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The NCLEX is the premier licensing examination for nursing licensure candidates, designed to test an applicant’s readiness for competency in entry-level nursing practice. In April 2023, the Next Generation NCLEX examination launched with exciting new features. This blog will explain some of the recent changes to the examination and how to study for the NCLEX so you can be prepared for success.

What is the NCLEX?

The NCLEX is a major milestone in the journey of a nursing school graduate. The test is designed to assess a candidate’s decision-making skills and clinical judgment for safe and effective nursing practice. Quality nursing programs prepare students to pass the exam, and study strategies can help you succeed if you are thinking about a nursing career.

The National Council of State Boards of Nursing (NCSBN) is dedicated to creating an examination using psychometrics to ensure validity and reliability in testing results. The exam is also created to be legally defensible because public safety when receiving nursing care is of utmost importance.

NCLEX Scoring

For many years, the examination has used computerized adaptive testing (CAT) as a way to maximize efficiency in the delivery of test items. As you answer exam questions, the computer continually evaluates your performance and uses this information to select the difficulty of upcoming questions. The new NCLEX continues to utilize this adaptive format but has added an updated scoring element that incorporates partial credit scoring for some items. On the prior version of the NCLEX items were either scored as correct or incorrect without partial credit awarded.

NCLEX scoring is based on key concepts:

  • A passing standard is established as the minimum requirement for nursing ability
  • A candidate’s ability is estimated by the computer as test items are answered
  • A set of pass-fail rules are used to objectively determine the final pass/fail result

When choosing a nursing program, it is important to look for an institution with a record of high pass rates on the NCLEX for graduates. Baylor University School of Nursing Online offers an online, accelerated Bachelor of Science in Nursing (ABSN) program with high NCLEX pass rates and preparation throughout the curriculum. 

The ever-changing complexity of the healthcare environment requires today's nurses to display the ability to match increased complexity with increased skill in clinical judgment and critical thinking.  

Measuring Clinical Judgment 

One of the major changes in the new NCLEX is an increased focus on clinical judgment skills that are mandatory for safe nursing practice. Researchers developed the NCSBN Clinical Judgment Measurement Model (NCJMM) as a framework for nursing thought processes that are applicable in teaching and practice. The model assesses a nurse’s clinical judgment ability to:

  • Refine hypotheses
  • Prioritize hypotheses
  • Generate solutions

For years, clinical judgment has always been an essential part of teaching and clinical competency assessments in nursing education and standardized examinations. The rigorous research at the foundation of the NCJMM has enabled another level of measuring inferences and clinical judgment in a way that is innovative and psychometrically sound.

Next, let’s explore the types of case study questions that appear in the new NCLEX format. 

Next Generation NCLEX Features

Case study questions are featured in the NCLEX to simulate the types of situations that nurses will encounter in real, everyday practice environments. The next generation NCLEX items focus on a clinical scenario, important information that an entry-level nurse should know, and the avoidance of thought processes that may lead to nursing errors. Examples include differentiating the information provided and sorting out valuable information from common misconceptions, inaccurate information, and irrelevant details. 

Types of items that have been introduced and finalized for inclusion in the new NCLEX are detailed below.

Extended Drag-and-Drop and Bowtie Questions

Drag-and-drop questions are presented to the test taker in two columns. The goal of these items is to pair the information in the first column with the corresponding information in the second column. Bowtie questions are a type of drag-and-drop question and require the test taker to evaluate all six steps in the NCJMM in one question. Extended drag-and-drop questions may evaluate the ability of the candidate to correctly determine and match cause-and-effect, patient scenarios with appropriate nursing interventions, or actions with rationales. 

Cloze Narrative Questions

Drop-down questions based on case studies, also called cloze questions, supply a patient scenario in narrative format and require the test taker to select information from drop-down boxes that fill in missing pieces of the narrative. There may be several drop-down boxes throughout the narrative that require the test taker to select accurate information to complete the sentences correctly.

Matrix Grid Questions

Questions displayed in a matrix grid format appear like a chart, where patient health information or case-based scenario content is presented in the left column and potential answer choices are presented in the right columns of the grid. You may have matrix grid questions that provide statements made by patients where your goal is to select whether the patient has an accurate understanding or requires further teaching. 

Other examples of matrix grid questions may provide assessment findings where you must determine the meaning or associate the finding with a particular health condition. Matrix grid items often require multiple selections and are scored with partial credit awarded for correct responses.

Enhanced Hot Spot Questions

Hot spot questions have been part of the NCLEX item set for some time, but the next generation NCLEX has enhanced this item type to present scenarios and client health information. A hot spot question presents answer choices in a text or table format where correct answers must be highlighted and incorrect answers avoided. You will know which areas of a narrative to select as possible answer choices because these answer options are delineated as predetermined selectable text.

Extended Multiple Choice Questions

Multiple choice questions are often the most familiar type of examination item. A real-world case scenario is typically presented along with several possible answer choices. The test taker may be required to choose one, best answer from a set of four responses or select multiple correct answers when prompted. Questions requiring the selection of all correct answers may be presented in groups or categories in this new item format.

Study Strategies for NCLEX Success

As you can see, the next generation NCLEX has some complex changes, and this will require NCLEX candidates to prepare for these unique question types. One of the most helpful study strategies is to familiarize yourself with the types of questions you will be expected to answer. A sample pack of questions and an exam preview are available for free download.

Review the Test Plan 

Every three years, the NCLEX test plan is reviewed and updated. NCLEX candidates are highly encouraged to review the test plan because it contains important details regarding:

  • Exam content
  • Exam administration
  • Definitions of clinical judgment and categories of client needs
  • Nursing activities
  • Sample test questions

A reason why more people are choosing nursing as a second career is that nursing allows the opportunity to make a meaningful, lasting difference in the lives of patients and families. As you explore the information on clinical judgment provided in NCLEX preparation resources, you will see the types of decisions you will be responsible for as a nurse that can lead to improved outcomes and quality care experiences.

Practice Questions and Assess Your Strengths

As you practice sample exam questions, you will grow more comfortable completing items and you will learn the topical areas where you are stronger and weaker in knowledge, critical thinking, and clinical judgment. Read the rationales provided when you answer practice questions and note any unfamiliar terms or concepts. 

It can boost your confidence to complete questions in your strongest topical areas, but it is also important to maintain a balance of study where you focus on less familiar content to strengthen your clinical judgment ability. Find a study partner and vary your study methods. Listening to audio resources, writing down the information, or talking it out with a friend can all be valuable learning techniques.

Know What To Expect on Exam Day

You can prepare for success on the exam by knowing what to expect on exam day. Thinking through the day can lessen the potential for overwhelm and lead to feelings of confidence and calm. Be sure to:

  • Dress comfortably for the exam
  • Locate the testing center before exam day 
  • Arrive approximately 30 minutes early for the test
  • Bring acceptable identification that meets requirements
  • Pace yourself through the test

You will have approximately five hours to complete the exam. Be sure to read through each question carefully and take breaks as needed. Once you complete a question, you are not permitted to return to the question.

Prepare for NCLEX Success at Baylor University 

Louise Herrington School of Nursing Online at Baylor University offers a Distance ABSN program with NCLEX preparation built into the curriculum. The program boasts high pass rates on the NCLEX and supports students by offering:

  • Collaboration in clinical placement 
  • Program completion in less than 1 year for students with a current baccalaureate degree
  • Hybrid learning that combines online coursework with clinical and lab experiences

Visit the accelerated BSN program page today to learn how you can prepare for NCLEX success and join the nursing workforce with Baylor’s ABSN program.

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