The National Council Licensure Examination (NCLEX-RN®)

  • NCLEX-RN is administered to all pre-licensure nursing candidates and measures the competencies that a newly graduated nurse is expected to perform in a safe and effective manner.
  • The exam is reviewed and approved by the NCLEX examination committee every 3 years.
  • The test plan for NCLEX should coincide with state nurse practice acts.

Cognitive Levels Tested in Exam

  • NCLEX employs cognitive levels adapted from Bloom’s taxonomy.
  • These levels include (ranked, top to bottom, from easiest to most challenging):

— Knowledge

— Comprehension

— Application

— Analysis

— Synthesis

— Evaluation

  • For the NCLEX exam, most questions are at an application level or higher, which is the level that you have been tested at in nursing school.
  • Junior nursing students are presented with knowledge- and understanding-level questions, but by the time they reach the graduation stage, these students are expected to use critical thinking that requires synthesis of concepts and application of skilled analysis to a patient need or problem, to help achieve expected patient outcomes.
  • NCLEX was designed around a framework of patient needs, since nursing practice is built around decisions made in regard to the needs of our patients:

— When making clinical decisions, issues of culture, background, comorbidities, knowledge, and education level, and ability to discuss and comply with a prescribed treatment regimen must be taken into consideration

— It is of fundamental importance to the practice of nursing to test the knowledge, skills, and abilities of the nurse in order to license a safe and competent beginner who is able to successfully care for a diverse group of patients

  • NCLEX tests four major patient needs categories:

Safe and effective care environment: The nurse provides and directs nursing care that enhances achievement of patient outcomes while protecting patients and health care personnel:

°    Management of care: Regulatory information (advocacy, delegation, patient rights, informed consent, and more)

°    Safety and infection control: Safety in care environments, equipment use, standard precautions, and emergency response

Health promotion and maintenance: Health promotion through the lifespan; health screening, including genetics, lifestyle choices, and physical assessment techniques

Psychosocial integrity: The therapeutic environment, adaptive processes, mental health, stress management across the lifespan, and alteration in sensorium

Physiological integrity:

°    Basic care and comfort: Performance of activities of daily life (ADLs), assistive devices, nutrition and oral hydration, elimination, and rest and sleep

°    Pharmacological and parenteral therapies: Medication administration, parenteral therapies, adverse effects, expected outcomes of therapy, central venous access devices (CVADs), dosage calculations, and blood and blood products administration

°    Reduction of risk potential: Interpretation of changes in vital signs, laboratory and diagnostic tests and complications related to procedures, and therapeutic procedures

°    Physiological adaptation: Recognition of fluid and electrolyte imbalance, and pathophysiology and responses to unexpected emergencies

  • On the exam, elements of the nursing process are interwoven with the categories of patient needs:

— Caring: The philosophy of trust and mutual respect that is achieved within the therapeutic relationship

— Communication and documentation:

°    The verbal and nonverbal items that constitute the nurse-patient relationship and the information regarding therapies, interventions, and events that require documentation

°    Documentation must adhere to regulatory standards and accountability requirements

— Teaching/learning: The acquisition of knowledge skills and attitudes promotes a change in behavior

— Culture and spirituality: The way that the nurse involves and incorporates self-identified preferences in care and unique patient needs in order to facilitate optimization of patient recovery from illness

  • Submit application to the state where you want to be licensed.
  • Register for the NCLEX exam.
  • You will receive an acknowledgment of receipt.
  • The Board of Nursing will decide if you are eligible to sit for the exam.
  • You should receive your Authorization to Test (ATT) within 2 weeks—you cannot schedule to test until you have received your ATT form.
  • There is a fee for taking the exam.
  • If you need to change the date of your test, you can do so online, or by calling candidate services.
  • Failing to appear on your test date means you will need to re‑register, repay, and reschedule the exam.
  • In preparing for NCLEX, use a study plan that you know works best for you:

— What type of learner are you?

— What type of study habits did you have during nursing school?

— Did you study in groups, or alone?

— Did you take notes, or draw diagrams to help you to learn information and to apply it effectively?

  • Strategize a plan:

— Ensure that you obtain and use a great study guide—like this one!

