We show our work.
It starts with the science
Every design decision traces back to four principles. These are the same methods your best professors use. Lily applies them consistently, every session.
- Retrieval practice
- Pulling answers from memory strengthens retention far more than re-reading notes. Every Lily session is active recall, not passive review.
- Roediger & Karpicke, 2006 ↗
- Spaced review
- Concepts resurface at increasing intervals based on how well you know them. The harder something is to recall, the more reviewing it strengthens the memory.
- Cepeda et al., 2006 ↗
- Interleaving
- Mixing topics within a session improves your ability to transfer knowledge to new clinical scenarios. No more studying one topic in isolation until you feel ready.
- Rohrer & Taylor, 2007 ↗
- Desirable difficulty
- Questions that feel appropriately hard produce deeper, longer-lasting learning. Easy questions feel good but do not grow your skills.
- Bjork & Bjork, 2011 ↗
Aligned to the exam you are actually taking
We read the same test plan your testing center uses. Every question maps to the 2026 NCSBN RN Test Plan, so your practice mirrors the actual exam structure.
Client Needs Categories
Safe and Effective Care Environment
Management of Care, Safety and Infection Control
Health Promotion and Maintenance
Health Promotion and Maintenance
Psychosocial Integrity
Psychosocial Integrity
Physiological Integrity
Basic Care and Comfort, Pharmacological Therapies, Reduction of Risk Potential, Physiological Adaptation
Learning Topics
27 categories · 288 sub-topics tracked
- Heart Failure & Cardiac Output
- Coronary Artery Disease & Angina
- Dysrhythmias & ECG Interpretation
- Hypertension & Vascular Disorders
- Peripheral Vascular Disease & Venous Thromboembolism
- Shock & Hemodynamic Monitoring
- Valvular Disorders & Cardiac Surgery
- Cardiac Catheterization & Pacing Devices
- Infective Endocarditis & Cardiac Inflammatory Disorders
- Aortic Aneurysm & Aortic Dissection
- Cardiac Tamponade & Pericarditis
- Chronic Obstructive Pulmonary Disease (COPD)
- Asthma & Reactive Airway Disease
- Pneumonia & Respiratory Infections
- Mechanical Ventilation & Airway Management
- Oxygen Therapy & Delivery Devices
- Chest Tubes & Thoracic Surgery
- Pulmonary Embolism & Venous Thromboembolism
- Tuberculosis & Respiratory Isolation
- Respiratory Assessment & Pulmonary Hygiene
- Acute Respiratory Distress Syndrome (ARDS)
- Lung Cancer & Thoracic Malignancies
- Sleep Apnea & Sleep-Disordered Breathing
- Cystic Fibrosis & Bronchiectasis
- Stroke (CVA) & Transient Ischemic Attack
- Seizures & Epilepsy
- Traumatic Brain Injury & Increased ICP
- Spinal Cord Injury & Neurogenic Shock
- Meningitis
- Encephalitis
- Multiple Sclerosis & Neurodegenerative Disorders
- Parkinson's Disease & Movement Disorders
- Neurological Assessment & Cranial Nerves
- Myasthenia Gravis & Neuromuscular Junction Disorders
- Trigeminal Neuralgia & Peripheral Neuropathy
- Guillain-Barre Syndrome
- Liver Disease & Hepatitis
- Peptic Ulcer Disease & Gastritis
- Inflammatory Bowel Disease & Bowel Disorders
- Bowel Obstruction & Abdominal Emergencies
- Pancreatitis
- Gallbladder Disease & Cholecystitis
- GI Bleeding & Upper/Lower GI Disorders
- Nutrition & Enteral/Tube Feeding
- Ostomy Care & Bowel Elimination
- GERD & Esophageal Disorders
- Appendicitis & Peritonitis
- Cirrhosis Complications (Encephalopathy, Varices, Ascites)
- Acute Kidney Injury & Renal Failure
- Chronic Kidney Disease & ESRD
- Dialysis & Renal Replacement Therapy
- Urinary Tract Infections & Pyelonephritis
- Urinary Catheterization & Bladder Management
- Renal Calculi & Urological Procedures
- Fluid Balance & Urine Output Monitoring
- Glomerulonephritis & Nephrotic/Nephritic Syndrome
- Benign Prostatic Hyperplasia & Urinary Retention
- Diabetes Mellitus Type 1
- Diabetes Mellitus Type 2
- Thyroid Disorders & Thyroid Storm
- Cushing's Syndrome & Hypercortisolism
- Addison's Disease & Adrenal Insufficiency
- SIADH & Fluid Retention
- Diabetes Insipidus
- Diabetic Ketoacidosis (DKA)
- Hyperosmolar Hyperglycemic State (HHS)
- Insulin & Oral Hypoglycemic Administration
- Hypoparathyroidism
