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NextGen NCLEX Test Bank

The purpose of this project was to develop a repository of nextgen nclex questions that can be accessed by all faculty and students in maryland..

The questions can be used by faculty to prepare students to understand the new format of Next Generation (NextGen) test items that are like those that will be used by the National Council of State Boards of Nursing (NCSBN) licensing exam beginning in April 2023 to test students’ ability to make clinical judgments.

Disclaimer: The items in the test bank are accessible to all through this nonsecure website. The test questions are not recommended to be used for summative assessments.

The test bank is composed of case studies with six questions each that follow the NCSBN Clinical Judgment Measurement Model steps:

• recognize cues
• analyze cues
• prioritize hypotheses
• generate solutions
• take action
• evaluate outcomes.

In addition, seven questions for reviewing bow-tie or trend items are included. All case studies were subjected to rigorous review both by the project team and subject matter experts.

The names of the case studies are provided with hyperlinks to all items.

• Using the Maryland NextGen Test Bank
• Student Instructions for Using the Test Bank

NCLEX Next Gen Test Bank

Next Generation NCLEX An Enhanced NCLEX

The NGN Project

The NGN launched on April 1, 2023 to better measure nursing candidates’ clinical judgment and decision making abilities through the use of innovative item types. The need to measure this stemmed from information gathered during the 2013-2014 NCSBN Strategic Practice Analysis, which showed newly licensed nurses are increasingly expected to make complex decisions while caring for patients.

The Development Process

As part of the NGN project, NCSBN conducted several phases of research that are shown in the model. If the evidence during any individual step indicated that potential innovations would not support the rigor and quality of the NCLEX, the project was reexamined at all levels.

Clinical Judgment Measurement Model

Clinical judgment is critical to nursing. NCSBN developed a model to measure clinical judgement that can also be used as a way of thinking and teaching

Be Prepared for the NGN

The NCLEX now includes next generation features, using real-world case studies to measure a nurse's ability to think more critically and make the right decisions.

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Next Generation NCLEX

The NCLEX exam, short for National Council Licensure Examination , is the licensing exam that nurse graduates must pass in order to legally practice nursing in the United States, Canada, and Australia.

Practical (or vocational) nurse graduates must pass the NCLEX-PN exam, and registered nurse graduates must pass the NCLEX-RN exam.

If you’re a nursing student who expects to graduate in the spring of 2023 or later, there are huge changes taking place with the NCLEX exam that you’ll want to know about.

Next Generation NCLEX (NGN)

The National Council of State Boards of Nursing (NCSBN) plans to release a new format of NCLEX called the Next Generation NCLEX , or NGN for short.

When Will The Next Generation NCLEX Go Into Effect?

The NCSBN plans to release the new Next Generation NCLEX format on April 1, 2023. So, unless the release date changes, those of you graduating in spring 2023 or later will likely get the new format.

What is the Next Generation NCLEX? What’s Changing?

All exam details are subject to change before the actual release date. However, one of the big changes that you’ll find on the Next Generation NCLEX is a shift toward case studies (also called scenarios) to help assess the critical thinking ability of test takers.

What’s a case study? It’s a created scenario that could happen in the real world of nursing that assesses the test taker’s ability to handle a particular nursing situation. The test taker is given information about a patient, their diagnosis, current assessment findings, medications, lab results, and a presenting problem.

Based on this information, the testing candidate will be asked several questions on how the nurse would response or deal with the situation. This type of question requires much more critical thinking and nursing knowledge, and it assess whether the person will be able to deliver good, quality patient care.

There will be approximately three case studies with 6 questions each, for a total of 18 items [3], in addition to other types of questions.

There will also be five new item types on the Next Generation NCLEX, including the following:

Extended Multiple Response – Although multiple response items such as SATA questions are on the current NCLEX, “Extended Multiple Response” will expand on the number of options for each question.

Extended Drag and Drop – These question types require you to drag a response into one of the blank answer spaces, and test takers will now have to determine whether they should use some or all of the options available.

Cloze (Drop-Down) – these are the drop-down options that allow you to select a correct response, and there can now be multiple drop-down boxes in a Cloze question type.

Enhanced Hot Spot – this enhanced item type allows you to select (or highlight) the relevant words or phrases from a sample medical record that correspond to the question.

Matrix / Grid – this item type features rows and columns with options that the candidate must select.

Next Generation NCLEX Scoring Changes

If any of that NCLEX news makes you nervous, I have some good news: the Next Generation NCLEX is also changing their scoring model to a polytomous scoring model, which means that you can now get partial credit on some questions with multiple inputs. This is different from the regular NCLEX model, which marked questions as “full credit” or “no credit” only.

And yes, this does include those dreaded “select all that apply” (SATA) questions!

The Next Generation NCLEX will use three different scoring models, depending on the question type [2]:

0/1 scoring means you earn a point for each correct option selected, and zero points when you select an incorrect option. The points are then added together for a total question score. This scoring type is used on questions such as multiple choice, matrix multiple choice, multiple response where you select a specified number of answers (select N), drop-down cloze, drop-down table, and bowtie questions.

+/- scoring means that you can earn a point when you select a correct option, but lose a point when you select an incorrect option. This method is used with select all that apply multiple response questions, matrix multiple response, and MR grouping questions.

Rationale scoring means that you only earn points when you select a response that reflects a proper understanding of the rationale of the question. In this format, you will select the paired options that logically follow (Example: A leads to B). Both options must be selected correctly to earn a point.

How Many Questions are on the Next Generation NCLEX?

Each candidate will receive a minimum of 85 and a maximum of 150 questions on the exam. However, 15 of those questions are pretest questions that are not scored, so test takers can expect between 70-135 questions that are actually scored on the Next Generation NCLEX exam [3].

The exact number of questions a test taker will receive varies because the NCLEX uses Computerized Adaptive Testing (CAT), which continues to provide questions of different difficulty levels based on the test taker’s previous responses.

The test taker will continue to receive questions until the computer can determine with 95% confidence that the individual either passed or failed the exam. The exam will also stop once time is up or the person reaches the maximum number of questions (135).

How Long Do I Have to Complete the Next Generation NCLEX Exam?

You will have 5 hours to complete the Next Generation NCLEX exam.

Can You Use a Calculator on NCLEX?

NCLEX currently allows you to use a provided calculator on the test screen, and this will likely continue for the Next Generation NCLEX.

Don’t Be Intimidated by the Next Generation NCLEX (NGN)

I know that some of you are stressed out about this new NCLEX format, but I don’t think you should worry about it at all.

Unlike the meme below, the NCSBN is not some evil organization with an agenda to torture nursing students with the fear of forever failing NCLEX. Instead, these individuals are professionals who want to ensure that you’re equipped with the proper knowledge so that you can offer great care and succeed in practice.

They have a very strict process whereby nursing instructors actually develop questions. Then those questions are peer-reviewed by actual nurses in practice, and they even pretest questions and gather statistics to ensure that the exam is accurate and ready to administer.

So this isn’t something slapped together on a whim by people who know nothing about the nursing profession. It is a long, reviewed process that is continually improved based on feedback and statistics.

How Should Nursing Students Prepare for the Next Generation NCLEX (NGN)?

So how should you prepare for the Next Generation NCLEX right now as a nursing student? First, so many people are asking, “What’s changing with NCLEX?” It’s great to know what’s coming and how the questions will be formatted, and I do think practicing some questions in similar NCLEX format can be helpful.

(For the record, the NCSBN even offers a mock NCLEX exam with actual questions from previous exams that you can take at NCLEX.com for a fee if you want to practice before the actual test.)

However, I wouldn’t spend too much time stressing about the new NCLEX format changes.

If you really want to succeed on NCLEX, you need to ask this question, ”What is NOT going to change about NCLEX?” And what’s not changing is the fact that they are trying to ensure that you know enough about nursing to think critically and make the right clinical decisions so that you can provide safe and effective patient care.

So your study strategy needs to have that focus from day one. How do you do that? I would still offer the same advice that I offered in my recent NCLEX Study Plan video.

1. Start studying as early as possible . I started studying hard during the break before my last semester.

2. Prioritize your weak areas . I talked about how you can assess your strengths and weaknesses through software and so forth.

3. Practice many NCLEX-style questions . I would practice 90-100 questions almost every day.

4. Go back and review questions and topics you keep missing . Look at the pathophysiology of diseases on questions you missed. Look up medications and their mechanism of action, and so forth. Go back and study those important details.

5. Switch between review lectures , textbooks, and notes when you are not practicing questions to help you understand the content in different ways. Your brain will appreciate the switch to different studying formats. In other words, when you are tired of reading, watch a lecture that covers similar topics.

In my review lectures , I always try to help you to understand not just the way something is done, but the “why” something is done. I spend time trying to explain the patho and rationale behind things so that you’ll understand it more deeply and be able to think critically on exams and in real-life nursing practice.

That’s the key to really passing NCLEX. They want you to know enough about nursing to think critically and make the right clinical decisions.

And if you put in the time to understanding those things, it doesn’t matter whether you get a drag and drop, hot spot question, select all that apply, or whatever. You’ll have the knowledge in your head, and you will be able to sift through and choose the correct option(s).

Final Thoughts on Next Generation NCLEX

In conclusion, don’t waste time worrying about the changes coming in Next Generation NCLEX . Instead, stay the course and put in the time studying and practicing questions, and you’re going to do great!

Even if you do fail your first time around, you have the opportunity to take it again, so go into the exam with confidence!

References:

1. https://www.ncsbn.org/11436.htm

2. https://www.ncsbn.org/15991.htm

3. https://www.ncsbn.org/16013.htm

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What You Need to Know About the Next Generation NCLEX (NGN)

What is nextgen nclex, when will next gen nclex start, why is the nclex changing, how is the nclex changing, next gen nclex test items.

• Where to Find More Information on NGN

There’s been a lot of buzz about the Next Gen NCLEX (NGN), especially among nursing students and educators. This nursing board exam update is “an exciting enhancement to an already rigorous exam.” And now, it’s just a few months away. 

This nurse’s guide to the Next Gen NCLEX explains the changes, what to expect, and where students can find additional resources. 

After nursing school, the next step to becoming a nurse is passing the National Council Licensure Examination ( NCLEX ). This exam validates the skills of graduate nurses. A passing score proves to the state boards that an individual has the entry-level knowledge and skills to practice safely and effectively in a clinical setting. 

The test changes periodically. The National Council of State Boards of Nursing (NCSBN) updates the test plans every three years to keep up with practice changes. However, the next update will be a significant overhaul of the current board exam. 

The NGN is the latest version of the NCLEX exam coming this spring. It will be administered the same way as previous exams but includes new question types and scoring models. 

The Next Gen text is designed to ask better questions and help nurses think critically to make the right decisions when providing care.

>> Related: What is the NCLEX?

The new NCLEX format goes into effect on April 1, 2023. As a result, students starting their nursing programs during or after Fall 2021 will take the Next Gen version for licensure. 

Both the NCLEX-RN for prospective registered nurses and the NCLEX-PN for prospective licensed and vocational nurses are changing.

NCLEX is changing to meet the growing demands of the healthcare system. Technologies are developing rapidly. Patients are experiencing more chronic and complex illnesses. The nurse’s job is more challenging today than ever, thanks to increasing regulations, litigation, and electronic EMRs. As the industry changes and patient needs evolve, nurses are increasingly tasked with making complex decisions . 

The NCSBN’s 2013-2014 Strategic Practice Analysis determined that better measurement of critical judgment was essential. Recent data supports the need to assess the critical judgment of graduate nurses better.  

Medical errors now rank as the third leading cause of death in the US

65% of entry-level nurse errors were related to poor clinical decision-making

50% of entry-level nurses were involved in practice errors

Only 20% of employers are satisfied with new nurses’ decision-making abilities

Clinical judgment is required in up to 46% of all tasks performed by entry-level nurses

The NCSBN defines clinical judgment as “the observed outcome of critical thinking and decision-making” It’s an iterative process that uses nursing knowledge to:

Observe and assess cues

Identify and prioritize concerns

Generate the best possible evidence-based solutions for safe care delivery

According to NCSBN, “NGN is about protecting the public and achieving the best outcomes for clients, nurses and institutions.”

Based on the 2013-2014 analysis, the national council developed new innovative question types to evaluate graduate nurses better. 

Those questions were tested as a “ special research section ” following NCLEX tests administered between July 2017 and December 2018. NCLEX-RN and NCLEX-PN exam candidates were given the option to complete the section evaluating clinical judgment ability. The majority of test-takers (85%) opted to take it. NCSBN used the results to prove the need for an exam revision and test the new item types.

The NGN test items attempt to simulate the work that nurses do daily. They evaluate the test taker’s critical thinking, judgment, and decision-making. Next Gen questions use case studies and patient scenarios that nurses will see in the real-life clinical setting.

Based on their analyses, the NCSBN approved new item types to measure nursing judgment on the NGN. 

Extended multiple-response

The extended multiple-response items allow candidates to choose more than one answer. It is similar to the traditional NCLEX multiple response; however, there are more answer options. 

Extended drag-and-drop 

Extended drag-and-drop items ask candidates to move or place responses into answer spaces. This type is similar to the current NCLEX ordered response question format, except that they may not use all the answer choices. Certain items may offer more options than answer spaces.