— If you can, access and work through at least 3,000 practice questions:

°    Consult online resources, bookstores, and nursing libraries to find these practice questions

°    By attempting to answer at least 3,000 questions, you vastly increase your exposure to the different types of questions that you may encounter in the test, and thereby increase your chances of success

  • Remember to study well in advance of the exam.
  • Remember to take care of yourself and nurture yourself holistically as you prepare to lessen stress.
  • Remember that physical activity is a good distraction and promotes the release of endorphins that can facilitate concentration when you return to your studies.
  • Palm vein scan and digital fingerprint, as well as digital signature and photo ID, will be required before entering the room.
  • Do not bring anything in with you to the testing room—no notes, cell phone, gum, food, drinks, etc.
  • You will be watched and recorded during the test.
  • No talking with anyone.
  • Note board will be provided and must be returned after the test.
  • The exam is administered by computer.
  • Test administrator will escort you to your assigned computer.
  • There will be a tutorial prior to starting.
  • If you become distracted by others typing on their computers, you may raise your hand to request ear plugs from the test administrator.
  • You will be given 6 hours to complete anywhere from 75–265/275 questions.
  • The 15 pretest questions are not scored.
  • Only the true questions are scored; the rest of the questions are not scored—you will not know the difference between these questions.
  • Breaks are built into the exam, but are optional:

— If you go on break, your palm vein scan, digital fingerprint, digital signature, and photo ID will be required before you can re-enter the testing room and resume the test

  • Keep moving forward in the exam—there is no going back to a question to review or change your answer.
  • You must answer every item.
  • Do not guess in order to progress faster—this will rapidly and drastically reduce your score due to the way the test is administered.
  • Multiple choice
  • Select all that apply/multiple response
  • Prioritization
  • Fill-in-the-blank: These usually involve calculations, IV flow rates, etc.
  • Complete a diagram/labeling/answer a question related to an image on the screen
  • Video or audio scenarios with the choice of appropriate responses to a given question
  • Chart/exhibit questions: Three answer options are available to provide more information for the question scenario
  • NCLEX-RN is adaptive, meaning that the test adapts to your ability to apply concepts so that maximum assessment is achieved with the fewest number of questions.
  • Do not overanalyze anything, simply approach each question as a unique and stand-alone item.
  • You may get test items that seem similar—this does not mean that you answered the previous question incorrectly, it may mean that you are being tested on a different element of that content, or from a different perspective.
  • Results are calculated by:

— 95% confidence interval rule: This means that the computer will end the test whenever its algorithm has determined (with 95% confidence) that you are either above or below the assigned passing standard.

— Maximum-length exam:

°    If your ability level is assessed to be very close to the passing standard, the computer will continue to administer questions until the maximum number is reached

°    In this case, the computer will calculate the percent of questions answered correctly without regard for the 95% rule

°    If the final score is below the passing standard, the candidate is unsuccessful

— Run-out-of-time rule:

°    If the candidate runs out of time before answering the maximum number of items, and the 95% rule cannot apply, the candidate fails.

°    If the minimum number of questions has been answered, the computer assesses ability based on the last 60 questions—if the student has been consistently above the standard, he or she passes; if the student falls below the passing standard, he or she fails

  • There is no partial credit—all answers are either correct or incorrect.
  • The computer will automatically stop when it determines whether you have passed or failed.
  • Some candidates are randomly selected to complete a “full” test:

— Just because you have to answer 230 questions does not necessarily mean that you have failed

— You may simply be one of those randomly selected by the computer program to answer the full test

  • Do not judge your performance at the end of the test.
  • Results are confidential.
  • Results are sent to the Board of Nursing, which records the results and sends them to you.
  • Exam results are mailed approximately 1 month after the test.
  • “Unofficial” results are posted on the NCLEX website 48 business hours following the test.
  • If you should happen to fail, a summary report is provided, and you must wait 45–90 days before testing again, depending on the laws in your state.
  • You receive an RN license number.
  • You are a professional, with an example to set in the world.
  • You have joined the most trusted family of professionals as declared by our patients in Gallup Polls for years now.
  • Always do your best to advocate for your patients, give the best care to the highest possible standard, and cherish yourself as a new nurse.
How to Deal with the Challenges of the NCLEX-RN® Exam