Next Gen NCLEX: The what, the why, and the how

What is Next Gen NCLEX?

NCLEX stands for National Council Licensure Examination, and is the computerized adaptive test used to measure the knowledge and competence of nursing school graduates. It is THE exam for which your nursing program prepares you, beginning on day one of school. So, what exactly is the Next Generation NCLEX and how is it different from the old generation NCLEX? Next Gen NCLEX (NGN) is the most recently updated NCLEX test model that incorporates brand new question types designed specifically to assess clinical judgment. These new question types were developed by the people who write the NCLEX (National Council for State Boards of Nursing) under the new clinical judgment model. Five specific characteristics are measured through the addition of new item types: critical thinking, clinical judgment, problem solving, professional communication, and active listening.

So, what does all this mean for me?

I want to start this section off by saying that NGN is only about 25 % different than the previous NCLEX; meaning that 75% of the exam consists of the traditional multiple choice and select all that apply item types. The remaining 25% will consist of the new item types and they are: Case studies, highlighting, cloze, matrix, extended multiple response, trend item, extended drag and drop, and bowtie items. This new testing format went into effect on April 1, 2023, and for the last several weeks I have been researching what students have to say about the NGN. According to most newly licensed RNs who have taken and passed the NGN, case studies seem to be the most encountered of the new item types followed by cloze items. The thing about case studies, is that one case study may include several of other item types within the question. Here is an example:

CASE STUDY EXAMPLE

1500: A 70-year-old male client presents to the emergency department with reports of dyspnea at rest and crushing chest pain that he rates 10/10. He states that the pain has been present for 2 days. The client states that he took an over-the-counter antacid that did not relieve the pain. He reports a family history of high cholesterol and hypertension. The client states no significant medical history but takes 600mg ibuprofen daily for low back pain and Flomax for benign prostatic hyperplasia.

The client appears clammy and diaphoretic on assessment. Skin is cool to touch. S1 and S2 are heard upon auscultation and lungs are clear throughout.

Current VS are: T 36.9C, HR 45 BPM, RR 18 BPM, BP 88/48, O2 sat 97% on 2 LPM per BNC.

ECG: Sinus rhythm with frequent PVCs and ST elevation 2 mm in leads V1, V2, V3, and V4.

Highlight the findings that require immediate follow-up. (Highlighting item type)

A 70-year-old male client presents to the emergency department with reports of dyspnea at rest and crushing chest pain that he rates 10/10 which has been present for 2 days. The client states that he took an over-the-counter antacid that did not relieve the pain. He reports a family history of high cholesterol and hypertension. The client states no significant medical history but takes 600mg ibuprofen daily for low back pain and Flomax for benign prostatic hyperplasia.

The client appears clammy and diaphoretic. Skin is cool to touch. S1 and S2 are heard upon auscultation and lungs are clear throughout.

Current VS are: T 36.9C, HR 45 BPM, RR 18 BPM, BP 88/48, O2 sat 97% on 2 LPM per BNC.

ECG: Sinus rhythm with frequent PVCs and ST elevation 2 mm in leads V1, V2, V3, and V4.

For each potential finding below, highlight the finding that is consistent with each diagnosis listed. (Matrix/grid response item)

Cloze item type

Based on the finding’s the client is most at risk for __________________________(NSTEMI, STEMI, coronary vasospasm), based on the client’s _________________________(ECG, HR/BP, chest pain)

Which interventions will the nurse implement? Select all that apply. (Traditional select all that apply item type)

1. Initiate a ROMI panel

2. Notify the cath lab

3. Keep the client NPO

4. Administer metoprolol 50mg PO

5. Place the client on room air

The nurse prepares to administer prescribed medications. For each of the medications listed, choose which medications will be indicated or not indicated for this client. (Matrix/ grid item type)

The nurse is conducting teaching with the client prior to discharge. Which should be included in teaching? Select all that apply. (Extended multiple response item)

1. Make sure to take aspirin PO daily as prescribed.

2. Call 911 if you experience chest pain or dyspnea.

3. You may return to normal activity upon discharge.

4. Feelings of irregular an heart beat are to be expected.

5. Check with your provider about resuming sexual activity.

6. Check your own blood pressure and pulse at least weekly.

Now that we have a little better grasp on the look of the new question types, let’s talk about scoring. The previous NCLEX did not offer partial credit for select all that apply questions, but NGN does! Let’s look back to our extended multiple response item asking about discharge teaching for our client. This item type is scored in a +/- format…meaning that for each correct answer chosen, you earn +1 points; however, for each incorrect answer you choose, 1 point is subtracted. There is good news about this type of scoring though! Let’s say you go wild and choose all answers as correct, you earn +3 points for the correct answer choices then -3 points for the incorrect answer choices meaning that you earn a big fat 0 for this question…BUT, 0 is the minimum score that may be earned for these item types! There are no points subtracted for too many incorrect answer choices.

Let’s look at another item type with partial scoring which includes the cloze questions.

Based on the finding’s the client is most at risk for __________________________(NSTEMI, STEMI, coronary vasospasm), based on the client’s _________________________(ECG, HR/BP, chest pain)

So, in this example, the first part of this question is testing clinical reasoning and the second portion is testing rationale. From what I have read up about these question types, if you answer the first portion of the question incorrectly, no partial credit is awarded, and you earn 0 points. If both portions of this question are answered correctly, two points are earned. However, if you answer the first portion correctly, but the second portion incorrectly, partial credit may be awarded, and one point is earned.

How do I prepare?

Alright, now that we know the what and the why, let’s talk about the how. What is the most effective way to prepare for NGN? First, remember, your nursing program has prepared you for this…from day one. You know more than you think you know! One of the biggest obstacles that my students must work to overcome is test anxiety. While I don’t have the cure-all for test anxiety, the best antidote is adequate preparation. While preparation for nursing exams may vary from student to student, the best way to prepare for NCLEX is to use practice questions. I highly recommend creating an NCLEX study schedule that spans between 6-8 weeks with the last 2 weeks being dedicated solely to practice questions. The two most popular test banks among NGN test-takers are first, Archer with U-World coming in as a close second. Both test banks provide content-based practice questions with detailed rationales. Make sure to take time to read over the rationales of missed questions and do not move on to new content until the content of focus is mastered. You can find all kinds of NCLEX study schedules on Pinterest that can help you get organized but it’s up to you to execute your plan of attack and stick to your study schedule.

Wrap up

Now that you know what to do, there is no better time than now to start preparing. The format of the exam may have changed but one thing remains the same: You CAN DO THIS! You have worked hard, finished the race of nursing school, now it’s time to go get that license!

Thanks so much for taking the time to read my post today and I really hope you have found it helpful! Make sure to follow us on social media so you get alerted first when there are new videos, inforgraphics, practice questions, care plans, and other resources added to the site!