.

What Is NGN?

NGN stands for Next Generation NCLEX. It’s not a different exam—it’s new question types added to the existing NCLEX-RN and NCLEX-PN exams.

The goal: test clinical judgment more effectively.

Traditional multiple-choice questions test whether you know the right answer. NGN questions test whether you can think like a nurse—gathering information, analyzing situations, prioritizing actions, and evaluating outcomes.

Why Did NCSBN Add NGN?

The National Council of State Boards of Nursing (NCSBN) found that traditional multiple-choice alone couldn’t adequately measure clinical judgment—the skill that separates safe nurses from dangerous ones.

Research showed new graduates were struggling with:

• Recognizing when patients were deteriorating
• Prioritizing multiple patient needs
• Making decisions with incomplete information
• Adjusting care based on changing conditions

NGN questions address these gaps by simulating real clinical scenarios more closely.

NGN Question Types

1. Extended Multiple Response (Select All That Apply 2.0)

You’re familiar with “select all that apply” questions. NGN expands on this with partial credit scoring.

How it works:

• Select all correct answers from a list
• You get partial credit for partially correct responses
• Selecting wrong answers deducts points

Example:

A client with heart failure is admitted. Which assessments indicate worsening condition? Select all that apply.

• Weight gain of 3 lbs overnight
• Oxygen saturation of 97%
• Crackles in lung bases
• Blood pressure 118/76
• Peripheral edema increased from +1 to +3

Strategy: Don’t guess wildly. Wrong selections hurt your score. Only select answers you’re confident about.

2. Extended Drag-and-Drop

Arrange items in correct order or match items to categories.

How it works:

• Drag items to correct positions
• May involve sequencing, categorizing, or matching
• Partial credit available

Example:

Arrange these nursing actions in the order they should be performed for a patient experiencing chest pain:

1. ---

2. ---

3. ---

4. ---

Options: Administer prescribed nitroglycerin, Obtain 12-lead ECG, Assess pain characteristics, Notify provider

Strategy: Think through the nursing process. Assessment usually comes first, then intervention, then communication.

3. Cloze (Drop-Down)

Fill in blanks by selecting from dropdown menus within a passage.

How it works:

• Read a scenario with blank spaces
• Select the best option from each dropdown
• Multiple blanks = multiple decisions

Example:

The nurse is caring for a client with pneumonia. The client’s temperature is 101.8°F and respiratory rate is 28. The priority nursing action is to [dropdown: administer antipyretic / increase oxygen flow / position for comfort / encourage fluid intake]. The nurse should then [dropdown: continue monitoring / notify the provider immediately / document findings / reassess in 4 hours].

Strategy: Read the entire scenario before selecting. Context from later sentences often helps earlier decisions.

4. Matrix (Grid)

Make multiple related decisions in a table format.

How it works:

• Grid with rows (conditions/actions) and columns (categories)
• Select appropriate cells
• Tests ability to differentiate between similar concepts

Example:

For each finding, indicate whether it’s expected or requires immediate notification to the provider.

Finding	Expected	Notify Provider
Post-op temp 99.2°F day 1	○	○
Urine output 20 mL/hour	○	○
Incision with serous drainage	○	○
Oxygen sat 88% on room air	○	○

Strategy: Evaluate each row independently. Don’t let one decision influence others.

5. Highlight

Select relevant text within a passage.

How it works:

• Read a clinical note, report, or documentation
• Highlight the portions that answer the question
• May ask for concerning findings, relevant history, etc.

Example:

Highlight the findings in this nurse’s note that require follow-up:

“Patient is 2 days post-appendectomy. Vital signs: T 100.4°F, HR 88, BP 124/78, RR 18. Patient reports pain level 4/10 at incision site. Incision has moderate redness extending 3 cm beyond suture line with purulent drainage noted. Abdomen soft, bowel sounds present in all quadrants. Patient ambulating in hallway without assistance.”

Strategy: Read carefully. The question tells you exactly what to look for—don’t highlight everything that seems important, only what’s specifically asked.

6. Bow-Tie

Connect conditions, actions, and parameters in a visual format.

