The NCLEX-PN® Exam

The National Council Licensure Examination for Practical Nurses (NCLEX-PN® exam) is administered by individual State Boards of Nursing. The NCLEX-PN is often referred to as "The Boards" or "State Boards." The NCLEX-PN has only one purpose: To determine if it is safe for you to begin practice as an entry-level practical/vocational nurse.

These boards have a mandate to protect the public from unsafe and ineffective nursing care, and each is responsible for regulating the practice of nursing in its respective state.

Framework

The NCLEX-PN® exam is organized according to the framework, "Meeting Client Needs." There are four major categories and eight subcategories. Many nursing programs are based on the medical model where students take separate medical, surgical, pediatric, psychiatric, and obstetric classes. However on the NCLEX-PN exam, all of the content is integrated.

Types of Questions

Questions are primarily multiple-choice with four possible answer choices; however, there are also alternate question types. Alternate question types include multiple-response, fill-in-the-blank, hot spots, chart/exhibit and drag-and-drop. All questions involve integrated nursing content.

Let's look at the following question:

A woman with type 1 diabetes is returned to the recovery room one hour after an uneventful delivery of a 9 lb., 8 oz., baby boy. The LPN/LVN would expect the woman's blood sugar to

  • (1) change from 220 to 180 mg/dl.
  • (2) change from 110 to 80 mg/dl.
  • (3) change from 90 to 120 mg/dl.
  • (4) change from 100 to 140 mg/dl.

Is this an obstetrical question or a medical/surgical question? In order to select the correct answer, (2), you must consider the pathophysiology of diabetes along with the principles of labor and delivery. This is an example of an integrated question.

How many questions are there?

Everyone answers a minimum of 85 questions to a maximum of 205 questions. Regardless of how many you answer, you will be given 15 experimental questions that do not count for or against you. The exam administrators use them to test for future questions on the exam.

How much time will I have?

There is no time limit for each individual question. You'll have a maximum of 5 hours to complete the exam, which includes a tutorial in the beginning. There are no mandatory breaks. However, there's an optional break after 2 hours of testing, and another optional break after an additional 90 minutes of testing.

When will the exam end?

Your exam ends when one of the following occurs:

  • You have demonstrated minimum competency and answered the minimum number of questions (85).
  • You have demonstrated a lack of minimum competency and answered the minimum number of questions (85).
  • You have answered the maximum number of questions (205).
  • You have used the maximum time allowed (5 hours).

Try not to focus on the length of your exam. You should just plan on testing for 5 hours and completing 205 questions. And if you have a long exam, remember that you are still in the game as long as the computer continues to give you questions; so focus on answering them all to the best of your ability.

CAT is an acronym for "computer adaptive test," a testing format that is interactively based on your response to the questions. Based on your skill level, the CAT ensures that the questions are not "too hard" or "too easy."

Your first question will be relatively easy—below the level of minimum competency. If you answer it correctly, the computer selects a slightly more difficult question. If answered incorrectly, the computer selects a slightly easier question. By continuing to do this throughout the test, the computer is able to determine your level of competence.

NCLEX-PN® questions are organized along four major Client Needs Categories. Let's take a look:

Safe and Effective Care Environment

The first Client Needs Category, Safe and Effective Care Environment, includes two concepts:

Coordinated Care accounts for 16-22 percent of questions on the NCLEX-PN exam. The nursing actions included in this subcategory are Advanced Directives, Advocacy, Client Care Assignments, Client Rights, Concepts of Management and Supervision, Confidentiality, Consultation with Members of the Health Care Team, Continuity of Care, Establishing Priorities, Ethical Practice, Informed Consent, Legal Responsibilities, Quality Assurance, Referral Process, and Resource Management.

Safety and Infection Control accounts for 10-16 percent of exam questions. Nursing actions include Accident/Error Prevention, Handling Hazardous Materials, Home Safety, Injury Prevention, Internal and External Disaster Plans, Medical and Surgical Asepsis, Incident Reporting, Safe Use of Equipment, Security Plan, Standard/Transmission-Based/and other Precautions, and Use of Restraints and Safety Devices.

Health Promotion and Maintenance

The second Client Needs Category is Health Promotion and Maintenance. These questions account for 7-13 percent of the exam. Nursing actions tested include the Aging Process, Ante/Intra/Postpartum and Newborn Care, Data Collection Techniques, Developmental Stages and Transitions, Disease Prevention, Expected Body Image Changes, Family Interaction Patterns, Family Planning, Health Screening, Immunizations, High Risk Behaviors, Human Sexuality, Lifestyle Choices, Self Care, and Health Promotion Programs.

Psychosocial Integrity

The third Client Needs Category is Psychosocial Integrity. It accounts for 6-12 percent of the exam and tested nursing actions include Coping Mechanisms, Grief and Loss, Mental Health Concepts, Spiritual Influence on Health, Sensory/Perceptual Alterations, Stress Management, Support Systems, Therapeutic Communication, Chemical Dependency, Behavioral Interventions, Crisis Intervention, Coping Mechanisms, End of Life Care, and Family Dynamics.

Physiological Integrity

The final Client Needs Category is Physiological Integrity. It includes four concepts:

Basic Care and Comfort accounts for 7-13 percent of questions on the NCLEX-PN exam. The nursing actions included in this subcategory are Assistive Devices, Elimination, Mobility, Non-pharmacological Comfort Interventions, Nutrition and Oral Hydration, Palliative/Comfort Care, Personal Hygiene, as well as Rest and Sleep.

