Tips for Answering Next Gen NCLEX® Case Studies

The biggest difference between the “old NCLEX” and Next Gen NCLEX (NGN) is the more precise measurement of your clinical judgment through new unfolding case studies. Every candidate will receive three scored case studies, each with six questions (18 questions total), making case study practice essential to NCLEX prep. We’ll walk you through the ins and outs of this new question style to help you understand what to expect on the NGN and how to achieve a passing score.

Prefer a video? Check out this UWorld NCLEX case study presented by one of our nursing experts:

What Are NGN Case Studies?

Next Gen NCLEX case studies measure a candidate’s clinical judgment by describing a clinical scenario, sharing “unfolding” client information, and asking questions related to Layer 3 of the NCSBN Clinical Judgment Measurement Model (NCJMM).¹ Put another way…

NGN case studies present a realistic patient scenario that you must navigate, step by step, starting with identifying and analyzing relevant client information, then planning and providing treatment, and lastly evaluating client outcomes.

The result is a six-question set that requires you to:¹

Form Hypotheses	1. Recognize Cues			Identify relevant client information like abnormal assessment findings and vital signs.
	2. Analyze Cues			Organize and connect the recognized cues to the client’s condition.
Refine Hypotheses	3. Prioritize Hypotheses			Evaluate and prioritize hypotheses based on urgency, risk for injury, time constraints, etc.
	4. Generate Solutions			Identify expected outcomes and plan appropriate interventions using hypotheses.
Evaluation	5. Take Action			Implement the interventions based on highest priority.
	6. Evaluate Outcomes			Compare observed outcomes to expected outcomes.

This multi-step approach is designed to better assess your entry-level nursing knowledge, skills, and abilities, and differentiate your understanding from that of other candidates by using partial-credit scoring.²

Components of an NGN Case Study

Instead of simply using traditional multiple-choice questions to test the six sequential NCJMM steps, NGN case studies may use any of the traditional or new Next Gen NCLEX item types (excluding trend and bow-tie questions). These include:²

You’ll also want to be familiar with the various types of information you will see as case study scenarios unfold and reveal changes in the patient’s status. This often begins with Nurses’ Notes or the client’s medical history, and incorporates other clinical data (like vital signs) in a tabular format that’s updated as the case study unfolds.

NGN case study clinical scenario

NGN case studies start by providing a general overview of a clinical scenario. Just like in real life, you may not have all of the information you need to make a sound clinical decision. In the following example from our NCLEX Review Course, you’re initially provided with Nurses’ Notes and must highlight the five most important client findings:

Remember that questions 1 and 2 in an NGN case study examine your ability to recognize and analyze cues. In this example, it’s not until question 3 that the scenario unfolds further and you’re provided with additional client information.

NGN case study supporting information

The way NGN case studies provide supporting client information varies. Sometimes, you’ll have access to all of the information you need from the beginning. In many cases, additional information will become available as if you were working with an actual patient and gathering clinical details in real-time. Read the new information carefully and answer the associated question as best you can. It’s important to note that on the NCLEX, you cannot go back and answer previous questions. Continuing our above NGN case study example, question 3 is when you gain access to Laboratory Results:

In this step, you’re asked the first of two questions related to refining your hypotheses. From here, this case study progresses through the remaining NCJMM steps, but does not provide any additional client information.

During your exam, client information will always be stored in this tabular format (common tabs are Nurses’ Notes, Vital Signs, History and Physical, Orders, Laboratory Results, Diagnostic Results, etc.). While their names may vary, what’s more important is understanding where relevant information is located so you can successfully answer the questions.

How Are NGN Case Studies Scored?

NGN case studies use partial-credit scoring (polytomous scoring) to differentiate between students who fully understand, partly understand, and don’t understand questions. This new NCLEX scoring method varies by question type, but there are three general rules to know:

• +/- scoring is used for questions that have more than one answer option, but with an unspecified number of correct answers (e.g., SATA, Highlight, and Matrix Multiple Response). Selecting a correct option provides +1 point, while selecting an incorrect option results in -1 point. The lowest possible score for all question types is 0.
• Rationale scoring is used for cause and effect-style questions. When there are two answer options, both must be answered correctly to receive credit. When there are three, partial credit may apply. For example, “A nurse must do X because of Y and Z.” If a student answers X and either Y or Z correctly, they will receive partial credit.³
• 0/1 scoring is a more familiar scoring method where you either get the question right or wrong (think multiple choice). Each correct option you select provides 1 point, and each incorrect option you select adds 0 points.

