NCLEX matrix (grid) questions
A matrix item is a grid. Each row is a finding, action or statement, and each column is a choice such as "needs follow-up" or "expected." You decide row by row. When you pick one column per row, each correct row earns a point. When you may pick several, wrong picks also cost points.
Sources: NCSBN, Leader to Leader, Spring 2022 (PDF); NCLEX.com, Frequently Asked Questions; NCSBN, 2026 NCLEX-RN Test Plan (PDF); NCLEX.com, Prepare (tutorial and sample items). Checked against NCSBN as of October 29, 2026.
What it looks like
NCSBN names matrix/grid among the new item formats built for the Next Generation NCLEX.
The rows are the things to judge. The columns are the answer choices. Some grids ask for one choice in each row; others let you mark more than one box in a row or column.
How to work one
- Read the column headings first, so you know the decision you are making.
- Judge each row on its own. One row does not change the answer to another.
- Check whether the instructions say one choice per row, or "select all that apply" within a row or column.
How it is scored
NCSBN gives partial credit on items that have more than one correct answer, under three rules, and ties each rule to what the instructions ask you to do. Its current pages do not publish a format-by-format table, so read the instructions on each item.
Zero/one (0/1)
NCSBN uses it when you are told to choose a specific number of responses. You earn a point for each correct response and nothing for an incorrect one. On an item worth several points, the item score is the sum of the correct responses.
When the grid asks for one choice in each row, that is a specific number of responses: each correct row earns a point and the item score is the sum.
Plus/minus (+/-)
NCSBN uses it when you may select an unspecified number of options. You earn a point for each correct option you select and lose a point for each incorrect one. The most you can earn is the number of correct options; the lowest score is zero.
When you may mark an unspecified number of boxes, the plus/minus rule fits: correct marks add a point and incorrect marks take one away, never below zero.
The example below asks for one choice in each of four rows, so it is worth up to 4 points.
Sources: NCSBN, Leader to Leader, Spring 2022 (PDF); NCLEX.com, Frequently Asked Questions; NCSBN, 2026 NCLEX-RN Test Plan (PDF); NCLEX.com, Prepare (tutorial and sample items). Checked against NCSBN as of October 29, 2026.
Example
A practice item from our own NCLEX-RN practice exams, written to the published test plan. It is not a real NCLEX question. Try it before you open the answer.
For each finding in a client receiving hemodialysis, identify whether it needs prompt nursing follow-up.
| Finding | Needs prompt follow-up | Expected or monitor as ordered |
|---|---|---|
| Dizziness with BP 86/50 during treatment | ||
| New bleeding at the access site | ||
| Thrill present at the access site as previously documented | ||
| Sudden shortness of breath after treatment |
Show the answer and rationale
- Dizziness with BP 86/50 during treatment: Needs prompt follow-up
- New bleeding at the access site: Needs prompt follow-up
- Thrill present at the access site as previously documented: Expected or monitor as ordered
- Sudden shortness of breath after treatment: Needs prompt follow-up
Hypotension, bleeding, and sudden shortness of breath are concerning changes requiring prompt follow-up. A previously documented thrill is an expected access finding that is monitored.
The other formats
Practice the formats
Try NCLEX-style questions in these formats, with a rationale for every answer.
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