How to Answer NGN Questions for Common NCLEX Question Types 

By Rachel Taylor, MSN, BSN, RN · Reviewed by Jennifer Bonner, DNP, MSN, CNM, RN, SANE | Last Reviewed: October 5, 2026

The NCLEX® includes traditional multiple-choice items and NGN questions, built by NCSBN to test clinical judgment, with differences in how each question type is approached and scoring rules across formats. If a bow-tie or a matrix has thrown you off in practice, plenty of RN and PN candidates feel the same, and learning how to answer NCLEX question formats can make them much easier to navigate.

This guide covers select all that apply (SATA), matrix, drop-down, highlight, drag-and-drop, bow-tie, and case study items, plus prioritization and delegation questions. Each section explains what you will see, how the item is scored, and the steps to answer it. Jump to the format giving you trouble, or finish with free NCLEX-style questions near the end.

What NGN Question Types Appear on the NCLEX?

The types of NCLEX questions fall into two families, traditional items and the NGN questions NCSBN introduced on April 1, 2023 to measure clinical judgment, according to the NCSBN Next Generation NCLEX overview. Case study items come in groups tied to one client, and the chart adds new data as you work through them. Stand-alone items appear on their own, and NCSBN designed the bow-tie and the trend item for that role. The NGN NCLEX questions inside case studies come in five NCSBN format families, matrix, multiple response (including SATA), drag-and-drop, drop-down, and highlight, and the sections below cover each one. Traditional multiple choice, calculation, and ordered response items still appear. For exam structure and a study plan, see how to prepare for the Next Generation NCLEX.

NCLEX Test Taking Strategies for Any Question Format

These NCLEX test taking strategies work on every question format. Here is how to answer NCLEX questions in four steps.

Read the whole stem, including details such as the client’s medications. Name the stem type from its hint words, since a positive stem asks what is correct, a negative stem says “further teaching is needed” or “contraindicated,” and a priority stem says “first,” “best,” or “initial.” A bolded keyword in the stem is an indicator that it is a priority question. Reword the stem as a simpler question, then judge each option against the client data. Answer as if staffing and resources are ideal, because the exam tests textbook practice. Here is how that works on a sample question.

A client taking warfarin is reviewing discharge teaching. Which statement by the client indicates a need for further teaching?

A. “I will keep the amount of leafy greens I eat about the same each week.”
B. “I plan to start taking ginkgo biloba to help my memory.”
C. “I will switch to a soft-bristled toothbrush.”
D. “I will keep my scheduled INR lab appointments.”

Warfarin is the key detail, and “further teaching” marks a negative stem, so the question becomes “Which statement is wrong?” Judged against warfarin, A, C, and D are correct, and ginkgo raises bleeding risk, so B is the answer.

Does NCLEX Give Partial Credit on NGN Questions?

The answer to “does NCLEX give partial credit” is yes for any item with more than one correct answer, and the NCSBN scoring FAQ names three rules. Plus/minus scoring subtracts a point for each wrong pick, zero/one scoring never subtracts, and rationale scoring gives a point only when both parts of a linked pair are correct.

Older advice calling SATA items all-or-nothing is out of date, and NCSBN guidance on SATA partial credit confirms they use plus/minus scoring. The table shows the rule for each format.

Format	Scoring rule	What a wrong selection costs
NCLEX SATA questions (multiple response select all)	Plus/minus	1 point per wrong pick; the item cannot drop below 0
Multiple response select N	0/1	Nothing beyond the missed point
Multiple response grouping	Plus/minus per group	1 point within that group; each group cannot drop below 0
Matrix multiple choice	0/1 per row	Nothing beyond the missed point
Matrix multiple response	Plus/minus per column	1 point within that column; each column cannot drop below 0
Drop-down cloze and drop-down table	0/1 per drop-down	Nothing beyond the missed point
Drop-down rationale and drag-and-drop rationale	Rationale	The whole pair scores 0 if either part is wrong
Bow-tie	0/1 per target, 5 points max	Nothing beyond the missed point
Highlight text and highlight table	Plus/minus	1 point per wrong highlight
Drag-and-drop cloze	0/1 per target	Nothing beyond the missed point

NCLEX Select All That Apply Scoring and Plus/Minus Rules

Plus/minus scoring gives you a point for every correct option you select and takes away a point for every incorrect one, and the item’s score never drops below zero. NCSBN uses it for SATA, matrix multiple response, and multiple response grouping items.

