Planning for the NCLEX Next Generation Test Question Formats – Part 3

Nursing Critical Thinking - Case Studies and Test Matrix

Matrix Grid and Extended Multiple Response Questions

Want to better prepare for Matrix Grid and Extended Multiple Response formats NGN questions? Continue reading Intellistem Writer’s 3-part blog series on Next Generation NCLEX (NGN) questions.

As mentioned in Part 1 and Part 2 of this series the Next Generation NCLEX (NGN) questions use a variety of case studies and scenarios in non-multiple choice questions to assess the student’s clinical judgment 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

In this blog, the focus is on the Matrix Grid and Extended Multiple Response formats.

Case Study

Remember that there is a Case Study part of each question. The case is unfolding, and students will have a question after each part. The student is presented with information that usually appears in the form of a case study or scenario. This case study will usually 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 opportunities to review real-world data and information and use that information to answer the questions.  Usually, the first part of the case study has information that requires students to identify what information is the most important. Then the student is asked a question about the important information. For example, the student might be asked to decide what action should be taken about an abnormality or abnormalities. The question format will be one of the 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. Questions can be assigned to any one of the six parts of the case study.

The six parts of the case study or scenario are:

  • Part 1 – Introduction and Background – Student Action Needed – Recognize Cues (Ensure clues are present)
  • Unfolding Part 2 – Student Action Needed – Analyzation of Cues (NP-Assessment)
  • Unfolding Part 3 – Student Action Needed – Prioritize Hypotheses (NP-Analysis/Diagnosis)
  • Unfolding Part 4 – Student Action Needed – Generation of Solutions (NP-Planning)
  • Unfolding Part 5 – Student Action Needed – Taking Action (NP-Implementation)
  • Unfolding Part 6 – Student Action Needed – Evaluation of Outcomes (NP-Evaluation)

Matrix Grid

This question format allows the student to select one or more answers from each row or column. This format is an important type of question because it allows the student to be tested over several pieces of the client’s situation or scenario.

Features of Matrix Grid:

  • Test taker reviews an unfolding case study such as patient assessment findings, nursing actions, and response to treatment elapsed over time (over several hours or several days.)
  • Nursing actions listed in the question or case study may or may not reflect standard of care; or may be incomplete or flawed (i.e., negative patient response occurs to actions.)
  • Matrix Grid allows the student to select one or more answer options for each row and/or column.
  • This item type can be useful in measuring multiple aspects of the clinical scenario with a single item.
  • For example, eight rows will need to have one of the three answer choices selected.
  • The scenario or client information is usually in tabs or layers. (See example below)


The nurse is caring for a 17-year-old male client who reports a recent injury to his left thoracic ribcage. What action should be taken secondary to the assessment?

Health History Nurses’ Notes Vital Signs Laboratory Results
Client reports injuring his left ribs after being struck by a bat during baseball practice.  He has bruising and feels lightheaded. He also reports some intermittent pain and states he has been taking Motrin 800 mg 4 times a day for pain.      
Action Secondary to Assessment Findings Appropriate Inappropriate Not applicable
Assess neuro status      
Assign patient to a private room      
Keep the client’s door open to prevent isolation      
Allow unlimited visiting hours      
Assess lab results      

Extended Multiple Response

In this type of question, students must answer one or more parts of the questions at one time. This is similar to a regular multiple response, but it usually has more options and can be graded with partial credit.  


  • Similar to Multiple Choice and Matrix Grid
  • Allows more than one option (answers and distractors) to be chosen.
  • Presents a long list of options.


The nurse is assessing the client who has sealed radioactive implants. For each finding, below click to specify whether the findings indicate the intervention was appropriate, inappropriate, or not applicable.

Action Secondary to Assessment Findings Appropriate Inappropriate Not applicable
Assign client to a private room      
Keep the client’s door open to prevent isolation      
Wear a lead apron when providing care      
Allow unlimited visiting hours      
Change scrubs after caring for a client      

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. Therefore, it is important to start usingMatrix Grid and Extended Multiple Response types of questions now so students will be prepared when they see them on the NCLEX exam.  It is known that this type of question is already appearing on the NCLEX exam but doesn’t count toward their pass or fail score.


Rischer, Keith.  “How to Prepare Your Students Now for Next Gen NCLEX.” Keith RN Blog Post. 28 February 2019.

Hensel, Desiree and Diane Billings. “Strategies to Teach the National Council of State Boards of Nursing Clinical Judgement Model.” Nurse Educator. 6 May 2020.

National Council of State Boards of Nursing. “Preparing Students for the NCLEX.” NCLEX & Other Exams.

Kleber, Kati.  “Preparing for the NCLEX – 4 Tips from a Nurse.” Fresh RN. 27 June 2017. <>  “Preparing for the NCLEX-RN Exam”. Nursing Careers>\