In our 2025 UWorld Nursing Educator Survey, we asked a straightforward question:
“Which NGN item type do your students tend to struggle with the most?”
The answer was clear: Multiple Response Matrix Items.
Despite over a year of exposure to the Next Generation NCLEX® (NGN) format, faculty report that students continue to underperform on matrix-style items requiring analyzing client conditions and applying interventions across multiple variables.
Why Are Matrix Items So Difficult?
Matrix multiple response items challenge more than factual recall. They test a student’s clinical judgment, requiring them to:
- Analyze and interpret multivariable patient data.
- Determine independent truth values for each row-column pairing.
- Distinguish critical cues from distractors under timed pressure.
The structure is unfamiliar and cognitively demanding, particularly for first-time testers. According to discussions on Reddit’s r/StudentNurse forum, many students report confusion not only with the format but also with how the scoring works.
“I hate the matrix questions. I never know if I should select all that apply or just one. They all seem ‘sort of right.’ UWorld is the only place I’ve seen that really prepares you for this.” — u/mednurseprep22, Reddit (2024).
In private NCLEX-focused Facebook groups, nursing students have also described initial poor performance on matrix-style predictor assessments until practicing consistently with UWorld’s platform (personal communication, March 2024).
How UWorld Supports Matrix Item Mastery
UWorld’s NCLEX-RN® and NCLEX-PN® QBank is designed from the ground up for NGN success. For faculty seeking meaningful support and measurable impact, here's what makes UWorld a trusted choice:
1. Complete NGN Item Type Coverage
UWorld includes all NGN item types, including matrix/grid, bow-tie, extended drag-and-drop, case studies, and trend-based questions. There is no partial exposure and no guesswork.
2. Auto-Graded NGN Items Save Faculty Time
Every matrix question is automatically scored using NCLEX-style partial credit rules, mirroring the actual exam’s scoring logic. Thus, faculty can quickly identify student performance gaps and reduce time spent manually grading high-volume assessments.
3. NCLEX-Matching Interface for Test-Day Familiarity
Unlike many competitors, UWorld’s testing environment replicates the NCLEX platform, right down to the submit buttons, font, and functionality. This minimizes interface shock and helps students enter exam day feeling confident, not confused.
Evidence-Based Design: UWorld’s Edge in NGN Mastery
Great content is not enough—instructional design matters. UWorld’s platform is built on proven educational principles that elevate learning outcomes:
Cognitive Load Theory (CLT)
Matrix items demand high cognitive processing. UWorld applies CLT by:
- Reducing extraneous load with an NCLEX-matching interface.
- Presenting content in a format that encourages focused engagement, helping learners manage the complex structure of NGN items without additional navigation friction.
- Supporting schema development by offering consistent, structured explanations for every answer choice, helping students connect clinical reasoning to test performance.
Sweller’s theory (1994) confirms that learning is optimized when extraneous challenges, like unfamiliar interfaces, are removed.
Formative Assessment & Feedback Loops
Every UWorld item includes instant feedback and detailed rationales—aligned with formative assessment best practices (Black & Wiliam, 1998; Shute, 2008). Faculty can:
- Monitor progress with item-level data dashboards.
- Deliver remediation sessions tailored to matrix-style performance gaps.
- Use digital notebooks, flashcards, and in-app annotations to promote retrieval and review.
High-Fidelity Simulation in Digital Context
UWorld brings simulation principles into the digital realm by:
- Using realistic patient data sets and time-based clinical scenarios
- Creating a psychologically faithful test-day experience that builds endurance and confidence
- Allowing reflective review, a known driver of clinical judgment (Lasater, 2007; Dickison et al., 2020)
Final Thoughts: Prepare Smarter, Teach Smarter
The NGN’s introduction fundamentally changed how we assess readiness for nursing practice. And matrix items are among the most complex.
UWorld gives nursing programs a powerful edge:
- Auto-graded NGN matrix items
- An interface that mirrors the real exam
- Built-in analytics to identify struggling students
- A solution that aligns with how the brain learns best
If your department is seeking better NCLEX outcomes and more efficient instruction, UWorld isn’t just a test prep tool. It’s a partner in academic success.
References
- Black, P., & Wiliam, D. (1998). Inside the black box: Raising standards through classroom assessment. Phi Delta Kappan, 80(2), 139–148.
- Dickison, P., Haerling, K. A., & Lasater, K. (2020). Defining clinical judgment in nursing. Journal of Nursing Regulation, 11(1), 5–16. https://doi.org/10.1016/S2155-8256(20)30002-0
- Hayden, J. K., Smiley, R. A., Alexander, M., Kardong-Edgren, S., & Jeffries, P. R. (2014). The NCSBN National Simulation Study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2), S3–S40.
- Lasater, K. (2007). Clinical judgment development: Using simulation to create an assessment rubric. Journal of Nursing Education, 46(11), 496–503.
- Shute, V. J. (2008). Focus on formative feedback. Review of Educational Research, 78(1), 153–189.
- Sweller, J. (1994). Cognitive load theory, learning difficulty, and instructional design. Learning and Instruction, 4(4), 295–312.
- Reddit. (2024). r/StudentNurse thread on NGN matrix confusion. https://www.reddit.com/r/StudentNurse/comments/qf6xb2/ngn_matrix_question_confusion/
