Since April 2023, the NCLEX has used the Next Generation (NGN) format. The exam still adapts to your ability level and still runs 85 to 150 questions, but many of those questions no longer look like classic multiple choice. NGN items test clinical judgment: reading real chart data, deciding what matters, and choosing what to do about it.

There are seven item formats. Most are scored with partial credit, so a partially correct answer earns partial points. Knowing how each format works before test day removes one source of stress.

1. Multiple choice

One question, four options, one correct answer. Still present on the exam, scored right or wrong with no partial credit.

2. Select all that apply (SATA)

A list of five or six options where any number can be correct. On the NGN, SATA is scored with partial credit: each correct selection earns a point and each incorrect selection loses one, with a floor of zero. This changes the strategy compared to the old all-or-nothing scoring. How SATA partial credit works covers the math and the approach.

3. Ordered response

You place steps in the correct sequence, for example the order of actions when a client is choking. Scored by how much of your sequence matches the key.

4. Drop-down cloze

A sentence or short paragraph with one or more blanks, each filled from a drop-down list. Example: "The nurse recognizes these findings are most consistent with [drop-down]." Each blank is scored separately.

5. Matrix

A grid of clinical findings or interventions where you mark each row against columns such as "indicated," "contraindicated," or "non-essential." Each row scores independently, so one wrong row does not zero the item.

6. Highlight

A section of a medical record where you tap or click the phrases that answer the question, for example the findings that require immediate follow-up. Correct selections earn points; incorrect ones cost them.

7. Bowtie

The signature NGN item. From a single scenario you select the client's condition, two priority actions, and two parameters to monitor, five answers in one question worth five points. How to answer bowtie questions walks through a full example.

Case studies use these same formats

Every NCLEX includes three unfolding case studies, each a six-question sequence that follows one client while the medical record grows. The individual questions inside a case use the formats above. NCLEX case studies and clinical judgment explains how they are built.

Practice in the real format

Reading about formats is not the same as answering them. You can try a real NGN question set, including a bowtie, in the free NCLEX demo, no account needed. The full NCLEX-RN question bank covers all seven types across every category of the 2026 test plan.