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Tips for Answering Next Gen NCLEX® Case Studies

• Last Updated: January 24, 2024

• Next Gen NCLEX

The biggest difference between the “old NCLEX” and Next Gen NCLEX (NGN) is the more precise measurement of your clinical judgment through new unfolding case studies. Every candidate will receive three scored case studies, each with six questions (18 questions total), making case study practice essential to NCLEX prep. We’ll walk you through the ins and outs of this new question style to help you understand what to expect on the NGN and how to achieve a passing score.

Prefer a video? Check out this UWorld NCLEX case study presented by one of our nursing experts:

What Are NGN Case Studies?

Next Gen NCLEX case studies measure a candidate’s clinical judgment by describing a clinical scenario, sharing “unfolding” client information, and asking questions related to Layer 3 of the NCSBN Clinical Judgment Measurement Model (NCJMM). 1 Put another way…

NGN case studies present a realistic patient scenario that you must navigate, step by step, starting with identifying and analyzing relevant client information, then planning and providing treatment, and lastly evaluating client outcomes.

The result is a six-question set that requires you to: 1

This multi-step approach is designed to better assess your entry-level nursing knowledge, skills, and abilities, and differentiate your understanding from that of other candidates by using partial-credit scoring. 2

Components of an NGN Case Study

Instead of simply using traditional multiple-choice questions to test the six sequential NCJMM steps, NGN case studies may use any of the traditional or new Next Gen NCLEX item types (excluding trend and bow-tie questions). These include: 2

You’ll also want to be familiar with the various types of information you will see as case study scenarios unfold and reveal changes in the patient’s status. This often begins with Nurses’ Notes or the client’s medical history, and incorporates other clinical data (like vital signs) in a tabular format that’s updated as the case study unfolds.

NGN case study clinical scenario

NGN case studies start by providing a general overview of a clinical scenario. Just like in real life, you may not have all of the information you need to make a sound clinical decision. In the following example from our NCLEX Review Course, you’re initially provided with Nurses’ Notes and must highlight the five most important client findings:

Remember that questions 1 and 2 in an NGN case study examine your ability to recognize and analyze cues. In this example, it’s not until question 3 that the scenario unfolds further and you’re provided with additional client information.

NGN case study supporting information

The way NGN case studies provide supporting client information varies. Sometimes, you’ll have access to all of the information you need from the beginning. In many cases, additional information will become available as if you were working with an actual patient and gathering clinical details in real-time. Read the new information carefully and answer the associated question as best you can. It’s important to note that on the NCLEX, you cannot go back and answer previous questions . Continuing our above NGN case study example, question 3 is when you gain access to Laboratory Results:

In this step, you’re asked the first of two questions related to refining your hypotheses. From here, this case study progresses through the remaining NCJMM steps, but does not provide any additional client information.

During your exam, client information will always be stored in this tabular format (common tabs are Nurses’ Notes, Vital Signs, History and Physical, Orders, Laboratory Results, Diagnostic Results, etc.). While their names may vary, what’s more important is understanding where relevant information is located so you can successfully answer the questions.

How Are NGN Case Studies Scored?

NGN case studies use partial-credit scoring (polytomous scoring) to differentiate between students who fully understand, partly understand, and don’t understand questions. This new NCLEX scoring method varies by question type, but there are three general rules to know:

• +/- scoring is used for questions that have more than one answer option, but with an unspecified number of correct answers (e.g., SATA, Highlight, and Matrix Multiple Response). Selecting a correct option provides +1 point, while selecting an incorrect option results in -1 point. The lowest possible score for all question types is 0.
• Rationale scoring is used for cause and effect-style questions. When there are two answer options, both must be answered correctly to receive credit. When there are three, partial credit may apply. For example, “A nurse must do X because of Y and Z.” If a student answers X and either Y or Z correctly, they will receive partial credit. 3
• 0/1 scoring is a more familiar scoring method where you either get the question right or wrong (think multiple choice). Each correct option you select provides 1 point, and each incorrect option you select adds 0 points.

NGN partial-credit scoring is more forgiving than traditional NCLEX scoring, which can help ease anxiety in answering case study questions. Even if you misinterpret a scenario and answer the initial questions incorrectly, you still have time to change course. Like with any exam, practicing beforehand is the best way to prepare.

NGN case studies vs stand-alone questions

NGN stand-alone questions are similar to case studies because they also measure your clinical judgment based on Layer 3 of the NCJMM. However, stand-alone questions can use any NGN question type, including trend and bow-tie questions : 4

• Trend questions feature one question apiece, and may include one or more steps from NCJMM Layer 3. This means you’ll need to make one or more clinical decisions per question.
• Bow-tie questions feature one question apiece, but include all six steps from NCJMM Layer 3. This means you’ll need to make multiple clinical decisions all in one question.

