[Pillar Infographic: The 6 NGN Question Types with Examples — Visual Overview]
What Is the Next Generation NCLEX (NGN)?
The Next Generation NCLEX (NGN) is the updated version of the NCLEX exam, launched in April 2023 by the NCSBN. It replaces multiple-choice-only testing with a broader set of item types specifically designed to measure clinical judgment — the thinking skills a safe nurse needs from day one.
The NGN is not a harder exam in terms of content knowledge. It is a different type of thinking challenge. Nurses who understand clinical reasoning and practise with NGN-style questions perform consistently well.
📝 What Changed and What Did Not
Changed: 6 new question types, case study format, clinical judgment scoring model
Did not change: Core nursing content (pharmacology, Med-Surg, OB, Peds, etc.), Computer Adaptive Testing, question count range, test duration
Why Did the NCLEX Change?
Research by the NCSBN found that newly licensed nurses were arriving in clinical settings with adequate knowledge but insufficient clinical judgment — the ability to assess, prioritise, and respond to patient situations in real time. Practice errors were linked to judgment deficits, not knowledge deficits.
The NGN was designed to screen for clinical judgment before licensure, not just after. This makes it a better test of entry-level nursing competence — and a more challenging test for candidates who only studied facts.
The 6 New NGN Question Types
Extended Multiple Response
Select more than one correct answer from a longer list. More complex than standard SATA — partial credit scoring.
Extended Drag-and-Drop
Place multiple items into categories or ordered sequences. Tests pattern recognition and prioritisation.
Cloze (Drop-Down)
Complete a sentence or table by selecting from drop-down menus. Often embedded in a nurse's note format.
Enhanced Hot Spot
Click on a part of an image (body diagram, chart, or lab result) to identify the most significant finding.
Bow-Tie Item
Connect assessment findings → nursing action → outcomes. The most complex NGN item type. Tests integrated clinical reasoning.
Trend Item
Analyse a patient's clinical data across time (shift notes, vital sign trends, lab changes) and determine what action is needed.
Deep-dive guide: All 6 NGN Item Types Explained with Examples →
The Clinical Judgment Measurement Model (CJMM)
NGN questions are based on the NCSBN Clinical Judgment Measurement Model (CJMM) — a 6-layer thinking framework that mirrors how expert nurses process clinical situations:
- Recognise Cues — What information is relevant?
- Analyse Cues — What do these cues mean clinically?
- Prioritise Hypotheses — What is the most likely patient problem?
- Generate Solutions — What should be done?
- Take Actions — Which intervention is priority?
- Evaluate Outcomes — Is the intervention working?
Full guide to Clinical Judgment and the NGN →
How NGN Scoring Works
The NGN uses partial credit scoring for many new item types. This means you can earn points for partially correct answers — unlike traditional all-or-nothing multiple choice. Understanding this changes your test-taking strategy: never skip complex items, because partial credit is available.
How to Prepare for the NGN in 2026
- ✓ Use study materials explicitly built for the NGN format (our course is NGN-first)
- ✓ Practise all 6 new item types, not just standard SATA
- ✓ Learn the CJMM — apply it to every question you practise
- ✓ Complete full case studies, not just isolated questions
- ✓ Do not rely on test-taking tricks from pre-2023 materials
Free NGN Practice Resources
Free NGN Practice Questions
20 NGN-style questions covering all 6 item types with full rationales.
NGN Case Study Walkthrough
Step-by-step walkthrough of a complete NGN case study.
Clinical Judgment Guide
Understanding and developing the CJMM for NCLEX success.
Free Download: NGN Question Type Cheat Sheet
All 6 NGN item types explained with examples — print-ready PDF.