NCLEX-PN case studies and Next Generation items: how many and how they are scored
Written and reviewed by Rebecca Moore, MSN, RN, CEN · 3 min read · Updated October 2026
Short answer
Every NCLEX-PN includes three clinical judgment case studies of six items each, 18 items in all, plus stand-alone clinical judgment items making up about 10% of the exam, according to the 2026 test plan. Each case study follows one client and measures the six steps of NCSBN's Clinical Judgment Measurement Model. Items with more than one key can earn partial credit.
How a PN case study is built
A case study is a set of six items about the same client, with information that unfolds as you go. Each of the six items measures one step of the clinical judgment model: recognise cues, analyse cues, prioritise hypotheses, generate solutions, take action and evaluate outcomes.
Because a case study can span several content areas, NCSBN counts it separately from the category items. On a minimum-length exam, the three case studies sit beside 52 category items and 15 unscored pretest items.
Stand-alone items and item formats
Beyond the case studies, about 10% of items are stand-alone clinical judgment items, selected depending on exam length. Any item may carry charts, tables or other exhibits, such as a section of a health record.
NCSBN does not publish a fixed share for each item format, and its FAQ says there is no predetermined percentage. To see every format before test day, use the official NCLEX Candidate Tutorial and Exam Preview on NCLEX.com, which show how each one works on screen.
Partial credit
The test plan says items with more than one key can earn partial credit, scored by one of three methods: plus/minus, zero/one, and rationale scoring. In plain terms, some items reward each correct choice and subtract for wrong ones, some score a group as all or nothing, and some only count a pair of answers when both halves agree.
You are not told which method an item uses. Select what you can defend and avoid ticking options just in case.
How to practise for them as a PN
Read the case through a PN lens. The take action step usually rewards collecting data, carrying out existing orders and reporting changes, not writing a new plan. Evaluate outcomes asks whether the client improved against what was expected.
Mix single items with full case work. Our free NCLEX-PN practice questions cover all eight categories with rationales, and our guides to bowtie questions and partial credit go deeper on the formats.
Common questions
How many case studies are on the NCLEX-PN?
Three, each with six items, for 18 case study items. The 2026 test plan builds them into every exam, including the minimum-length one.
Are NGN items on the NCLEX-PN the same as on the NCLEX-RN?
Both exams use case studies and Next Generation formats, but the PN items are written to the PN test plan and scope. The PN answer usually stops where the PN role stops.
Do case study items count more than other items?
NCSBN does not describe case study items as weighted more heavily. Each item feeds your ability estimate, and items with more than one key can earn partial credit.