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What You Need to Know About the Next Generation NCLEX

What You Need to Know About the Next Generation NCLEX

It’s official. The much-anticipated Next Generation NCLEX (NGN) exam goes into effect on April 1, 2023, the National Council of State Boards of Nursing (NCSBN) confirmed. The revised exam addresses a gap between education and practice abilities, testing nurses’ critical thinking, judgment, and decision-making skills. “A nurse’s job is more challenging than ever,” said MedPro International Executive Vice President, International Operations Patty Jeffrey. “Rapidly developing technologies, chronic and complex illnesses, and the additional burdens created by staffing shortages necessitate revisions to an already challenging exam.”

NGN is designed to measure nurses’ clinical judgment, protect the public, and achieve the best outcomes for patients, nurses, and institutions. Nursing students who began nursing school in or after the fall of 2021 will take the NGN version.


Clinical Judgement

Every three years, NCSBN evaluates the NCLEX to see if changes need to be made. According to the NCSBN’s 2017 RN Nursing Knowledge Survey, newly licensed RNs, nursing supervisors, and nurse educators cited clinical judgment as “important” to “critically important” in their practice. NCSBN defines clinical judgment as the observed outcome of critical thinking and decision-making. But research showed novice nurses suffer from a lack of clinical judgment ability. According to NCSBN, 65 percent of nursing errors are due to poor clinical decision-making, and 50 percent of those errors involve novice nurses. NGN addresses this shortcoming to better prepare nurses for the job.


Next Generation Enhancements
NGN aims to improve nurses’ critical thinking, judgment, and decision-making skills.

The Next Generation NCLEX measures clinical judgment through questions focused on nurse and patient interaction, patient needs, and expected outcomes. Questions reflect real-world nursing care using realistic case studies or scenarios focusing on decisions made in a clinical setting.

The test was designed using the NCSBN Clinical Judgment Measurement Model. NGN still uses computerized adaptive testing, which generates increasingly difficult questions with each correct answer and easier questions in response to incorrect answers.

All of the original question types remain − Multiple Choice, Select All That Apply, Hot Spot, Fill in the Blank, Drag and Drop, Chart or Graphics, Graphic Multiple Choice, Audio or Video. However, there are some additions and revisions.


Question Types:

Extended Multiple Response: Candidates can select one or more answers simultaneously, with more options available than in the previous test. Partial credit is awarded to answers that are close to correct.

Extended Drag and Drop: The new version is similar to the previous one, but candidates may not need to use all responses to answer. A candidate may be presented with a list of patients and a description of their symptoms and asked to pair room assignments with patient scenarios.

Cloze/Drop Down: Candidates are presented with a narrative case study and asked for as many as six responses regarding the proper course of care.

Enhanced Hot Spot: Candidates are presented a scenario and patient data and asked to highlight specific sections in the scenario to answer questions.

Matrix/Grid: A candidate is given a scenario and patient data and then asked to make judgments about the findings, checking appropriate boxes in a supporting matrix.


NGN focuses on clinical judgement.

The Next Generation NCLEX will contain a minimum of 85 questions to a maximum of 150 questions compared to the previous 75 to 145 questions, but the test will still be five hours long. The new additions to NGN are designed to mimic a nurse’s daily work experience by testing their critical thinking, judgment, and decision-making skills. For more information about Next Generation NCLEX and changes to the exam, visit




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