Writing Next Generation NCLEX-Style Case Study Questions - Collaborative Momentum Consulting (2024)

By Susan Sportsman, PhD, RN, ANEF, FAAN

Recently, our blog featured tips for developing Next Generation NCLEX (NGN)-style questions, particularly the revision of test questions faculty already include on their examinations. Revising these questions provides a strategy to adapt current test items to reflect the NGN process, since these knowledge questions represent many questions on the NGN exam.

Now let’s turn our attention to writing NGN Case Study questions. Although only three case studies will be on the NGN examination, all test-takers must respond to the six questions embedded in these case studies, regardless of how many total questions they receive. Case Studies are complex and require some thinking to create. However, I think they are fun to write—the exercise is very much like writing (a truly short) short story! Here are some suggestions for getting started.

    1. Begin with the objective(s) that emphasize the content you want students to apply. Keep in mind that the point of case studies (and NGN questions in general) is to evaluate how well students can apply content to a specific clinical situation.
    2. Develop a clinical problem that students must address that represents the objective(s) in your course. Ideas for this this problem might come from:
      • Clinical situations highlighted in past tests (or in test banks to which you have access).
      • Your own clinical experiences-or those of your colleagues.
      • Content outlined in the NCLEX Test Design.
      • Case Studies you use for class discussion or assignments for students.
      • NCSBN’s Top Priority Knowledge Statements or Skills
    1. The introduction to the case study scenario should include:
      • Client demographics (age, gender, brief and relevant social history)
      • Client history
      • Relevant environmental factors, such as where the client lives (own home, LTC facility, etc.)
      • Normal/abnormal findings (e.g., Physical assessment findings, V/S, Lab values, psychological behaviors)
      • Time considerations for the nurse/client
      • Client/Nurse Interaction
    1. The six questions in the case study should focus on the application of one of the cognitive skills highlighted in the Clinical Judgment Measurement Model (CJMM). Silvestri (2020) identifies questions that test-writers (and test-takers) ask themselves to understand each of the six cognitive skills.
      • Recognize Cues: What matters most?
      • Analyze Cues: What could it mean?
      • Prioritize Hypothesis: Where do I go to start
      • Generate Solution: What can I do?
      • Take Action: What will I do?
      • Evaluate Outcomes: Did it help?

Remember that the case study should represent situations that are appropriate for the level of student you are testing. Later in the curriculum the questions should represent clinical judgment that a novice nurse is expected to use in actual practice.

Starting the Process of Writing a Case Study

As you begin to write your own case studies, an example might be helpful in integrating the NGN components into an actual case study. The case study below was written for students in an early nursing clinical course, such as Fundamental in Nursing. In addition, the NGN Resources website also provides examples of case studies written at the level of a novice nurse.

Note: The templates we developed for this post can be found on our Resources page. Feel free to use them.

Scenario

An 86 y/o female is 1-day post-op repair of a hip fracture. A previously active senior, she fell in her front yard, fracturing her L hip. She did not receive immediate assistance for several hours, until a neighbor, on returning to his home, noticed that she was lying in her yard, and called 911. The client’s daughter is with her mother and is the primary historian. Her daughter says that prior to the fall, her mother had been lucid and able to take care of her own needs.

#1. Recognize Cues (Drag and Drop)

Drag & Drop the 4 cues the RN observed the initial assessment which require following up.

#2. Analyze Cues (Select All that Apply-N)

The RN is concerned about the client’s confusion. Identify factors that may be causes for this confusion.
a. Hospital Environment *
b. Early indication of Alzheimer’s Disease
c. Use of Morphine for control of Pain *
d. Anesthesia *
e. Reduction in O2
f. Limited Sleep

#3. Prioritize Hypothesis (CLOZE)

Complete the following sentence by choosing from the following lists of options:

The client is at highest risk for developing

as evidenced by

#4. Generate Solutions (Matrix)

Confusion continues to be a problem for the client on day three post-surgery.

Which of the possible interventions to the problem are indicated and which are contraindicated?

The RN notifies the surgeon of elevated TPR, drainage at surgical site, and pain and received orders.

#5. Take Action (Highlighting)

Upon receiving the following physician orders, highlight those which the nurse should implement right away.

#6. Evaluate Outcomes (Matrix)

The nurse has performed the interventions as ordered by the physician for the client. For each assessment finding, click to specify if the finding indicates that the client’s condition has improved, has not changed, or become worse.

Case study questions are an important part of the NGN emphasis on measuring test-takers’ clinical judgment competence.Hopefully, the example above will give you some ideas for developing your own case study questions.You may notice that these questions are not exactly formatted like those on the NGN website.Currently, most of us do not have the necessary software to completely mimicthe NGN questions.But simple templates can come close. Please don’t let the differences in the format of these questions stop you from using case study questions in your testing and classroom teaching. Remember, the point of the NGNtesting process is to assess new graduates’ ability to use good clinical judgment in a variety of clinical situations. Giving students the opportunity to practice clinical judgment is key to their success on NCLEX and in clinical practice.

References

Silvestri, L. (2020) Higher-Cognitive Level Test Question: A Starting Point for Creating Next Generation NCLEX Test Questions. White Paper. Elsevier.