Cloze (drop-down)  

Cloze (drop-down) items ask candidates to select an option from a drop-down list. On the NGN, there may be more than one drop-down list in the cloze question. For instance, candidates may read a passage and have to choose the right words or phrases within tables, charts, or sentence passages.

Learn how to answer NCLEX drop-down questions in our comprehensive guide.

Enhanced hot spot (highlighting)

Enhanced hot spot items let candidates choose their answers by highlighting certain words or phrases. For example, they may read a nursing note, medical history, or medication record and then be asked to highlight areas or lines that answer the test question. 

Learn how to answer NCLEX highlight questions in our comprehensive guide.

Matrix grid 

Matrix grid items allow candidates to select multiple answers on a chart. Each row or column may require a response. This question type may give a scenario with client data and then require test-takers to judge the findings by checking appropriate boxes in a supporting table. It is useful for measuring multiple aspects of a question in one test item.

Stand-alone: Bow-tie, and Trend items

In addition to these new formats, candidates will also see “stand-alone” items that ask a single question.

 Bow-tie is one type of “stand-alone” question that candidates must drag and drop answers into a bow-tie shaped figure. 

Source NCSBN

Trend items are another “stand-alone” type question where candidates are given information to review over time and choose the correct intervention.

Unfolding Case Studies

The NGN will also contain “Unfolding Case Studies.” In these questions, candidates receive information from a medical record, followed by question sets leading them to recognize and analyze findings, make clinical judgments for appropriate care, and evaluate patient response.

The new questions are scored based on the revised NGN scoring model . The previous NCLEX scored items as either ‘all correct’ or ‘all incorrect’ — a dichotomous model. In contrast, the Next Gen scoring model uses three different methods and gives partial credit for some items with multiple points — a polytomous model. 

Where to Find More Information on NGN 

The best resource for students to learn more about the Next Gen exam is the NCSBN site. With the implementation of NGN, they’ve also released updated NCLEX-RN and NCLEX-PN Test Plans , which outline the test content and include practice questions. 

Another resource is NCLEX.com, where you’ll find a sample pack of Next Gen NCLEX-RN and NCLEX-PN case studies and examples. 

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Sarah S. Falcone, BSN, RN, is a nurse and health content writer in Fort Worth, TX. She has worked in various settings, including Med-Surg and L&D, but home health has her heart. Sarah is a passionate advocate for moving advanced levels of care to the home, where her clients can safely receive medical treatments they need, with greater satisfaction and comfort. She focuses on patient experience, outcomes, and advancing clinical models using innovative technology to serve patients better. Sarah draws from 15 years of practicing patient care and nursing leadership, to share her own nursing experiences and expertise online. Connect with her on LinkedIn !

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Understanding the Next Gen NCLEX (NGN): What to Expect and Question Types

Jump to Sections

Goals of the NGN

What is still the same on the next gen nclex.

• What’s new on the next gen NCLEX?
• Breaking Down the Next Gen NCLEX questions?

Prep for the Next Gen NCLEX Questions Here

The NCLEX exam plays a crucial role in the journey of every nursing student, serving as the final hurdle before entering professional practice.

As of April 2023, the National Council Licensure Examination (NCLEX) updated their exam to the Next Gen NCLEX or NGN .

But it’s more than just a name change.

The NGN includes an updated scoring system and new question types that focus on your clinical judgment and decision-making skills, making NCLEX prep even more important than ever.

This guide will provide a comprehensive overview of the changes to the NGN NCLEX, a breakdown of the new next gen NCLEX questions with examples, and how to study for the NCLEX NGN moving forward.

What is the Next Generation NCLEX (NGN)?

The NGN is a result of changing demands in the nursing profession. As a result, the NCSBN re-evaluates the NCLEX exam every three years to ensure those who pass are ready for nursing.

This new NCLEX rolled out in April 2023 , and no doubt will change again in the future.

• Assess Clinical Judgment : The primary goal is to measure a candidate’s clinical judgment and decision-making skills more accurately.
• Reflect Real-World Scenarios : It aims to reflect the realities of current clinical environments.
• Improve Patient Outcomes : By ensuring nurses are better prepared, the NGN aims to improve patient care and outcomes.

The NCLEX exam evaluates if a post-grad nursing student is ready to begin making crucial decisions affecting clients. So to keep up with constant changes in the medical field, the exam has also recently undergone a substantial change.

The NGN has many new changes, but a lot remains the same from the previous NCLEX.

Computer Adaptive Testing

One thing that remains the same in the NGN is that the exam still uses computer adaptive testing (CAT) . This means that the answer for each question determines the difficulty of the next question you get. 

A correct answer makes the following question harder, while an incorrect answer makes it easier. The goal is to achieve and maintain a certain difficulty level so that the computer algorithm can evaluate your knowledge level.

Existing Question Types 

All the old question types are still used on the NGN. The types of questions that you may see on the NGN (and old NCLEX) include:

• Multiple choice – The most common form of NCLEX question, multiple choice questions, provide multiple answers to a question from which you must select the correct one.
• Select all that apply – Select all that apply questions are considered relatively difficult. For these questions, you need to select each of the answers that apply to the question.
• Hot spot – While less common, hot spot questions have you select a particular area in a graphic that answers the question.
• Fill in the blank – Fill in the blank questions require you to enter a free text answer that must be correct. This is often a number, such as a dose calculation.
• Drag and drop – This question format is normally used to have the test taker order the answers in the correct order, such as sequentially describing steps in a procedure.
• Chart or graphics question – These questions consist of an image and text. An example of this type of question could be a question asking you to name a heart rhythm based on its appearance.
• Graphic answer multiple choice – This is the same as normal multiple choice questions, but uses graphics or images as answers instead of text. 
• Audio or video – These questions require you to listen to a sound or watch a video, then answer a question about the audio or video.

What’s new on the next gen NCLEX?

While the NGN incorporates many existing NCLEX features, it’s different in the following ways:

Harder Question Content

One of the NCSBN’s findings when evaluating the NCLEX is that nurses are more often caring for critically ill clients than has traditionally been the case. This increased client acuity means that new NCLEX questions are more difficult , with an increased focus on caring for more critically ill clients.

New Question Types on the NGN

While all the existing NCLEX question types are retained, there are multiple new question types in the NGN that are significantly different from what nursing students have been accustomed to. Some of these new question types include:

• Case Scenario – NCLEX questions have traditionally been standalone questions, each question unrelated to others. In the new NCLEX, two to eight questions may be derived from a single case. These cases provide a client record with multiple tabs and a split screen. The client record is on one side, and questions appear on the other, with multiple, non-adaptive questions.
• Extended multiple choice – A significant difference with these questions is that partial credit is given for answers that are close to correct. 
• Cloze (drop-down) – Essentially a cross between multiple choice and fill in the blank, these questions provide a drop-down list of possible answers to complete a sentence.
• Extended drag-and-drop – This question type is like the traditional drag-and-drop, except that there are more answers than spaces, and some answers need to be excluded.
• Highlight text – These questions are answered by highlighting an area of text from a given passage.
• Matrix/grid – Seen on multiple response questions, these are like a “select all that apply,” question, but with more than just a, “select or don’t select,” option. For example, there may be a list of eight different interventions you have to choose if they are anticipated, nonessential, or contraindicated based on the question stem.
• Trend – This question type tests knowledge of the NCJMM, which is a series of steps for measuring clinical judgment.

Number of Scored Questions

The new NCLEX has 70-145 scored questions (including fifteen pretest questions), which increased the max number of NCLEX questions (previously 60-130 on the old NCLEX). The unscored questions won’t contribute to the overall score, but will be used for future exam development.

Among the scores on a minimum length test, test-takers should expect to see three case studies with eighteen questions, which make up 21% of the overall score.

The New NCLEX Scoring System

Traditional NCLEX questions are either right (counting as one point) or wrong (counting as zero points). This is referred to as dichotomous scoring .

The new NGN-style items have new scoring methods to allow for partial credit: +- scoring, Dyad scoring, and Triad scoring. 

All of the items will be either correct or incorrect, and some will have partial credit. This is referred to as polytomous scoring .

+/- Scoring

Test-takers earn one point for each correct response, and lose one point for each incorrect response. If the total score is negative, the final score will be reduced to 0. Points are not deleted for incorrect responses.

Dyad and Triad Scoring

In a dyad scoring system, if both answers in a paired set are correct, you get one point. In a triad scoring system, you get one point for each correct answer. If you get all three correct, you get two points.

Standard items (Fill-in-the-blank numeric, Multiple choice, Multiple-response select all that apply, Hot spot, and Ordered response) will continue to be worth 1 point. Multiple-response items will receive partial scoring.

Breaking Down the Next Gen NCLEX questions with Examples?

Questions (items) are standalone items or unfolding (case studies).

Case studies reflect real-world scenarios based on the six functions of clinical judgment in the Clinical Judgment Measurement Model. Stand-alone items are similar to case study questions, but are not a part of them. They are introduced after the minimum number of items.

These new question types (as both case studies and standalones) include:

Extended Drag-and-Drop

Purpose: Items that require placing answers in the correct order or categorizing them appropriately.

Test-takers can choose a response to drag a choice to, but there might be more than one answer that could be correct. You can either drag the choice back to the list or remove it from the question entirely.

Drop Down Cloze

Purpose: To assess knowledge in context.

This includes a paragraph with one or more drop‐down options from which to complete the paragraph, each option having three to five possible answers.

Drag-and-Drop Rationale

Purpose : To evaluate understanding of cause-and-effect relationships.

This question is made up of one sentence with one cause, one effect, or two causes. Test-takers can select a choice on top of a target and remove it by either dragging it back to the choice list or just removing it.

This can be a dyad (two sentences with one target) or a triad (three sentences with one target).

Drop Down Rationale & Table

Purpose : To test logical reasoning and the ability to identify relationships within the provided information.

This question type includes one sentence with one cause, one effect and another effect. The answer can be a dyad (one sentence with two drop‐downs) or a triad (one sentence with three drop-downs each).

Matrix Multiple Choice/Grid

Purpose : To evaluate the ability to analyze and correlate data.

These questions have four to ten rows with two or three options. Each row must have one response selected. A test-taker can only continue to the next question once responding to all rows.

Multiple Response Select N

Purpose : To test the ability to prioritize and select the most relevant answers from a set of possibilities.

This differs from other multiple response item types in that the test-taker may not select all but is limited to a certain number of keys.

Multiple Response Grouping

Purpose: To assess the ability to categorize information appropriately.

The multiple-choice question has a table with two to five groupings, each with two to four options. The number of options is the same for all groupings, so test-takers must select at least one option from each grouping.

Highlight Text & Table

Purpose : To test attention to detail and the ability to identify key information.

Test-takers must select parts of the text to determine what is critical for the action. Responses are tokenized, and there can be no more than ten options. Test-takers can choose and deselect options as they see fit.

Purpose : To assess the ability to choose the most appropriate action or intervention from a list of options, helping to achieve desired outcomes or prevent adverse outcomes. Test-takers must correctly drag and drop an item onto a series of targets within the bowtie diagram.

Bowtie questions present a graphic representation of a clinical situation as a bowtie diagram with a central problem and various possible outcomes or actions.

Purpose : To evaluate the ability to recognize and interpret patterns over time.

This question type tests knowledge of the NCJMM, which is a series of steps for measuring clinical judgment.

For more NGN questions, try our free NCLEX practice test .

The New NCLEX exam, Next Gen NCLEX (NGN), is here to stay. The most significant changes include new question types and a scoring system that considers not just your correct answers, but also the ones you got wrong.

It requires a lot of preparation. But with the right study tools, including an NCLEX study plan and sample NCLEX question practice , you can claim back your time and understand nursing concepts with ease.

SimpleNursing NCLEX Review Course equips you with lecture series, question banks, cheat sheets , adaptive exams, study guides, and much more. 

Ace the new NCLEX, starting with a free trial today.

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Writing Next Generation NCLEX-Style Case Study Questions

By Susan Sportsman, PhD, RN, ANEF, FAAN

Recently, our blog featured tips for developing Next Generation NCLEX (NGN)-style questions, particularly the revision of test questions faculty already include on their examinations. Revising these questions provides a strategy to adapt current test items to reflect the NGN process, since these knowledge questions represent many questions on the NGN exam.

Now let’s turn our attention to writing NGN Case Study questions . Although only three case studies will be on the NGN examination, all test-takers must respond to the six questions embedded in these case studies, regardless of how many total questions they receive. Case Studies are complex and require some thinking to create. However, I think they are fun to write—the exercise is very much like writing (a truly short) short story! Here are some suggestions for getting started.

• Begin with the objective(s) that emphasize the content you want students to apply. Keep in mind that the point of case studies (and NGN questions in general) is to evaluate how well students can apply content to a specific clinical situation.
• Develop a clinical problem that students must address that represents the objective(s) in your course. Ideas for this this problem might come from:
• Clinical situations highlighted in past tests (or in test banks to which you have access).
• Your own clinical experiences-or those of your colleagues.
• Content outlined in the NCLEX Test Design.
• Case Studies you use for class discussion or assignments for students.
• NCSBN’s Top Priority Knowledge Statements or Skills
• The introduction to the case study scenario should include:
• Client demographics (age, gender, brief and relevant social history)
• Client history
• Relevant environmental factors, such as where the client lives (own home, LTC facility, etc.)
• Normal/abnormal findings (e.g., Physical assessment findings, V/S, Lab values, psychological behaviors)
• Time considerations for the nurse/client
• Client/Nurse Interaction
• Recognize Cues: What matters most?
• Analyze Cues: What could it mean?
• Prioritize Hypothesis: Where do I go to start
• Generate Solution: What can I do?
• Take Action: What will I do?
• Evaluate Outcomes: Did it help?

