As you certainly already know, the NCLEX® exam underwent a major update that went into effect on April 1st, 2023. Launching in spring 2023 is the Next Generation NCLEX (NGN) exam. As of this date, all test takers are administered the NGN regardless of their graduation year.
The new exam format is intended to more effectively test the skills that are required of nurses in today’s healthcare environment. The Next Gen NCLEX is different from its predecessor due to its real-life scenarios and more in-depth questions designed to test your clinical judgment. The most significant test change on the Next Gen NCLEX is the introduction of new item (question) types.
So, will it be more difficult? The blunt answer is, yes, it may be a bit harder. The good news is that nursing schools are introducing these new question types and it is very likely your school already has started showing them to you in your own exams. Additionally, the information itself is not changing - just the way the questions are asked.
Increase your confidence on exam day by familiarizing yourself with the new NGN item types and formatting so there are no surprises. Getting to know these new question types and knowing how to tackle each of them will be a crucial part of preparing for the new NCLEX. Following a Next Gen NCLEX review course and utilizing our Next Gen NCLEX practice questions are some of the best ways to study for the NGN.
Overview of NGN Question Types
The NCSBN has chosen 12 new item (question) types for use with case studies and 2 for the use of stand-alone items on the Next Generation NCLEX. Stand-alone items consist of two types: a bow-tie item and a trend item. Case studies are displayed on a split-screen and will use 12 item types.
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New Question Formats
- Multiple Response: These questions allow you to select one or more answer options at a time. They are different from the previous NCLEX multiple-response questions in that they have more answer options, and it is possible to get partial credit for partially correct answers.
- Extended Drag-and-Drop: Extended drag-and-drop items allow you to move or place response options into answer spaces. This is similar to the current NCLEX questions of ordered response, but in this new format, there may be more response options than answer spaces - so test-takers will have to figure out which ones are just there for distraction.
- Cloze (Fill-in-the-Blanks): Cloze questions can also be called fill-in-the-blanks. The task is to select one option from a list to fill in the blank, which can be done with a dropdown or by dragging and dropping items.
- Enhanced Hot Spot: Enhanced hot spot items allow you to select your answer by highlighting predefined words or phrases in response to a question. You can highlight parts of text by clicking on specific words or phrases.
- Matrix/Grid: Matrix or grid items allow you to select one or more answer options for each row and column. This item type can be useful for associating multiple aspects of a clinical scenario with one single item.
- Bow-tie item: Drawing on all six steps of the NCSBN Clinical Judgment Measurement Model, the Bow-tie item type requires candidates to analyze cues within an electronic health record or patient scenario in order to determine what medical condition the patient is experiencing, actions to take, and parameters to monitor.
- Drag & Drop: The Drag & Drop question type in the NGN is very similar to the ordered response questions in the current NCLEX, though there are some key differences. This item requires candidates to select an option from provided choices within a table, chart, or paragraph.
Next Gen NCLEX NGN Question Types PART 6 | Bowtie Questions & Rationales
Clinical Judgment and Question Types
Testing for a soft skill, like a nursing candidate’s sense of clinical judgment, is difficult. Candidates review a patient scenario consisting of admission notes, vital signs, nurse’s notes, and other details available in customizable tabs. The Matrix/Grid question type is ideal for measuring a candidate’s understanding of complex, multifaceted clinical scenarios with a single exam item.
NGN Scoring System
Yes, you can get partial credit on the Next Gen NCLEX. The NGN's new scoring system is polytomous, meaning a test taker's response may be partially correct and receive partial credit. The NGN introduces polytomous, a new partial scoring method. You can now receive partial credit for correct responses on questions with more than 1 correct answer. The polytomous scoring method allows for a more accurate assessment of your abilities, as it considers the level of proficiency demonstrated by each response.
Your answer is either correct or incorrect, earning you 1 point for a correct response and no points for an incorrect one. You earn points for selecting correct options but lose points for selecting incorrect ones. Your score is calculated by adding points for correct answers and subtracting points for incorrect ones. The rationale scoring rule applies to questions that assess relational or paired information. To earn 1 point, both of your selected answers must be correct.
Computerized Adaptive Testing (CAT)
Test takers can expect between 70-135 scored questions on the Next Gen NCLEX in addition to 15 pretest questions that are not scored. The exact number of questions a test taker will encounter on the Next Gen NCLEX varies because the exam uses Computerized Adaptive Testing (CAT), so questions are geared toward the level of each person taking the exam based on their previous responses.
What is CAT? Computerized Adaptive Testing (CAT) customizes your exam to match your ability level, making each test unique. An algorithm adjusts the difficulty of each question based on your response to the previous one. You’ll start with a question near the passing level. If you answer correctly, the next question will be slightly harder. If you answer incorrectly, the next question will be easier.
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Confidence Interval Rule: The computer ends the exam when it is 95% certain that your ability is clearly above or below the passing standard. This is the most common scenario.
Run-Out-of-Time Rule (ROOT): If you run out of time and haven’t answered the minimum number of questions, you will fail.
Time Management
No, the new NCLEX is not all multiple-choice. You have up to 5 hours to complete the NGN. You can expect to receive a minimum of 85 and a maximum of 150 questions in that time. The number of scored questions ranges from 70 to 135. You have about 2 minutes to answer each question and finish the exam. Recent results from NCSBN’s beta testing show that students spent about 1 minute on each question. You can take a break after 2 hours of testing and another after 3.5 hours. The computer will stop delivering new questions when the algorithm determines with 95% confidence that you have achieved competency. For example, the computer may determine that you've passed once you've answered the minimum 85 questions or could quiz you up to 150 questions.
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