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Next Generation NCLEX Case Study Sample Questions

One of the big changes on the Next Generation NCLEX exam is a shift toward case studies. Case studies often require a deeper level of critical thinking, and understanding diseases on a more in-depth level (especially the pathophysiology) will make these types of questions easier to answer.

In this article, you’ll be able to watch a free video to help you prepare for the new Next Generation NCLEX case study format. Nurse Sarah will walk you step-by-step through each scenario and help you understand how to use critical thinking and nursing knowledge to answer these types of questions.

Next Generation NCLEX Case Study Review Questions Video

NGN Case Study Sample Questions and Answers

First, let’s take a look at our case study summary below:

Case Study Summary:

A 68-year-old male is admitted with shortness of breath. He reports difficulty breathing with activity, lying down, or while sleeping. He states that in order to “breathe easier,” he has had to sleep in a recliner for the past week. The patient has a history of hypertension, myocardial infarction (2 years ago), and cholecystectomy (10 years ago). The patient is being transferred to a cardiac progressive care unit for further evaluation and treatment.

Question 1 of 6: The nurse receives the patient admitted with shortness of breath. What findings are significant and require follow-up? The options are listed below. Select all that apply.

To answer this first question in the NGN case study, let’s look at the information provided in the nursing notes and vital signs tabs provided:

This question is asking us to identify findings that are significant and require the nurse to follow-up. In other words, what is presenting that we can’t ignore but need to investigate further.

Therefore, let’s comb through the nursing notes and vital signs to see what is abnormal and requires follow-up.

First, the patient arrived to the room via stretcher. That’s fine and doesn’t necessarily require follow-up.

Next, the patient is alert and oriented x 4 (person, place, time, event). This tells us that the patient’s neuro status is intact so far. Therefore, the shortness of breath isn’t affecting the patient’s mental function yet (we have enough oxygen on board right now for brain activity).

However, the nurse has noticed the shortness of breath with activity and talking, which should not normally happen. This tells us something is wrong and is significant enough to require follow-up. We want to know why is this happening, is it going to get worse, etc.

The patient’s weight and vital signs were collected (this is good). Weight is 155 lbs. and BMI is within a healthy range (doesn’t tell us too much but may be useful later). The patient is also connected to a bedside monitor, so they need to be monitored constantly like on a progressive care unit.

The monitor shows sinus tachycardia . This is significant because it seems the patient’s shortness of breath is causing the heart to compensate by increasing the heart rate to provide more oxygen (hence the lungs may be compromised).

Then we find out that the lungs are indeed compromised because crackles are heard in both lungs , and this may be why our patient is short of breath. This is significant (could the patient have pulmonary edema?)

Then we find out the nurse has noted an S3. This is an extra heart sound noted after S2. And what jumps out to me about this is that it is usually associated with volume overload in the heart like in cases of heart failure . However, S3 may be normal in some people under 40 or during pregnancy, but that’s not the case with our patient based on what we read in the case summary.

Therefore, based on everything I’m reading in this case study, I’m thinking this patient may have heart failure, but we need those test results back (especially the echo and chest x-ray, and hopefully a BNP will be in there too).

We are also told that the patient has an 18 gauge IV inserted (which is good thing to have so we can give medications if required), orders have been received, labs drawn, and testing results are pending.

Now let’s look at the “Vital Signs” tab above, and ask yourself what is normal vs. abnormal for this patient (adult male).

• The heart rate is high at 112 (tachycardia), and should normally be 60-100 bpm (see heart rhythms ).
• Blood pressure is higher than normal (normal is 120/80), which indicates hypertension.
• Oxygen saturation is 94% (this is on the low side as we’d normally want around 95% or higher, and the patient is on 4 L nasal cannula, which tells us the lungs are not okay).
• Respiratory rate is increased (26 breaths per minute)…normal is 12-20 breaths per minute.

Based on the information we were provided, I’ve selected the answers below. These findings are significant and definitely require follow-up by the nurse.

When answering these NGN case study questions, it’s helpful to think of the ABCDE (airway, breathing, circulation, etc.) as all of these fall into that category. If we don’t follow-up on the shortness of breath, crackles, respiratory rate, o2 saturation (94% on 4 L nasal cannula), the respiratory system can further decline.