Remember that the case study should represent situations that are appropriate for the level of student you are testing.  Later in the curriculum the questions should represent clinical judgment that a novice nurse is expected to use in actual practice.

Starting the Process of Writing a Case Study

As you begin to write your own case studies, an example might be helpful in integrating the NGN components into an actual case study. The case study below was written for students in an early nursing clinical course, such as Fundamental in Nursing. In addition, the NGN Resources website also provides examples of case studies written at the level of a novice nurse.

Note: The templates we developed for this post can be found on our Resources page . Feel free to use them.

#1. Recognize Cues (Drag and Drop)

Drag & Drop the 4 cues the RN observed the initial assessment which require following up.

#2. Analyze Cues (Select All that Apply-N)

The RN is concerned about the client’s confusion. Identify factors that may be causes for this confusion. a. Hospital Environment  * b. Early indication of Alzheimer’s Disease c. Use of Morphine for control of Pain  * d. Anesthesia  * e. Reduction in O2 f. Limited Sleep

#3. Prioritize Hypothesis (CLOZE)

Complete the following sentence by choosing from the following lists of options:

#4. Generate Solutions (Matrix)

Confusion continues to be a problem for the client on day three post-surgery.

Which of the possible interventions to the problem are indicated and which are contraindicated?

The RN notifies the surgeon of elevated TPR, drainage at surgical site, and pain and received orders.

#5. Take Action (Highlighting)

Upon receiving the following physician orders, highlight those which the nurse should implement right away.

#6. Evaluate Outcomes (Matrix)

The nurse has performed the interventions as ordered by the physician for the client. For each assessment finding, click to specify if the finding indicates that the client’s condition has improved, has not changed, or become worse.

Case study questions are an important part of the NGN emphasis on measuring test-takers’ clinical judgment competence. Hopefully, the example above will give you some ideas for developing your own case study questions. You may notice that these questions are not exactly formatted like those on the NGN website. Currently, most of us do not have the necessary software to completely mimic the NGN questions. But simple templates can come close. Please don’t let the differences in the format of these questions stop you from using case study questions in your testing and classroom teaching.  Remember, the point of the NGN testing process is to assess new graduates’ ability to use good clinical judgment in a variety of clinical situations.  Giving students the opportunity to practice clinical judgment is key to their success on NCLEX and in clinical practice.

Silvestri, L. (2020) Higher-Cognitive Level Test Question:  A Starting Point for Creating Next Generation NCLEX Test Questions. White Paper. Elsevier.

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Can you answer these free NGN practice questions for the NCLEX?

Get quality practice for the NCLEX—for free!—by working through these NGN practice questions, learning first-hand from experienced NCLEX tutor Justine Buick about the best ways to apply your knowledge and critical thinking skills to passing the exam!

In April 2023, the NCSBN released a revamped NCLEX to the world—the Next Generation NCLEX (NGN) —compelling nursing students/grads just like you to rethink your studying strategies! (To learn more about the way NGN questions differ from the previous generation exam, check out: What to expect from Next Generation NCLEX .)

So, to help you adapt and prepare, the team here at Brainscape joined forces with NCLEX prep expert Justine Buick ( www.theNCLEXTutor.com ) who has crafted from scratch a collection of Next Gen NCLEX practice questions , which you'll see shortly.

Combined with our digital flashcards for the NCLEX-RN and NCLEX-PN licensing exams, these constitute a powerful resource you can lean on to take your NCLEX prep to the next level!

These flashcards have been carefully curated and vetted to offer nurse students a hyper-efficient way to drill the enormous amounts of content they need to learn and remember in order to answer the more complex questions posed by Next Generation NCLEX questions.

• Get Brainscape’s Nursing Fundamentals flashcards (for nursing school) 
• Get Brainscape’s certified NCLEX-RN flashcards
• Get Brainscape’s certified NCLEX-PN flashcards
• Get Brainscape’s FNP flashcards
• Use Brainscape's free NCLEX study planners and exam countdown sheets to plot your path towards and remain razor focused on your study goals!

And if you're still in nursing school, check out our flashcards for all the topics you'll be learning: Pediatrics flashcards , Adult Health flashcards , Pharmacology flashcards , Management of Care flashcards , Maternity flashcards , Mental Health flashcards , and Safety & Infection flashcards .

Now, let’s dive into some Next Generation NCLEX practice questions with, first, a brief aside on the difference between standalone and case study questions...

Standalone vs case study NGN questions

The NCLEX poses questions either as “stand-alone” questions or as “case studies”. In the case of the former, they are—as their name suggests—one-off, discrete questions. Once you finish answering them, you move on to the next question, which isn’t at all related. 

Case studies, on the other hand, ask a series of questions based on the same patient/case and so it serves you to bear in mind your previous answers and maintain a degree of cohesiveness as you work through them.

The first Next Generation NCLEX practice question we’ll be tackling, however, is a standalone bowtie. This is one of the more common types of standalone questions on the NCLEX, which very simply gives you a patient scenario and then you have one question that you have to answer.

NGN Practice Question: Standalone Bowtie

The nurse is caring for a 67-year-old client in the cardiac care unit. The nurse documents the following data in the Nurses’ Notes.

Nurses' Notes

1530: Client was admitted 2 days ago for a scheduled coronary artery bypass graft (CABG) x 2 vessels. No complications during surgery and recovered in the ICU overnight. Client transferred out of the ICU this morning to the cardiac care unit. History of coronary artery disease, hypertension, hyperlipidemia, and osteoporosis. Assessment findings are as follows: alert and oriented x 3; denies shortness of breath, sore throat or cough, lungs clear bilaterally; irregular heart rhythm auscultated, denies chest pain, skin is warm to touch, cap refill < 3 seconds, no edema and peripheral pulses 2+ and equal bilaterally; denies nausea/vomiting, bowel sounds active x 4 quadrants, reports passing flatus and last bowel movement was the morning of surgery; indwelling foley catheter was discontinued this morning and has been voiding clear, yellow urine without complications; up to bathroom 2 times with assistance; gait steady. Client is currently sitting at bedside and reporting a "racing heartbeat" and "feeling faint". Vital signs are HR 142 beats/min, BP 116/78, RR 18 breaths/min, pulse oximetry 96% on room air, and temperature 98.4 F (36.9 C).

Complete the diagram by selecting from the choices below to specify which potential condition the client is most likely experiencing, 2 actions the nurse takes to address that condition, and 2 parameters the nurse monitors to assess the client's progress.

For the answers...

Simply sign up for Brainscape's nursing flashcard collections (below) and we'll send the detailed answer and rationale to your inbox! These flashcards are FREE to sign up for ; and you can study a certain number of them before being asked to subscribe. But for full access to the Brainscape study experience, which will help you prepare for the NCLEX so much more efficiently , sign up for pro .

NGN Practice Question: Case Study

Now, let's try another type of NGN question: the case study, which, if you remember what we previously explained, poses a series of questions based on the same patient/case. So remember to bear in mind your previous answers and maintain a degree of cohesiveness as you work through them!

The nurse is caring for an older adult in the intermediate care unit.

1000: Client admitted with an exacerbation of chronic obstructive pulmonary disease (COPD). Client has used home oxygen at 3 L/minute by nasal cannula for 4 years but reports increased dyspnea over the last several days. Client increased portable oxygen to 5 L/minute. Currently, the client is fatigued but alert and oriented x 3. Client reports shortness of breath at rest, increased coughing and large amounts of thick, tan sputum. Client has labored breathing and is in the tripod position. Lung sounds with wheezes bilaterally. S1 and S2 heart sounds heard, no murmur or gallop noted. Vital signs obtained. Healthcare provider in to see client and admission laboratory tests completed. Respiratory therapist was in to obtain ABGs.

V ital Signs

Lab Results

The nurse assesses the client, obtains the vital signs and reviews the laboratory results. 1. Which laboratory findings require follow-up? Select all that apply.

2. The nurse reviews the assessment findings and laboratory results. For each client finding, click to select the finding that is most consistent with the condition of hypercapnia or hypoxemia. Each finding may support more than one condition.

3. Complete the following sentence by choosing from the list of options.The client is at highest risk for developing [Option 1] as evidenced by the client's [Option 2] .

4. For each finding below, choose the potential nursing intervention that is appropriate for the nurse to include in the plan of care. Each finding may support more than one intervention.

The nurse reviews the healthcare provider's orders.

• Continuous pulse oximetry monitoring
• Oxygen via venturi face mask, titrate to maintain pulse ox >88% • collect sputum culture for culture and sensitivity
• Repeat ABGs at 1800 today
• X-ray of chest today
• albuterol 2.5 mg via inhaler three times a day
• fluticasone 88 mcg via inhaler three a day guaifenesin 400 mg PO every 4 hours

5. What teaching points does the nurse provide regarding the inhaled medications? Select 3 teaching points.

The nurse assesses the client after implementing the healthcare provider's orders. 

6. Check whether the assessment findings indicate that the client’s condition is either Improved/Stable or Not Improved .

NGN Case Study Answers

For the full answers and rationale, include video explanations, simply sign up for Brainscape’s Nursing Fundamentals flashcards (for nursing school) or our certified NCLEX-RN or NCLEX-PN flashcards , which offer you a hyper-efficient way to drill the enormous amounts of content you need to learn in order to answer the more complex questions posed by Next Generation NCLEX questions. (And YES, they’re fully Next Generation NCLEX aligned.)

Once you've signed up, we'll email you the answers. (By the way, these flashcards are FREE to sign up for ; and you can study a certain number of them before being asked to subscribe.)

Finally, for truly excellent advice on excelling in nursing school, taking the NCLEX, and beyond, make sure you follow Brainscape Nursing on YouTube and check out our free Academy of articles and nursing guides !

Flashcards for serious learners .

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Next generation nclex (ngn) questions and case study.

Dr. Paul Biluan, CEO Aspire RN:  Thank you for attending Connetics College. This is a Connetics USA Initiative, where we do classes every Monday. This is Dr. Nurse Paul is tasked to do classes for free every first Monday of the month.

Thank you guys for joining today. Please kindly tag your friends and share this to your pages so we can reach more nurses for today we're going to talk about next-generation NCLEX I'm going to show you guys a case study. So you guys get to have clarifications with your questions about the next-gen NCLEX but next-gen NCLEX is happening April 1 2023.

We're gonna get our first batches of nurses that will be taking the next-gen NCLEX if you guys are not familiar I've done a couple of live shows both for Connetics USA but I also do my own show and my own social media and Facebook and YouTube and Instagram and TikTok at doctor nurse Paul and you can just search my playlists in YouTube. And you'll see there all the best shows that I did about next-generation NCLEX. Again welcome everyone to Connetics you as a watch Aspire RN NCLEX review provider in partnership with Connetics USA every first Monday of the month. We have classes every Monday it's different companies different ethics providers and English exam providers. But doctor nurse Paul and Aspire RN hosts their shows every first Monday we have Charles watching from Uganda and Dorothy is tagging your friends thank you guys for joining us today April is also here. Thank you for joining me Good job guys. Please tag more of your friends and charities to your pages so we can reach more friends today and again Connetics USA is offering anklet scholarships you must meet the requirements that Connetics USA have set but in partnership with in partnership with Aspire RN Connetics, USA is offering NCLEX scholarships if this is what you are interested with. We have posted the garments of the link it's HTTP s, colon, backslash cu as a dot Lin backslash Aspire RN so click that link right now. And one of the Connetics students a recruiter is going to talk to you and check your qualifications and you can pass a qualifying exam for scholarship but this is entirely free. So if you are short on budget but you want to do or want to get a quality review for foreign graduate nurses like you and me this is the best time to click that link right now and as a contact Connetics USA or if you're having issues looking at this link you can also directly send me a message and I can help you as well. All right. Again welcome to Connetics USA Connetics College in partnership with Aspire RN we are doing a Connetics college NCLEX class today and we're going to talk about next gen NCLEX Yay. I'm so excited. We are less than 60 days away from the next generation NCLEX. Any nurses will be taking the NCLEX soon after April one If you're taking the NCLEX before April 1, please make sure you pass the NCLEX.

