Ace the NCLEX

Snapshot: This article reviews the format and content of the NCLEX, how to study, and strategies for succeeding on the exam.

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NCLEX Overview Studying for the NCLEX Testing Center Advice Taking the NCLEX If You Don’t Pass on the First Attempt

NCLEX Overview

Total Number of Questions 75 – 265
Question Type Primarily multiple choice (80-90% of all questions); some alternative item answer* (10–20% of questions)
Format Computer-adaptive testing (CAT)
Total Test Time up to 6 hours. Note: Total test time usually includes 2 optional breaks; the first break is typically offered 2 hours into the test and the second break is typically offered 3.5 hours into the test; see your individual test center policies for further details.
Content Areas Management of Care: 17-23%. Safety & Infection Control: 9-15%. Health Promotion & Maintenance: 6-12%. Psychosocial Integrity: 6- 12%. Basic Care & Comfort: 6-12%. Pharmacological & Parenteral Therapies: 12-18%. Reduction of Risk Potential: 9-15%. Physiological Adaptation: 11-17%.

  • The NCLEX-RN focuses on applied nursing knowledge. Questions are primarily scenario-based and test critical thinking ability in the form of nursing prioritization, nursing delegation, and nursing assessment and intervention. While knowledge of pathophysiology, pharmacology, and health assessment is useful, don’t forget that the NCLEX-RN is a professional licensing exam, not a test of general academic knowledge.
  • The test is given in computer adaptive testing (CAT) format. This means that each question you receive on the test (with the exception of the very first question) will depend upon whether or not you answered the previous question correctly and the level of difficulty of that previous question. For those test-takers who are either clearly above the minimum passing standard or clearly below the minimum passing standard after answering 75 questions, the test will shut off and end. The test will continue (for up to 6 hours or up to 265 questions, whichever is reached first) until the computer has determined whether the test-taker has either met or not met the minimum passing standard. This means that it is possible to pass or fail the test in as few as 75 questions (the minimum number of questions), or to pass or fail the test in as many as 265 questions (the maximum number of questions). The number of questions answered alone does not indicate whether you have passed or failed the exam.

Studying for the NCLEX

  • Practice questions should form the core of your review. While selectively reviewing textbooks and other written study materials can be helpful, there is simply too much content to memorize to make this an effective study strategy. Completing practice questions forces you to engage with the material, and they help you retain crucial knowledge while learning testing strategies. (The most valuable part of both professional test-prep programs and NCLEX review books are usually the ‘question banks’ and their accompanying question answer rationales).
  • Consider paying for professional test-prep. While it would be great to avoid paying approximately $500 for test-prep, studying for the NCLEX isn’t a time to get cheap. Consider that the cost of not passing as a result of inadequate preparation (in terms of both re-testing costs and foregone income) is much higher than the cost of test prep. Moreover, if you attend a specified number of the classes and complete a specified number of practice questions, many test-prep companies offer money-back guarantees in the unlikely event you don’t pass the NCLEX on your first attempt.
  • Give yourself plenty of time to prepare. Most NCLEX candidates should begin their review at least 4 weeks prior to taking the exam. You should plan to complete at least 500 – 800 practice questions – and preferably 1,200 – 1,500 practice questions. While you may certainly pass the exam with less review (or for strong test-takers, with little review at all), why chance it? You’ve worked hard to earn your nursing degree, and you should make every effort to prepare yourself well for the NCLEX.
  • Pace yourself as you study. Plan to study no more than 4 – 5 hours per day, and to complete between 50 – 150 questions per day. If you practice more than 150 questions per day, your ability to learn from the questions (and to retain the information) will likely decline, undermining the effectiveness of your review. Work backwards from your test date and calculate how many questions per day you should aim to complete.

  • Review the rationales for all of the practice questions you do – including your correct answers. Simply completing a large number of practice questions won’t constitute adequate review. Your most effective learning will occur when you review – and actively study from – the rationales provided with the answers to practice questions. While you should obviously review the rationales of all your incorrect answers, you should review the rationales of correct answers too. You may have gotten the right answer by chance or for the wrong reason, and reviewing the rationales will help reinforce your knowledge.
  • Simulate NCLEX test conditions as you practice questions. Even though you’re just completing practice questions, complete these questions in ‘timed’ mode. Spend a little over 1 minute (on average) per question. This means you should be able to complete about 50 questions in 1 hour, about 100 questions in 2 hours, and so on. Don’t be a perfectionist, and remember to move on if you just don’t understand something. Get used to the idea that you will miss a lot of questions, no matter how skilled you may be (this is one of the features of the NCLEX that makes it so different from other tests). In addition, remember that when you take the NCLEX, you won’t be able to bring any food or drink into the testing room. Prepare by re-creating these test conditions when you do practice questions. This will help you build the testing habits you need to be prepared for the real thing.
  • Learn your normal ranges for your lab values. One of the most important areas you need to master in studying for the NCLEX is to understand what’s normal and abnormal in any given clinical scenario. Make sure you’re rock solid on all the normal ranges for your lab values, and this task will become easier. You can use “Lab Values & Ranges” here as a reference.
  • Study pharmacology. While the body of knowledge tested by the NCLEX is very broad, one of the ‘highest value’ ways you can focus your study time is to become familiar with the most-frequently tested drugs on the NCLEX. The percentage of NCLEX questions devoted to pharmacology has increased in recent years, so while this has always been an important section of the test it is even more important today. The most effective way to study pharmacology is to learn classes of medications, and to focus on drugs’ nursing implications.
  • Take breaks and don’t overdo it. It’s crucial to pace yourself and take breaks as you prepare for the NCLEX. Take off at least 1 day per week and don’t study at all. Spend time with friends and families, eat and sleep well, and exercise. As you approach your test day, consider stopping doing practice questions at least a few days prior. You want to approach the test relaxed and prepared, not cramming and stressed.

