Are You Preparing for the Latest Version of the NCLEX-RN Exam

Have you heard? The NCLEX is changing! Although questions on the NCLEX are updated regularly, it's been quite some time since the format of the actual exam has changed. In fact, the last major format change was when the exam went from paper and pencil tests to the current Computer Adaptive Testing (CAT) format in 1994! And so, almost 30 years later and with so many changes that have occurred in the rest of the nursing profession, it's time for an update and some changes.

1. What Is Happening and Why?

Why is the NCLEX changing? Well, the short answer is "it's time."Bu the longer answer is that the National Council of State Boards of Nursing (NCSBN), which manages the NCLEX, realized a large number of new nurses (as many as 60%) were making errors related to clinical judgement. The NCSBN is answering the call for increased competence from new nurses by ensuring they are able to apply the book knowledge into real-life scenarios using critical thinking. With this change, the NCSBN is really looking out for you to make sure YOU are ready for your first nursing job. The new testing format is known as Next-Generation NCLEX (often called NextGen) or NGN.

Many people can memorize facts (drugs, diseases, terminology), but they aren't able to apply that information to a real client situation and aren't fit to provide care for a sick patient. In other words, they are not able to put all the puzzle pieces together to develop a plan. So, the NGN is testing your ability to put the puzzle pieces together before becoming licensed. As an example of the change, a traditional exam question might ask, "The client is prescribed carvedilol. Which side effect does the nurse monitor for?" and the test taker would select "hypotension" from a list of four options. In the new format, a short case study would be presented through a H&P, nurses notes, flowsheet, or results, and then the test taker will need to be able to recognize that the client is taking carvedilol and is experiencing hypotension as a side effect. Overall, you will be looking more for a cause-and-effect relationship or identifying the problem and solution within a case rather than simply being able to answer textbook knowledge. Prioritization is also especially important with NGN items.

2. When Is the Change?

If you are graduating and planning to test prior to April 2023, then you will be taking the current format of the NCLEX exam. If you started your nursing program in the fall of 2021 or later and will graduate after April 2023 or plan to test after that, then you will need to adapt to the new testing format of NGN. But don't worry! Nursing educators across the U.S. have been learning more about this format and learning how to adapt their own testing formats in order to begin preparing nursing graduates for this exam format. If you haven't already seen exam items presented in this format yet, you will soon. Your instructors will ensure that you have had plenty of exposure to new item formats - they want you to succeed on the NCLEX!

3. What Is Different?

The NCLEX format change involves changes in the presentation of data and questions, a change in the analysis model, a change in question format, and a change in scoring.

3.1 Data and Questions

Traditional NCLEX questions are individual items much like questions you've been answering on tests in many subjects for years. NGN format is presented more like a real-life situation and provides a case scenario through simulated Electronic Medical Record (EMR) tabs such as History & Physical (H&P), provider's orders, nurses' notes, flow sheet, laboratory results, and imaging studies. Test takers will review the provided tabs and use the provided information to answer a question. But the difference is that the case may be either a stand-alone question that addresses multiple steps of the Clinical Judgement Model (CJM) or an unfolding case with 6 questions that may provide new details in each question, and each question addresses a new step of the CJM.

3.2 The Model

Whereas the current version of the NCLEX exam asks the test taker to think through the 5 steps of the Nursing Process (Assessment, Analysis, Planning, Implementation, Evaluation), the NGN shifts to a large focus on clinical judgement through the use of the CJM. Items will also progress through the steps rather than just addressing 1 step of the nursing process. The 6 steps of the CJM are:

• Recognize cues (what is most important?)
• Analyze cues (what could the cues mean?)
• Prioritize hypotheses (where do I start?)
• Generate solutions (what can I do?)
• Take actions (what will I do?)
• Evaluate outcomes (did my actions help?)

You'll notice that there are a lot of similarities between the models.

3.3 Question Format

Question types on the traditional exam are presented as a simple sentence, paragraph, or exhibit with a simple question, and formats include:

• Multiple choice (select 1 correct answer)
• Multiple response (select all that apply)
• Fill in the blank (numerical response)
• Exhibit item (use a graphic to answer the question)
• Drag and drop / ordered response (provided responses are moved around to be in chronological order)
• Graphic item (answers presented are graphics rather than words)

There are a few new Item formats for NGN. The new formats mostly involve drop-down options or highlight certain pieces of information. The formats that may be seen on the NGN include:

• Drag and drop cloze (choose a choice from the provided answers, and drag it into the sentence, could have more than 1 response to drag an answer to)
• Drag and drop rationale (choose a choice from the provided answers, and drag it into the sentence to provide either 1 cause and 1 effect or 1 cause and 2 effects)
• Drop down cloze (1 or more drop-down options are provided; choose the most likely option from each drop-down)
• Drop-down rationale (similar to the drag and drop rationale except you choose the cause and effect from a drop-down menu)
• Drop-down table (a table is provided with missing information that will be selected from drop-down items)
• Highlight table (a table of data, such as lab results, is provided, and you must highlight the data as requested)
• Highlight text (a text is provided, and directions will be given for which information should be highlighted)
• Matrix multiple-choice (3-10 rows of data with 2-3 columns are provided, and in each row a selection will be made from the column choices - each row is basically its own multiple-choice answer)
• Multiple-choice (this is a traditional style question with 1 correct response)
• Multiple response -select all that apply (5-10 options are provided; a minimum of 1 response is correct, or all provided responses may be correct)
• Multiple response - select N (similar to multiple response except the instructions will tell you how many to select)
• Bowtie (this is a stand-alone item type and addresses all 6 steps of the CJM in 1 question, asking you to identify the condition, actions to take, and parameters to monitor)
• Trend (this is a stand-alone item type and addresses multiple steps of the CJM in 1 question, asking you to review a flow sheet or notes and identify changes through time)

3.4 Scoring

The current NCLEX exam allows for either a correct answer or an incorrect answer, even if the question is a select all. With NGN, there are three different scoring models which are a bit more complex. Items can be scored in 1 of 3 ways: 1 point for each correct response within an item, 0 points for an incorrect response, and all points totaled within the item; 1 point rewarded for each correct response within an item, 1 point subtracted for an incorrect response, and all points totaled within the item; or rationale scoring which will award points when both responses in the cause/effect pair are correct. The new scoring model is a benefit to the test taker since it's not "all or nothing" scoring on the items with multiple responses required.

3.5 Length

The testing time to complete your exam is not changing - you have 5 hours. Each test will include 3 unfolding case studies with 6 items each, for a total of 18 NGN questions. The remainder of the exam will be conventional items. Students that require a longer exam due to the need to verify competency may also see up to seven of the "stand-alone" item types, such as the bowtie or trend items.

Don't worry! The NGN format items have been tested on the NCLEX with current nursing graduates for a few years. Many students have found they prefer the new format to traditional questions. The best approach to these items is to review the notes provided as if you are doing a chart review prior to assuming care of a client, observe for any abnormal results or trends in a flowchart, and review provider orders to prioritize and glean any cues. Place yourself in the situation presented and answer the questions using the same critical thinking skills you would use in real life, and you'll do just fine!

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References

NGN resources. NCSBN. (n.d.). Retrieved March 31, 2022, from https://www.ncsbn.org/ngn-resources.htm