How to Approach the NGN NCLEX®
- The Next Generation NCLEX (NGN NCLEX®) has brought changes to the exam experience that could require you to change your study approach.
- The design now mirrors real-world nursing practice and includes helpful features like partial credit for certain question types.
- Consider the sample scenario as explained by Slone NCLEX Professor Tanya Killian.
The Next Generation NCLEX (NGN NCLEX®) has brought some exciting changes to the exam experience, showing much higher pass rates than the traditional NCLEX.
In 2023, the year the NGN made its debut, the pass rates were 88.56% for the NCLEX-RN® and 92.10% so far for 2024. That’s a big improvement! Just to compare, before the NGN NCLEX® rolled out in 2022, the pass rate for NCLEX-RN® was 79.9%.
This increase is largely attributed to the NGN design, which mirrors real-world nursing practice and includes helpful features like partial credit for certain question types. The NGN NCLEX® employs an improved format for its questions, focusing on a more scenario-based approach that frequently incorporates case studies.
This method is believed to better evaluate candidates’ clinical judgment and decision-making skills.
To successfully pass the NGN NCLEX®, you must have a comprehensive understanding of the exam structure and its content.
Here are a few key NGN NCLEX® areas you should focus on:
- Know the Exam Format: Understand NGN NCLEX® structure, including the types of questions, both the traditional types (such as multiple-choice questions) and the new item types (such as case studies and drop-down questions) and how they evaluate clinical judgment.
- Create a Study Plan: Develop a structured study schedule covering all essential nursing concepts, prioritizing areas needing more practice. Use memory aids like mnemonics to retain important information and nursing principles. Identify the areas where you struggle and focus your study efforts on those topics.
- Practice with NGN Questions: Use practice exams and question banks specifically created for the Next Generation NCLEX® to become familiar with the question style and format.
- Join Study Groups: Collaborate with peers to discuss complex topics and gain different perspectives on nursing concepts.
- Apply Clinical Knowledge: Remember to leverage your real-world nursing experience and clinical judgment when answering questions. Always, keeping in mind that the NCLEX® will test you on perfect-world nursing, having all resources available.
- Understand the Clinical Judgment Measurement Model (NCJMM): Familiarize yourself with this model, as it is the foundation of the NGN, outlining the decision-making process. Remember the clinical judgment categories: Recognize cues, analyze cues, prioritize hypotheses, generate solutions, take actions, and evaluate outcomes.
- Manage Test Anxiety: Practice relaxation techniques and employ time management strategies to stay calm during the exam.
If you’re wondering about the best way to approach the NGN NCLEX®, the answer is with peace of mind knowing that the NGN NCLEX® is for your benefit.
To further help you understand the NGN NCLEX®, let’s complete this case study together.
Scenario: The client presents to the emergency room with new-onset, right-sided facial drooping and weakness. They are alert and oriented to person, place, and time but are unable to explain why they are in the hospital. The client follows commands appropriately but shows distinct weakness on the right side. When asked to smile, facial drooping is noted on the right side. Drooling from the right side of their mouth. The client is able to maintain eye contact and no visual loss is noted. Their National Institutes of Health Stroke Scale (NIHSS) score is 8. Lung sounds are clear throughout, and peripheral pulses are +1 in all extremities, with pitting edema noted in the bilateral lower extremities. S1 and S2 heart sounds noted. The abdomen is soft and nontender, and the client voided x 1 and urine was amber in color.
1. Recognize Cues: A nurse is assessing the client. Highlight the findings that require immediate follow-up.
The client presents to the emergency room with new-onset, right-sided facial drooping and weakness. They are alert and oriented to person, place, and time but are unable to explain why they are in the hospital. The client follows commands appropriately but shows distinct weakness on the right side. When asked to smile facial drooping is noted on the right side. Drooling from the right side of their mouth. The client is able to maintain eye contact and no visual loss is noted. Their NIHSS score is 8. Lung sounds are clear throughout, and peripheral pulses are +1 in all extremities, with pitting edema noted in the bilateral lower extremities. S1 and S2 heart sounds noted. The abdomen is soft and nontender, and the client voided x 1 and urine was amber in color.
Added Information:
Vitals: BP 128/88, HR 97, RR 19, T 37.0 C (98.6 F), SpO2 95% on RA, Pain is stated as being a 0/10.
