NCLEX Next Generation: What You Need to Know

by | Dec 2, 2022 | Nursing School and NCLEX® | 0 comments

Alert! Alert! A massive update to the NCLEX is COMING PEOPLE! It is called NCLEX Next Generation, often referred to as NCLEX Next Gen. This will go into effect on April 1, 2023. Let’s chat about everything you’ll need to know about it. 

Estimated Read Time: 11 minutes

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Why the change to NCLEX Next Generation? 

The National Council of State Boards of Nursing (NCSBN) is the group who writes the NCLEX, and subsequently any updates (like NCLEX Next Generation). Part of this massive task is asking questions that assess the prospective nurse’s knowledge appropriately to determine if they truly are competent enough to earn that coveted RN behind their name. 

As you can imagine, the medical field is rapidly evolving. Technology gets more complex and innovative, so we can care for sicker patients, but that increase in complexity requires the caregivers to be able to handle it. The last thing we want is for nurses to make poor clinical decisions that impact patients. 

Therefore, the screening process for becoming a nurse (AKA passing nursing school and the NCLEX) needs to adapt with the advancements. They have to assess if the people taking the NCLEX truly can think critically at the basic level required to be a successful nurse, hence the need for NCLEX Next Generation.

According to the NCSBN, 65% of nursing errors are from poor clinical decision making, and 50% of those errors involve novice nurses. Simply put, if there is a better measurement of clinical judgment, then the test can better assess if you’re truly ready. 

This is why the test is changing so dramatically. While it is reviewed and updated regularly, the upgrade to NCLEX Next Generation status is a bit more complex and different than adding harder multiple choice and select all that apply (SATA) questions. Let’s dig into specifics. 

NCLEX Next Generation: A new way to assess clinical judgment

The new framework to assess this is called the “NCSBN Clinical Judgment Measurement Model” (NCJMM). This breaks down the actual steps needed to successfully work through a patient situation. Now, this model gets quite complex. But one thing it really focuses on are six measurable steps in the clinical decision making process that are imperative to know to navigate the case studies the test will cover. 

These six steps are:

  1. Recognize cues (noticing that something’s up)
  2. Analyzing cues (what could these new findings really mean?)
  3. Prioritizing hypotheses (ok, I think I have an idea of what’s going on here, what are the most important things to address first?)
  4. Generate solutions (identify what to do about it)
  5. Actions to take (get it done!)
  6. Evaluate outcomes (did it work?)

Let’s discuss specifically how they are going to see if you know how to use those steps to work through theoretical situations and what updates will be on the NCLEX Next Generation going forward.

Specific NCLEX Next Generation changes

It’s not just new types of questions that are getting an upgrade! The scoring will be different, there are difficult types of questions, and the total minimum and maximum number of questions has changed.

One change I noticed that I was excited about is that items that contain a numeric laboratory value will include the corresponding normal reference range. Woo hoo!

New scoring for the NCLEX Next Generation

Before this update, you either got the question correct or incorrect. Even the dreaded SATA questions were a win-lose situation. But because the questions are now going to be much longer and more complex, you can now get partial credit! This new scoring model is called polytomous. You will be scored in one of three ways:

The 0/1 scoring rule 

This means that the answer is either correct or incorrect. This is the normal scoring we’re all familiar with and likely how your nursing school multiple choice tests are scored. 

The +/- scoring rule 

This means that you will earn points for correct answers but lose points for incorrect answers. For example, let’s say it was a SATA question with 4 correct options. You selected 3 correct answers and 1 incorrect one. Therefore, 3-1 = 2 and you would earn 2 points. Important note: If you answer more incorrectly than correctly, you cannot go into the negatives. For example, if there are 3 correct answers and you select 4 incorrect answers, your score would be 0, not -1. 

The rationale scoring 

This would be used if the question is asking about paired information, or information that relates specifically to something else and they want to see if you can make that connection. To get credit for these questions, you must answer it fully. For example, “the patient is at risk of developing X [you’ll be given a drop-down menu of options] as evidenced by Y [with another drop down of options]”. You must select the correct option for both to earn credit for the question. 

New types of questions on the NCLEX Next Generation

Gone are the days of only regular multiple choice question or SATA. On NCLEX Next Generation, there different types of questions you may encounter. 

Extended multiple response

This is like your normal SATA but more than four options. Simple enough, right? While it is intimidating to have more options, remember you now can earn partial credit on them. 

Extended drag and drop

These questions provide a list of potential steps on one side, then you will need to drag and drop them into the correct order on the other side to indicate the appropriate steps. However, you may not need to drag all options over. This is similar to the current NCLEX ordered response items, but the twist is that you may not need to drop all of the possible options to the other side for the answer to be correct.

