Naxlex Next Gen NCLEX case study examples: bowtie, matrix and highlight
Worked examples of Next Generation NCLEX case studies and how to approach each item type using the clinical judgment model.
Last reviewed October 21, 2026 · Naxlex RN Hub study team
Next Generation NCLEX (NGN) case studies follow one client through six questions, one for each step of the NCSBN Clinical Judgment Measurement Model: recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action and evaluate outcomes.
Example scenario: a 68-year-old client two days after hip surgery is newly confused, with a heart rate of 112, a temperature of 38.6 °C and a respiratory rate of 24. The first question might be a highlight item asking you to select the abnormal findings in the nurse's notes. Select only what is clinically significant, not every number.
Next, a matrix item might ask whether each finding is consistent with pneumonia, a urinary tract infection or sepsis. Answer each row on its own. Later, a bowtie item asks for the most likely condition in the center, two actions on the left and two parameters to monitor on the right.
Many NGN items give partial credit. Some use +/- scoring, where each wrong selection subtracts a point, so selecting everything 'just in case' costs points. Choose what the evidence supports.
On Naxlex RN Hub, NGN practice includes grid, highlight, bowtie, ordering and fill-in items, plus six-question case sets with rationales for each part.
Official reference resources
- NCLEX candidate tutorial and preparation resources
- Official computerized adaptive testing overview
- Official ATI TEAS information
FAQ
How many case studies are on the NCLEX?
Three unfolding case studies of six items each are scored, per NCSBN. Standalone NGN items may also appear.
What is a bowtie question?
It asks you to link one condition to two actions to take and two parameters to monitor.
Put your study plan into practice
Choose RN or PN practice, review the rationale for each answer, and request original material for the topics you need next.
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