NGN partial-credit scoring is more forgiving than traditional NCLEX scoring, which can help ease anxiety in answering case study questions. Even if you misinterpret a scenario and answer the initial questions incorrectly, you still have time to change course. Like with any exam, practicing beforehand is the best way to prepare.

NGN case studies vs stand-alone questions

NGN stand-alone questions are similar to case studies because they also measure your clinical judgment based on Layer 3 of the NCJMM. However, stand-alone questions can use any NGN question type, including trend and bow-tie questions:⁴

• Trend questions feature one question apiece, and may include one or more steps from NCJMM Layer 3. This means you’ll need to make one or more clinical decisions per question.
• Bow-tie questions feature one question apiece, but include all six steps from NCJMM Layer 3. This means you’ll need to make multiple clinical decisions all in one question.

How many NGN case studies are on the NCLEX?

Whether you answer the minimum 85 questions, maximum 150 questions, or somewhere in between, three of your case studies (totaling 18 questions) will be scored. It’s important to note that you may receive more case studies (one or two additional) that are being piloted for pretesting and are not scored. Question types may differ, but 18 case study questions will count toward your score.²

How to Approach NGN Case Studies

Before you begin an NGN case study, remember that you cannot go back after a question is submitted. So make sure you’ve fully answered each question before moving on to the next one. With this in mind, here are some additional NGN case study tips from our nursing team:

Understand the NCSBN’s Clinical Judgment Measurement Model

Getting familiar with the NCJMM may sound like overkill, but it will help you develop your clinical judgment and truly think like a nurse. This is crucial when it comes to successfully answering NGN case studies, where simply memorizing facts isn’t enough to achieve success.

The NCJMM was designed as a thinking and teaching framework, and fully breaks down a nurse’s decision-making process into six measurable steps. These steps form Layer 3 of the NCJMM that NGN case studies test you on. Keeping the full framework in mind as you take the NCLEX will make it easier to recognize the what and why behind each NGN case study question.

Identify the main question in the case study scenario

Just like when caring for a real patient, identifying the condition(s) that your simulated patient is experiencing is the first step in deciding how to provide effective care. Everything else in the case study will build on this initial information. Don’t forget that NGN case studies are written to be as realistic as possible, so some information you receive will likely be irrelevant. This is where your skills in prioritization come into play.

Look for clues in the case study scenario

Figuring out what clinical information matters and what doesn’t requires practice. One trick you can use when reading an NGN case study is to identify keywords that signal something is important (e.g., new, change in, increased/decreased, etc.). You should also consider questions like, “How long have symptoms persisted?” And, “What changes to the body are present?”

Think critically about the supporting information

As a case study unfolds and you’re presented with supporting client information, ask yourself why the new information is relevant to the client’s main condition(s). The best way to go about this is to visualize yourself working with a real patient. Did the lab results we ordered become available? Great! Let’s consider how they impact our hypotheses. Did we receive an update about the patient in the form of new Nurses’ Notes? Interesting. Let’s check to see if our treatment worked as expected.

Carefully follow the directions for each question

The Next Gen NCLEX is unique in that it evaluates students’ performance using a variety of question types. You can’t just assume a question is multiple choice with one correct response. Especially when completing case studies, pay attention to the NGN item type you’re being asked to complete (e.g., Highlight, SATA, Drag and Drop, Matrix, etc.).

Eliminate “distractors” in the answer choices

As you tackle case study questions, eliminate potential distractors (incorrect answer choices). When you work with real patients, you’ll be confronted with irrelevant medical information that may lead you to draw incorrect conclusions. NGN case studies purposely incorporate common clinical judgment errors and allow candidates to pursue incorrect treatment paths. To avoid mistakes, always keep the case study’s main client condition(s) in mind and cross out obvious distractors.

Practice Next Gen NCLEX Case Study Questions

NGN case studies take some time to get used to. At first, half the battle is understanding the item types and how to identify relevant information. But, as the saying goes, practice makes perfect! By practicing NGN case studies before your exam, you can get familiar with the testing layout, develop your clinical judgment, boost your confidence, and maximize your score.

At UWorld Nursing, we offer over 500 NGN questions for RN and 400 NGN questions for PN with over 200  lecture videos to enhance your understanding. While NGN case studies may appear intimidating, they’re nothing you can’t handle with a little practice.