What Is the Next Generation NCLEX (NGN)? Item Types & Scoring Explained

By the Asaclex Review faculty · Aligned with the 2026 NCLEX-RN test plan

The Next Generation NCLEX changed how nursing candidates are tested — moving from "do you know the fact?" to "can you make the clinical decision?" Here is exactly what that means, every item type you will see, and how the new scoring works.

What the NGN is — and why it changed

The Next Generation NCLEX (NGN) launched on April 1, 2023. It was built by the NCSBN to measure something traditional multiple-choice questions struggle to capture: clinical judgment — the ability to notice what matters in a patient situation and decide what to do about it.

NGN is built on the Clinical Judgment Measurement Model (CJMM), which breaks clinical reasoning into six steps. Most NGN case studies ask one question per step:

The NGN item types

NGN keeps standard multiple-choice questions but adds richer formats, usually presented with a realistic patient chart (nurses' notes, vital signs, labs, and orders) on a split screen.

Unfolding case studies

A single patient scenario that develops over six linked questions — one for each clinical-judgment step. You will typically see a few of these on exam day, and they carry significant weight.

Stand-alone item formats

• Extended Multiple Response (SATA): select all that apply, sometimes "select N."
• Extended Drop-Down (Cloze): complete sentences by choosing from drop-down menus.
• Matrix / Grid: mark choices across rows and columns (e.g., expected vs. unexpected).
• Highlight: click the words or rows in a chart that are clinically significant.
• Drag-and-Drop: place items into the correct order or category.
• Bow-Tie: a stand-alone item linking actions, a priority condition, and parameters to monitor.

How NGN scoring works

This is the biggest practical difference. Traditional NCLEX items are all-or-nothing. Many NGN items award partial credit, using three models:

• Plus/Minus (+/−): each correct selection earns a point, each incorrect one loses a point (your score can't go below zero). Guessing every option is not a strategy.
• 0/1 (dyad / all-or-nothing): you must get the full item right to earn the point.
• Rationale scoring: points depend on correctly pairing elements — for example, matching a condition to the right supporting findings and actions.

The takeaway: you are rewarded for sound reasoning even when an item is partly right, so careful, evidence-based selection beats guessing.

How to prepare for NGN questions

Reading about clinical judgment isn't enough — it has to be practiced in the exam's actual formats. Effective preparation looks like:

• Working through realistic unfolding case studies that move through all six judgment steps.
• Getting comfortable with each interface (highlight, matrix, drop-down, bow-tie) so the format never surprises you.
• Reviewing a detailed rationale after every item — understanding why an answer is right is what transfers to exam day.
• Tracking which clinical-judgment steps you miss most, and drilling those.

Frequently asked questions

When did the Next Generation NCLEX start?

The NGN launched on April 1, 2023, adding new item types and clinical-judgment case studies to the NCLEX-RN and NCLEX-PN.

What are the NGN item types?

Unfolding case studies plus Extended Multiple Response (SATA), Extended Drop-Down (Cloze), Matrix/Grid, Highlight, Drag-and-Drop, and Bow-Tie.

How are NGN questions scored?

With partial-credit models — Plus/Minus, 0/1, and Rationale scoring — so a partly correct answer can still earn points.

How do I prepare for NGN questions?

Practice realistic case studies in the real item formats and review rationales. Asaclex Review's 60+ NGN cases are built for exactly this.