- Hyperparathyroidism
- Metabolic Syndrome & Endocrine Assessment
- Pheochromocytoma & Adrenal Tumors
- Fractures & Cast/Splint Care
- Joint Replacement & Orthopedic Surgery
- Osteoporosis & Bone Health
- Traction & Immobilization Devices
- Compartment Syndrome & Neurovascular Assessment
- Rheumatoid Arthritis & Autoimmune Musculoskeletal
- Amputation & Prosthetic Care
- Osteomyelitis & Bone Infections
- Low Back Pain & Spinal Disorders
- Gout & Crystal Arthropathies
- Wound Care & Wound Healing Stages
- Burns & Burn Classification
- Pressure Injuries & Prevention
- Skin Assessment & Lesion Identification
- Surgical Site Management & Wound Drains
- Skin Infections & Dermatological Conditions
- Skin Cancer & Melanoma Assessment
- Latex Allergy & Contact Dermatitis
- Wound Irrigation & Debridement Methods
- Antepartum Care & Prenatal Assessment
- Intrapartum & Labor Management
- Postpartum Care & Complications
- Newborn Assessment & Adaptation
- High-Risk Pregnancy & Complications
- Fetal Monitoring & Diagnostic Tests
- Breastfeeding & Newborn Nutrition
- Gestational Diabetes & Hypertensive Disorders of Pregnancy
- Postpartum Contraception & Reproductive Planning
- Neonatal Complications & NICU Nursing
- Preterm Labor & Tocolytic Therapy
- TORCH Infections & Perinatal Infections
- Growth & Development Milestones
- Pediatric Respiratory Disorders
- Pediatric Cardiac Conditions
- Childhood Infectious Diseases
- Pediatric Pain Management & Assessment
- Pediatric Emergencies & Injury Prevention
- Pediatric GI & Metabolic Disorders
- Pediatric Neurological Conditions
- Pediatric Hematologic & Oncologic Conditions
- Pediatric Renal & Genitourinary Disorders
- Congenital Heart Defects (TOF, VSD, ASD, PDA)
- Child Development & Anticipatory Guidance
- Immunizations & Pediatric Vaccine Schedule
- Anxiety Disorders & Phobias
- Major Depressive Disorder
- Bipolar Disorder
- Schizophrenia & Psychotic Disorders
- Substance Use Disorders & Withdrawal
- Therapeutic Communication Techniques
- Crisis Intervention & Suicide Prevention
- Eating Disorders & Body Image
- Abuse & Neglect Recognition
- Personality Disorders & Maladaptive Behaviors
- Trauma & Stressor-Related Disorders (PTSD)
- Cardiovascular & Antihypertensive Medications
- Anticoagulant Therapy
- Thrombolytic Therapy
- Antibiotics & Anti-infectives
- Psychotropic Medications
- Diabetic & Endocrine Medications
- Respiratory & Bronchodilator Medications
- Immunosuppressants & Biologic Therapies
- Adverse Effects of Cardiovascular Medications
- Adverse Effects of Anticoagulants & Thrombolytics
- Adverse Effects of Antibiotics & Anti-infectives
- Adverse Effects of Psychotropic Medications
- Adverse Effects of Diabetic & Endocrine Medications
- Adverse Effects of Respiratory Medications
- Adverse Effects of Immunosuppressants
- Adverse Effects of Opioids & Analgesics
- Drug Contraindications & Allergy Recognition
- Drug-Drug Interactions
- Medication Administration Safety & Rights
- High-Risk & High-Alert Medications
- Parenteral & IV Therapies
- Pharmacological Pain Management
- Blood Product Administration
- Total Parenteral Nutrition (TPN)
- Medication Reconciliation
- Client Education on Medications
- Dosage Calculations & Safe Dose Ranges
- Controlled Substances & Regulatory Guidelines
- Diuretics & Electrolyte Monitoring
- Neurological Medications (Anticonvulsants, Parkinson's, Alzheimer's)
- Corticosteroids & Adrenal Suppression
- GI Medications (PPIs, Antiemetics, Laxatives)
- Antifungals & Antivirals
- Thyroid Medications (Levothyroxine, Methimazole)
- Muscle Relaxants & Skeletal Medications
- Anesthetics, Sedatives & Reversal Agents
- Ophthalmic & Otic Medications
- Herbal Supplements & OTC Interactions
- Standard & Universal Precautions
- Transmission-Based Precautions (Airborne/Droplet/Contact)
- Surgical Asepsis & Sterile Technique
- Healthcare-Associated Infections
- Hand Hygiene & PPE
- Isolation Procedures & Immunocompromised Clients
- Multidrug-Resistant Organisms (MRSA, VRE, C. diff)
- Needlestick Injury & Bloodborne Pathogen Exposure
- Sepsis & Systemic Inflammatory Response Syndrome (SIRS)
- Hyponatremia
- Hypernatremia
- Hypokalemia
- Hyperkalemia
