On April 1, 2023, the NCSBN NCLEX® launched a major overhaul called the Next Generation NCLEX®, also known as Next-Gen NCLEX® or NGN. The updated exam includes a clinical judgment model and new question item types. However, the exam is still administered using computer-adaptive testing. You’ve probably heard the National Council of State Boards of...
You’ll need to focus on specialties when reviewing nursing NCLEX® questions, including categories like medical surgical nursing and mental health nursing. Plan to include all eight National Council of State Boards of Nursing client need categories and the six NCLEX® clinical judgment categories when studying. Be sure to review at least 200 to 400 questions...
If you’re considering which item types to include in your NCLEX® practice questions, the answer is all of them.
When studying, you can break the item types into two categories: NCLEX® Nex-Gen new item types and traditional NCLEX® item types.
Always remember that patient safety is at the core of each answer.
The Nex-Gen NCLEX® has a variety of item types, and if you’re considering which item types to include in your NCLEX® practice questions, the answer is ALL of them! It is an important part of your exam preparation to ensure that you study all areas of the exam — and with all item types that are included in the NCLEX®.
Let’s break down the items types you will see on exam day and that you should incorporate into your NCLEX® practice questions.
We are going to split this into two sections. The first section will cover all the NCLEX® Nex-Gen (NGN) new item types, and the second will cover the traditional NCLEX® item types.
On April 1, 2023, the NCSBN NCLEX® launched a major overhaul called the Next Generation NCLEX®, also known as Next-Gen NCLEX® or NGN.
The updated exam includes a clinical judgment model and new question item types.
However, the exam is still administered using computer-adaptive testing.
You’ve probably heard the National Council of State Boards of Nursing (NCSBN) completed a major change to the National Council Licensure Examination (NCLEX®) in 2023. On April 1, 2023, the NCSBN NCLEX® launched a major overhaul called the Next Generation NCLEX®, also known as Next-Gen NCLEX® or NGN. The change resulted in several updates and additions, with the goal of improving test functionality and providing a better way to evaluate the tester’s clinical judgment and safety as an entry-level nurse.New additions to the 2023 NCLEX® included:
Incorporating the NCSBN Clinical Judgment Measurement Model (CJMM);
Adding new question item types;
Adding updated scoring; and
Increasing the total number of NCLEX® questions on the exam.
What’s the Clinical Judgment Measurement Model?
The clinical judgment model ensures that the tester can be a safe practicing nurse and is incorporated throughout the NCLEX® exam. The model also is being used in residency programs, preceptorships, and for new graduate orientation. Previously, the NCLEX® utilized the nursing process within the eight client need categories (Management of Care, Safety and Infection Control, Health Promotion and Maintenance, Psychosocial Integrity, Basic Care and Comfort, Pharmacological and Parenteral Therapies, Reduction of Risk Potential, and Physiological Adaptation). With the addition of the clinical judgment model, we have created this image to help you visualize the way it connects with the nursing process and what each means:Clinical judgment begins with recognizing cues, then analyzing those cues, prioritizing hypotheses based on those cues, generating solutions to those hypotheses, taking action while prioritizing the most important client needs first, and, finally, evaluating the outcomes of those actions.
Exploring the Next-Gen NCLEX® Question Item Types
But don’t forget about the new question item types that were added to the exam. The NGN NCLEX® will include three unfolding case studies in every exam. The tester will have to answer a series of questions via different item types. The case study will “unfold” and questions will apply to each of the new areas. There will also be bowtie questions; new multiple response item types that include Select All That Apply (SATA), select N, and multiple response group; and highlight questions that include highlight test and highlight table. Drag-and-drop questions that have the tester complete a sentence have also been added. Some questions will require you to complete one to three sentences, and others will be a rationale sentence that will be a cause-and-effect statement. Like drag and drop, there will also be drop-down questions where the tester will complete the sentence selecting from the drop-down options. Finally, there are now matrix grid questions where users will select answers in a matrix set. For more information on the new item types, reference our previous blog, “Include these Item Types in Your NCLEX® Practice Questions.”The NCSBN NCLEX® also updated the scoring for all item types. This ensures partial credit for multiple-part questions, including SATA. There are now four types of scoring models used in the NCSBN NCLEX®-RN. Partial credit scoring is used for items with more than one key. There will be three methods for scoring items for partial credit: plus/minus, zero/one, and rationale scoring.
