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Ask a Nurse: How Can I Study for the Next Generation 2023 NCLEX?

Gayle Morris, BSN, MSN
Updated March 28, 2024
    The NCLEX 2023 format has changed. Nursing students can consider these resources that may help their chances of passing the first time.
    Credit: Ivan Pantic / Getty Images

    Books can help with studying nursing content, but online resources may better help you get ready for the new National Council Licensure Examination (NCLEX) 2023 question style. On this page, you’ll find out more about these online resources, along with several other helpful ways to prepare for the new NCLEX.

    So, why has the NCLEX changed? NCSBN tested the next generation NCLEX question format from July 2017 through December 2018. During that time roughly 340,000 students participated in the beta testing. The NCSBN found that students who performed well on the regular NCLEX questions also performed well on the NGN questions.

    This suggests that the change in question format may help focus test-taking on critical thinking skills. The content nursing students are tested over and the guiding principles of nursing care have remained the same.

    How Can Students Prepare for the New NCLEX Test Questions?

    Review Resources

    Several resources, like ATI and Elsevier, are available to help faculty prepare students for the new question format. This should ultimately help new nursing graduates to improve their critical thinking skills in practice.

    There are many online resources available to students preparing for the Next Generation 2023 NCLEX exam. These include:

    • Kaplan

      Provides test preparation for nursing, medical school, bar review, graduate admissions, and college admission.
    • Princeton Review

      Another education company for test preparation, also offers a course for the NCLEX-RN examination.
    • NurseAchieve

      Has a comprehensive online content study program that includes 20 case studies with interactive simulations that include all question types included on the Next Generation NCLEX (NGN).
    • National Council of State Board of Nursing (NCSBN)

      NCSBN produces the NCLEX, and also has practice tests available online for the NCLEX-RN.

    Pay Close Attention in Nursing School

    Much of the information for faculty focuses on helping students improve their clinical judgment and critical thinking skills. In other words, the content has not changed, only how students will process and apply the information during the test. The intent is to mimic the necessary skills to provide excellent patient care as closely as possible.

    This means that nursing students can begin to best prepare for the test by thoroughly understanding the material. Instead of being able to regurgitate pure facts and knowledge, the test will ask students to apply that knowledge to specific clinical case studies.

    Familiarize Yourself With Question Functions

    Students should become familiar with how each test question functions so they aren’t surprised during the test situation. This can raise a student’s anxiety level and lower their overall performance.

    Hone Critical Thinking Skills

    The NCLEX 2023 combines new question styles and a stronger focus on knowledge application and critical thinking for nurses. Nursing students may find it helpful to train their critical thinking skills. These skills are important in nearly every aspect of life and are part of the nursing process.

    Critical thinking deliberately employs intellectual tools that may have gotten rusty without use. Habits you can begin to develop include:

    • Question your assumptions about the situation
    • Use reasoning to form a logical conclusion
    • Be open-minded to include potential answers you may not have otherwise considered

    Evaluate Case Studies

    Study books have been the mainstay of preparing for standardized testing. And they will still be helpful to ensure you have a firm grasp on the content. However, because of the interactive nature of the next generation NCLEX, it may be more helpful to use online resources to practice evaluating case studies while using the new test question format.

    Prepare in Advance

    It is crucial you begin preparing several months before the examination so you can learn from your mistakes and don’t repeat them on test day. It is possible to have an excellent grade point average in school and still fail the next generation NCLEX.

    Make the First Time Count

    Do not make the mistake of taking the NCLEX 2023 the first time as a “practice test.” In other words, your intention when taking the test should be to pass the test since it is difficult to overcome a poor test score.

    The NCSBN keeps statistics on NCLEX pass rates for each year. According to their statistics, the pass rate for first-time test-takers was 88% from January to March 2021 for bachelor’s-prepared nurses.

