Report from the 2021 NCSBN NCLEX Conference

By Susan Sportsman, PhD, RN, ANEF, FAAN                                                            

April 2023 remains the target date for the Next Generation NCLEX (NGN) for both the NCLEX-RN and NCLEX-PN licensure examinations. These examinations emphasize the use of clinical judgment in caring for patients in a variety of healthcare settings by focusing on interactions between nurse and client, the client’s needs, and expected outcomes.

Nursing faculty across the US and Canada are ramping up their preparation for the new NGN approach to testing. I recently attended the 2021 National Council of State Boards of Nursing (NCSBN) annual NCLEX conference, a single day virtual education conference. This conference focused on the structure and content of the NGN exam, clarifying questions we all have about this process. Below, I have provided some of the clarifying items the presenters discussed which seemed particularly important to those who are writing test questions for their students.

Question Categories

The NGN test will include three categories of questions:
Knowledge Items—similar to current test questions: 52-110 questions will be on the exam depending on the number of test questions a student receives in the Computer Adaptive Test (CAT).
Clinical Judgment Stand-Alone items which emphasize one or more of the six cues in Level 4 of the Clinical Judgment Measurement Model (CJMM): Approximately 7 questions.
Case studies—Unfolding case studies with six questions in each case study, representing each of the six cognitive cues: three case studies with six questions; one question represents each cognitive cue in Level 4 of the model.

See for questions representing the Clinical Judgment Measurement Model.

Question Structure

The structure of a question may include:

  • Multiple Choice
  • Matrix Multiple Choice
  • Multiple Response Select All That Apply
  • Multiple Response Select N
  • Multiple Response Grouping
  • Matrix Multiple Response
  • Bowtie (Stand-Alone only)
  • Trend (Stand-Alone only)
  • Drag-and-Drop Close
  • Drag-and-Drop Rationale
  • Drag-and-Drop Table
  • Drop Down Rationale
  • Highlight Text
  • Highlight Table

See,, and for examples of these types of questions.

Other Information

    • In Case Studies, the scenario and information from resources such as nursing notes, patient history and physical, vital signs, lab work, I & O, medications and diagnostics will appear on the left side of the computer screen; the questions will appear on the right side. Test-takers may toggle between screens while answering a question.
    • Influencing factors outlined in the CJMM will often be part of the question.
    • The context of care will expand to include acute care, long term care, and community agencies.
    • All categories of the NCLEX Test Design will be represented. Questions will require test-takers to demonstrate the ability to use the application cognitive level or higher.
    • Key qualifying words in the question will be bolded.
    • The NGN will not ask questions about procedures. The items may ask questions regarding nursing care related to certain procedures.
    • Normal lab references will be given along with patient lab information in the scenario.
    • The correct answer for Select All That Apply (SATA) questions may range from one option to all options. The question may or may not give the test-taker the number of options to be chosen.
    • The examination will be Computer Adaptive (CAT), evaluating the difficulty of a question to offer a more or less difficult question next.
    • The maximum time to take the NGN NCLEX test will remain the same as the current NCLEX (5 hours).
    • The screens will meet the requirements of the Americans with Disabilities Act.
    • Test-takers will be given an erasable board when they enter the testing area.
    • Math problems will be included in the examination only in the context of answering a practice application question. No math problems without application will be included.
    • Scoring of the examination will be changed to partial credit in some questions. See for more information.

The content of the NGN conference and discussion of various nurse faculty related to strategies to write these new test questions. I have heard faculty expressing the desire for a template for test development. Look for our next blog post, where we present just such a template.

I would recommend that if you have not yet perused the NGN Resources on the National Counsel of State Board of Nursing website (, you do so. These resources will certainly help you as we all move toward April 2023.

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