FAQs About the Next Generation NCLEX (NGN)

Nurse Beth, MSN

Why is the NCLEX changing?

The National Council of State Boards of Nursing (NCSBN) developed and reviews the national NCLEX exam every three years. Reasons that led to the revision of the NCLEX include:

increased technology.
higher acuity patients.
recognition that new grads need increased clinical judgment to practice safely.

The primary impetus for the new exam is the third bullet point, clinical judgment. New grads need clinical judgment and critical thinking skills. Can testing measure critical thinking ability? According to the NCSBN, NGN test items (test questions) better evaluate clinical judgment.

Never before has the exam been based on a clinical judgment model that measures critical thinking. What matters is not just information. It's the application of knowledge.
These new items are based on NCSBN's Clinical Judgment Measurement Model (NCJMM)⁽¹⁾. which reflects the nursing process (assess, plan, implement, evaluate).

NGN items based on the NCCJMM measure the test taker's ability to:

recognize cues.
analyze cues.
prioritize hypotheses.
generate solutions.
take action.
evaluate outcomes.

What is different about the NGN?

The revised exam retains much of the traditional format, but significant changes exist. In addition to testing for clinical judgment, changes include:

partial credit scoring⁽¹⁾. Partial credit scoring is good news for test-takers. The NGN gives partial credit for some select-all-that-apply (SATA) items.
a shift towards case studies. Case studies are less didactic and more applicable to real-life situations. Throughout the NGN case study exam portion, clinical judgment is assessed.
inclusion of bowtie-type questions. Bowties cover all six aspects of the NCJMM. Read more on bowtie NCLEX questions.

What type of test questions should I expect?

According to the NCSBN⁽¹⁾, the new question types include:

extended multiple responses (SATA, Select N, multiple group response).
drag and drop.
cloze or drop-down (choose a word or phrase from a drop-down list to complete a blank).
highlight (read a section and highlight specific findings).
matrix/Grid (multiple responses).
Bowtie items. When written out on the screen, it resembles a bowtie. The bowtie layout shows antecedents on the left side, with outcomes on the right side. Test takers match the antecedents with outcomes.

Is the NGN harder?

The NGN will not necessarily be more challenging for all candidates. There is a decided emphasis on critical thinking, which is new.

Whether it's harder depends on the test taker's ability to think critically. When faced with a large amount of information, can the test-taker recognize what is essential?

Why do I get different test questions than my classmates?

NCSBN uses computer-adaptive testing (CAT). CAT is not new. CAT algorithms adapt questions to past answers and estimate ability by analyzing previous responses.

Exams are unique. Candidates receive a slightly more challenging or less challenging question based on their last answer.

Incorrect answers lead to easier questions.
Correct answers lead to harder questions.

How many questions are on the NGN?

According to the NCSBN⁽¹⁾

the minimum number of questions is 85 (includes 15 non-scored questions).
the maximum number of questions is 150 (includes 15 non-scored questions)
non-scored questions are dispersed throughout the test.
non-scored questions are not labeled as such.
the total test time is 5 hours.
the test keeps giving questions until there's a 95 percent certainty of passing.
the test shuts off if you have answered the maximum number of questions or run out of time.
if you run out of time, you can still pass if your total responses are above the passing standard and you've answered the minimum number of questions.

How can I prepare for the NGN?

Practicing questions similar to NGN questions is the best approach.

There are many review sources available. When purchasing a test review product, use a reputable company that specializes in NCLEX review.

When studying, take the time to understand the material thoroughly. Effective NGN preparation involves more than memorizing information because what matters most is how the knowledge is applied.

Practice as many NGN-type questions as possible. Practice is active, as compared to reading, which is passive.
Choose questions that provide rationales and performance tracking.
Use quizzes.
Use self-assessment tests.

During the test:

review all choices before selecting an answer.
reread the stem if necessary. Don't rush. The time limit is five hours.

What are the NGN case studies like?

According to NCSBN, every candidate receives a minimum of three case studies, each with six questions, for a total of 18 questions from case studies⁽¹⁾.

Test-takers receive an unfolding clinical scenario. The six questions associated with each scenario are sequential. Each question builds on the previous question⁽⁴⁾.

The case study information is always available during the questions, so there is no need to memorize the initial case study information.

The bolded bulleted words are six steps from NCSBN's NCJMM⁽⁴⁾.

Recognize cues in the scenario. Cues are signs and trends that a problem exists. Cues include abnormal vital signs, assessment findings, chief complaints, patient history, lab values out of range, and more.
Analyze the cues. Think- what is the most pertinent clinical information? What data stands out? Ignore information that is not relevant. As an example, let's say the most prevalent and significant cues are cardiac in nature.
Prioritize hypotheses. What condition or explanation is most likely? The patient may have multiple problems, but which problem represents the highest risk? You may determine the patient is at the highest risk for myocardial infarction.
Generate solutions. What outcomes are needed, and how can you achieve them? There will be multiple potential interventions. Some may be strictly nursing interventions; others may require an order.
Take action. Address and prioritize your actions. From the options, you may choose to start an IV, monitor the heart rhythm, obtain an EKG, and administer morphine.
Evaluate the outcomes. As an example, evaluate if giving morphine helped with the chest pain.

Good luck to the next generation of nursing students. Go in with confidence and positivity and visualize yourself writing RN after your name!

References

1. Betts, J., Muntean, W., Doyoung, K. Shu-Chuan Kao, S. Next Generation NCLEX®: Test Design in Next Generation. From NCLEX News. Winter 2022 edition. https://www.NCSBN.org/public-files/NGN_Winter22_English_Final.pdf Retrieved January 15, 2023.

2. How different is NGN NCLEX? Educator Blog. December 1, 2022.
https://atitesting.com/educator/blog/knowledge/2022/12/01/different-from-current-NCLEX
Retrieved January 15, 2023.

3. NGN Case Study. From Next Generation NCLEX News. Summer 2020. https://NCSBN.org/public-files/NGN_Spring20_Eng_02.pdf Retrieved January 15, 2023.

4. Nurse FAQs for Educators. https://www.NCSBN.org/exams/next-generation-NCLEX/NGN+FAQS/ngn-faqs-for-educators.page Retrieved January 15, 2023.