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What are the Next Generation NCLEX question types?

Every NCLEX has 3 case studies (18 items) and stand-alone items. The official tutorial shows 11 item types, including Bow Tie and Highlight Text.

Checked November 10, 2026

Short answer: The Next Generation NCLEX (NGN) measures clinical judgment with 3 case studies of 6 items each (18 items on every exam) plus about 10% stand-alone clinical judgment items. The official NCLEX Item Types Tutorial shows 11 practice item types, including Multiple Choice, Select All That Apply, Bow Tie, Matrix, Drop-Down Cloze and Highlight Text, and calls them a representative sample.

The National Council of State Boards of Nursing (NCSBN) launched the NGN on April 1, 2023.

The six clinical judgment steps

The items are built on the NCSBN Clinical Judgment Measurement Model (NCJMM). The 2026 RN test plan defines its six steps:

  1. Recognize cues: find the relevant and important information.
  2. Analyze cues: organize the cues and connect them to the client's presentation.
  3. Prioritize hypotheses: evaluate and rank the hypotheses.
  4. Generate solutions: define interventions for the expected outcomes.
  5. Take action: carry out the solution that addresses the highest priority.
  6. Evaluate outcomes: compare what you observe with what you expected.

Case studies and stand-alone items

A case study is a set of 6 items about one client whose situation unfolds. Each item measures one of the six steps. The information sits in exhibit tabs such as Nurses' Notes, Vital Signs and Diagnostic Results. Every RN and PN exam has 3 case studies, which is 18 items.

A stand-alone item is independent of other items. NCSBN states that about 10% of items are stand-alone clinical judgment items, selected depending on the length of your exam.

No official public page today names or defines a "trend" item, so we do not describe one.

The 11 item types in the official tutorial

The names are written as the tutorial shows them.

Number Item type
1 Multiple Choice, Graphic Item
2 Multiple Response, Select All That Apply
3 Multiple Response, Select N
4 Bow Tie (Includes functionality of Drag-and-Drop Cloze and Drag-and-Drop Rationale)
5 Matrix Multiple Response
6 Matrix Multiple Choice
7 Drop-Down Cloze (Includes functionality of Drop-Down Rationale)
8 Multiple Response Grouping
9 Drop-Down Table
10 Highlight Text (Includes functionality of Highlight Table)
11 Fill-in-the-Blank Item

NCSBN sets no fixed percentage for each item format. When an item says "select all that apply", one or more options are correct.

How these items are scored

Items with more than one correct answer can earn partial credit, by one of three methods:

  • Plus/minus: points for correct options, points taken away for incorrect ones, never below zero.
  • Zero/one: used when you must choose a set number of responses. Each correct response earns a point; an incorrect one earns nothing.
  • Rationale: two linked pieces of information, and both must be correct to earn the point.

The passing standard and the rest of the scoring are in How is the NCLEX scored?.

What the 2026 RN test plan covers

The 2026 NCLEX-RN Test Plan is in effect from April 1, 2026, through March 31, 2029. These are its Client Needs categories:

Client Needs category Share of the exam
Safe and Effective Care Environment: Management of Care 15 to 21%
Safe and Effective Care Environment: Safety and Infection Prevention and Control 10 to 16%
Health Promotion and Maintenance 6 to 12%
Psychosocial Integrity 6 to 12%
Physiological Integrity: Basic Care and Comfort 6 to 12%
Physiological Integrity: Pharmacological and Parenteral Therapies 13 to 19%
Physiological Integrity: Reduction of Risk Potential 9 to 15%
Physiological Integrity: Physiological Adaptation 11 to 17%

What to do next

  1. Work through the free NCLEX Item Types Tutorial, linked from the nclex.com Prepare page.
  2. Download the 2026 test plan for your exam.
  3. Plan your time with How long should you study for the NCLEX?.

Common questions

Are normal lab values given in the items?

Yes. NCSBN says items with a numeric lab value include the normal reference range.

Is the tutorial a full list of every item type?

No. The tutorial calls its items a representative sample. We found no single official public list of every item type.

How many questions are on the whole exam?

Both exams have 85 to 150 items, in five hours. See How many questions are on the NCLEX?.

Prep from our team

NCLEXPace has NCLEX-RN practice questions with rationales, Next Generation NCLEX case studies and CAT Readiness Exams. You can try 10 free questions without payment, and plans start from US$59 paid once, with nothing that renews. All Nursing Exams, NCLEXPace and NPractitioner are run by the same team. See https://www.nclexpace.com.

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