So you don't have to deal with next gen NCLEX. If God forbid, you fail your exam, and you have to retake, you're gonna retake it the next gen NCLEX format, so everybody that are yet to take the NCLEX are choosing or deciding if they want to take the NCLEX or will be taking the NCLEX very soon after April 1 we're going to do the next generation NCLEX and Aspire RN is one of the leading foreign graduate NCLEX review provider with me as the CEO, doctor nurse Paul. And I will be one of your instructors and mentors. We are one of the leading providers providing next gen ethics for foreign graduate nurses, a lot of Next Gen X compatible providers are targeted for Americans. But there is a special, you know way of delivering review programs for foreign graduates like us because our competencies are not really exactly the same as American graduates. There's a reason why there's a national pass rates for foreign graduates for first time takers of only 46% Compared to 86% of the Americans. So more than 54 55% fail the NCLEX the first time and it's a very difficult exam because of the educational differences in competencies, and now their next gen NCLEX. But don't worry if you enroll with my program, if you don't go sorry about that. If you don't qualify for this scholarship and you're enrolling my program, I will make sure that you will pass the NCLEX through my program and today we'll be releasing a new program. We call it the doctor nurse Paul method or DNP method. All of our classes are going to be next gen NCLEX compatible. And you will get 42 live classes up to the time that you will be taking your exam to final coaching from the orientation to final coaching, you're gonna get 42 live classes with me and many of my instructors, the most number of live classes and the NCLEX review industry nobody else could provide you better, right? Because I've added more days for NG and glasses. I called it the NG and masterclass that's where all we talked about is Ng and types of questions and we're going to answer this just like what I'm going to do right now I'm going to give you a preview of what's going to happen if you're enrolled in that program. Right or, again Connetics USA can also provide you scholarship let's flash that link again at the bottom. So we're gonna see the link right now being flashed on the screen.

This is how you avail or get or get qualified for the NCLEX scholarship being provided by Connetics USA in partnership with Aspire RN the link is cusa.link/AspireRN that is how you get connected with us or send us a message through social media channels as well and we can send you a message back so we can answer your questions. All right, I guess many people are joining today thank you again let me know where you guys are located for those that are haven't called yet and many people are joining us today Mani is here from India. She wants to apply as an RN please get a hold of one of our Connetics you as a rigors again the link is cusa.link/Aspirern okay, let me have coffee real quick. It's too early or at 7am Haven't had sleep because of jetlag.

We're going to talk about case studies today case studies will be an integral or vital part of the next gen NCLEX each case study. So case studies involving case we're going to show you what it looks like. Each case study will have six questions. So one case study six questions. This will be talking about the clinical judgment model of the next gen NCLEX. Question wanted a case study would always be about recognizing cues. Question number two is about analyzing cues. Question number three is about prioritizing. I suppose he says question number four is about generating solutions. Question number five, it's going to be about taking actions. And question number six, it will be about evaluating outcomes. So we're gonna have six questions today six questions from one case study. All right. And we have Youssef joining us in linked in from Nigeria Yousef, thank you for joining us today. We have joy, also watching us from Nigeria. Wow, we're all over the world today. Anyone here from the Americas Latin Americas or Northern Americas? Because I've only seen people from the African European and Asian continent but haven't seen that American continent people yet. Just to make sure that we're covering the whole world but thank you guys for joining today. And Um, when are you guys planning to take your NCLEX exam while we're still waiting for more people to join anyone? Anyone will be taking the next gen NCLEX very soon after April one. You're gonna have your next gen and click Screen is joining us from Philippines. Hi Karen. Thank you for joining baya is joining us from Philippines as well thank you for joining me today. This is gonna be an interactive show people I want you guys to help me answer the case study that I'm gonna be showing in a little bit. Alright, again, for those that just came in thank you for joining Connetics College, by Connetics, you as an Aspire RN. Today we're going to talk about the next generation NCLEX case study and there will be six questions per case study. And each question will meet the competency of the clinical judgment model by the NCS the and we observed from UAE and Felicity from Nigeria Thank you. Joy said she will be taking the NCLEX soon using the next gen FX format and she is under Connetics right now.

Thank you joy for joining and essentially we'll be taking the exam in July and a bond Julie's taking it on June this year. Good luck guys. If you need help with NCLEX preparation and next gen NCLEX preparation just send me a message and the doctor nurse Paul social media pages or you can also log onto my website Aspire RN. We'll be launching today our new NCLEX program called the doctor nurse Paul method which will include next generation NCLEX preparation and review classes in to the review program Alright, so if this is what you are interested with, send me a message Oh Bom Julie said you send me a message on Facebook. Well, I'm sorry if I don't reply as fast as I can. I have a team that helps me answer messages as well because I'm flooded with a lot of messages. If I don't respond back send your message again. So you get the top of the list because we do get hundreds of questions every day in all my social media channels but I will be gladly I will be glad to answer I'll be happy to answer your question today after this show. Okay, thank you guys. Now let's talk about the case study. We're going to have case study number two today. Worse Number One Number one was shown back in December or January I think in one of my past shows, with Connetics you as a I gave you an example of case study number one is this the first time that you're joining me today or have you seen me do this class in the past.

Anyone here is joining me for the first time and has never seen me do this because I don't only do this with Connetics USA nursing agency I also do this every Saturday in my own social media channel, the doctor nurse Paul show and let me see how many of you guys have just joined me today or have never seen me do the classes in the past. For those who do not know me, I'm the CEO of Aspire R which is an NCLEX review provider based here in Houston Texas. And I am an NCLEX instructor for 15 years 15 years that's what I'm bringing my experiences both outside the US in my hometown Philippines and also here in the US and I'm combining them to create a very high quality NCLEX review program under Aspire art and this is the reason why Connetics USA which is one of the largest foreign graduate nurse recruiters trust Aspire RN because of the quality that we bring onto the table thank you guys for joining me thank you Connetics of course for trusting my company Aspire RN and my team if I was part of Aspire RN last year do I need to join an engine program? Nope. If you are already a current aspiring student you will be transitioned to the next gen program so don't worry about it. We're gonna be transitioning you for free if you are already our student right so don't worry about it. And Craig said she has also seen me before in my doctor nurse Paul Fit Page and she said I'm a fan. Thank you for that and feel flattered. I'm just here to like do free classes online. That's my passion ever since right? And let's see Stephanie if you want if you're interested, go to AspireRN.com or send us a message on Facebook Aspire RN or doctor nurse Paul in one of my team members will get a hold of you. All right. Let's see case study number two today.

Are you guys ready? Right now Okay, can you guys pass the next gen NCLEX. I want you to write this in the comment section. We With all gaps, yes, I can, if we are manifesting that you're passing the NCLEX write it down right now on common section. Yes, I can. Are you going to pass the next gen NCLEX? Write it down, type it down right now. Yes, I can. There you go. Good morning to those that are just joining us today. Please tag your friends. Yes, I can. Yes, I can. Yes, I can. Ooh, let's go. All right, let's do it. You guys are going to help me answer these questions. All right. We're right. I think everybody's ready now because everybody's responding in the comment section. Yes, I can. All right. Okay. This case, I'm sorry, it's not as big as I can. I want to do it. But you can zoom it in. If you're using your phone. I'm going to read it for you. All right, we're going to answer this together. The nurse in the emergency department is caring for a 17, one seven year old male client.

Let's check the tabs because you're gonna have to flip through the tabs, open all the tabs to see the whole chart. It's like an emerge. Sorry, it's like an electronic medical records like a patient chart, you're gonna have to open all the chart to see what's going on with a case. Remember, a case is a story about a patient and this story changes over time. Just like how will you deal with a patient clinically, right when you're in the hospital, right. And a lot of you foreign grad nurses like me, are already experienced nurses at bedside so this will give you a little advantage because you're already you already have developed the clinical judgment but you're just gonna put it to test right now.

Okay, let's read history and physicals for body system pulmonary. We're going to read the question first. The nice shortness of breath reports discomfort in the lower left side of chest when taking a deep breath, gastrointestinal reports feeling abdominal fullness, and occasionally nauseated, muscular skeletal. The patient sustained an injury to the left ribcage after being struck by a mechanically beach baseball in a batting cage last week. Right battling cage last week, reports intermitted pain in the left shoulder six over 10 and the numerical rating scale feels lightheaded, significant bruising through their left shoulder or at the scoping repair to the left shoulder for a torn rotator cuff. Last year psychosocial client has not felt well enough don't that baseball practice since the injury? So we're seeing a lot of red flags here. Right. There's respiratory issues for sure. There's gastrointestinal issues. There's Musculoskeletal and Skin issues. We're seeing bruises there and pain. Alright, so let's remember that it's going to be important to answer the question later. Now let's click nurses notes right there. If I click nurses notes, this is what we see. At nine o'clock the client appears fail and slightly diaphoretic large amount of bruising noted along the left torso and over the left upper quadrant of the abdomen, tenderness, guarding dullness to percussion noted in the abdominal assessment, slightly diminished breath sounds noted and the left lung fields and auscultation blind does a productive guff EKG shows normal sinus rhythm. Alright, remember, remember those spots any flags, flags, bail, diaphoretic, bruising, tenderness, garden dullness to percussion to the abdomen, diminish breath sounds productive guff. Those are positive sides are significant findings, vital signs, what can you see? What are the abnormal findings in the vital signs here? What are the abnormal findings we have both degrees are decreased BP is also decreased. Right? So what's our concern here? Be our blood pressure both I mean, all of them are all decreased. Right? How about the labs? About the labs, the good the labs? What are our normal?

Look at the white blood cell count. It's 19,000 your hemoglobin and hematic. Great H and H is nine and 27. So all of them are AB nor Mo? Correct. All of them are abnormal. Now that we've seen the whole case of what's going on, let's now proceed to the question on the right side of your screen right there. Okay, Which of the following assessment findings require immediate follow up, immediate follow up? All right. Your options are lung sounds, shoulder pain, productive abdominal assessment findings, pulse, respiration, blood pressure and temperature and pulse oximetry reading. What are your answers? This is a select all that apply. It's also right minus wrong question. What are your answers? Anyone? Anyone? Please tell your friends and more people can join us today. Anyone? What are your answers? Lila already showed me her answers. But what about the rest?

I'm still waiting for everyone's answers. I'm not sure if I got disconnected though. I don't think so. All right. Michi gave her answers already. Oh, by the others. We have more than 100 viewers today. I want to see your answers. Don't go the question which assessment findings would require follow up?

Who's attended my class in the past? Some of you guys, right. We prioritize lung sounds. Yes. Because there's shortness of reading and decrease breaths out on the left side. Do we prioritize shoulder pain? There's pain here. There's Rousses. Yes, let's consider that. Right, because that's still a significant finding. lab results, obviously. Yes. productive cough. Yes. abdominal assessment, fullness, nausea. Yes. Both respiration and blood pressure. Yes. The only not included here is temperature and pulse oximetry, because your bowls and temps I'm sorry, pulse oximetry reading attempts are both normal. There are both normal address 123456. Right. 123456. Okay. 123456 are the answers everything that has an abnormal finding you include, that's just how it is. Okay. Everything that has abnormal finding, you include with the exception of number seven. Alright, that's number seven. All right. John Doe is an Aspire RN NCLEX passer. Congratulations. Let's all clap our hands agenda.

Can we feature that? Common miscellaneous? So we can everybody could see that John Doe, is one of our NCLEX passers. Congratulations, John Doe sent me a message I want to interview you all of my pastors, I want to put on a little video chat and see what we can help you with after Okay, thank you, John Doe for trusting Aspire RN my team, thank you for being in my class. Thank you for being one of the Aspire RN Lister. That's why we call our ambassadors. Thank you. Congratulations. That's all say congratulations, Gendo. I don't know if it's full name, but you can say jazz. Congratulations. All right. Anyway, and hopefully we can get that energy from John as well. So we can pass our NCLEX you guys are ready to achieve your American dream? Yes. Can you pass your NCLEX? Yes, I can. All right, let's dive it down.

Congratulations, Jan, you're receiving a lot of compliments. Right on the comment section. Thank you. Thank you. We want that energy from Jan to fill us up right now. Right? We want that faster energy to be with us today. Right? Anyway, thank you, John, for sharing that information. And thank you for sharing your victory efforts is very tough. I can tell you, I've been teaching this for 15 years, I wouldn't be here teaching you guys. Connetics, don't even invite me. If this is not valuable at all. We're here because there's so many people failing, we're here to help solve that problem. And I'm still here educating nurses 15 generations down since I graduated nursing and started teaching, but I'm happy with what I'm doing. Okay, this is my passion. So thank you, John, for trusting Aspire RN in my team and for everybody. I wish you all good luck right. Now let's go to question number two. Same situation. Same case, nothing was ever added to the notes. Let's go through the question right away. Which of the following issues is the client at risk for developing or off developing? Let's do your differential diagnosis, differential diagnosis, stroke pneumothorax or hemothorax. I'm sorry, bowel perforation, spleen, a glass array. pulmonary embolism abdominal aortic aneurysm? What are your answers? This is select all that apply. I want to put your assessment skills to the test. Let's see if you know your signs and symptoms for all of these conditions.

So you see the thing would next generics while I'm waiting for you guys to answer put your answers on the comment section is the contents are the same. It's just a different way of showing the questions and providing the answers. There's just more different types of questions this time, but contents are the same. So it's still important that you know your contents.

If you don't know your contents, then you will have a difficult time answering next gen NCLEX very important that you know your contents means when we talk about stroke, you should know your signs and symptoms there your pathophysiology, your priority assessment, priority management, positioning, medications to use, what are the side effects of those medications? That's only stroke. We're not talking about the others yet. So you have to have a very good grasp or mastery of skills. I keep talking about this in my TikTok and Instagram. Mastery of concept is the most important test taking strategy for the NCLEX. Now we'll put this to the test. Let me see what your answers are. We have diverse answers. Does this look like stroke? No, because there's no Henry Prius. It's right or he may Perris it Nope. hemothorax. Yes, because there's difficulty of breathing decreased breath sounds on one side, and this is trauma. Yes. bowel perforation.

