The NCLEX-RN® Exam

The National Council Licensure Examination (NCLEX-RN® exam) has one purpose: To determine if it's safe for you to begin practice as an entry-level nurse. It is significantly different from any test that you took in nursing school. While nursing school exams are knowledge-based, the NCLEX-RN tests application and analysis using the nursing knowledge you learned in school. You will be tested on how you can use critical thinking skills to make nursing judgments.

Framework

The NCLEX-RN® 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-RN 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 23-year-old woman with insulin dependent diabetes mellitus (IDDM) is returned to the recovery room one hour after an uneventful delivery of a 9 lb., 8 oz., baby boy. The nurse would expect the woman's blood sugar to

  • (1) rise
  • (2) fall
  • (3) remain stationary
  • (4) fluctuate

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.

How many questions are there?

Everyone answers a minimum of 75 questions to a maximum of 265 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 6 hours to complete the exam, which includes a tutorial in the beginning. There are no mandatory breaks. However, there's an optional break after 2.5 hours of testing, and another optional break after 3.5 hours of testing.

When does the exam end?

Your exam ends when one of the following occurs:

  • You have demonstrated minimum competency and answered the minimum number of questions (75).
  • You have demonstrated a lack of minimum competency and answered the minimum number of questions (75).
  • You have answered the maximum number of questions (265).
  • You have used the maximum time allowed (6 hours).

TIP: Try not to focus on the length of your exam. You should just plan on testing for 6 hours and completing 265 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-RN® 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:

Management of Care accounts for 17-23 percent of questions on the NCLEX-RN exam. Some of the nursing actions included in this subcategory are Advanced Directives, Advocacy, Case Management, Client Rights, Concepts of Management, Confidentiality, Consultation, Continuity of Care, Quality Improvement, Delegation, Establishing Priorities, Ethical Practice, Informed Consent, Legal Responsibilities, Referrals, and Supervision.

Safety and Infection Control accounts for 9-15 percent of exam questions. Nursing actions include Accident Prevention, Error Prevention, Hazardous Materials, Surgical Asepsis, Standard Precautions, and Use of Restraints.

Health Promotion and Maintenance

The second Client Needs Category is Health Promotion and Maintenance. These questions account for 6-12 percent of the exam. Nursing actions tested include the Aging Process, Ante/Intra/Postpartum and Newborn, Developmental Stages and Transitions, Disease Prevention, Health Screening, Lifestyle Choices, Physical Assessment Techniques, Health Promotion Programs, High Risk Behaviors, and Self-Care.

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 6-12 percent of questions on the NCLEX-RN exam. Nursing actions included in this subcategory are Assistive Devices, Elimination, Mobility, Nonpharmacological Comfort Interventions, Nutrition and Oral Hydration, Personal Hygiene, as well as Rest and Sleep.

Pharmacological and Parenteral Therapies accounts for 12-18 percent of the exam. Tested nursing actions include Adverse Effects, Contrindications, Blood and Blood Products, Central Venous Access Devices, Chemotherapy, Expected Effects, Intravenous Therapy, Medication Administration, Pharmacological Pain Management, Total Parenteral Nutrition, and Dosage Calculation.

Reduction of Risk Potential accounts for 9-15 percent of the exam. Its tested nursing actions include Diagnostic Tests, Laboratory Values, Potential for Complications from Surgical Procedures, and Health Alterations, as well as Therapeutic Procedures.

Physiological Adaptation accounts for 11-17 percent of the exam. Its tested nursing actions include Alterations in the Body Systems, Fluid and Electrolyte Imbalances, Hemodynamics, Medical Emergencies, Pathophysiology, and Unexpected Response to Therapies.

Pass/Fail

The NCLEX-RN® 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 2-4 weeks after your test date.

What if I fail?

First, don't despair. You are not alone. Many students do not pass the NCLEX-RN 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 the first 75 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-RN exam is permitted 45 days after the initial administration (unless you're in Georgia or Guam—contact SBON for details).

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.

About six weeks prior to graduation, you'll receive two applications from your nursing school: An application for licensure and an application for the NCLEX-RN® Exam.

On a predetermined date, you will be required to submit the completed forms and the licensure fees to your nursing school. Upon receipt of an ATT (authorization to test), you will be able to schedule your test date and time. Testing is available year-round, 15 hours a day, 6 days a week, in 6-hour time slots.

The NCLEX-RN® Test Application

Your first step is to submit an application to the National Council of State Boards of Nursing (NCSBN). You will be required to follow the procedures established by the individual State Boards of Nursing. Some states have combined registration for the NCLEX-RN exam with the application for licensure. In all other states, you must apply for licensure with the State Board of Nursing in the state in which you wish to become licensed. Once you have applied, you will receive a Candidate Bulletin to register for the NCLEX-RN exam.

NCLEX-RN Exam® and Licensure Fees

The cost to take the NCLEX-RN exam is $200. Additional licensure fees are determined by the individual State Boards of Nursing. Send your completed test application and fee to the National Council of State Boards of Nursing. You can register by phone by calling: 1-866-496-2539 in the USA (1-952-681-3815 for outside the USA) between 8 a.m. and 8 p.m. (Eastern), Monday through Friday. Phone registrants are required to pay by VISA or Master Card. There is a $9.50 service fee for the phone registration. If you prefer, you may send a personal check, cashier's check or money order to the National Council of State Boards of Nursing.

You'll receive a postcard acknowledging receipt of registration. You will not be able to schedule an appointment to take the exam until your State Board of Nursing declares you eligible and you receive an Authorization to Test (ATT) in the mail.

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