Hey everyone, welcome to our comprehensive article on the new NCLEX Exam Format.

In this article, we’ll discuss why NCLEX is changing and the new changes in the NCLEX exam.

By the time you are done reading, you’ll have details on the changes to expect in the next generation NCLEX.

In brief, here is what we’ll cover in this article:

  • Why is NCLEX changing?
  • New NGN format

Let’s get started.

Why is NCLEX Changing? (Next Generation NCLEX)

Next Generation NCLEX

The next generation NCLEX is launched on 1st April 2023, which means nursing students who got into nursing school in the fall of 2021 will take the new NCLEX.

The main aim of the NGN is to measure test-takers’ clinical judgment skills in patient care in the ever-changing healthcare industry.

This national exam is evaluated every three years to determine if it meets its objective.

The old NCLEX is transitioning to the new one to ensure graduate nursing students are well-prepared to make the right choices for their patients.

The National Council of State Boards of Nursing is the body that develops and administers the National Council Licensure Examination.

NCSBN usually conducts ongoing assessments to refine the NCLEX exam to be up-to-date with changes in healthcare.

In 2017, the NCSBN’s Nursing Knowledge Survey revealed that, as technology advances, clients increasingly face complex diseases.

That means nurses regularly face complex decisions when caring for patients.

Thus, the new NCLEX exam mimics the actual hospital conditions and therefore tests nurses’ critical thinking, decision-making, and clinical judgment skills, laying the foundation for a better outcome in patient care.

The bottom line is that the new NCLEX tests learners’ critical thinking skills to determine whether they can make the right decisions.

New NGN Format

New NGN Format

While the NCLEX is changing, the new NCLEX format has retained some elements from the old NCLEX.

The new exam still uses computer adaptive testing, where the NCLEX questions get more difficult depending on how you answer the questions.

If you give a correct answer, the next one becomes more challenging, and if it’s incorrect, you’ll get an easier question.

CAT establishes test-takers’ level of competency depending on how they answer the questions.

Apart from CAT, the new format has retained the type of questions on the old NCLEX and added new ones.

The question types you may notice from old NCLEX include multiple-choice, drag and drop, fill-in-the-blank, hot spot, SATA, audio/video, and chart/graphic questions.

Now that you know what didn’t change let’s delve into the changes in the current NCLEX.

Conceptual Changes

Recent research reveals that entry-level nurses lack clinical judgment skills, yet 46% of their tasks require this skill.

Another research from John Hopkins showed that medical errors are the third cause of death in the US.

To put it simply, 250,000 patients die annually because of medical errors.

The deduction is that new nurses’ lack of clinical judgment can be closely linked to medical errors.

The National Council of State Boards of Nursing seeks to remedy the situation through the next-gen NCLEX exam.

The new questions seek to establish whether nursing students can correctly assess patients’ situations, identify their problems, prioritize their needs, and provide safe patient care.

The clinical judgment measurement model tests nursing skills learned from nursing education and its application.

It strives to establish whether novice nurses can differentiate relevant and irrelevant information, prioritize the relevant information, use hypotheses to determine clients’ situations and develop a solution that will give the desired outcome.

The new NCLEX exam tests nurses’ ability to provide the best client care through critical thinking and decision-making skills.

Types of Questions

While the old types of questions have been retained, there are additional new questions in the new NCLEX.

The new NCLEX format requires learners to be conversant with different types of test questions.

The different questions give real-world scenarios that nursing students will likely encounter in their work.

That said, what new question types can you expect in the NGN?

Here is a breakdown.

Cloze (Drop Down) Items

Test-takers are presented with a case study and must provide the right client care.

They are required to give between one and six answers from the drop-down list.

There can be more than one list.

Extended Drag-and-Drop

The extended drag-and-drop question items are almost similar to the old NCLEX one, but the only exception is that the spaces are fewer than the answer options, meaning when you complete pairing the two columns, some answers will remain.

Extended Multiple Choice

Extended multiple-choice items resemble select-all-that-apply questions, except there are more answer options.

With these item types, you get partial credits for answer options close to the correct answer.

Enhanced Hot Spot (Highlighted Text)

Here you are given a passage that could be about medical history, client chart, or medical record.

You are supposed to highlight a word, phrase, or section that answers the question from the paragraph.

Matrix/Grid Items

You’ll be presented with a scenario and required to check the right boxes on the grid.

That means you’ll choose multiple answers.

Case scenarios

With case scenario items, two to eight questions are derived from one scenario.

You must thoroughly understand the case scenario to answer the questions as they tie together.

Number of Questions

The new NCLEX exam has a minimum of 85 questions and a maximum of 150 with 15 pretest questions.

Scored number of questions ranges from 75 to 135.

But since it’s a CAT exam, the number of questions you’ll answer depends on how soon the system determines whether you’ve failed or passed or when the 5-hour time limit lapse.

The minimum number of questions (75 questions) in this new test includes three case studies with six questions each, making a total of eighteen and 52 stand-alone questions.

After the minimum number of questions, the following questions include traditional NCLEX type of questions and around 10% of clinical questions.

What does that tell you?

Whether you are taking NCLEX-PN or NCLEX-RN, practice questions are a must-do.

There’s no way you’ll pass this exam without understanding how to answer the new item types of questions.

Scoring System

There are some changes in the scoring method for the new test.

The old NCLEX used dichotomous scoring where you either get all correct or all incorrect.

The NGN uses polytomous scoring where test-takers can get partial credit for multiple answer items.

The next-generation NCLEX scoring method also has 0/1 scoring, -/+ scoring, and rationales scoring rules.

Let’s break these down for you.

0/1 scoring rule: A candidate get a point if the answer is correct and nothing if it’s incorrect.

+/- scoring rule: NCLEX exam-takers get a point for a correct answer and lose a point for an incorrect answer. The final score for the items is calculated by deducting the incorrect points from the total of the correct points.

Rationales scoring rule: This scoring rule is for paired items. All the paired answer options must be correct for test-takers to earn a point. You don’t get a point if any of the answer options are incorrect.


Conclusion on NCLEX New Format

The new NCLEX format includes new item types to best test candidates on their decision-making and critical-thinking skills.

The many changes are geared towards ensuring nurses have what it takes for the best outcome when caring for patients.

The new changes will take effect on 1st April.

And so, if you are graduating from a nursing program, start your NCLEX preparation with the new NCLEX format in mind.

New NCLEX Format FAQs

New NCLEX Format FAQs

What is the NCLEX changing to in 2023?

The NCLEX is changing to the next generation NCLEX (NGN), which will take effect on 1st April 2023. The new NCLEX focuses on clinical judgemental skills. The NGN will have new types of questions besides the old ones. Plus, there are changes in the scoring method.

Is the NCLEX changing in 2022?

No. The NCLEX is changing in 2023. The NCSBN evaluates the NCLEX every three years to ensure it meets the needs of changing nursing practices. The special research section collects data on the types of questions that could help better test novice nurses’ competency in providing the best patient care.

What is the new NCLEX format?

The new NCLEX format includes a new scoring system, new item types, and number of questions. The NGN uses polytomous scoring that includes giving partial credit, +/- scoring rule, 0/1 scoring rule, and rationales scoring rate. The exam questions range from 75 to 135. Additional item types help test clinical judgment.

When do the new NCLEX changes start?

The new NCLEX changes start on 1st April 2023. Nursing graduates are required to familiarize themselves with the new test that seeks to test candidates’ clinical judgment skills. The NGN is designed to help reduce errors in the nursing field and better prepare nurses for the real world.



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