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How to Prep for the Next Gen NCLEX Questions

Written by: Kristine Thorndyke

The Next Gen NCLEX measures your clinical judgment and reasoning skills. But what does that mean, and how is it measured? We’ll dive into this and more to prepare you for the new NCLEX testing format so you will be ready to pass the first time.

What is the Next Gen NCLEX?

The NCLEX, short for the National Council Licensure Examination (NCSBN), is a standardized exam that nursing graduates must pass to obtain a nursing license in the United States and Canada. The exam assesses the knowledge, skills, and abilities essential for safe and effective practice as a registered nurse (RN) or licensed practical nurse (LPN)/licensed vocational nurse (LVN).

The Next Generation NCLEX (NGN) was launched on April 1, 2023, to better measure nursing candidates’ clinical judgment and decision-making abilities through the use of innovative item types.1 Translation? They added new and innovative questions to the licensure exam to better measure candidates’ ability to evaluate information from various sources, including patient assessments, medical history, diagnostic tests, and professional guidelines, to make decisions about patient care. 

The NCSBN Clinical Judgment Measurement Model (NCJMM)

The NCSBN’s Clinical Judgment Measurement Model (CJMM) is a framework used on the Next Gen NCLEX to evaluate a nursing candidate’s clinical judgment, which is crucial in making sound decisions in patient care.

The NCSBN Clinical Judgment Measurement Model2

The NCSBN’s Clinical Judgment Measurement Model diagram

The model breaks down the process of clinical judgment into distinct, measurable steps:

The NCJMM’s 6 Nursing Steps

  1. Recognize Cues
  2. Analyze Cues
  3. Prioritize Hypotheses
  4. Generate Solutions
  5. Take Actions
  6. Evaluate Outcomes

*These six steps inform the six sequential items within NGN case studies and stand-alone items.

What Are the Next Gen NCLEX Changes?

To better understand the NGN as a whole, it’s important to understand the exam format, the new practice questions, and the updated scoring models. While much of the NCLEX will remain the same, here are a few key changes that will impact your study plan and test-taking experience.

How Long Is the Next Gen NCLEX?

Like the old NCLEX, the Next Gen NCLEX gives candidates up to five hours to complete their exam. Because the NGN is also a Computerized Adaptive Test (CAT), not every student will answer the same number of questions. The minimum length is 85 questions (70 scored and 15 unscored), while the maximum length is 150 questions (135 scored and 15 unscored).

NGN Item Types

The most notable change between the old and new NCLEX comes with NGN practice questions. The NCSBN introduced seven new question types:

  1. Extended Multiple Response
  2. Extended Drag and Drop
  3. Cloze (click or drag answer options to fill in the blank)
  4. Highlight Text
  5. Matrix/Grid
  6. Bowtie
  7. Trend

Unfolding case studies include an in-depth patient scenario, providing information such as patient history, current symptoms, vital signs, lab results, and other relevant clinical data. The case study is divided into a series of questions, each focusing on different aspects of patient care. These questions are designed to be answered in sequence, with each question building on the information gathered and decisions made in the previous ones. The case studies require applying all six steps of the CJMM – recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions, taking actions, and evaluating outcomes. This approach tests the candidate’s ability to think critically and make sound decisions throughout the entire patient care process.

NGN Case Study practice question from UWorld’s NCLEX-RN Review

Stand-alone clinical judgment questions target one or more steps of the CJMM, such as recognizing cues, analyzing information, prioritizing hypotheses, generating solutions, taking actions, or evaluating outcomes. Stand-alone clinical judgment questions can utilize various formats, including multiple-choice, select-all-that-apply, fill-in-the-blank, and drag-and-drop. This variety tests the candidate’s ability to apply clinical judgment in different contexts. These questions require candidates to directly apply their nursing knowledge and skills to make decisions or judgments about patient care without the need to navigate through a lengthy case study.

NGN stand-alone practice question from UWorld’s NCLEX-RN Review

Bow-tie and trend questions are two of the innovative question types designed to measure a candidate’s clinical judgment. Bow-tie questions are structured to assess the candidate’s ability to identify relationships between multiple components of patient care. The format typically involves a central concept or patient scenario, with related factors or options branching out from this center, resembling the shape of a bow-tie. Trend questions are designed to evaluate a nursing candidate’s ability to analyze and interpret trends in patient data over time. These items focus on assessing the candidate’s skill in recognizing patterns, changes, or trends in a patient’s condition.

Bow-tie practice question from UWorld’s NCLEX-RN Review

How Is the Next Gen NCLEX Scored?