How it works:

• Left side: Conditions/causes to address
• Center: Actions to take
• Right side: Parameters to monitor
• Creates a “bow-tie” shape visually

Example:

Complete the bow-tie for a patient with suspected sepsis:

[Conditions to address] → [Actions] → [Parameters to monitor]

Select 2 conditions, 2 actions, and 2 parameters from the options provided.

Strategy: Think cause → intervention → evaluation. What’s the problem? What do you do? How do you know it worked?

7. Case Studies (Unfolding)

The signature NGN format. Follow one patient through a clinical scenario.

How it works:

• Initial presentation with patient data
• 6 questions following the patient’s progression
• Situation evolves based on time passing or interventions
• Tests the full clinical judgment process

Structure:

1. Recognize cues (what’s relevant?)
2. Analyze cues (what do they mean?)
3. Prioritize hypotheses (what’s most likely?)
4. Generate solutions (what should you do?)
5. Take action (implement the best intervention)
6. Evaluate outcomes (did it work?)

Strategy: Treat each question as a snapshot in time. Information may change between questions—don’t assume the patient’s status is static.

The Clinical Judgment Model

NGN questions are built on NCSBN’s Clinical Judgment Measurement Model (NCJMM). Understanding it helps you approach these questions systematically.

The 6 cognitive skills:

Skill	What It Means	Example
Recognize cues	Identify relevant information	Which vital signs are concerning?
Analyze cues	Interpret what data means	What does this combination suggest?
Prioritize hypotheses	Rank possible explanations	What’s most likely happening?
Generate solutions	Identify possible interventions	What could you do?
Take action	Choose the best intervention	What should you do first?
Evaluate outcomes	Assess effectiveness	Did the intervention work?

When you’re stuck on an NGN question, ask yourself: which of these skills is being tested? That often clarifies what the question wants.

How to Practice NGN Questions

1. Use a question bank with extensive NGN content

Not all prep resources have adequate NGN coverage. You need practice with:

• All question types (not just case studies)
• Partial credit scoring
• The clinical judgment framework

Archer Review’s Sure Pass includes 1,100+ NGN items plus 175+ standalone case studies and 63+ unfolding case studies. This is among the most extensive NGN coverage available.

2. Practice case studies under timed conditions

Real case studies have time pressure. Practice:

• Reading efficiently (don’t re-read endlessly)
• Making decisions with incomplete information
• Moving forward even when uncertain

3. Learn from wrong answers

NGN questions with partial credit make this even more important. When you review:

• Which parts did you get right?
• Which parts did you miss?
• Was it a knowledge gap or a reasoning error?

4. Study the clinical judgment model

Understand the 6 cognitive skills. When you miss a question, identify which skill failed. This helps you target your studying.

Common NGN Mistakes

1. Over-selecting on extended multiple response With partial credit, wrong answers hurt you. Don’t guess—only select what you’re confident about.

2. Ignoring information in case studies Every piece of data in a case study is there for a reason. Labs, vital signs, history—it all matters.

3. Not adjusting to evolving scenarios In unfolding case studies, the patient’s condition changes. Don’t anchor to your initial assessment.

4. Rushing through tabs/exhibits Case studies often have multiple tabs of information. Read them all. Missing data leads to wrong answers.

5. Overthinking NGN questions test clinical judgment, not obscure knowledge. The answer is usually straightforward if you think like a bedside nurse.

NGN Scoring: What You Need to Know

NGN items use polytomous scoring (partial credit) rather than dichotomous (all-or-nothing).

What this means:

• You can get partial credit for partially correct answers
• You can lose points for selecting wrong options
• The algorithm evaluates your overall clinical judgment

Practical implications:

• Don’t guess randomly on select-all-that-apply
• Aim for accuracy, not completeness
• One wrong selection might cost you more than a missing correct selection

The Bottom Line

NGN questions test clinical judgment—your ability to think like a nurse. They feel different from traditional multiple-choice, but they’re not inherently harder.

The key is practice. Students who work through hundreds of NGN items before their exam report feeling prepared and confident. Students who avoid them report feeling blindsided.

Don’t be the second group.

Practice with Archer Review’s 1,100+ NGN questions

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Related resources:

• Is Archer Review Worth It? — Archer has 1,100+ NGN items
• NCLEX Study Strategies — How to structure your prep
• 2-Week NCLEX Study Plan — Intensive prep timeline