NCLEX Changes in 2023: What to Expect on the NGN

Jump to Sections

1. When is the NCLEX changing?
2. Why is the NCLEX changing?
3. What is still the same?
4. How is the NCLEX changing?

After nursing school graduation, The National Council Licensure Examination (NCLEX) is the final step in the academic process of becoming a nurse. For 2023 graduates and beyond, they will take the Next Generation NCLEX (NGN).

The NGN has gone into effect as of April 2023. 

New nursing students who begin their studies in Fall of 2021 will be tested with this new version of the NCLEX. So nursing students graduating in 2023 or beyond should know how the Next Generation NCLEX (NGN) affects them, and what they need to change in their studies. 

When is the NCLEX changing?

The NCLEX has officially changed to include NGN questions and scoring as of April 1st, 2023.

Why is the NCLEX changing?

The National Council of State Boards of Nursing (NCSBN) is responsible for creating the NCLEX and making sure that it correctly evaluates the competency of new nurses. Every three years, the NCSBN evaluates how well the NCLEX performs this evaluation, making changes if necessary.

The Next Generation NCLEX (NGN) exam asks questions that are better designed to help nurses think critically when providing care, making it easier for them to make the right decisions. This new NCLEX has placed a major emphasis on clinical judgment.

While they make adjustments every three years, the NGN is a larger-than-normal change (affecting both the NCLEX-PN and the NCLEX-RN).

Check out our NCLEX test-taking tips here,

What is still the same (compared to the traditional NCLEX)?

The NCLEX exam evaluates if a post-grad nursing student is ready to begin making crucial decisions affecting clients. So to keep up with constant changes in the medical field, the exam has also recently undergone a substantial change.

The NGN has many new changes, but a lot remains the same from the previous NCLEX.

1. Computer Adaptive Testing

One thing that remains the same in the NGN is that the exam still uses computer adaptive testing (CAT). This means that the answer for each question determines the difficulty of the next question you get. 

A correct answer makes the following question harder, while an incorrect answer makes it easier. The goal is to achieve and maintain a certain difficulty level so that the computer algorithm can evaluate your knowledge level.

2. Existing Question Types 

All the old question types are still used on the NGN. The types of questions that you may see on the NGN (and old NCLEX) include:

• Multiple choice – The most common form of NCLEX question, multiple choice questions, provide multiple answers to a question from which you must select the correct one.
• Select all that apply – Select all that apply questions are considered relatively difficult. For these questions, you need to select each of the answers that apply to the question.
• Hot spot – While less common, hot spot questions have you select a particular area in a graphic that answers the question.
• Fill in the blank – Fill in the blank questions require you to enter a free text answer that must be correct. This is often a number, such as a dose calculation.
• Drag and drop – This question format is normally used to have the test taker order the answers in the correct order, such as sequentially describing steps in a procedure.
• Chart or graphics question – These questions consist of an image and text. An example of this type of question could be a question asking you to name a heart rhythm based on its appearance.
• Graphic answer multiple choice – This is the same as normal multiple choice questions, but uses graphics or images as answers instead of text. 
• Audio or video – These questions require you to listen to a sound or watch a video, then answer a question about the audio or video.

How is the NCLEX changing?

While the NGN incorporates many existing NCLEX features, it’s different in the following ways:

1. Harder Question Content

One of the NCSBN’s findings when evaluating the NCLEX is that nurses are more often caring for critically ill clients than has traditionally been the case. This increased client acuity means that new NCLEX questions are more difficult, with an increased focus on caring for more critically ill clients.

2. New Question Types on the NGN

While all the existing NCLEX question types are retained, there are multiple new question types in the NGN that are significantly different from what nursing students have been accustomed to. Some of these new question types include:

• Case Scenario – NCLEX questions have traditionally been standalone questions, each question unrelated to others. In the new NCLEX, two to eight questions may be derived from a single case. These cases provide a client record with multiple tabs and a split screen. The client record is on one side, and questions appear on the other, with multiple, non-adaptive questions.
• Extended multiple choice – A significant difference with these questions is that partial credit is given for answers that are close to correct. 
• Drop down answers – Essentially a cross between multiple choice and fill in the blank, these questions provide a drop-down list of possible answers to complete a sentence.
• Extended drag-and-drop – This question type is like the traditional drag-and-drop, except that there are more answers than spaces, and some answers need to be excluded.
• Highlight text – These questions are answered by highlighting an area of text from a given passage.
• Matrix/grid – Seen on multiple response questions, these are like a “select all that apply,” question, but with more than just a, “select or don’t select,” option. For example, there may be a list of eight different interventions you have to choose if they are anticipated, nonessential, or contraindicated based on the question stem.
• Trend – This question type tests knowledge of the NCJMM, which is a series of steps for measuring clinical judgment.

3. Number of Scored Questions

The new NCLEX has 70-135 scored questions (including fifteen pretest questions), which was previously 60-130 on the old NCLEX. The unscored questions won’t contribute to the overall score, but will be used for future exam development.

Among the scores on a minimum length test, test-takers should expect to see three case studies with eighteen questions, which make up 21% of the overall score.

4. The New NCLEX Scoring System

Traditional NCLEX questions are either right (counting as one point) or wrong (counting as zero points). This is referred to as dichotomous scoring.

The new NGN-style items have new scoring methods to allow for partial credit: +- scoring, Dyad scoring, and Triad scoring. 

All of the items will be either correct or incorrect, and some will have partial credit. This is referred to as polytomous scoring.

+/- Scoring

Test-takers earn one point for each correct response, and lose one point for each incorrect response. If the total score is negative, the final score will be reduced to 0. Points are not deleted for incorrect responses.

Dyad and Triad Scoring

In a dyad scoring system, if both answers in a paired set are correct, you get one point. In a triad scoring system, you get one point for each correct answer. If you get all three correct, you get two points.

Standard items (Fill-in-the-blank numeric, Multiple choice, Multiple-response select all that apply, Hot spot, and Ordered response) will continue to be worth 1 point. Multiple-response items will receive partial scoring.

What do I need to do differently for the NGN?

Preparing for these different question types and more difficult questions is vital when the NCLEX changes go into effect.

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