What are Next Gen NCLEX® Practice Questions?
- When preparing for the NCLEX®, you need to practice with Next Gen NCLEX® practice questions in addition to traditional NCLEX® practice questions.
- The Next Gen NCLEX® practice questions are intended to mimic real-life scenarios you’ll encounter in the field.
- Consider the unfolding case study presented here as an example of what to expect on exam day.
In 2023, the National Council of State Boards of Nursing (NCSBN) introduced the Next Generation NCLEX® (NGN). This new version of the exam was designed to better assess nursing candidates’ clinical judgment and decision-making abilities. The NCSBN added new question formats that closely mimic real-world scenarios nurses will encounter in their daily practice. The NGN enhances the exam’s relevance to the modern demands of nursing.
The primary goal of this change was to place a greater emphasis on evaluating candidates’ abilities to make clinical judgments in complex situations, which is essential for ensuring safe nursing practice. The NGN includes new question formats such as case studies, matrix questions, and bowtie questions.
These new item types require you to analyze information and make decisions based on the presented scenarios. Unlike the previous NCLEX®, the NGN also now allows for partial credit on certain questions. This enables a better assessment of your nursing knowledge. The new exam aims to present scenarios that reflect the actual situations nurses face in practice, incorporating relevant lab values and reference ranges.
When preparing for the NCLEX®, you need to practice with Next Gen NCLEX® practice questions in addition to traditional practice questions. The new next-generation item types include Extended Multiple Response, Matrix/Grid, Drag and Drop, Drop Down, Highlight, and Bowtie.
The NGN has also introduced the unfolding case study, which presents a client scenario in six stages. You will start with a scenario and answer a question based on that information. You will then receive more information progressively and will be required to make clinical decisions based on the unfolding details.
This format simulates real-life client care situations and necessitates the identification of cues, analysis of cues, prioritization of hypotheses, generation of solutions, actions taken, and evaluation of outcomes. The purpose of these unfolding case studies is to assess your clinical judgment throughout the scenario.
Unfolding case studies present information over time, often displayed in medical records or flow sheets that require evaluation. The tester will review the information and answer questions throughout these phases. Unfolding case studies can include various question types, including both traditional and next-generation NCLEX® item types, assessing the user across all six clinical judgment categories.
To illustrate what to expect on exam day, consider this unfolding case study — one of several next gen NCLEX® practice questions you can find in prep programs like Slone NCLEX®. For the purposes of this blog, we will present the information using only traditional item types to make it easier to read and understand.
Scenario:
A 52-year-old presents to the emergency room via ambulance with chest pain, shortness of breath, and jaw pain. Vital signs are BP 118/70 mmHg, HR 108 bpm, RR 28 breaths/min, SpO2 is 94% on 2L nasal cannula.
Question 1: Recognize cues
Based on the initial presentation which of these cues would be most important to investigate further to determine the potential underlying cause?
- A: Complaints of chest pain and dyspnea
- B: Heart Rate
- C: Blood Pressure
- D: Oxygenation
Next information provided:
The patient is administered a 12-lead ECG and had labs drawn. Electrocardiogram (ECG) shows ST-segment elevation in the anterior leads. Lab values are as follows:
Troponin T:
- 28 ng/mL
Complete Blood Count (CBC):
- WBC (4.5–11.0 mm 3) 5.8
- Hgb (12–16 g/dL) 11.2
- HCT (36%-48%) 32%
- Platelets (150-450 x103/µl) 150
- Neutrophil % (42–72) 65
- Band forms (3–5%) 0
Basic Metabolic Panel (BMP):
- Sodium (135–145 mEq/L) 142
- Potassium (3.5–5.0 mEq/L) 4.8
- Glucose (70–110 mg/dL) 140
- BUN (7–25 mg/dl) 26
- Creatinine (0.6–1.2 mg/dL) 1.6
- Chloride (96-106 mEq/L) 100
- Calcium (8.5-10.5) 9.0 mEq/L
Question 2: Analyze cues
Based upon the information presented, the nurse identifies which finding as the most concerning and requiring immediate action?
- A: ST-Elevation
- B: Troponin of 28 ng/mL
- C: WBC of 5.8 mm 3
- D: Creatinine 1.6 mg/dL
Next information provided:
The client is very anxious and cries to the nurse, “What is happening?”
Question 3: Prioritize Hypotheses
Based on the initial presentation and ECG findings, what does the nurse identify as the likely diagnosis for this client?
- A: Myocardial infarction
- B: Pulmonary embolism
- C: Panic Attack
- D: Infected oral abscess
Next information provided:
The patient is given nitroglycerin sublingual x 2 doses. The client states that their chest pain has slightly improved.
Question 4: Generate Solutions
What is the next appropriate nursing intervention based on the patient’s response to nitroglycerin?
- A: Administer morphine sulfate
- B: Contact the healthcare provider immediately
- C: Monitor vital signs and continue to assess pain level
- D: Start an IV fluid bolus
Next information provided:
The nurse calls the provider and updates them on the client’s assessment, lab results, and response to medication. The provider places the following orders.
Question 5: Take Actions
Which of the following orders does the nurse complete first?
- A: Prepare the client for cardiac catheterization.
- B: Obtain repeat troponins every four to six hours.
- C: Reconcile the client’s medication history.
- D: Initiate a 1000mL fluid bolus.
Next information provided:
The client is admitted to the cardiovascular step-down unit after having a cardiac catheterization where they had two drug-eluding stents placed in their coronary arteries.
Question 6: Evaluate Outcomes
The nurse is providing education to the client on coronary artery disease and the prevention of further myocardial infarctions. Which of the following statements by the client indicates an understanding of the teaching for this client?
- A: “I will avoid exercising, so I don’t strain my heart.”
- B: “I will take my clopidogrel if I have any chest pain.”
- C: “Now that I have stents in place, I will feel 100% better.”
- D: “I will avoid adding any salt to my foods when cooking.”
The correct answers are:
- A
- A
- A
- B
- A
- D
The Bottom Line
When gearing up to take the NCLEX®, it is crucial to incorporate Next Gen NCLEX® practice questions into your study routine. These questions place a significant emphasis on clinical judgment and complex scenarios, reflecting the scenarios you will endure as a nurse. It’s important to recognize that relying solely on traditional practice questions will not fully equip you for the challenges you’ll face on test day.
Engaging with Next Gen NCLEX® practice questions, such as detailed case studies like the one above, will not only help you become familiar with these new question formats but also enhance your critical thinking abilities. This preparation is essential for navigating the exam, helping you to be comfortable on exam day, and ultimately achieving success.