Writing Next Generation NCLEX-Style Case Study Questions - Collaborative Momentum Consulting (2024)

FAQs

How to write a NGN case study? ›

Let me provide you with easy steps to transform your lived nursing experience into a case study for new graduates.
  1. Step One: Ask, what is the goal of the case study? ...
  2. Step Two: Tell a clinical story. ...
  3. Step Three: Consider the process of recognizing cues. ...
  4. Step Four: Consider the process of analyzing critical information.

How to write next generation NCLEX questions? ›

Six Steps to Effective Next Generation NCLEX® Item Writing
  1. Determine the objective you wish to test. Before you write an NGN item, determine the test objective. ...
  2. Decide which NGN item type to use. ...
  3. Write the stem. ...
  4. Write the answer. ...
  5. Write a few distractors. ...
  6. Ask yourself whether your test question meets NGN standards.
Mar 30, 2023

How to study for NCLEX next gen? ›

10 Tips to Prepare for the Next Gen NCLEX
  1. Familiarize yourself with the NCLEX test format. ...
  2. Review the NCLEX test plan. ...
  3. Practice with sample questions & simulated exams. ...
  4. Build a study schedule. ...
  5. Utilize case studies. ...
  6. Seek guidance from nursing faculty or mentors. ...
  7. Join study groups or online forums.
Dec 18, 2023

Are case studies considered hard on NCLEX? ›

Although case studies might be considered hard on NCLEX, the questions can be easy to handle for candidates who prepare effectively.

What is the format for writing a case study? ›

However, these vary depending on discipline-specific requirements and assessment criteria.
  • Executive Summary/Synopsis. Introduce the topic area of the report. ...
  • Introduction. Summarise the your task. ...
  • Findings. ...
  • Discussion. ...
  • Conclusion. ...
  • Recommendations. ...
  • References. ...
  • Appendices (if any)

What is the pass rate for the NCLEX next generation? ›

Next Gen NCLEX Pass Rates in the First Quarter of 2024. The pass rate for all RN candidates taking the NCLEX-RN exam in the first quarter of 2024 was 79.08%. While this is a decent passing percentage, approximately one in five test-takers failed this challenging exam.

Is the new generation NCLEX more difficult? ›

Is the Next Gen NCLEX easier than the old NCLEX exam? A common question nursing students ask about the Next Gen NCLEX is whether or not the exam is easier than the old NCLEX. The short answer is no, the Next Gen NCLEX is not easier.

How many NGN questions will be on the NCLEX? ›

In all, the total exam length is 85-150 items. Among the scored items on a minimum length test, candidates should expect 3 case studies with 18 of the 85 items (21%) to be NGN.

How many case studies are on Next Gen NCLEX? ›

Within the minimum-length exam, there will be 52 stand-alone items and three case studies (each case has six items for a total of 18 items) that will be scored and contribute to the pass/fail decision. This results in 70 scored items.

What type of NCLEX questions are the hardest? ›

Each category of questions requires an increasing level of critical thinking skills. Analysis, synthesis and evaluation questions would be considered higher-level NCLEX questions. Synthesis questions are based on creating or proposing solutions, such as a plan of care.

What score do you need to pass the next gen NCLEX? ›

The NCLEX scoring system uses a unit of measurement called logits to score questions and determine whether candidates pass or fail. Logits report the differences between the candidate's ability estimates and the question difficulty. The current passing standard of the NCLEX is -0.18 logits.

Where to practice NCLEX style questions? ›

Free NCLEX Practice Questions: Pass Your Exam with Confidence. Ace your NCLEX exam with the Nurse Plus Academy! Expert-authored questions mirror the actual test format and content, come with detailed rationales, and are organized by NCLEX topics, ensuring you have the knowledge and confidence to succeed on exam day.

How to answer NCLEX NGN questions? ›

The most important thing is to read the question carefully and contemplate what it asks you. Then think of the answer or solution without looking at the list of options. Then once you have a solution in your mind, you can check out all the options and select the ones that relate directly to the solution.

What words are bolded on NCLEX? ›

Does the NCLEX bold key words in items? Yes, the NCLEX bolds key words such as best, most, essential, first, priority, immediately, highest, initial, next, refute, increased, decreased and support. Does NCSBN use generic and trade names on items with medications? The NCLEX uses consistent language for every examinee.

How do you write a case study step by step? ›

How to write a case study
  1. Determine your case study's purpose. ...
  2. Choose the right clients to use in your case study analysis. ...
  3. Choose the right medium to present your case study. ...
  4. Ask the right questions. ...
  5. Let your clients tell the story. ...
  6. Make sure your case study works for everyone. ...
  7. Show your audience rather than tell.

How do you write a case study for criminal justice? ›

In short, a case study examines a real life situation and includes three components: (1) Part A--a detailed factual background section that raises (but does not resolve) several significant questions/dilemmas in the case; (2) Part B--a follow up factual section explaining what subsequently occurred and how the ...

How do you write a nursing case study example? ›

How to Write a Case Study Paper for Nursing
  1. The status of the patient. Demographic data. Medical History. Current diagnosis and treatment.
  2. The nursing assessment of the patient. Vital signs and test results. Nursing observations (i.e., range of motion, mental state)
  3. Current Care Plan and Recommendations.

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