In addition, the sinus tachycardia, S3 gallop, and hypertension could indicate fluid overload in the heart. This may cause the heart to tire out and lead the lethal rhythm. On the other hand, temperature, pain, weight, and BMI are not abnormal and do not require follow-up.

See the Complete Next Generation NCLEX Case Study Review

Each question in the case study builds on the previous question. To see how these questions evolve based on the patient’s condition and labs, watch the entire Next Generation NCLEX Case Study Review video on our YouTube Channel (RegisteredNurseRN).

NCLEX Practice Quizzes

We’ve developed many free NCLEX review quizzes to test your knowledge on nursing topics and to help you prepare for the Next Generation NCLEX exam.

Nurse Sarah’s Notes and Merch

Just released is “ Fluid and Electrolytes Notes, Mnemonics, and Quizzes by Nurse Sarah “. These notes contain 84 pages of Nurse Sarah’s illustrated, fun notes with mnemonics, worksheets, and 130 test questions with rationales.

You can get an eBook version here or a physical copy of the book here.

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NCLEX Study Guides and Practice Tests

Archives: Next Generation NCLEX (NGN) Questions

Identifying Key Clinical Features of Mononucleosis

Infectious Disease, Mononucleosis, Physical Assessment: NCLEX Practice Quiz

Complications and Management of Tube Feeding

Mastering Tube Feeding Challenges: An NCLEX Practice Explanation

NGN Quiz: Assessment in Gastric Cancer Home Care

Gastric Cancer Home Care: Identifying Critical Observations (NCLEX Next Gen Practice Question)

New Year’s Eve 2024 Nursing Prioritization – Next Gen NCLEX Practice Question

NCLEX Next Gen Quiz: Medical Management of Epiglottitis

• 1. Prepare the child for tracheotomy.
• 2. Prepare to administer epinephrine.
• 3. Prepare the child for a chest radiograph.
• 4. Assist the primary health care provider with intubation.

NCLEX NGN Quiz on Side Effects of Chlorpromazine

Chlorpromazine: What Nurses Need to Know

• (A) Dry mouth
• (B) Lip smacking
• (D) Hand tremors
• (D) Increased urinary output

Critical Lab Monitoring for a Pneumonia Patient on Gentamicin

NCLEX NGN Quiz on Critical Lab Monitoring for a Pneumonia Patient on Gentamicin Topic: Pharmacological Management in Pneumonia System: Renal and Hematological Systems

• 1. BUN and creatinine
• 2. Hemoglobin and hematocrit
• 3. Sodium and potassium
• 4. Platelet count and clotting time

NCLEX Pharmacology Quiz: Heparin Sodium Therapeutic Effect Monitoring

• 1. Hematocrit level
• 2. Hemoglobin level
• 3. Prothrombin time (PT)
• 4. Activated partial thromboplastin time (aPTT)

NCLEX NGN Quiz: New Nurse Injection Preparation

NCLEX NGN Quiz: Ampule Injection Preparation/Safety

• 1. Snaps the neck of the ampule gently towards the body.
• 2. Uses a filter needle when drawing up the ampule contents.
• 3. Folds gauze around the ampule neck before snapping open.
• 4. Avoids touching edges of the ampule when inserting needle.

Next Gen Quiz: Neurological Emergencies in Spinal Cord Injury

Next gen nclex quiz: neurological emergencies in spinal cord injury.

• 1. autonomic dysreflexia
• 2. autonomic crisis
• 3. autonomic shutdown
• 4. autonomic failure

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Urinary Disorders NCLEX Practice Quiz (150 Questions)

Here are your NCLEX practice questions for urinary system disorders. In this nursing test bank , test your nursing knowledge on the nursing care management of patients with renal disorders.

Urinary Disorders Nursing Test Bank

This nursing test bank set includes 150 NCLEX -style practice questions for urinary system disorders. Included topics are kidney transplant, acute kidney disease, chronic renal failure , acute glomerulonephritis , peritoneal dialysis, prostatectomy, renal calculi, urinary tract infection , and more. All questions on this set are updated to give you the most challenging questions, along with insightful rationales to reinforce learning .

Quiz Guidelines

Before you start, here are some examination guidelines and reminders you must read:

• Practice Exams : Engage with our Practice Exams to hone your skills in a supportive, low-pressure environment. These exams provide immediate feedback and explanations, helping you grasp core concepts, identify improvement areas, and build confidence in your knowledge and abilities.
• You’re given 2 minutes per item.
• For Challenge Exams, click on the “Start Quiz” button to start the quiz.
• Complete the quiz : Ensure that you answer the entire quiz. Only after you’ve answered every item will the score and rationales be shown.
• Learn from the rationales : After each quiz, click on the “View Questions” button to understand the explanation for each answer.
• Free access : Guess what? Our test banks are 100% FREE. Skip the hassle – no sign-ups or registrations here. A sincere promise from Nurseslabs: we have not and won’t ever request your credit card details or personal info for our practice questions. We’re dedicated to keeping this service accessible and cost-free, especially for our amazing students and nurses. So, take the leap and elevate your career hassle-free!
• Share your thoughts : We’d love your feedback, scores, and questions! Please share them in the comments below.

Quizzes included in this guide are:

Recommended Resources

Recommended books and resources for your NCLEX success:

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy .

Saunders Comprehensive Review for the NCLEX-RN Saunders Comprehensive Review for the NCLEX-RN Examination is often referred to as the best nursing exam review book ever. More than 5,700 practice questions are available in the text. Detailed test-taking strategies are provided for each question, with hints for analyzing and uncovering the correct answer option.

Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items Next Generation NCLEX®-style practice questions of all types are illustrated through stand-alone case studies and unfolding case studies. NCSBN Clinical Judgment Measurement Model (NCJMM) is included throughout with case scenarios that integrate the six clinical judgment cognitive skills.

Saunders Q & A Review for the NCLEX-RN® Examination This edition contains over 6,000 practice questions with each question containing a test-taking strategy and justifications for correct and incorrect answers to enhance review. Questions are organized according to the most recent NCLEX-RN test blueprint Client Needs and Integrated Processes. Questions are written at higher cognitive levels (applying, analyzing, synthesizing, evaluating, and creating) than those on the test itself.

NCLEX-RN Prep Plus by Kaplan The NCLEX-RN Prep Plus from Kaplan employs expert critical thinking techniques and targeted sample questions. This edition identifies seven types of NGN questions and explains in detail how to approach and answer each type. In addition, it provides 10 critical thinking pathways for analyzing exam questions.

Illustrated Study Guide for the NCLEX-RN® Exam The 10th edition of the Illustrated Study Guide for the NCLEX-RN Exam, 10th Edition. This study guide gives you a robust, visual, less-intimidating way to remember key facts. 2,500 review questions are now included on the Evolve companion website. 25 additional illustrations and mnemonics make the book more appealing than ever.

NCLEX RN Examination Prep Flashcards (2023 Edition) NCLEX RN Exam Review FlashCards Study Guide with Practice Test Questions [Full-Color Cards] from Test Prep Books. These flashcards are ready for use, allowing you to begin studying immediately. Each flash card is color-coded for easy subject identification.

Recommended Links

An investment in knowledge pays the best interest. Keep up the pace and continue learning with these practice quizzes:

• Nursing Test Bank: Free Practice Questions UPDATED ! Our most comprehenisve and updated nursing test bank that includes over 3,500 practice questions covering a wide range of nursing topics that are absolutely free!
• NCLEX Questions Nursing Test Bank and Review UPDATED! Over 1,000+ comprehensive NCLEX practice questions covering different nursing topics. We’ve made a significant effort to provide you with the most challenging questions along with insightful rationales for each question to reinforce learning.

11 thoughts on “Urinary Disorders NCLEX Practice Quiz (150 Questions)”

Nurseslabs has real NCLEX questions with good rationales, and has shown me concepts I had not looked at during my review of particular topics. Thank you

Question 28 asks about the 2nd stage of AKI which they refer to be the diuretic stage. Was the 1st stage, onset, left out or is it not accounted for when counting the stages?

I came to the comment section once I got to this exact question. The second stage should be oliguria less than 400/mL day

It is counted as one of the stages.

Question 28 is incorrect. There is the onset stage, oliguric, diuretic and recovery. Sometimes the oliguric stage is skipped, however, but the 4 stages are as I listed.

I think this one is incorrect. There are 4 stages: initiation, oliguria, diuresis and recovery. Situation in the question is 3rd stage, duresis.

The initiation/onset stage is often not considered. so most questions will refer to the oliguric stage as stage 1

question 41’s explanation can be confusing due to definition of oliguria is less than 400 ml in 24 hours not 50 ml

Hello Grace, Thanks for the feedback! Glad you liked the urinary system disorders quiz. If there’s a specific area you’re curious about or if you need more quizzes or info, just let me know. Always happy to help!

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Free nclex-rn practice questions, explore both traditional nclex-rn questions and new ngn item types with our 30-question test drive. analyze your performance and get ready to succeed.

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Free Next Generation NCLEX-RN Sample Test

Lecturio’s Free Next Generation NCLEX-RN Sample Test was created to help students measure their preparedness and get firsthand experience in a simulated NGN testing.

This sample test comprises 30 realistic questions that blend new NGN item types with traditional NCLEX-RN questions.

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The comprehensive performance report will help you identify which topics require more study attention.

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Don’t let wrong answers hold you back: Lecturio’s adaptive review includes detailed text-based rationales and in-depth video explanations.

Frequently asked questions about the new NGN item types

The NCLEX exam is currently undergoing a major update that is going into effect on April 1st, 2023. The new format is intended to more effectively test the skills that are required of nurses in today’s healthcare environment, focusing more strongly on clinical judgment and critical thinking.

The NGN exam features new question types like multiple-response questions, bowtie, highlight questions, drag-and-drop, and matrix/grid questions. The new question formats require stronger critical thinking skills of test-takers. New content areas tested are e.g. nursing informatics, genomics, and social determinants of health. 

Multiple-response items require the test-taker to select more than one correct answer from a list of options.

For extended multiple-choice items , students have to select one best answer from a list and additionally have to provide the reasoning for their response. 

Hot spot items assess knowledge with anatomical landmarks, e.g. where to insert IVs or where to listen for a maternal heartbeat. The answer to the question will be given by marking an area on a procided image or graphic.

In highlight-text item type questions, you are required to mark parts of a text that are relevant to your answer. 

In these items, the task is to sort the response items in the correct order, usually by drag-and-drop. It could require the student to order the steps of a dressing change, a procedure like a tube insertion, or deciding which client to see most urgently. 

With the newly-formatted questions, it is even more crucial that aspiring nurses practice for their NCLEX with a properly formatted test environment that simulates the real exam. The earlier you get used to the question mechanics, the more secure you can feel in the exam. Whichever question format you’re facing, always remember why you’re taking this exam: It is to make sure you are  safe to practice as a nurse, and the questions make sure to test that. Read the question thoroughly, identify how it works, the context, and which nursing topics you studied are relevant. Then, always view the questions from the angle how each option might affect the client and choose the response that is safest. 

Aside from studying up on the nursing content, make sure to:

• Review the test blueprint
• Practice with sample NGN questions in the new format
• Focus on developing your clinical judgment and decision-making skills
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Next Gen NCLEX® (NGN): Free Nursing Educator Resources

By kaplan nursing | march 30, 2023.

The National Council of State Boards of Nursing (NCSBN) is launching a new and improved NCLEX® exam called the Next Generation NCLEX-RN® examination (NGN) in 2023. The NGN, also called the Next Gen NCLEX®, is not a complete overhaul of the NCLEX®; however, it will feature some significant changes. As we approach the launch of the Next Generation NCLEX®, Kaplan understands that nursing educators need increased support and innovative resources to prepare their students for the rigors of the exam. In the following article, we outline what you need to know about the NGN and offer resources to help you guide your nursing students to success.

[Read next: Virtual Simulation: Free Resources for Nursing Educators ]

How is the NCLEX® Changing?

Kaplan experts met with the NCSBN to learn more about the Next Gen NCLEX® and walked away with several pieces of new information about the pending test changes. Here are five things to know about the NGN:

1. New NGN Item Types 

The test will consist of new NGN items plus current NCLEX®-style items. Five item types have been approved for the NGN: Extended Drag & Drop, Matrix, Cloze, Highlight, Select All That Apply (SATA). 

2. New NGN Question Formats

New items will be presented on a split-screen: the case on the left and the question items on the right. An Electronic Health Record will contain both relevant and irrelevant information. More information tabs may be added as the case progresses.

3. NGN Clinical Judgment Item Updates

Every case scenario will have six items associated with the case, and each test will contain 2-5 cases or item sets, resulting in 12-30 clinical judgment items per test. The name of the former clinical judgment task model has been changed to NCSBN Clinical Judgment Measurement Model.

4. Matrix Item Answers

Matrix items may have either one possible answer or more than one possible answer, which will be indicated by the style of the selection buttons next to answer choices: circles indicate only one possible answer, whereas squares indicate there is more than one possible answer. 

5. Changes to the NCLEX-RN® and NCLEX-PN®

Both the NCLEX-RN® and NCLEX-PN® are changing and will have the Clinical Judgment Measurement Model applied to practice with case studies that focus specifically on clinical judgment. While there are elements of clinical decision-making in the PN nursing process, the NCLEX-PN® questions will not use hypotheses or prioritization as often since they are not reflected in the scope of PN practice.

Free NGN Practice Questions

Experience the new item types on the Next Gen NCLEX with our newly-released practice questions. Below, you can read and watch webinars about each new item type on the NGN. If you’re ready to get a feel for the exam and work through items on your own, try our free practice questions for the Next Gen NCLEX .

Frequently Asked Questions about the Next Generation NCLEX®

Below, we address some frequently asked questions about the Next Generation NCLEX®.

When will the Next Generation NCLEX® start?

The Next Generation NCLEX® is scheduled to launch in April 2023.

Will the Next Generation NCLEX® still be a Computer Adaptive Test?

Yes, the Next Generation NCLEX® will continue to use computer adaptive testing (CAT).

Is the Next Gen NCLEX® harder than the NCLEX®?

The Next Gen NCLEX® will feature more in-depth questions to thoroughly test nursing students’ readiness to enter the field. Some questions will include unfolding case studies intended to take students to the bedside.

Is NCLEX® changing in 2022?

No, the NCLEX® will not be transitioning to the Next Generation NCLEX® until April 2023.

Building Student Clinical Judgment Skills for the Next Generation NCLEX®

Research suggests that strengthening clinical judgment skills can remedy a majority of mistakes made by novice nurses. Therefore, it is the responsibility of nursing educators to provide students with the comprehensive tools they will need to succeed on the NGN as well as provide safe, effective, and competent care when they enter the workforce.

In the Kaplan Nursing white paper, “Building Student Clinical Judgment Skills for the Next Generation NCLEX,” Shannon Meijer DNP, RN , Kaplan Nurse Consultant, takes a deep dive into the ways in which educators can and must help their students build strong critical thinking, clinical reasoning, and clinical judgment skills.

• DOWNLOAD " Building Student Clinical Judgment Skills for the Next Generation NCLEX " to read the white paper.

The white paper offers detailed information and analysis about:

• Defining the function and importance of critical thinking, clinical reasoning, and clinical judgment for success on the Next Generation NCLEX® and beyond
• Preparing students to confidently make higher cognitive-level decisions in advance of what they will be examined on for NGN
• Exploring traditional as well as outside-of-the-box methods for providing students with opportunities to practice and build on these skills 
• Examining the importance of evaluating students’ critical thinking, clinical reasoning, and clinical judgment skills
• Enhancing student comprehension, retention, and ultimate ability to provide competent patient care through virtual simulations, such as i-Human Patients

What Changes to the NCLEX® Mean for Nurse Educators

Early research from NCSBN indicates that while educators believe they are teaching the nursing process in an iterative format, candidates tend to use the nursing process in a linear way; meaning that students come to one hypothesis and run through the entire nursing process (including evaluation) before looking at another hypothesis. 

Good news—Kaplan's proven test prep methodologies align with the new Measurement Model, including a focus on developing clinical reasoning through various hypotheses and potential outcomes as part of our Decision Tree. Our critical thinking model prepares students with the skills necessary to demonstrate competent clinical judgment on test day.

On NGN, it will be important for your students to be familiar with Electronic Health Records. You can offer students additional opportunities to master clinical judgment skills and get comfortable with Electronic Health Records in a safe, standardized, and virtual clinical setting with i-Human Patients by Kaplan. The i-Human Patients by Kaplan decision-making model was designed to be aligned with NGN; it prepares students to think like nurses by putting the student at the bedside of the patient and allows educators to measure clinical competency. To learn more about i-Human Patients virtual simulation, request a demo.

Next Generation NCLEX® Item Writing

In today’s rapidly changing world, nurses need to be able to collect and synthesize information and formulate and test hypotheses in a matter of moments. These skills can collectively be called higher-level cognitive reasoning and reflect the nurse’s ability to make clinical judgments. This need to enhance and test nurses' clinical judgment and critical thinking skills has led the NCSBN, the makers of the NCLEX® licensing exams, to create a new class of test items called Next Generation NCLEX® (NGN) test items.  

NGN test items are designed to test higher-level cognitive thinking skills of future nurses and are meant to bridge the gap between preparedness for and successful completion of the NCLEX® and on-the-job performance for nurses. Nurses must be prepared for their important role in healthcare in a manner that is more profound than simply knowing how to recite facts or protocols.

The NCLEX® strives to be a reflective assessment of nursing clinical judgments, therefore, the NGN items are built upon a rich theoretical and psychometric framework. The NCSBN Clinical Judgment Measurement Model, based on several years of study of the skills essential to nursing, provides a mental model and framework in order to establish a foundation in which other models (e.g., relating to assessment) could be advanced.

While the NGN items are not expected to debut in the NCLEX® until at least April 2023, the NCSBN is taking steps to create new test items that align to the NGN standard. By doing so, the desired outcome is an improvement in the NCLEX®’s ability to test higher-order cognitive skills, which would be useful in a hospital setting.

Six Steps to Effective Next Generation NCLEX® Item Writing

Writing effective NGN items can help test essential higher-level cognitive skills, which are required for effective nursing clinical judgments. In this way, NGN items can help identify nursing students who understand the nursing curriculum and have developed the proper analytical skills through their training.

1. Determine the objective you wish to test

Before you write an NGN item, determine the test objective. The test item objectives are typically based on nursing curriculum objectives. Ideally, the objective focuses on one task, skill, or concept that the student has learned. Keep in mind that the different levels of Bloom’s taxonomy―from remembering concepts to synthesizing and creating new work―will need to be considered in this objective. NGN test items are focused towards the application, analysis, and evaluation of novel information, which places them on the higher end of the taxonomy.

2. Decide which NGN item type to use

The new NGN item types include:

• Cloze (Drop-Down) items: The applicant completes sentences or information in a chart by choosing a word or phrase from a dropdown list.
• Extended Multiple Response items: In this item type, up to 10 options are presented, and only one, more than one, or all may be correct. Before answering this type of question, the applicant may have to read a passage upon which the test item is based.
• Extended Drag-and-Drop items: The applicant uses “drag and drop” to complete a given scenario.  For example, the applicant may be presented with several different steps involved in treating a given condition. The applicant would then drag and drop the steps into the proper order for treatment. Other types of “drag and drop” questions could involve sorting different types of patients who may require private rooms or to “drag and drop” the correct words to complete a sentence. Unlike current NCLEX® test items, the Extended Drag-and-Drop items may not require that all options be used when completing a given scenario.
• Enhanced Hot Spot (Highlighting) items: In this item type, the applicant is asked to highlight concerning findings that require follow-up by the nurse or health care provider.
• Matrix/Grid items: In Matrix/Grid items, the applicant assigns a value to a group of responses. For example, the applicant may be asked to decide whether a given action is indicated, non-essential, or contraindicated.
• Bow-tie items: To complete the bow-tie item, all targets (placeholders for response options) must be filled with a token (the response option), which are found directly below the bow-tie display in labeled columns. Tokens from the same column are interchangeable, but a token from an “Actions to Take” column cannot be used to fill a “Parameter to Monitor” target and vice versa. 
• Stand Alone Trend items: These are individual items that require the entry-level nurse to review information gathered over a  period of time. Trend items address multiple steps of Layer 3 of the NCJMM, but do not follow the six-item sequence like case studies do. 

3. Write the stem

The question stem is the part of the question that prompts the student to select the correct answer or perform other tasks necessary to provide an answer (such as drag-and-drop items in a “drag-and-drop” question). The stem should be written based on the test objective and should have relevant information needed to formulate a response.

4. Write the answer

The next step in writing an NGN item is to write a good correct answer. The ideal answer should not be confusing or unclear and should be easy to pick out from the list of answers with the relevant knowledge base.

5. Write a few distractors

Distractors are incorrect answers that are written which, though wrong, can probe the student’s knowledge and reasoning skills. Distractors can be a predictable error, a common misconception, a clinical error, or a common mistake that might occur in a hospital setting.  Distractors should be realistic and well-written. The wording of distractors is important, and they must be phrased clearly and unambiguously in order to be best able to illuminate deficiencies in learning rather than to trick the student into choosing a wrong answer.

6. Ask yourself whether your test question meets NGN standards

These test items should answer the following questions essential to on-the-job, higher-level cognitive thinking processes predictive of success in nursing:

• Can students recognize clinical cues? In other words, can they identify the most important information?
• Can students analyze cues? In other words, can they distinguish the most important information?
• Can students prioritize hypotheses? That is, can they synthesize important information to determine client needs?
• Can students generate solutions or develop possible care options that align with client needs?
• Can students identify and perform the appropriate clinical actions?
• Can students evaluate outcomes and determine the effectiveness of interventions they have deemed appropriate?

Writing NGN-style items requires a combination of patience, skill, and practice; therefore, knowing the purpose of NGN items is crucial. An effective NGN-style item will gauge and reliably test a students ability to make safe, effective clinical decisions. When writing NGN-style items, validate both the content and the appropriateness of the item to test entry-level preparedness for nursing. Know the job your NGN-style item is being tasked with performing. Meaning, is the purpose of the NGN-style item to gauge the student’s ability to identify relevant information that requires further probing and investigation by the nurse (i.e., recognizing and analyzing cues), or is the purpose of the NGN-style item to determine whether the student’s actions met the client’s needs (i.e., evaluating outcomes)?

Creating Next Generation NCLEX® Test Items

In the Kaplan Nursing white paper, “Creating Next Generation NCLEX® Test Items to Ensure the Success of the Nursing Workforce,” Ryan Goble, MSN, RN, CEN, CPEN , Senior Content & Curriculum Manager, Kaplan Nursing, takes a deep dive into the theory and practice of creating test items that not only prepare students for the exam but also hone their overall nursing clinical judgment skills.

• DOWNLOAD "Creating Next Generation NCLEX® Test Items to Ensure the Success of the Nursing Workforce" to read the white paper.
• Factors that contribute to and improve nursing clinical judgment (NCJ)
• The importance of higher-level cognitive functions in NCJ
• How Kaplan is preparing for NGN
• New NGN item types and methodology for effective writing of NGN items
• ...and much more.

NGN Bow-Ties & Trends

The NGN has introduced new item types, which are answered based on the information you receive in Case Studies. This information is presented in the form of medical record tabs. There are 6-question sets that progress, asking you to recognize and analyze findings, make clinical judgments to provide appropriate care, and evaluate the client's response. There are also two standalone item types, the bow-tie and the trend. Both standalones also use the information provided in a client's Case Study.

The bow-tie item is really three drag and drops with three answer wells. In order to answer the bow-tie, you must be able to use all of the cognitive skills needed for clinical judgment. First, you will recognize, analyze and prioritize information to determine what condition is being described. Then, you will decide which nursing actions you should take to address that condition. Finally, you will select the parameters you will need to monitor for a client with that condition.

The center drag and drop is the condition. You select one response from the answer well and pull it into the correct space. You select two responses from the answer well of nursing actions on the left and two responses from the answer well of parameters to monitor on the right. The result? A diagram that looks like a BOW-TIE!

The key to the trend item is that the information in the medical record tabs is trended over time. For example, vital signs may be improving or worsening, or lab results may indicate a worsening or improving condition. You will need to analyze that trend to determine what is happening and what the nurse should do in response. The trend item can use any of the new NGN item types except for the bow-tie. So a trend item can be a single highlight, cloze, matrix, rationale, or extended multiple response item. You could just be recognizing the trend or generating a solution because of what the trend means for the client.