Does this look like a bowel perforation? Are there two sides of bowel perforation to you guys? Rigid abdomen fever, nausea, vomiting, constipation, shock like symptoms. I have not seen fever. I have not seen rigid abdomen. It just says feeling full but not rigid because it shouldn't be peritonitis. There shouldn't be fever, right? So we're gonna remove number three, does it look like valid birth? You don't get Bruce's with Bible birth. Right? About splenic. laceration. I'll include that just because the case was a baseball bat. Alright, it's a trauma. The patient was hit on the left side with a baseball bat. The spleen could have ruptured. Right. So spleen laceration, yes. How about pulmonary embolism? Guys, if there's pulmonary embolism there's shortness of breathing decrease SPO to right patients having chest pain, lightheadedness, dizziness, mainly chest pain. We don't have it. It literally says there. I mean shortness of breath do it literally says there denies shortness of breath. Remember pulmonary embolism is occlusion of the pulmonary arteries, which can lead to both respiratory and cardiac collapse.

So there shouldn't be signs of respiratory problems like shortness of breathing, right? We don't have that. So pulmonary embolism is ruled out. abdominal aortic aneurysm? Yes, because we have abdominal fullness and the blood pressure is going down. It might ever ruptured. So adds her ear is two, four, and six to four and six to four and six. All right, very good. All right. Now question number three, same situation. Same situation right. Nothing was added so I'm not going to flip through the different tabs anymore. I'm not going to open these three nurses notes vital signs and lab but during your NCLEX please open it make sure that you guys have read everything and that nothing changed right?

Complete the following sentence matches it from the list of offerings the nurse should first address the clients or choose from this clients what all of them are part of her priority but now you can only pick one what is our priority? And only pick one what is our priority? We're on my people from YouTube and LinkedIn haven't seen them for a bit I've only been seeing the Facebook people joining us but the linked in people and YouTube. Are you guys still here? What's your priority? wunderbar is also here. He was also in my class last night and it's also our Aspire RN students. Thank you Please don't miss your class. It's wonder burger this far in right. But Trisha already has answers Sal already has answer.

Can you already provide her answer Troy I'm still waiting for more people. I've only seen like 20 people. I want at least half of the attendees to give me the answers. This is fairly easy for me. All right. I hope it is also easy for you but what will you prioritize it's principle of ABC airway, breathing and circulation. respiratory takes priority. You've already seen signs like, decrease breaths on one side, you've already seen signs like chest pain, guys, there might be a hemothorax there, right? This is a trauma.

So you think about those things answer is respiratory status. Very good. You guys are enjoying case studies. I think for me, it's straightforward for as long as your concept is good. So you see, when you check my tech talk, people go crazy about when I say something about natural quick, some people are saying, oh my god, I'm so scared, like, what am I going to do? Like? How can you help me? While other people would say, Why are you guys scared about Next Gen X? It's pretty easy. That's all that's both right and wrong. Right? Remember, each student have different learning abilities, right? Those students that are saying next gen and what slips easy for me it is because all the case that all the information that I need is already there, right? If I if I'm good with my signs and symptoms, and I know what they are, if I know my pathophysiology, and my meds and all my treatments, I can honestly answer this easily. So if my concept is master, if I've mastered a concept, if my foundation for nursing concepts are good, then I want to have problems with ng n. The same is true with view. Now, if your problem is Foundation, like if I talk about hemothorax, and you can even define oh my god, what is seam authority? So Oh, my God, why is there lung collapse and pneumothorax? What happened? Guys, you have to go back to your books, you have to go back to your lectures. That's what we're doing as fire art. And we train you first with your concepts. And if you progress and we think you're good with your concepts, then you can proceed to the NG and master classes.

That way, there's correct progression. And we make sure that you actually complete all the objectives that Dr. Nurse Paul has set in our program. Okay. Anyway, question number five, we have a new data from 10 o'clock am right. Emma said she couldn't near me from LinkedIn. I'm so sorry about that. We were having technical issues. Thank you for jumping in and joining us in Facebook. Right. Anyway, let's look at 10 o'clock. It says glide was diagnosed with splenic, laceration and left sided hemothorax Oh, now we have dramatic obligations, bleeding lacerations, lift left sided Demuth arcs, what's your major complication? For both? For both? Both complication for both? Well for left handed pneumothorax, are gonna have lung collapse, a circulatory and respiratory collapse, but both of them are also leaders. So you're gonna have to consider bleeding and shock.

Do you remember your vital signs earlier? What was happening with a blood pressure? They're going up or down? You remember your blood pressure earlier? What was going on? Up or down? They're going down. It's going down. Right? How about the pulse and our respirations? They're, they're both going up. These are signs of shock. Typical dry adverse shock. Is the patient having shock already? Yes. Is the patient possibly bleeding at this point? Yes. You look at your H and H earlier, it's also down to patients bleeding, right? What's our management here? Do we need to send the patient if I'm in the ER who are ER nurses here, I'm an ER nurse.

I'm a trauma nurse. And that's why I like case studies because they always talk about the patients in the ER the patients in the ER patients in the ER so that's what I can help you with because I'm an ER nurse and I'm going to do the edge in masterclasses myself and inspire art and as many instructors, all of them are good night quality because I chose them. But I'm going to do the NG and masterclasses myself. Alright, back to the situation. Right? So what is the priority if m&e are nurses and this patient is diagnosed and splenic, laceration and pneumothorax? My priority is to send this patient right away to the trauma surgeon into the O R. Correct. All right. So what's your management here? Do we give IV fluids indicated or not indicated in the gate a very good April we have to bring the patient start o r but while waiting for the O R we can start our trauma management if you got some taken your trauma nursing course it's a B, C, D E, F G H I J K LMNOP.

So many letters, but all of those means something right? Part of that is stabilizing the patient or IV fluid indicated serum typing screen in the gated chest physiotherapy not indicated it's gonna cause more injuries. No, no, no, no CPT insertion of ng t. Now right now, right because there's splenic ends or injury we don't have there's diaphragmatic trauma as well. Right? Don't do ng t yet, because the patient has probably a diaphragmatic trauma as well. So what's the problem? If there's a diaphragmatic trauma if there's a tear you might be able to, like the tube might feel left and go back to the respiratory or you can have more complications. What if the esophagus is also bleeding or trachea? So you don't want to do ng D for now until there's a clearance from the doctor. That's usually after intubation. So don't do MGT right now. Not yet. Not yet. How about administer prescribed pain medication? Pain medication? I think I've seen someone here said no.

The other one said yes. Pain medication. Yes or no? Yes or no? Guys, ng t is not a priority right now. It will be done later. But NCLEX is all about priority. It's about right now. All right, baby. Yes, don't we don't pay medicine if you're in the US and you would have been medicine the patient can sue you for under medicating the patient

. That's for nursing care. Yes, we need to give pain medicine right. So again, IV fluids indicated zero typing screen indicated CP teach as physiotherapy not indicated MGT not indicated. Administration prescribe a medication about question number five look at 1030 The client is now referred to immediate or for immediate surgery, we're not going to go to the or no look at your right side of the screen right there. This is select all that apply which of the following actions should the nurse take letter A provide or mark the surgical site provide a client with isotopes number two, three, perform med reconciliation for obtain consent five, insert IV fluids six I'm sorry, five is insert burden for a VAD or IV six inform the client about risks and benefits. Seven assess declines previous experience with surgery or ASIC line spirits to wait in the waiting room no plan of care discuss with the client. All right, what's your answers? Or answer ads? Or ads? Or what's your answer? And one this is OR nurses here? Please stand up. Please stand up. Anyone?

Please don't forget to follow doctor nurse Pauline, Facebook, YouTube and Instagram for more shows like this. I do this almost every week. Every Saturday I have the show doctor nurse Paul show. Right? Oh, that's a lot of answers. Are you guys sure about this? Oh, anyone who? Some people just like to check everything. Remember in next gen lecture select all that apply becomes right minus wrong say if you're answering too much. And that's not required, you are going to get zero points. Can you mark the surgical site? No, that's for the surgeon? Can you provide a client with ice chips? No patients on NPO? Can you perform medication reconciliation? No, that's the primary responsibility of the prescriber or the surgeon or the anesthesiologist. Can you obtain consent from surgery?

No, the doctor has to do it. You can only witness if you're updating, explaining the risks and benefits that's for the doctor. Can you insert IV? Yes, you need that for the medicines and IV fluids and blood transfusion? Can you inform the client about the risks and benefits of surgery? No, that's for the doctor. Can you assess the client's previous experience with surgery and anesthesia? Yes, because this is both the responsibility of the nurse and the anesthesiologist. That's part of your assessment. You have to know present illness, past medical history past surgical history you have to know that because there might be an allergy to certain medications. How about as the client's parents doing in the waiting room? No, the patient is a minor. So what are our answers people? What's the answers? Wonder Bert is leading the way.

W hat's the answer? five and seven only? All right, a lot of people have answered multiple answers. I'm so sorry. But you guys get zero points because this is a right minus wrong kind of thing. Right? This is a right minus wrong question. So if you answer too much, you're gonna get a penalty. That's one of the things you need to remember with next gen NCLEX. But don't be scared. That's why we're doing these glasses to help you understand and guide you how to answer these things properly. Right? For many people that have consistently getting incorrect answers from number one through number five, I can honestly say that your problem as an expert for NCLEX instruction is with the concepts, right? Go to classes, attend review classes, if you don't have the money, go grab the adequate scholarship by Connetics USA or if not, then tried to talk to one of my team members who might be able to help you but you need to invest on yourself.

And NCLEX is a very expensive exam, you don't want to be taking it multiple times because you keep failing. I've had a student fail seven times, right seven times on the seventh time, or no, no, failed six times, I think, the seventh time she joined us by our and finally after trying so many different programs that actually didn't work for her. Because all they do is take your money and put you in a group class that's doing the same thing all the time. Each student is different. That's why yes, we do group classes and aspire are in but you get your own personal student advisor and personal mentor that tracks your progress and make sure you're progressing correctly and in a timely fashion.

If not, we can tell you, you're not ready. Maybe you need to spend more time in this space. Or maybe take more of these exams first, before we can proceed, we can help you proceed to the next phase. That's called guidance. That's called mentorship. Not a lot of review providers do that because they don't have time for that. But in Aspire RN, we care for you. We treat you as an individual not as another number or student Right? Very important to partner with the right people and invest with yourself. All right answers five and seven Riza. And Jen classes will start on March. Right now we're still transitioning the students to the from the old program to the new program, everybody that will start so my Ng and masterclasses EB three phases in my review program. Just watch my TikTok, I'm gonna release a video, I guess tomorrow. The first phase is the concept building phase. It takes eight weeks to finish that that's 24 live classes every week and in the remaining days of the week, you have activities like both tests and certain stuff. And then after eight weeks on your month number three, or month number two, for four weeks, you do Ng and masterclasses every week and right. And after that, you do your final coaching face or hit classes, which is 10 days of live classes, question and answer only just like this for the next 10 days. But you progress to different phases .

Depending on your ability, you're not going to get to Ng and master classes if your concepts are not good. Because even if I teach you for 10 hours a day, if your concepts are not good, it's not going to help you write for reason, my whole review program is $550. But we're going to be offering promotions this month. Alright in connection to the NG and program that we're going to be releasing. So please watch out, follow Dr. Neurospora and inspiring. We're going to be announcing very important things this week. Right? I'm going to talk to you about the program and private message because some other people are here online and they're waiting for the answers number five and seven are the answers here. Let's go to question number six. All right, nothing was changed in the case.

It's still the same case. Right? Same situation. They do mar I think Maura was one of my students in the past. Thank you. I've been in the teaching industry for 15 years before I left the Philippines. I was teaching there for 10 years 10 generations of and of nurses that have thought so I'm an old guy now. I'm an old man, but uh, happy to be able to help a lot of nurses. I feel like I still have more to be able to help more nurses to become quality, safe and effective nurses that we need because we have so much shortages right now in America's right. Anyway, guys, we're gonna have to highlight the findings that indicate a worsening of the client status. I'm not I don't have the ability to do it right now with stream yard. But let's highlight. Alright, the findings that indicate your worsening of the client status.

So what are you going to highlight? Clients post operative day after a split neck tummy is able to ambulate in the corridor three to four times a day with minimal assistance. assistance so there's no problem there. How about the second sentence? Client is clear bread sounds a left sided chest tube in place attach or close? Just raise just if there's no problem there. How about sentence number three titling of the water chamber no other than deep inspiration. Is this correct? Is this normal? That is normal. How about the fourth statement or scent? Client refuses to use the incentive spirometer it causes left sided chest pain. Is that normal or abnormal? Is that correct or incorrect statement? Should we highlight that? Should we highlight that yes, you can start highlighting from client refuses or you can also start with a word refuse as action word so I prefer that you guys start highlighting from refuses to use incentives for ramen or consequence causes left sided just me right either or it's going to score you the same, okay?