Traditional Scoring
The “original” NCLEX® scoring type.
This scoring type means you either get the question right or wrong, there is no partial credit.
0/1 Scoring
Partial Credit Scoring Type.
With 0-1 scoring, the tester earns one point for each correct response picked and they earn zero points for each incorrect response picked. The total score for a multi-point item is the sum of all correct responses.
+/- Scoring
Partial Credit Scoring.
The tester earns one point for each correct response picked and also will subtract one point for each incorrect response picked. The total score for a multi-point item is the sum of all positive and negative points. *Negative total scores are a 0, there are no negative scores.
Rationale Scoring
The tester earns points when both responses in the pair are correct. This is applied to items that require a full understanding of paired information (e.g., cause/effect relationships).
The maximum number of questions for the Next-Gen NCLEX® also increased. The new NCLEX® has 85-150 scored questions (including 15 unscored pretest questions). It was previously 75-145 on the old version.
What Hasn’t Changed on the Next-Gen NCLEX®
The NCLEX® continues to be administered using computer-adaptive testing. This means the computer re-estimates the candidate's ability after each item is answered, based on the difficulty of the item and the candidate's previous answers. The computer then selects the next item for the candidate that is most optimal based on their previous responses. This ensures that the next item is neither too easy nor too hard, and the examination can obtain maximum information about the candidate's ability from the item. Candidates should find each item challenging because the items are targeted to their ability level. After each item is answered, the computer's estimate of the candidate's ability becomes more precise.The test also continues to be a pass/fail exam and remains timed with a five-hour limit. The exam will automatically shut off if the tester reaches the maximum time and/or maximum number of questions. The exam will then be scored, and a pass/fail result is given to the user.
The Bottom Line
Regardless of what has changed or what has remained the same, the NCLEX® still tests your abilities to be a safe practicing entry-level nurse. Preparation is key to passing the exam. Make sure you select a preparation like Slone NCLEX that will provide you with the structure, organization, and variety that mirrors the Next-Gen NCLEX®. Setting yourself up for success is what will make you the most confident on test day. Focus hard and prepare and you will do great!
You’ll need to focus on specialties when reviewing nursing NCLEX® questions, including categories like medical surgical nursing and mental health nursing.
Plan to include all eight National Council of State Boards of Nursing client need categories and the six NCLEX® clinical judgment categories when studying.
Be sure to review at least 200 to 400 questions per day until exam day.
When preparing to take the NCLEX® Exam, creating a well-rounded and comprehensive preparation program will help you be successful and pass the exam on your first attempt. Your plan will need to include all eight National Council of State Boards of Nursing (NCSBN) Client Need Categories:
Management of Care, which tests your ability to prioritize, delegate, and coordinate care for yourself, your patients, and other healthcare professionals.
Safety and Infection Control, which tests your ability to follow proper isolation precautions, sterile techniques, and general infection control protocols, such as proper hand hygiene.
Health Promotion and Maintenance, which tests your ability to properly educate patients on their preventative care and healthy lifestyle choices.
Psychosocial Integrity, which assesses your ability to assess and address a client’s emotional and psychological needs.
Basic Care & Comfort, which tests your ability to provide care to your patients in a safe way that promotes their care and ensures their basic needs are met and their ADLs are performed to the best of their ability safely.
Pharmacological and Parenteral Therapies, which test your understanding of medications, their administration, dosages, and side effects.
Reduction of Risk Potential, which tests your ability to identify and manage potential risks for patients such as medication errors, fall prevention techniques, and safe sex practices; and
Physiological Adaptation, which tests your ability to understand how the body responds to alterations in their health and the interventions needed to prevent further harm from occurring.
You'll also need to know the six NCLEX® Clinical Judgment Categories:
Recognize Cues
Analyze Cues
Prioritize Hypotheses
Generate Solutions
Take Actions, and
Evaluate Outcomes.
In addition to the NCSBN categories, you’ll need to focus on specialties when reviewing nursing NCLEX® questions. You will need to be able to answer questions in medical surgical nursing, pediatric nursing, maternal newborn or obstetrics nursing, pharmacology nursing, leadership, prioritization, delegation, and behavioral and mental health nursing.