- Hypocalcemia
- Hypercalcemia
- Hypomagnesemia
- Hypermagnesemia
- Acid-Base Balance & ABG Interpretation
- IV Therapy & Fluid Replacement
- Dehydration & Fluid Volume Overload
- Phosphorus & Chloride Imbalances
- Fluid Spacing & Third-Space Fluid Shifts
- Anemia & Blood Disorders
- Leukemia
- Lymphoma
- Cancer Nursing & Oncologic Emergencies
- Chemotherapy Side Effects & Management
- Radiation Therapy Side Effects & Management
- Blood Transfusion Reactions & Administration
- Bone Marrow Transplant & Immunosuppression
- Tumor Lysis Syndrome & Disseminated Intravascular Coagulation
- Sickle Cell Disease & Hemoglobinopathies
- Coagulation Disorders & Thrombocytopenia
- Polycythemia Vera & Myeloproliferative Disorders
- HIV/AIDS & Opportunistic Infections
- Systemic Lupus Erythematosus (SLE)
- Rheumatoid Arthritis
- Anaphylaxis & Allergic Reactions
- Organ Transplant & Rejection
- Immunodeficiency Disorders
- Immunizations & Vaccine Administration
- Hypersensitivity Reactions (Type I-IV)
- Sexually Transmitted Infections
- Contraception & Family Planning
- Menopause & Hormonal Changes
- Prostate & Testicular Disorders
- Breast & Cervical Cancer Screening
- Sexual Health Assessment & Education
- Infertility & Assisted Reproduction
- Gynecological Disorders & Surgical Interventions
- Delegation & Assignment Making
- Prioritization & Triage
- Ethical & Legal Nursing Practice
- Informed Consent & Advance Directives
- Quality Improvement & Evidence-Based Practice
- Scope of Practice & Chain of Command
- Patient Advocacy & Rights
- Interprofessional Collaboration
- Restraint Use & Safety Devices
- Incident Reporting & Error Prevention
- Continuity of Care & Discharge Planning
- Staffing, Nurse-to-Patient Ratios & Unsafe Assignments
- Advance Directives, DNR & Goals of Care Conversations
- Glaucoma & Intraocular Pressure
- Cataracts & Lens Disorders
- Macular Degeneration & Retinal Disorders
- Hearing Loss & Hearing Aids
- Meniere's Disease & Vestibular Disorders
- Eye Injury & Emergency Eye Care
- Otitis Media & Ear Infections
- Retinal Detachment & Vitreous Disorders
- Conjunctivitis & External Eye Conditions
- Otosclerosis & Stapedectomy
- Sensory Assessment & Cranial Nerves
- Assistive Devices & Sensory Communication
- Diabetic Retinopathy
- Tinnitus Management
- Dementia & Alzheimer's Care
- Polypharmacy & Medication Reconciliation
- Falls Prevention & Mobility Safety
- Elder Abuse Recognition & Reporting
- Age-Related Physiological Changes
- End-of-Life Care & Palliative Nursing
- Delirium vs. Dementia Differential
- Sensory Changes & Social Isolation in Aging
- Triage Systems & Emergency Prioritization
- Basic Life Support (BLS)
- Advanced Cardiac Life Support (ACLS)
- Disaster Preparedness & Response
- Trauma Assessment & Stabilization
- Emergency Medications & Rapid Response
- Mass Casualty Incident Management
- Poisoning & Toxicological Emergencies
- Environmental Emergencies
- Musculoskeletal Anatomy & Kinesiology
- Organ Systems & Histology
- Cellular Biology & Metabolism
- Neuroanatomy & Neurophysiology
- Cardiovascular Anatomy & Hemodynamics
- Bacteriology & Bacterial Pathogenesis
- Virology & Viral Infections
- Immunology & Immune Response
- Epidemiology & Disease Transmission
- Antimicrobial Agents & Resistance
- Macronutrients & Energy Balance
- Vitamins & Minerals
- Therapeutic Diets & Medical Nutrition Therapy
- Nutritional Assessment & Screening
- Metabolism & Biochemistry
- Physical Examination Techniques
- Health History & Patient Interview
- Vital Signs & Baseline Data
- Diagnostic Reasoning & Clinical Findings
- Documentation & Communication
- Study Design & Methodology
- Biostatistics & Data Interpretation
- Evidence-Based Practice Models
- Ethical Research Principles
- Literature Review & Critical Appraisal
- Bioethics & Ethical Decision-Making
- Healthcare Law & Regulation
- Health Disparities & Social Determinants
- Patient Rights & Advocacy
- Healthcare Systems & Policy
Source: 2026 NCSBN RN Test Plan
Clinical Judgment, not a checkbox
The NCSBN's Clinical Judgment Measurement Model has 6 steps. Most apps test one or two. Lily covers all of them through every Next Gen format.
