Know the 10 Question formats on the Next Gen NCLEX
The Next Generation NCLEX (NGN) has revolutionized how prospective nurses are tested. Rather than relying purely on standard multiple-choice, the NGN simulates real-world clinical scenarios to assess not just what you know, but how you think. Here’s a deep-dive into each of the ten question formats you’ll encounter. Understanding them thoroughly—and practicing deliberately—will help you move beyond apprehension to genuine control.
1. Extended Multiple Response (formerly “Select All That Apply”)
What it is
● A list of six or more answer options is presented. Some, none, or all may be correct. You may or may not be told how many to select.
Why it matters
● It simulates comprehensive assessments where multiple factors must be identified—like recognizing all signs of shock, or patient safety priorities after surgery.
Strategy
1. Read the scenario carefully. Look for clues: “most appropriate,” “initial,” or “primary.” 2. Eliminate obviously incorrect options first.
3. Apply the NARROW technique—Necessary, Accurate, Relevance, Able to intervene, Rationale match.
4. Ideally, aim to identify a coherent cluster of correct answers rather than ticking everything.
Sample
A postoperative patient begins breathing rapidly with low urine output. Select all nursing interventions you anticipate:
● Increase IV flow
● Administer oxygen
● Call the provider
● Measure central venous pressure
● Encourage ambulation
● Elevate the head of the bed
2. Select N
What it is
● You’re explicitly told how many answers to mark (e.g., “Select the 3 most appropriate actions.”)
Why it matters
● Incorporates a triage mindset—prioritizing patient safety, time-sensitivity, and clinical relevance.
Strategy
● Prioritize using ABC (Airway-Breathing-Circulation), Maslow’s Hierarchy, and immediate vs. long-term interventions.
● Be precise: if told “Select the top two”, mark only two—extra selections may invalidate correct picks.
Sample
Select two signs that suggest impending respiratory failure:
● Bradycardia
● Use of accessory muscles
● Increased appetite
● Hypoactive bowel sounds
● Worsening O2 saturation
3. Matrix/Grid
What it is
● A table with rows (e.g., medications) and columns (e.g., side effects, contraindications). You match each row’s item to the correct column response(s).
Why it matters
● Reflects documentation and chart review workflows—matching patient data to clinical implications.
Strategy
● Approach one row at a time. Read the item, then mentally review its associations before marking all appropriate columns.
● Do they want one or multiple columns? Chart may allow multiple selections per row. Sample
Match the following medications to their side effect(s):
● Furosemide → hypotension? electrolyte imbalance? tachycardia?
● Metformin → hypoglycemia? lactic acidosis? diarrhea?
4. Drag and Drop (Sequencing)
What it is
● Place steps of a procedure or timeline of disease progression in the correct order. Why it matters
● You demonstrate understanding of nursing process orders, ie. assessment → planning → implementation → evaluation.
Strategy
● Read the full list before dragging. Identify beginning and end steps. Mentally map the process before acting.
● Watch out for decoys that seem related but are out of sequence.
Sample
Arrange steps for administering a subcutaneous injection:
a. Apply alcohol swab
b. Pinch skin
c. Insert needle at 90°
d. Check patient ID band
e. Discard syringe in sharps container
5. Bowtie
What it is
● You work from a central clinical scenario: identify the core condition, list two related interventions (left), and two assessment or monitoring parameters (right). It visually resembles a bowtie diagram.
Why it matters
● Tests ability to connect diagnosis to treatment and evaluate outcomes—integrated clinical thinking in one screen.
Strategy
1. Identify the central issue (e.g., “Acute asthma exacerbation”).
2. Choose interventions that immediately support the issue.
3. Choose parameters that indicate improvement or deterioration.
● Avoid red herrings that may fit loosely but don’t square with core condition. Sample
Center condition: Pulmonary embolism
Interventions: Administer heparin; Implement oxygen therapy
Monitoring: Watch oxygen saturation; Check PTT lab results
6. Trend
What it is
● Vital signs, lab results, or patient-reported symptoms over time are displayed. You interpret whether trends signify improvement, decline, or stability—and choose next steps.
Why it matters
● Mimics chart review and reassessment processes in hospitals.
Strategy
● Look first for patterns: rising, falling, erratic, plateau.
● Identify clinical significance (e.g., is blood pressure dropping below goal?). ● Choose interventions tied to the most critical trend, not minor fluctuations. Sample
Over a 24-hour period, a patient’s heart rate rises from 90 to 130 bpm. Blood pressure drops slightly and urine output declines. Which action is most appropriate?
7. Hot Spot
What it is
● You click on the correct area of an image—anatomy, wound site, EKG lead placement, etc.
Why it matters
● Clinical skills testing can be visual and hands-on.
Strategy
● Know basic anatomy, labs set-up, and assessment points.
● Use process of elimination: click confidently, but watch out for distractor zones close to the correct answer.
Sample
Click on the correct site for a dorsogluteal injection or site of pain in a patient with appendicitis. 8. Cloze (Drop-down)
What it is
● Text contains blank spaces; each is accompanied by a drop-down menu to complete the sentence or statement.
Why it matters
● Requires precise knowledge—each dropdown answer contributes to full credit. Strategy
● Complete each blank independently. Read the full sentence to confirm logic, grammar, and clinical accuracy.
Sample
“Administering _________ (med name) at ________ (time interval) helps maintain therapeutic levels.”
9. True/False
What it is
● One or multiple statements are presented. You indicate each as “True” or “False.” Why it matters
● Forces you to critically assess the accuracy of assertions—straight knowledge checks. Strategy
● Read each statement fully. Look for absolutes (“always,” “never”) which often signal falsehood. Answer each individually.
Sample
a. “Hypokalemia may cause muscle weakness.”
b. “An EKG with peaked T waves indicates hypocalcemia.”
10. Fill in the Gaps
What it is
● You must complete a missing part of a statement or clinical text—possibly with drop-downs or short typed answers.
Why it matters
● Tests high-stakes ability to both recall and apply nursing knowledge precisely. Strategy
● Read the context carefully. If typing, ensure spelling and formatting (units or abbreviations) meet prompt instructions.
Sample
The patient's oxygen saturation dropped to __%. Initiate ________ (intervention).
Using These Formats Together
All of these question types are different tools testing the same core skill: clinical judgment. Your job is to read scenarios carefully, stay organized, and choose—or arrange—the responses that match safest, most effective care.
Final Takeaway
The NGN isn’t about tricking you—it’s about showing your readiness. When you answer confidently and logically, you’re demonstrating that you’re ready to practice safe, smart nursing care. Yes, the formats are varied—but your mindset stays the same. Think like a nurse. Read each question thoughtfully. Trust your training, and apply it deliberately. Onward to full clinical confidence.
