Matrix / grid items
Classify each finding across columns — every cell is scored, so partial credit is real.
Classify each finding across columns — every cell is scored, so partial credit is real. It is one of six Next Gen NCLEX formats, and like most of them it is scored per element rather than all-or-nothing — so partial credit is real, and an incorrect selection is scored against you as surely as a correct one is scored for you.
How it is scored
Per element. That is worth stating plainly because it changes the arithmetic of guessing: on four-option multiple choice, eliminating two and picking between the rest is rational; here an unconsidered selection is a scored decision.
What changes about answering it
- There is no "eliminate two and guess". On a per-element format an unconsidered selection is a scored decision, not a free one.
- Answer what you are sure of. Leaving an element blank costs you that element; filling it in wrongly costs you the same element and nothing more — but on select-N and highlight, a wrong selection is scored against you, so filling everything in is worse than filling in nothing.
- The stem tells you the shape. How many to select, what the columns mean, what order is being asked for — the format is stated, and misreading it is the cheapest way to lose an item you understood.
The other five formats
Classify each finding across columns — every cell is scored, so partial credit is real.
One condition in the middle, actions on one side and parameters to monitor on the other.
Put the steps in the sequence they must happen in.
Complete a clinical sentence from a list at each blank.
Select the words in the record that are the relevant findings.
Choose exactly the number asked for — no more, no fewer.
Where you meet several of them against one patient: case studies.
A worked example, in the real structure
Match each finding to the most likely cause.
| Finding | Hypovolemic shock (likely surgical bleed) | Neurogenic shock | Cardiogenic shock (fluid overload) | Septic shock |
|---|---|---|---|---|
| Falling BP + rising HR + dizziness + small dressing stain not enlarging | ○ | ○ | ○ | ○ |
| Falling BP + bradycardia + warm skin + neurogenic injury below T6 | ○ | ○ | ○ | ○ |
| Falling BP + crackles + JVD + recent fluid bolus | ○ | ○ | ○ | ○ |
| Falling BP + fever + warm flushed skin + lactate 4 | ○ | ○ | ○ | ○ |
Show answer and rationale
- Falling BP + crackles + JVD + recent fluid bolus → Cardiogenic shock (fluid overload)
- Falling BP + fever + warm flushed skin + lactate 4 → Septic shock
- Falling BP + bradycardia + warm skin + neurogenic injury below T6 → Neurogenic shock
- Falling BP + rising HR + dizziness + small dressing stain not enlarging → Hypovolemic shock (likely surgical bleed)
Shock state pattern recognition: HYPOVOLEMIC — falling BP + RISING HR (compensatory) + dressing stain (occult bleed); NEUROGENIC — falling BP + BRADYCARDIA + WARM SKIN + neuro injury below T6 (loss of sympathetic outflow); CARDIOGENIC FLUID OVERLOAD — falling BP + crackles + JVD + recent bolus; SEPTIC — falling BP + fever + WARM FLUSHED + lactate 4.
Practise where your reasoning actually breaks
Every item is tagged to the step of clinical judgment it tests, so the report says where it went wrong — not just how many.
Frequently asked questions
What is an NCLEX matrix / grid question?
Classify each finding across columns — every cell is scored, so partial credit is real.
Is it scored all-or-nothing?
No — most Next Gen formats award partial credit per element.
How many Next Gen items are on the exam?
Clinical judgment is measured by 18 case study items plus approximately 10% stand-alone items, selected depending on exam length.
Sources
Exam facts checked against the 2026 NCLEX-RN Test Plan on 30 August 2026.
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