NCLEX NextGen Question Building Cheat Sheet

How To Build NextGen “Next Generation” Questions Using Templates

First, we all know building NextGen or “Next-Generation” NCLEX exam questions can be difficult. It’s hard to know where to start and what to put into the case study or scenario. Having a template or a guide can be extremely helpful. Luckily, templates in the form of a simple word document or tool such as a software application can be of assistance.

Next, we now know there are 15 different formats of next-generation questions which deal with Case Studies. It should be noted 13 of these formats deal with unfolding case studies.  Then the other which are Stand-Alone Items present client information that has two unique types of formats (Bow-tie and Trend Items). Likewise, Stand Alone questions usually address 1 of the 6 components of Layer 3 of the NCSBN Clinical Judgment Measurements Model (NCJMM).

Unfolding Case Studies questions center on the Steps from Layer 3 of the NCSBN Clinical Judgment Measurements Model (NCJMM). The questions address all 6 components of Layer 3 of the NCJMM. Equally important, each component/question has specific information that leads the student to take some type of action. These actions include “Recognize Cues”, “Analyze Cues”, “Prioritize Hypothesis”, “Generate Solutions”, “Take Actions”, and “Evaluate Outcomes”.

Recognize Cues

To start, the unfolding case study must-have information for each of the six components. The Recognize Cues must include the client information that helps the student to build the “description” of the client. For example vital signs, assessment findings, and other data that adds to the case study such as the client’s comments or impressions of their situation. Then the question on this component deals with recognizing cues. Case Study information (often seen in tabs on the NCLEX-RN® exam) has several components such as Health History, Nurses’ Notes, Vital Signs, Laboratory Results, and/or Diagnostic Testing.

Nurses’ Notes	What To Include	Question deals With Recognizing Client Information
1000	• Client Health History • Vital Signs • Assessment Findings • Client Perceptions & Psychosocial Findings	• Multiple Choice • Multiple Response • Dropdown • Drag and Drop • Highlight • Standalone Format

Analyze Cues

Now this component includes information that requires the student to “Analyze Cues”. The case study information can be the same information as in Recognize Cues or have new client status information. In fact, the impact the data has on required nursing action and/or pathophysiology information needed for a student analysis cues can be added. Also note, the time of the patient care can progress as well.

Nurses’ Notes	What To Include	Question Type That Analyzes Cues
1000	• Client Health History • Vital Signs • Assessment Findings (Lab Results, Diagnostic Testing) • Client Perceptions and Psychosocial Findings • Pathophysiology Information About the Client That Will • Affect Client Care • Client Needs • Potential Complications • Impact of Data	• Multiple Choice • Multiple Response • Dropdown • Drag and Drop • Highlight • Standalone Format

Prioritize Hypothesis

In this section, students must hypothesize the patient’s condition and prioritize needs; determine the impact those needs will have on resources; and also how the situation is impacting the client. Although, the Nurses’ Notes may be the same as previously written, the student must still make decisions about what is the important data, and which has the highest priority.  Similarly, information about priority needs, impact on the client, demographics, history can be included. Again, the time can progress as well.

Nurses’ Notes	What To Include	Question Type that Prioritizes Hypothesis
1000 1100 1200 1400	• Client Health History • Vital Signs • Assessment Findings • Client Perceptions and Psychosocial Findings • Pathophysiology Information About the Client That Will Affect Client Care • Add • Priority Needs • Judgment on Condition • Other Needs • Impact on Client • Demographics • History	• Multiple Choice • Multiple Response • Dropdown • Drag and Drop • Highlight • Standalone Format

Generate Solutions

In addition, students must identify what interventions are needed and which are appropriate, and how these interventions can impact the patient’s situation. The case study must include the client’s changing status or other important client information that requires the student to change the plan of care or generate solutions to the client’s problem. Of course, the time can progress as well.

Nurses’ Notes	What To Include	Question Type That Generates Solutions
1000 1100 1200 1400	• Client Health History • Vital Signs • Assessment Findings • Client Perceptions and Psychosocial Findings • Pathophysiology Information About the Client That Will Affect Client Care • Add • New information about the Client’s Status • Interventions (Appropriate and Inappropriate) • Resources • Demographics • History	Multiple Choice Multiple Response Dropdown Drag and Drop Highlight Standalone Format

Take Action

Then based on the identified interventions in the “Generate Solutions”, students must determine and prioritize the actions needed, identify how the actions may affect resources, and how they may impact a patient’s situation. Remember, the time can progress as well.

Nurses’ Notes	What To Include	Question Type That Has Student Taking Action
1000 1100 1200 1400	• Client Health History • Vital Signs • Assessment Findings • Client Perceptions and Psychosocial Findings • Pathophysiology Information About the Client That Will Affect Client Care • Add • New information about the Client’s Status • Actions That Should Be Taken • Priority of Action • Impact of Action Chosen • Resources • Demographics • History	• Multiple Choice • Multiple Response • Dropdown • Drag and Drop • Highlight • Standalone Format

Evaluate Outcomes

Finally, students must be able to identify expected outcomes, whether the outcomes were achieved or if nursing care would require additional resources, and what assessments or reassessments are needed. Time can progress as well.

Nurses’ Notes	What To Include	Question Types That Evaluate Outcomes
1000 1100 1200 1400	• Client Health History • Vital Signs • Assessment Findings • Client Perceptions and Psychosocial Findings • Pathophysiology Information About the Client That Will Affect Client Care • Add •New information about the Client’s Status •Expected Outcomes •Achievement of Outcomes •Resources Needed to Evaluate Outcomes •Should Outcomes Be Assessed •Outcomes Needed Reassessment	• Multiple Choice • Multiple Response • Dropdown • Drag and Drop • Highlight • Standalone Format

In conclusion, using a template will help to develop the unfolding case study. Remember that the unfolding case study must include the six components of Layer 3 of the NCJMM.