Say a SATA item has six options and three correct answers. Picking two correct options and one incorrect option earns 2 minus 1, or 1 point out of 3, while picking only the two correct options earns 2. Since NCLEX gives partial credit this way, an extra option raises your expected score only when you think it is more likely right than wrong. Select what the client data supports and leave the rest.

0/1 and Rationale Scoring for Other NGN Questions

Zero/one scoring, as the NCSBN scoring FAQ defines it, awards 1 point per correct response and subtracts nothing. NCSBN uses it for select-N, drop-down cloze, drop-down table, bow-tie, and one-answer-per-row matrix items, and a wrong choice never reduces points earned elsewhere in the item.

Rationale scoring applies when responses must be correct together. In a dyad, both parts must be correct to earn 1 point. In a triad, each correct condition–finding pair earns 1 point, for up to 2. If the keyed response is “hyperkalemia, as evidenced by low urine output and peaked T waves,” all three correct earns 2, the right condition with one right finding earns 1, and a wrong condition earns 0, even with both findings correct.

How to Answer NCLEX SATA Questions

NCLEX SATA questions are easiest to handle when you treat each option as its own true-or-false statement. NCSBN states that “select all that apply” means one or more options are correct, so the number of right answers changes from item to item on both the NCLEX-RN and NCLEX-PN.

Before reading the options, predict what the client needs from the stem alone. Test each option by asking whether it would help, harm, or do nothing for this client now, and select only the ones that help. Watch for options that travel together, such as two signs of the same complication, and for options that contradict each other. Avoid guessing a count from earlier SATA questions on the NCLEX, since one item’s count says nothing about the next. That approach is especially important under plus/minus scoring, where every incorrect selection subtracts a point.

Sample question: A client with heart failure is starting furosemide 40 mg by mouth daily. Which statements show the client understands the teaching? Select all that apply.

A. “I will weigh myself each morning before breakfast.”
B. “I will take this pill at bedtime.”
C. “I will call if I gain more than 2 pounds in a day.”
D. “I will get up slowly from the bed or chair.”
E. “I will use a potassium salt substitute daily without asking my provider.”

Answer: A, C, and D. Daily weights and reporting fast weight gain track fluid status, and rising slowly prevents falls from low blood pressure. A bedtime dose causes urination overnight, and a potassium salt substitute needs provider review first.

Matrix NCLEX Questions and How to Work the Grid

Matrix NCLEX questions present a grid with findings or actions in the rows and answer categories in the columns, and you judge each row against the client data on its own. Read the column headers before the first row, because they define the decision each row asks for, such as improved, no change, or declined.

The selection format tells you which matrix type you are working in. Round radio buttons allow one selection per row, which marks the single-select version, and square checkboxes allow more than one selection, which marks the multiple response version. The two versions follow different scoring rules, covered in the next two sections.

Sample matrix grid: A client has had 2 hours of treatment for diabetic ketoacidosis. Mark each finding as improved, no change, or declined.

Finding	Improved	No change	Declined
Glucose went from 540 to 310 mg/dL	●	○	○
Respirations stayed at 30 per minute	○	●	○
Potassium went from 5.4 to 3.3 mEq/L	○	○	●

Potassium counts as declined because 3.3 mEq/L is now below the 3.5 to 5.0 reference range.

Matrix Multiple Choice Questions

Matrix multiple choice items accept one response per row, every row needs an answer, and NCSBN scores each row 0/1. In the sample grid above, getting two rows right but calling the potassium change ‘no change’ earns 2 of 3 points.

