NCLEX › Next Generation NCLEX
Next Generation NCLEX (NGN) question types, explained
Short answer: the Next Generation NCLEX (launched April 1, 2023) measures clinical judgment with unfolding case studies and new item types such as bowtie, matrix, cloze, highlighting and trend items, and gives partial credit on items with more than one correct answer.
The six clinical judgment steps
NCSBN's Clinical Judgment Measurement Model breaks a decision into six steps. Each case study has six items, one per step, about the same client as new information unfolds.
| Step | The question behind it |
|---|---|
| Recognize cues | What matters in the data? |
| Analyze cues | What could it mean? |
| Prioritize hypotheses | What is most likely and most urgent? |
| Generate solutions | What outcomes and actions fit? |
| Take action | What do you do now? |
| Evaluate outcomes | Did it work? |
NCLEX item types
| Item type | What you do and how it is scored |
|---|---|
| Multiple choice | One correct answer. Scored zero/one. |
| Multiple response: select all that apply | One or more correct answers. Scored plus/minus: a point for each correct choice, minus one for each incorrect choice, never below zero. |
| Multiple response: select N | Choose a set number of answers (for example, "select 3"). Scored zero/one per correct choice. |
| Extended multiple response | A longer list where you select every option that applies; partial credit. |
| Matrix / grid | A table where you choose one or more options per row (for example, "indicated" or "not indicated" for each action). |
| Cloze (drop-down) | Choose the right word or phrase from drop-down menus inside a sentence, table or chart. |
| Highlighting (enhanced hot spot) | Highlight the parts of a nurse's note or chart that matter for the question. |
| Extended drag and drop | Drag options into place, such as ordering steps or matching findings. |
| Bowtie | A drag-and-drop item: the condition the client is most likely experiencing in the middle, actions to take on one side, parameters to monitor on the other. |
| Trend | You review data over time (vital signs, labs, notes) and answer using the change, not a single value. |
Item type names follow NCSBN's own list. NCSBN's free item types tutorial lets you try each one with the real on-screen tools.
How partial credit works
Plus/minus applies when you choose an unspecified number of options, like select all that apply: +1 for each correct choice, -1 for each incorrect choice, minimum zero. Zero/one applies when the item tells you how many to choose: +1 for each correct choice, nothing for incorrect ones. Rationale scoring applies to paired answers: both parts must be right to earn the point.
Practical takeaway for SATA: judge every option on its own as true or false for this client. Guessing extra options can cost you points.
Practice SATA and multiple-choice questions
Start with our free SATA practice set, then keep going in the app: 600+ NCLEX-style questions with rationales.
Get NurseLingo freeFrequently asked questions
When did the Next Generation NCLEX start?
NCSBN launched the Next Generation NCLEX on April 1, 2023. The 2026 test plans kept the same format.
How many case studies are on the NCLEX?
Three case studies of six items each are part of every minimum-length exam (18 case study items), alongside 52 other scored items and 15 unscored pretest items.
Is there partial credit on the NCLEX?
Yes. Items with more than one key earn partial credit using plus/minus, zero/one or rationale scoring.
Were new question types added in 2026?
No primary NCSBN source announces a new item type for 2026.
Sources
- NCSBN launches the Next Generation NCLEX
- Next Generation NCLEX (nclex.com)
- Clinical Judgment Measurement Model (nclex.com)
- Dickison, Next Generation NCLEX Update (NCSBN 2021, archived)
- NCLEX Item Types Tutorial (Pearson VUE)
- NCLEX FAQ
- 2026 NCLEX-RN Test Plan
- NCSBN 2026 Annual Meeting Business Book
Facts checked 2026-10-10 against NCSBN, nclex.com and Pearson VUE documents. NurseLingo is not affiliated with NCSBN.