NCLEX 2023-2026 Test Plan: What Publishers Need to Know

What is the NCLEX?

The NCLEX test is a crucial step for nursing students to become licensed nurses. It is developed by the National Council of State Boards of Nursing (NCSBN) to assess whether nursing graduates have the right skills to begin working in patient care. In 2023, the NCLEX will become the Next Generation NCLEX, or NGN. Students who enrolled in programs in the fall of 2021 or after will take the Next Gen NCLEX starting on April 1st, 2023. Publishers will need to update their study materials to note these changes. 

What Is Different about the Next Gen NCLEX?

Clinical Judgment

One key change is that the Next Gen NCLEX aims to better evaluate clinical judgment. Defining clinical judgment as the ability to think critically and make the best possible decisions for patient care, the NGN will give aspiring nurses the opportunity to:

  • Observe and assess presenting situations
  • Identify a prioritized client concern
  • Generate the best possible evidence-based solutions to deliver safe client care

Question Types

Another change that educational publishers will need to adjust for is the additional question types. These include:

  • Extended multiple response – An advanced version of “select all the apply,” with many more options
  • Extended drag and drop –  Students will match information from 2 columns, but not all the options will be needed to complete the questions
  • Cloze (drop down) – Previously, students were able to fill in the blank from a drop down list. Now, there may be more than one blank and up to 6 options including words and phrases
  • Matrix (grid) – Students will be presented with a scenario and data, then must check the appropriate boxes within the grid to show the appropriate judgment
  • Enhanced hot spot – Students will also use data and scenarios to answer these types of questions. With enhanced hot spot questions, students will highlight information to answer questions
  • Stand Alone – Students will need to answer these single questions in a bow-tie-shaped drag-and-drop format or in a trend format, where they will use information over time
  • Unfolding Case Studies – Students will see a medical record, followed by question sets that lead them to analyze findings, make decisions for appropriate care, and evaluate patient responses

Timing and Items

The NGN will remain the same length of 5 hours, including breaks. However, students must now answer between 85 and 150 items during that time. 15 of the items will be unscored pretest items, so the scored item range will now be between 70 and 135 instead of 60 and 130. 


In addition to scoring more items, the Next Gen NCLEX will be now able to score some items as partially correct. For assessment questions with multiple correct answer parts, for example, students will be able to earn partial credit.

Why Did They Change the NCLEX?

The test is updated every three years based on data from thousands of new nurses. Since healthcare is such a rapidly changing field, it is vital that the test is updated regularly. The current update is based on the Report of Findings from the 2021 RN Practice Analysis: Linking the NCLEX-RN® Examination to Practice. Twenty-four thousand newly licensed RNs were asked about their nursing care activities. The nursing care activities were analyzed in relation to the frequency of performance, impact on maintaining client safety, and client care settings where the activities are performed. The analysis was then used to create a framework for the test.


What Topics Will Be on the NGN?

The framework of Client Needs was selected for the test.  This framework provides a universal structure for defining nursing actions and competencies and focuses on clients in all settings. There are four major Client Needs categories. Two of the four categories are split into subcategories.

Client Needs

  • Safe and Effective Care Environment
    •  Management of Care
    •  Safety and Infection Control
  • Health Promotion and Maintenance
  • Psychosocial Integrity
  • Physiological Integrity
    • Basic Care and Comfort
    • Pharmacological and Parenteral Therapies
    • Reduction of Risk Potential
    • Physiological Adaptation

Integrated Processes

Interwoven throughout the client needs categories and sub-categories are the fundamental processes that future nurses must understand. Publishers must remember these processes when developing materials for Next Gen NCLEX preparation. In addition to the clinical judgment mentioned above, they include:

  • Caring – interactions are based on mutual respect, collaboration, trust, and compassion to help achieve desired outcomes
  • Communication and documentation – interactions between nurses and clients, as well as between the health care team and the client’s significant others, are recorded in accordance with the standards or practice and accountability
  • Culture and spirituality – interactions show that nurses recognize and consider the client-reported, self-identified and individual preferences to client care while keeping in mind the applicable standard of care and legal considerations 
  • Nursing process – clinical reasoning is used to care for clients in a way that includes assessment, analysis, planning, implementation and evaluation
  • Teaching/learning – new knowledge is acquired to facilitate changes in behavior 



In conclusion, the Next Generation NCLEX is a significant update to the current NCLEX test, aimed at better evaluating nursing graduates’ clinical judgment skills. The Next Gen NCLEX introduces additional question types, and students will have to answer between 85 and 150 items during the five-hour test. The Next Gen NCLEX framework focuses on four major Client Needs categories and integrated processes. Educators and publishers must be aware of these changes to prepare students adequately. Ultimately, the Next Gen NCLEX aims to ensure nursing graduates have the skills necessary to provide safe and effective patient care in all settings.

Who is A Pass?

A Pass Educational Group, LLC is an organization dedicated to the development of quality educational resources. We partner with publishers, K-12 schools, higher ed institutions, corporations, and other educational stakeholders to create custom quality content. Have questions?

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