Judge one row at a time as if the other rows were hidden, since one row’s answer has no bearing on the next. Read the column labels closely, because headers such as indicated, not indicated, and contraindicated ask for three different judgments. Pay attention to the difference between “not indicated” and “contraindicated.” An action that is not indicated is simply unnecessary, while an action that is contraindicated could be harmful.

Matrix Multiple Response Questions

Of the matrix questions NCLEX candidates see, the multiple response version allows more than one checkbox per row or column and uses plus/minus scoring. NCSBN applies that rule to each column separately and rounds any negative column score up to zero, so wrong checks in one column never cost points in another.

A single finding can fit more than one condition, so check every column for each row before moving on. Leave a cell blank whenever the client data does not support it, since each unsupported check subtracts a point within its column.

How to Solve NCLEX Drop-Down Questions

Drop-down items ask you to complete a sentence, a paragraph, or a table by choosing one option from a short menu at each blank. NCSBN describes each drop-down as “conceptually identical to a multiple-choice item, though having a different response format,” so multiple choice elimination habits apply inside every menu.

The format comes in three variants, drop-down cloze, drop-down table, and drop down rationale. Cloze and table items score every blank separately, while rationale items score linked blanks together.

Drop-Down Cloze and Drop-Down Table Items

A drop-down cloze item places menus inside a sentence or short passage, and a drop-down table item places them inside the cells of a chart. Both use 0/1 scoring, so each correct menu earns 1 point and a wrong one costs nothing.

Read the full sentence before opening any menu, since words near the end often limit which options fit earlier blanks. Then read the finished sentence with each option in place to check that it makes clinical sense. Before selecting, check your choice against the EHR tabs, such as vital signs or lab results.

Drop Down Rationale NCLEX Questions

Drop down rationale items ask you to complete one cause-and-effect sentence, either as a dyad with one cause and one effect or as a triad with one cause and two effects. Wording such as “due to,” “as evidenced by,” and “related to” links the blanks, and that link is the sign the item uses rationale scoring.

Choose the cause first, based on the most abnormal or most changed finding in the chart, and then confirm that each effect follows from it. A condition that sounds more serious is still wrong when the chart supports a different one, and abnormal evidence unrelated to the chosen condition costs you the pair.

Sample question: A client who had a stroke 2 days ago coughs when drinking thin liquids. The client is at highest risk for [aspiration / dehydration / skin breakdown] as evidenced by the client’s [coughing during meals / serum sodium / Braden score].

The correct answer, “aspiration as evidenced by coughing during meals,” earns 1 point.

How to Answer NCLEX Highlight Questions

NCLEX highlight questions ask you to click the words, phrases, or table cells that answer the stem, in a passage such as nurses’ notes (highlight text) or a chart or flow sheet (highlight table). NCSBN’s guidance on what candidates see on highlight items explains that selectable text shows a highlighted hue on hover, while other text shows a ø symbol and cannot be selected.

Before clicking, identify which clinical judgment step the stem tests. A stem asking which findings need follow-up tests whether you recognize cues, and one asking which findings show improvement tests whether you evaluate outcomes. Highlight only findings that answer that step, leaving out values expected for the condition or already improved. To find out whether you can highlight on the NCLEX outside these items, see the FAQ below.

How to Answer Drag and Drop NCLEX Questions

Drag and drop NCLEX questions ask you to move tokens from a list into targets, either blanks inside a sentence (drag-and-drop cloze) or the cause and effect slots of one statement (drag-and-drop rationale). Some items offer more tokens than targets, so not every token has to be used. Traditional ordered response items also use dragging, but they ask you to sequence every step.

Drag-and-drop cloze items score each target 0/1, and rationale items earn a point only when the linked cause and effect are both correct. Read the sentence, every token, and the chart before dragging, then place the token the evidence best supports and check the rest against it. On a rationale item, pick the cause from the client data first.

How to Solve NCLEX Bow-Tie Questions Step by Step

NCLEX bow-tie questions are stand-alone items where you drag one condition into the center, two actions to the left, and two parameters to monitor to the right. Each set of tokens has its own list, and NCSBN scores each of the five targets 0/1, for up to 5 points. Actions and parameters can go in either box on their side without changing the score.

