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Study Guide

Every NCLEX question type, explained.

Since April 2023, the NCLEX-RN goes far beyond A/B/C/D. Here's every item type you can see — what it looks like, how it's scored, and a quick example you can try. CertifyRN renders and grades all of them.

Jump to a type
Single bestSelect allDrop-downMatrixHighlightBow-tieTrendCase study

Single best answer

Pick 1

The classic item: one stem, four options, one correct answer. Tests recognition, priority, and delegation. Still the most common item on the exam.

Try it — pick one
A client reports chest pain rated 8/10. Which action should the nurse take first?
Document the pain in the chart
Obtain the client's vital signs and an ECG
Reassure the client it will pass
Ask about the client's diet
Check answer
Assess first. Vital signs and an ECG give the data every next decision depends on — you act on findings, not on documentation or reassurance.

Select all that apply

NGNAll-or-nothing

Choose every correct option — there may be one, or all of them. Graded all-or-nothing, so each choice has to earn its place. Treat every option as its own true/false question.

Try it — select all that apply
Which findings suggest fluid volume overload? Select all that apply.
Crackles in both lung bases
Jugular vein distension
Dry, tenting skin
Sudden weight gain
Check answer
Crackles, JVD, and weight gain. Dry, tenting skin points the other way — toward deficit. Miss one or add a wrong one and the whole item is marked incorrect.
Tip: Don't assume "about three." Decide yes/no on each option independently.

Drop-down / Cloze

NGNEach blank scored

Complete a sentence by choosing from in-line drop-down menus. It forces you to state a conclusion in clinical language — often the diagnosis and the priority.

How it reads
The findings are most consistent with septic shock ▾, and the priority is to restore tissue perfusion ▾.
Each drop-down carries 3–4 options; you pick the best for each blank, and every blank must be right for credit.

Matrix / Grid

NGNEach row scored

Classify each finding across columns — for example, whether it's expected or unexpected, or which condition it supports. A fast way to test analysis across several cues at once.

How it reads
FindingConsistentNot consistent
Lactate 4.3 mmol/L
Blood glucose 148 mg/dL
New confusion
One selection per row; a mildly high glucose in a diabetic is expected, so it's "not consistent" with the acute picture.

Highlight

NGNClick the cues

Click the significant words or phrases in a passage — the findings that require follow-up. It tests whether you can pick the signal out of a realistic note.

Try it — click the concerning findings
On arrival the client is oriented only to name, with a blood pressure of 86/48 and a heart rate of 124. The skin is warm and dry and the client reports mild thirst.
Check answer
Altered mentation, hypotension, and tachycardia are the cues that demand follow-up. Warm/dry skin and mild thirst are nonspecific here.

Bow-tie

NGNAll zones scored

The NGN capstone. You link actions to take and parameters to monitor to the condition at the center — the whole clinical-judgment cycle in one item.

How it reads (filled example)
Actions to take
Start norepinephrine
Continue crystalloid
→
Condition
Fluid-refractory septic shock
←
Parameters to monitor
Mean arterial pressure
Urine output

Trend

NGNRead the trajectory

A time-series of vitals or labs sits above the question. The answer depends on the direction of change over time, not any single value.

Try it — read the trend
Time10:0011:0012:0013:00
MAP (mmHg)58647074
Lactate4.33.62.71.9
Urine (mL/hr)12223445
What does this trend indicate?
Treatment is working; perfusion is improving
The client is deteriorating
No meaningful change
Check answer
Improving. A rising MAP, clearing lactate, and rising urine output together show the resuscitation is restoring perfusion.

Unfolding case study

NGN6 linked items

The real-exam centerpiece: a shared client chart beside six linked questions that unfold one clinical situation — recognize cues, analyze, prioritize, generate solutions, take action, evaluate. CertifyRN renders and grades full unfolding case studies, end to end.

How it reads
VitalsLabsOrders
Temp39.1 °C
HR124
BP86/48
RR28
SpO₂92%
The 6 items unfold →
  1. Recognize cues — highlight the concerning findings
  2. Analyze cues — matrix: consistent or not
  3. Prioritize — drop-down: name the problem
  4. Generate solutions — select all appropriate
  5. Take action — bow-tie
  6. Evaluate — trend over time
Only here you'll need to log in: case studies serve real bank questions, so the live drill is behind sign-in. Everything else on this page is open.

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