Next Generation NCLEX (NGN)

    NGN Question Formats, Explained

    The Next Generation NCLEX tests clinical judgment with six interactive item types. Learn exactly how each one works — with an example of each — then practice it in the question bank.

    Start Free Practice Browse Unfolding Case Studies
    1

    Extended Multiple Response

    Select several correct actions from a longer list.

    How it works

    • You are given a client scenario followed by a longer-than-usual list of possible responses — often 7 to 10 options.
    • More than one option is correct, and you usually will not know exactly how many to pick.
    • You must select every action that is appropriate and avoid the ones that are not.
    Scoring: Scored like select-all-that-apply: your selections must match the correct set exactly to earn credit on MnemoNurse practice quizzes.

    Example: pneumonia care

    A client with bacterial pneumonia has a fever of 102.4°F (39.1°C) and thick secretions. Which actions should the nurse take? Select all that apply.

    • Encourage fluids: Appropriate — helps thin secretions.
    • Administer prescribed antipyretic: Appropriate — treats the fever.
    • Restrict coughing: Not appropriate — coughing clears secretions.
    • Obtain sputum specimen before antibiotics: Appropriate — protects culture accuracy.

    Answer: The appropriate actions are encouraging fluids, giving the prescribed antipyretic, and collecting the sputum specimen first. Suppressing coughing would trap secretions.

    Try it in Respiratory practice
    2

    Matrix / Grid

    Mark one choice per row in a table.

    How it works

    • You see a table where each row is an assessment finding or action, and the columns are choices such as Expected / Unexpected or Indicated / Contraindicated.
    • You make one selection in every row — each row is judged on its own.
    • This format tests whether you can sort many findings at once instead of one at a time.
    Scoring: Every row must be marked correctly for credit — one wrong row means the item is missed, which mirrors how strictly the NCLEX scores grids.

    Example: post-op findings

    For a client 4 hours after abdominal surgery, mark each finding as Expected or Unexpected.

    • Serous drainage on dressing: Expected — normal early drainage.
    • Urine output 20 mL/hr: Unexpected — possible hypovolemia; report it.
    • Pain 6/10 at incision: Expected — treat it, but it is anticipated.
    • Absent bowel sounds with a rigid abdomen: Unexpected — possible complication.

    Answer: Expected: serous drainage and incisional pain. Unexpected: low urine output and a rigid abdomen with absent bowel sounds — both need provider notification.

    Try it in Health Assessment practice
    3

    Cloze (Drop-Down)

    Complete a sentence by choosing from drop-down lists.

    How it works

    • A sentence or short paragraph about the client has one or more blanks.
    • Each blank opens a drop-down list of word or phrase choices.
    • You pick the option that makes the statement clinically correct.
    Scoring: Every blank must be filled in with the correct option for credit — partial answers earn nothing on MnemoNurse practice quizzes.

    Example: interpreting a finding

    The nurse reviews a client's digoxin level of 2.4 ng/mL. The nurse determines the client is at risk for [drop-down 1] and should first [drop-down 2].

    • Drop-down 1 options: toxicity / therapeutic effect / subtherapeutic dosing
    • Drop-down 2 options: hold the dose and notify the provider / give the next dose / repeat the level in 1 week

    Answer: Correct completions: toxicity (level above the 0.8–2.0 ng/mL range) and hold the dose and notify the provider.

    Try it in Pharmacology practice
    4

    Bowtie

    Identify the condition, the actions, and what to monitor.

    How it works

    • The item is shaped like a bowtie: the client condition goes in the middle.
    • On one side you choose the two actions the nurse should take; on the other side you choose the two findings to monitor.
    • You drag or select the correct options from a bank into each of the five slots.
    Scoring: All five slots — condition, two actions, two parameters to monitor — must be correct for credit.

    Example: chest pain

    A client reports crushing chest pain radiating to the left arm. Build the bowtie: condition in the center, two actions to take, two findings to monitor.

    • Condition (center): Potential acute coronary syndrome.
    • Actions: Obtain a 12-lead ECG; administer prescribed aspirin.
    • Monitor: Cardiac rhythm; serial troponin levels.
    • Distractors: Options like "apply a heating pad" or "encourage ambulation" belong nowhere.

    Answer: Center: acute coronary syndrome. Actions: 12-lead ECG and prescribed aspirin. Monitor: cardiac rhythm and troponin.

    Try it in Cardiovascular practice
    5

    Drag-and-Drop (Ordered Response)

    Place steps in the correct order.

    How it works

    • You are given a set of steps for a skill or response in scrambled order.
    • You arrange them in the exact sequence a safe nurse would perform them.
    • Some versions ask you to place responses into matching targets instead of a sequence.
    Scoring: The full sequence must be exactly right — one step out of order means no credit, because order is the skill being tested.

    Example: donning PPE

    Place the steps for putting on personal protective equipment in the correct order.

    • 1. Perform hand hygiene: Always first.
    • 2. Gown: After hand hygiene.
    • 3. Mask: After gown.
    • 4. Goggles or face shield: After mask.
    • 5. Gloves: Last — pulled over gown cuffs.

    Answer: Hand hygiene → gown → mask → eye protection → gloves. Reversal matters too: removal order is nearly the opposite, gloves first.

    Try it in Safety & Infection Control practice
    6

    Unfolding Case Study

    A client's story revealed part by part, with a question at each step.

    How it works

    • You read the opening of a real-feeling client scenario and answer a question about it.
    • The story then unfolds — new vitals, new symptoms, new orders — and you answer again at each stage.
    • Typical stages mirror clinical judgment: recognize cues, decide what to do, then evaluate whether it worked.
    Scoring: On MnemoNurse practice quizzes you answer each part as it appears and every part must be correct for full credit; the NCLEX uses partial-credit scoring per part.

    Example: worsening heart failure

    Part 1: A client with heart failure has gained 4 lb in 2 days and new crackles — what do you recognize? Part 2: The client is now more short of breath at rest — what do you do first? Part 3: After prescribed furosemide, what finding shows the treatment worked?

    • Recognize cues: Fluid overload from worsening heart failure.
    • Take action: Sit the client upright, apply oxygen as prescribed, notify the provider.
    • Evaluate outcomes: Increased urine output and easier breathing.

    Answer: Each part builds on the last — the skill is following a client over time, not answering one frozen question.

    Try a full case study

    Ready to practice the real thing?

    Every format on this page is in the practice quizzes, each with a full rationale — so you learn the judgment, not just the format.

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