Preparing for Nursing NCLEX® Questions
During your NCLEX® preparation, use questions like the ones on Slone NCLEX that provide a review that encompasses both the client need categories and clinical judgment. The NCLEX® is essentially the biggest nursing school final. It puts everything you have learned over the past few years into one exam. This is why being prepared and using a structured preparation program is so important. It is a lot of information for you to recall and recall accurately. So, when asked what NCLEX® questions you need to focus on, the answer is everything. The NCLEX® is administered via computer using computer adaptive testing. This means that if you answer a question correctly, the next question might be more difficult, and vice versa, which adjusts the difficulty level of the questions based on your performance. As you answer questions, the test calculates your competency relative to the minimum passing competency level. Once the exam determines your competency level, the test will end.Some tricks to help you remember those nursing NCLEX® questions include:
Pay attention to key words
Use the key words within the question stem to identify what the question is asking for.
For example, if the question is about education, it may be asking you which option indicates a need for further education or follow-up. The key word here is “further.”
Apply Maslow's Hierarchy of Needs
As a reminder, Maslow’s Hierarchy of Needs is in this order: Physiological (food, water, shelter, and rest); safety (security, stability, and freedom from fear); social and belonging (friendship, intimacy, and acceptance); esteem (respect, recognition, and status; and self-actualization (achieving one's full potential and creativity).
When answering questions, prioritize them based on addressing the highest-level of needs first.
Analyze rationales
Use your selected answer to see if it makes sense with the question. This is a great help you understand why the right answer is right and why the wrong options are wrong.
Remember safety is always the priority!
Key Factors in Nursing NCLEX® Questions
The most important thing for you to focus on when preparing to take the NCLEX® is to remember the key factors for every question:
The NCLEX® tests your ability to be a SAFE nurse who can provide entry-level nursing care and not harm anyone.
Focus on questions that prioritize patient care based on the "ABCs" of airway, breathing, and circulation.
Take practice questions that test your ability to recognize critical patient changes that require immediate intervention.
These nursing NCLEX® questions expect that you understand basic concepts such as Maslow's Hierarchy of Needs. You will also be expected to apply your knowledge to complex clinical scenarios, particularly those related to management of care, safety and infection control, and physiological integrity. Pay close attention to key details in question stems, such as vital signs, lab results, and medications. These are usually indicators of what you need to look for when selecting your answers. Other important areas to focus on are priority questions that have you identify the most critical patient needs and select the most appropriate interventions. Practice questions that require you to delegate actions and tasks to varying levels of healthcare professionals. Practice clinical scenario questions that apply your nursing knowledge to realistic patient situations. Finally, make sure you take a lot of medication administration questions, as these tend to hit almost every area of nursing NCLEX® questions and can assess every level of the clinical judgment process.
The Bottom Line
Your plan for NCLEX® should be to take 200-400 questions per day, every day, until your scheduled testing day. Also, do NOT wait to take the NCLEX® exam. You are never more ready to take the NCLEX® than when you have just completed nursing school. Nursing school exams are designed to align with the NCLEX® and force you to critically think so being in the mindset of answering nursing school style questions helps you to be successful!
If you’re considering which item types to include in your NCLEX® practice questions, the answer is all of them.
When studying, you can break the item types into two categories: NCLEX® Nex-Gen new item types and traditional NCLEX® item types.
Always remember that patient safety is at the core of each answer.
The Nex-Gen NCLEX® has a variety of item types, and if you’re considering which item types to include in your NCLEX® practice questions, the answer is ALL of them! It is an important part of your exam preparation to ensure that you study all areas of the exam — and with all item types that are included in the NCLEX®.Let’s break down the items types you will see on exam day and that you should incorporate into your NCLEX® practice questions. We are going to split this into two sections. The first section will cover all the NCLEX® Nex-Gen (NGN) new item types, and the second will cover the traditional NCLEX® item types.
NCLEX® Practice Questions: New Next-Generation Item Types
Extended Multiple Response
Select All That Apply (SATA)
The tester will select one or more answer options.
There can be up to 10 right answers.
There will be between five and 10 options to choose from.
Select N (Specified Number)
The question will tell the tester the number of items (N) that should be selected.
There can be up to 10 right answers.
There will be five to 10 options to choose from.
Multiple Response Grouping
Options are presented on a table, and the table can have two to five groupings.
Each grouping has two to four options, and the number of options for each grouping will be the same.
The tester will select at least one option from each group.
Matrix/Grid
Multiple Response
This is another way to present a SATA item type.
The item type has response columns, and each response column could have multiple correct responses.
