How Will Next Generation Affect the NCLEX Test Design?

Green sign indicating there will be changes ahead to the NCLEX exam.
Learn how much time students will have to take the Next Generation NCLEX exam, the number of questions administered to each student, and what mix of traditional vs. Next Gen-style items that students must answer.
Share this blog
Green sign indicating there will be changes ahead to the NCLEX exam.
Quick Links

Emily N. Giddings, MSN, RN, CNE, CCRN
UWorld Nursing

With the upcoming Next Generation NCLEX® transition on the horizon, faculty are wondering what other testing changes to anticipate. While the National Council of State Boards of Nursing (NCSBN) is still finalizing many aspects of the Next Gen transition, they recently announced what other changes to the test plan can be anticipated along with the new item types. Here, we answer questions regarding how much time students will have to take the exam, the number of questions administered to each student, and what mix of traditional vs. Next Gen-style items that students must answer.

When will the NCLEX® Next Generation change take place?

Currently, the NCSBN is on track to fully implement Next Generation NCLEX®-style items into the exam as early as April 2023. This update will occur at the same time as the anticipated exam plan changes that roll out every three years. While April 2023 may seem like a long way off, keep in mind that this means pre-licensure students matriculating this upcoming fall (2021) into a traditional four-semester program will be graduating in the spring of 2023 and taking NCLEX® after the Next Generation transition.

Will the entire exam be made of Next Generation case studies?

No. Each student, regardless of whether they receive a minimum or maximum length exam, will be administered three Next Gen case studies. Each case study includes a total of six items (NCSBN, 2021). This means that all students will receive three case studies for a total of 18 total Next Generation questions. The remainder of the items will consist of the more familiar, traditional NCLEX® item types, including both multiple-choice and alternate-format items such as select-all-that-apply. In addition, students that receive a longer exam will also receive up to seven “stand-alone” clinical judgment Next Gen item types (i.e., “bowtie” and “trend” items). This means that regardless of exam length, each exam will consist of approximately 20–25% new, Next Gen-style items, including both case study and stand-alone items.

Here are the changes in exam length to expect:

Number of items Next Generation
Minimum-length exam
Next Generation
Maximum-length exam
Next Generation case studies 3 case studies of 6 items each
Total 18 Next Gen items
Clinical judgment stand-alone items (bow tie and trend items) 0 Up to 7
Conventional item types 52 Up to 110
Total scored items 70 135
Pre-exam (unscored) items15 items
Total item count 85 150

(NCSBN, 2021)

Are items within case studies adaptive?

For the purposes of integrating Next Gen items into the computerized adaptive testing model, one strategy that might be employed is using a single difficulty level for each case study based on the student’s responses to the items within the case study. This could then be used to determine which item following the case study should be administered to the student. Whatever strategy is employed to integrate the Next Gen items into the CAT exam, the student’s response to one item within a case study will not influence the difficulty level of the next item within the same case study. The entire six-item case study is already queued as a whole in advance for the student. The remainder of the exam will function within the NCLEX computerized adaptive testing algorithm.

Will students be given more time to answer Next Gen-style items?

The maximum allotted time to take the NCLEX® currently is five hours, and it will remain at five hours following the Next Gen transition. The NCSBN’s (n.d.) data collected during the pre-exam special research section has shown that students do not take significantly longer to answer Next Gen-style questions than they do traditional NCLEX®-style questions.

Overall, this is an exciting time for nurse educators and students alike. The Next Generation transition represents a much-needed change to evaluating students’ readiness for safe practice. While the transition may be daunting, UWorld hopes to answer all your questions and provide you with the resources necessary to prepare for this change.


National Council of State Boards of Nursing. (n.d.). NGN FAQs for educators. NCSBN.
Retrieved March 15, 2021, from
National Council of State Boards of Nursing. (2021). Next generation NCLEX update [Webinar].

Share this blog

View More...
Pass the Next Generation NCLEX® the First Time!

High-yield videos, thousands of practice questions, multiple self-assessment tests, and more.

Scroll to Top