What is the Next Gen NCLEX (NGN)?
The Next Gen NCLEX is the current NCLEX-RN licensure exam. The National Council of State Boards of Nursing (NCSBN) launched it on April 1, 2023. It's built to measure clinical judgment — how you reason through a patient situation — not just what facts you can recall.
Judgment, not just recall.
The older NCLEX leaned heavily on multiple-choice recall. The Next Gen NCLEX keeps that foundation but adds formats and case studies designed to test whether you can think like a nurse at the bedside: notice what matters, decide what to do, act, and check the result. To do that, the NCSBN built the exam around a model of how nurses make decisions — and then created new question types to measure each part of it.
The six clinical-judgment skills.
The NCSBN Clinical Judgment Measurement Model (NCJMM) breaks clinical judgment into six cognitive skills. NGN case studies move a patient through them in order.
Recognize Cues
Identify the relevant, meaningful information in a patient situation and filter out what doesn't matter.
Analyze Cues
Connect those cues to the patient's condition and figure out what they point to.
Prioritize Hypotheses
Rank the possible explanations by likelihood and risk to decide what to address first.
Generate Solutions
Identify the range of appropriate actions and expected outcomes for the prioritized problem.
Take Action
Choose and carry out the most appropriate interventions for the situation.
Evaluate Outcomes
Compare the actual result to the expected one and judge whether the plan is working.
The new item types.
Beyond traditional multiple choice, NGN adds the formats below. Most appear inside unfolding case studies — a single patient presented across the six clinical-judgment steps as their condition develops — though Bow-tie and Trend items also appear on their own.
Highlight
Select the relevant words or phrases directly in a chart or passage.
Matrix / Grid
Mark responses across a grid — for example, indicating which findings are expected, unexpected, or unrelated.
Extended Multiple Response
Select-all-that-apply or select-N — choose every correct option, or a set number of them.
Cloze (drop-down)
Complete sentences by choosing from drop-down menus embedded in the text.
Drag-and-drop
Move responses into the correct order or category.
Rationale
Pair an action or finding with the reasoning that supports it.
Bow-tie
A stand-alone item linking actions, conditions, and parameters to monitor around a central problem.
Trend
A stand-alone item asking you to interpret data that changes over time across a patient's course.
Want to see them in action? Walk through NGN case studies.
Scoring and what changed.
Polytomous (partial-credit) scoring
Many NGN items aren't all-or-nothing. They use polytomous scoring — partial credit through methods like plus/minus (+/−) and 0/1 — so a partly correct answer can still earn points. Some item types remain all-or-nothing.
How it differs from the old exam
The pre-2023 exam was mostly stand-alone multiple-choice recall scored all-or-nothing. NGN keeps multiple choice but adds clinical-judgment case studies, new item types, and partial-credit scoring — shifting the emphasis from memorized facts to reasoning through a patient.
Practice every NGN format free.
The fastest way to get comfortable with the Next Gen NCLEX is to do the formats themselves — bow-tie, trend, matrix, cloze, highlight, and full unfolding case studies — scored the way the real exam scores them. All of it is free on FirstPassRN during our open beta, with no card.
Building a schedule? See how to make an NCLEX study plan and the 2026 NCLEX-RN test plan.
Common questions.
What is the NGN NCLEX?+
The Next Gen NCLEX (NGN) is the current version of the NCLEX-RN licensure exam. It launched on April 1, 2023, and is built to measure clinical judgment — how a nurse recognizes a problem, decides what to do, and evaluates the result — rather than testing isolated recall. It adds new item types and unfolding case studies on top of the traditional question formats.
When did the Next Gen NCLEX start?+
The Next Gen NCLEX launched on April 1, 2023. It is not new in 2026; the exam has used the NGN format since 2023. The 2026 test plan is simply the current blueprint, not the start of NGN.
What are the NGN item types?+
Alongside traditional multiple choice, NGN includes Highlight, Matrix/Grid, Extended Multiple Response (select-all-that-apply / select-N), Cloze (drop-down), drag-and-drop, and Rationale items, plus stand-alone Bow-tie and Trend items. Many appear inside unfolding case studies that walk one patient through the six clinical-judgment steps.
Is the Next Gen NCLEX harder?+
It isn't necessarily harder, but it is different. NGN rewards clinical reasoning over memorization, and its item types are scored with partial credit, so getting part of an answer right can still earn points. Candidates who practice the formats and the clinical-judgment loop tend to find it more familiar than those who only study content facts.