The question will have two to 10 columns and four to seven rows.
Each column must have one response option selected, but one or all options can be correct.
Multiple Choice
This item type will have one correct answer per row and is another way to present a multiple-choice question.
The item type will have four to 10 rows and have two to three columns.
Drag and Drop
Drag and Drop Cloze
Will have one to two sentences of information with drag and drop options the user will use to complete the sentence(s).
Drag and Drop Rationale
Will have one sentence with one cause and one effect OR one sentence with one cause and two effects.
Drop Down
Drop Down Cloze
Will have one to two sentences of information with one or more dropdown options from which to complete the sentence(s).
Drop Down Rationale
Includes one sentence with one cause and one effect OR one sentence with one cause and two effects.
Drop Down in Table
These item types will have a table of information with drop down options in different parts of the table.
Highlight
Highlight in Text
This item type will have a paragraph of information.
The tester will highlight parts of the text based on what the question is asking.
Highlight in Table
This item type will have a table of information.
The tester highlights part of the text within the table based on what the question is asking.
Bowtie
These questions will look like a bowtie.
Will have five options on the left side, five options on the right side of the bowtie (wells), and four options in the middle.
Unfolding Case Study
These types of questions will trend information.
They will give information over time in a medical record or flow sheet requiring evaluation.
All case-studies will have six parts or phases.
The tester will review the information and answer questions throughout each part or phase.
The unfolding case studies can use any question type and will test the user on all six clinical judgment categories.
NCLEX® Practice Questions: Traditional Item Types
Multiple Choice
Standard question format with one correct answer.
Multiple Choice – SATA
Select multiple correct answers.
Remember SATA questions can have only one option correct, or they may have all options as correct.
Hot Spot
Select specific areas on a graphic image.
For example: The nurse is caring for a client prescribed digoxin and is ordered to take the client’s apical pulse. Where on the above figure does the nurse place the stethoscope to listen? Click the correct area to assess the apical pulse.
Fill-in-the-Blank
Calculate and input numerical values.
These are dosage calculation questions.
Drag and Drop – Ordered Response
Arrange answers in a specific order.
Chart/Exhibit Item
Analyze data/information presented in charts or exhibits and answer questions from that information.
Audio Item
The tester will listen to audio clips and select answers based off of what they are hearing.
Graphics Item
The tester will answer questions based on graphical content provided.
The Bottom Line
Remember the NCLEX® is always going to test you on the same thing, whether or not can you practice nursing safely. The purpose of the exam is to ensure you are a safe, entry-level nurse who can provide safe patient care and not harm people. So, answer your NCLEX® practice questions (and the questions on exam day!) in that way. Ask yourself: which is the safest action? Is this a safe dose? Which action prevents harm? Who do you need to see first because they are at the greatest risk of harm? Keep safety at the center and you will pass the NCLEX® with flying colors!
[post_title] => Include These Item Types in Your NCLEX® Practice Questions
[post_excerpt] =>
[post_status] => publish
[comment_status] => open
[ping_status] => open
[post_password] =>
[post_name] => nclex-practice-questions-item-types
[to_ping] =>
[pinged] =>
[post_modified] => 2024-12-12 21:46:57
[post_modified_gmt] => 2024-12-12 21:46:57
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://nclex-review.com/?p=813
[menu_order] => 0
[post_type] => post
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
)
[post_count] => 3
[current_post] => -1
[before_loop] =>
[in_the_loop] =>
[post] => WP_Post Object
(
[ID] => 841
[post_author] => 3
[post_date] => 2025-01-15 06:45:56
[post_date_gmt] => 2025-01-15 06:45:56
[post_content] =>
On April 1, 2023, the NCSBN NCLEX® launched a major overhaul called the Next Generation NCLEX®, also known as Next-Gen NCLEX® or NGN.
The updated exam includes a clinical judgment model and new question item types.
However, the exam is still administered using computer-adaptive testing.
You’ve probably heard the National Council of State Boards of Nursing (NCSBN) completed a major change to the National Council Licensure Examination (NCLEX®) in 2023. On April 1, 2023, the NCSBN NCLEX® launched a major overhaul called the Next Generation NCLEX®, also known as Next-Gen NCLEX® or NGN. The change resulted in several updates and additions, with the goal of improving test functionality and providing a better way to evaluate the tester’s clinical judgment and safety as an entry-level nurse.New additions to the 2023 NCLEX® included:
Incorporating the NCSBN Clinical Judgment Measurement Model (CJMM);
Adding new question item types;
Adding updated scoring; and
Increasing the total number of NCLEX® questions on the exam.
