Planning for the new NCLEX Next Generation Test Question Formats – Part 2

Nurse writing NextGen NCLEX nursing exam questions

Cloze and Enhanced Hot Spot Questions

Review how to construct Cloze (Drop-Down) and Enhanced Hot Spot (Highlighting) NGN questions.

As mentioned in Part 1 of this series the Next Generation NCLEX (NGN) nursing exam questions use a variety of case studies and scenarios in non-multiple choice questioning to assess the student’s ability to make critical decisions in real-world situations. These types of questions include:

  • Extended Drag and Drop
  • Cloze (Drop-Down)
  • Enhanced Hot Spot (Highlighting)
  • Matrix Grid
  • Extended Multiple Response

Case Study

In a review of what is included in the Case Study part of the questions, the nursing student is presented with information that usually appears in the form of a case study. This case study will include information that appears in an abbreviated electronic health record. It may include Nurses’ Notes, Health History, Vital Signs, Orders, Laboratory Results, Radiology Reports, etc. This information is provided to give students a review of real-world data. Usually, the first part of the case study has information that requires a student to identify which information is the most important. The student is then asked a question about that important information.

For example, the nursing student may be asked to decide what action should be taken about an abnormality or abnormalities. The question format will be one of the NCLEX Next Generation formats as listed above. It might be an extended drag and drop where the student must move findings found in the case student into a space that will answer the question.

Cloze (Drop Down)

Features of Cloze

  • There is a dropdown list of options in each box.
  • Embedded answer questions including multiple choice, short answers, and numerical answers

CLOZE Example:

Example: Complete the following sentences by choosing from the list of options.

Enhanced Hotspot (Highlighting)

In this type of question, nursing students must look at an image and identify what is incorrect or the solution to the question being posed.


Be sure you have permission to use the photo. There are also photos for sale that you can purchase for a small fee. Check with the school, they have some sets of photos for which they already have rights. Of course, you can take your own photos to add to the exam. 

Hotspot example:

What actions associated with the number on the picture should have been taken to promote client safety? Highlight the number in the photo that depicts safety hazards.

Example of an enhanced hot spot

Text Highlighting Hotspot

There is another type of Enhanced Hot Spot. This type of highlighting takes place over a client’s situation or information found in the electronic health record.

Text Highlighting Example:

Click to highlight a finding that requires follow-up.

Nurses’ Notes

  • The client is receiving titrated intravenous oxytocin for augmentation of labor via the secondary line on an intravenous pump. The client is also receiving maintenance intravenous fluid of lactated Ringer’s solution at 125 mL/hr via an intravenous pump. The client has a cervical dilatation of 5 cm and a cervical effacement of 100% with a fetal station of 0 in vertex presentation. Intact amniotic membranes are noted. Category I tracing of fetal heart rate (FHR) of 150 bpm, with moderate variability, and 3 accelerations of 15 bpm over the baseline lasting 15 seconds via external ultrasound. The client is experiencing contractions every 5 minutes, which are lasting 70 seconds with moderate intensity via toco transducer. Vital Signs: HR of 88, BP of 115/78, RR of 15, T of 100.4°F (38.0°C). Has a continuous epidural infusion of 0.25% bupivacaine with fentanyl running at 10 mL/hr. Pain 0/10 at this time. Client states, “I had postpartum hemorrhage with my last vaginal delivery, and I required a blood transfusion.” *


*Excerpt from PowerPoint – Next Generation NCLEX® (NGN) Project by Alyson Brenton, MSN, RN, CNL

Each of the new NCLEX Next Generation questions require higher cognition and if students are not prepared to use the new Clinical Judgment Measurement Model, they will do poorly on the NCLEX exam.