The NGN introduces partial credit scoring to account for the exam’s more interactive practice questions. In short, the Next Gen NCLEX has three scoring rules you should know:

  1. 0/1 Scoring Rule: The answer selection is right or wrong, resulting in 1 point or 0 points (e.g., standard multiple-choice scoring).
  2. +/- Scoring Rule: For questions that require more than one entry, correct responses result in positive points and incorrect responses result in negative points (i.e., partial-credit scoring). The lowest possible score for a question is 0 points.
  3. Rationales Scoring Rule: For questions assessing relational or paired information, both responses must be correct to receive a point. If one or both entries are wrong, 0 points will be awarded.

Students will still receive a candidate performance report (CPR) after completing the Next Gen NCLEX. If you do not pass, you will receive feedback on your clinical judgment performance based on the NCJMM to help you improve your weaknesses. For more detailed information about scoring, check out this NGN scoring guide and learn about passing NCLEX scores.

How to Prep for the Next Gen NCLEX

Prepping for the NGN requires a strategic and well-prepared mindset due to its focus on clinical judgment and the introduction of new question formats. Here are a few key strategies to consider:

Understand the Test Format:

  • Familiarize yourself with the test plan and exam structure, including the types of questions (like case studies, stand-alone items, bow-tie items, and trend items).
  • Learn about the Clinical Judgment Measurement Model (CJMM) as it forms the basis of many questions.

Practice with New Question Types:

  • Get comfortable with the innovative question types in the NGN, such as extended multiple responses, drag and drop, and the new bow-tie and trend items.
  • Choose a resource that provides unlimited practice tests and study materials that include these new question formats.

Strengthen Your Content Knowledge:

  • Ensure a strong foundation in nursing content, as a solid understanding of nursing principles is essential for applying clinical judgment.
  • Watch high-yield lecture videos, review question rationales, or revisit textbook content to supplement your practice tests.  

Simulate Exam Conditions:

  • Take a self-assessment test or readiness exam under conditions similar to the actual test to build endurance and familiarity with the testing environment.
  • Incorporate adaptive (CAT) practice tests into your study plan. These tests adjust their difficulty based on your answers, mimicking the adaptive nature of the NGN, which helps you adapt to the varying levels of question complexity.

Self-Care and Stress Management:

  • Ensure you are well-rested and mentally prepared on the day of the exam.
  • Develop stress-management techniques to stay calm and focused during the exam.

Using a high-quality Next Gen NCLEX Review course is the most effective way to prepare for the NGN. A high-quality NCLEX Review course will help you identify weaknesses, build test-taking endurance, and familiarize yourself with the exam format. Be sure to choose a resource that includes NGN case studies, NGN stand-alone questions, and classic NCLEX-style practice questions to prepare you for anything that comes your way on exam day.


When did the new NGN format go into effect?

The Next Gen NCLEX was launched on April 1, 2023, to address findings from the NCSBN’s 2013-2014 Strategic Practice Analysis. The report showed that newly licensed nurses were increasingly expected to make complex decisions while caring for patients,1 creating a need for nurses with better clinical judgment.

What’s the Next Gen NCLEX pass rate?

Generally speaking, Next Gen NCLEX pass rates have been higher than historic NCLEX pass rates. The first two quarters of Next Gen NCLEX-RN exam results saw overall pass rates of 81.61% and 75.46% compared to a Q1 (old NCLEX) pass rate of 57.79%. Similarly, overall Next Gen NCLEX-PN pass rates for Q2 and Q3 were 77.91% and 81.44%, respectively, compared to Q1 at 65.53%. First-time, U.S.-educated students have a Next Gen NCLEX pass rate of over 90% so far.3

Is the Next Gen NCLEX harder than the original NCLEX?

The Next Gen NCLEX has a higher pass rate than the original NCLEX, so many would consider it “easier.” However, this outcome is likely due to the NGN’s new partial-credit scoring system, not easier content. 

About the Author:

UWorld Nursing – Our goal is to build exceptional content that makes really hard stuff easy to understand. Call us geeks. Call us nerds. Call us overly obsessive. But make no mistake about it: when you have a make-or-break exam, our nursing experts have made us the company you can rely on. We are the most user-friendly test prep company on the market, and we’ll help you know what to expect—and how to succeed—on test day.


  1. “Next Generation NCLEX: An Enhanced NCLEX.” NCLEX, NCSBN,
  2. “Clinical Judgment Measurement Model.” NCLEX, NCSBN,
  3. “Statistics from NCSBN: Number of Candidates Taking the NCLEX® Examination and Percent Passing, by Type of Candidate.” NCLEX, NCSBN,