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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.

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Next Generation NCLEX: Case Studies 1-2

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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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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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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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How to Prepare Your Students Now for Next Gen NCLEX