    However, during the same time period for bachelor’s-prepared nurses taking the test for the second time or more, the pass rate was half that, at 43%. Interestingly, the pass rate for first-time test-takers was lowest between October and December 2021 for bachelor’s, diploma, or associate-prepared nurses.

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    What Has Changed for the 2023 Test and Beyond?

    The framework for the NCLEX has not changed, but the next generation NCLEX format will include five new types of questions. These questions aim to create situations more like what a nurse encounters in their practice.

    The questions will be used alongside case studies. Some questions will be stand-alone, and others will build from one question to the next. Each case study will have six questions that fit the NCSBN Cognitive Aspects of Clinical Decision-Making, which they define as:

    • Recognize clues
    • Analyze clues
    • Prioritize hypothesis
    • Generate solutions
    • Take actions
    • Evaluate outcomes

    This is essentially the same nursing process that students are taught and use for clinical decision-making.

    • Assessment
    • Diagnosis
    • Plan
    • Implementation
    • Evaluation

    The change in the structure of some of the questions on the NCLEX 2023 is to help assess a student’s ability to think critically as they provide patient care.

    New Question Types

    • Extended multiple responses: These are similar to other multiple-choice type questions. However, the test-taker has more options and more than one correct response. Partial credit is given for these questions.
    • Extended drag-and-drop: These questions require the test-taker to prioritize the answers. While similar to ordered response questions on past tests, not all responses in these questions are required or appropriate for the case study.
    • Cloze (dropdown): Test-takers choose from a possible list in a dropdown menu within a sentence, table, or chart.
    • Enhanced hotspot: Test-takers highlight a part of the text or table to answer the question.
    • Matrix or grid: These questions measure multiple parts of a scenario and require the test-taker to choose one or more answers.
    • Bowtie: The test-taker fills in five blanks that resemble a bowtie. For example, the middle blank may have a condition. The left two blanks may be the actions needed, and the right two blanks are filled in with the parameters a nurse should monitor.

    There are multiple ways these questions may appear on the test. Elsevier, a medical and scientific publishing company, has created several videos to demonstrate how these types of questions could be used.

    About the NCLEX

    The NCLEX establishes a standard measurement of nurses’ skills to provide excellent patient care. These skills are critical to healthcare. The NCLEX has always been a test unlike any other you may have taken in the past.

    Typical college and high school tests are straight knowledge-based examinations. In other words, the test asks the test-taker to regurgitate facts they’ve learned. Instead, the NCLEX is an application-based test. This means the test-taker must think strategically, logically, and wisely through case studies, in much the same way a nurse must think through patient care situations.

    This also means that students must prepare completely differently than they would for a standard test. There won’t be a recitation of memorized facts on this exam. Rather, you’ll be expected to know the information and apply it to specific situations.

    In 2009, the NCSBN began having conversations with clinicians about the large number of clinical practice errors made by entry-level nurses. They found as much as 65% of those errors were related to poor clinical decision-making skills. They collaborated on two studies from 2012 to 2014, which ultimately established the need for entry-level nurses to have:

    • Better clinical judgment
    • Sharper critical thinking
    • Improved problem-solving

    From July 2017 to December 2018, a special research section was added to the NCLEX that took an additional 30 minutes for the participants to complete. The section had no impact on the scoring or results but gave the NCSBN data on which to base changes to the test.

    In Summary:

    • The next generation NCLEX tests the same content as in the past but requires the test-taker to apply the knowledge using clinical judgment and critical thinking skills. This is accomplished using five new formats for test questions, including questions with multiple right answers and partial credit.
    • Since the test is interactive, students may find it helpful to use online resources to practice answering questions based on case studies using the new question format.
    • Nursing students may also find it helpful to intentionally practice and hone their critical thinking skills and avoid taking the NGN as a “practice test.” The pass rate for repeat tests is less than half the rate of first-time test-takers.
    • The new test questions are based on the NCSBN’s Cognitive Aspects of Clinical Decision-Making, which closely follows the nursing process.