What Are the New NCLEX Question Types in 2025-2026? Master Every Format

What Are the New NCLEX Question Types in 2025-2026? Master Every Format

Last updated: September 2025 | Reading time: 15 minutes

Quick Overview: The Next Generation NCLEX introduced 12 new question types plus enhanced traditional formats. These questions assess clinical judgment through stand-alone items and case studies, with partial credit scoring available for the first time.

The Next Generation NCLEX has revolutionized nursing licensure testing with innovative question formats that better reflect real-world nursing practice. If you're preparing for the 2025-2026 NCLEX, understanding these new question types isn't optional—it's essential for success.

🎯 Overview: What Changed with Next Gen NCLEX Questions?

Traditional NCLEX

Dichotomous Scoring

Right or Wrong Only

No partial credit

Next Gen NCLEX

Polytomous Scoring

Partial Credit Available

Rewards partial knowledge

The Next Generation NCLEX (NGN) introduced 12 new question types plus enhanced versions of traditional formats. These questions are designed to assess clinical judgment through two main categories:

  1. Stand-alone items (single questions)
  2. Case studies (2-8 related questions about one patient scenario)

The biggest change? You can now earn partial credit on complex questions, moving away from the old all-or-nothing scoring system. This polytomous scoring method rewards partial knowledge while still maintaining rigorous standards.

Master All Question Types with Our NGN Bundle →

🎯 Stand-Alone NGN Question Types

Bow-Tie Questions
Potential Causes
  • MI
  • Pneumonia
  • Anxiety
  • PE
Client with
Chest Pain
Nursing Actions
  • O2 therapy
  • 12-lead EKG
  • VS monitoring
  • Pain assessment

What they test: Connecting causes, conditions, and interventions in a logical framework

Strategy: Think systematically about pathophysiology, assessment findings, and evidence-based interventions. Practice connecting the "why" behind patient presentations.
Trend Questions
Blood Pressure Trend
24-Hour Period






↗ Improving | ↘ Concerning

What they test: Ability to analyze data changes over time

Strategy: Focus on recognizing normal vs. abnormal patterns, understanding trends that indicate improvement or deterioration, and knowing when to intervene.

📋 Case Study Question Types

Case studies present a comprehensive patient scenario with multiple information tabs (medical history, vital signs, lab results, medications, etc.). You'll answer 2-8 questions about this single patient, requiring sustained clinical reasoning.

Medical History
Vital Signs
Lab Results
Medications
Patient: 68-year-old male
Admission: Acute exacerbation of COPD
History: 40-pack-year smoking history, Type 2 diabetes, hypertension
Current complaint: Increased shortness of breath, productive cough

1. Matrix Multiple Choice

Format: Grid with multiple rows and columns where you select one answer per row

Nursing Intervention High Priority Medium Priority Low Priority
Administer oxygen therapy ☑ ☐ ☐
Monitor blood glucose ☐ ☑ ☐
Provide patient education ☐ ☐ ☑
Strategy: Consider each row independently, then review your selections for logical consistency. Use prioritization frameworks like ABCs.

2. Matrix Multiple Response

Format: Grid where you can select multiple answers in each row

Labor Phase Pain Management Position Changes Fetal Monitoring Breathing Techniques
Latent Phase ☑ ☑ ☑ ☑
Active Phase ☑ ☑ ☑ ☑
Transition ☑ ☐ ☑ ☑
Strategy: Think systematically about each phase and what nursing actions are appropriate for that specific situation.

3. Enhanced Select All That Apply (SATA)

Question: Select all signs and symptoms that indicate infection in an immunocompromised patient:

Strategy: Evaluate each option independently as true or false. Don't get distracted by the number of correct answers.

4. Multiple Response: Select N

Question: Select the 3 highest priority nursing actions for a patient experiencing anaphylaxis:

Strategy: Identify all correct options first, then prioritize using frameworks like ABCs or Maslow's hierarchy.

5. Drag-and-Drop: Cloze

Instructions: Drag the appropriate terms to complete the nursing note:

increased decreased oxygen therapy pain medication
Patient reports

shortness of breath. Administered

as ordered. Respiratory rate

to 16/min.
Strategy: Read the entire passage first, then consider what type of information logically fits each blank.

6. Drop-Down Selections

Complete the medication order:

Administerfor treatment of heart failure.

Strategy: Consider each dropdown independently while maintaining awareness of how choices relate to the overall scenario.

7. Highlight Questions

Instructions: Highlight all assessment findings that indicate potential complications:

Patient reports chest pain rated 8/10. Vital signs: BP 90/60, HR 120, RR 24, temp 98.6°F. Skin is cool and clammy. Patient states he feels hungry and wants breakfast. Urine output decreased to 20ml/hr. Patient asking about discharge planning.
Strategy: Read actively, looking for specific types of information based on the question prompt. Know normal vs. abnormal findings.

