Free NCLEX NGN questions — case studies, SATA, and bow-tie practice
The Next Generation NCLEX (NGN) launched April 2023 and brought six new item types designed to measure clinical judgment, not just knowledge recall. Five of those item types appear below, each with full rationale: extended multiple response (SATA), case study with multi-step reasoning, matrix grid, drag-and-drop ordering, and bow-tie decisions. Free, no signup.
What are NGN questions?
Next Generation NCLEX (NGN) items test the six steps of the NCSBN Clinical Judgment Measurement Model: recognize cues, analyze cues, prioritize hypotheses, generate solutions, take actions, and evaluate outcomes. Each NGN item type targets one or more of those steps.
The 6 NGN item types you'll see on the NCLEX-RN
1. Extended multiple response (SATA)
Select all that apply, but with partial-credit scoring. Each correct selection earns a point, each incorrect selection loses a point. Guessing is penalized in a way traditional SATA was not.
2. Extended drag-and-drop
Place items from a pool into a target zone in a specific order. Common for ordering nursing actions, ranking priorities, or sequencing a procedure.
3. Cloze (drop-down)
Fill in the blank from a drop-down menu, often nested inside a sentence like "The nurse should administer [drug] because the client is in [condition]." Multiple drop-downs can appear in a single item.
4. Enhanced hotspot (highlighting)
Click words or phrases in a passage that are clinically significant. Frequently used for analyzing assessment notes, vital signs, or lab results.
5. Matrix / grid
A table of rows (findings, interventions, or assessments) and columns (categories such as "indicated," "not indicated," "essential," "non-essential"). You assign each row to the correct column.
6. Bow-tie
A three-zone item: one condition in the center, two actions on the left, two parameters to monitor on the right. Often the "take actions" sub-question of a case study. Bow-ties weight heavily in scoring because they integrate diagnosis, action, and evaluation in a single item.
How NGN scoring differs from old-format SATA
Old SATA was all-or-nothing. NGN uses polytomous scoring on most item types so you can earn partial credit. This is good news: you don't have to get every cell right to do well on a case study, and one wrong matrix row doesn't tank the whole question.
The 0/+/- scoring rule applies to most NGN items: correct selection = +1, incorrect = -1, no selection = 0 (floor at zero — you can't go negative). This rewards measured judgment and penalizes shotgun guessing.
How to study NGN questions effectively
- Practice the item type, not just the topic. Doing 50 SATA questions builds different reasoning skills than 50 standalone MCQs on the same content.
- Slow down on matrix items. Read every row before you start answering. Test writers plant a few obviously-correct rows to anchor you, then insert subtler rows that depend on rereading.
- For bow-tie items, anchor on the center condition first. Pick the condition. Then ask: what two actions treat this condition right now, and what two parameters tell me whether those actions worked?
- Time yourself loosely. Case studies should take 5–8 minutes total. SATA should take 60–90 seconds. If you're going much longer, you're overthinking.
What percentage of the NCLEX is NGN?
On the post-April-2023 NCLEX-RN, roughly 25% of items are NGN format. Three case studies (six items each = 18 items) are guaranteed, and the rest are standalone NGN item types mixed with traditional multiple choice. Expect to see 8–10 standalone NGN items in addition to the case studies on your test day.
Try these 5 questions now
No signup required. Tap an answer to reveal the rationale.
- Question 1 · Cardiac · NGN case study
A 62-year-old client arrives in the ED with crushing substernal chest pain radiating to the left arm, diaphoresis, and a heart rate of 112 bpm. The 12-lead ECG shows ST elevation in leads II, III, and aVF. Troponin is 4.8 ng/mL. The provider orders aspirin 325 mg, sublingual nitroglycerin, and prepares for cardiac catheterization. Which finding would most prompt the nurse to hold the nitroglycerin?
- a.Blood pressure 88/52 mmHg
- b.Heart rate 102 bpm
- c.Reports pain of 7/10
- d.SpO2 95% on 2L nasal cannula
Show answer + rationale
Correct: A. Inferior wall MI (II, III, aVF) frequently involves the right ventricle, which is preload-dependent. Nitroglycerin causes venodilation, dropping preload, and in RV infarction can precipitate profound hypotension and shock. A systolic of 88 with an inferior STEMI is an absolute contraindication. Heart rate 102 is appropriate sympathetic response, pain warrants treatment, and SpO2 95% is acceptable.
- Question 2 · Pharmacology · SATA
A nurse is teaching a client about warfarin therapy. Which statements indicate the teaching has been effective? Select all that apply.