Work a bowtie item from the center out. Settle the condition first, because both sides depend on it, then pick the two actions that treat it directly. Finish with the two parameters that would show whether those actions worked, and check that all five tokens describe one consistent picture of the client. The Archer Review walkthrough below works through an OB bow-tie practice question.

NCLEX Case Study Questions and the Six Clinical Judgment Steps

NCLEX case study questions come in sets of six items built around one client, and every NCLEX-RN and NCLEX-PN exam includes three sets, or 18 items, according to the 2026 test plans. Each item measures one step of the NCSBN clinical judgment measurement model (CJMM), the framework behind all NGN NCLEX questions.

The client record sits in tabs such as nurses’ notes, vital signs, and lab results, and new time-stamped entries can appear as the case moves forward. The exam does not remind you to check the tabs, so reopen all of them on every item in case new information changes your answer. Before answering, name the CJMM step the item tests by using the table below.

CJMM step	What the item asks you to do
1. Recognize cues	Identify relevant and important information from different sources
2. Analyze cues	Organize and connect the recognized cues to the client’s clinical presentation
3. Prioritize hypotheses	Rank possible explanations by urgency, likelihood, risk, difficulty, and time constraints
4. Generate solutions	Identify expected outcomes and define a set of interventions
5. Take action	Implement the solutions that address the highest priority
6. Evaluate outcomes	Compare observed outcomes to expected outcomes

To practice rereading the chart and naming each step with an instructor, see the Sure PASS NCLEX-RN review course or its NCLEX-PN version, which adds live NGN case studies to the Q-Bank.

Traditional NCLEX Question Types You Will Still See

NCLEX question types also include traditional items that appear alongside NGN items. Multiple choice asks for one best answer, so eliminate options that are true but do not answer the stem. NCLEX ordered response questions ask you to drag steps into sequence, so place the first and last steps, then fill the middle.

NCLEX hot spot questions ask you to click an area on an image, so confirm the landmarks before clicking. NCLEX fill in the blank questions cover calculations, so round only at the end and use the on-screen calculator. Chart, exhibit, and graphic items hide key data behind a tab, so open each one first. SATA is traditional too, and the SATA section covers it.

NCLEX Prioritization and Delegation Questions

NCLEX priority questions and delegation questions are question styles that can show up in any format, from standard multiple choice to matrix and SATA items. Both draw on Management of Care, the largest client needs category on the 2026 NCLEX-RN test plan at 15 to 21% of the exam, and on its NCLEX-PN counterpart, Coordinated Care, at 18 to 24%. The two sections below cover ranking clients and handing off tasks.

How to Answer NCLEX Priority Questions

Priority items ask you to decide which client, finding, or action comes first, and a short list of frameworks, used in order, gives you a place to begin. Work through airway, breathing, and circulation, then Maslow’s hierarchy, then acute over chronic, unstable over stable, and actual over potential. When the stem lacks the data to act, assess before intervening.

Check the client’s age and setting first, since a respiratory rate of 52 is expected in a newborn and alarming in an adult. When frameworks disagree on NCLEX prioritization questions, use NCSBN’s criteria of urgency, likelihood, and risk, and choose the client who would be harmed fastest if you waited.

Sample question: Which client should the nurse see first?

A. A client with COPD who has an oxygen saturation of 89% on 2 L of oxygen
B. A client 1 day after hip replacement with new chest pain and a respiratory rate of 28
C. A client with diabetes who is due for insulin before breakfast
D. A client who had a stroke and needs repositioning

Answer: B. New chest pain and rapid breathing after surgery suggest a pulmonary embolism. An oxygen saturation of 89% is a common baseline in COPD, and the insulin dose and repositioning are routine care for stable clients.

How to Answer NCLEX RN Delegation Questions

NCLEX RN delegation questions test which tasks stay with you and which you can assign, based on the National Guidelines for Nursing Delegation from NCSBN and the ANA. Those guidelines list five rights, the right task, circumstance, person, directions and communication, and supervision and evaluation, and they bar delegating clinical reasoning, nursing judgment, or critical decision making.

