Writing NGN-Style Questions

By Susan Sportsman, PhD, RN, ANEF, FAAN

As we move closer and closer to April 2023, preparing students for the Next Generation NCLEX (NGN) is a primary responsibility for nursing faculty. The test questions we use in our courses must mirror those on the NGN to the extent possible.  The NGN test questions focus on evaluating students’ ability to use effective clinical judgment in clinical scenarios. The National Council of State Boards of Nursing (NCSBN) has provided a wealth of information to help us prepare for the implementation of the new NCLEX examination. These resources include a schematic presentation of the Clinical Judgment Measurement Model (CJMM) and quarterly publications, “Next Generation NCLEX News,” which provide an explanation of the research behind the development of the model, as well as examples of the structure of various NGN test questions. These examples demonstrate how to structure a test item to evaluate test-takers’ ability to use clinical judgement.

Three broad categories of questions will be on the NCLEX exam beginning in April of 2023:

    1. Case Studies: All test-takers, regardless of how many questions they receive, will respond to three case studies. Each of these case studies will have six questions. Questions in the Case Study will focus on application of one of the following cognitive skills highlighted in the Clinical Judgment Measurement Model (CJMM): Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solution, Take Action, and Evaluate Outcomes.
    2. Clinical Judgment Standalone questions: Bowtie and Trend Question types also require the test-taker to use at least one cognitive skill to correctly answer the question. Anywhere from 0 to 7 such questions will be included in the NCLEX, depending on the number of questions required for an individual test-taker.
    3. Knowledge Items: This type of question is similar to those currently on the NCLEX. However, these questions also require the test-taker to use at least one cognitive skill to correctly answer the question. Test-takers may take anywhere from 52-110 knowledge questions, depending on the number of questions required to assess their clinical judgment competence.

Regardless of the type of question that is developed, the NCSBN suggest that all questions developed should highlight a clinical scenario (clinical story). The scenario should include:

    • The client’s age, gender identity, client history and/or medical diagnosis, and physical and psychosocial aspects of care.
    • Client/nurse interaction, client need, and an expected outcome (either explicit or implicit)

In addition to these new categories of questions, the NCSBN has identified several ways that questions can be structured in order to simulate the clinical judgment process. The structures of these questions are similar to some of the question types currently on the NCLEX. However, they have been made more complex, so that test-takers have a greater opportunity to demonstrate their ability to apply their knowledge of complex findings than they have been able to do in the past. Illustrations of the various item structures and related information can be found here.

Most faculty are relieved to know that the majority of the test items on the NCLEX exam are knowledge questions, similar to those currently on the NCLEX. As is currently the case, these questions must require the application of knowledge, reflect multi-logic thinking, and have a high level of discrimination. They must also meet all the requirements of NGN test items. Because these questions are the most frequently used test item in the NGN exam, it seems reasonable to start with revising some of our knowledge test questions to meet the standards of the NGN.

Below is an example of how you might change a knowledge test question to meet the new standards.

Standard Test Question for a Beginning Student

Which of the following Vital Signs values are within normal limits for a 40-year-old woman? (SATA)

a. BP – 120/82*
b. Temperature – 100.4
c. Pulse – 110
d. Respiratory Rate – 18
e. BP – 150/96
f. Pulse – 74*

NGN-Style Question

A 40-year-old woman is admitted to the hospital for a hysterectomy due to leiomyomas (Uterine fibroids). Her admission Vital Signs are BP – 120/78, Temperature 96.8, Pulse 75, and Respiratory Rate – 12. After surgery and recovering in the Post-Anesthesia Care Unit (PACU) and upon return to the unit, the nurse caring for the patient takes the client’s vital signs. The nurse’s initial assessment of the client is that she appears anxious, moving her legs and hands, even though she grimaces as she moves. Her dressing is dry.

Use the following table to categorize as normal or abnormal each of the specific findings.

Please note: The presentation of the scenario of NGN questions on the NCLEX exam will appear on the left side of the computer screen. The question related to the scenario will appear on the right side of the screen. As you write your own questions, you may or may not be able to lay questions out in this manner.

Many of the knowledge questions will require test-takers to apply only one cognitive skill to answer the question (in the case of the above question, Recognize Cues). In some knowledge questions, a second question associated with the scenario will be presented. If so, the scenario will appear on the left side of the second question, perhaps with additional information regarding the patient, and the actual question will be on the right.

Checklist for NGN Knowledge Questions

The following checklist outlines criteria for an NGN Knowledge question. The checklist can be helpful for ensuring that your revised test questions meet the NGN standards for questions that your students may see on the NGN examination.

Criteria for NGN Knowledge Questions
I hope this criterion will be helpful as you begin your journey to revise test questions that require your students to use clinical judgment. This skill will not only help them to be successful on the NGN examination, but also as they begin their practice.

In subsequent posts we will explore ways to develop case study questions and clinical standalone questions. In the meantime, I would love to hear about what you have learned as you begin to revise your current questions.

Good Luck!


Leave a Reply

%d bloggers like this: