What Is the Next Generation NCLEX (NGN) and How Is It Different 

By Tiffany Paolino, MSN, BSN · Reviewed by Rachel Taylor, MSN, BSN, RN

If you’re preparing to take the NCLEX-RN® or NCLEX-PN® this year, the exam you’ll take is the Next Generation NCLEX®, also referred to as NGN or NGN NCLEX. Every candidate takes this version of the exam, so it makes sense to learn how it works before you build a study plan. Understanding the question formats and what the exam measures will also help you feel more confident on test day. This guide covers what the exam is, the NCSBN model behind it, how it compares with the old NCLEX, and how long the test runs.

What the New NCLEX Is and What It Measures

The Next Generation NCLEX is the current version of the NCLEX-RN and NCLEX-PN, the licensing exams developed by NCSBN to assess whether candidates have the knowledge, skills, and clinical judgment needed for safe, effective entry-level nursing practice. It tests clinical judgment, meaning how you recognize and respond to changes in a client’s condition, alongside the nursing knowledge the exam has always covered.

That’s the short answer to “what is NGN NCLEX.” If you’re wondering “what does NGN mean?” it stands for Next Generation NCLEX. Both RN and PN candidates take the NGN format, but their exam questions reflect their respective scopes of practice.

Why NCSBN Changed the NCLEX

NCSBN changed the NCLEX after its Strategic Practice Analysis found that clinical judgment was linked to more than 46 percent of the tasks entry-level nurses perform, and the old exam had no direct way to measure it. Over the next several years, NCSBN developed new question types that could measure clinical judgment consistently. Beginning in July 2017, NCSBN tested NGN items with NCLEX-RN candidates through an optional, unscored Special Research Section, collecting candidate-response data over a period spanning more than five years.

When the New NCLEX Started and Who Takes It

When did the next gen NCLEX start? NCSBN launched it on April 1, 2023. All NCLEX-RN and NCLEX-PN candidates testing on or after that date take the updated exam, regardless of whether they were educated in the U.S. or abroad. The NCLEX changes that were introduced in 2023 apply to both licenses, since the RN and PN exams share the same NGN NCLEX item formats. Each exam’s scenarios match that license’s scope of practice, so PN case studies tend to center on clients whose conditions are more stable. Read more about the differences between the NCLEX-RN and NCLEX-PN.

The NCSBN Clinical Judgment Measurement Model (NCJMM) Explained

The NCSBN Clinical Judgment Measurement Model (NCJMM) explains the thinking skills tested in NGN questions. The model is organized in layers, starting with broad ideas about how nurses make decisions and narrowing down to specific skills you can practice. You don’t need to memorize every layer to benefit from it; focus on practicing the six clinical judgment skills.

Each layer and each step inside it, can be targeted by a specific question and scored the same way for every candidate. You can read NCSBN’s own summary on its NCSBN Clinical Judgment Measurement Model page. The three sections below cover the layers, the six steps, and how the model compares with what you may have learned in class.

The Five Layers of the NCJMM

The NCJMM has five layers (0–4) that explain how nurses make safe patient care decisions. Layer 0 focuses on the client’s needs and decisions required to provide safe care, while Layer 1 represents clinical judgment itself. Layer 2 breaks that process into three phases: forming, refining, and evaluating hypotheses. Layer 3 is particularly important for NCLEX preparation because it identifies the six skills assessed in case study questions, covered in the next section. Layer 4 considers factors that influence decisions, such as time constraints, available resources, and the nurse’s experience.

An NCLEX Example of the Six Clinical Judgment Steps

Imagine you’re caring for a patient admitted with pneumonia who develops increasing shortness of breath, a respiratory rate of 30 breaths/min, and an oxygen saturation of 86%.

Step	What you do
Recognize cues	Identify concerning findings, such as low oxygen saturation and increased respiratory rate.
Analyze cues	Recognize that these findings suggest impaired oxygenation.
Prioritize hypotheses	Determine that impaired gas exchange is the priority concern.
Generate solutions	Identify appropriate interventions, such as administering oxygen and positioning the patient upright.
Take action	Initiate oxygen therapy according to orders or protocol, position the patient upright, and notify the healthcare provider.
Evaluate outcomes	Reassess oxygen saturation, respiratory rate, and breathing effort to determine whether the interventions were effective.

How the Six Clinical Judgment Steps Fit Inside the NCJMM

The six clinical judgment steps are recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action, and evaluate outcomes. They sit at Layer 3 of the model, which identifies the six skills assessed by case study questions. Each question in a case study is designed to measure one of these skills. For additional practice, Archer’s guide on how to answer Next Generation NCLEX questions shows how each step appears in case study questions.

How the NCSBN Model Differs From Tanner’s Clinical Judgment Model

Some nursing programs teach Tanner’s model of clinical judgment, which Christine Tanner published in 2006 with four phases called noticing, interpreting, responding, and reflecting. While Tanner’s model focuses on how nurses develop clinical judgment in practice, the NCSBN model is designed to assess these skills on the NCLEX. The two still line up closely. Noticing matches recognize cues, interpreting covers analyze cues and prioritize hypotheses, responding covers generate solutions and take action, and reflecting during care maps to evaluate outcomes.

How the Clinical Judgment Model Shaped Case Studies and Scoring

The clinical judgment model led to three changes on the exam, which are unfolding case studies, stand-alone clinical judgment items, and partial-credit scoring.

In a Next Generation NCLEX case study (NGN case study), you answer six questions about the same client. The case unfolds as you move through it, with new assessment findings, lab results, or provider orders introduced along the way. Each question aligns with one of the six clinical judgment steps, so the exam assesses your reasoning in sequence. Because an NGN case study can integrate several content areas, NCSBN counts these items separately from the rest of the test.

NCSBN also measures clinical judgment through stand-alone items outside the case studies, mainly bow-tie and trend items.

Some NGN questions allow partial credit, meaning you may earn points for a partially correct response. Not every question uses partial-credit scoring. Archer’s guide explains how partial credit works under each scoring rule.

Old vs New NCLEX Side by Side

The Next Generation NCLEX kept the adaptive format and the core structure of the old exam while adding case studies, new item types, and partial credit. When you look at NGN vs NCLEX, the biggest differences are the addition of unfolding case studies, new question formats, and partial-credit scoring for eligible items. The NCLEX still uses computerized adaptive testing (CAT).

The table below lays out each feature using NCSBN’s published specifications, so you can see what moved and what stayed put. The three sections that follow cover what changed, what carried over, and whether the new version is harder.

Feature	Old NCLEX (before April 1, 2023)	Next Generation NCLEX (NGN) (from April 1, 2023)
Adaptive format (CAT)	Yes	Yes
Question range	75–145 items for RN and PN.	85 to 150 items for RN and PN
Time limit	5 hours for both RN and PN, including the introductory screen and all breaks.	5 hours for RN and PN, including the introductory screen and all breaks.
Case studies	No scored six-item case studies; experimental items appeared only in the unscored Special Research Section.	3 scored clinical judgment case studies, each containing 6 questions, for a total of 18 scored questions.
Stand-alone clinical judgment items	No scored stand-alone clinical judgment items.	Approximately 10% stand-alone clinical judgment items, selected depending on exam length; these include bow-tie and trend items.
Item types	Multiple choice plus alternate formats such as select all that apply, hot spot, fill-in calculation, ordered response, and chart/exhibit items.	Traditional formats plus extended multiple response, extended drag-and-drop, cloze/drop-down, highlighting, and matrix/grid items; stand-alone clinical judgment items include bow-tie and trend.
Scoring	Scored items were marked entirely correct or incorrect, with no partial credit.	Single-response items remain scored correct or incorrect. Eligible multi-point items allow partial credit using zero/one, plus/minus, or rationale scoring rules.

What Changed on the New NCLEX

The largest change is the unfolding case study, which appears three times on every exam. New formats joined the old ones too, including matrix, cloze drop-down, highlight, extended drag and drop, bow-tie, and trend items. Scoring moved to partial credit for items with several correct answers. The question range also changed, and the comparison table above shows the old and new figures. Candidates who don’t pass also see a difference, since the NCLEX performance report now breaks down clinical judgment results across the six steps.

What Stayed the Same From the Old NCLEX

In comparing the old vs new NCLEX, several parts stayed identical. The NCLEX is still computer adaptive, meaning the exam adjusts question difficulty as it estimates your nursing ability. It can end once the scoring rules determine whether you have met the passing standard. The NCLEX test plan still groups exam content into the same four main Client Needs categories. You still receive a pass or fail result, and the RN passing standard stayed at 0.00 logits through the 2023 launch.

Is the New NCLEX Harder Than the Old One

Is the next gen NCLEX harder? Difficulty is hard to compare, because the new exam measures judgment in a different way than the old one did. Case studies ask you to read more and keep one client’s changing details in mind across six screens, so many candidates find it more demanding. Most students who ask “Is the next gen NCLEX harder?” are reacting to case studies that require you to review several pieces of patient information. The best preparation is to practice identifying relevant cues, prioritizing concerns, and choosing safe actions rathern than relying only on memorized facts.

New NCLEX Question Count and Test Length

The number of questions on the Next Generation NCLEX varies by candidate because the exam is computer adaptive. After the minimum number of items, the computer stops once it is 95% confident your ability is clearly above or below the passing standard, or when you reach the maximum number of items or the five-hour limit. Both the NCLEX-RN and NCLEX-PN include 18 scored case study questions across three six-question case studies, along with additional stand-alone clinical judgment questions. The exam also includes 15 unscored pretest items. Because you won’t know which ones they are, approach every question as though it counts. If you’re asking “what are NGN questions?” they are the case study and stand-alone items. For the full breakdown, see how many questions are on the NCLEX and how the NCLEX is scored.

FAQs about the New NCLEX

Can you still take the old version of the NCLEX?

No. The earlier format is retired, and NCSBN delivers only one version of each exam at a time. If you sat the old NCLEX and didn’t pass, your retake is on the new exam. Nurses who passed before the switch kept their licenses and didn’t need to retest.

Did the NCLEX test plan change in 2026?

Yes. NCSBN released new NCLEX-RN and NCLEX-PN test plans that took effect on April 1, 2026. The content percentages stayed the same, and the most visible edit renamed Safety and Infection Control to Safety and Infection Prevention and Control. Archer’s guide to NCLEX changes in 2026 covers the rest.

Where can you find free official NCLEX sample questions?

NCSBN posts a free sample pack of Next Generation items on its official NCLEX candidate information site, with three RN case studies, two PN case studies, and extra stand-alone examples. It’s the clearest official answer to “what are NGN questions?” because the samples use the same item formats you’ll see on test day.

Do Canadian nursing candidates take the same NCLEX?

RN candidates in most Canadian provinces take the same NCLEX-RN used in the U.S., including the new format, and it has been offered for Canadian registration since January 5, 2015. Practical nurse candidates don’t take the NCLEX-PN. Most provinces and territories use the CPNRE, British Columbia and Ontario use the REx-PN, and Quebec runs its own exam. The requirements may differ by province or territory, so check with your regulator.

Does the NCLEX start with a tutorial?

The exam opens with a short introductory screen, and that time counts toward your five-hour limit along with every break. NCSBN offers the full Candidate Tutorial on NCLEX.com before test day, so you can work through it at home and arrive knowing how each item format works.

Preparing for the Next Generation NCLEX With Archer Review

You now know what the Next Generation NCLEX measures, the model behind its case studies, and how it compares with the old exam. The next step is practice that matches the exam’s format, which means working full unfolding case studies in one sitting so you get used to carrying a client’s details from screen to screen. Archer Review’s SurePASS includes NGN-style practice questions, unfolding case studies, and readiness assessments to help you track your progress and identify areas to review. See everything included in Sure PASS.