Next Generation NCLEX Test Question Formats

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Explore The 15 NCLEX Test Formats

Discover the 15 types of question formats that can be found within the NCLEX exam. This article will review the different types of NCLEX question formats at a high level.

The National Council of State Boards of Nursing (NCSBN) has determined the number of Next Generation NCLEX test question formats to 15 different formats. These include specific question formats that center on “Unfolding Case Studies” (vignettes). 

To begin, the first 13 NCLEX question formats we will review are:

Multiple Choice Questions

  • Multiple Choice Question
  • Matrix Multiple Choice Question

Multiple Response Questions

  • Multiple Response (Select all that apply)
  • Multiple Response – N (Directions tell the Candidate the number of correct answers)
  • Multiple Response Grouping
  • Matrix Multiple Response


Drag and Drop

Highlight/Hot Spot

Next, the other two NCLEX Next Generation question formats are “Standalone” questions.

NCLEX Standalone Questions

  • Bowtie Question
  • Trend Question



To summarize, the “Unfolding Case Studies” are referred to as “Next Generation NCLEX” vignettes. Each vignette has six parts that match the Clinical Judgment Measurement Model Layer 3. “Layer 3 outlines the cognitive aspects of clinical decision making that are directly measurable and are the basis for the development of Next Generation NCLEX test items and case studies for the NCLEX exam.”1 Each part presents the client’s situation over time and often has the client’s condition becoming worse or evolving into a different set of situations.

With that in mind, the vignette provides information that focuses on the topic being tested as well as other information. The vignette is presented in the form of a client’s health record with changing information that shows up in the nurses’ notes, client history, radiology reports, laboratory reports, MAR, assessment results, health care provider orders, etc. The information mirrors events in the client’s day or events that may cause client problems. Events such as changes in vital signs, diagnostic results becoming available, new health care provider orders, etc. Then the person who is to answer the question must review the client’s record and draw conclusions based on the questions posed.

In contrast, the “Standalone” scenarios usually only have one part and present a question at one point in time and answer associated questions to that one point in time. These types of question formats can test can address more than one cognitive skill. The “Trend” question format does present information that spans time, but it is not as involved as a vignette.

Then each format has specific properties on how they should be written, and each is suitable to measure specific Next Generation NCLEX Clinical Judgment Model cognitive skills. These cognitive skills are: “Recognize Cues,” “Analyze Cues,” “Prioritize Hypotheses,” “Generate Solutions,” “Take Action,” and “Evaluate.” These cognitive skills are found in the NSCBN Clinical Judgment Measurement Model Layer 3. Some of the question formats only measure some of the cognitive skills while other types are suitable to measure all six cognitive skills. Each of the new formats can measure one or more of the Clinical Judgment Measurement Model cognitive skills.

In conclusion, in order to learn to write these types of questions, the nurse educator must be able to recognize the 15 different question formats and put each part of the vignette into a question for the tester to answer. The NSCBN will be having workshops and other workshops are available. 



  1. “NCSBN Clinical Judgment Measurement Model.” NCSBN, NCSBN, 2019,