Drop Down Cloze

My first question was what the heck “cloze” means. Basically it’s when a word or text has been removed from a sentence and you need to figure out what the missing word/phrase is to make the sentence correct. 

You’ll have a sentence (or more) in which words or phrases are missing. In the missing spot, there will be a drop down menu option and you’ll need to select the correct one to make the sentence accurate. 

There will likely be more than one that you’ll need to fill in correctly. Let’s say there are 3 drop-downs and you get 2 of them correct. You would get a score of 2 points for that question. If you selected all of the wrong answers, you would get 0 points.

Drop Down Table

This is the same as above, except the elements are inside of a table rather than a sentence or group of sentences. 


Boy, these are tricky looking questions. IMHO I think they’re probably the most difficult ones of the NCLEX Next Generation update. These questions have a max score of 5 points each. There is a middle concept that you need to select correctly from a list of options (1 point), with two correct options on either side (1 point each, 4 total). It’s called a “bowtie” question because one option with two on either side of it looks like a bowtie.

For example, the middle concept could be a condition the patient is most likely experiencing. They may give you a list of things like hypoglycemia, hyperkalemia, UTI, bell’s palsy, etc. 

On the left side, you’ll need to select two actions to take. They’ll list various actions like call the physician, get a urine sample, apply oxygen, activate hypoglycemia protocol, and so forth. Again, you must select two.

On the right, you’ll need to select two parameters to monitor. The options could be things like blood sugar, potassium level, neuro status, telemetry, etc. 

If you’re counting, that’s 5 total selections to make, which is 5 total points possible for a bow tie question. You will get a point for each correct answer, and 0 points for each incorrect answer. 

Enhanced hotspot

With these questions, you’ll get a large paragraph that will outline some sort of patient scenario.The directions may say something like, “Click to highlight the findings that would require a follow-up”. There might be a list of vital sign findings, lab values, meds, or nursing note information that you could highlight to answer the question successfully. 


For these, you’ll get a situation described in paragraph form. Then, there will be a grid, which will have a list of items (for example, assessment findings) and then it will ask you to select an appropriate response (for example, effective, ineffective, unrelated) in the correct column or row.

Different number of questions

The minimum number of questions will be 85, this will include 70 scored and 15 unscored. The unscored are used to test questions for future exams. The maximum number of questions is now 150, with 135 scored and 15 unscored. 

Within these questions, you will receive multiple case studies. Let’s say you got the minimum number of questions (85). Of the 85, there would be 3 case studies. Each case study has 6 questions. There would also be 52 stand-alone questions. With more questions comes the possibility of more case studies and corresponding questions. In totality, there are 5 case studies (with 6 questions each, for a max of 30 questions related to case studies).

Things that are staying the same

Despite the massive update to NCLEX Next Generation, there will be a few major aspects of the exam that will remain exactly the same.

You will still register through Pearson Vue to take the exam. You must also register with your state board of nursing too (and if you need a little help navigating all of that, check out our free mini-course here). 

The NCLEX Next Generation will still be a computer adaptive test (CAT). This is a great explanation of CAT exams. Basically, with CAT exams, the questions adapt to your answers. So, you won’t necessarily get the same questions as your nursing school BFF when they sit for boards. You’ll get a medium difficulty question to start off with, and then depending on how you answer it will determine your next question. If you answer it wrong, you’ll get easier and easier questions until you get one right. When you answer a question correctly, you’ll get more difficult questions until you get one wrong. The test will keep adapting to your responses until it determines that your answers clearly demonstrate you’re above the passive standard and pass, or far enough below that you fail.

You will still get up to five hours to take the exam. Keep in mind that the NCSBN does anticipate that even though they’re making all these changes the test will take about the same amount of time for candidates. 

How should I study for the NCLEX Next Generation if I’m graduating in May 2023?

My #1 recommendation for any graduating nursing student wanting to pass the NCLEX Next Generation on the first attempt is to get a great study tool. Unfortunately, nursing school alone isn’t enough to prep you. Not only do you need you need to know the content of the exam, but also how to answer these very unique questions.

Pick a review option, create a study schedule, and stick with it. Don’t cross reference over 15 sources, question every little thing, and drive yourself crazy.

Below are some wonderful NCLEX-prep options.

Each review has pluses and minuses, but please note they all are strictly online resources and not in-person reviews.

FAQs about taking the NCLEX and NCLEX Next Generation

More FreshRN Resources

NCLEX Next Generation References from the NCSBN

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Hi, I’m Kati.

Kati Kleber, MSN RN is a nurse educator, author, national speaker, host of the FreshRN® Podcast, and owner of FreshRN® – an online platform created to educate, encourage, and motivate newly licensed nurses in innovative ways.

Connect with her on YouTube, Pinterest, TikTok, Instagram, and Facebook, and sign-up for her free email newsletter for new nurses.


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