Pharmacological and Parenteral Therapies accounts for 11-17 percent of the exam. Tested nursing actions include Adverse Effects, Expected Effects, Medication Administration, Pharmacologic Actions, Pharmacologic Agents, and Side Effects.

Reduction of Risk Potential accounts for 10-16 percent of the exam. Its tested nursing actions include Diagnostic Tests, Laboratory Values, Potential for Body System Alterations, Potential for Complications of Diagnostic Tests, Treatments, and Procedures, Therapeutic Procedures, and Vital Signs.

Physiological Adaptation accounts for 7-13 percent of the exam. Its tested nursing actions include Alterations in Body Systems, Basic Pathophysiology, Fluid and Electrolyte Imbalances, Medical Emergencies, Radiation Therapy, and Unexpected Response to Therapies.

Pass/Fail

The NCLEX-PN® exam is pass/fail—there is no numerical score. A determination will be made at the conclusion of the exam as to whether you have passed or failed. However, the results will not be made available at the exam site. You'll be notified by your State Board of Nursing approximately 2-6 weeks after your test date.

What if I fail?

First, don't despair. You certainly are not alone. Many students do not pass the NCLEX-PN exam on their first attempt.

Failing the exam means that you did not successfully answer questions at or above the level of difficulty needed to pass. On this particular exam, you were unable to demonstrate your ability to provide safe and effective care.

If you fail, you'll receive a diagnostic profile that evaluates your test performance. Read it carefully. You'll see how many questions you answered on the exam. The more questions you answered, the closer you came to passing.

The only way you continue to get questions after you answer the first 85 is if you are answering questions close to the level of difficulty need to pass. Use the diagnostic profile to determine your problem areas. You can then focus your preparation accordingly.

Should I test again?

Absolutely. Re-testing for the NCLEX-PN exam is permitted 45-90 days after the initial administration.

If you prepared on your own for the first time, you may want to consider a formal preparation option to help you focus your study time more effectively.

Regardless of the method you choose, don't forget to use the diagnostic profile to guide your preparation.

During you last semester of nursing school, you'll receive two applications: An application for licensure and an application for the NCLEX-PN® Exam. On a predetermined date, you will be required to submit the completed forms and the licensure fees to your nursing school.

NCLEX-PN® Exam and Licensure Fees

The cost to take the NCLEX-PN exam is $200. Additional licensure fees are determined by the individual State Boards of Nursing. Send your completed test application and fee to NCS Pearson. You can register by phone by calling: 866-49-NCLEX or online at vue.com/nclex. Some states require that the testing application and fee be sent along with the licensure application and fee.

NOTE: If you're applying for licensure in Massachusetts, you must register through your jurisdiction.

Scheduling Your NCLEX-PN® Exam

You'll receive a postcard acknowledging receipt of registration. You will not be able to schedule an appointment to take the exam until NCS Pearson sends you a document entitled "Authorization to Test" (ATT). On the ATT, you'll find your candidate number, the testing expiration date, as well as a list of test centers. At that point, just schedule your date at vue.com/nclex.

The National Council of State Boards of Nursing (NCSBN) reviews the test plan for the NCLEX-PN® examination once every three years. In 2013, the NCSBN voted on the changes to the 2014 NCLEX-PN® Test Plan and passing standard.* These changes are based on empirical data collected from newly licensed nurses by the NCSBN and will go into effect on April 1, 2014. The following sections describe the format of the test and the changes made.

Passing Standard Increase

Due to the continuous changes in U.S. health care and nursing practice, the NCSBN has determined that effective entry-level licensed practical/vocational nurse (PN/VN) practice requires a greater level of knowledge, skills and abilities than was previously required, resulting in the passing standard increase.

The passing standard will change from the current -.27 logits** to -.21 logits. This passing standard will go into effect on April 1, 2014 and will remain in effect through March 31, 2017.

What does this mean for future test-takers?

The NCLEX-PN® examination will be more difficult. The National Council of State Boards of Nursing expects that by increasing the passing standard, the pass rate for first time-U.S. educated nurses will decrease slightly.

Test Plan Structure

NCLEX-PN® test questions are organized into four major Client Needs categories. Two of the four categories are divided into subcategories:

  • Safe and Effective Care Environment
    • Coordinated Care
    • Safety and Infection Control
  • Health Promotion and Maintenance
  • Psychosocial Integrity
  • Physiological Integrity

See a more detailed explanation on the specific Client Needs categories.

Distribution of Content

The percentage of test questions assigned to each Client Needs category and subcategory of the 2014 NCLEX-PN® Test Plan has changed from the current NCLEX-PN® Test Plan.

Below is a breakdown of the percentage of questions in each test plan category, comparing the previous test plan to the 2011 plan:

Client Categories / Subcategories Percentage of Questions Change in Percentage of Questions
Safe and Effective Care Environment
• Coordinated Care
• Safety and Infection Control
16-22%
10-16%
3% increase in 2014
1% decrease in 2014
Health Promotion and Maintenance 7-13% No change in 2014
Psychosocial Integrity 8-14% 1% increase in 2014
Physiological Integrity
• Basic Care and Comfort
• Pharmacological Therapies
• Reduction of Risk Potential
• Physiological Adaptation
7-13%
11-17%
10-16%
7-13%
2% decrease in 2014
No change in 2014
1% increase in 2014
2% decrease in 2014

Percentages range for each Client Need category due to the variable length format of the NCLEX-PN. To accommodate possible variations in exam length, content area distributions of the individual exams may differ slightly in each category.

*National Council of State Boards of Nursing. (2013). 2014 NCLEX-RN® Test Plan.
**A logit is defined as a unit of measurement to report relative differences between candidate ability estimates and item difficulties.

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