But sometimes there are compound sentences here we go with the English classes. And this is why I like ng because now you have to learn English as well. Sometimes there's compound sentences like okay, the titling is found on deep inspiration. And the suction chamber has absent bubbling so now there's two sentences in one sentence, it's compound sentence. So you only highlight those things that are being looked for or that we are looking for in this case, worsening glad status. All right, how about the next sentence Glide is using prescribed patient controlled analgesia device maximally every hour and still continues to have nausea and vomiting so I will highlight that right because the patients are already on maximum pain management but still nauseated and is vomiting which means the patient still uncomfortable and is still in pain, which means the medication is not working. It's not enough those the patients in pain patients uncomfortable.

If you don't address this, they can sue you. So we're gonna, we're gonna highlight that as well. How about the next adequate URI now but nope. Abdominal surgical incision redressing screen dry intact with no erythema, edema or drainage. That's also Nope. So there are only two things that I will highlight the clog review systems incentive spirometer and blindness using prescribed BCA device maximally every hour continuous to intermittent nausea and vomiting. Those are two signs that the patient is not improving and is worsening. All right. So in the actual NCLEX are actually going to click a nightlight, I hope you guys can do that. That's basic computer skill. Just like you're highlighting words in the internet and copying it and pasting it to your Facebook posts, or copying and pasting in Microsoft Word. It's the same, but you're gonna have to highlight it. And it's going to turn color yellow during the emphasis once you highlight so click and then drag to highlight, right. That's one of the new things in NCLEX highlighting. All right, April, please send me a message, a doctor nurse Paul in Facebook, and I'm going to be able to help you and my team, right. All right, you guys have questions? Who found it easy? Who found it difficult? Who found it challenging? Be honest with me? Be honest, I know some people found it easy. Some people found it confusing. But that's why we're doing a lot of these drills to train you live, how to answer these types of questions and how to attack them. And so you can also figure out your deficiencies. All right. Will there be penalty if you highlighted the whole sentence instead of just some parts of sentence? Shelley? No. But then again, that's only for simple sentences.

If this is a compound sentence, where one sentence is composed of two standalone sentences connected by what they call that interjections I forgot, I'm not an English major, but the end or but or, or if they're connected sentences, then you cannot highlight the whole thing. Because that's two sentences that you're highlighting. Right? So it's only per sentence or phrase need to review concepts, Shelly said tricky but passable, of course. Michi. Alright, with proper training. Yes, you can. Can you guys pass your NCLEX? Can you guys pass your next generation NCLEX? Very good road that this is a very important comment by Rhoda. Can we flash that on the screen member Linus. She said it is challenging, but easy if you are equipped with the content, information. That's right. So that's why I keep emphasizing next gen NCLEX is just another way to test your knowledge. Don't get me Don't get scared with that. What you actually need to prepare with is your concepts because now in the form of case scenario where you are overwhelmed reading hundreds of words to find out the problem.

It can easily trick you if you don't know the concept. So a lot of people are not able to answer the first few questions because they don't have a full grasp of what is pulmonary embolism versus what is bowel perforation versus what is Wieneke laceration versus what is hypovolemic shock versus what is stroke? So that's a problem because you get confused with things like that. All right. And thank you guys, I do this every Saturdays please join me can you faster next gen networks Yes, I can follow doctor nurse Paul in Facebook, YouTube, Instagram and TikTok. I do live classes every Saturday 8am Central US time. That's Texas time. And I do secrets of next generation and blitz every first and third Saturdays of the month. Every second and fourth Saturdays of the month I do us a nurse series that's very good conversation with experts with people have experiences migrating to the US and we're talking about many things like contracts and moving into the United States and settling into your work and finding jobs and bringing your family. So many learnings I love talking to my peers here in the US. So please follow and support doctor nurse Paul as I do these free classes so we can help more nurses. I know a lot of nurses don't have adequate funds to really be in a review program. And that's why Connetics is offering anklet scholarship. We're going to flash that one more time on the screen. Here in the bottom right, we're going to flash the link where you can apply for NCLEX scholarship under Connetics USA and aspire are in Alright, so go click that link right now fill up the form and one of the Connetics recruiters or get ahold of you and explain to you how the scholarship program works. But we have hundreds of Connetics scholars in Aspire are in right now. 

Thank you guys for dressing Aspire RN and doctor nurse Paul. I am here to help you. If you guys have questions, send me an email info at doctor nurse Paul.com That's info at doctor nurse Paul.com Or just follow me on social media and we're gonna get ahold of you once we can we have tons of messages but we're still trying to like respond to everybody. So please be patient with us. Alright, and also follow up Connetics USA we do this classes every Monday with other human Connetics partners.

And there's a lot of shows that Connetics do actually which I love because they do immigration Q&A day. They do their onwards and upwards days. So many shows. I love working with Connetics USA I've been doing shows with them for a long time before I put up my own show. And that's why I have my own show because I was inspired what Connetics is doing. Alright, thank you guys for allowing me to help you guys today. Thank you for being patient with me while we are going to connection issues at the beginning.

If you guys have questions, drop a message in my Facebook, Instagram or TikTok and I will respond to you as soon as I can. All right, you guys have a great day. Thank you so much. I'll see you soon every first Monday Connetics college with Connetics USA and Aspire RN with doctor nurse Paul have a great day. Bye

AI on Trial: Legal Models Hallucinate in 1 out of 6 Queries

A new study reveals the need for benchmarking and public evaluations of AI tools in law.

Artificial intelligence (AI) tools are rapidly transforming the practice of law. Nearly  three quarters of lawyers plan on using generative AI for their work, from sifting through mountains of case law to drafting contracts to reviewing documents to writing legal memoranda. But are these tools reliable enough for real-world use?

Large language models have a documented tendency to “hallucinate,” or make up false information. In one highly-publicized case, a New York lawyer  faced sanctions for citing ChatGPT-invented fictional cases in a legal brief;  many similar cases have since been reported. And our  previous study of general-purpose chatbots found that they hallucinated between 58% and 82% of the time on legal queries, highlighting the risks of incorporating AI into legal practice. In his  2023 annual report on the judiciary , Chief Justice Roberts took note and warned lawyers of hallucinations. 

Across all areas of industry, retrieval-augmented generation (RAG) is seen and promoted as the solution for reducing hallucinations in domain-specific contexts. Relying on RAG, leading legal research services have released AI-powered legal research products that they claim  “avoid” hallucinations and guarantee  “hallucination-free” legal citations. RAG systems promise to deliver more accurate and trustworthy legal information by integrating a language model with a database of legal documents. Yet providers have not provided hard evidence for such claims or even precisely defined “hallucination,” making it difficult to assess their real-world reliability.

AI-Driven Legal Research Tools Still Hallucinate

In a new preprint study by  Stanford RegLab and  HAI researchers, we put the claims of two providers, LexisNexis and Thomson Reuters (the parent company of Westlaw), to the test. We show that their tools do reduce errors compared to general-purpose AI models like GPT-4. That is a substantial improvement and we document instances where these tools can spot mistaken premises. But even these bespoke legal AI tools still hallucinate an alarming amount of the time: these systems produced incorrect information more than 17% of the time—one in every six queries.

Read the full study, Hallucination-Free? Assessing the Reliability of Leading AI Legal Research Tools

To conduct our study, we manually constructed a pre-registered dataset of over 200 open-ended legal queries, which we designed to probe various aspects of these systems’ performance.

Broadly, we investigated (1) general research questions (questions about doctrine, case holdings, or the bar exam); (2) jurisdiction or time-specific questions (questions about circuit splits and recent changes in the law); (3) false premise questions (questions that mimic a user having a mistaken understanding of the law); and (4) factual recall questions (questions about simple, objective facts that require no legal interpretation).

Figure 1: Comparison of hallucinated (red) and incomplete (yellow) answers across generative legal research tools.

These systems can hallucinate in one of two ways. First, a response from an AI tool might just be  incorrect —it describes the law incorrectly or makes a factual error. Second, a response might be  misgrounded —the AI tool describes the law correctly, but cites a source which does not in fact support its claims.

Given the critical importance of authoritative sources in legal research and writing, the second type of hallucination may be even more pernicious than the outright invention of legal cases. A citation might be “hallucination-free” in the narrowest sense that the citation  exists , but that is not the only thing that matters. The core promise of legal AI is that it can streamline the time-consuming process of identifying relevant legal sources. If a tool provides sources that  seem authoritative but are in reality irrelevant or contradictory, users could be misled. They may place undue trust in the tool's output, potentially leading to erroneous legal judgments and conclusions.

Figure 2:  Left: Example of a hallucinated response by Thomson Reuters’s Ask Practical Law AI. The system fails to correct the user's mistaken premise—in reality, Justice Ginsburg joined the Court's landmark decision legalizing same-sex marriage—and instead provides additional false information about the case. Right: Example of a hallucinated response by LexisNexis’s Lexis+ AI.  Casey and its undue burden standard were overruled by the Supreme Court in  Dobbs v. Jackson Women's Health Organization , 597 U.S. 215 (2022); the correct answer is rational basis review.

RAG Is Not a Panacea

Figure 3: An overview of the retrieval-augmentation generation (RAG) process. Given a user query (left), the typical process consists of two steps: (1) retrieval (middle), where the query is embedded with natural language processing and a retrieval system takes embeddings and retrieves the relevant documents (e.g., Supreme Court cases); and (2) generation (right), where the retrieved texts are fed to the language model to generate the response to the user query. Any of the subsidiary steps may introduce error and hallucinations into the generated response. (Icons are courtesy of FlatIcon.)

Under the hood, these new legal AI tools use retrieval-augmented generation (RAG) to produce their results, a method that many tout as a potential solution to the hallucination problem. In theory, RAG allows a system to first  retrieve the relevant source material and then use it to  generate the correct response. In practice, however, we show that even RAG systems are not hallucination-free. 

We identify several challenges that are particularly unique to RAG-based legal AI systems, causing hallucinations. 

First, legal retrieval is hard. As any lawyer knows, finding the appropriate (or best) authority can be no easy task. Unlike other domains, the law is not entirely composed of verifiable  facts —instead, law is built up over time by judges writing  opinions . This makes identifying the set of documents that definitively answer a query difficult, and sometimes hallucinations occur for the simple reason that the system’s retrieval mechanism fails.

Second, even when retrieval occurs, the document that is retrieved can be an inapplicable authority. In the American legal system, rules and precedents differ across jurisdictions and time periods; documents that might be relevant on their face due to semantic similarity to a query may actually be inapposite for idiosyncratic reasons that are unique to the law. Thus, we also observe hallucinations occurring when these RAG systems fail to identify the truly binding authority. This is particularly problematic as areas where the law is in flux is precisely where legal research matters the most. One system, for instance, incorrectly recited the “undue burden” standard for abortion restrictions as good law, which was overturned in  Dobbs (see Figure 2). 

Third, sycophancy—the tendency of AI to agree with the user's incorrect assumptions—also poses unique risks in legal settings. One system, for instance, naively agreed with the question’s premise that Justice Ginsburg dissented in  Obergefell , the case establishing a right to same-sex marriage, and answered that she did so based on her views on international copyright. (Justice Ginsburg did not dissent in  Obergefell and, no, the case had nothing to do with copyright.) Notwithstanding that answer, here there are optimistic results. Our tests showed that both systems generally navigated queries based on false premises effectively. But when these systems do agree with erroneous user assertions, the implications can be severe—particularly for those hoping to use these tools to increase access to justice among  pro se and under-resourced litigants.

Responsible Integration of AI Into Law Requires Transparency

Ultimately, our results highlight the need for rigorous and transparent benchmarking of legal AI tools. Unlike other domains, the use of AI in law remains alarmingly opaque: the tools we study provide no systematic access, publish few details about their models, and report no evaluation results at all.

This opacity makes it exceedingly challenging for lawyers to procure and acquire AI products. The big law firm  Paul Weiss spent nearly a year and a half testing a product, and did not develop “hard metrics” because checking the AI system was so involved that it “makes any efficiency gains difficult to measure.” The absence of rigorous evaluation metrics makes responsible adoption difficult, especially for practitioners that are less resourced than Paul Weiss. 

The lack of transparency also threatens lawyers’ ability to comply with ethical and professional responsibility requirements. The bar associations of  California ,  New York , and  Florida have all recently released guidance on lawyers’ duty of supervision over work products created with AI tools. And as of May 2024,  more than 25 federal judges have issued standing orders instructing attorneys to disclose or monitor the use of AI in their courtrooms.

Without access to evaluations of the specific tools and transparency around their design, lawyers may find it impossible to comply with these responsibilities. Alternatively, given the high rate of hallucinations, lawyers may find themselves having to verify each and every proposition and citation provided by these tools, undercutting the stated efficiency gains that legal AI tools are supposed to provide.

Our study is meant in no way to single out LexisNexis and Thomson Reuters. Their products are far from the only legal AI tools that stand in need of transparency—a slew of startups offer similar products and have  made   similar   claims , but they are available on even more restricted bases, making it even more difficult to assess how they function. 

Based on what we know, legal hallucinations have not been solved and the legal profession should turn to public benchmarking and rigorous evaluations of AI tools. 

The authors of this study chose to evaluate “Ask Practical Law AI” because, despite several requests, they were not given access to Thomson Reuters’ other products at the time of the study. The authors look forward to evaluating more tools, but underscore that it should not be incumbent on academic researchers alone to provide transparency and empirical evidence on the reliability of marketed products. 

