October 22, 2021

What You Need to Know About the Next Generation NCLEX (NGN)

What You Need to Know About the Next Generation NCLEX (NGN)

What is the Next Generation NCLEX (NGN)?

The Next Generation NCLEX (NGN) is going to be the new version of the NCLEX exam that prospective registered nurses and licensed practical nurses must pass. Changes to the NCLEX exam are slated to begin sometime in 2023, although the exact date has not yet been determined by the NCSBN.

If you’re a nursing student, or a prospective nursing student, you probably have some questions about the new NCLEX exam. So, we decided to answer some of the most common questions we’ve heard right here. 

Why is the NCLEX Exam Changing?

Every 3 years, the NCSBN performs a practice analysis to determine “the knowledge, skills, and abilities needed for entry-level nurses and to evaluate the validity of the test plan that guides content distribution of the licensure examination”. After the most recent practice analysis, the NCSBN found that nurses (including newly licensed nurses) are caring for more critically ill patients and are responsible for making increasingly complex decisions and judgments regarding their care.

The RN Nursing Knowledge Survey from 2017 confirmed these findings as well with newly licensed RNs, nursing supervisors, and nurse educators identifying that clinical judgment is “important” to “critically important” in nursing practice. And this rating for clinical judgment was consistent across healthcare settings including hospitals, community-based settings, long-term care and other healthcare settings. The conclusion mirrors previous research showing that clinical judgment is essential for entry-level nurses to provide safe care.

For this reason, the NCSBN is developing a “new and improved NCLEX exam” that “asks better questions to help nurses think critically when providing care and make the right decisions.”

>> Related: Watch Nurse Alice's Free Webinar on How to Prepare for the NCLEX, exclusively available in the Nurse Network

Are Both the NCLEX-RN and NCLEX-PN Exams Changing?

Yes, the NCSBN is making changes to both of these NCLEX exams in 2023. 

What Will the Next Generation NCLEX Be Like?

The NGN will use a mix of item types that require candidates to demonstrate their nursing knowledge, skills, and clinical judgment. There will be a mix of current NCLEX exam items types and new NGN items. The exams will also continue to use computer adaptive testing (CAT). 

For example, the NCSBN has approved five different types of exam questions: Extended Multiple Response (SATA), Extended Drag & Drop, Cloze (Drop-Down), Enhanced Hot Spot (Highlighting), and Matrix/Grid. Both SATA and Drag & Drop questions are currently used on the NCLEX. However, some new formats for questions will include Enhanced Hot Spot (Highlighting), Matrix/Grid, and Cloze (Drop-Down).

New NGN Question Formats


A split-screen will be used to display new test items. The case description will be on the left and exam questions will be on the right. When electronic health records are presented, they will contain both pertinent and extraneous information. If the case progresses, more information tabs may be added for subsequent questions.

Image via NCBSN

Each test will have 2-5 case scenarios or item sets. Each case will have 6 items associated with it. This will allow for 12-30 clinical judgment items per test. 

Cloze (Drop-Down)

These test items include one or more drop-down lists allowing the candidate to select one option from a list. These drop-down lists may be used within a sentence, table, or chart and may include words or phrases.

Image via NCBSN

Enhanced Hot Spot (Highlighting)

Test items in this format require candidates to highlight their answer by selecting or deselecting “pre-defined” words or phrases. These test items will allow the candidate to read and select the words or phrases in a portion of a client’s medical record to answer the test item (e.g. lab values, a nursing note, or a portion of the client’s medication record).

Image via NCBSN


Will have only one correct answer or more than one correct answer. The candidate will know if the question is indicating there is only one correct answer or more than one correct answer based on the style of the selection buttons next to the possible answer choices. Circles next to a possible answer indicate only one possible correct answer whereas squares next to answer choices indicate more than one possible correct answer.

Both NGN exams will also use a new clinical judgment task model the NCSBN developed called the NCSBN Clinical Judgment Measurement Model (NCJMM). The NCJMM will be applied to case studies requiring the candidate to use clinical judgment to answer test items. Although there are aspects of clinical decision making in the PN nursing process, prioritization and hypothesis are not part of the PN scope of practice. As a result, the NCLEX-PN exam will not include many of these types of questions.

Will the NGN Look Very Different Than the Current NCLEX?

Aside from the split-screen format for new test items, the NGN will not look much different than the current exams because of the NGN. The exams will still assess if a candidate has adequate entry-level knowledge and clinical judgment skills for a newly licensed nurse. Some question formats will also remain the same such as select all that apply (SATA) and Drag & Drop. 

However, the way in which test items are scored is changing. The good news is the new scoring method will reward candidates for partial understanding of a question which is discussed more below.

Are There Any Advantages to the New NGN Exam Format?

Yes, there certainly is! The current NCLEX exams score candidates’ responses on an exam item as “'all correct' or 'all incorrect' (known as a dichotomous scoring model). 

However, the new NCLEX exams will be scored using a new polytomous scoring method that gives the candidate marks for partial knowledge. For example, select all that apply (SATA) questions on the current NCLEX are only marked as correct or incorrect. But using the new polytomous scoring method, candidates will be able to get partial marks if they get part of a question correct. 

Will Candidates Need to Prepare Differently for the NGN Compared to the Current NCLEX?

Fortunately, candidates will not need to learn any additional material to pass the NGN including the NCJMM. The NCSBN states on their website that “ Any evidence-based curriculum that teaches clinical judgment effectively will provide students with preparation necessary for the new components of the exam.”

More information about the upcoming NGN can be found at the NCSBN website here.

Find Nursing Programs

Email Signup

Find a job, learn, connect and laugh.

Try us out.

Join our newsletter