What’s the Clinical Judgment Measurement Model?
The clinical judgment model ensures that the tester can be a safe practicing nurse and is incorporated throughout the NCLEX® exam. The model also is being used in residency programs, preceptorships, and for new graduate orientation. Previously, the NCLEX® utilized the nursing process within the eight client need categories (Management of Care, Safety and Infection Control, Health Promotion and Maintenance, Psychosocial Integrity, Basic Care and Comfort, Pharmacological and Parenteral Therapies, Reduction of Risk Potential, and Physiological Adaptation). With the addition of the clinical judgment model, we have created this image to help you visualize the way it connects with the nursing process and what each means:Clinical judgment begins with recognizing cues, then analyzing those cues, prioritizing hypotheses based on those cues, generating solutions to those hypotheses, taking action while prioritizing the most important client needs first, and, finally, evaluating the outcomes of those actions.
Exploring the Next-Gen NCLEX® Question Item Types
But don’t forget about the new question item types that were added to the exam. The NGN NCLEX® will include three unfolding case studies in every exam. The tester will have to answer a series of questions via different item types. The case study will “unfold” and questions will apply to each of the new areas. There will also be bowtie questions; new multiple response item types that include Select All That Apply (SATA), select N, and multiple response group; and highlight questions that include highlight test and highlight table. Drag-and-drop questions that have the tester complete a sentence have also been added. Some questions will require you to complete one to three sentences, and others will be a rationale sentence that will be a cause-and-effect statement. Like drag and drop, there will also be drop-down questions where the tester will complete the sentence selecting from the drop-down options. Finally, there are now matrix grid questions where users will select answers in a matrix set. For more information on the new item types, reference our previous blog, “Include these Item Types in Your NCLEX® Practice Questions.”The NCSBN NCLEX® also updated the scoring for all item types. This ensures partial credit for multiple-part questions, including SATA. There are now four types of scoring models used in the NCSBN NCLEX®-RN. Partial credit scoring is used for items with more than one key. There will be three methods for scoring items for partial credit: plus/minus, zero/one, and rationale scoring.
Traditional Scoring
The “original” NCLEX® scoring type.
This scoring type means you either get the question right or wrong, there is no partial credit.
0/1 Scoring
Partial Credit Scoring Type.
With 0-1 scoring, the tester earns one point for each correct response picked and they earn zero points for each incorrect response picked. The total score for a multi-point item is the sum of all correct responses.
+/- Scoring
Partial Credit Scoring.
The tester earns one point for each correct response picked and also will subtract one point for each incorrect response picked. The total score for a multi-point item is the sum of all positive and negative points. *Negative total scores are a 0, there are no negative scores.
Rationale Scoring
The tester earns points when both responses in the pair are correct. This is applied to items that require a full understanding of paired information (e.g., cause/effect relationships).
The maximum number of questions for the Next-Gen NCLEX® also increased. The new NCLEX® has 85-150 scored questions (including 15 unscored pretest questions). It was previously 75-145 on the old version.
What Hasn’t Changed on the Next-Gen NCLEX®
The NCLEX® continues to be administered using computer-adaptive testing. This means the computer re-estimates the candidate's ability after each item is answered, based on the difficulty of the item and the candidate's previous answers. The computer then selects the next item for the candidate that is most optimal based on their previous responses. This ensures that the next item is neither too easy nor too hard, and the examination can obtain maximum information about the candidate's ability from the item. Candidates should find each item challenging because the items are targeted to their ability level. After each item is answered, the computer's estimate of the candidate's ability becomes more precise.The test also continues to be a pass/fail exam and remains timed with a five-hour limit. The exam will automatically shut off if the tester reaches the maximum time and/or maximum number of questions. The exam will then be scored, and a pass/fail result is given to the user.
The Bottom Line
Regardless of what has changed or what has remained the same, the NCLEX® still tests your abilities to be a safe practicing entry-level nurse. Preparation is key to passing the exam. Make sure you select a preparation like Slone NCLEX that will provide you with the structure, organization, and variety that mirrors the Next-Gen NCLEX®. Setting yourself up for success is what will make you the most confident on test day. Focus hard and prepare and you will do great!
