Next Generation NCLEX (NGN) Item Types

The Next Generation NCLEX (NGN), launched in April 2023, introduces new question types designed to measure clinical judgment—the most critical skill for safe nursing practice. These items use the NCSBN Clinical Judgment Measurement Model (NCJMM) to assess how nurses think through patient care decisions.

The Clinical Judgment Measurement Model (NCJMM)

The NCJMM identifies six cognitive skills that nurses use when making clinical decisions:

NGN Question Types

The NGN includes several new item formats beyond traditional multiple choice:

1. Extended Multiple Response (Select All That Apply)

• Select ALL correct answers from 5+ options
• No partial credit—must select all correct and no incorrect answers
• Tests recognition of multiple related concepts

2. Extended Drag-and-Drop

• Drag items to correct locations or categories
• May involve sequencing steps or matching concepts
• Tests organization and prioritization

3. Cloze (Drop-Down)

• Complete statements by selecting from drop-down menus
• Multiple blanks may appear in one question
• Tests understanding of relationships and conditions

4. Matrix/Grid Items

• Answer multiple related questions in a grid format
• May combine with other item types
• Tests systematic assessment across multiple variables

5. Highlight Items

• Identify key information by highlighting text
• May highlight words, phrases, or sentences
• Tests recognition of relevant cues in documentation

6. Unfolding Case Studies

• 6 questions based on an evolving patient scenario
• Information changes as the case progresses
• Tests clinical judgment across the care continuum

Scoring NGN Items

NGN items use different scoring methods:

Preparing for NGN Items

Focus on:

1. Understanding the nursing process deeply
2. Practicing clinical reasoning with patient scenarios
3. Identifying relevant vs. irrelevant information
4. Prioritizing nursing interventions
5. Evaluating outcomes systematically