The Next Generation NCLEX: case studies and question types

What a case study is

A case study is six questions about the same client. The client’s information unfolds as you work through them. Each of the six questions matches one step of NCSBN’s Clinical Judgment Measurement Model.

1. Recognize cues: pick out the information that matters, like history or vital signs.
2. Analyze cues: connect those cues to what’s going on with the client.
3. Prioritize hypotheses: decide which problem is most urgent or likely.
4. Generate solutions: choose the interventions that fit the outcomes you want.
5. Take action: carry out the one that addresses the top priority.
6. Evaluate outcomes: compare what happened with what you expected.

Stand-alone clinical judgment questions

Clinical judgment is also tested outside the case studies, in single questions. The 2026 RN test plan counts the case studies separately from the eight content areas, because a case can touch any of them. In a minimum-length exam of 85, 18 questions are case study questions.

The question formats

NCSBN doesn’t set a share for each format, so you can’t predict how many of each you’ll get. Its FAQ names multiple response, the select-all-that-apply style. NCSBN’s own write-up of the research behind the NGN describes formats such as extended multiple response, matrix or grid questions and the “bowtie” drag-and-drop. Any question can come with charts, tables or graphics.

The best way to see every live format is NCSBN’s free Candidate Tutorial, which runs on the real exam software. The Sample Pack and Exam Preview show how the formats fit into a full exam.

How partial credit works

Partial credit is only used on items with more than one correct answer. Your overall result is still a plain pass or fail.

• Plus/minus: you get a point for each right choice and lose one for each wrong choice, but never go below zero. Guessing extra boxes can cost you.
• Zero/one: when you’re told to choose a set number of answers, each right one earns a point and wrong ones earn nothing.
• Rationale: two linked parts are scored together, so you only get the credit if both are right.