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Next Gen NCLEX: Clinical Judgment
The six NCJMM steps, NGN item types and partial-credit scoring on the 2026 NCLEX-RN and NCLEX-PN
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The six clinical judgment steps
NCSBN's Clinical Judgment Measurement Model (NCJMM) is a testing framework, not a replacement for the nursing process. Each case follows its six steps in order.
| Step | What it asks | Typical item |
|---|---|---|
| 1. Recognize cues | Which data matter right now? | Highlight findings that need follow-up |
| 2. Analyze cues | What do the cues point to? | Matrix: finding fits condition A, B or C |
| 3. Prioritize hypotheses | Which problem is most urgent or likely? | Drop-down: most at risk for ___ because of ___ |
| 4. Generate solutions | Which interventions reach the goal? | Matrix: indicated, nonessential or contraindicated |
| 5. Take action | What do you do now, and first? | Select all, or drop-down table of actions |
| 6. Evaluate outcomes | Is the plan working? | Matrix: improved, no change or declined |
Exam format (2026 test plans)
- 85 to 150 items in 5 hours; the intro screen and all breaks count
- Minimum length: 52 Client Needs items, 18 case items (3 cases × 6), 15 unscored pretest items
- About 10% stand-alone clinical judgment items; any item type can stand alone
- After 85 items it stops once 95% sure you are above or below passing; otherwise at 150 or time-out
- No skipping, no going back; length does not predict the result
- Classic formats remain: multiple choice, select all, calculation, ordered response, exhibit and graphic
- In effect April 1, 2026 to March 31, 2029
NCLEX-PN: same model, LPN/VN scope
The NCLEX-PN uses the same steps, item types, scoring, length and time; Management of Care is Coordinated Care. The keyed action changes:
- Collect data; recognize and report changes to the supervisor or provider
- Reinforce education
- Contribute to the plan of care
- Clients with common problems and predictable outcomes
Three scoring rules
| Rule | Used when | How it scores |
|---|---|---|
| 0/1 | Set number to pick, or one per row or blank | +1 per correct; wrong picks cost nothing |
| +/− | Free to pick any number (select all, highlight) | +1 per correct, −1 per wrong; floor 0 |
| Rationale | Linked cause and effect | 1 point per cause-effect pair, both halves right |
| Item type | What you do | Scoring |
|---|---|---|
| Select all that apply | Pick every correct option (at least 1) | +/− |
| Select N | Pick exactly N | 0/1 |
| Multiple response grouping | Select all within each group | +/− per group, floor 0 |
| Matrix multiple choice | One choice per row | 0/1 per row |
| Matrix multiple response | Any boxes per row; at least 1 per column | +/− per column, floor 0 |
| Cloze: drop-down, drag-and-drop or table | Fill each blank | 0/1 per blank |
| Rationale: drop-down or drag-and-drop | Cause plus 1 or 2 effects | Dyad 1 pt; triad up to 2 |
| Highlight: text or table | Pick phrases or rows that answer the stem | +/− |
| Bow-tie | 1 condition, 2 actions, 2 parameters; pair order is free | 0/1; 5 pts |
| Trend (NCSBN 2021 term) | Data across time points; any format but bow-tie | Its format's rule |
Case study structure
- One client, six items, data that unfold over time
- Chart tabs (notes, vitals, labs, orders) can change as the case unfolds; open every tab, since nothing prompts you
- Items run in step order and are scored one by one; a miss does not carry forward
- Labs show reference ranges; units mix SI and imperial
- An extra case may be unscored pretest; you cannot tell which
- Answer from the current screen: if the client changed, so may the best action
Strategies by item type
- Highlight: mark only what the stem asks for; expected findings are usually distractors
- Matrix: treat every row as its own question
- Cloze and rationale: choose the condition first, then its evidence; reread the sentence
- Bow-tie: condition first, then actions that treat it and parameters that track it
- Trend: compare time points; direction of change outweighs one value
- Select N: fill every slot; wrong picks cost nothing
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Related one-pagers
- Prioritization and DelegationWho to see first, five rights, scope, SBAR and escalation for NCLEX-RN and PN
- NCLEX-PN: The LPN/VN RoleCoordinated Care, PN vs RN scope, what to report, working with UAP, and consent and client rights under the 2026 NCLEX-PN test plan
Sources
- NCSBN. 2026 NCLEX-RN Test Plan, effective April 1, 2026. Link
- NCSBN. 2026 NCLEX-PN Test Plan, effective April 1, 2026. Link
- NCSBN. Test Plans (NCLEX.com). Link
- NCSBN. NCLEX Frequently Asked Questions (NCLEX.com). Link
- NCSBN Help Center. What are the current scoring models? (updated July 2026) Link
- NCSBN Help Center. What is the current format and item types for the NCLEX? Link
- NCSBN Help Center. What is an alternate item format? Link
- NCSBN Help Center. Are items in case studies dependent on the correct response to a prior item in the same set? Link
- NCSBN Help Center. Do items provide candidates with normal reference ranges? Link
- NCSBN Help Center. Which units of measurement will be used with lab values on the NCLEX exam? Link
- NCSBN Help Center. How long is the NCLEX? Link
- NCSBN Help Center. Does the NCJMM replace the need for the nursing process? Link
- NCSBN Help Center. What are stand-alone items? Link
- NCSBN Help Center. What should a candidate expect when they see an NCLEX Highlight item? Link
- NCSBN. Next Generation NCLEX News, Summer 2021: Scoring Models (copy hosted by Campaign for Action). Link
- NCSBN. Clinical Judgment Measurement Model (NCLEX.com). Link
- Hensel D. Overview of Next Generation Questions (educator workshop handout, University of Maryland School of Nursing, 2021). Link