How many NGN case studies are on the NCLEX?

Whether you answer the minimum 85 questions, maximum 150 questions, or somewhere in between, three of your case studies (totaling 18 questions) will be scored. It’s important to note that you may receive more case studies (one or two additional) that are being piloted for pretesting and are not scored. Question types may differ, but 18 case study questions will count toward your score. 2

How to Approach NGN Case Studies

Before you begin an NGN case study, remember that you cannot go back after a question is submitted . So make sure you’ve fully answered each question before moving on to the next one. With this in mind, here are some additional NGN case study tips from our nursing team:

Understand the NCSBN’s Clinical Judgment Measurement Model

Getting familiar with the NCJMM may sound like overkill, but it will help you develop your clinical judgment and truly think like a nurse. This is crucial when it comes to successfully answering NGN case studies, where simply memorizing facts isn’t enough to achieve success.

The NCJMM was designed as a thinking and teaching framework, and fully breaks down a nurse’s decision-making process into six measurable steps. These steps form Layer 3 of the NCJMM that NGN case studies test you on. Keeping the full framework in mind as you take the NCLEX will make it easier to recognize the what and why behind each NGN case study question.

Identify the main question in the case study scenario

Just like when caring for a real patient, identifying the condition(s) that your simulated patient is experiencing is the first step in deciding how to provide effective care. Everything else in the case study will build on this initial information. Don’t forget that NGN case studies are written to be as realistic as possible, so some information you receive will likely be irrelevant. This is where your skills in prioritization come into play.

Look for clues in the case study scenario

Figuring out what clinical information matters and what doesn’t requires practice. One trick you can use when reading an NGN case study is to identify keywords that signal something is important (e.g., new, change in, increased/decreased, etc.). You should also consider questions like, “How long have symptoms persisted?” And, “What changes to the body are present?”

Think critically about the supporting information

As a case study unfolds and you’re presented with supporting client information, ask yourself why the new information is relevant to the client’s main condition(s). The best way to go about this is to visualize yourself working with a real patient. Did the lab results we ordered become available? Great! Let’s consider how they impact our hypotheses. Did we receive an update about the patient in the form of new Nurses’ Notes? Interesting. Let’s check to see if our treatment worked as expected.

Carefully follow the directions for each question

The Next Gen NCLEX is unique in that it evaluates students’ performance using a variety of question types. You can’t just assume a question is multiple choice with one correct response. Especially when completing case studies, pay attention to the NGN item type you’re being asked to complete (e.g., Highlight, SATA, Drag and Drop, Matrix, etc.).

Eliminate “distractors” in the answer choices

As you tackle case study questions, eliminate potential distractors (incorrect answer choices). When you work with real patients, you’ll be confronted with irrelevant medical information that may lead you to draw incorrect conclusions. NGN case studies purposely incorporate common clinical judgment errors and allow candidates to pursue incorrect treatment paths. To avoid mistakes, always keep the case study’s main client condition(s) in mind and cross out obvious distractors.

Practice Next Gen NCLEX Case Study Questions

NGN case studies take some time to get used to. At first, half the battle is understanding the item types and how to identify relevant information. But, as the saying goes, practice makes perfect! By practicing NGN case studies before your exam, you can get familiar with the testing layout, develop your clinical judgment, boost your confidence, and maximize your score.

At UWorld Nursing, we offer over 500 NGN questions for RN and 400 NGN questions for PN with over 200  lecture videos to enhance your understanding. While NGN case studies may appear intimidating, they’re nothing you can’t handle with a little practice.

High-yield videos, thousands of practice questions, multiple self-assessment tests, and more.

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Next Generation NCLEX Case Study Sample Questions

One of the big changes on the Next Generation NCLEX exam is a shift toward case studies. Case studies often require a deeper level of critical thinking, and understanding diseases on a more in-depth level (especially the pathophysiology) will make these types of questions easier to answer.

In this article, you’ll be able to watch a free video to help you prepare for the new Next Generation NCLEX case study format. Nurse Sarah will walk you step-by-step through each scenario and help you understand how to use critical thinking and nursing knowledge to answer these types of questions.