Nurse’s Notes:
Day 1: 0945- Client is having a difficult time swallowing; when attempting to administer morning medications the client coughs trying to swallow liquids and medications.
Day 1 Labs:
Urinalysis –
Color- (Normal-Yellow) Amber
Clarity (Normal-Clear) Clear
Glucose (Negative mg/dL) Negative
Bilirubin (Negative mg/dL) Negative
Ketones (Negative mg/dL)
Specific Gravity (1.005-1.035) 1.016
Blood (Negative-Trace mg/dL) Negative
pH (5.5-8.5) 7.5
Protein (Negative-10 mg/dL) Negative
Urobilinogen (<2.0 mg/dL) <2.0
Nitrate (Negative0 Negative
Leukocyte Esterase (Negative leu/uL) Negative
2. Analyze Cues: Based off of the information the nurse recognizes the client is at risk for which of the following conditions?
A. Urinary tract infection
B. Aspiration
C. Hypoxia
D. Hypertenstive crisis
Added Information:
Provider Orders:
Admit to critical care unit
Administer alteplase: 0.9 mg/kg. The total dose should not exceed 90 mg. 10% of the total dose gets administered as an intravenous (IV) bolus over 1 minute, infuse remaining over 60 minutes.
3. Prioritize Hypotheses: The nurse is reviewing the client’s medical record. Which of the following areas does the nurse identify as the priority? (select 4)
A. Elimination
B. Maintaining a Patent Airway
C. Skin Breakdown
D. Risk for bleeding
E. Neurological status
F. Fall risk
Added Information:
Nurse’s Notes:
Day 2: 1045- While assessing the client, they became frustrated when they were trying to express their thoughts. Speech is slurred and the client is unable to say familiar words. The client continues to cough when swallowing and has right-sided weakness with the right arm being flaccid.
4. Generate Solutions: When planning care for this client, the nurse identifies which of the following nursing interventions as anticipated (A) or contraindicated (C)?
- Initiate using straws and thin liquids for this client. (A or C)
- Request a speech therapist evaluation (A or C)
- Initiate swallowing precautions for this client (A or C)
- Place the client on fall precautions (A or C)
- Use picture boards to help the client communicate (A or C)
- Encourage the family to finish the client’s sentences when they are having difficulty communicating. (A or C)
Added Information:
Day 3: Vital signs: BP 108/74, HR 101, T 39 C (102.2 F) RR 21, SpO2 90% on room air, client states pain is 0/10.
Nurses Note:
Day 3 1100- The client is alert and orientated x 4. Speech is clear and the client responds with appropriate words and is able to communicate without delay. Course crackles are noted in bilateral lung bases. The client continues to cough when swallowing liquids and their voice is hoarse. NIHSS score is 4.
Provider orders: Based off of speech language pathologist report, client placed on full liquid diet with honey-thickened liquids. Repeat swallow evaluation ordered for next week.
5. Take Actions: Based off of the information from the client’s electronic medical record, which of the following actions does the nurse take? (Select all that apply)
A. Place food on the right side of the client’s mouth
B. Sit client at 45 degrees when eating
C. Encourage the client to use their incentive spirometer
D. Request a chest X-ray
E. Ensure all liquids are honey consistency
F. Request a supplemental oxygen order
Added Information:
Nurses Notes:
Day 3: 1200- The client is being seen by the social worker to discuss discharge planning.
Evaluate Outcomes: Based off of all the information above, which findings indicate that the client has improved (I) or declined (D) in condition since they were brought into the emergency room.
- Oxygen saturation (I or D)
- NIHSS score (I or D)
- Temperature (I or D)
- Communication (I or D)
Correct Answers:
- Recognize cues: new-onset right-sided facial drooping, unable to explain why they are in the hospital, distinct weakness on the right side, facial drooping is noted on the right side. Drooling from the right side of their mouth.
- Analyze Cues: B- Aspiration
- Prioritize Hypotheses: B (Patent Airway), D (Risk for Bleeding), E (Neuro status), F (fall risk)
- Generate Solutions: C, A, A, A, A, C (Contraindicated, Anticipated, Anticipated, Anticipated, Anticipated, Contraindicated)
- Take Actions: B, D, E, F
- Evaluate Outcomes: D, I, D, I (Declined, Improved, Declined, Improved)