As of 2025, the NCLEX includes a variable number of case studies, which are part of the Next Generation NCLEX (NGN) item types designed to assess clinical judgment. Each candidate will encounter at least one case study, and most test takers will see two to three case studies during their exam.
Each case study presents a realistic clinical scenario and includes six associated items (questions). These items may be a mix of traditional multiple choice and NGN formats such as extended multiple response, drag and drop, or matrix/grid questions. All six items within a case study are linked to the same patient situation, requiring candidates to analyze data, prioritize actions, and make sound clinical decisions.
Case studies are scored as a single unit using a polytomous scoring model, meaning partial credit may be awarded based on the accuracy of responses within the set.
The total NCLEX exam length varies:
- NCLEX RN: 85 to 150 questions
- NCLEX PN: 85 to 150 questions
Since case studies account for up to 18 questions (3 case studies × 6 items), they represent a significant portion of the exam and play a key role in evaluating a candidate’s readiness for safe, effective nursing practice.
Certilyst provides NGN style practice, including fully simulated case studies with clinical judgment scoring, to help candidates build confidence and competence. Prepare with realistic scenarios at Certilyst NCLEX Prep .
For official details on exam structure, visit the National Council of State Boards of Nursing: www.ncsbn.org/next-generation-nclex .