The RN keeps assessment, initial teaching, care planning, evaluation, and any unstable client. An LPN/VN can typically care for stable clients with predictable outcomes and reinforce teaching, and assistive personnel can handle daily living tasks and vital signs for stable clients. Scope varies by state, so RN and NCLEX-PN delegation questions test widely accepted entry-level scope.

Sample question: Which task can the RN delegate to assistive personnel?

A. Teaching a newly diagnosed client to use an insulin pen
B. Walking with a stable client 2 days after an appendectomy
C. Assessing a client just back from cardiac catheterization
D. Evaluating a client’s response to pain medication

Answer: B. Walking with a stable client is routine care that assistive personnel can provide. Teaching, assessing after a procedure, and evaluating a medication response all require nursing judgment.

Free NGN Practice Questions by Format

The free NGN practice questions above let you test yourself with NCLEX-style questions in the exam’s layout. Each item scores itself with the NCSBN rule for its format, so a matrix multiple response item subtracts for wrong checks while a drop-down or select N item does not, and a short rationale follows every answer. If a format still trips you up, work through more of it in the NCLEX-RN demo or NCLEX-PN demo.

NGN Questions Checklist for NCLEX Test Day

Run these NCLEX test taking strategies, the core NCLEX tips and tricks from this guide, on every item.

• Read the full stem, including the client’s medications, age, and setting.

• Name the stem type as positive, negative, or priority from its hint words.

• Reword the stem as a simpler question, the goal is 5 words or less.

• Identify the format and its scoring rule.

• Predict what the client needs before reading the options.

• Judge each option or row on its own against the client data.

• Reopen every EHR tab on case study items, since new entries can appear.

• On NCLEX SATA questions and other plus/minus items, select only what the data supports and only what you are fully confident with.

• Work bow-ties from the center out, starting with the condition.

Frequently Asked Questions About NGN Questions

The questions below cover exam-day rules, from note boards to pacing, and each answer adds a detail the sections above do not.

Can You Highlight on the NCLEX Outside of Highlight Items?

NCSBN does not have a general highlighter or strike-through tool for marking up question text, so plan to study without one. For notes, the testing center provides an erasable note board and marker, and you can raise your hand to request a clean board during the exam. Do not erase your board.

Can You Tell Which NCLEX Questions Are Un-scored Pretest Items?

Every NCLEX includes 15 unscored pretest items, and NCSBN says they share the style and format of scored items, so you cannot tell them apart. Treat every item as if it counts. These items can occur anywhere throughout the exam. According to NCSBN, seeing an item similar to one you answered earlier also does not mean you missed the first one.

Will Every Candidate See a Bow-Tie or Trend Item?

NCSBN guarantees three case studies on every exam, plus stand-alone items that make up about 10% of the exam and are selected depending on exam length. It does not promise that every candidate sees a bow-tie or a trend item specifically. Prepare for NCLEX bow-tie questions and trend items alike. Some candidates may have up to five case studies.

Can You Go Back to Earlier Questions in an NCLEX Case Study?

No. Once you select Next, you cannot return to a previous item, and that rule applies inside NCLEX case study questions too. Settle each of the six items with the chart data in front of you before moving on, since new information later in the case cannot change an earlier answer.

How Long Should You Spend on Each NGN Question?

The five-hour limit includes the introduction and all breaks, and the exam runs up to 150 items, so aim for about 2 minutes per item. If you set aside 20 minutes for breaks, that drops to about 1 minute 52 seconds, or roughly 11 to 12 minutes for a six-item case study.

Practice NGN Questions With Archer Review

If any format in this guide still throws you off, the fix is more practice in that format under the same scoring rules. The Archer Review Q-Bank has 70 unfolding cases, 174 standalone cases, and 500+ SATA questions. Every item has a rationale and uses the matching NGN scoring rule, so partial credit on those items works the way it will on test day. Pick the format that gave you the most trouble and start with NGN practice questions in the Archer Q-Bank.