- a.I should call my provider if I see blood in my urine.
- b.I will avoid large amounts of leafy green vegetables.
- c.I can take ibuprofen for headaches.
- d.I will use an electric razor for shaving.
- e.I will get my INR checked as scheduled.
Show answer + rationale
Correct: A, B, D, E. Warfarin increases bleeding risk so hematuria warrants provider notification (A). Vitamin K from leafy greens antagonizes warfarin, so consistency rather than total avoidance is the goal, but large variations are problematic (B is acceptable phrasing). Electric razors reduce cut risk (D). INR monitoring is essential (E). Ibuprofen (C) is an NSAID that increases bleeding risk and is contraindicated — acetaminophen is preferred.
- Question 3 · Neuro · NGN case study
A 28-year-old is admitted after a motor vehicle collision with a Glasgow Coma Scale of 7. ICP monitoring shows pressures of 24 mmHg sustained over 10 minutes. Which intervention is most appropriate?
- a.Lower the head of bed to flat
- b.Cluster nursing care to provide rest periods
- c.Administer prescribed mannitol 1 g/kg IV
- d.Suction the airway every 30 minutes
Show answer + rationale
Correct: C. Normal ICP is 5–15 mmHg; sustained pressure above 20 mmHg requires intervention to prevent herniation. Mannitol is an osmotic diuretic that pulls fluid from brain tissue. Head of bed should be 30°, not flat. Clustering care raises ICP — care should be spaced. Routine suctioning raises ICP; suction only as needed with pre-oxygenation.
- Question 4 · Infection control · SATA
A client is admitted with active pulmonary tuberculosis. Which precautions should the nurse implement? Select all that apply.
- a.Place the client in a negative-pressure room
- b.Wear an N95 respirator when entering the room
- c.Use a surgical mask when transporting the client
- d.Have the client wear an N95 during transport
- e.Keep the door open for ventilation
Show answer + rationale
Correct: A, B. TB requires airborne precautions: negative-pressure room with door closed, N95 or PAPR for staff. During transport the client wears a surgical mask (not N95) to contain droplet nuclei — the staff member outside the room can wear a regular mask. Door must remain closed to maintain negative pressure.
- Question 5 · Maternity · NGN case study
A laboring client at 39 weeks suddenly reports severe abdominal pain. The nurse notes dark red vaginal bleeding, a rigid uterus, and fetal heart tones drop to 90 bpm. Maternal vitals: BP 86/48, HR 132. Which complication is most likely?
- a.Placenta previa
- b.Placental abruption
- c.Uterine rupture
- d.Cord prolapse
Show answer + rationale
Correct: B. The classic triad of placental abruption is painful dark vaginal bleeding, a rigid/board-like uterus, and non-reassuring fetal heart tones. Placenta previa is painless bright red bleeding. Uterine rupture typically follows a previous uterine scar with sudden cessation of contractions. Cord prolapse presents with a visible or palpable cord and variable decelerations.
These are 5 of 5,000+ NCLEX questions in the Clarity bank. The full bank includes real NGN case studies, bow-tie items, AI tutor follow-up, and 5 readiness exams.
Get 5,000+ more questions free for 10/day →Frequently asked questions
What is the NGN on the NCLEX?
The Next Generation NCLEX (NGN) is the format launched April 2023 to measure clinical judgment through new item types: case studies, bow-tie, matrix, cloze, hotspot, extended drag-and-drop, and extended multiple response (SATA with partial credit).
How many NGN questions are on the NCLEX-RN?
Approximately 25% of the NCLEX-RN is NGN format. Every test-taker gets three case studies (18 items total) plus 8–10 standalone NGN items mixed throughout the rest of the test.
Are NGN questions harder than regular NCLEX questions?
They feel harder because they require more clinical synthesis, but they're scored with partial credit (polytomous scoring) which makes them more forgiving. You don't need to get every cell right to pass them.
How do I practice NGN bow-tie questions for free?
The case study and SATA items below give you real NGN-style reasoning. For a dedicated bow-tie practice set, visit our free bow-tie questions page. Clarity premium includes 30+ true 3-zone bow-tie items.
What's the best NGN practice resource?
NCSBN's official Learning Extension is the authoritative source. Commercial banks like UWorld, Bootcamp, Kaplan, and Clarity build on top of NCSBN guidance. Clarity is the most affordable at $9.99/mo and includes real multi-step case studies plus an AI tutor.