Next Generation NCLEX (NGN) Question Types Explained with Examples

The Next Generation NCLEX (NGN) has transformed the way nursing students are evaluated. Instead of testing memorization, the new format measures real clinical judgment—how a nurse thinks, prioritizes, and makes safe decisions. To pass confidently, you must understand the different NGN question types and how they appear on the exam.

Below is a complete breakdown of all major NCLEX question types, explained in simple terms with clear examples.

1. Case Study Questions

NGN includes 6-item case studies, each based on a single client scenario. These questions simulate how nurses assess, plan, intervene, and evaluate care in real situations.

What you’ll see:

• Client history
• Lab results
• Nursing notes
• Provider orders
• Vital signs

Example:

You may receive a case about a client with heart failure, followed by six related questions on prioritization, risk factors, and nursing actions.

2. Matrix Multiple-Response Questions

These allow multiple correct answers across rows and columns, giving a more detailed assessment of your knowledge.

Example:

Example: You may need to classify symptoms as expected, unexpected, or requires immediate action. This format ensures you truly understand nursing priorities, not just isolated facts.

Extended Multiple-Response Questions

Unlike traditional “select all that apply,” these NGN questions offer partial scoring. Even if you miss one option, you still earn credit.

Example:

“Which of the following findings indicate worsening COPD?” You select all that apply—partial credit is awarded based on how many correct options you choose.

4. Bow-Tie Questions (Most Popular NGN Format)

Bow-tie questions test three essential nursing skills at once:

• Problem identification
• Actions to take
• Complications to avoid

The layout forms a bow-tie shape: left, center, and right panels.

Example:

Center: What condition is the client most likely experiencing?

Left: Select two actions to take now.

Right: Select two potential complications you must prevent.

This format closely mirrors real-life decision-making at the bedside.

5. Trend Questions

These NGN questions present data over time—such as vital sign trends, progress notes, or repeated lab results.

Example:

A patient’s potassium level rises over 8 hours. You must determine the priority intervention based on the trend.

Final Tips for Success

• Practice NGN questions daily to build familiarity.
• Focus on clinical judgment, not memorization.
• Review bow-tie questions—they appear frequently and carry high scoring potential.
• Use official NCLEX prep tools to stay aligned with current exam standards.

Understanding these NCLEX question types will help you approach the NGN format with confidence and score higher on test day.