Editing NCLEX-PN Exam Blueprint (section)

== Next Generation NCLEX ==

NCSBN launched the Next Generation NCLEX (NGN) in April 2023 for both the RN and PN examinations, and the 2026 test plan continues and formalizes it. The change was driven by evidence that entry level nurses make a high proportion of practice errors involving clinical judgment rather than knowledge recall.

The '''NCSBN Clinical Judgment Measurement Model''' describes six cognitive steps that NGN items are designed to measure:

# '''Recognize cues.''' Identify which findings are relevant and significant.
# '''Analyze cues.''' Link those findings to the patient's condition.
# '''Prioritize hypotheses.''' Rank the most likely and most urgent explanations.
# '''Generate solutions.''' Identify possible actions and desired outcomes.
# '''Take action.''' Implement the highest priority interventions.
# '''Evaluate outcomes.''' Compare observed outcomes to expected outcomes.

At the practical nurse level these steps are applied within the PN scope, so the expected action is frequently to collect focused data, report to the RN, or implement an intervention within scope rather than to redesign the plan of care.

Under the 2026 test plan, clinical judgment on the PN examination is measured explicitly by '''18 case study items''', that is three unfolding case study sets of six items each, plus '''approximately 10 percent stand-alone clinical judgment items''', selected depending on exam length (NCSBN, 2026a). '''This is a change candidates should note.''' Unfolding case studies are no longer an RN-only feature; the PN examination now carries the same three-set case study structure as the RN examination. Each set of six items maps to the six steps of the clinical judgment model.

Stand-alone clinical judgment items present a single clinical scenario followed by one item. Two commonly discussed formats are the '''bow tie''' item, which asks the candidate to place the condition, the actions to take, and the parameters to monitor into a bow tie shaped diagram, and the '''trend''' item, which presents data over several time points and asks the candidate to interpret change.

Because clinical judgment is an integrated process, case study items span multiple content areas and are counted independently of the eight content area percentages in the table above.