Study guide
Next Generation NCLEX (NGN)
NCLEX-RN Registered Nurse
Track your progress as you read
Finished sections get a check mark.
1 Introduction
About the NCLEX-RN Exam Next Generation NCLEX (NGN) Clinical Judgment Measurement Model (NCJMM) How to Use This Course
2 Chapter 2: Management of Care
2.1 Legal Rights and Responsibilities 2.2 Advance Directives and Self-Determination 2.3 Informed Consent Protocols 2.4 Client Advocacy and Rights (HIPAA) 2.5 Assignment, Delegation, and Supervision 2.6 Five Rights of Delegation 2.7 Scope of Practice (RN vs LPN vs UAP) 2.8 Ethical Practice Principles
3 Chapter 3: Safety and Infection Prevention and Control
3.1 Standard Precautions and Hand Hygiene 3.2 Transmission-Based Precautions (Contact, Droplet, Airborne) 3.3 PPE Donning and Doffing Sequences 3.4 Fall Prevention and Restraints 3.5 Fire Safety (RACE/PASS) 3.6 Disaster Triage and Emergency Response
4 Chapter 4: Health Promotion and Maintenance
4.1 Growth and Development (Erikson/Piaget) 4.2 Developmental Stages: Infancy through Older Adult 4.3 Maternal and Newborn Care (Antepartum) 4.4 Intrapartum Care and Fetal Monitoring 4.5 Postpartum Care (BUBBLE-HE) 4.6 Health Screening Guidelines 4.7 Immunization Schedules
5 Chapter 5: Psychosocial Integrity
5.1 Therapeutic Communication Techniques 5.2 Non-Therapeutic Communication (What to Avoid) 5.3 Anxiety Disorders and Mental Health Concepts 5.4 Schizophrenia: Hallucinations and Delusions 5.5 Depression and Suicide Assessment 5.6 Substance Misuse and Withdrawal 5.7 Grief and End-of-Life Care
6 Chapter 6: Basic Care and Comfort
6.1 Mobility and Hazards of Immobility 6.2 Assistive Devices (Crutches, Canes, Walkers) 6.3 Nutrition and Diet Therapy 6.4 Enteral Nutrition (Tube Feeding) 6.5 Bowel Elimination and Ostomy Care 6.6 Urinary Elimination and Catheter Care
7 Chapter 7: Pharmacological and Parenteral Therapies
7.1 Medication Administration Rights 7.2 Medication Calculations 7.3 High-Alert Medications: Insulins 7.4 High-Alert Medications: Anticoagulants 7.5 High-Alert Medications: Opioids 7.6 High-Alert Medications: Digoxin and Electrolytes 7.7 IV Therapy and Complications 7.8 Blood Product Administration 7.9 Total Parenteral Nutrition (TPN)
8 Chapter 8: Reduction of Risk Potential
8.1 Laboratory Values: Hematology (CBC) 8.2 Laboratory Values: Metabolic Panel (BMP) 8.3 Laboratory Values: Coagulation Studies 8.4 Vital Signs and Trend Recognition 8.5 Perioperative Care (Pre-Op and Post-Op) 8.6 Nasogastric Tubes and Therapeutic Procedures
9 Chapter 9: Physiological Adaptation
9.1 Fluid Imbalances (Hypovolemia and Hypervolemia) 9.2 Arterial Blood Gases (ABGs) and Acid-Base Balance 9.3 Medical Emergencies: Stroke (CVA) 9.4 Medical Emergencies: Myocardial Infarction (MONA) 9.5 Diabetic Emergencies (Hypoglycemia and DKA) 9.6 Respiratory Conditions (COPD, Pneumonia) 9.7 Cardiac Conditions (Heart Failure) 9.8 Neurological Conditions (Seizures)
Next Generation NCLEX (NGN)
Key Takeaways Explain This Topic AI
NGN was launched in April 2023 to better assess clinical judgment skills
NCSBN's new NGN item types are extended multiple response, extended drag and drop (including bowtie), cloze (drop-down), matrix/grid, highlighting, and trend items
Partial credit scoring applies to items with more than one key, using plus/minus, zero/one, or rationale scoring
Case studies present six sequential questions following the NCJMM framework
- NGN items simulate real-world clinical decision-making using EHR-style interfaces
- Last updated: October 2026
The Next Generation NCLEX (NGN) represents a fundamental shift in how nursing competency is assessed. Launched in April 2023, NGN moves beyond testing "what you know" to testing "how you think."
Why NGN Was Developed
NCSBN's 2013-2014 Strategic Practice Analysis showed that newly licensed nurses are increasingly expected to make complex decisions while caring for patients. NGN launched on April 1, 2023 to better measure candidates' clinical judgment and decision making through new item types.
NGN Item Types
NCSBN lists these new item types for case studies and stand-alone items: highlighting, cloze (pull-down menu), matrix/grid, extended multiple response, trend items, and extended drag and drop, including bowtie. Many present information like an electronic health record (EHR):
Extended Multiple Response
An extended version of the multiple-response ("Select All That Apply") item. Tests your ability to distinguish relevant from irrelevant clinical cues.
Matrix / Grid
A grid format where you select options across rows and columns. Used for comparing multiple diseases, drug classes, or patient assignments simultaneously.
Cloze (Drop-Down)
Select words or phrases from dropdown menus embedded in sentences, charts, or nurse's notes. Simulates clinical documentation.
Highlighting
Highlight the words or phrases in a client record or nurse's note that answer the question (for example, the findings that need follow-up).
Extended Drag and Drop
Drag response options (tokens) into place to complete the item; the bowtie below is a form of extended drag and drop.
Bowtie
A complex standalone item where you identify:
- A condition (center)
- Two actions to take
- Two parameters to monitor
Tests synthesis of assessment, diagnosis, planning, and evaluation in one visual structure.
Trend Items
Presents data (vital signs, labs) across multiple time points. Tests your ability to recognize deterioration or improvement over time.
Partial Credit Scoring
NCSBN uses partial credit scoring for items with more than one key. An item with a single key is scored correct or incorrect. There are three partial-credit methods:
Scoring Method How It Works
Plus/minus Used when you may select an unspecified number of options: a point for each correct option, a point deducted for each incorrect option; the minimum item score is zero
Zero/one Used when you are told how many responses to choose: a point for each correct response and none for an incorrect one; on multipoint items the correct responses are added up
Rationale Used for closely linked pairs of information (for example, a cause and its effect): both parts of the pair must be correct to earn the point
This acknowledges that clinical decision-making is rarely binary—you may correctly identify a condition but select suboptimal interventions.
Case Studies
NGN Case Studies present six sequential questions that follow the NCSBN Clinical Judgment Measurement Model. Each case study walks you through:
- Recognizing cues from patient data
- Analyzing what those cues mean
- Prioritizing which hypothesis is most concerning
- Generating solutions
- Taking action
- Evaluating outcomes