Next Gen NCLEX stand-alone items

These item types also assess clinical judgment.

Stand-alone items are individual questions that are not part of a case study but have a similar format. They are introduced after the minimum number of items.

Stand-alone items target one or more of the clinical judgment functions in Layer 3 of the NCJMM.

NOTE: Candidates who answer more than the minimum number of items will be presented with additional questions of which about 6 to 7 will be NGN stand-alone items.

Stand-alone items consist of 2 item types:

A bow-tie item

Bow-tie items address all 6 steps of the NCJMM in one item. The candidate reads a scenario to recognize whether findings are normal or abnormal (recognize cues), understands the possible complications or medical conditions the client may be experiencing (analyze cues), and identifies possible solutions to address the client’s needs and issues (generate solutions). The candidate then answers the question to determine the most likely cause of the client’s issues (prioritize hypotheses), the appropriate actions to take (take actions), and the parameters to monitor once interventions have been implemented (evaluate outcomes).

Trend item

Trend items are individual items in a scenario in which the candidate reviews information in the medical record that trends over time (from minutes to hours, days, or more). Trend items address one to all of Layer 3 of the NCJMM. Trend items can feature any item response type. Possible tabs include “Nurses’ notes,” “History and physical,” “Laboratory results,” “Vital signs,” “Admission notes,” “Intake and output,” “Progress notes,” “Medications,” “Diagnostic results,” and “Flow sheet.”

Sample of a bow-tie item

The nurse is reviewing the client’s assessment data to prepare the client’s plan of care.

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, two actions the nurse should take to address the condition, and two parameters the nurse should monitor to assess the client’s progress.