Next Generation NCLEX Case Study Review Questions Video

NGN Case Study Sample Questions and Answers

First, let’s take a look at our case study summary below:

Case Study Summary:

A 68-year-old male is admitted with shortness of breath. He reports difficulty breathing with activity, lying down, or while sleeping. He states that in order to “breathe easier,” he has had to sleep in a recliner for the past week. The patient has a history of hypertension, myocardial infarction (2 years ago), and cholecystectomy (10 years ago). The patient is being transferred to a cardiac progressive care unit for further evaluation and treatment.

Question 1 of 6: The nurse receives the patient admitted with shortness of breath. What findings are significant and require follow-up? The options are listed below. Select all that apply.

To answer this first question in the NGN case study, let’s look at the information provided in the nursing notes and vital signs tabs provided:

This question is asking us to identify findings that are significant and require the nurse to follow-up. In other words, what is presenting that we can’t ignore but need to investigate further.

Therefore, let’s comb through the nursing notes and vital signs to see what is abnormal and requires follow-up.

First, the patient arrived to the room via stretcher. That’s fine and doesn’t necessarily require follow-up.

Next, the patient is alert and oriented x 4 (person, place, time, event). This tells us that the patient’s neuro status is intact so far. Therefore, the shortness of breath isn’t affecting the patient’s mental function yet (we have enough oxygen on board right now for brain activity).

However, the nurse has noticed the shortness of breath with activity and talking, which should not normally happen. This tells us something is wrong and is significant enough to require follow-up. We want to know why is this happening, is it going to get worse, etc.

The patient’s weight and vital signs were collected (this is good). Weight is 155 lbs. and BMI is within a healthy range (doesn’t tell us too much but may be useful later). The patient is also connected to a bedside monitor, so they need to be monitored constantly like on a progressive care unit.

The monitor shows sinus tachycardia . This is significant because it seems the patient’s shortness of breath is causing the heart to compensate by increasing the heart rate to provide more oxygen (hence the lungs may be compromised).

Then we find out that the lungs are indeed compromised because crackles are heard in both lungs , and this may be why our patient is short of breath. This is significant (could the patient have pulmonary edema?)

Then we find out the nurse has noted an S3. This is an extra heart sound noted after S2. And what jumps out to me about this is that it is usually associated with volume overload in the heart like in cases of heart failure . However, S3 may be normal in some people under 40 or during pregnancy, but that’s not the case with our patient based on what we read in the case summary.

Therefore, based on everything I’m reading in this case study, I’m thinking this patient may have heart failure, but we need those test results back (especially the echo and chest x-ray, and hopefully a BNP will be in there too).

We are also told that the patient has an 18 gauge IV inserted (which is good thing to have so we can give medications if required), orders have been received, labs drawn, and testing results are pending.

Now let’s look at the “Vital Signs” tab above, and ask yourself what is normal vs. abnormal for this patient (adult male).

• The heart rate is high at 112 (tachycardia), and should normally be 60-100 bpm (see heart rhythms ).
• Blood pressure is higher than normal (normal is 120/80), which indicates hypertension.
• Oxygen saturation is 94% (this is on the low side as we’d normally want around 95% or higher, and the patient is on 4 L nasal cannula, which tells us the lungs are not okay).
• Respiratory rate is increased (26 breaths per minute)…normal is 12-20 breaths per minute.

Based on the information we were provided, I’ve selected the answers below. These findings are significant and definitely require follow-up by the nurse.

When answering these NGN case study questions, it’s helpful to think of the ABCDE (airway, breathing, circulation, etc.) as all of these fall into that category. If we don’t follow-up on the shortness of breath, crackles, respiratory rate, o2 saturation (94% on 4 L nasal cannula), the respiratory system can further decline.

In addition, the sinus tachycardia, S3 gallop, and hypertension could indicate fluid overload in the heart. This may cause the heart to tire out and lead the lethal rhythm. On the other hand, temperature, pain, weight, and BMI are not abnormal and do not require follow-up.

See the Complete Next Generation NCLEX Case Study Review

Each question in the case study builds on the previous question. To see how these questions evolve based on the patient’s condition and labs, watch the entire Next Generation NCLEX Case Study Review video on our YouTube Channel (RegisteredNurseRN).

NCLEX Practice Quizzes

We’ve developed many free NCLEX review quizzes to test your knowledge on nursing topics and to help you prepare for the Next Generation NCLEX exam.

Nurse Sarah’s Notes and Merch

Just released is “ Fluid and Electrolytes Notes, Mnemonics, and Quizzes by Nurse Sarah “. These notes contain 84 pages of Nurse Sarah’s illustrated, fun notes with mnemonics, worksheets, and 130 test questions with rationales.

You can get an eBook version here or a physical copy of the book here.

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