Testing Center Advice

  • Check out the testing center before test day. It may be helpful to make a “dry run” to your testing center so you know exactly where your test center is (and how to get there, how long your trip will take, where to park, etc). Doing this a few days before the test can help put you at ease, and ensures that you won’t be stressed trying to find or get to the test center the day of the NCLEX.
  • Dress in loose, comfortable layers. Temperatures inside buildings and test centers vary; dress in layers so you can add or remove clothing as necessary. The last thing you want as you’re trying to concentrate is to feel uncomfortable. Also make sure you wear clothing that is loose, soft, and comfortable; after all, you may be sitting down for several hours.
  • You can’t bring anything into the testing center. This means no water, no snacks, no pens and pencils, no calculators, not even a watch is allowed. You’ll be provided with a dry erase board (or “whiteboard”) in your testing cubicle, and that’s it. If you wish, you will be allowed to drink water or eat food outside of the testing room during the 2 optional breaks in the exam (at 2 hours and 3.5 hours into the NCLEX). Keep this in mind and make sure you’ve had a good meal and are well hydrated before beginning the exam.
  • If you’re easily distracted, sit away from the door. Your NCLEX exam room will likely consist of 10 – 15 cubicles, each with a computer. Pearson Vue (the company that administers the NCLEX) administers a variety of other examinations of varying length, and people may be coming and going from the exam room at various points as they finish, or leave to take breaks. If you think it will help, try to avoid sitting in a cubicle where the door to the room will be opening and closing; some NCLEX exam candidates find this distracting.
  • Do bring water and snacks for breaks. While you aren’t allowed to bring anything into the exam room, you should prepare yourself to stay for the full 6 hours, and if you get out early, consider it a bonus. Drinking some water and eating a snack during breaks will help ensure you aren’t distracted by hunger or thirst while you finish the exam.

Taking the NCLEX

  • Try to get a good night’s sleep before the NCLEX. Your goal the night before the NCLEX should be to relax and try to get as good a night’s rest as possible. The last thing you should be doing at this point is cramming your brain with more facts and practice questions. At this point you know what you know, so give it a rest and let yourself relax.
  • Pace yourself and be persistent. The NCLEX is a marathon, not a sprint. Don’t make the mistake of concentrating well for the first 75 – 100 questions, and then let yourself fade. Remember, it doesn’t matter how many questions it takes you to pass (no one will know unless you tell them, and no one will care anyway). The only thing that matters is you give each question your full attention and consideration to pass and get licensed. If you feel psyched out, remind yourself that NCLEX is there to test minimum competency.
  • Spend about 1 – 1.5 minutes per question. Don’t fall into the trap of spending 4 – 5 minutes on a single question. While it’s useful to double-check your reasoning, if you haven’t found a “best answer” after a minute or two, chances are spending on more time on that question isn’t going to help you. Select the best choice you can and move on. And remember – if the questions start seeming very difficult or very obscure, that’s probably a good sign because you’ve been answering the easier questions correctly and the computer is increasing the level of difficulty to match your ability.
  • Prepare to be there for the full 6 hours and 265 questions. Whatever you do, don’t let yourself get ‘thrown’ if you have to answer more than 75 questions. If you pass, you pass, and again, no one will ever ask you or care how many questions you ‘needed’ to pass. If you finish before 6 hours or 265 questions, simply consider it a bonus.

If You Don’t Pass on the First Attempt

  • Take a deep breath, and then plan to take the NCLEX again. If you don’t pass the NCLEX on your first attempt, you should know that you are in good company. Let yourself feel sad or upset, but know that some of the brightest, most effective and most compassionate nurses in the profession were not successful in their first attempt at the NCLEX. Remember that your goal is simply to get licensed – the number of attempts it took you to pass the NCLEX is unimportant. A license is a license, and once you’re working no one will know or care how many times you had to take the exam.
  • Assess your performance, and study accordingly. Take a good look at the post-test report you received. This report will break down your performance by section, and should give you an idea of how close or far you were from the passing standard. Ask yourself whether you likely didn’t pass due to a knowledge deficit, or more likely, because of some problem with the test-taking experience itself such as high anxiety, a lack of time management, etc. You’ll generally be required to wait 30 – 45 days to re-test (regulations vary among individual states). Use this time to brush up on content in weaker areas, in particular. You will need to re-pay the testing and registration fees, but there is no additional financial penalty for re-taking the NCLEX.
  • Whatever you do, don’t give up. You worked hard to receive your nursing degree. The fact that you successfully completed a nursing program means you already possess the knowledge and critical thinking skills you need to be successful on the NCLEX. Have faith in yourself as you move forward, and take comfort in the fact that you are more familiar with the testing procedures and testing environment than first-time test-takers. The next time you walk into the NCLEX you’ll be better-prepared. Visualize your success, and make it happen.