Assessment
Reasoning
Action
Single Best Answer (SBA) and Select All That Apply (SATA) test recall, comprehension, and application across the clinical judgment spectrum.
BowTie items exercise all 6 CJMM steps in a single question. You identify the condition, choose nursing actions, and select monitoring parameters, all with realistic differential diagnoses as distractors.
Unfolding Case Studies present a patient scenario that evolves over multiple phases. You assess, intervene, and reassess as the clinical picture changes, just like real practice.
The NCSBN continues to expand Next Gen item types. As new formats are introduced, Lily will add them with the same validation and adaptive difficulty. More formats coming soon.
How each question is built
Lily uses intelligent technology to build questions. We're transparent about that. What matters is how it's constrained.
Questions aren't invented from thin air. They're built from specific nursing concepts, anchored to source material, and structured within strict clinical rules. Every question must map to a body system, a nursing process phase, and a Client Needs category. Difficulty is locked to Bloom's Taxonomy. Question angles rotate through assessment, intervention, medication, delegation, and prioritization. Nothing is random.
When medications appear, they're cross-referenced against a pharmacology database covering drug classes and naming patterns. Lily filters out non-clinical content before it can become practice material. Every question traces back to the specific concepts it tests.
We know the concern: what if a question contains something clinically wrong? A fabricated drug dose or an incorrect lab range could be dangerous to study from. That's exactly why questions aren't served raw. Medications are verified against a known database. Lab values and clinical terms are pulled directly from source material, not invented. Body systems are classified by an independent step, not just the original tag. Questions are checked for minimum clinical depth. If a question fails any of the 7 checks, you never see it. The system catches errors before they reach you, not after.
Then it passes 7 validation checks.
The technology builds the question. The guardrails decide whether you ever see it.
Option counts and structure
Stem and rationale quality
No near-identical stems
Distinct concepts per session
Body system independently verified
BowTie diagnosis balance
Pool kept fresh and varied
Then they adapt to you
Once a question is built and validated, Lily decides when and how to show it to you.
Difficulty Scaling
Get 3 out of 4 right? The next question gets harder. Struggling? It scales back. Difficulty maps to Bloom's Taxonomy.
Weak Topic Resurfacing
Drop below this in any topic and it comes back more often. Not as punishment. As targeted practice. You'll see it until you've genuinely mastered it.
Concept-Level Tracking
Most apps just track which questions you got right. Lily tracks which concepts you actually understand.
Other apps
Lily
Each concept has its own review schedule. Well-understood concepts come back less often. Struggling concepts come back sooner and from different angles until your understanding is solid.
Every answer teaches you something
Not “Incorrect, review Chapter 12.” Real reasoning you can actually learn from.
- Overall rationale. A paragraph explaining the correct answer, the clinical reasoning, and why it matters.
- Option-level explanations. Each wrong answer is explained too. Why it is a common misconception, where it would apply differently, and how it differs from the correct choice.
- Source traceability. Every question connects back to the specific concept it tests. You can see exactly what you need to review, not just that you got it wrong.
It also works with your course materials
Everything above applies to NCLEX® Mode. But Lily has a second mode. Upload your own syllabus, lecture slides, or study guide, and the same methodology builds practice questions from your professor's content. PDFs, slide decks, Word docs, images, and text files are all supported.
Your materials go through the same pipeline. Nursing concepts are identified, non-clinical content is filtered out, medications are cross-referenced, and every question is validated through the same 7 checks. The result is practice that connects your coursework to the boards, so you study once instead of twice.
For Nursing Educators
Evaluating for your program?
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Study With Lily is an independent study tool. NCLEX® is a registered trademark of the National Council of State Boards of Nursing (NCSBN®). Study With Lily is not affiliated with or endorsed by NCSBN. Questions are original practice items built with smart technology and validated for clinical accuracy. They are not derived from actual NCLEX® exam content.