Practice all these question types with our comprehensive NCLEX Question Bank featuring over 3,000 questions including all NGN formats.

📈 How to Prepare for New NCLEX Question Types

1. Practice with Authentic Materials

Don't wait until exam day to encounter these formats. The Next Gen NCLEX Bundle provides comprehensive practice with all question types.

2. Develop Clinical Reasoning

These questions test your ability to think like a nurse. Use our Ultimate Mastery Notes to build foundational knowledge.

3. Master Content First

You can't apply clinical reasoning without solid knowledge. Start with Pharmacology Mastery Notes for high-yield content.

4. Practice Case-Based Thinking

Consider how different body systems interact. Our Critical Care Flashcards help with complex scenarios.

Get Complete NGN Preparation Bundle →

❓ Frequently Asked Questions About New NCLEX Question Types

How many new question types will I see on my exam?

You'll encounter both traditional and new question types on the NGN. While 80-90% are still multiple choice, expect to see several case studies with new formats. The exact mix varies by exam, but practicing all types ensures you're prepared for any combination.

Can I get partial credit on the new question types?

Yes! Unlike the old NCLEX, you can earn partial credit on complex questions. For example, if a matrix question has 5 correct selections and you choose 3 correctly, you'll receive partial points rather than zero.

Are the new question types harder than traditional multiple choice?

They're different, not necessarily harder. These questions better reflect real nursing practice, so they may feel more natural if you understand clinical reasoning. Success depends on understanding the format and practicing clinical judgment skills.

How should I approach case study questions?

Read all tabs thoroughly before answering any questions. Understand the complete patient picture, then approach each question systematically. Consider how your answers relate to the overall case scenario.

What's the best way to practice drag-and-drop questions?

Use computer-based practice materials rather than paper-based questions. The Mark Klimek 2025 MEGA Bundle includes interactive practice with all NGN question formats.

How do I know which interventions to prioritize in "Select N" questions?

Use established prioritization frameworks:

  • ABCs (Airway, Breathing, Circulation)
  • Maslow's hierarchy (physiological needs first)
  • Safety first (prevent harm before providing comfort)
  • Acute before chronic conditions
Should I spend extra time on case study questions?

Yes, but manage your time wisely. Case studies provide more information and require deeper thinking. Budget extra time for these sections, but don't get stuck on any single question.

How can I improve my clinical judgment skills?

Focus on understanding pathophysiology, evidence-based practice, and the nursing process. Ask yourself "why" for every intervention, assessment, or evaluation. Practice connecting patient presentations with appropriate nursing responses.

💡 Test-Taking Strategies for New Question Types

Matrix Questions
  • Read all row and column headers before selecting
  • Consider each cell independently
  • Review for logical consistency
  • Look for patterns but don't force them
Drag-and-Drop Questions
  • Read the entire scenario first
  • Consider what information fits logically
  • Don't second-guess yourself
  • Trust your clinical reasoning
Highlighting Questions
  • Read question stem carefully
  • Scan systematically, not randomly
  • Consider both obvious and subtle indicators
  • Know normal vs. abnormal findings
Select N Questions
  • Identify all correct options first
  • Apply prioritization frameworks
  • Consider immediate vs. long-term needs
  • Think about patient safety first

🏆 Building Confidence with New Formats

Your Success Strategy:

  1. Start Early: Begin practicing new question types during content review
  2. Use Quality Materials: Invest in NGN-specific preparation resources
  3. Practice Partial Credit Thinking: Remember you can earn points for partial knowledge
  4. Focus on Clinical Reasoning: Develop nursing thinking over memorization
⚠️ Common Mistake: Don't wait until the last week to practice new question types. These formats require time to master and feel comfortable with.

🚀 The Bottom Line: Embrace the Evolution

The new NCLEX question types better reflect the complexity and clinical reasoning required in modern nursing practice. While they may seem intimidating initially, they actually provide more opportunities to demonstrate your nursing knowledge and clinical judgment.

Success with NGN questions comes from:
  • Understanding each format through deliberate practice
  • Developing strong clinical reasoning skills
  • Building comprehensive content knowledge
  • Practicing with authentic materials

Don't let unfamiliar question formats derail your confidence. With proper preparation using current materials and focused practice, you'll master these new formats and approach your NCLEX with confidence.

The nursing profession has evolved, and the NCLEX has evolved with it. These enhanced question types will actually help you become a better nurse by reinforcing the critical thinking skills you'll use every day in practice.

🎯 Ready to Master the New NCLEX Question Types?

Start practicing with authentic NGN formats and build your confidence for exam day.

 

Back to blog