How to Write a Next Generation NCLEX® Case Study

The new question types on the Next Gen NCLEX® will include case study information. The NGN case study is designed to provide data for the student to utilize in applying the clinical judgment measurement model. The model identifies six cognitive processes a nursing graduate must master. These include recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes. Nursing students must practice mastering the cognitive processes in question format before taking the high stakes NCLEX® examination. The Kaplan experts have many resources available to assist educators in helping their nursing students to be successful. Below, we provide you with easy steps to transform your nursing experience into a case study for new graduates.

1. Determine the goal of the NGN case study

What is the goal of the case study? Do you want to teach a specific concept, a disease process, or appropriate interventions for a clinical situation? Remember, all case studies should be leveled to the new graduate. Try hard not to include lessons learned from years of clinical nursing practice. We need nursing students to provide safe, quality care equal to the entry-level nurse competencies.

2. Tell a clinical story

Don’t worry about the specific questions you intend to develop. Think about a patient you may have cared for while performing bedside nursing. We all have those patients that have impacted our lives and our nursing careers. Use that story to bring the case alive for the student. Put the student at the bedside.

3. Consider the process of recognizing cues

Once you have a story, consider the first cognitive process of recognizing cues . What are the most pertinent clinical findings, objective and subjective, necessary for the nurse to identify? These findings can include vital signs, clinical signs the healthcare provider can observe, symptoms the patient describes, or observations by family members. This information forms the basis for the selection of findings that need follow-up by the nurse.

4. Consider the process of analyzing critical information

Once the nurse identifies the pertinent cues, they need to interpret the information. For example, does the presence of fever indicate a disease process? Is the shortness of breath a pulmonary issue or a cardiac problem? The nurse will apply the clinical manifestations to what is known about the patient, thus analyzing the cues .

5. Prioritize hypotheses

The next step is to prioritize hypotheses . What is the problem or problems the patient is experiencing? Which one is most important for the nurse to address first? For example, the patient has shortness of breath and foot pain from stubbing their toe on the curb leading to the Emergency Department. A simple example but one which requires the nurse to make a decision.

6. Generate solutions

Now what? Generate solutions . What actions can the nurse do to assist this patient? Does the patient need oxygen, medications, diagnostic tests, or immediate intervention by a physician? In this question, the nurse will select from essential interventions needed, actions that can wait until later, or actions that will cause more harm to the patient and need to be avoided. Consider the story; what were the choices you had when you were caring for this patient in real life?

7. Take action!

Assessments are done and decisions are made; now is the time to intervene for the patient’s benefit. The questions you develop for this step can include selecting appropriate actions, identifying how to perform specific interventions, or even the need for additional assessment.

8. Ask yourself, "did it work?"

The final phase is to ask, "did it work?" Is the patient better or worse? How do you know? What clinical findings support that decision? The cognitive process encompasses evaluating outcomes—the last but often the most crucial step in the case study process.

You did it – you have designed an NGN case study! Maybe you don’t have the technology available in your testing system to deliver the questions in the manner that NCLEX® questions will be delivered in 2023, but that is okay for now. Giving students a head start on thinking through the case study is valuable for their clinical judgment development and success in the future.

National Council of State Boards of Nursing (NCSBN). (2020). Next generation NCLEX news:The NGN case study. https://www.ncsbn.org/NGN_Spring20_Eng_02.pdf .

Free Downloadable Next Generation NCLEX® Resources

• DOWNLOAD  your complimentary copy of Kaplan’s Next Generation NCLEX: What You Need to Know, Spring 2021 Edition e-Book for even more information about NGN test updates, tips for success, and more.

Article Contributors

• Shannon Meijer DNP, RN, Nurse Educator Consultant
• Christi Doherty, DNP, MSN, RNC-OB, CNE, CHSE, CDP, Director, Nursing Research
• Susan Sanders, DNP, RN, NEA-BC, Vice President of Kaplan Nursing
• Ryan Goble, MSN, RN, CEN, CPEN, Senior Content & Curriculum Manager
• Jennifer Allen, MS, RN, ACNP-BC
• Rebecca L. Potter PhD(c), MSIDT, MSN/ED, RN, Director of Nursing Product Content
• Susie Compton, RN, MSN, Kaplan Content Manager

NCLEX® is a registered trademark of the National Council of State Boards of Nursing, Inc. Test names are the property of the respective trademark holders, none of whom endorse or are affiliated with Kaplan.

#nextgenerationnclex , #NGN , #nurseeducators , #nursingeducators

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