Recent Changes to the NCLEX
In April 2023, the NCSBN launched the Next Generation NCLEX (NGN), built to reflect the complex clinical situations modern nurses face (NCSBN). The questions simulate hospital settings and test the skills you use on the floor: critical thinking, judgment, decision-making, and clinical skills.
The NGN added new formats to handle that complexity, including extended multiple-response, extended drag-and-drop, and grid-based items. The scoring model changed too. The old model scored answers right or wrong; the new one allows partial credit on several item types (NCSBN Clinical Judgment Measurement Model).
How Learning Styles Help in NCLEX Test-Taking
Anne Dabrow Woods, chief nurse at Wolters Kluwer Health Learning, Research and Practice, tells candidates to know their learning style and stick with what has worked before, whether that's auditory, kinesthetic, visual, or a mix.
"Some tried and true methods are using mnemonics, drawing out concepts or relationships, using the teach-back method where you teach someone else about concepts and applications, or using flashcards," Dabrow Woods says. "As adult learners, we retain more information if we use a variety of study methods to learn information."
NCLEX Test-Taking Strategies
Break a multiple-choice question into its parts before you answer it:
- The stem asks the question.
- The case is the patient's situation or scenario.
- Distractors are the wrong or weaker choices.
Read the stem at least twice before you commit. The strategies below tighten that up.
Identify Keywords
Focus on what the question is actually asking for. "If the question asks for an intervention, look for the answer that is an intervention," Dabrow Woods says. Choices that list signs and symptoms instead of an intervention get eliminated.
Identify Repeated Words
Watch for repeated words and synonyms across the question and answers. If a question contains "signs," the right answer may include "symptoms."
"Test-takers have a tendency to read too much into answer choices and overanalyze," says Alaina Ross, RN and expert contributor for Test Prep Insight. "Do not fall into this trap."
Do Not Second Guess Yourself
Don't reread meaning into the question and don't change answers. "The first answer is usually the correct one if you have taken the time to reason through the question," Dabrow Woods says. Ross adds: "Read each answer choice and pick the best choice based on instinct."
Look for Opposite Answers
When two choices are opposites, like increased heart rate versus decreased heart rate, one of them is usually correct. Knowing every question type you might see makes this easier to spot, Ross says.
Read the Entire Question Before Answering
"Read the entire question before focusing on the answer," Dabrow Woods says. Skim it and you'll miss a keyword or misread the focus. Make sure you understand what's really being asked, on practice tests and the real thing.
Eliminate Distractors
Cut the wrong choices first, then weigh what's left. "If the question asks for an intervention but some of the distractors are signs and symptoms, eliminate those distractors and focus on the one that most closely resembles the right answer," Dabrow Woods says.
Use Prioritization Techniques
Words like initial, first, and best are asking you to prioritize. The choices are often all correct, but only one comes first. Use these frameworks:
- ABCs (Airway, Breathing, Circulation): Airway problems and airway interventions get top priority.
- Maslow's Hierarchy of Needs: Physiologic needs (pain, food, sleep) come before safety, security, and psychosocial problems. Useful for complex patients with multiple problems.
- Nursing Process: Assess before you plan or intervene. Ask whether you need more assessment data before acting or calling the provider.
NCLEX Scenarios
In NCLEX scenarios, you're the only nurse with a single patient and every order you need. You can call the provider, but realistically you only do that after an intervention has failed and there's nothing else within your scope.
Real shifts are messier, but the exam isn't hard for its own sake. These stripped-down scenarios test your grasp of fundamentals and critical thinking so you're ready for the complicated version on the floor.
Frequently Asked Questions
What kinds of questions are on the Next Generation NCLEX? Alongside standard multiple-choice items, the NGN uses extended multiple response, extended drag-and-drop, cloze (drop-down), matrix (grid), and enhanced hot-spot questions, often anchored in a case study with the scenario on one side of the screen and the question on the other (NCSBN).
Does the NCLEX give partial credit now? Yes. The original exam scored each item all-correct or all-incorrect, while the NGN awards partial credit on several of the new item types, so you can earn points even if you miss part of a question (NCSBN Clinical Judgment Measurement Model).
Should I change my first answer if I second-guess it? Usually no. If you read the stem carefully and reasoned through it, your first answer is most often the right one. Rereading meaning into a question tends to talk you out of a correct choice.
How do I handle "first," "initial," and "best" questions? These ask you to prioritize when more than one choice is correct. Work through the ABCs (airway, breathing, circulation), then Maslow's hierarchy, then the nursing process, assessing before you act.
Does memorizing facts get me through the NGN? Not on its own. The exam is built around clinical judgment, so you need the underlying knowledge but the questions reward applying it to a scenario rather than reciting it (NCSBN).
How much time do I get per question? Plan for roughly a minute on a standard item, though longer case studies take more. Read the entire question before weighing answers so you don't miss a keyword.