Paper authors: Varun Magesh is a research fellow at Stanford RegLab. Faiz Surani is a research fellow at Stanford RegLab. Matthew Dahl is a joint JD/PhD student in political science at Yale University and graduate student affiliate of Stanford RegLab. Mirac Suzgun is a joint JD/PhD student in computer science at Stanford University and a graduate student fellow at Stanford RegLab. Christopher D. Manning is Thomas M. Siebel Professor of Machine Learning, Professor of Linguistics and Computer Science, and Senior Fellow at HAI. Daniel E. Ho is the William Benjamin Scott and Luna M. Scott Professor of Law, Professor of Political Science, Professor of Computer Science (by courtesy), Senior Fellow at HAI, Senior Fellow at SIEPR, and Director of the RegLab at Stanford University. 

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GenCost: cost of building Australia’s future electricity needs

Each year, CSIRO and the Australian Energy Market Operator (AEMO) collaborate with industry stakeholders to update GenCost. This leading economic report estimates the cost of building new electricity generation, storage, and hydrogen production in Australia out to 2050.

GenCost 2023-24 report released

The latest release was shaped by an unprecedented level of industry participation.

What’s new?

• Renewables (solar and wind + firming) remains the lowest cost new build electricity technology.
• Large-scale nuclear technology costs included for the first time.
• Future wind costs revised upwards.
• An extensive FAQ section addressing common questions from current and past consultations.

What is GenCost?

GenCost is a leading economic report for business leaders and decision-makers planning reliable and affordable energy solutions to achieve net zero emissions by 2050.

Published annually in collaboration with the Australian Energy Market Operator (AEMO), GenCost offers accurate, policy and technology-neutral cost estimates for new electricity generation, storage, and hydrogen technologies, through to 2050.

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GenCost 2023-24 report

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GenCost projects the cost of electricity generation and storage for a wide range of technologies up to the year 2050.  

Renewables remain lowest cost

The report highlights wind power’s slower recovery from global inflationary pressures, resulting in upward revisions for both onshore and offshore wind costs over the next decade.

Despite this, updated analysis reaffirms that renewables, including associated storage and transmission costs, remain the lowest cost, new build technology out to 2050.

This competitive position reflects a decade of cost reductions in wind, solar photovoltaics (PV) and batteries before the pandemic. This is in contrast with costs of mature competitors which have remained flat.

Large-scale nuclear costs introduced

The inclusion of large-scale nuclear costs this year was prompted by increased stakeholder interest in nuclear technology following the updated cost estimates for SMRs in the 2023-24 consultation draft.

Applying overseas costs to large-scale nuclear projects in Australia is complex due to the lack of a domestic nuclear industry and significant global differences in labor costs, workforce expertise, governance, and standards. The GenCost 2023-24 report team estimated large-scale nuclear costs using South Korea’s successful nuclear program. They adjusted for differences in Australian and South Korean deployment costs by comparing the cost ratio of new coal generation in each country. GenCost found nuclear power to be more expensive than renewables and estimated a development timeline of at least 15 years, including construction. This reflects the absence of a local development pipeline, additional legal, safety and security requirements, and stakeholder evidence. Achieving the reported nuclear costs depends on Australia committing to a continuous building program like South Korea’s. Initial units are likely to incur higher costs, and a first-of-a-kind premium of up to 100 per cent is possible, although not included in the cost estimates for nuclear or other new electricity technologies in the report.

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The promise and the reality of gen AI agents in the enterprise

The evolution of generative AI (gen AI) has opened the door to great opportunities across organizations, particularly regarding gen AI agents—AI-powered software entities that plan and perform tasks or aid humans by delivering specific services on their behalf. So far, adoption at scale across businesses has faced difficulties because of data quality, employee distrust, and cost of implementation. In addition, capabilities have raced ahead of leaders’ capacity to imagine how these agents could be used to transform work.

However, as gen AI technologies progress and the next-generation agents emerge, we expect more use cases to be unlocked, deployment costs to decrease, long-tail use cases to become economically viable, and more at-scale automation to take place across a wider range of enterprise processes, employee experiences, and customer interfaces. This evolution will demand investing in strong AI trust and risk management practices and policies as well as platforms for managing and monitoring agent-based systems.

In this interview, McKinsey Digital’s Barr Seitz speaks with senior partners Jorge Amar and Lari Hämäläinen and partner Nicolai von Bismarck to explore the evolution of gen AI agents and how companies can and should implement the technology, where the pools of value lie for the enterprise as a whole. They particularly explore what these developments mean for customer service. An edited transcript of the conversation follows.

Barr Seitz: What exactly is a gen AI agent?

Lari Hämäläinen: When we talk about gen AI agents, we mean software entities that can orchestrate complex workflows, coordinate activities among multiple agents, apply logic, and evaluate answers. These agents can help automate processes in organizations or augment workers and customers as they perform processes. This is valuable because it will not only help humans do their jobs better but also fully digitalize underlying processes and services.

For example, in customer services, recent developments in short- and long-term memory structures enable these agents to personalize interactions with external customers and internal users, and help human agents learn. All of this means that gen AI agents are getting much closer to becoming true virtual workers that can both augment and automate enterprise services in all areas of the business, from HR to finance to customer service. That means we’re well on our way to automating a wide range of tasks in many service functions while also improving service quality.

Barr Seitz: Where do you see the greatest value from gen AI agents?

Jorge Amar: We have estimated that gen AI enterprise use cases  could yield $2.6 trillion to $4.4 trillion annually in value across more than 60 use cases. 1 “ The economic potential of generative AI: The next productivity frontier ,” McKinsey, June 14, 2023. But how much of this value is realized as business growth and productivity will depend on how quickly enterprises can reimagine and truly transform work in priority domains—that is, user journeys, processes across an entire chain of activities, or a function.

Gen-AI-enabled agents hold the promise of accelerating the automation of a very long tail of workflows that would otherwise require inordinate amounts of resources to implement. And the potential extends even beyond these use cases: 60 to 70 percent of the work hours in today’s global economy could theoretically be automated by applying a wide variety of existing technology capabilities, including generative AI, but doing so will require a lot in terms of solutions development and enterprise adoption.

Consider customer service. Currently, the value of gen AI agents in the customer service environment is going to come either from a volume reduction or a reduction in average handling times. For example, in work we published earlier this year, we looked at 5,000 customer service agents using gen AI and found that issue resolution increased by 14 percent an hour, while time spent handling issues went down 9 percent. 2 “ The economic potential of generative AI: The next productivity frontier ,” McKinsey, June 14, 2023.

About QuantumBlack, AI by McKinsey

QuantumBlack, McKinsey’s AI arm, helps companies transform using the power of technology, technical expertise, and industry experts. With thousands of practitioners at QuantumBlack (data engineers, data scientists, product managers, designers, and software engineers) and McKinsey (industry and domain experts), we are working to solve the world’s most important AI challenges. QuantumBlack Labs is our center of technology development and client innovation, which has been driving cutting-edge advancements and developments in AI through locations across the globe.

The other area for value is agent training. Typically, we see that it takes somewhere between six to nine months for a new agent to perform at par with the level of more tenured peers. With this technology, we see that time come down to three months, in some cases, because new agents have at their disposal a vast library of interventions and scripts that have worked in other situations.

Over time, as gen AI agents become more proficient, I expect to see them improve customer satisfaction and generate revenue. By supporting human agents and working autonomously, for example, gen AI agents will be critical not just in helping customers with their immediate questions but also beyond, be that selling new services or addressing broader needs. As companies add more gen AI agents, costs are likely to come down, and this will open up a wider array of customer experience options for companies, such as offering more high-touch interactions with human agents as a premium service.

Barr Seitz: What are the opportunities you are already seeing with gen AI agents?

Jorge Amar: Customer care will be one of the first but definitely not the only function with at-scale AI agents. Over the past year, we have seen a lot of successful pilots with gen AI agents helping to improve customer service functions. For example, you could have a customer service agent who is on the phone with a customer and receives help in real time from a dedicated gen AI agent that is, for instance, recommending the best knowledge article to refer to or what the best next steps are for the conversation. The gen AI agent can also give coaching on behavioral elements, such as tone, empathy, and courtesy.

It used to be the case that dedicating an agent to an individual customer at each point of their sales journey was cost-prohibitive. But, as Lari noted, with the latest developments in gen AI agents, now you can do it.

Nicolai von Bismarck: It’s worth emphasizing that gen AI agents not only automate processes but also support human agents. One thing that gen AI agents are so good at, for example, is in helping customer service representatives get personalized coaching not only from a hard-skill perspective but also in soft skills like understanding the context of what is being said. We estimate that applying generative AI to customer care functions could increase productivity by between 30 to 45 percent. 3 “ The economic potential of generative AI: The next productivity frontier ,” McKinsey, June 14, 2023.

Jorge Amar: Yes, and in other cases, gen AI agents assist the customer directly. A digital sales assistant can assist the customer at every point in their decision journey by, for example, retrieving information or providing product specs or cost comparisons—and then remembering the context if the customer visits, leaves, and returns. As those capabilities grow, we can expect these gen AI agents to generate revenue through upselling.

[For more on how companies are using gen AI agents, see the sidebar, “A closer look at gen AI agents: The Lenovo experience.”]

Barr Seitz: Can you clarify why people should believe that gen AI agents are a real opportunity and not just another false technology promise?

A closer look at gen AI agents: The Lenovo experience

Three leaders at Lenovo —Solutions and Services Group chief technology officer Arthur Hu, COO and head of strategy Linda Yao, and Digital Workplace Solutions general manager Raghav Raghunathan—discuss with McKinsey senior partner Lari Hämäläinen and McKinsey Digital’s Barr Seitz how the company uses generative AI (gen AI) agents.

Barr Seitz: What existing gen AI agent applications has Lenovo been running and what sort of impact have you seen from them?

Arthur Hu: We’ve focused on two main areas. One is software engineering. It’s the low-hanging fruit to help our people enhance speed and quality of code production. Our people are already getting 10 percent improvements, and we’re seeing that increase to 15 percent as teams get better at using gen AI agents.

The second one is about support. We have hundreds of millions of interactions with our customers across online, chat, voice, and email. We’re applying LLM [large language model]-enhanced bots to address customer issues across the entire customer journey and are seeing some great improvements already. We believe it’s possible to address as much as 70 to 80 percent of all customer interactions without needing to pull in a human.

Linda Yao: With our gen AI agents helping support customer service, we’re seeing double-digit productivity gains on call handling time. And we’re seeing incredible gains in other places too. We’re finding that marketing teams, for example, are cutting the time it takes to create a great pitch book by 90 percent and also saving on agency fees.

Barr Seitz: How are you getting ready for a world of gen AI agents?

Linda Yao: I was working with our marketing and sales training teams just this morning as part of a program to develop a learning curriculum for our organization, our partners, and our key customers. We’re figuring out what learning should be at all levels of the business and for different roles.

Arthur Hu: On the tech side, employees need to understand what gen AI agents are and how they can help. It’s critical to be able to build trust or they’ll resist adopting it. In many ways, this is a demystification exercise.

Raghav Raghunathan: We see gen AI as a way to level the playing field in new areas. You don’t need a huge talent base now to compete. We’re investing in tools and workflows to allow us to deliver services with much lower labor intensity and better outcomes.

Barr Seitz: What sort of learning programs are you developing to upskill your people?

Linda Yao: The learning paths for managers, for example, focus on building up their technical acumen, understanding how to change their KPIs because team outputs are changing quickly. At the executive level, it’s about helping leaders develop a strong understanding of the tech so they can determine what’s a good use case to invest in, and which one isn’t.

Arthur Hu: We’ve found that as our software engineers learn how to work with gen AI agents, they go from basically just chatting with them for code snippets to developing much broader thinking and focus. They start to think about changing the software workflow, such as working with gen AI agents on ideation and other parts of the value chain.

Raghav Raghunathan: Gen AI provides an experiential learning capability that’s much more effective. They can prepare sales people for customer interactions or guide them during sales calls. This approach is having a much greater impact than previous learning approaches. It gives them a safe space to learn. They can practice their pitches ahead of time and learn through feedback in live situations.

Barr Seitz: How do you see the future of gen AI agents evolving?

Linda Yao: In our use cases to date, we’ve refined gen AI agents so they act as a good assistant. As we start improving the technology, gen AI agents will become more like deputies that human agents can deploy to do tasks. We’re hoping to see productivity improvements, but we expect this to be a big improvement for the employee experience. These are tasks people don’t want to do.

Arthur Hu: There are lots of opportunities, but one area we’re exploring is how to use gen AI to capture discussions and interactions, and feed the insights and outputs into our development pipeline. There are dozens of points in the customer interaction journey, which means we have tons of data to mine to understand complex intent and even autogenerate new knowledge to address issues.

Jorge Amar: These are still early days, of course, but the kinds of capabilities we’re seeing from gen AI agents are simply unprecedented. Unlike past technologies, for example, gen AI not only can theoretically handle the hundreds of millions of interactions between employees and customers across various channels but also can generate much higher-quality interactions, such as delivering personalized content. And we know that personalized service is a key driver of better customer service. There is a big opportunity here because we found in a survey of customer care executives we ran that less than 10 percent of respondents  in North America reported greater-than-expected satisfaction with their customer service performance. 4 “ Where is customer care in 2024? ,” McKinsey, March 12, 2024.

Lari Hämäläinen: Let me take the technology view. This is the first time where we have a technology that is fitted to the way humans interact and can be deployed at enterprise scale. Take, for example, the IVR [interactive voice response] experiences we’ve all suffered through on calls. That’s not how humans interact. Humans interact in an unstructured way, often with unspoken intent. And if you think about LLMs [large language models], they were basically created from their inception to handle unstructured data and interactions. In a sense, all the technologies we applied so far to places like customer service worked on the premise that the customer is calling with a very structured set of thoughts that fit predefined conceptions.

Barr Seitz: How has the gen AI agent landscape changed in the past 12 months?

Lari Hämäläinen: The development of gen AI has been extremely fast. In the early days of LLMs, some of their shortcomings, like hallucinations and relatively high processing costs, meant that models were used to generate pretty basic outputs, like providing expertise to humans or generating images. More complex options weren’t viable. For example, consider that in the case of an LLM with just 80 percent accuracy applied to a task with ten related steps, the cumulative accuracy rate would be just 11 percent.

Today, LLMs can be applied to a wider variety of use cases and more complex workflows because of multiple recent innovations. These include advances in the LLMs themselves in terms of their accuracy and capabilities, innovations in short- and long-term memory structures, developments in logic structures and answer evaluation, and frameworks to apply agents and models to complex workflows. LLMs can evaluate and correct “wrong” answers so that you can have much higher accuracy. With an experienced human in the loop to handle cases that are identified as tricky, then the joint human-plus-machine outcome can generate great quality and great productivity.

Finally, it’s worth mentioning that a lot of gen AI applications beyond chat have been custom-built in the past year by bringing different components together. What we are now seeing is the standardization and industrialization of frameworks to become closer to “packaged software.” This will speed up implementation and improve cost efficiency, making real-world applications even more viable, including addressing the long-tail use cases in enterprises.

Barr Seitz: What sorts of hurdles are you seeing in adopting the gen AI agent technology for customer service?

Nicolai von Bismarck: One big hurdle we’re seeing is building trust across the organization in gen AI agents. At one bank, for example, they knew they needed to cut down on wrong answers to build trust. So they created an architecture that checks for hallucinations. Only when the check confirms that the answer is correct is it released. And if the answer isn’t right, the chatbot would say that it cannot answer this question and try to rephrase it. The customer is then able to either get an answer to their question quickly or decide that they want to talk to a live agent. That’s really valuable, as we find that customers across all age groups — even Gen Z — still prefer live phone conversations for customer help and support. .

Jorge Amar: We are seeing very promising results, but these are in controlled environments with a small group of customers or agents. To scale these results, change management will be critical. That’s a big hurdle for organizations. It’s much broader than simply rolling out a new set of tools. Companies are going to need to rewire how functions work so they can get the full value from gen AI agents.

Take data, which needs to be in the right format and place for gen AI technologies to use them effectively. Almost 20 percent of most organizations, in fact, see data as the biggest challenge to capturing value with gen AI. 5 “ The state of AI in 2023: Generative AI’s breakout year ,” McKinsey, August 1, 2023. One example of this kind of issue could be a chatbot sourcing outdated information, like a policy that was used during COVID-19, in delivering an answer. The content might be right, but it’s hopelessly out of date. Companies are going to need to invest in cleaning and organizing their data.

In addition, companies need a real commitment to building AI trust and governance capabilities. These are the principles, policies, processes, and platforms that assure companies are not just compliant with fast-evolving regulations—as seen in the recent EU AI law and similar actions in many countries—but also able to keep the kinds of commitments that they make to customers and employees in terms of fairness and lack of bias. This will also require new learning, new levels of collaboration with legal and risk teams, and new technology to manage and monitor systems at scale.

Change needs to happen in other areas as well. Businesses will need to build extensive and tailored learning curricula for all levels of the customer service function—from managers who will need to create new KPIs and performance management protocols to frontline agents who will need to understand different ways to engage with both customers and gen AI agents.

The technology will need to evolve to be more flexible and develop a stronger life cycle capability to support gen AI tools, what we’d call MLOps [machine learning operations] or, increasingly, gen AI Ops [gen AI operations]. The operating model will need to support small teams working iteratively on new service capabilities. And adoption will require sustained effort and new incentives so that people learn to trust the tools and realize the benefits. This is particularly true with more tenured agents, who believe their own skills cannot be augmented or improved on with gen AI agents. For customer operations alone, we’re talking about a broad effort here, but with more than $400 billion of potential value from gen AI at stake, it’s worth it. 6 “ The economic potential of generative AI: The next productivity frontier ,” McKinsey, June 14, 2023.

Barr Seitz: Staying with customer service, how will gen AI agents help enterprises?

Jorge Amar: This is a great question, because we believe the immediate impact comes from augmenting the work that humans do even as broader automation happens. My belief is that gen AI agents can and will transform various corporate services and workflows. It will help us automate a lot of tasks that were not adding value while creating a better experience for both employees and customers. For example, corporate service centers will become more productive and have better outcomes and deliver better experiences.

In fact, we’re seeing this new technology help reduce employee attrition. As gen AI becomes more pervasive, we may see an emergence of more specialization in service work. Some companies and functions will lead adoption and become fully automated, and some may differentiate by building more high-touch interactions.

Nicolai von Bismarck: As an example, we’re seeing this idea in practice at one German company, which is implementing an AI-based learning and coaching engine. And it’s already seeing a significant improvement in the employee experience as measured while it’s rolling this out, both from a supervisor and employee perspective, because the employees feel that they’re finally getting feedback that is relevant to them. They’re feeling valued, they’re progressing in their careers, and they’re also learning new skills. For instance, instead of taking just retention calls, they can now take sales calls. This experience is providing more variety in the work that people do and less dull repetition.

Lari Hämäläinen: Let me take a broader view. We had earlier modeled a midpoint scenario when 50 percent of today’s work activities could be automated to occur around 2055. But the technology is evolving so much more quickly than anyone had expected—just look at the capabilities of some LLMs that are approaching, and even surpassing, in certain cases, average human levels of proficiency. The innovations in gen AI have helped accelerate that midpoint scenario by about a decade. And it’s going to keep getting faster, so we can expect the adoption timeline to shrink even further. That’s a crucial development that every executive needs to understand.

Jorge Amar is a senior partner in McKinsey’s Miami office, Lari Hämäläinen is a senior partner in the Seattle office, and Nicolai von Bismarck is a partner in the Boston office. Barr Seitz is director of global publishing for McKinsey Digital and is based in the New York office.

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Scientists Are Studying Weight-Loss Drugs for Way More Than Weight Loss

T he new weight-loss drugs Wegovy and Zepbound are in high demand, and the clamoring will only increase in coming years, experts predict. That's because drugs like these, which rely at least in part on the appetite-regulating hormone GLP-1, are being investigated not just for weight loss and diabetes, but also for a wide range of other conditions.

"Weight loss is only part of it," says Dr. Ian Neeland, chair of the American Heart Association’s obesity science committee and an associate professor of medicine at Case Western Reserve University.

Here’s the latest (and still-growing) list.

Heart disease

In March, the U.S. Food and Drug Administration (FDA) allowed doctors to prescribe Wegovy (semaglutide) to reduce the risk of heart attack or stroke in people who are overweight and have a history of heart problems. In one study, people taking Wegovy had a 20% lower risk of heart attack, stroke, or death from a heart event compared to people who didn't take it.

Some of that benefit to the heart may come from the weight loss itself, since weight can have an adverse effect on the heart. But in the study that Wegovy’s maker, Novo Nordisk, submitted to the FDA, some of the benefits appeared before people began losing weight—suggesting that the drugs are working in other ways to improve the cardiovascular system.

It’s possible that the new weight-loss drugs, which belong to a broader group of hormones called incretins, work directly on fat cells that promote inflammation and contribute to atherosclerosis or narrowing of the blood vessels. “Markers of inflammation drop pretty dramatically in patients taking tirzepatide [Zepbound] in trials,” says Dan Skovronsky, chief scientific officer at Eli Lilly, which makes Zepbound. (Zepbound combines two incretins: GLP-1 and GIP.) “That suggests there may be secondary effects to obesity since visceral fat is inflammatory. That’s exciting to explore.”

Read More : Is Ozempic the New Anti-Inflammatory Wonder Drug?

Lilly is also studying Zepbound's potential heart benefits by focusing on people with heart failure, since “body mass puts a strain on the heart, and reducing weight should have a profound effect on overall health," Skovronsky says.

To better understand some of the broader effects that the drugs are having on body, Lilly is also conducting a large trial tracking how Zepbound affects 15,000 people with obesity and their overall rates of a variety of diseases and death. “We are studying death from any cause to see if incretins could have life-saving or life-preserving benefits, which we expect to be true,” Skovronsky says.

Social media is full of stories of “Ozempic babies” that were born to people struggling with infertility who were able to get pregnant after starting GLP-1 drugs for diabetes or weight loss.

Reproductive health experts caution that the connection may not be as direct as people might think. “What would surprise nobody is that getting weight into normal range will promote fertility,” says Dr. Zev Williams, director of the Columbia University Fertility Center. “If that’s through diet, exercise or medications, the net result is that there is a common pathway from reducing obesity to improving fertility.”

Read More : How Researchers Are Working to Make IVF More Effective

Extra weight can lead to abnormal menstrual cycles, which can also make pregnancy more difficult, says Dr. William Dietz, director of the Stop Obesity Alliance at George Washington University. Losing weight could help to restore cycles and increase the chances of pregnancy.

Beyond that, however, incretins could address some of the biological processes involved in fertility. About 10% of women of childbearing age in the U.S. have polycystic ovary syndrome (PCOS), which is the most common cause of infertility. PCOS is a hormone disorder, and it can be driven by insulin resistance or increased levels of insulin in the body. And because insulin is closely tied to weight, controlling weight—and the resulting normalization of insulin responses—could also address PCOS and ultimately a woman’s chance of getting pregnant.

Kidney disease

People with diabetes often develop kidney complications. Those taking the drug Ozempic (semaglutide—the same drug as Wegovy—but approved in different doses for diabetes) reduced their risk of dying from either kidney or heart events by 24% , according to data from Ozempic’s maker Novo Nordisk.

Read More : 7 Myths About Kidney Cancer, Debunked

Lars Freurgaard Jorgensen, the company's CEO, says he anticipates that in coming years, the market for drugs like Ozempic will become more specialized and diverse, due to the wide range of body systems that are affected by weight gain. “Today we look at obesity as one market, but going forward it will be made up of different segments—some people will have obesity and fatty liver, some with obesity and cardiovascular disease, and others with obesity and kidney disease ,” he says. “Different products might lend themselves to slightly better outcomes, so we may see more personalized obesity care over time.”

Over time, obesity can lead to the accumulation of fat cells in the liver, contributing to a condition called metabolic dysfunction associated steatohepatitis (MASH). The excess fat causes inflammation that can damage the organ and potentially lead to liver failure. In early studies, Lilly scientists reported that tirzepatide can slow the progression of MASH, possibly preserving liver function. In the study involving 190 people with the condition, 74% receiving the highest dose of the drug (three times the dose for weight loss) were able to clear themselves of the disease after a year, compared to 13% of those receiving placebo.

Obstructive sleep apnea

About 40% of people who have a BMI of 50 or greater also have obstructive sleep apnea, which causes them to stop breathing temporarily. Losing weight can directly lower the risk of sleep apnea, and results from a late-stage study from Lilly showed that tirzepatide led to 30 fewer such events, or a reduction of 63%, each hour for people with obesity and the sleeping disorder. The drug could be “practice changing” for these patients, says Skovronsky, since there are no effective medications currently available, and most people rely on CPAP machines and other cumbersome and inconvenient devices.

Read More : Why Waking Up Earlier Isn’t Necessarily Better

Osteoarthritis

Excess weight has a damaging effect on joints and can alter the body's fat-to-muscle ratio, so losing weight may also impact the muscles and skeletal system. Researchers are studying whether incretins, which can reduce inflammation, represent a new group of potential treatments for conditions like osteoarthritis, in which joints deteriorate as inflammation flares up.

Weight gain can also lead to changes in the brain, including increasing inflammation that can affect nerves. But research also suggests that incretins can have direct effects on brain pathways, in particular those involved in the reward system implicated in addictive behaviors. Studies in animals show that incretins, and GLP-1s in particular, can dampen brain signals associated with reward and addiction, and lead to lower intake of alcohol and addictive drugs. Scientists are now studying whether the same effects occur in people.

The range of conditions impacted by incretins hints at the potential power they may have in addressing a number of chronic diseases—and that’s not lost on the scientists developing the next generation of these drugs, which combine multiple incretins. The goal also includes shifting these from injections to pills to make it more convenient and accessible to more people.

The many conditions implicated by the medications are “a good reminder of how important metabolism is for overall health, and it impacts our risk for disease,” says Skovronsky. “It’s something we knew but were never able to improve with pharmacology. Now we can, so seeing all the benefits that could occur is super exciting.”

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